Abnormal or Exceptional Mental Health Literacy for Child and Youth Care Canadian 1st Edition Gural – Test Bank

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Test Item File

For

Gural and MacKay-Chiddenton

Abnormal or Exceptional:

Mental Health Literacy for

Child and Youth Care

First Edition

Prepared by

Deborah M. Gural

Red River College

Contents

Chapter 1 Perspectives: Abnormal or Exceptional? 3

Chapter 2 Trauma- and Stressor-Related Disorders 17

Chapter 3 Neurodevelopmental Disorders 28

Chapter 4 Attention Deficits 36

Chapter 5 Disruptive Behaviour 48

Chapter 6 Anxiety, Obsessive-Compulsive, and Related Disturbances 60

Chapter 7 Mood Disturbances 74

Chapter 8 Eating Disturbances

Chapter 9 Psychosis and Schizophrenia

Chapter 10 Substance Misuse and Addictions

Appendix 1 Understanding Suicide

Chapter 1 Perspectives: Abnormal or Exceptional?

Multiple Choice Questions

Learning Objective 1.1 – Identify, define, and provide examples for the four elements of abnormality. Explain how cultural and societal norms play a role in definitions of abnormality.

All of the following are one of the major elements of abnormality EXCEPT:
1. risk to self and others
2. personal distress
3. impairment or maladaptiveness
4. altered consciousness

Answer: D

Page Reference: 3-7

Skill: factual; Difficulty: easy

For someone to be described as exhibiting “abnormal behaviour” according to the psychological perspective and the DSM, behaviour must be
1. genetically based
2. maladaptive and harmful
3. something everybody does
4. not seen at all in “normal people”

Answer: B

Page Reference: 6

Skill: conceptual; Difficulty: moderate

Alice orders dinner in a Winnipeg restaurant. After receiving her spaghetti dinner, she starts to eat it with her fingers. Alice has violated a social
1. norm
2. tradition
3. taboo
4. sanction

Answer: A

Page Reference: 3

Skill: applied; Difficulty: easy

What is considered “abnormal” in one culture may be considered quite “normal” in another culture. This illustrates that abnormality is a
1. nonsocial concept
2. dimensional concept
3. useless concept
4. relative concept

Answer: D

Page Reference: 4-5

Skill: conceptual; Difficulty: challenging

Although binge drinking is considered culturally unacceptable in Canada, it occurs frequently on college and university campuses. Considering the basic elements of abnormality, binge drinking in Canada is best viewed as being
1. a social variant
2. normal behaviour
3. socially deviant
4. statistically deviant

Answer: C

Page Reference: 4-5

Skill: applied; Difficulty: moderate

Learning Objective 1.2 – Describe the field of abnormal psychology. Distinguish between mental health, mental illness, and abnormality. Summarize the DSM approach to abnormality.

The branch of psychology that focuses on the scientific study of disorders of behaviour, mood, and mental processes is referred to as
1. abnormal psychology
2. biopsychosocial psychology
3. abnormal psychology
4. developmental psychology

Answer: A

Page Reference: 8

Skill: factual; Difficulty: easy

All of the following are among the primary goals of abnormal psychology EXCEPT
1. describe
2. explain
3. decrease
4. control

Answer: C

Page Reference: 8

Skill: factual; Difficulty: easy

Mental health is associated with each of the following EXCEPT
1. productive activities
2. an ability to cope with the normal stresses of life
3. making a contribution to one’s community
4. an ability to avoid stressful and traumatic events

Answer: D

Page Reference: 9

Skill: conceptual; Difficulty: moderate

The term that is used to refer to a pattern of specific behavioural, cognitive, emotional, or physical symptoms shown by an individual that is marked by distress and decreased functioning is
1. mental health
2. mental disorder
3. mental illness
4. abnormal psychology

Answer: B

Page Reference: 8-9

Skill: factual; Difficulty: moderate

Which of the following is TRUE?
1. Abnormal behaviour and mental disorder are equivalent terms that mean the same thing
2. Mental disorder refers to a pattern of behaviour, not just a single act
3. Mental illness only refers to psychological problems that are related to biological factors
4. Mental illness and mental disorder are equivalent terms that mean the same thing

Answer: B

Page Reference: 8-9

Skill: conceptual; Difficulty: challenging

How are disorders organized in the DSM-5?
1. There are 5 major categories or groupings of disorders
2. There are 5 major areas or axes of assessment (i.e., stress, physical health, etc.)
3. There are 22 major categories or groupings of disorders
4. Each disorder is considered along 2 dimensions: internal/external and controlled/overcontrolled

Answer: C

Page Reference: 9

Skill: factual; Difficulty: easy

Abnormal behaviour is commonly described as “symptoms” of mental “illness” to be “diagnosed” and “cured.” This terminology illustrates the importance of ______________in how the DSM defines abnormality.
1. research data
2. alternative approaches
3. the medical model
4. legal considerations

Answer: C

Page Reference: 9-10

Skill: conceptual; Difficulty: moderate

The basic function of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is to
1. Determine the total number of individuals suffering from a disorder
2. Compare and contrast the effectiveness of different therapies
3. Summarize the primary causes of specific mental disorders
4. Help practitioners correctly identify specific disorders by specifically describing each disorder

Answer: D

Page Reference: 9-12

Skill: conceptual; Difficulty: moderate

Philips conducted a series of tests and interviews with Vera and determined that she best fell into the category of “anxiety disorders.” The collection of information about Vera is referred to as______ while assigning her behavioural pattern to a category of the DSM is referred to as_________.
1. assessment; diagnosis
2. diagnosis; assessment
3. etiology; comorbidity
4. diagnosis; etiology

Answer: A

Page Reference: 9-12

Skill: conceptual; Difficulty: moderate

Learning Objective 1.3 – Summarize key elements of a CYC conceptual model and highlight those elements that are particularly relevant in CYC work with young people experiencing mental health concerns. Define mental health literacy.

As a Child and Youth Care practitioner, Emily has a basic knowledge of mental health issues even though she is not a psychologist or psychiatrist and believes that this will help her to better recognize important behaviours in the youth she works with. This best illustrates the concept of ___________.
1. mental health literacy
2. ‘the other 23 hours’
3. CYC domains of practice
4. evidence-based practice

Answer: A

Page Reference: 13

Skill: applied; Difficulty: easy

All of the following are one of Carol Stuart’s seven domains of CYC practice EXCEPT
1. communication
2. cultural competence
3. professionalism
4. self

Answer: B

Page Reference: 14-15

Skill: factual; Difficulty: easy

Although widely used, Life Space Crisis Intervention has little scientific evidence to support its effectiveness with youth. This best illustrates which key element of a CYC conceptual model?
1. mental health literacy
2. person-first language
3. evidence-based practice
4. cultural respect

Answer: C

Page Reference: 19

Skill: applied; Difficulty: moderate

Learning Objective 1.4 – Summarize the CYC perspective on diagnostic labelling. Identify the strengths and limitations of using the DSM-5 in CYC practice.

One strength of using the DSM system of classification is that it
1. reduces the number of people diagnosed with disorders
2. can help a child and family access help or services
3. emphasizes resilience rather than pathology
4. reinforces the notion that mental illness is very different from physical illness

Answer: B

Page Reference: 16-17

Skill: conceptual; Difficulty: moderate

Each of the following is a limitation of diagnostic labelling EXCEPT
1. it draws attention to the negative behaviours of the child
2. it can result in a loss of uniqueness and individuality
3. it overemphasizes the emotional turmoil the precedes exceptional behaviour
4. it overlooks the context or background issues associated with behaviour

Answer: C

Page Reference: 16-17

Skill: conceptual; Difficulty: challenging

13-year-old Carl was recently diagnosed with ADHD. He is now afraid of hanging out with his friends for fear he will be recognized as mentally ill and treated differently. This example best illustrates
1. a lack of cultural safety
2. comorbidity
3. inaccurate diagnosis
4. his fear of stigma

Answer: D

Page Reference: 16-17

Skill: applied; Difficulty: easy

Kelly was diagnosed with both ADHD and Major Depressive Disorder. This is an example of
1. a flaw in the DSM-5 which does not describe symptoms in enough detail
2. a psychologist’s error, since two disorders cannot be diagnosed in the same person
3. comorbidity, a common occurrence in psychiatric diagnosis
4. a diagnosis that could have been made based on earlier versions of the DSM but not today

Answer: C

Page Reference: 21

Skill: applied; Difficulty: moderate

Learning Objective 1.5 – Compare and contrast the psychological paradigms (both historical and modern) of abnormal behaviour.

Based on the holes found in skulls from ancient times, it has been concluded that symptoms of mental illness were believed to be caused by
1. improper diet
2. brain tumours
3. poverty
4. evil spirits

Answer: D

Page Reference: 23-24

Skill: factual; Difficulty: easy

From a supernatural perspective, the best way to treat an individual with a mental illness would be to
1. provide medication
2. ignore them to shock them into reality
3. cut a hole in their head to allow the release of evil spirits
4. talk to them to show them they are cared for

Answer: C

Page Reference: 23-24

Skill: applied; Difficulty: moderate

According to the _______________perspective, attempts to understand exceptional behavior should consider the role of the body, mind, and social context.
1. psychiatric
2. biopsychosocial
3. psychodynamic
4. behavioural

Answer: B

Page Reference: 25

Skill: conceptual; Difficulty: moderate

According to the biological paradigm, explanations for mental illness would likely include all of the following EXCEPT
1. genetic defects
2. physical injury to the brain
3. faulty learning experiences
4. a virus

Answer: C

Page Reference: 26-27

Skill: conceptual; Difficulty: moderate

Which paradigm of abnormality assumes that abnormal behavior is caused by unconscious conflicts?
1. biological
2. behavioural
3. psychodynamic
4. cognitive

Answer: C

Page Reference: 28-31

Skill: conceptual; Difficulty: easy

From a behavioural paradigm, abnormal behaviour is caused by
1. repression of childhood conflicts
2. faulty learning experiences
3. physiological malfunction
4. cognitive distortions

Answer: B

Page Reference: 31-33

Skill: conceptual; Difficulty: challenging

What does the cognitive paradigm emphasize as the cause of abnormal behaviour?
1. dysfunctional schemas and beliefs
2. unconscious conflict
3. chemical imbalance
4. negative family systems

Answer: A

Page Reference: 33-34

Skill: conceptual; Difficulty: easy

Learning Objective 1.6 – Summarize ways in which CYC professionals may use the major psychological paradigms in their CYC practice.

The ______________ paradigm can be relevant to CYC practitioners in its emphasis on early traumatic experiences and defence mechanisms.
1. biological
2. psychodynamic
3. behavioural
4. cognitive

Answer: B

Page Reference: 36

Skill: conceptual; Difficulty: moderate

The ______________ paradigm fits very well with a CYC perspective because of its emphasis on contextual and societal variables (e.g., poverty, race, ethnicity) in determining behaviour.
1. sociocultural
2. psychodynamic
3. behavioural
4. cognitive

Answer: A

Page Reference: 39

Skill: conceptual; Difficulty: moderate

Today, many CYC practitioners acknowledge that all theoretical paradigms have something to offer when it comes to trying to understand exceptional behaviours. This best illustrates
1. re-enactment processes
2. singular causality
3. the dynamic-maturational model
4. a holistic model

Answer: D

Page Reference: 40

Skill: conceptual; Difficulty: moderate

The ecological model is____________in that it examines the overall pattern of interactions between a young person and all variables in his or her environment: teachers, parents, caregivers, peers, etc.
1. self-limiting
2. exclusionary
3. relational
4. applied

Answer: C

Page Reference: 40

Skill: conceptual; Difficulty: challenging

Learning Objective 1.7 – Identify and describe the major psychological approaches to treatment for mental disorders.

A psychologist that believes the best treatment for abnormality is to use drugs/medications, is working within the ____________ paradigm.
1. biological
2. psychodynamic
3. behavioural
4. cognitive

Answer: A

Page Reference: 42

Skill: applied; Difficulty: moderate

Amber’s therapist is trying to help her decrease her symptoms of depression by thinking positive thoughts and helping her see that failing grades do not mean she is a failure overall. Her therapist is using the________________paradigm in her approach to treating Amber.
1. sociocultural
2. psychodynamic
3. behavioural
4. cognitive

Answer: D

Page Reference: 44

Skill: applied; Difficulty: moderate

Therapists adopting an integrative or eclectic approach provide therapy that is based on
1. a psychodynamic paradigm
2. behavioural strategies
3. family engagement
4. a combination of paradigms

Answer: D

Page Reference: 41

Skill: applied; Difficulty: challenging

Learning Objective 1.8 – Describe strength-based assessment processes and the general types of intervention approaches for child and youth mental health concerns.

Variables that increase one’s ability to avoid negative outcomes, despite being exposed to chronic stress and adversity are referred to as
1. risk factors
2. resilience factors
3. comorbid factors
4. equifinal factors

Answer: B

Page Reference: 46-47

Skill: conceptual; Difficulty: moderate

Forces that threaten one’s normal development are referred to as
1. risk factors
2. resilience factors
3. comorbid factors
4. equifinal factors

Answer: A

Page Reference: 46-47

Skill: factual; Difficulty: easy

When it comes to assessment in CYC practice, all of the following are true EXCEPT
1. assessments need to be strength-based
2. assessments need to be trauma-informed
3. assessments usually require paper-and-pencil tests
4. assessments are complex

Answer: C

Page Reference: 46-48

Skill: conceptual; Difficulty: challenging

Research demonstrates that regardless of the conceptual paradigm adopted by practitioners, the most important factor that determines the effectiveness of psychotherapy or counselling is
1. the genetic make-up of the client
2. the open-mindedness of the therapist
3. the verbal skills of the client
4. the quality of the relationship between client and therapist

Answer: D

Page Reference: 50

Skill: factual; Difficulty: moderate

Psychoeducation and individual counselling in CYC practice were significantly influenced by the________________paradigm.
1. sociocultural
2. psychodynamic
3. behavioural
4. cognitive

Answer: B

Page Reference: 55

Skill: factual; Difficulty: easy

Which of the following is TRUE regarding family support interventions in CYC practice?
1. Being family focused and family driven is a core principle of CYC practice.
2. Most families want CYC practitioners to be involved in their lives.
3. Family group conferencing (FGC) has little relevance for Canadian groups.
4. Family support interventions fail to incorporate a strength-based approach.

Answer: A

Page Reference: 55-56

Skill: conceptual; Difficulty: moderate

Ten-year-old Tommy has been diagnosed with ADHD and his grandmother takes him to an elder who recommends exercise and traditional ceremonies to help Tommy. This best illustrates
1. psychoeducation
2. family group conferencing (FGC)
3. alternative healing
4. relational CYC practice

Answer: C

Page Reference: 58

Skill: applied; Difficulty: moderate

Learning Objective 1.9 – Summarize the pros and cons of using psychotropic medications with children and youth.

One benefit associated with using psychotropic medications to treat youth exceptionalities is that it
1. can reduce symptoms for some
2. poses fewer risks than other treatment approaches
3. is more evidence-based than any other approach to treatment
4. helps to decrease stigma associated with diagnosis

Answer: A

Page Reference: 52-54

Skill: conceptual; Difficulty: moderate

Each of the following is TRUE regarding the use of psychotropic medications with youth EXCEPT
1. Long-term implications of psychotropic medications on youth development is unknown
2. Many youth do not have a say about whether they want to take a medication or not
3. Psychotropic medications are being increasingly prescribed to children and youth
4. Psychotropic medications are most effective when they are used as the sole treatment approach

Answer: D

Page Reference: 52-53

Skill: conceptual; Difficulty: challenging

Short-Answer Questions

Identify each of the four elements of abnormality and provide a specific example for each.

Answer: The four elements of abnormality are: (1) deviance, (2) personal distress or suffering, (3) impairment or maladaptiveness; and (4) risk to self and others. Examples of each element will vary. Students may also distinguish between statistical deviance associated with infrequent or rare behaviour (e.g., few adolescents share a bed with their parents) and social deviance associated with behaviours that are considered socially unacceptable (e.g. eating spaghetti with your fingers instead of a fork in a Canadian restaurant is frowned upon).

Page Reference: 3-7; Objective 1.1

Explain why person-first language is important in CYC practice and provide a specific example of such language.

Answer: In keeping with a CYC perspective, person-first language puts the person before the diagnosis. For example, rather than referring to the FASD child or the ADHD youth, we refer to a young person affected by FASD or the adolescent diagnosed with ADHD. Person-first language maintains the respect for the individual and ensures we focus on the youth not the disorder.

Page Reference: 17; Objective 1.3

Identify one advantage and one disadvantage of using the DSM-5 in diagnosing mental disorders in children and youth.
1. Answer: Various responses are acceptable. Advantages include: helping youth and their family access help or services and providing a common language for practitioners working with youth with exceptionalities. Disadvantages include: overlooking individual uniqueness, stigma and differential treatment, focus on problems and deficits, and permanence of the label. A complete list of pros and cons can be found in Table 1.2.

Page Reference: 16-17; Objective 1.4

Compare and contrast the behavioural and cognitive paradigms of mental disorder.

Answer: The behavioural paradigm emphasizes immediate environment, observable behaviour, and learning experiences in determining behaviour. The same behavioural principles that shape normal behaviour (classical, operant, and observational learning processes) also shape exceptionalities. By comparison, the cognitive paradigm argues that it isn’t our actual experiences that determine behaviour, but rather, how we think about events and the meaning we assign to them. Distressing and disruptive emotions are associated with dysfunctional beliefs and schemas (general cognitive frameworks that help us organize and interpret information); once formed, dysfunctional schemas are maintained through the use of cognitive distortions which alter our perceptions of events so they are consistent with the schemas (whether they are reality-based or not).

Page Reference: 31-33; Objective 1.5

Summarize the holistic or ecological model and describe how it differs from the other major paradigms in its approach to understanding exceptional behaviour.

Answer: Rather than focusing on one causal element, the holistic or ecological model acknowledges that the cause of exceptional behaviour is likely related to a variety of factors including biological factors, attachment issues, faulty learning experiences, etc. In addition to including elements from all of the major paradigms, the ecological model also examines the overall pattern of relationships between a young person and multiple factors in their environment including parents, teachers, and peers. Accordingly, it is a relational model.

Page Reference: 40; Objective 1.6

Describe cognitive behavioural therapy (CBT) and its role in CYC practice.

Answer: Cognitive behavioural therapy refers to therapeutic strategies that focus on altering thoughts as well as including behavioural exercises in their approach to changing emotion and behaviour. CBT fits well with a CYC perspective and is likely to be used by CYC practitioners in their practice which includes assertiveness training, enhancing problem solving, and family communication skills training. A significant amount of research supports the efficacy of the CBT model and in the area of children and youth, it is considered the gold-standard of evidence-based interventions.

Page Reference: 44 and 51-52; Objectives 1.7 and 1.8

Summarize the risk-resiliency model. Identify two resiliency protective factors discussed in your text.

Answer: The risk-resiliency model considers not only risk factors (forces that threaten normal development) but also those factors that serve to protect an at-risk youth resulting in good outcomes despite experiencing chronic stress and adversity. Resiliency protective factors include: an easy temperament, presence of an adult mentor, informal sources of support, activities and creativity.

Page Reference: 46-47; Objective 1.8

Identify one advantage and one disadvantage of using psychotropic medications in the treatment of exceptionalities in children and youth.

Answer: Various responses are acceptable. One advantage includes reducing symptoms for some youth; this is particularly relevant when symptoms are severe and impairing to the point where other strategies are no longer effective or helpful. Disadvantages include: inadequate confirmation of their effectiveness and safety, being driven by a profit motive, failure to obtain informed consent from the youth, used as a means to enforce compliance rather than treatment, and over reliance on medications to the exclusion of other interventions.

Page Reference: 52-55; Objective 1.9

Essay Questions

Case: 10-year-old Nadia has been throwing tantrums for quite some time now—violent, screaming tantrums that cause her to throw objects, hyperventilate, perspire, and just be completely out of control. Her parents first thought it was a passing phase but now they feel it is concerning given her age; none of her friends throw tantrums anymore. It is interfering with her performance in school and very few children if any want to play with her. Even her grandparents are losing sleep over Nadia’s distressing behaviour.

Question: Using each of the 4 major indicators of abnormality, discuss whether Nadia’s behaviour would be considered “abnormal.” In your answer, identify and briefly describe each of the 4 indicators and describe how each is illustrated in the example using specific content from the case. Can it be concluded that Nadia’s behaviour is abnormal? Explain your answer.

