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Valerie Crandall, MD Pediatric Behavior Medicine Johns Hopkins University Baltimore, MD.

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Presentation on theme: "Valerie Crandall, MD Pediatric Behavior Medicine Johns Hopkins University Baltimore, MD."— Presentation transcript:

1 Valerie Crandall, MD Pediatric Behavior Medicine Johns Hopkins University Baltimore, MD

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3  Disruptive behavior  Apprehension—false starts  Indecision  Withdrawal  Brief physical contacts—touch and release  Hyperactivity

4  Non-compliance  Recurrent abdominal pain—RAP (no organic basis)  Asthma  Pruritis  Facial expressions

5  Neatness-- +/-  Friendship retention

6  Nature / Nurture  Nature reflects social capacity on an organic basis—brain centers  Nurture reflects patterning, rearing, learning, physical and emotional security

7  Co-morbidities—(transient)  Situations  Losses  Missed opportunities (games, trips, etc.)  Chronic illness  Cancer  Diabetes  Cystic fibrosis  Epilepsy  “I’m different”

8  Maternal anxiety  Being female  Very low birth weight (<1500gm)  4 x peers’ incidence of anxiety/depression

9 Emotional Physical Situational Self esteem Self image—physical health Stability/consistency…security

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11  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

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13  Increased volume of Superior Temporal Gyrus ass’d with increased anxiety  Posterior right hemisphere ass’d with GAD (generalized anxiety disorder)

14  Amygdala/Hippocampus  (Fear and fear-related centers)  Larger and more electrically active… ass’d with increased anxiety states in turn, influences social behavior in turn, programs frontal lobe

15 …factors influencing social development (Pediatric Social Security)

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17  Clues (all ages):  Peer relationships  Dating relationships  Pain—especially chronic  No victimization  Think about security  Promotes self-control …..self discipline

18  Anger  Anger management  BE CALM…..NOT CONFRONTATIONAL

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20  Examples:  Breath holding  Stomping  Screaming

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24  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

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27  …..if not, question a possible mental cause  Asberger’s syndrome  Bipolar disorder (2% of adults)

28  Hormone rages  Responses are learned …so, self examination is a good idea  Time  Personal space

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30  Depression, Anxiety, Rage  Social development physical, emotional, situational  Children mimic …model from parents and teachers

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