valerie crandall, md pediatric behavior medicine johns hopkins university baltimore, md
TRANSCRIPT
Valerie Crandall, MDPediatric Behavior Medicine
Johns Hopkins UniversityBaltimore, MD
Disruptive behavior Apprehension—false starts Indecision Withdrawal Brief physical contacts—touch and
release Hyperactivity
Non-compliance Recurrent abdominal pain—RAP
(no organic basis) Asthma Pruritis Facial expressions
Neatness-- +/- Friendship retention
Nature / Nurture Nature reflects social capacity on an
organic basis—brain centers Nurture reflects patterning, rearing,
learning, physical and emotional security
Co-morbidities—(transient) Situations Losses Missed opportunities (games, trips, etc.)
Chronic illness Cancer Diabetes Cystic fibrosis Epilepsy “I’m different”
Maternal anxiety Being female Very low birth weight (<1500gm) 4 x peers’ incidence of
anxiety/depression
EmotionalPhysical
Situational
Self esteemSelf image—physical health
Stability/consistency…security
Bedwetting—outgrow by age 4, familial Night terrors (Pavo Nocturnus) Night walking—outgrow in 6 mos.
…all believed to reflect CNS immaturity
Remove stress—especially for night terrors Reassure—still “clearly wrong”; concentrate Emotional security
Increased volume of Superior Temporal Gyrusass’d with increased anxiety
Posterior right hemisphereass’d with GAD (generalized anxiety disorder)
Amygdala/Hippocampus (Fear and fear-related centers)
Larger and more electrically active…ass’d with increased anxiety states
in turn, influences social behaviorin turn, programs frontal lobe
…factors influencing social development
(Pediatric Social Security)
Clues (all ages): Peer relationships Dating relationships Pain—especially chronic No victimization
Think about security Promotes self-control
…..self discipline
Anger Anger management
BE CALM…..NOT CONFRONTATIONAL
Examples: Breath holding Stomping Screaming
List of options: Ignore Give child some space Offer a diversion Investigate what is frustrating the child Enhance communication by pointing to possibilities Hug to reassure…but don’t invade space if needed Speak calmly, preferably eye-to-eye Laugh…don’t mock Relocate
…..if not, question a possible mental cause
Asberger’s syndrome Bipolar disorder (2% of adults)
Hormone rages Responses are learned
…so, self examination is a good idea
Time Personal space
Depression, Anxiety, Rage Social development
physical, emotional, situational
Children mimic…model from parents and
teachers