Suggested answer: Nadia’s behaviour illustrates (1) deviance, both statistical deviance (few children her age have tantrums anymore) and social deviance (her parents and peers find her behaviour unacceptable); (2) personal distress or suffering (she hyperventilates, perspires, is completely out of control, and has few friends, (3) impairment or maladaptiveness (it is interfering with her performance in school and few people want to spend time with her; and (4) risk to self and others (her tantrums are violent and she throws things).

Students conclusions as to whether her behaviour is abnormal will vary from yes it is abnormal (considering her behaviour in relation to the four indicators), to maybe (despite her behaviour we cannot draw a clear distinction between normal and abnormal) to no (it is inappropriate to use the label abnormal from a CYC approach).

Page Reference: 3-7; Objective 1.1

Case: 15-year-old Stan lives in a First Nations community in Saskatchewan and was recently taken to a local nursing station after experiencing a panic attack in school. He has been unable to sleep lately and when he does, he often wakes in the middle of the night frightened and alarmed. Stan lives with his grandmother following the death of his parents in a tragic car accident when he was 11-years-old but spends a significant amount of time alone or with his older cousin who is physically abusive. Lately, he has been thinking that there is something wrong with him because he worries about everything so much.

Question: Summarize how a CYC practitioner might use each of the following major psychological paradigms in her work with Stan: biological, psychodynamic, behavioural, cognitive, sociocultural. Specifically, identify major issues that might be explored from each perspective given the details provided in the case.

Suggested answer: Multiple responses are possible and might include the following points: (1) biological paradigm, benefits of positive human connection and how lasting change in the brain requires new programming with new connecting experiences, corrective interpersonal attachments, establishment of trusting relationships, healthy communication and opportunity to learn new strategies of emotional control and coping skills; (2) psychodynamic paradigm, emphasis on early traumatic experiences and attachment difficulties; (3) behavioural paradigm, understanding the role of learning experiences (classical, operant, and observational) in the development of dysfunctional behavior as well as their application to decreasing negative behaviours (using reinforcement, exposure); (4) cognitive paradigm, exploration of thoughts and beliefs in emotions; (5) sociocultural paradigm, would emphasize relevant contextual variables essential to understanding behaviour including cultural norms, societal standards, cultural variations, poverty, racism, discrimination.

Page Reference: 35-45; Objective 1.6

Chapter 2: Trauma- and Stressor-Related Disorders

Multiple Choice Questions

Learning Objective 2.1 – Distinguish between stress and trauma.

Shannon is concerned about her upcoming presentation in economics class. Her emotional, cognitive, and physical responses to this event are referred to as
1. stressors
2. trauma
3. stress
4. neglect

Answer: C

Page Reference: 66

Skill: applied; Difficulty: easy

The major difference between a stressor and a traumatic event is that a stressor
1. is associated with physical symptoms
2. is more likely to result in mental disorder
3. is a part of daily life
4. is outside of everyday experiences

Answer: C

Page Reference: 66

Skill: conceptual; Difficulty: easy

Learning Objective 2.2 – Distinguish between the three trauma- and stressor-related disorders and the three dissociative disorders summarized in the text, and describe their symptoms.

Disorders in which there is a disruption of normally integrated functions (perception, consciousness, memory, identity) are referred to as
1. Stressor-related disorders
2. Dissociative disorders
3. Trauma-related disorders
4. Attachment disorders

Answer: B

Page Reference: 68

Skill: conceptual; Difficulty: easy

Bea feels removed from her feelings and environment and has moments where she feels she is seeing herself from across the room. This best illustrates
1. derealization
2. delayed expression
3. depersonalization
4. amnesia

Answer: C

Page Reference: 68

Skill: applied; Difficulty: moderate

Sally has been diagnosed with PTSD. She continues to experience distressing memories that just pop into her mind and in her dreams no matter how much she doesn’t want to experience these. These experiences BEST illustrate which of the four major areas of symptoms for PTSD?
1. intrusion symptoms
2. amnesia
3. arousal and reactivity
4. avoidance

Answer: A

Page Reference: 69

Skill: applied; Difficulty: moderate

Phil was in a serious car accident and has suffered with nightmares and avoidance of cars for two weeks. He would BEST be diagnosed with
1. Adjustment disorder
2. Dissociative amnesia
3. PTSD
4. Acute stress disorder

Answer: D

Page Reference: 70

Skill: applied; Difficulty: challenging

Larry has been writing exams and is experiencing extreme distress, inability to experience positive emotions, and difficulties concentrating and sleeping. These symptoms are now interfering with his performance and relationships. Although his friends are managing exams well, he is having significant difficulty coping with them. Larry would most likely be diagnosed with
1. Adjustment disorder
2. Dissociative amnesia
3. PTSD
4. Acute stress disorder

Answer: A

Page Reference: 70

Skill: applied; Difficulty: challenging

Fredrica has memory loss for several hours of every day. At times, she talks in a high-pitched child’s voice and is passive and quiet while at other times, she is aggressive, hostile, and claims she is a 40-year-old man. Which diagnosis would be most appropriate for Fredrica?
1. Depersonalization disorder
2. Dissociative amnesia
3. Dissociative identity disorder
4. Dissociative fugue

Answer: C

Page Reference: 71

Skill: applied; Difficulty: easy

After witnessing her brother get shot in a bank robbery, Philomena cannot recall any details of that day. This best illustrates
1. Depersonalization disorder
2. Dissociative amnesia
3. Dissociative identity disorder
4. Dissociative fugue

Answer: B

Page Reference: 71

Skill: applied; Difficulty: easy

Learning Objective 2.3 – Summarize the concepts of complex trauma, developmental trauma, and relational trauma.

Jen has experienced various forms of maltreatment throughout childhood including sexual and physical abuse and exposure to family violence. She now exhibits self-concept challenges, anxiety, and attachment difficulties as a result. From a CYC perspective, this would best be described as
1. parental detachment
2. stress
3. complex trauma
4. social neglect

Answer: C

Page Reference: 73

Skill: applied; Difficulty: easy

All of the following are true according to a CYC approach to trauma EXCEPT
1. after exposure to a traumatic event, a pattern of over-arousal is always observed
2. youth in the justice and child welfare systems have usually experienced maltreatment
3. in understanding youth responses to trauma, both risk and resiliency factors must be examined
4. older youth are likely to self-medicate with various substances to manage symptoms of trauma

Answer: A

Page Reference: 72-77

Skill: factual; Difficulty: challenging

What can we conclude regarding the role of age and developmental stage in trauma?
1. symptoms of trauma are entirely different from one person to the next
2. symptoms of trauma can vary significantly across different age groups
3. developmental stage has little to do with the type of trauma symptoms observed
4. early trauma-related disturbances are always temporary due to child resilience

Answer: B

Page Reference: 78-79

Skill: conceptual; Difficulty: easy

When she was 3-years-old, Amanda was removed from her home because of inadequate care by her biological parents. She was placed in multiple foster homes over the course of her childhood and didn’t always receive the care and nurturance she needed. Amanda’s experience BEST illustrates the concept of
1. parental detachment
2. stress
3. multifinality
4. social neglect

Answer: D

Page Reference: 79

Skill: applied; Difficulty: moderate

Which of the following diagnostic categories applies primarily to children?
1. Disinhibited Social Engagement Disorder
2. Acute stress disorder
3. PTSD
4. Adjustment disorder

Answer: A

Page Reference: 79-80

Skill: factual; Difficulty: moderate

What is required in order for a diagnosis of Disinhibited Social Engagement Disorder to be applied to a child?
1. dissociative symptoms
2. psychotic symptoms
3. experience of social neglect
4. complex trauma

Answer: C

Page Reference: 79-80

Skill: factual; Difficulty: moderate

Learning Objective 2.4 – Compare and contrast primary psychological explanations (biological, behavioural, cognitive, psychodynamic, and sociocultural) for trauma- and stressor-related disorders.

Evidence suggests that trauma- and stressor-related disorders
1. can be explained in relation to the inheritance of a specific gene
2. are completely determined by environmental experience
3. run in families and therefore, are genetically influenced
4. are unrelated to biological factors

Answer: C

Page Reference: 82-83

Skill: factual; Difficulty: moderate

According to the biological paradigm, trauma- and stressor-related disorders are related to each of the following EXCEPT
1. altered levels of hormones and neurotransmitters
2. changes in size and functioning of various brain structures
3. a sensitization of the nervous system that results from exposure to repeated trauma
4. changes in brain structure and function but only immediately after the traumatic event

Answer: D

Page Reference: 82-84

Skill: factual; Difficulty: challenging

Repressing one’s fear and pushing painful memories out of one’s awareness summarizes the basic idea behind ________approach to explaining trauma- and stressor-related disorders.
1. the psychodynamic
2. Mowrer’s two-factor
3. the behavioural
4. Bowlby’s ethological

Answer: A

Page Reference: 84-85

Skill: conceptual; Difficulty: easy

Alan’s mother takes him to the doctor for an immunization shot. Before the shot, the nurse hands him a lollipop. Alan cries after he receives the shot. When they return home, Alan refuses to take another lollipop, crying every time he sees one. From a behavioural approach, Alan’s development of the fear of lollipops is the result of
1. overgeneralization
2. operant conditioning
3. classical conditioning
4. extinction

Answer: C

Page Reference: 85

Skill: applied; Difficulty: moderate

According to the behavioural paradigm, it is the_______________________that helps explain why traumatic symptoms persist long after exposure to the stressful or traumatic event.
1. use of defence mechanisms
2. continued avoidance of cues that remind one of the event
3. continued use of a fear structure
4. lack of familial support

Answer: B

Page Reference: 85

Skill: conceptual; Difficulty: moderate

According to the cognitive paradigm, symptoms of stressor- and trauma-related disorders are best explained by
1. use of defence mechanisms
2. operant conditioning
3. development and use of a fear structure
4. lack of familial support

Answer: C

Page Reference: 86

Skill: conceptual; Difficulty: moderate

As discussed in your text, which of the following family factors decreases the risk for trauma- and stressor-related disorders?
1. over-protective parenting
2. social support
3. high social standing
4. emphasis on trying new things

Answer: B

Page Reference: 86-87

Skill: factual; Difficulty: easy

Learning Objective 2.5 – Summarize the NMT model and describe how the brain is affected by trauma.

Perry’s NMT model emphasizes the role of __________as the root cause of troublesome behaviour.
1. the brain
2. poor choices
3. poverty
4. culture

Answer: A

Page Reference: 95

Skill: factual; Difficulty: easy

Each of the following is consistent with Perry’s neurosequential (NMT) model EXCEPT
1. therapeutic interventions must create new patterns in the brain
2. the brain is organized in a hierarchical fashion and is impacted by stressful events
3. effective treatment approaches should be regimented, focused, and goal-oriented
4. healthy brain development requires exposure to the ‘right’ stimulation at the right time

Answer: C

Page Reference: 94-96

Skill: conceptual; Difficulty: challenging

Learning Objective 2.6 – Describe the psychological treatment approaches used in treating trauma-and stressor-related disorders.

Medications commonly prescribed to treat symptoms of trauma- and stressor-related disorders include all of the following EXCEPT
1. antipsychotics
2. SSRI’s
3. anxiolytics
4. Ritalin

Answer: D

Page Reference: 91

Skill: factual; Difficulty: moderate

In the treatment of childhood trauma- and stressor-related disorders, medication
1. is the best treatment available
2. is associated with significant decreases in symptoms, particularly for youth
3. may be effective for adults but does not appear to be helpful for youth
4. appears to be effective in reducing symptoms for most but not all youth

Answer: C

Page Reference: 91

Skill: factual; Difficulty: challenging

According to the behaviour paradigm, treatments for childhood trauma- and stressor-related disorders need to include
1. exploration of unconscious fears and conflicts
2. exposure to what is feared
3. cognitive restructuring
4. social support

Answer: B

Page Reference: 92-93

Skill: factual; Difficulty: easy

One approach to intervention for trauma- and stressor related disorders helps youth identify distorted assumptions and schemas associated with the traumatic event, examine their validity, and replace these with more balanced/accurate beliefs. This is referred to as
1. extinction therapy
2. cognitive restructuring
3. exposure therapy
4. integrative therapy

Answer: B

Page Reference: 92-93

Skill: conceptual; Difficulty: moderate

Learning Objective 2.7 – Describe the impact of trauma in seven domains of functioning.

According to Cook et al. (2007), each of the following is one of the seven domains of functioning likely to be impaired by exposure to traumatic events EXCEPT
1. autonomy
2. self-concept
3. cognitive processing
4. biology

Answer: A

Page Reference: 98-99

Skill: factual; Difficulty: challenging

Devon has been diagnosed with a trauma-related disorder. He refuses to modify his schedule, maintains strict control over his intake of food and occasionally has aggressive outbursts. This best illustrates the impact of trauma in the________________domain of functioning.
1. attachment
2. self-concept
3. cognitive processing
4. behavioural regulation

Answer: D

Page Reference: 98-99

Skill: applied; Difficulty: moderate

Learning Objective 2.8 – Describe behaviours associated with a trauma response in youth, including the symptoms of complex trauma.

From a CYC perspective, cutting, burning, and punching oneself are associated with____________________and are generally believed to reflect_________________.
1. Nonsuicidal Self-Injury; an intention to end one’s life
2. Nonsuicidal Self-Injury; an intention reduce psychological distress
3. the hyper-arousal continuum; poor coping resources
4. the dissociative continuum; an inability to develop reality-based goals

Answer: B

Page Reference: 98-99

Skill: applied; Difficulty: moderate

During assessment of complex trauma, it is most important for CYCPs to consider the_____________ of the youth in order to most accurately identify relevant indicators of distress.
1. socioeconomic status
2. the intellectual functioning
3. developmental age and stage
4. the goals

Answer: C

Page Reference: 99-101

Skill: applied; Difficulty: challenging

Learning Objective 2.9 – Explain trauma-informed care and identify CYC strategies to help young people with memories of trauma and those engaged in self-harm behaviour.

When supporting young people who have experienced trauma, a CYC approach emphasizes
1. psychotropic medication
2. trauma-informed care
3. reality-based counselling
4. avoidance of painful memories

Answer: B

Page Reference: 101-102

Skill: applied; Difficulty: easy

The core principle of CYC practice is understanding pain-based behaviour in the context of
1. the needs underlying the behaviour
2. the hyper-arousal and dissociative continuum
3. the policies of the organization in which one is working
4. the interrelationships between helpers working with the youth

Answer: A

Page Reference: 102

Skill: conceptual; Difficulty: challenging

Relational CYC practice requires all of the following EXCEPT
1. self-awareness
2. a focus on strengths
3. a focus on resiliency
4. working knowledge of psychotropic medications

Answer: D

Page Reference: 106-107

Skill: conceptual; Difficulty: easy

Short-Answer Questions

Describe the difference between stress and trauma.

Answer: Stress refers to the behavioural, emotional, cognitive, and physical responses that result from exposure to stressors (events that challenge the individual that are a part of daily life for everyone). Trauma refers to the lasting undesirable social, emotional, physical, and cognitive effects that result from exposure to traumatic events (sudden, unexpected, or ongoing events that are extreme in nature and threaten or cause harm to the emotional and physical well-being of the individual or another person).

Page Reference: 66; Objective 2.1

Summarize what is meant by the term complex trauma and how it differs from trauma.

Answer: Complex trauma refers to the exposure to multiple or prolonged traumatic events and the impact of this exposure on the young person’s development. This is different from trauma which refers to the lasting undesirable social, emotional, physical, and cognitive effects that have traditionally been associated with a single incident.

Page Reference: 72-73; Objective 2.3

Describe dissociation and explain the role it plays in exposure to traumatic events according to the psychodynamic paradigm.
1. Answer: From a psychodynamic perspective, dissociation can be considered a defence used to cope with traumatic experiences and includes emotional numbing, substance use, forgetting (repression and other defence mechanisms are relevant here), social withdrawal, and freezing. Short-term use of dissociation is adaptive and makes sense although over the long-term, continued use of this strategy takes one away from expected conscious experience and reality and is associated with lasting negative outcomes.

Page Reference: 84-85; Objective 2.4

Summarize the primary difference between the DSM approach to understanding trauma responses and that of Perry’s neurosequential model of therapeutics (NMT).

Answer: The primary difference is one of focus. While the DSM focuses on identifying and categorizing symptoms, Perry’s NMT model focuses on the root cause of troublesome behaviour (i.e., the brain).

Page Reference: 94-95; Objective 2.5

Describe the primary approach a psychologist working from the behavioural paradigm might take to reduce traumatic symptoms.

Answer: The behavioural paradigm uses exposure therapy which involves presenting feared (and usually avoided) reminders to young people in a safe environment after they’ve been taught relaxation skills. Repeated exposure to feared stimuli followed by relaxation results in extinction of the fear response and can be effective in reducing traumatic symptoms.

Page Reference: 92; Objective 2.6

Identify two of the seven domains of functioning in which impairment is likely to be observed for children exposed to complex trauma. Provide a specific example for each domain.

Answer: The seven domains include: attachment, biology, affect regulation, dissociation, behavioural regulation, cognitive processing, and self-concept. Specific examples for each domain will vary but should reflect the domain identified.

Page Reference: 98-99; Objectives 2.7

Identify 5 behaviours associated with complex trauma that you would be most likely to notice in your CYC practice. Describe one factor that might impact the behaviours you notice.

Answer: Various responses are acceptable (refer to Table 2.6 for a detailed list of behavioural indicators of complex trauma); students may also mention Nonsuicidal Self-Injury. Factors that might impact the behaviours noticed can include the developmental age and stage of the individual, the practitioner’s past experience, the context in which the behaviour occurs, and the time available to observe the youth.

Page Reference: 98-99; Objective 2.8

Identify the three main elements of trauma-informed care and describe how each may be implemented in CYC practice.

Answer: The three main elements of trauma-informed care include challenging cognitions, dealing with emotions, and teaching effective coping skills (behaviour).

Page Reference: 102; Objective 2.9

Essay Questions

Distinguish between Trauma- and Stressor-Related Disorders and Dissociative Disorders. Provide one example of a specific disorder from each category. Why do you think the authors of your text decided to include them together in this chapter even though the DSM-5 discusses them in separate chapters?

Suggested answer: Trauma- and Stressor-Related Disorders are a group of psychological disturbances associated with exposure to stressful and traumatic events. Onset of these disorders is clearly associated with exposure to a stressful or traumatic event. Examples of Trauma- and Stressor-Related Disorders include: Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, PTSD, Acute Stress Disorder, and Adjustment Disorders.

Dissociative Disorders refer to disturbances associated with a disruption in the integration of memory, identity, emotions, behaviour, and other aspects of psychological functioning. Examples of Dissociative Disorders include: Dissociative Identity Disorder, Dissociative Amnesia, and Depersonalization/Derealization Disorder.

Dissociative Disorders were included in this chapter because they are often (but not always) associated with exposure to a traumatic event.

Page Reference: 66-72; Objective 2.2

Describe the key elements of relational CYC practice that one should be aware of when assisting young complex-trauma survivors. Identify two of the five core components of complex-trauma intervention and describe how you might utilize these in your practice.

Suggested answer: Key elements of relational CYC practice include: a high level of self-awareness and a focus on strengths and resiliency.

The five core components of complex-trauma intervention and possible examples of how they may be utilized include: (1) safety, establish a safe, nurturing environment; (2) self-regulation, helping the youth regulate arousal; (3) self-reflective information processing, helping the child construct self-narratives, reflect on past experiences, and develop problem solving and planning skills; (4) traumatic experiences integration, using meaning making strategies and developing coping skills, and cultivating present-oriented thinking and behaviour; and (5) relational engagement, teaching the child to form appropriate attachments and develop skills of assertiveness, cooperation, and social skills. (NOTE: students only need identify and describe two of these 5 components).

Page Reference: 106-107; Objective 2.9

Chapter 3: Neurodevelopmental Disorders

Multiple Choice Questions

Learning Objective 3.1 – Define developmental psychopathology and distinguish between the seven general categories of neurodevelopmental disorders.

The study of how disorders emerge in the course of one’s development and how they change or persist over time is referred to as
1. abnormal psychology
2. developmental psychopathology
3. neurodevelopmental science
4. behavioural psychopathology

Answer: B

Page Reference: 114

Skill: factual; Difficulty: easy

Each of the following is one of the areas of general impairment associated with neurodevelopmental disorders EXCEPT
1. Motor skills
2. Communication
3. Mental abilities
4. Empathy

Answer: D

Page Reference: 114

Skill: factual; Difficulty: easy

Neurodevelopmental disorders are organized into 7 general categories on the basis of
1. the severity of the impairment
2. the age of onset
3. the nature of the impairment
4. how long the disorder persists

Answer: C

Page Reference: 115

Skill: conceptual; Difficulty: moderate

According to the DSM-5, deficits in Intellectual Disabilities are observed each of the following domains EXCEPT
1. conceptual
2. verbal
3. practical
4. social

Answer: B

Page Reference: 116

Skill: factual; Difficulty: moderate

Sheri has difficulty solving problems. This illustrates a deficit in which of the major domains of Intellectual Disability?
1. conceptual
2. verbal
3. practical
4. social

Answer: A

Page Reference: 116

Skill: applied; Difficulty: challenging

When young people are diagnosed with an Intellectual Disability, the level of severity is specified according to the level of their
1. intelligence
2. abstract reasoning skills
3. emotional insight
4. adaptive functioning

Answer: D

Page Reference: 116

Skill: conceptual; Difficulty: moderate

Which child would MOST likely be labeled as having a Communication Disorder?
1. Mary is failing all her first-grade subjects
2. Kai who has difficulty paying attention in class
3. Tanya who difficulty using words to express thoughts
4. Sam who has poor handwriting and makes many grammatical errors

Answer: C

Page Reference: 116-117

Skill: applied; Difficulty: moderate

Learning Objective 3.2 – Summarize the primary features of Autism Spectrum Disorder (ASD).

Impairments in Autism Spectrum Disorder are observed in two general areas:
1. abstract reasoning and problem solving
2. social communication and restricted/repetitive interests or behaviours
3. intrapersonal and interpersonal social skills
4. emotional insight and verbal communication/language skills

Answer: B

Page Reference: 117

Skill: factual; Difficulty: moderate

Which of the following is TRUE regarding Asperger’s Disorder?
1. It is no longer included as a formal diagnosis in the DSM-5
2. Compared to autism, there are more delays in language development
3. Individuals with Asperger’s Disorder show few deficits and have above-average IQ scores
4. It is associated with deficits similar to those seen in Pervasive Developmental Disorder

Answer: A

Page Reference: 117

Skill: factual; Difficulty: moderate

With regard to intelligence,
1. most children with autism are above average
2. all children with autism fall into the range of intellectual disability
3. there is a broad range of intellectual functioning found in those with autism
4. performance on tasks involving perceptual-motor skills shows the most deficiency

Answer: C

Page Reference: 117

Skill: factual; Difficulty: moderate

Children with Autism Spectrum Disorder have been found to show deficits in joint attention A clear example of a joint attention interaction is
1. Expressing friendship by hugging a person
2. Expressing a command verbally by saying “be quiet”
3. Drawing attention to the self by smiling at someone
4. Drawing attention to an object by pointing to it

Answer: D

Page Reference: 117-118

Skill: applied; Difficulty: moderate

Which of the following is an example of a Specific Learning Disorder?
1. Lara, who stutters
2. Dan, who has a below-average IQ
3. Chia, who has above average IQ but cannot complete simple math problems
4. Gerald, who has average IQ but has difficulty following rules for social communication

Answer: C

Page Reference: 118

Skill: applied; Difficulty: moderate

People diagnosed with Specific Learning Disorders usually have intelligence scores that are
1. in the genius range
2. at least average
3. far below average
4. unable to be assessed due to their specific impairments

Answer: B

Page Reference: 118

Skill: factual; Difficulty: moderate

Learning Objective 3.3 – Summarize the psychological explanations for neurodevelopmental disorders, with an emphasis on ASD.

Psychological explanations for neurodevelopmental disorders emphasize the role of
1. Early childhood trauma and genetics
2. Genetics and brain damage
3. Inadequate parenting
4. Early attachment difficulties

Answer: B

Page Reference: 124

Skill: factual; Difficulty: easy

Each of the following has been related to neurodevelopmental disorders EXCEPT
1. altered influence of oxytocin
2. an enlarged prefrontal cortex
3. subtle brain damage
4. abnormalities in the amygdala

Answer: B

Page Reference: 125

Skill: factual; Difficulty: challenging

When it comes to neurodevelopmental disorders, psychological and social factors are generally viewed as
1. important causal factors
2. irrelevant to the onset and outcome of these disturbances
3. affecting one’s development and level of functioning
4. important as genetic factors in causing these disorders

Answer: C

Page Reference: 125

Skill: conceptual; Difficulty: challenging

Learning Objective 3.4 – Define theory of mind and explain how it relates to ASD.

Jenny has great difficulty imagining the feelings and thoughts of others. As a result, she has little empathy for her peers and family members. This illustrates the absence of
1. theory of mind
2. central drive for coherence
3. executive functions
4. mind blindness

Answer: A

Page Reference: 128

Skill: applied; Difficulty: moderate

The absence of________________is the root of most difficulties people with Autism Spectrum Disorder experience in their communication and social interaction.
1. theory of mind
2. central drive for coherence
3. executive functions
4. mind blindness

Answer: A

Page Reference: 128

Skill: conceptual; Difficulty: moderate

For those with Autism Spectrum Disorder, paying attention to minor details and failing to see the big picture is best explained by deficits in
1. theory of mind
2. executive functions
3. central drive for coherence
4. mind blindness

Answer: B

Page Reference: 128-129

Skill: applied; Difficulty: moderate

Learning Objective 3.5 – Explain whether inclusiveness is always the preferred approach for every young person with an ASD.

The term_____________refers to the predominant belief in our society that physically and mentally able individuals are normal while developmentally challenged persons are somehow abnormal.
1. neurotypical
2. integration
3. alteration
4. ableism

Answer: D

Page Reference: 131

Skill: factual; Difficulty: easy

Which of the following is true regarding inclusiveness for those diagnosed with an ASD?
1. It is the best option for every child
2. It is always the best option
3. It may result in bullying
4. It should never be considered

Answer: C

Page Reference: 131-132

Skill: conceptual; Difficulty: easy

Learning Objective 3.6 – Describe the psychological approaches used in treating neurodevelopmental disorders.

For those with Autism Spectrum Disorder, medical treatments are
1. effective in managing the most prominent symptoms
2. are used primarily to reduce symptoms of agitation and anxiety
3. never used
4. the first line of treatment

Answer: B

Page Reference: 130

Skill: factual; Difficulty: moderate

For those with Autism Spectrum Disorder, psychological approaches to intervention include all of the following EXCEPT
1. Behavioural reinforcement strategies
2. Family education and support
3. Social communication skills training
4. Psychodynamic interpersonal therapy

Answer: D

Page Reference: 130

Skill: factual; Difficulty: moderate

Learning Objective 3.7 – Summarize interventions that CYCP’s could use with children diagnosed with ASD.

Billy is particularly sensitive to physical touch and physical contact often results in a panic attack. This illustrates
1. Sensory Processing Disorder
2. Tourette’s disorder
3. Catatonia
4. Synaesthesia

Answer: A

Page Reference: 134

Skill: applied; Difficulty: moderate

The most commonly seen forms of sensory integration dysfunctions include all of the following EXCEPT
1. lack of sensitivity to pain
2. visual sensitivity
3. palilalia
4. synaesthesia

Answer: C

Page Reference: 135

Skill: factual; Difficulty: moderate

The successful and empirically supported approaches to treating children with ASD include
1. Cognitive behavioural therapy
2. Insight therapy
3. Holding therapy
4. Applied behaviour analysis

Answer: D

Page Reference: 136

Skill: conceptual; Difficulty: moderate

Which strength-based technique uses a child’s special interest to motivate improvement in behaviour and social skills?
1. Sensory integration therapy
2. The power-card strategy
3. Applied behaviour analysis
4. Relationship development intervention

Answer: B

Page Reference: 137-138

Skill: conceptual; Difficulty: moderate

A school-based intervention that utilizes play time to pull children with ASD into a ‘shared world’ is
1. Sensory integration therapy
2. The power-card strategy
3. DIR Floortime
4. Relationship development intervention

Answer: C

Page Reference: 141

Skill: conceptual; Difficulty: moderate

What can be concluded regarding holding therapy?
1. It has been associated with physical and psychological harm to the child
2. It has been associated with significant gains in joint attention
3. It is considered evidence-based
4. It is used by CYCPs in various settings

Answer: A

Page Reference: 142

Skill: factual; Difficulty: easy

The primary goal of gentle teaching is
1. To reduce problem behaviours
2. To increase social skills in the child
3. To increase academic performance through sensitive responding
4. To build a trusting bond between caregiver and child

Answer: D

Page Reference: 143

Skill: factual; Difficulty: moderate

Short-Answer Questions

Identify the five areas of general impairment associated with neurodevelopmental disorders.

Answer: The five areas of general impairment include deficits in: general mental abilities, specific areas of learning (e.g., math, spelling), communication (e.g., producing or understanding speech) social communication and interaction, and motor skills.

Page Reference: 115; Objective 3.1

When it comes to CYC practice, CYCPs are most likely to work with young people with what was formerly referred to as Asperger’s Syndrome. Summarize distinct behaviours associated with this former diagnosis.

Answer: Youth with Asperger’s Disorder typically have lower levels of impairment than those diagnosed with more severe Autism Spectrum Disorder. Specific behaviours include: awkward motor coordination, flat tone of voice, failure to read social signals, awkwardness in social small talk, excellent recall of trivial detail, extremely limited sense of humour, narrow range of interests, and an obsessive impulse to argue and split hairs.

Page Reference: 121; Objective 3.2

From a psychological perspective, compare the role of biological factors to psychological and social factors in understanding neurodevelopmental disorders.
1. Answer: From a psychological perspective, biological factors (i.e., genetics, brain structures, neurotransmitters) are generally viewed as being the cause of neurodevelopmental disorders. Psychological and social factors, however, are generally viewed as playing a role in influencing the outcome of neurodevelopmental disorders, rather than being a cause per se.

Page Reference: 124-1255; Objective 3.3

Define theory of mind and explain its role in Autism Spectrum Disorder.

Answer: Theory of mind refers to one’s capacity to understand that other people have thoughts and feelings and recognize these in others by creating a picture of our own thoughts and feelings; we can then predict some of their behaviours and anticipate a response. Youth with ASD have difficulty conceptualizing and appreciating the feelings and thoughts of others and therefore are said to have an absence of theory of mind which underlies their difficulties in communication and social interaction.

Page Reference: 128; Objective 3.4

Identify pros and cons of inclusiveness for those diagnosed with ASD.

Answer: Inclusiveness ensures those with ASD are provided appropriate opportunities for learning, the fundamental human right of all children and youth with ASD. However, it may not be the best option for every child, every time because: (1) it may not prioritize the needs of the individual child or (2) be able to provide the specialized education required. In addition, children with ASD may be subject to bullying.

Page Reference: 131; Objective 3.5

Summarize the role of medication in the treatment of neurodevelopmental disorders.

Answer: Medical treatments do not help address the core symptoms that create impairment in neurodevelopmental disorders. Although some medications are used to reduce specific symptoms of agitation and anxiety, they should not be used to replace other forms of intervention.

Page Reference: 130; Objectives 3.6

Describe the general approach of applied behaviour analysis (ABA) and its use with youth diagnosed with ASD.

Answer: Applied behaviour analysis (ABA) is the process of observing children’s behaviour so as to develop an intervention plan. Most frequently used as a behaviour management tool, it can also be used to teach social, motor, and verbal behaviours and to manage challenging and/or self-harm behaviours.

Page Reference: 136; Objective 3.7

Define the controversy surrounding holding therapy.

Answer: Holding therapy consists of forced holding by a therapist or parent until the child stops resisting or until a fixed time period has elapsed. It is highly controversial (and the authors of the text are opposed to its use) because it is associated with significant dangers (including physical and psychological harm to the child) and it has no empirical evidence to support its use.

Page Reference: 142; Objective 3.7

Essay Questions

Describe sensory integration therapy. How might it be used by CYCPs? Provide specific examples of interventions that may be used to reduce excess sensory input and those that might be used to increase sensory stimulation. What is your position on the use of this approach to intervention? Explain.

Suggested answer: Sensory integration therapy involves the use of pressure, weight, and movement techniques to alter children’s sensory experiences. CYCPs can employ many of its facets. Strategies to reduce excess sensory input include dimmed lighting, avoiding unexpected touch and reducing sound stimulation; strategies to increase sensory stimulation include using background music, aromatherapy candles, and chewing gum (see pages 138-139 for detailed list of strategies). Students will vary in their positions on this intervention but should provide an explanation for where they stand.

Page Reference 138-139; Objective 3.7

Consider all of the various approaches to working with those diagnosed with ASD. Identify three specific approaches that you would be likely to use in some form in your CYC practice, highlighting their benefits.

Suggested answer: Answers will vary but can include: applied behaviour analysis, power-card strategy, sensory integration therapy, gentle teaching.

Page Reference: 135-143; Objective 3.7

Chapter 4: Attention Deficits

Multiple Choice Questions

Learning Objective 4.1 – Summarize the diagnostic criteria for each of the three presentations of ADHD identified in the DSM-5.

Behaviours exhibited by youth diagnosed with ADHD are often experienced as disruptive by parents, teachers, peers, and society at large. For this reason, they are often referred to as
1. adaptive
2. multidimensional
3. internalizing
4. externalizing

Answer: D

Page Reference: 148

Skill: factual; Difficulty: easy

With respect to attention, which of the following has been found to be a specific attention deficit?
1. attentional capacity
2. sustained attention
3. redirected attention
4. none of the above—no specific attention deficit has been identified

Answer: B

Page Reference: 149

Skill: conceptual; Difficulty: moderate

Those diagnosed with ADHD show__________in the area of___________, defined as the amount of information we can remember and attend to for a short period of time.
1. little impairment; sustained attention
2. little impairment; attentional capacity
3. significant impairment; attentional capacity
4. no impairment; selective attention

Answer: B

Page Reference: 149

Skill: conceptual; Difficulty: challenging

Vernon cannot help but call out in class and often acts without considering the consequences. This relates to deficits in
1. behavioural impulsivity
2. cognitive impulsivity
3. motor hyperactivity
4. attentional capacity

Answer: A

Page Reference: 149

Skill: applied; Difficulty: moderate

According to the DSM, all of the following are a primary manifestation of ADHD EXCEPT
1. aggressive behaviour
2. impulsivity
3. activity problems
4. attention deficits

Answer: A

Page Reference: 150

Skill: factual; Difficulty: easy

Each of the following is a secondary manifestation of ADHD EXCEPT
1. motor coordination problems
2. low self-esteem
3. impulsivity
4. academic problems

Answer: C

Page Reference: 150

Skill: factual; Difficulty: moderate

ADHD is included in the DSM-5 grouping of
1. impulse control disorders
2. disorders first identified in childhood
3. disintegrative disorders
4. neurodevelopmental disorders

Answer: D

Page Reference: 151

Skill: factual; Difficulty: easy

According to the DSM, in order to be diagnosed with ADHD, symptoms must be observed
1. in the school
2. by more than two people
3. in multiple settings
4. in the home

Answer: C

Page Reference: 151

Skill: factual; Difficulty: moderate

Alicia seems to always be in a fog, is easily confused, and is withdrawn and shy. Which subtype of ADHD would she likely be diagnosed with?
1. Predominantly inattentive presentation
2. Predominantly hyperactive-impulsive presentation
3. Predominantly aggressive presentation
4. Combined presentation

Answer: A

Page Reference: 152-153

Skill: applied; Difficulty: moderate

Learning Objective 4.2 – Summarize a CYC perspective for understanding attention deficits.

Because ADHD affects outer-directed functions (e.g., behaviour, emotional responding), CYCP’s need to appreciate that
1. symptoms will be observed equally in all environments
2. some environments will evoke or aggravate the symptoms more than others
3. there are few emotional consequences for the youth diagnosed with the disorder
4. ADHD is considered a mental illness

Answer: B

Page Reference: 154

Skill: conceptual; Difficulty: moderate

One concern from a CYC perspective is that viewing ADHD as a neurological disorder
1. minimizes the biological aspects of the disorder
2. ignores the behavioural symptoms of the disorder
3. makes it a mental illness rather than a psychiatric illness
4. turns those diagnosed with the disorder into victims

Answer: D

Page Reference: 153-155

Skill: conceptual; Difficulty: challenging

From a CYC perspective, each of the following is true regarding attention deficits EXCEPT
1. youth diagnosed with ADHD have low tolerance frustration resulting in temper tantrums
2. youth diagnosed with ADHD are likely to experience emotional pain
3. youth struggling with ADHD are likely to be unaware of their impairments
4. youth diagnosed with ADHD have many strengths

Answer: C

Page Reference: 153-155

Skill: conceptual; Difficulty: challenging

Which of the following is TRUE regarding gender and ADHD?
1. males and females are equally likely to be diagnosed with ADHD
2. males are more likely to be diagnosed with ADHD
3. females are more likely to be diagnosed with ADHD
4. more females than males are diagnosed with ADHD in childhood, but this is reversed in adolescence

Answer: B

Page Reference: 157

Skill: factual; Difficulty: easy

Each of the following is frequently comorbid with ADHD EXCEPT
1. PTSD
2. substance use disorders
3. learning disorders
4. disruptive behaviour disorders

Answer: A

Page Reference: 158-160

Skill: factual; Difficulty: moderate

Learning Objective 4.3 – Compare and contrast primary psychological explanations for ADHD.

Compared to Conduct Disorder and other behaviour disorders, ADHD is more strongly linked to
1. financial disadvantage
2. biological/neurological factors
3. adverse family variables
4. family conflict

Answer: B

Page Reference: 161

Skill: conceptual; Difficulty: challenging

Research into genetic factors in ADHD has revealed
1. specific abnormalities in the number of chromosomes
2. no evidence for any kind of genetic influence
3. some evidence for heredity in males only, based on twin studies
4. some evidence for heredity, based on twin studies

Answer: D

Page Reference: 161

Skill: factual; Difficulty: moderate

It is believed that the __________of the brain may play a significant role in ADHD.
1. medulla
2. frontal-lobe areas
3. brainstem
4. occipital lobes

Answer: B

Page Reference: 161

Skill: factual; Difficulty: moderate

What neurotransmitters appear to be low in those diagnosed with ADHD?
1. serotonin and oxytocin
2. serotonin and acetylcholine
3. dopamine and norepinephrine
4. dopamine and oxytocin

Answer: C

Page Reference: 161

Skill: factual; Difficulty: challenging

According to the behavioural paradigm, those diagnosed with ADHD appear to have an overactive
1. behavioural inhibition system
2. behavioural alteration system
3. behavioural activation system
4. behavioural automation system

Answer: C

Page Reference: 162

Skill: conceptual; Difficulty: challenging

According to the behavioural paradigm, those diagnosed with ADHD are particularly sensitive to
1. immediate rewards
2. punishments
3. social criticism
4. peer rejection

Answer: A

Page Reference: 162

Skill: conceptual; Difficulty: moderate

Which of the following can be concluded regarding family influences and ADHD?
1. The role of the family environment in ADHD has yet to be explored by researchers.
2. Most researchers agree that family factors are the most significant causal factor in ADHD.
3. The social environment has little influence for those diagnosed with ADHD.
4. The social environment interacts with biological factors to impact the severity of symptoms.

Answer: D

Page Reference: 163

Skill: conceptual; Difficulty: moderate

Learning Objective 4.4 – From a CYC perspective, summarize predominant explanations for the causes of ADHD.

From a CYC perspective, understanding the causes of ADHD requires consideration of each of the following EXCEPT
1. the interplay between genetic and environmental factors
2. environmental influences such as maternal smoking and parental stress
3. attachment and early childhood relationships
4. the role of ‘bad parenting’ and maltreatment

Answer: D

Page Reference: 163-164

Skill: conceptual; Difficulty: challenging

From a CYC perspective, considerations of attunement are associated with recommendations that interventions for ADHD be based on
1. reinforcement principles
2. genetic counselling
3. attachment theory
4. physical exercise

Answer: C

Page Reference: 163

Skill: conceptual; Difficulty: moderate

Learning Objective 4.5 – Identify and describe psychological treatment approaches used in treating ADHD.

The most common type of medication used to treat ADHD is the class of drugs referred to as
1. anti-anxiety medications
2. stimulants
3. anti-depressants
4. neuroleptics

Answer: B

Page Reference: 166

Skill: factual; Difficulty: easy

Medications used to treat ADHD decrease symptoms by___________the activation of__________.
1. increasing; dopamine and norepinephrine
2. increasing; serotonin and acetylcholine
3. decreasing; dopamine and norepinephrine
4. decreasing; serotonin and norepinephrine

Answer: A

Page Reference: 166

Skill: factual; Difficulty: challenging

The most typical first line of treatment of ADHD is
1. medication
2. psychodynamic therapy
3. parent management training
4. response inhibition training

Answer: A

Page Reference: 167

Skill: factual; Difficulty: easy

As discussed in your text, cognitive approaches to intervention for youth diagnosed with ADHD
1. involve helping the youth get insights into their internal world
2. are generally not supported by empirical evidence as to their effectiveness
3. are just as effective as medication in decreasing the primary symptoms of ADHD
4. are more effective than medication in reducing symptoms

Answer: B

Page Reference: 168

Skill: factual; Difficulty: moderate

Parent Management Training programs for parents of children with ADHD
1. help parents to manage their child’s noncompliant behaviours and educate them about ADHD
2. focus on facilitating youth academic skills rather than changing behaviour
3. teach parents to “lighten up” on their children and take responsibility for their role in the disorder
4. are more effective than medication in reducing the primary symptoms of ADHD

Answer: A

Page Reference: 169

Skill: conceptual; Difficulty: moderate

Generally, psychosocial treatments for ADHD are
1. ineffective and have few benefits for youth
2. most likely to provide benefits to those with comorbid disorders
3. most likely to be effective with adolescents than with children
4. just as effective as medication alone

Answer: B

Page Reference: 170

Skill: conceptual; Difficulty: moderate

Learning Objective 4.6 – List and describe the most common comorbid conditions and secondary manifestations that can serve as indicators for ADHD.

In relation to CYC assessment of ADHD, an important consideration to keep in mind is situational variability which highlights the need for CYC practitioners to
1. conduct their assessments in a single context
2. base their assessments on information obtained from a single source rather than many
3. base their assessments on medical information which is more objective in nature
4. consider observational data from many sources and contexts

Answer: D

Page Reference: 171

Skill: conceptual; Difficulty: moderate

In relation to the assessment of ADHD, CYCPs should be aware that the signs of ADHD are more likely to be observed when children are
1. completing specific tasks
2. at home with their parents
3. in their peer groups
4. in an unstructured, informal setting

Answer: C

Page Reference: 171

Skill: factual; Difficulty: moderate

Children and youth who constantly fidget and move about may also be struggling with a neurological condition known as_________________that can co-occur with ADHD.
1. Fetal Alcohol Spectrum Disorder
2. Sensory Integration Disorder
3. Attunement Disorder
4. Executive Functioning Disorder

Answer: B

Page Reference: 172

Skill: factual; Difficulty: easy

Trevor, diagnosed with ADHD, tends to exaggerate his self-worth and competence. Which of the following is most likely TRUE?
1. Trevor has been misdiagnosed.
2. This reflects a distorted self-perception, often seen in those diagnosed with ADHD.
3. This reflects hyperactivity, a primary manifestation of ADHD.
4. This is an accurate perception, as those diagnosed with ADHD are more competent than others

Answer: B

Page Reference: 159-160

Skill: applied; Difficulty: challenging

Deficits in ___________________ associated with ADHD can lead to risk taking behaviour.
1. executive functioning
2. self-esteem
3. temporal lobe function
4. social skills

Answer: A

Page Reference: 160

Skill: conceptual; Difficulty: moderate

Learning Objective 4.7 – Describe a variety of strength-based, CYC-relevant support strategies and interventions for ADHD behaviours.

Which of the following is TRUE regarding CYC approaches for youth struggling with ADHD?
1. they consider context to be less relevant in ADHD than in other disorders
2. they tend to focus on changing and correcting inappropriate parenting strategies
3. they involve a combination of strategies with primary focus on the context in which they occur
4. they tend to focus on identifying and changing specific behaviours of the diagnosed youth

Answer: C

Page Reference: 170; 174

Skill: conceptual; Difficulty: moderate

Marcia has been encouraged to ask herself questions during class in order to increase her awareness of her own thought processes. During math class she asks herself, “Am I paying attention?” This illustrates the cognitive-behavioural technique of_________________.
1. self-monitoring
2. self-absorption
3. positive self-talk
4. cognitive restructuring

Answer: A

Page Reference: 174

Skill: applied; Difficulty: moderate

From a CYC perspective, which of the following is true regarding the use of medication to treat ADHD?
1. long-term use of medications, even without behavioural interventions, is evidence-based
2. the benefits of medication have been overstated with little support for long-term effectiveness
3. there is little research to support the effectiveness of medication in decreasing ADHD symptoms
4. medications alone address all of the functional impairments associated with ADHD

Answer: B

Page Reference: 175

Skill: factual; Difficulty: challenging

In providing one-on-one support to youth diagnosed with ADHD, each of the following strategies might be recommended for use in CYC practice EXCEPT
1. provide a structured routine
2. be unpredictable in your consequences in order to get their attention
3. actively encourage physical exercise
4. tell the child what the consequences will be for various behaviours

Answer: B

Page Reference: 178-179

Skill: factual; Difficulty: moderate

Alternative healing approaches include________________which helps the youth diagnosed with ADHD become better able at managing the activity in the frontal lobe.
1. self-monitoring
2. equine therapy
3. cognitive restructuring
4. biofeedback

Answer: D

Page Reference: 179

Skill: factual; Difficulty: easy

Short-Answer Questions

Identify the three major areas of symptoms for ADHD and provide a specific example for each.

Answer: Major symptom areas include: (1) inattention (e.g., not paying attention to instructions); (2) hyperactivity (e.g., fidgeting and jumping up and down in seat); (3) impulsivity (e.g., blurting out answer before teacher has finished asking a question). A variety of examples are acceptable.

Page Reference: 150; Objective 4.1

What questions and concerns arise from a CYC perspective now that ADHD has been categorized in the DSM as a neurodevelopmental disorder?

Answer: The primary question for CYCPs is whether viewing ADHD as a neurological disorder help CYCPs support youth with an ADHD diagnosis. Concerns arise that shifting responsibility for negative behaviours onto brain functioning results in youth becoming victims and viewed as helpless in the face of their disability.

Page Reference: 153-154; Objective 4.2

Distinguish between the BAS and the BIS according to the behavioural paradigm. Which of these is most relevant in understanding ADHD?

Answer: The BAS refers to the behavioural activation system which stimulates behaviour in the context of reinforcements and is associated with seeking rewards and pleasure. The BIS refers to the behavioural inhibition system which inhibits behaviour, particularly in the context of possible punishments. The BAS is most relevant to in understanding ADHD because research demonstrates that those diagnosed with ADHD have greater sensitivity to rewards (particularly immediate reward) which suggests that one strategy for enhancing learning in those diagnosed with ADHD is to provide frequent reinforcements.

Page Reference: 162; Objective 4.3

Summarize the explanation for ADHD from a sociocultural paradigm.
1. Answer: According to the sociocultural paradigm, there is no single cause of ADHD. Instead, it makes more sense to consider how biological factors (that create a predisposition for developing the disorder) interact with various social and cultural factors to contribute to the likelihood that ADHD symptoms will arise. Therefore, although considered a ‘brain-based disorder’, a sociocultural perspective emphasizes the role of family factors and cultural and social factors.

Page Reference: 162-163; Objective 4.3

Describe two causal factors of ADHD identified from a CYC perspective.

Answer: Using an ecological framework, a variety of causal factors might be identified. In particular, environmental influences (e.g., maternal smoking, traumatic brain injury, maltreatment), disruptions in early attachment relationships, and early childhood experiences should be highlighted.

Page Reference: 164; Objective 4.4

From a psychological perspective, what is considered the first line of treatment? Identify two concerns with this approach.

Answer: From a psychological perspective, medication is the first line of treatment for ADHD. Despite its use, however, concerns include: side effects, overuse and misuse, lack of knowledge about long-term developmental consequences, the role of medication in aggression and suicidal thoughts, the fact that not all youth show benefits from treatment, and general concerns about efficacy and safety in both the short- and long-term.

Page Reference: 166-167; Objectives 4.5

Identify two secondary manifestations of ADHD.

Answer: Any two of the following are acceptable: academic and learning problems, motor coordination difficulties, distorted self-perceptions, low self-esteem, deficits in executive functioning, conduct problems.

Page Reference: 159-160; Objective 4.6

Identify and describe two specific techniques for CYC intervention (discussed in your text) that you would be most likely to use in your work to support a youth diagnosed with ADHD. Why would you be most likely to use these particular techniques?

Answer: Many possible strategies are acceptable (refer to Box 4.3, p. 177 for a detailed list of possibilities). Explanations for choice of strategy should also be provided (note that it is the explanation that is important, rather than the rationale).

Page Reference: 177; Objective 4.7

Essay Questions

Summarize arguments for and against the use of medication in the treatment of ADHD. Include research and arguments from both the psychological and CYC perspectives in your answer. Where do you stand with respect to this important issue and why?

Suggested answer: From a psychological perspective, the efficacy of medication is well documented and fits well with the view that ADHD is a neurological disorder. Although effectiveness may be considered an argument for the use of medication, arguments against it use include the following concerns: side effects, overuse and misuse, lack of knowledge about long-term developmental consequences, the role of medication in causing aggression and suicidal thoughts, the fact that not all youth show benefits from treatment, and general concerns about efficacy and safety in both the short- and long-term.

From a CYC perspective, arguments for the use of medication may also include evidence of benefits for some youth while additional arguments against the use of medication might include the following points: medications alone don’t address all of the functional impairments associated with ADHD; it may lead one to overlook other approaches to treatment; the use of medication in treatment may be inconsistent with the CYCP’s personal approach.

Students should also summarize their personal stand on this issue and provide a rationale for their position (responses will vary and are all acceptable as it is a personal view).

Page Reference: 166-167; 174-176; Objectives 4.5 and 4.7

Suppose you are working with an 8-year-old named Mark who has been diagnosed with ADHD. He has recurrent problems with school work and often forgets to do his homework or brush his teeth. As a result, he often gets down on himself and can be heard saying, “You are stupid, stupid, stupid!” while looking in the mirror. He gets easily distracted which results in his room being unorganized (he can’t find his clothes before going to school). He enjoys playing video games and watching hockey and football on TV. Using specific details from the case, describe how you would provide one-on-one support to Mark, identifying 4 specific strategies you would use in your CYC practice.

Suggested answer: Various one-on-one support strategies and other approaches might be identified. Common responses given details in the case might include: establishing routines (provide reminders, give direction), use video games and football as rewards for on-task behaviour, demonstrate organizational strategies for his room and homework, and positive self-talk.

Page Reference: 174; 178; Objective 4.7

Chapter 5: Disruptive Behaviour

Multiple Choice Questions

Learning Objective 5.1 – Summarize the DSM criteria for ODD, Intermittent Explosive Disorder, CD, Pyromania, and Kleptomania.

As disruptive behaviour disorder refers to disorders defined by disturbances in which of the following general areas?
1. behavioural and emotional self-regulation or self-control
2. neurobiological and neurochemical processes
3. executive and higher-level cognitive processes
4. social and socioemotional relationships

Answer: A

Page Reference: 186

Skill: factual; Difficulty: easy

All of the following are characteristics of oppositional defiant disorder EXCEPT
1. temper tantrums
2. refusing to comply with demands
3. easily annoyed
4. physical aggression

Answer: D

Page Reference: 188

Skill: factual; Difficulty: easy

A child who does not follow through on a reasonable request but is not vocal or actively refusing is exhibiting
1. defiance
2. noncompliance
3. passive aggression
4. delinquency

Answer: B

Page Reference: 188

Skill: factual; Difficulty: easy

Marty’s parents are concerned about his behaviour. Although he’s now nine years old, he has frequent temper tantrums when frustrated, throwing objects and hitting those around him. Yesterday, when his video game didn’t work, he smashed it into the mirror on the wall, breaking it to pieces. Marty would most likely be diagnosed with
1. pyromania
2. kleptomania
3. intermittent explosive disorder
4. trichotillomania

Answer: C

Page Reference: 188

Skill: applied; Difficulty: easy

Jones is a child psychologist attempting to make a DSM-5 diagnosis of a 9-year-old male’s disruptive behaviour. Which of the following would MOST likely lead Dr. Jones to make a diagnosis of conduct disorder?
1. The child acts inappropriately at school, at home, and in public.
2. The child is defiant with parents and teachers.
3. The child is hyperactive, inattentive, and impulsive.
4. The child exhibits behaviours that are harmful to others or to property.

Answer: D

Page Reference: 189

Skill: applied; Difficulty: moderate

According to the DSM-5, two subtypes of Conduct Disorders are
1. Socialized/unsocialized
2. Childhood onset/adolescent onset
3. Aggressive/group-delinquent
4. Aggressive/nonaggressive

Answer: B

Page Reference: 189-190

Skill: factual; Difficulty: moderate

Which of the following is MOST associated with persistent and severe conduct problems?
1. adolescent-onset conduct disorder
2. both adolescent and childhood onset conduct disorder
3. childhood-onset conduct disorder
4. none of the above…these problems disappear by age 15

Answer: C

Page Reference: 189-190

Skill: factual; Difficulty: moderate

Learning Objective 5.2 – Summarize the CYC perspective on the disruptive behaviour disorders.

From a CYC perspective, most disturbed behaviour in children results from
1. the disease in the child
2. unconscious conflicts
3. poor parenting skills
4. discord in the ecology

Answer: D

Page Reference: 191-192

Skill: conceptual; Difficulty: easy

Which of the following is most consistent with a CYC approach to disruptive behaviour disorders?
1. “despair turns into rage”
2. “it’s a solo performance”
3. “there is no free lunch”
4. “what goes around comes around”

Answer: A

Page Reference: 192

Skill: conceptual; Difficulty: easy

When it comes to Conduct Disorder,
1. females are more likely to be diagnosed than males
2. males are more likely to be diagnosed than females
3. males and females are equally likely to be diagnosed
4. males are more likely to be diagnosed later in age than females

Answer: B

Page Reference: 193

Skill: factual; Difficulty: easy

According to your text, each of the following factors has been found to influence the risk of disruptive behaviour disorders EXCEPT
1. cultural tolerance of anger, aggression, and strong emotion
2. limited resources
3. a diet high in sugar and low in protein
4. maltreatment or exposure to violence in families of origin

Answer: C

Page Reference: 194

Skill: factual; Difficulty: challenging

Which of the following BEST predicts persistent and lasting conduct problems?
1. the age at which the behaviour is first observed
2. early childhood poverty
3. exposure to childhood maltreatment
4. level of social intelligence

Answer: A

Page Reference: 195

Skill: factual; Difficulty: moderate

As discussed in your text when it comes to Conduct Disorder, the _______________is observed earlier and is generally associated with more severe disturbances than the__________________.
1. life-course persistent pattern; adolescent-limited pattern
2. adolescent-limited pattern; life-course persistent pattern
3. antisocial pattern; psychopathic pattern
4. life-altered pattern; life-stabilized pattern

Answer: A

Page Reference: 195

Skill: factual; Difficulty: moderate

Conduct disorder in childhood is most likely to lead to which adult disorder?
1. Schizophrenia
2. Antisocial personality disorder
3. Borderline personality disorder
4. Obsessive compulsive disorder

Answer: B

Page Reference: 195

Skill: factual; Difficulty: moderate

Learning Objective 5.3 – Compare and contrast primary psychological explanations (biological, psychodynamic, behavioural, cognitive, and sociocultural) for disruptive behaviour disorders.

According to the biological paradigm, which of the following predicts conduct problems?
1. poor school performance
2. difficult temperament
3. low intelligence
4. high levels of social inhibition

Answer: B

Page Reference: 198

Skill: factual; Difficulty: moderate

Which of the following is most likely to have a genetic, biological basis?
1. life-course persistent pattern
2. adolescent-limited pattern
3. both the life-course persistent and adolescent-limited patterns
4. none of the above…genetics aren’t involved in Conduct Disorder

Answer: A

Page Reference: 198

Skill: factual; Difficulty: moderate

Which of the following is most likely to have a genetic, biological basis?
1. non-aggressive conduct problems
2. adolescent-limited pattern conduct problems
3. noncompliant behaviour
4. aggressive conduct problems

Answer: D

Page Reference: 198

Skill: factual; Difficulty: moderate

Abnormalities in the____________have been found to be related to conduct-disordered behaviour.
1. reticular activating system
2. basal ganglia
3. corpus callosum
4. prefrontal cortex

Answer: D

Page Reference: 198

Skill: factual; Difficulty: moderate

Which of the following is TRUE regarding the biological influences in Conduct Disorder?
1. Children with CD have an underactive behavioural activation system
2. Children with CD have an underactive behavioural inhibition system
3. Children with CD inherit an easy temperament
4. Children with CD have an overactive behavioural inhibition system

Answer: B

Page Reference: 198

Skill: conceptual; Difficulty: moderate

John has been diagnosed with early onset conduct disorder. When he is told that he should clean his room or he will “get into trouble”, which of the following is most likely? John will experience
1. a lower fear response than other children would to this threat of punishment
2. excitement due to pleasure associated with making others angry
3. confusion due to deficits in executive functioning
4. a increase in overall brain activity due to extreme fear and anxiety

Answer: A

Page Reference: 198-199

Skill: applied; Difficulty: challenging

Conduct Disorder has been found to be related to
1. high levels of serotonin
2. high levels of epinephrine
3. high levels of testosterone
4. low levels of acetylcholine

Answer: C

Page Reference: 199

Skill: factual; Difficulty: challenging

Which paradigm argues that conduct disordered behaviour is a result of an unconscious attempt to reject the control that high moral standards and authority figures attempt to impose on the individual?
1. psychodynamic
2. behavioural
3. cognitive
4. sociocultural

Answer: A

Page Reference: 199

Skill: conceptual; Difficulty: moderate

According to the social learning approach, research on TV-watching and aggression has
1. not yet been conducted
2. revealed that watching violence makes children more anxious
3. found a link between watching violent role models on TV and aggression
4. not found a consistent relationship between watching violent role models on TV and aggression

Answer: C

Page Reference: 200

Skill: conceptual; Difficulty: moderate

Each of the following is a common type of distorted thinking related to disruptive behaviour disorders EXCEPT
1. blaming self
2. minimizing
3. assuming the worst
4. self-centred

Answer: A

Page Reference: 200

Skill: factual; Difficulty: moderate

According to the sociocultural paradigm, each of the following is emphasized in explanations for conduct disorder EXCEPT
1. early psychological trauma
2. high degrees of parental monitoring
3. parental discipline styles
4. beta commands

Answer: B

Page Reference: 201

Skill: conceptual; Difficulty: challenging

In regard to parental discipline, parents of conduct disordered children
1. “natter or nag” more in response to low levels of coercive behavior
2. give more alpha commands than beta commands
3. spend more time monitoring their children
4. classify fewer behaviours as deviant

Answer: A

Page Reference: 201

Skill: conceptual; Difficulty: moderate

Julia’s mother tells her to stop being so lazy and tidy up, then proceeds to put Julia’s toys away for her. This is an example of a(n)
1. negative coercive cycle
2. alpha command
3. beta command
4. amplifier command

Answer: C

Page Reference: 201

Skill: applied; Difficulty: moderate

Learning Objective 5.4 – Outline CYC theoretical explanations for the development of ODD and CD.

From a CYC perspective, two of the most important factors influencing the development of disruptive behaviour disorders have been found to be
1. poverty and poor nutrition
2. peer rejection and social isolation
3. low intelligence and shyness
4. family influence and emotional dysregulation

Answer: D

Page Reference: 202

Skill: factual; Difficulty: moderate

The_____________discipline style, characterized by a high rate of commands, yelling, hitting, threatening, and humiliating statements, is a risk factor for disruptive behaviour disorders.
1. authoritarian
2. irritable explosive
3. permissive
4. disorganized

Answer: B

Page Reference: 202

Skill: factual; Difficulty: moderate

According to the _____________method of calculating one’s risk for disruptive behaviour disorder, the number of risk factors present is more important than the type of risk factor.
1. cumulative pathway
2. multiple pathways
3. interactionist pathway
4. exploratory pathway

Answer: A

Page Reference: 203

Skill: factual; Difficulty: moderate

Each of the following are one of the four known common patterns in the families of youth diagnosed with disruptive behaviour disorders EXCEPT
1. Parental deviance
2. Marital conflict
3. Over-involvement and enmeshment
4. Parental rejection and coerciveness

Answer: C

Page Reference: 204

Skill: factual; Difficulty: moderate

From a CYC approach, it is recommended that CYCPs view “Conduct Disorder” as a__________rather than a_________________.
1. lack of resilience; mental illness
2. mental illness; disease
3. diagnosis; descriptor of behaviour
4. descriptor of behaviour; diagnosis

Answer: D

Page Reference: 204

Skill: conceptual; Difficulty: easy

One important resilience factor in the context of risk factors for disruptive behaviour disorders is
1. a lack of empathy
2. a positive internal working model
3. an positive attributional bias
4. a difficult temperament

Answer: B

Page Reference: 206

Skill: factual; Difficulty: moderate

Learning Objective 5.5 – Describe psychological treatment approaches used in treating disruptive behaviour disorders.

Which of the following is true regarding the use of medication for Conduct Disorder?
1. It is the first line of treatment
2. It is sometimes used to treat comorbid conditions or specific symptoms that occur along with CD
3. It is never used in the treatment of this disorder
4. SSRI’s have been found to be very effective in reducing conduct disordered behaviour

Answer: B

Page Reference: 209

Skill: factual; Difficulty: challenging

Problem-solving skills training appears to be LESS effective with
1. girls than boys
2. adolescent-onset CD than childhood-onset CD
3. adolescents than with children
4. those with high IQ than with those with low IQ

Answer: C

Page Reference: 210

Skill: factual; Difficulty: moderate

Which of the following is true regarding the use of behavioural and cognitive intervention strategies for Conduct Disorder?
1. they are the first line of treatment
2. they are evidence-based
3. adolescents benefit less from these strategies than children
4. children benefit less from these strategies than adolescents

Answer: C

Page Reference: 210

Skill: conceptual; Difficulty: challenging

Parent Management Training
1. emphasizes the use of punishment in discipline
2. is relatively unsuccessful in changing children’s behaviours
3. is less effective for children than for adolescents
4. is the first line of approach of treatment for young children with ODD and CD

Answer: D

Page Reference: 211

Skill: conceptual; Difficulty: moderate

Learning Objective 5.6 – Summarize specific indicators of disruptive behaviour disorders, including specific forms of aggression.

Aisha shouted, “Get up! I get to sit next to Daddy!” and then she pushed her sister and sat down beside her dad. Aisha’s behaviour is an example of ___________ aggression.
1. proactive
2. hostile
3. passive
4. delinquent

Answer: A

Page Reference: 213

Skill: applied; Difficulty: moderate

Ben has been diagnosed with ODD. When a peer accidentally steps on his foot, Ben believes this was intentional and pushes the child to the ground. Ben’s misinterpretation illustrates
1. a positive illusory bias
2. a psychopathic response
3. a cognitive distortion
4. an attributional bias

Answer: D

Page Reference: 213

Skill: applied; Difficulty: easy

Those diagnosed with conduct disorder are more likely to be_________aggressive compared to those diagnosed with oppositional defiant disorder who are more likely to be__________aggressive.
1. covertly; overtly
2. reactively; proactively
3. proactively; reactively
4. unintentionally; intentionally

Answer: C

Page Reference: 215

Skill: conceptual; Difficulty: moderate

Learning Objective 5.7 – Describe the various CYC-focused and evidence-based interventions for disruptive behaviours.

Two of the most effective cognitive-behavioural interventions for conduct issues are
1. action-oriented and multisystemic therapy
2. social skills training and problem solving skills training
3. token economies and group conferencing
4. biofeedback and peer counselling

Answer: B

Page Reference: 215

Skill: conceptual; Difficulty: moderate

Which of the following has been found to be ineffective and unfavourable in helping youth with conduct problems?
1. rational emotive behaviour therapy
2. individual psychodynamic therapy
3. multisystemic therapy
4. social skills training

Answer: B

Page Reference: 216

Skill: factual; Difficulty: challenging

All of the following are considerations in alternative healing approaches for disruptive behaviour disorders EXCEPT
1. melatonin supplements
2. exercise
3. vitamin and mineral supplements
4. acupuncture

Answer: D

Page Reference: 220

Skill: factual; Difficulty: easy

Short-Answer Questions

Define both noncompliance and defiance, highlighting their differences. Provide a specific example for each. Why might a child engage in noncompliance?

Answer: Noncompliance refers to not complying with adult requests and is more passive than defiance which refers to more extreme and active refusal to comply with requests (and may include aggressive acts). There are various reasons for noncompliance (e.g., forgetting to comply, being distracted).

Page Reference: 188; Objective 5.1

What do Intermittent Explosive Disorder, Pyromania, and Kleptomania have in common?

Answer: Each of these disorders is associated with feelings of tension and emotional arousal that precedes the disruptive behaviour. In addition, deficits in emotional regulation underlie the maladaptive behaviour.

Page Reference: 188-190; Objective 5.1

Summarize major criticisms forwarded by CYCPs regarding the DSM’s consideration of disruptive behaviour disorders.

Answer: Major criticisms of the DSM include: it is deficit-based; it fails to identify resiliencies and strengths of youth; it doesn’t discuss etiology or causes of the disorder or provide real direction for interventions; it overlooks the context in which behaviours occur unlike the ecological model.

Page Reference: 191-192; Objective 5.2

Define alpha command and beta command. Provide a specific example for each and explain why this distinction is important in a consideration of disruptive behaviour disorders.
1. Answer: Alpha commands are specific requests that identify an appropriate and realistic response (e.g., Pick up your clothes and make your bed.). Beta commands are vague, interrupted requests that the child is not given time to comply with (e.g., Clean up your mess! Followed by the parent picking up the child’s clothes). Parents of children diagnosed with disruptive behaviour disorders are more likely to use beta commands.

Page Reference: 201; Objective 5.3

Describe two specific risk factors for disruptive behaviour disorders identified from a CYC perspective.

Answer: From a CYC perspective, risk factors include: emotional dysregulation, family influence, difficult temperament, lack of empathy, child malfunctioning, limited insight, family patterns.

Page Reference: 202-204; Objective 5.4

From a psychological perspective, what is considered the first line of treatment? Do all youth benefit equally from this approach? Explain.

Answer: From a psychological perspective, parent training is the first line of treatment for ODD and CD. Despite its use, however, it may be that children benefit from this approach more than adolescents do.

Page Reference: 211; Objectives 5.5

Identify two specific indicators of ODD and two specific indicators of CD. How would you summarize the difference between these two disorders?

Answer: Specific indicators of ODD include: frequent temper tantrums, noncompliance, deliberately annoying others. Specific indicators of CD include: aggression, destruction, lack of conscious/empathy, rule violation. (See detailed list for indicators in Table 5.3 on page 215; students need only identify two indicators from each category). Generally, CD is associated with more disruptive, severe, and damaging behaviour and tends to occur at an older age than ODD behaviours.

Page Reference: 214; Objective 5.6

Summarize the Roots of Empathy program including its goals and effectiveness.

Answer: The Roots of Empathy (ROE) program is a school-based Canadian program aimed at creating a caring, peaceful, civil society through the development of empathy in children and adults. This program can be facilitated by trained CYCPs and has been found to be effective in increasing positive social behaviour and decreasing bullying and aggression.

Page Reference: 219; Objective 5.7

Essay Questions

Define temperament and discuss its role in disruptive behaviour disorders.

Suggested answer: From a psychological perspective, temperament (defined as stable, individual differences in cognitive, emotional, and behavioural tendencies that appear in infancy) has been the focus of investigations of genetic influence in disruptive behaviour disorders. Of particular relevance to disruptive behaviour disorders is the difficult temperament (associated with intense negative reactions to stimuli, irritability, impulsivity, restlessness, and difficulties adapting to new routines and experiences) that has been found to predict conduct problems in childhood and involvement in criminal activity and Antisocial Personality Disorder in adulthood.

Students might also mention that difficult temperament can be considered an individual child/youth risk factor in the context of disruptive behaviour disorders.

Page Reference: 197-198; 202-207; Objectives 4.3 and 4.4

Write a story of a child that develops conduct disorder from a CYC perspective. Include relevant risk factors and resiliency factors in your story.

Suggested answer: Answers will vary but should include both risk factors (e.g. genetic influence, prenatal environment, limited resources, parental discipline strategies, etc.) as well as resiliency factors (parental involvement, a positive internal working model, easy temperament, high self-esteem, etc.).

Page Reference: 191-195 and 202-207; Objectives 4.2, 4.4, and 4.6

Chapter 6: Anxiety, Obsessive-Compulsive, and Related Disturbances

Multiple Choice Questions

Learning Objective 6.1 – Distinguish between anxiety and fear.

The major difference between fear and anxiety is that anxiety is more
1. associated with immediate reaction to current danger
2. future-oriented
3. common and adaptive
4. functional

Answer: B

Page Reference: 326

Skill: factual; Difficulty: easy

Which of the following is true regarding anxiety?
1. it can help to improve performance
2. is always “abnormal”
3. it always interferes with performance
4. it is a tension state that should be avoided at all times

Answer: A

Page Reference: 326

Skill: conceptual; Difficulty: moderate

Learning Objective 6.2 – Distinguish between the six anxiety and five obsessive-compulsive and related disorders identified in the text and summarize their primary symptoms.

Which of the following is TRUE regarding the two general categories of Anxiety Disorders and Obsessive-Compulsive and Related Disorders?
1. they are included in the same category/chapter in the DSM-5 because of their similar symptoms
2. they are included in the same category/chapter in the DSM-5 because their common causes
3. they are considered in separate groupings/chapters in the DSM-5 to emphasize the role of preoccupation and repetitive behaviours in the OCD category
4. they are considered in separate groupings/chapters in the DSM-5 to emphasize the greater role of genetic factors in the Anxiety Disorders category

Answer: C

Page Reference: 227

Skill: factual; Difficulty: moderate

_______________would be considered an internalizing disorder, while______________would be considered an externalizing
1. Generalized anxiety disorder; conduct disorder
2. ADHD; panic disorder
3. Conduct disorder; panic disorder
4. Separation anxiety disorder; panic disorder

Answer: A

Page Reference: 227

Skill: conceptual; Difficulty: moderate

Tasha has had an unexplained episode during which her heart pounded, she was short of breath, and felt as though she was about to die. Doctors could find no physical basis for her symptoms. Based on the fact that this happened on only one occasion, what is the likely diagnosis?
1. panic disorder
2. generalized anxiety disorder
3. panic attack
4. phobic disorder

Answer: C

Page Reference: 228

Skill: applied; Difficulty: challenging

Fran has a panic attack every time she steps onto a bus. This BEST illustrates
1. unexpected panic attacks
2. expected panic attacks
3. obsessive compulsive disorder
4. acute anxiety disorder

Answer: B

Page Reference: 228

Skill: applied; Difficulty: easy

Sandy is 5-years-old and is afraid to leave her parents because she worries they may be harmed. This would MOST likely be diagnosed as
1. Generalized anxiety disorder
2. Separation anxiety disorder
3. School refusal
4. Specific phobia

Answer: B

Page Reference: 229

Skill: applied; Difficulty: easy

Carl is a healthy 5-year-old who refuses to speak to anyone when he’s left at daycare. He has few friends and his mother is worried that this behaviour will continue when he begins school. Carl’s mother doesn’t understand his behaviour because he speaks to her all the time at home as well as to his friends next door. Carl would most likely be diagnosed with
1. Selective mutism
2. Generalized anxiety disorder
3. School refusal
4. Specific phobia

Answer: A

Page Reference: 229

Skill: applied; Difficulty: easy

A highly focused, irrational fear of an object or situation is likely to be classified as
1. Selective mutism
2. Generalized anxiety disorder
3. Panic disorder
4. Specific phobia

Answer: D

Page Reference: 230

Skill: conceptual; Difficulty: easy

Karen can’t stop worrying. Her symptoms of anxiety aren’t related to any particular situations or events. Her mother refers to her as a ‘worry wart’ and says she is a very ‘nervous’ person. Karen would MOST likely be diagnosed with
1. Generalized anxiety disorder
2. Specific phobia
3. Obsessive compulsive disorder
4. Post-traumatic stress disorder

Answer: A

Page Reference: 230-231

Skill: applied; Difficulty: moderate

Neale repeatedly counts to 100 as a way to decrease the anxiety he feels in relation to thoughts that his mother will be hurt if she leaves the house. His repetitive actions illustrate the concept of
1. a hallucination
2. an obsession
3. a compulsion
4. a delusion

Answer: C

Page Reference: 231

Skill: applied; Difficulty: moderate

Each of the following is true regarding compulsions in OCD EXCEPT
1. they reduce anxiety
2. they serve no purpose
3. they may or may not be related to the obsession
4. they can change frequently for any one individual

Answer: B

Page Reference: 231-232

Skill: applied; Difficulty: challenging

Alice can’t stop worrying about her nose. Although everyone tells her it looks fine, she can’t stop thinking that it is deformed and looks strange. She spends hours trying to disguise her perceived imperfections and is constantly seeking reassurance from friends and family members that it looks ‘OK’. Alice would most likely be diagnosed with
1. excoriation disorder
2. selective mutism
3. agoraphobia
4. body dysmorphic disorder

Answer: D

Page Reference: 232

Skill: applied; Difficulty: moderate

Learning Objective 6.3 – Summarize the CYC perspective regarding child and youth anxiety issues.

From a CYC perspective, increased rates of anxiety disorders may be best explained by
1. a shift toward an external locus of control
2. a dramatic increase in the number of external events that are anxiety provoking
3. a significant increase in free time compared to earlier generations
4. none of the above—anxiety disorders have decreased from past years

Answer: A

Page Reference: 235-236

Skill: conceptual; Difficulty: challenging

From a CYC perspective, one factor that helps to explain the increased rates of anxiety disorders in recent years is
1. an increased ability to recognize and accurately diagnose anxiety disorders in youth
2. a dramatic increase in the number of children born with an inhibited temperament
3. the increase in diagnostic labelling of normal emotional pain and worry
4. the lower level of expectations placed on today’s youth

Answer: C

Page Reference: 237

Skill: conceptual; Difficulty: challenging

In general, all fears___________with age.
1. become more obvious
2. intensify
3. increase
4. decrease

Answer: D

Page Reference: 239

Skill: factual; Difficulty: easy

Which of the following fears tends to decrease as one moves from childhood to adolescence?
1. fear of the boogeyman
2. fear of ridicule
3. fear of war
4. fear of failure

Answer: A

Page Reference: 237

Skill: conceptual; Difficulty: easy

Which of the following developmental advances explain why fears change as individuals get older?
1. decreases in social expectations
2. changes in cognitive capacities
3. decreased concerns with self
4. increased egocentrism

Answer: B

Page Reference: 240

Skill: conceptual; Difficulty: challenging

From a CYC perspective, it is important to be aware of the likelihood that difficult anxiety responses for young people are likely to be comorbid with each of the following EXCEPT
1. depression
2. substance misuse
3. psychosis
4. complex trauma

Answer: C

Page Reference: 241

Skill: factual; Difficulty: challenging

Learning Objective 6.4 – Explain Foxman’s theory regarding the cause of anxiety in children and youth.

Each of the following is a factor of Foxman’s three-ingredients model of anxiety disorders EXCEPT
1. biological sensitivity
2. reactions to stress overload
3. social supports
4. personality traits

Answer: C

Page Reference: 251

Skill: factual; Difficulty: moderate

According to Foxman’s three-ingredients model of anxiety disorders, anxiety personality traits result from
1. a sensitive temperament together with certain life experiences
2. prenatal influences and harsh parenting
3. traumatic experiences
4. genetic influences

Answer: A

Page Reference: 251

Skill: conceptual; Difficulty: challenging

From a CYC perspective, one advantage of Foxman’s three-ingredients model of anxiety disorders is that it
1. acknowledges the biological aspects of anxiety
2. highlights the developmental nature of anxiety problems
3. focuses solely on the environmental aspects of anxiety problems
4. emphasizes the role of cognitive factors in anxiety problems

Answer: B

Page Reference: 252

Skill: conceptual; Difficulty: moderate

Learning Objective 6.5 – Describe differences in prevalence rate of anxiety disorders by gender, socioeconomic status, Aboriginal status, and newcomer status.

Each of the following groups have an increased prevalence of anxiety disorders EXCEPT
1. low socioeconomic status groups
2. females
3. newcomer youth in Canada
4. Aboriginal youth in Canada

Answer: A

Page Reference: 238-239

Skill: factual; Difficulty: moderate

Learning Objective 6.6 – Compare and contrast primary psychological explanations (biological, behavioural, cognitive, psychodynamic, and sociocultural) for anxiety and obsessive-compulsive and related disorders.

Evidence suggests that anxiety disorders “run in families” and that
1. familial risk is for developing a specific anxiety disorder
2. genetic influences are the result of a single gene
3. familial risk is for developing an anxiety disorder in general
4. environment plays no role in the onset of anxiety disorders

Answer: C

Page Reference: 243

Skill: factual; Difficulty: challenging

Which brain structure seems to be overactive in those with anxiety disorders?
1. cerebellum
2. medulla
3. parietal area
4. amygdala

Answer: D

Page Reference: 243

Skill: factual; Difficulty: moderate

Research on obsessive-compulsive disorder shows that obsessions are associated with___________while compulsions are associated with______________.
1. abnormalities in the basal ganglia; abnormalities in the frontal lobe
2. abnormalities in the frontal lobe; abnormalities in the basal ganglia
3. abnormalities in the temporal lobe; abnormalities in the amygdala
4. abnormalities in the frontal lobe; abnormalities in the parietal lobe

Answer: B

Page Reference: 243

Skill: factual; Difficulty: moderate

Which of the following biological factors has been found to be related to anxiety?
1. a high tolerance for pain
2. an underactive amygdala
3. a higher sensitivity to unusual events
4. low blood pressure

Answer: C

Page Reference: 243

Skill: conceptual; Difficulty: moderate

Two specific temperament traits that appear to be associated with anxiety disorders are:
1. negative affectivity and impulsivity
2. openness and neuroticism
3. impulsivity and behavioural inhibition
4. behavioural inhibition and negative affectivity

Answer: D

Page Reference: 243-244

Skill: factual; Difficulty: moderate

Anxiety symptoms and disorders have been associated with low levels of which two neurotransmitters?
1. dopamine and cortisol
2. serotonin and dopamine
3. GABA and acetylcholine
4. serotonin and GABA

Answer: D

Page Reference: 244

Skill: factual; Difficulty: challenging

Repressing one’s fear and displacing it onto alternative objects summarizes the ________approach to explaining anxiety disorders.
1. psychodynamic
2. two-factor
3. behavioural
4. cognitive-behavioural

Answer: A

Page Reference: 244

Skill: conceptual; Difficulty: easy

According to Mowrer’s two-factor theory, what is responsible for establishing phobias?
1. physiological arousal
2. operant conditioning
3. classical conditioning
4. cognitions about the feared stimulus

Answer: C

Page Reference: 245

Skill: conceptual; Difficulty: moderate

According to Mowrer’s two-factor theory, the fears in anxiety disorders persist because
1. the individual’s temperament is unable to adapt to new situations
2. it is biologically rooted in the emotional attachment needed for survival
3. the individual is classically conditioned to fear a harmless object
4. the individual avoids the feared object and is reinforced by the reduction in distress

Answer: D

Page Reference: 245

Skill: conceptual; Difficulty: moderate

Troy was bitten by a poodle years ago and now experiences significant fear and anxiety whenever he sees a poodle. He notices, however, that it’s not just poodles he fears but ALL dogs. This best illustrates the behavioural principle of
1. anxiety sensitivity
2. generalization
3. vicarious conditioning
4. attentional bias

Answer: B

Page Reference: 245

Skill: applied; Difficulty: moderate

According to the cognitive paradigm, youth diagnosed with anxiety disorders are more likely to perceive ambiguous situations and people as threatening. This is referred
1. anxiety sensitivity
2. generalization
3. interpretation bias
4. attentional bias

Answer: C

Page Reference: 247

Skill: conceptual; Difficulty: moderate

According to the sociocultural paradigm, all of the following family factors have been related to anxiety disorders EXCEPT
1. insecure attachment
2. overprotective parenting
3. anxious parenting
4. high social standing

Answer: D

Page Reference: 248-249

Skill: factual; Difficulty: easy

Learning Objective 6.7 – Describe the psychological treatment approaches used in treating anxiety disorders.

Which of the following is true regarding the use of medications to treat anxiety disorders?
1. Benzodiazepines are preferred over SSRI’s
2. They decrease levels of the inhibitory neurotransmitter GABA
3. They are the first line of intervention for youth
4. SSRI’s have been found to be effective in reducing anxiety symptoms

Answer: D

Page Reference: 253-254

Skill: factual; Difficulty: challenging

Which of the following is the key factor in all behavioural therapies for phobias?
1. exploration of unconscious factors
2. training in thought-stopping
3. exploration of cognitive distortions
4. exposure to the feared stimulus

Answer: D

Page Reference: 255

Skill: conceptual; Difficulty: moderate

Systematic desensitization consists of
1. Exposing the patient to the feared stimulus at full intensity
2. Teaching the patient to alter his or her irrational self-talk while confronting the feared stimulus
3. Having the patient imagine a series of increasingly frightening scenes paired with relaxation
4. Prescribing medication together with progressive muscle relaxation

Answer: C

Page Reference: 255

Skill: conceptual; Difficulty: easy

Each of the following is true regarding flooding to treat anxiety disorders EXCEPT
1. it is effective in reducing anxiety associated with specific phobias
2. it involves exposure to the person’s most feared stimulus
3. it is not often used because individuals find it too upsetting
4. it requires a high level of verbal skills which makes it less effective for some

Answer: D

Page Reference: 255-256

Skill: conceptual; Difficulty: moderate

Bob is receiving treatment for his anxiety disorder that stems from fear of being judged by others. In therapy, Bob is taught a relaxation technique and is asked to imagine increasingly intense scenes, such as having to speak in front of a small group of people. What treatment method is this?
1. systematic desensitization
2. coping skills training
3. self-reinforcement
4. flooding

Answer: A

Page Reference: 255

Skill: applied; Difficulty: moderate

In treating a child with obsessive-compulsive disorder a behaviour therapist is most likely to use
1. antipsychotic medication
2. exposure with response prevention
3. sensitivity training
4. cognitive restructuring

Answer: B

Page Reference: 256

Skill: conceptual; Difficulty: easy

Kyle experiences panic attacks. In therapy, the therapist helps him to understand how he can think differently about his symptoms, replacing his thoughts of, “I’m going to die” with “I’m just feeling dizzy right now.” This illustrates
1. systematic desensitization
2. response prevention
3. sensitivity training
4. cognitive restructuring

Answer: D

Page Reference: 257

Skill: applied; Difficulty: moderate

Learning Objective 6.8 – List the behavioural indicators for the most common child and adolescent anxiety and obsessive-compulsive and related issues.

Two important indicators of generalized anxiety disorders that CYCPs can observe for include
1. physical symptoms such as dizziness and frequent avoidance of social situations
2. sleep difficulties and excessive worry in one particular aspect of life
3. perfectionism and excessive worry in all aspects of the youth’s life
4. social withdrawal and unusual attention to personal hygiene

Answer: C

Page Reference: 259

Skill: conceptual; Difficulty: moderate

Chest pain, shortness of breath, panting, blushing, nausea and/or vomiting, shaking and dizziness are all common indicators of
1. panic attack
2. excoriation disorder
3. generalized anxiety disorder
4. trichotillomania

Answer: A

Page Reference: 260

Skill: conceptual; Difficulty: easy

When CYCPs observe behavioural rituals in youth, requests for referral to a mental health clinician for a diagnosis should be requested
1. as soon as they are observed
2. in all cases because they are rare and unusual
3. only if the youth is twelve years old or older
4. when such rituals create functional impairment

Answer: D

Page Reference: 261

Skill: applied; Difficulty: moderate

Learning Objective 6.9 – Describe a relational-based approach to CYC interventions for child and youth anxiety difficulties.

Joyce has been suffering from excoriation disorder for several years. Her CYCP provided her with some pamphlets that summarized explanations for her behaviour as well as different ways to cope with her anxiety. This illustrates the CYC intervention of
1. enhancing emotional literacy
2. externalizing-the-issue practices
3. psychoeducation
4. cognitive restructuring

Answer: C

Page Reference: 263

Skill: applied; Difficulty: easy

Janice, a CYCP, encourages Brad to use relaxation methods as a way to cope with his anxiety. From a cognitive-behavioural perspective, Janice is helping Brad develop
1. emotional literacy
2. altered awareness
3. psychoeducation
4. biological insight

Answer: A

Page Reference: 263

Skill: applied; Difficulty: moderate

Short-Answer Questions

Define both fear and anxiety, highlighting their differences. Provide a specific example for each. What function can anxiety serve?

Answer: Fear generally refers to a response to current danger; therefore, it is adaptive (i.e., facilitates survival), realistic (because it occurs in relation to an actual threat), and oriented toward the present (i.e., immediate danger in the current environment). For example, fear will be experienced if you suddenly see a car that is speeding toward you. Anxiety is a negative emotional state characterized by the worry, fear, and bodily reactions related to thoughts of an actual or potential event, object, or situation; therefore, it is typically future-oriented and is generally considered to be an unreasonable or excessive emotional reaction because it occurs in the absence of an immediate threat (e.g., the anxiety experienced in relation to thoughts of a possible car crash before you even leave the house). Anxiety can serve a function in that it can motivate productive action (e.g., you study because you feel anxious about an upcoming test).

Page Reference: 126; Objective 6.1

Define obsessions and compulsions and provide a specific example for each. What function do compulsions serve?

Answer: An obsession is a persistent, recurrent, and intrusive thought that can include images or ideas; they are usually focused on unrealistic events, are excessive and irrational, and result in significant distress and anxiety. Compulsions are repetitive, purposeful, and intentional behaviours or mental acts; they are typically time-consuming, maybe recognized as excessive or unreasonable, and create distress for the individual. The function of compulsions is that they serve to decrease the distress created by the obsessional thought.

Page Reference: 231; Objective 6.2

From a CYC perspective identify major explanations for an increase in anxiety disorders in youth.

Answer: Major factors discussed in relation to an increase in anxiety disturbances in youth include increased media exposure to concerning external events, a shift toward an external locus of control, a decline in children’s freedom to play and explore on their own, and the increased tendency to diagnose and label emotional pain, angst, and worry as pathological rather than part of normal human experience.

Page Reference: 235-237; Objective 6.3

Identify specific groups in Canada that demonstrate higher prevalence rates of anxiety disorders.
1. Answer: Specific groups in Canada that have higher prevalence rates of anxiety disorders include: females, Aboriginal youth, newcomer youth, and youth of intact families from predominantly middle classes or from higher socioeconomic status groups.

Page Reference: 238-239; Objective 6.5

Define vicarious conditioning and provide a specific example of how it might explain anxiety disorders.

Answer: Vicarious conditioning, associated with the general process of observational learning, is when someone observes another person react in a fearful manner to a particular object and the observer also develops a conditioned fear response to the object. For example, a child watching her mother run in fear to avoid a dog can result in the child fearing dogs.

Page Reference: 246; Objective 6.6

Describe the three basic steps of systematic desensitization. What is the core element of this technique in reducing anxiety symptoms?

Answer: The three steps include: (1) train the individual to develop a relaxation strategy that can be used to elicit a state of relaxation, such as muscle relaxation training; (2) have the client construct a fear hierarchy, which identifies a sequences of situations involving the feared stimulus ranging from those that produce little anxiety to those that produce intense anxiety, and (3) exposure to each level of the hierarchy (real or imagined) paired with engagement in the relaxation response. Exposure to what is feared is the core element of this technique.

Page Reference: 255; Objectives 6.7

Identify two specific indicators of generalized anxiety disorder that you would be most likely to notice in a CYC setting. If you notice these behaviours, what would be the first thing to do?

Answer: Specific indicators of GAD include sleep difficulties, the pervasive nature of anxiety (i.e., worry about everything), and perfectionism. First response strategies may vary but starting with asking and listening is mentioned in the text.

Page Reference: 259-260; Objective 6.8

Consistent with a relational-based approach, identify two specific communication strategies you would use in your CYC practice to assist a youth struggling with anxiety symptoms.

Answer: Various answers are possible (a detailed list of possibilities is found in Box 6.4 on page 268).

Page Reference: 267-268; Objective 6.9

Essay Questions

Describe the general role that temperament plays in the development of anxiety disorders. Identify and describe specific temperamental traits that have been found to be related to anxiety disturbances.

Suggested answer: In general, temperament creates a readiness to react to unfamiliar or unexpected events in such a way that predisposes an individual to developing an anxiety disorder. Some infants respond more intensely to novel stimuli; this serves as the basis for the development of persistent fears and anxieties.

Specific temperamental traits that have been found to be related to anxiety disturbances include behavioural inhibition (a tendency to stop ongoing behaviour and react with focal restraint, caution, and withdrawal when encountering unfamiliar situations or people), negative affectivity (the extent to which one feels distress rather than calm and relaxed), and a sensitive temperament (high emotional reactivity, and sensitivity to many stimuli including lights, sounds, and feel of clothes against the skin).

Page Reference: 243-245; 251; Objectives 6.3, 6.4, 6.6

Case: 10-year-old Laura has been diagnosed with Generalized Anxiety Disorder. Her mother wasn’t surprised by this diagnosis Laura was always sensitive to her surroundings, reacting negatively to new toys, clothing, and new people. Laura’s symptoms first began after she was in a car accident at the age of five but they became significantly worse following the loss of her best friend (who moved out of the country) at age nine. Laura is intelligent and has supportive teachers but experiences significant distress and anxiety about her school performance and is very sensitive to criticism.

Question: Describe the 3 major components of Foxman’s three-ingredients model regarding the cause of anxiety in children and youth. Identify specific details in Laura’s case that illustrate each of these components. What resiliency factors stand out to you when reading the case of Laura?

Suggested answer: Foxman’s three components include: (1) biological sensitivity (illustrated in the case by her sensitive temperament, i.e., negative reactions to novel stimuli in environment); (2) personality traits, formed when temperament interacts with early life experience (illustrated by the interaction of her sensitive temperament and the events of the car accident and loss of friend which seem to have resulted in the formation of anxiety personality traits); (3) reactions to stress overload (illustrated by her experience of distress and anxiety about school performance and social feedback).

Resiliency factors noted can vary although intelligence and social supports are likely to be noted.

Page Reference: 250-252; Objective 6.4

Chapter 7: Mood Disturbances

Multiple Choice Questions

Learning Objective 7.1 – Define and distinguish between mood disturbances, mood disorders, and mood episodes.

A________is defined as a general, non-diagnostic term that refers to some type of mood symptoms.
1. mood episode
2. mood disturbance
3. mood disorder
4. mood alteration

Answer: B

Page Reference: 274

Skill: factual; Difficulty: easy

Carlos is a 15-year-old who was hospitalized after he attempted suicide. He is unhappy, feels guilty, and has little energy or interest in doing anything. In which general category would his problem most likely be listed?
1. Bipolar disorder
2. Mood disorders
3. Anxiety disorders
4. Psychotic disorders

Answer: B

Page Reference: 274

Skill: applied; Difficulty: moderate

In order for Sally to be diagnosed with either a depressive disorder or a bipolar disorder, she must show evidence of a
1. mood episode
2. mood disturbance
3. mood disorder
4. mood alteration

Answer: A

Page Reference: 275

Skill: applied; Difficulty: challenging

Because depression is a(n)_______________problem, it may go undetected and undiagnosed.
1. externalizing
2. latent
3. internalizing
4. somatic

Answer: C

Page Reference: 276

Skill: conceptual; Difficulty: moderate

Learning Objective 7.2 – Distinguish between the three depressive disorders and the three bipolar and related disorders identified in the text and summarize their primary symptoms.

_______________________ is the only diagnosis that is applied exclusively to youth.
1. Dysthymia
2. Bipolar II
3. Cyclothymic Disorder
4. Disruptive mood dysregulation disorder

Answer: D

Page Reference: 276

Skill: conceptual; Difficulty: moderate

The major difference between Major Depressive Disorder and Dysthymia is
1. the presence of mood swings
2. the degree of impairment of functioning
3. the presence of mania (it occurs only in Dysthymia)
4. the duration of the disorder (Dysthymia is more chronic and lasting)

Answer: D

Page Reference: 277

Skill: factual; Difficulty: moderate

For the past three weeks, ten-year-old Sara has appeared sad and tearful most of the time. On occasion, however, she has high levels of energy during which it is difficult to interrupt her and she has engaged in risk-taking activities. The DSM-5 diagnoses that would BEST fit Sarah is
1. conduct disorder
2. bipolar disorder
3. major depression
4. dysthymia

Answer: B

Page Reference: 278

Skill: applied; Difficulty: easy

In order to be diagnosed with Bipolar I Disorder, one must exhibit
1. any mood episode
2. a hypomanic episode
3. a manic episode
4. excessive paranoia

Answer: C

Page Reference: 278

Skill: applied; Difficulty: moderate

The major difference between Bipolar I and Bipolar II disorders is
1. the presence of mood swings
2. the degree of impairment of functioning
3. the presence of mania (it is absent in Bipolar II)
4. the age at which the diagnosis is applied

Answer: B

Page Reference: 279

Skill: conceptual; Difficulty: challenging

Learning Objective 7.3 – Explain how mood disorders differ from expected emotions in children and youth.

From a CYC approach, the addition of the diagnosis of Disruptive mood dysregulation disorder to the DSM-5
1. is a concern because the symptoms seem to describe most children
2. is a positive change because children can now receive a diagnosis
3. is a concern because it groups children and adults in the same category
4. will likely result in fewer children being misdiagnosed

Answer: A

Page Reference: 281

Skill: conceptual; Difficulty: challenging

From a CYC approach, mood disturbances can be distinguished from expected emotions in youth by
1. the presence of mood swings
2. the presence of sadness and despair
3. the age at which symptoms are first observed
4. the degree to which symptoms interfere with functioning

Answer: D

Page Reference: 280-281

Skill: conceptual; Difficulty: moderate

Learning Objective 7.4 – Describe differences in the prevalence rates of mood disorders with respect to gender and age.

Which of the following statements regarding the prevalence of childhood depression is correct?
1. In adolescence, depression is more prevalent among girls
2. In adolescence, there is usually no difference in prevalence
3. In childhood & adolescence, depression is more prevalent in girls
4. In childhood, depression is more prevalent among boys

Answer: A

Page Reference: 282

Skill: factual; Difficulty: moderate

The increase in depressive disorders observed in elementary school children compared to preschool children is likely due to
1. different diagnostic criteria for depression for these age groups
2. cognitive changes that occur in the developing child
3. the minimum age requirement of 6-years-old for diagnosis
4. none of the above—there are no age-related changes in rates of depression

Answer: B

Page Reference: 283

Skill: factual; Difficulty: challenging

The significant increase in depressive disorders observed in adolescence is likely due to
1. different diagnostic criteria for depression for children and adolescents
2. errors in diagnosis
3. biological changes in the brain and an increase in stressors
4. none of the above—there are no age-related changes in rates of depression

Answer: C

Page Reference: 283

Skill: factual; Difficulty: moderate

Which of the following symptoms appear more often in depressed children than in adolescents?
1. fatigue and suicidal ideation
2. somatic or bodily complaints
3. self-blame
4. delusions

Answer: B

Page Reference: 283

Skill: factual; Difficulty: easy

Which of the following is TRUE regarding depression and development?
1. Even infants can show signs of depression (although this is controversial).
2. Depression is rarely comorbid with other conditions.
3. All depressed youth show signs of self-harm or suicide.
4. Bipolar disorder is a common diagnosis in adolescence.

Answer: A

Page Reference: 283-284

Skill: factual; Difficulty: easy

Learning Objective 7.5 – Compare and contrast biological, psychodynamic, behavioural, cognitive, and sociocultural explanations for mood disorders.

Which of the following is the MOST accurate conclusion regarding the role of genetics in mood?
1. Genes play a minor role in bipolar disorder
2. Genes do not seem to play a role in depressive disorders
3. Genes alone determine the occurrence of mood disturbances
4. Genes play a role in depressive disorders but an even larger role in bipolar disorders

Answer: D

Page Reference: 285

Skill: factual; Difficulty: moderate

Depressive disorders have been associated with alterations in activity and/or structure for each of the following brain structures EXCEPT
1. hippocampus
2. amygdala
3. ventromedial hypothalamus
4. thalamus

Answer: C

Page Reference: 285

Skill: factual; Difficulty: moderate

Symptoms of depression appear to be related to
1. low levels of dopamine and serotonin
2. high levels of serotonin and low levels of norepinephrine
3. high levels of serotonin and oxytocin
4. high levels of norepinephrine and acetylcholine

Answer: A

Page Reference: 286

Skill: factual; Difficulty: moderate

Symptoms of mania appear to be related to
1. low levels of dopamine
2. high levels of oxytocin
3. high levels of serotonin
4. high levels of norepinephrine

Answer: D

Page Reference: 286

Skill: factual; Difficulty: moderate

Symptoms of bipolar disorders are often treated using
1. Opiates
2. Lithium
3. SSRI’s
4. Opioids

Answer: C

Page Reference: 287

Skill: factual; Difficulty: easy

According to the psychodynamic perspective, depression often results following
1. loss of a significant other
2. a period of nightmares
3. the birth of a sibling
4. a head injury

Answer: A

Page Reference: 287

Skill: conceptual; Difficulty: easy

According to the behavioural paradigm, depression results from
1. loss of a significant other
2. behavioural avoidance
3. too many rewarding experiences
4. social rejection

Answer: B

Page Reference: 287

Skill: conceptual; Difficulty: moderate

Which of the following paradigms/theories of depression explain the disorder in relation to a lack of quality reinforcements?
1. stress exposure model
2. negative cognitive triad
3. attachment theory
4. behavioural paradigm

Answer: D

Page Reference: 287

Skill: conceptual; Difficulty: easy

Beck’s negative cognitive triad involves feeling negatively about
1. Helplessness, hopelessness, and sorrow
2. One’s family, one’s self, and one’s friends
3. Oneself, the world, and the future
4. One’s past, present, and future

Answer: B

Page Reference: 288

Skill: conceptual; Difficulty: moderate

According to cognitive theory, following a failure on an important exam, which of the following explanations for the failure is MOST likely to be associated with depression?
1. The teacher doesn’t like me.
2. I did not study hard enough.
3. I was in a bad mood on the day of the test.
4. I am stupid.

Answer: D

Page Reference: 288

Skill: applied; Difficulty: moderate

The theory that examines the relationship between challenging life events and depression is the
1. stress exposure model
2. depressogenic theory
3. negative triad theory
4. regulation theory

Answer: A

Page Reference: 289

Skill: factual; Difficulty: easy

Learning Objective 7.6 – Describe the relationship between trauma/maltreatment and youth depression.

An important consideration for CYCPs when it comes to depression in children and youth is that
1. early childhood experiences have little impact on depression in adolescence
2. depression is always expressed as an internalizing problem making it difficult to identify
3. pain-based behaviour associated with trauma may be internalizing or externalizing
4. all psychological paradigms are equally relevant to CYC practice

Answer: C

Page Reference: 290-291

Skill: conceptual; Difficulty: challenging

According to the________________________, depression is viewed as a coping mechanism or strategy that is developed over time as a response to dangers in the environment.
1. stress exposure model
2. dynamic-maturational model
3. emotional regulation theory
4. cognitive distortion theory

Answer: B

Page Reference: 292

Skill: conceptual; Difficulty: easy

Which of the following is true regarding medications for youth diagnosed with depressive disorders?
1. They are being used less frequently today than 20 years ago
2. They reduce the need for a strength-based perspective in CYC practice
3. They may actually impair the development of healing interpersonal relationships
4. They increase a sense of trust which can ease relational practice for CYCPs

Answer: C

Page Reference: 293

Skill: conceptual; Difficulty: moderate

For CYCPs working with youth with mood disturbances, the first question should be
1. How long has this been going on for?
2. What strengths can I bring to this situation?
3. What family dysfunction may have caused these problems?
4. What caused this behaviour in the first place?

Answer: D

Page Reference: 293

Skill: conceptual; Difficulty: moderate

Learning Objective 7.7 – Describe psychological treatment approaches used in treating mood disorders from each of the major psychological paradigms.

The medication most commonly prescribed to treat major depression in children & adolescents is
1. Lithium
2. SSRI’s
3. Anxiolytics
4. Tricyclics

Answer: B

Page Reference: 294

Skill: factual; Difficulty: easy

For depressed children, antidepressant medication
1. has not been found to be effective in controlled research
2. is the treatment of choice
3. is effective with all children
4. can be effective in some cases but is controversial

Answer: D

Page Reference: 293

Skill: conceptual; Difficulty: moderate

Many antidepressants work by ___________the activity of ___________.
1. increasing; GABA
2. decreasing; dopamine
3. increasing; serotonin
4. decreasing; serotonin

Answer: C

Page Reference: 293

Skill: conceptual; Difficulty: moderate

Each of the following is a valid concern regarding the use of medications for youth EXCEPT
1. they are addictive to the developing brain
2. controlled research shows mixed results for their effectiveness
3. they have been implicated in increased thoughts of suicide and self-harm
4. their effects on the developing brain are largely unknown

Answer: A

Page Reference: 295-296

Skill: conceptual; Difficulty: moderate

Which of the following recommends an interpersonal approach to treatment of depressive disorder, rather than an intrapsychic approach?
1. behavioural activation therapy or BAT
2. interpersonal therapy or IPT
3. cognitive behavioural therapy
4. extinction by removal therapy

Answer: B

Page Reference: 296

Skill: factual; Difficulty: moderate

Which approach to treatment would be recommended for depression from a behavioural approach?
1. antidepressants
2. behavioural amplification
3. behavioural activation
4. stress reduction

Answer: C

Page Reference: 297

Skill: conceptual; Difficulty: easy

Kristy, a 14-year-old girl diagnosed with depression is having a conflict with her friend. Kristy believes this means her friend hates her. A behaviour therapist would encourage Kristy to
1. participate in dream analysis and hypnosis
2. examine her irrational thoughts in relation to the conflict
3. generate more positive explanations for her friend’s behaviour
4. interact with peers with whom she has positive experiences with

Answer: D

Page Reference: 297

Skill: applied; Difficulty: moderate

Kristy, a 14-year-old girl diagnosed with depression is having a conflict with her friend. Kristy believes this means her friend hates her. A cognitive therapist would encourage Kristy to
1. participate in dream analysis and hypnosis
2. confront her friend directly
3. generate more positive explanations for her friend’s behaviour
4. explore her relationships with family and peers

Answer: C

Page Reference: 297-298

Skill: applied; Difficulty: moderate

Learning Objective 7.8 – Identify different symptoms of mood disturbances exhibited by infants, preschoolers, school-aged children, and adolescents.

When compared to children, adolescents are more likely to display which of the following depressive symptoms?
1. phobias
2. somatic/bodily complaints
3. irritability
4. running away

Answer: D

Page Reference: 302

Skill: applied; Difficulty: moderate

When compared to adolescents, elementary school children are more likely to display which of the following depressive symptoms?
1. fatigue and suicidal ideation
2. separation anxiety disorder
3. hopelessness
4. aggression

Answer: C

Page Reference: 302

Skill: factual; Difficulty: moderate

Low self-esteem is related to depression
1. in early childhood, but not in adolescence
2. more often in older than younger children
3. for boys but not for girls
4. only in rare circumstances

Answer: B

Page Reference: 302

Skill: factual; Difficulty: challenging

Which of the following is MOST likely to be observed in adolescent depression (as compared to depression in younger children)?
1. tearfulness
2. feelings of loneliness and guilt
3. stomachaches
4. fear of separation or abandonment

Answer: B

Page Reference: 302

Skill: conceptual; Difficulty: challenging

Learning Objective 7.9 – Summarize selected approaches to intervention that fit best with a CYC approach.

From a CYC approach, working with youth struggling with depressive symptoms should include
1. distraction techniques
2. avoidance of those topics that result in sadness
3. open communication in a supportive environment
4. an emphasis on one particular model or approach

Answer: B

Page Reference: 302

Skill: conceptual; Difficulty: moderate

From a CYC perspective, cognitive distortions in the context of depressive symptoms
1. are relatively easy to challenge and correct
2. are resistant to change and therefore, not usually the focus of CYC practice
3. are more easily corrected when the parent is depressed as well
4. might be challenged by offering alternative ‘plot lines’

Answer: D

Page Reference: 303

Skill: conceptual; Difficulty: moderate

Interpersonal therapy for adolescents (IPTA)
1. is inconsistent with a CYC approach
2. is effective for youth diagnosed with bipolar disorders only
3. aims to improve one’s self-concept and relationships with others
4. is less effective than originally believed

Answer: C

Page Reference: 303

Skill: conceptual; Difficulty: moderate

An alternative healing approach that has been found to be particularly effective in improving adjustment among those struggling with depression is
1. Mindfulness-based stress reduction
2. Equine therapy
3. Herbal supplements
4. Roots of Empathy program

Answer: A

Page Reference: 307

Skill: factual; Difficulty: easy

Short-Answer Questions

Describe what is meant by a mood episode and explain the relationship between these episodes and mood disorders.

Answer: A mood episode is the experience of some type of mood disturbance defined in relation to specific symptoms that differ from typical emotional experience. They are related to mood disorders because in order for someone to be diagnosed with either a depressive or bipolar disorder, evidence of a mood episode is required.

Page Reference: 275; Objective 7.1

Summarize the primary difference between depressive disorders and bipolar disorders.

Answer: The primary difference between the two is that bipolar disorders include symptoms of mania, characterized by elevated mood, high levels of arousal, energy, and irritability that can result in negative consequences and impaired functioning.

Page Reference: 275-276; Objective 7.2

From a CYC approach, how does depression differ from expected emotions in children and youth?

Answer: Depression in young people is very real and is different from the sadness any child might experience because it is persistent, severe, interferes with daily functioning (including daily routines, academic performance, social relationships), and negatively impacts psychosocial development.

Page Reference: 281-282; Objective 7.3

Identify two factors that have been linked to the sharp increase in depressive symptoms in adolescence.
1. Answer: Increased symptoms of depressive symptoms (and diagnosis) have been linked to (1) biological changes in the brain as well as (2) an increase in stressors.

Page Reference: 283; Objective 7.4

Describe the stress exposure model of depression. Summarize research findings that support the model and others that bring the model into question.

Answer: The stress exposure model of depression suggests that exposure to stressful events makes one more likely to develop depression. Research supporting the model shows that exposure to stress is followed by the onset of and/or an increase in depressive symptoms. Research that questions the applicability of the model relates to the observation that not all youth exposed to stressors develop depression.

Page Reference: 289-290; Objective 7.5

Describe the behavioural activation approach to treating depression.

Answer: The behavioural activation approach seeks to change behaviours in such a way that one experiences positively reinforcing events and activities. These rewarding experiences can reduce feelings of passivity and depression.

Page Reference: 297; Objectives 7.7

Summarize depressive symptoms that you would more likely to look for in your work with an adolescent versus a child.

Answer: Because of their cognitive and social development, adolescents are significantly more likely to display symptoms of hopelessness, pessimism, worthlessness, substance use, antisocial behaviour, and social withdrawal than younger children. For a detailed list of possible responses, refer to Table 7.4 on page 302.

Page Reference: 301-302; Objective 7.8

Explain the role of negative internal working models in depressive symptoms. What strategies can be used in CYC practice to alter these?

Answer: Literature suggests the children who’ve been maltreated develop pervasive negative plot lines or negative internal working models which result in their perceiving the world to be a dangerous place and adults in general to be unsafe. Perceptions such as “I’m unsafe,” “I’m unlovable,” and “adults are not to be trusted” are common. By providing alternative ‘plot lines’ (e.g., teaching positive self-talk techniques, providing opportunities for success), CYCPs can help youth alter these negative models.

Page Reference: 267-268; Objective 7.9

Essay Questions

Summarize the pros and cons of using medication in the treatment of youth mood disorders. Cite specific evidence that supports both sides of the argument. What is your personal position on this issue? Provide a rational for your position and explain why it is important to consider this debate as a CYCP.

Suggested answer: Evidence supporting the use of medications includes: SSRIs have been found to reduce symptoms of depression in children and adolescents; comprehensive reviews suggest that the benefits of antidepressant medications likely outweigh their risks; they are not addictive and can be taken on an ongoing basis. Evidence that questions the appropriateness of the use of medications includes: psychoactive drugs can become a substitute for interpersonal therapeutic interventions; they may interfere with oxytocin or vasopressin (human trust and bonding hormones) and consequently impair the development of healing interpersonal relationships and directly impede the forming of a therapeutic alliance; the effects on the developing brain are unknown; they do not work for everyone; side-effects, particularly those including suicidal thoughts and self-harm.

Students will vary in their position on this issue but should include that as a CYCP, understanding the evidence on both sides of this issue as well as where they stand personally on the issue can inform the care they provide to youth. Awareness of alternative approaches, side-effects, and ways to help youth make decisions about medications might also be mentioned.

Page Reference: 286; 292-295; 304; Objectives 7.7 and 7.9

Imagine you are working with an adolescent that has been diagnosed with a depressive disorder. Identify and describe the model of intervention (e.g., cognitive, behavioural, etc.) that you would be most likely to keep in mind in your practice. Summarize specific questions that you might ask the youth. Describe three specific techniques for CYC intervention that you would be likely to utilize in your practice.

Suggested answer: Answers will vary. Models of intervention might include cognitive-behavioural, sociocultural, etc. Specific questions will also vary but examples might include “How many hours did you sleep last night” or “Are you sadder than usual?” (see text, page 301 for additional examples). Specific techniques will also vary but a detailed list of possible CYC techniques for intervention is provided in Box 7.5 on page 306.

Page Reference: 298-308; Objective 7.9

Chapter 8: Eating Disturbances

Multiple Choice Questions

Learning Objective 8.1 – Summarize the DSM criteria for Pica, Rumination Disorder, Avoidant/Restrictive Food Intake Disorder, Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder.

Harmful behavioural strategies that are used in attempt to decrease body weight are referred to as
1. ruminating behaviours
2. adaptive strategies
3. perfectionistic tendencies
4. compensatory behaviours

Answer: D

Page Reference: 314

Skill: factual; Difficulty: easy

Each of the following is a DSM-5 Feeding and Eating Disorder EXCEPT
1. Rumination disorder
2. Obesity
3. Pica
4. Avoidant/Restrictive Food Intake Disorder

Answer: B

Page Reference: 314

Skill: factual; Difficulty: easy

Five-year-old Greg sits in the back yard and regularly eats dirt and other objects he finds there. This illustrates which of the following Feeding and Eating Disorder?
1. Rumination disorder
2. Obesity
3. Pica
4. Avoidant/Restrictive Food Intake Disorder

Answer: C

Page Reference: 315

Skill: applied; Difficulty: moderate

For the last two months, four-year old Tommy has been chewing and swallowing his food, but then brings it back up into his mouth. This illustrates
1. Rumination disorder
2. Obesity
3. Pica
4. Avoidant/Restrictive Food Intake Disorder

Answer: A

Page Reference: 315

Skill: applied; Difficulty: moderate

9-year-old Alex has been losing weight and was recently diagnosed with multiple nutritional deficiencies. His mother explains that ever since he choked on a carrot, it seems he is afraid to eat. This best illustrates
1. Rumination disorder
2. Obesity
3. Pica
4. Avoidant/Restrictive Food Intake Disorder

Answer: D

Page Reference: 316

Skill: applied; Difficulty: moderate

Each of the following is a key feature of Anorexia Nervosa EXCEPT
1. Significantly underweight
2. Intense fear of gaining weight
3. A profound sense of lack of control
4. Distorted body image

Answer: C

Page Reference: 316

Skill: conceptual; Difficulty: moderate

Each of the following is a compensatory strategy EXCEPT
1. purging
2. self-induced vomiting
3. use of laxatives
4. use of diuretics

Answer: A

Page Reference: 317

Skill: conceptual; Difficulty: easy

What consideration does the DSM-5 make for age-related differences in Anorexia Nervosa?
1. A complete set of criteria that apply only to children are provided
2. None—the same criteria for Anorexia Nervosa are applied to all ages
3. It requires that the diagnosis can only be applied to children age 11 or older
4. It highlights the indicator of failure to make expected weight gains for children

Answer: D

Page Reference: 317

Skill: factual; Difficulty: moderate

Which of the following is a key difference between anorexia and bulimia?
1. Only those with bulimia purge
2. Only those with anorexia are significantly underweight
3. Only those with anorexia purge
4. Those with bulimia have greater distortions in body image

Answer: B

Page Reference: 316-317

Skill: conceptual; Difficulty: challenging

For the last year, Carol has been ingesting large amounts of food when she is feeling stressed. Immediately after eating, she feels overwhelming guilt which sends her into a serious depression. This illustrates_________________and is most likely to be observed in____________________.
1. Bulimia Nervosa; adolescents
2. Binge Eating Disorder; older aged women
3. Avoidant Food Disorder; adolescents
4. Binge Eating Disorder; adolescents

Answer: B

Page Reference: 318-319

Skill: applied; Difficulty: moderate

Learning Objective 8.2 – Describe the CYC perspective regarding child and youth eating disturbances.

Each of the following is associated with poorer outcomes for eating disturbances EXCEPT
1. substance abuse
2. existence of other mental health concerns
3. severe disturbance in perception of body size
4. fewer binge episodes at the onset of the disturbance

Answer: D

Page Reference: 320

Skill: factual; Difficulty: easy

For CYCP’s concerned that a young person may be struggling with an eating disorder, they must first
1. Refer to a medical professional
2. Weigh the individual
3. Speak with a psychologist
4. Provide psychoeducation

Answer: A

Page Reference: 320

Skill: applied; Difficulty: easy

Which of the following has the highest mortality rate?
1. Rumination disorder
2. Anorexia Nervosa
3. Bulimia Nervosa
4. Avoidant/Restrictive Food Intake Disorder

Answer: B

Page Reference: 321

Skill: factual; Difficulty: moderate

Learning Objective 8.3 – Compare and contrast biological, psychodynamic, behavioural, cognitive, and sociocultural explanations for eating disorders.

Which of the following has the highest mortality rate?
1. Rumination disorder
2. Anorexia Nervosa
3. Bulimia Nervosa
4. Avoidant/Restrictive Food Intake Disorder

Answer: B

Page Reference: 321

Skill: factual; Difficulty: moderate

What can be concluded regarding genetics and eating disturbances?
1. Specific genes appear to determine one’s risk for eating disturbances
2. Genetics do not seem to play a role in these disorders
3. Genetics alone determines one’s risk for eating disorders
4. Research has yet to be conducted to evaluate the impact of genetics in eating disturbances

Answer: A

Page Reference: 324

Skill: factual; Difficulty: moderate

Which of the following appears to be related to eating disorders?
1. Low levels of serotonin
2. High levels of dopamine
3. Low levels of dopamine
4. High levels of epinephrine

Answer: A

Page Reference: 324

Skill: factual; Difficulty: easy

From a psychodynamic paradigm, symptoms of eating disorders represent an attempt to
1. avoid painful memories
2. better understand one’s feelings
3. punish significant others
4. achieve a sense of control and self-respect

Answer: D

Page Reference: 325

Skill: conceptual; Difficulty: moderate

From a behavioural paradigm, one view of eating disorders is that they are a form of
1. Generalized anxiety disorder
2. Post-traumatic stress disorder
3. Phobia
4. Panic response

Answer: C

Page Reference: 325

Skill: conceptual; Difficulty: moderate

From a cognitive paradigm, core irrational beliefs associated with eating disturbances include all of the following EXCEPT
1. A distorted body image
2. The need to be superior to others
3. An irrational fear of gaining weight
4. The need to be perfect and exact

Answer: B

Page Reference: 325-326

Skill: conceptual; Difficulty: moderate

From a sociocultural paradigm, which of the following has been found to predict body dissatisfaction and dieting?
1. Internalization of the standard for beauty
2. A perfectionistic personality
3. A distorted body image
4. Socioeconomic status

Answer: A

Page Reference: 327

Skill: conceptual; Difficulty: easy

Prior to the introduction of American television programming to Fiji, being overweight was valued and being thin was associated with illness and incompetence. Following the introduction of American television programs, rates of eating disturbances_____________supporting a___________explanation for eating disorders.
1. Decreased; biological
2. Decreased; psychodynamic
3. Increased; cognitive
4. Increased; sociocultural

Answer: D

Page Reference: 327

Skill: conceptual; Difficulty: challenging

Learning Objective 8.4 – From a CYC perspective, summarize and distinguish between sociocultural, developmental, personality, trauma-related, and familial risk factors for eating disturbances.

According to the tripartite model, each of the following factors influence the development of disturbed eating behaviours EXCEPT
1. The media
2. Parents
3. Self
4. Peers

Answer: C

Page Reference: 328

Skill: factual; Difficulty: easy

According to the developmental risk factors theory, eating disturbances represent
1. A dysfunctional attempt to express strong emotions
2. An irrational attempt to increase helplessness
3. An attempt to re-establish attachment relationships
4. An attempt to develop a sense of independence

Answer: A

Page Reference: 329

Skill: conceptual; Difficulty: moderate

Which of the following is one of the most commonly known and widely accepted personality risk factors for eating disorders?
1. introversion
2. the need for control
3. social inhibition
4. hostility

Answer: B

Page Reference: 329

Skill: factual; Difficulty: easy

CYCP’s need to be aware of the relationship between eating disturbances and each of the following factors EXCEPT
1. Trauma-related risk factors
2. Indirect self-harm
3. Direct self-harm
4. Psychotic symptoms

Answer: D

Page Reference: 330

Skill: conceptual; Difficulty: easy

Sixteen-year-old Janet feels she can’t make even the smallest of decisions without her mother putting in her two cents worth. Sometimes, it feels like she has no say at all in her daily life. This best illustrates
1. reciprocal relationships
2. rigidity
3. familial over-enmeshment
4. dialectical environments

Answer: C

Page Reference: 333

Skill: applied; Difficulty: moderate

Learning Objective 8.5 – Describe psychological treatment approaches used in treating eating disorders for each of the major psychological paradigms.

Which of the following is true regarding a biological approach to treatment for eating disorders?
1. Medication alone is sufficient for eliminating symptoms of anorexia and bulimia
2. Antidepressants that increase serotonin are among the most popular biological treatments
3. Medications appear to be more effective for anorexia and bulimia
4. There is general agreement that medications should be utilized in treating eating disturbances

Answer: B

Page Reference: 334

Skill: conceptual; Difficulty: moderate

From a psychodynamic paradigm,which of the following is true regarding the use of family therapy in the treatment of eating disorders?
1. Although logical, few controlled studies have examined the efficacy of this approach
2. There is overwhelming support that family therapy is effective in treating eating disorders
3. Family therapy seems to increase symptoms of various eating disorders
4. It is the first-line evidence based approach to treating eating disorders

Answer: A

Page Reference: 334

Skill: factual; Difficulty: challenging

Amber has been trained to engage in deep breathing after she eats in order to reduce her symptoms of Rumination Disorder. This illustrates which behavioural approach to treatment?
1. Exposure with response-prevention
2. Systematic desensitization
3. Habit reversal
4. flooding

Answer: C

Page Reference: 335

Skill: applied; Difficulty: moderate

Amber has been trained to engage in deep breathing after she eats in order to reduce her symptoms of Rumination Disorder. This illustrates which behavioural approach to treatment?
1. Exposure with response-prevention
2. Systematic desensitization
3. Habit reversal
4. flooding

Answer: C

Page Reference: 335

Skill: applied; Difficulty: moderate

While cognitive behavioural therapy has been found to be effective with_____________, the treatment of choice for ______________________is family therapy.
1. Rumination disorder; Binge Eating Disorder
2. Anorexia Nervosa; Bulimia Nervosa
3. Binge Eating Disorder; Bulimia Nervosa
4. Bulimia Nervosa; Anorexia Nervosa

Answer: D

Page Reference: 335-336

Skill: conceptual; Difficulty: challenging

Learning Objective 8.6 – Describe the role of CYCPs in the assessment of eating disorders.

Each of the following in an important aspect of strength-based relational CYC practice in the context of eating disturbances EXCEPT
1. Assess the level of impact of disturbed eating symptoms
2. Respectfully consider what young people tell them about how they’re feeling
3. Avoid challenging the youth’s dysfunctional beliefs underlying eating difficulties
4. Consider cultural influences related to food and eating behaviours

Answer: C

Page Reference: 336-337

Skill: applied; Difficulty: challenging

When assessing eating disturbances in youth, CYCPs might consider each of the following EXCEPT
1. Referring to a medical professional
2. Assume the behaviour is an expression of intense emotion
3. Assess the insight the youth has regarding their symptoms
4. Ask specific questions about their compensatory behaviours

Answer: B

Page Reference: 337-338

Skill: applied; Difficulty: moderate

Learning Objective 8.7 – Describe specific indicators of the major eating disorders.

Each of the following is a specific major indicator in anorexia nervosa EXCEPT
1. restricted eating or fasting
2. repetitive checking of reflection in mirror
3. concerns about eating in public
4. impaired control when eating

Answer: D

Page Reference: 339

Skill: conceptual; Difficulty: easy

Each of the following is a specific major indicator in bulimia nervosa EXCEPT
1. perfectionism
2. eating alone because of embarrassment
3. eating until uncomfortably full
4. average or above average weight

Answer: A

Page Reference: 339

Skill: conceptual; Difficulty: easy

Learning Objective 8.8 – Explain various treatment methods and describe ways in which you might use them in your CYC practice with youth with eating disorders.

When it comes to cognitive-behavioural techniques for eating disorders,
1. CYCPs largely leave the intervention up to psychologists trained in CBT
2. there is little empirical evidence demonstrating their effectiveness
3. they are consistent with CYC practice because it’s solution-focused
4. CYCPs must receive specialized training prior to helping youth in cognitive restructuring

Answer: C

Page Reference: 340

Skill: conceptual; Difficulty: moderate

When it comes to medication for eating disorders in a CYC context,
1. it is rare to see medications being used for eating disturbances
2. antidepressants are often used despite their limited success
3. antipsychotics are often used with significant success
4. they are only used when comorbid conditions are present

Answer: B

Page Reference: 340

Skill: conceptual; Difficulty: challenging

Group work for eating disorders has been found to be
1. equally effective for bulimia and anorexia
2. effective for anorexia but not for bulimia
3. recommended for those with bulimia but not for those with anorexia
4. ineffective for all eating disturbances

Answer: C

Page Reference: 341

Skill: conceptual; Difficulty: moderate

Primary goals for structural family therapy include
1. exploring the causes of eating disturbances through psychoeducation
2. helping parents regain control and discipline
3. reestablishing a close bond between family members and increasing empathy
4. improving communication and helping the family recognize the youth’s need for autonomy

Answer: D

Page Reference: 341

Skill: conceptual; Difficulty: moderate

Each of the following is true regarding prevention strategies for eating disturbances EXCEPT
1. CYCPs adopt a prevention strategy by creating a ‘body friendly’ therapeutic environment
2. There has been little research on prevention because of an emphasis on the medical model
3. There is insignificant or contradictory evidence supporting their effectiveness
4. Research suggests they are effective with children but not adolescents

Answer: D

Page Reference: 342

Skill: conceptual; Difficulty: challenging

Short-Answer Questions

Distinguish between the two subtypes of Anorexia Nervosa.

Answer: The Restricting Type is characterized by the use of excessive exercise or restrictive eating to achieve weight loss. The Binge-Eating/Purging Type is diagnosed when binge-eating and/or purging have occurred in the context of other symptoms of Anorexia Nervosa.

Page Reference: 317-318; Objective 8.1

Distinguish between eating disorder symptoms for early (i.e., early childhood) versus late (i.e., adolescence) eating disturbances. What factor likely explains these differences?

Answer: Early conditions of eating disturbances tend to lack the core psychological features of fear of weight gain, distorted body image, and extreme emphasis on body weight as an indicator of self-worth. This difference is likely a reflection of the level of cognitive development of the individual and the fact that concerns about physical appearance become particularly relevant only in middle childhood and adolescence.

Page Reference: 322; Objective 8.2

Summarize key components of the diathesis stress model of eating disorders. Provide a specific example to illustrate the model and its factors.

Answer: According to the diathesis stress model, eating disorders occur based on an interaction between a diathesis (predisposition) and stress (environmental or psychosocial disturbances). For example, one might inherit a biological/genetic predisposition for the disorder (i.e., a particular gene) that combines with the environmental stressor of racial discrimination. Together, these factors interact so as to increase the individual’s risk of developing an eating disorder. (Note: other examples of the two factors are possible).

Page Reference: 324; Objective 8.3

Define indirect self-harm and explain how it relates to eating disturbances.
1. Answer: Indirect self-harm refers to behavours where the damage to self is generally cumulative rather than acute or immediate. In addition, the intent to actually hurt oneself may be somewhat ambiguous. Indirect self-harm relates to eating disturbances because eating disorders are one of the most common indirect self-harming behaviours (the other is substance abuse).

Page Reference: 230; Objective 8.4

Summarize the major challenges to treatment for eating disturbances.

Answer: Major challenges include: lack of positive outcomes after treatment, high drop-out rates, lack of motivation to seek treatment, perceived lack of competence of professionals working with youth in this area, stigma, and lack of resources.

Page Reference: 333; Objective 8.5

Summarize key elements of strength-based relational CYC practice for eating disorders.

Answer: Student responses may include any of the following: exploring all aspects of the context of the young person’s eating difficulties; a caring, supportive, and nonjudgmental approach; emphasis on resilience protective factors, and strengths; communicating a sense of hope but establishing expectations for success within the youth’s capacity; promoting empowerment and independence; assess level of impact of symptoms on daily functioning, refer to collateral resources; consider the role of culture; gently challenge relevant cognitive distortions.

Page Reference: 337; Objectives 8.7

Summarize the steps of cognitive restructuring that CYCPs can use to support youth struggling with eating disturbances.

Answer: CYCPs can help youth in cognitive restructuring. The steps include: (1) having youth record thoughts and judgments about food and weight as well as arguments and evidence for their validity; (2) record arguments and evidence doubting their validity as well as support for these counterarguments; (3) generate realistic and appropriate interpretations; and (4) make a reasoned conclusion for use in governing weight and weight-related behaviours. CYCPs can help youth evaluate both the process and the results.

Page Reference: 340; Objective 8.8

Essay Questions

Summarize the psychological aspects of anorexia and bulimia. What implications might these factors have for your CYC practice?

Suggested answer: Psychological aspects of anorexia include: irrational nature of motivating emotions (e.g., fear of gaining weight increases with weight loss, rather than decreases), denial of serious medical consequences associated with disordered eating behaviour (i.e., lack of insight into their condition); distortions in perceptions of size and shape of one’s body and the amount of fat believed to be present. Psychological aspects of bulimia include: overemphasis on the significance of body shape and weight in self-evaluations (negatively effects self-esteem); distortions in body image; profound sense of a lack of control over eating; feelings of dissociation during binges; extreme guilt following a binge that then motivates a purge.

Responses for implications to CYC practice will vary but can include the importance of maintaining a nonjudgmental attitude, the role of gentle challenging of cognitive distortions, and monitoring the impact of symptoms on daily functioning.

Page Reference: 317-318; 337; Objectives 8.1 and 8.8

Compare and contrast major indicators for anorexia versus bulimia. Which would you be most likely to identify in your CYC practice and why? Identify three specific techniques for CYC intervention that you would be most likely to use in your practice. Why did you select the techniques you did?

Suggested answer: Answers will vary. Major indicators can include any of those summarized in the text (refer to detailed checklist in Table 8.3, text page 339). Specific interventions identified will also vary (refer to detailed list of alternatives in Box 8.7, text page 342) but should also include an rational for the selections made.

Page Reference: 339; 342; Objectives 8.8.7 and 8.8

Chapter 9: Psychosis and Schizophrenia

Multiple Choice Questions

Learning Objective 9.1 – Define psychosis and outline its primary symptoms. Distinguish between hallucinations, delusions, and disordered thinking.

Which of the following is TRUE regarding psychotic symptoms?
1. They are only observed in psychotic disorders
2. They are only observed in the disorder of schizophrenia
3. They can be observed with many different disorders, including depression
4. They are most severe in schizophreniform and delusional disorders

Answer: C

Page Reference: 349

Skill: factual; Difficulty: easy

Each of the following is a major type of psychotic symptom EXCEPT
1. Disorganized thinking
2. Hallucinations
3. Delusions
4. Catatonic behaviour

Answer: D

Page Reference: 349

Skill: conceptual; Difficulty: easy

Catherine believes she is the saviour sent by God and thinks that all of her thoughts are controlled by a mysterious force that wants to save the planet. These beliefs are examples of
1. schizophrenia
2. hallucinations
3. delusions
4. expressed emotion

Answer: C

Page Reference: 349

Skill: applied; Difficulty: moderate

Frederic reports seeing dragons and fairy-like creatures enter his bedroom through the window at night. These perceptual experiences are examples of
1. schizophrenia
2. hallucinations
3. delusions
4. expressed emotion

Answer: B

Page Reference: 349

Skill: applied; Difficulty: moderate

Learning Objective 9.2 – Summarize the DSM criteria for Brief Psychotic Disorder, Schizophrenia, and Substance/Medication-Induced Psychotic Disorder, distinguishing between negative and positive symptoms in your discussion.

Which of the following is an example of a negative symptom of psychotic disorders?
1. social withdrawal
2. hallucinations
3. delusions
4. disorganized speech

Answer: A

Page Reference: 350

Skill: factual; Difficulty: moderate

The two factors used to distinguish among the various psychotic disorders include
1. the cause and the duration of symptoms
2. duration of symptoms and number of domains affected
3. the nature of onset (gradual or sudden) and age of onset
4. intensity of symptoms and the age of onset

Answer: B

Page Reference: 351

Skill: factual; Difficulty: moderate

On Tuesday, Shana began hearing voices that told her to “stop it!” and began to think that everyone around her was trying to harm her. By Saturday, the voices and paranoid thoughts had disappeared. Which of the following would Shana most likely be diagnosed with?
1. Delusional disorder
2. Schizophreniform disorder
3. Schizophrenia
4. Brief psychotic disorder

Answer: D

Page Reference: 351

Skill: applied; Difficulty: easy

Compared to Schizophrenia, Brief Psychotic Disorder is
1. more severe in its symptoms
2. more gradual in onset
3. less likely to result in lasting impairments
4. observed less frequently

Answer: C

Page Reference: 352

Skill: conceptual; Difficulty: moderate

Amy was at a party and began to behave erratically, talking with people no one else could see and yelling violently to no one in particular. Her friend noticed that these behaviours began after Amy had taken a pill that someone had given her. The most likely diagnosis in this case would be
1. Delusional disorder
2. Substance/Medication-Induced Psychotic Disorder
3. Schizophrenia
4. Brief psychotic disorder

Answer: B

Page Reference: 353

Skill: applied; Difficulty: easy

Which of the following is accurate concerning schizophrenia?
1. Most children with schizophrenia also show moderate mental retardation
2. Onset of schizophrenia can be sudden or gradual
3. It is easier to diagnose schizophrenia in younger children than in adolescents
4. Onset is more likely to occur in childhood than in adolescence

Answer: B

Page Reference: 356-358

Skill: factual; Difficulty: moderate

What distinguishes schizophrenia from autism?
1. Autism is more likely to be diagnosed later than schizophrenia
2. Delusions are more prominent in autism than in schizophrenia
3. Schizophrenia is associated with good language development, autism is not
4. Language and communication problems are more prominent in schizophrenia

Answer: C

Page Reference: 357-358

Skill: factual; Difficulty: moderate

Learning Objective 9.3 – Compare and contrast biological, psychodynamic, behavioural, cognitive, and sociocultural explanations for psychotic disorders.

What can be concluded regarding genetics and schizophrenia?
1. Multiple genes determine one’s risk for schizophrenia
2. Genetics play less of a role in the disorder than environment
3. Genetics alone determines one’s risk for schizophrenia
4. Genetics determine risk for males but not for females

Answer: A

Page Reference: 359

Skill: factual; Difficulty: moderate

All of the following have been related to schizophrenia EXCEPT
1. Decreased volume in the thalamus
2. Abnormalities in the amygdala
3. Shrinkage/loss of brain matter
4. Smaller ventricles in the brain

Answer: D

Page Reference: 359

Skill: factual; Difficulty: challenging

Which of the following appears to be related to positive symptoms of schizophrenia?
1. Low levels of serotonin
2. High levels of dopamine
3. Low levels of dopamine
4. High levels of epinephrine

Answer: B

Page Reference: 359

Skill: conceptual; Difficulty: moderate

According to the psychodynamic paradigm, current approaches consider the role of_____________in schizophrenia.
1. lack of punishments
2. negative self-schemas
3. family communication patterns
4. fearful temperament

Answer: C

Page Reference: 360

Skill: conceptual; Difficulty: moderate

Which of the following family factors has been implicated in schizophrenia?
1. Expressed emotion
2. Overly relaxed parenting style
3. Strict parenting
4. Lack of involvement

Answer: A

Page Reference: 363

Skill: conceptual; Difficulty: moderate

Learning Objective 9.4 – Summarize the diathesis-stress and traumagenic neurodevelopmental models of Schizophrenia.

Which model of schizophrenia focuses on the interplay between predisposing conditions, stressful events, and protective factors in explaining schizophrenia?
1. The two-factor model
2. The traumagenic neurodevelopmental model
3. The diathesis-stress model
4. The interactionist model

Answer: C

Page Reference: 363

Skill: conceptual; Difficulty: moderate

Which model of schizophrenia argues that early psychosocial trauma should be considered a diathesis in the context of schizophrenia?
1. The two-factor model
2. The traumagenic neurodevelopmental model
3. The diathesis-stress model
4. The interactionist model

Answer: B

Page Reference: 363

Skill: conceptual; Difficulty: moderate

Which of the following research findings supports the traumagenic neurodevelopmental model?
1. Individuals with greater degrees of genetic relatedness have higher concordance rates for schizophrenia
2. Males tend to have higher incidence rates in cases of schizophrenia where negative symptoms are prominent
3. Females tend to have higher incidence rates in cases of schizophrenia where mood symptoms are prominent
4. There are similarities between the effects of traumatic events on the brain and the neurological abnormalities associated with schizophrenia

Answer: D

Page Reference: 364

Skill: conceptual; Difficulty: challenging

Learning Objective 9.5 – Describe psychological treatment approaches used in treating psychotic disorders for each of the major psychological paradigms.

Many medications that alleviate the positive symptoms of schizophrenia
1. lower levels of dopamine
2. increase levels of serotonin
3. increase levels of dopamine
4. decrease levels of acetylcholine

Answer: A

Page Reference: 367

Skill: conceptual; Difficulty: moderate

An example of a positive symptom of schizophrenia would be________ and research shows these are best treated by medications which lower levels of _________.
1. social withdrawal; dopamine
2. hallucinations; dopamine
3. hallucinations; serotonin
4. delusions; serotonin

Answer: B

Page Reference: 367

Skill: conceptual; Difficulty: challenging

Compared to first-generation antipsychotics, second-generation or atypical antipsychotics
1. have more serious side effects
2. appear effective in decreasing only the negative symptoms of schizophrenia
3. actually increase dopamine activity
4. exert their effects by altering the activation of various neurotransmitters

Answer: D

Page Reference: 367-368

Skill: factual; Difficulty: moderate

In general, a psychodynamic approach to treatment for schizophrenia is
1. ineffective and not at all relevant to a treatment of psychosis
2. preferred over behavioural and cognitive approaches
3. viewed as a complement to other approaches to the treatment of psychosis
4. avoided because it has been found to actually make psychotic symptoms worse

Answer: C

Page Reference: 368

Skill: factual; Difficulty: moderate

A behavioural approach to treatment for schizophrenia focuses on
1. punishment for inappropriate behaviour
2. social skills training
3. avoidance conditioning
4. aversion training

Answer: B

Page Reference: 369

Skill: factual; Difficulty: moderate

Which of the following might be the focus of family interventions for schizophrenia?
1. somatosensory retraining
2. activation training
3. decreasing expressed emotion
4. enhancing communication deviance

Answer: C

Page Reference: 370

Skill: conceptual; Difficulty: moderate

Laurie, diagnosed with schizophrenia, has been undergoing treatment that encourages her to engage in repetitive drumming and controlled breathing. It is most likely she is undergoing therapy based on
1. somatosensory mapping and retraining
2. activation training
3. interpersonal therapy
4. the neurosequential model of therapeutics

Answer: D

Page Reference: 370

Skill: applied; Difficulty: easy

Learning Objective 9.6 – Describe specific indicators of psychosis and Schizophrenia.

Which of the following is the hallmark of psychosis?
1. Flat affect
2. Loss of touch with reality
3. Emotional extremes
4. Antisocial behaviour

Answer: B

Page Reference: 373

Skill: conceptual; Difficulty: easy

Each of the following is a positive symptom of schizophrenia EXCEPT
1. Hallucinations
2. Restricted emotion
3. Delusions
4. Loose associations

Answer: B

Page Reference: 374-376

Skill: conceptual; Difficulty: moderate

Each of the following is a negative symptom of schizophrenia EXCEPT
1. Blunted or no affect
2. Lack of speech
3. Limited physical movement
4. Rambling speech

Answer: D

Page Reference: 374-376

Skill: conceptual; Difficulty: moderate

Learning Objective 9.7 – Describe the multimodal treatment options used for adolescent Schizophrenia and psychosis.

During the____________phase of psychosis, early signs of psychosis may appear but they’re frequently vague and often go unnoticed by others.
1. premorbid
2. prodromal
3. acute
4. residual

Answer: B

Page Reference: 376

Skill: conceptual; Difficulty: easy

Laurie was diagnosed with schizophrenia two years ago but currently has no symptoms. Laurie is in the______________phase.
1. premorbid
2. prodromal
3. acute
4. residual

Answer: D

Page Reference: 376

Skill: applied; Difficulty: easy

In a variation of CBT called_____________, adolescents with schizophrenia are taught problem-solving, attention, and social-perception skills.
1. behavioural activation therapy
2. cognitive skills therapy
3. cognitive remediation therapy
4. dynamic cognitive alignment therapy

Answer: C

Page Reference: 377

Skill: factual; Difficulty: easy

The most common antipsychotic medication used with adolescents is
1. Risperdal
2. Clozapine
3. Lithium
4. Zyprexa

Answer: A

Page Reference: 378

Skill: factual; Difficulty: challenging

When it comes to psychoeducation and individual counselling, CYCPs are encouraged to
1. Avoid social interaction
2. Avoid emotionally supportive interactions
3. Probe deep into emotional layers of the mind so as to increase insight
4. Keep discussions at the surface level of thoughts, emotions, and behaviours

Answer: D

Page Reference: 378-379

Skill: conceptual; Difficulty: moderate

One relatively new alternative healing approach for schizophrenia emphasizes providing treatment sessions in which all participants feel heard and responded to. This new approach is called
1. Community chat
2. Open dialogue
3. Free talk
4. Safe space

Answer: B

Page Reference: 380

Skill: factual; Difficulty: easy

Learning Objective 9.8 – Outline the role of CYCPs when working with youth with psychosis and/or Schizophrenia.

Each of the following is an important role of the CYCP when working with youth with psychosis and/or schizophrenia EXCEPT
1. facilitating early identification of symptoms
2. recognizing comorbid conditions such as substance use
3. identifying the ‘fragile brain’
4. psychoeducation

Answer: C

Page Reference: 365-366

Skill: applied; Difficulty: easy

When it comes to medication in the treatment of psychotic symptoms, CYCPs should engage in all of the following EXCEPT
1. closely monitor the use of medications
2. educate themselves on the effects of medication
3. educate the youth about the effects of medication
4. help youth to reduce the medication they take

Answer: D

Page Reference: 378

Skill: conceptual; Difficulty: easy

Short-Answer Questions

Define hallucinations and delusions. Provide a specific example for each.

Answer: Hallucinations are disturbances in perception. For example, hearing voices when no one is talking, seeing things that aren’t there. Delusions are distortions in thought, including maintaining strong beliefs that aren’t based in reality. For example, believing that other people are inserting thoughts into one’s mind and controlling their behaviour.

Page Reference: 349; Objective 9.1

Distinguish between positive and negative symptoms of psychotic disorders, providing specific examples for each.

Answer: Positive symptoms represent excesses or alterations in expected functioning and include delusions, hallucinations, disorganized thinking, and disorganized motor behaviour. Negative symptoms refer to symptoms associated with processes or functions that are diminished or reduced in comparison with expected functioning and include lack of speech, absent emotional expression, and social withdrawal.

Page Reference: 351; Objective 9.2

Define expressed emotion and explain its relationship to Schizophrenia.

Answer: Expressed emotion is a psychosocial stressor in which family members express significant hostility and criticism toward the individual/family member diagnosed with Schizophrenia. Numerous studies have found that families scoring high on expressed emotion are less likely to be supportive toward the diagnosed individual and that such dynamics predict future relapses for that individual.

Page Reference: 363; Objective 9.3

Explain the primary difference between the diathesis-stress model of Schizophrenia and the traumagenic neurodevelopmental (TN) model of Schizophrenia.
1. Answer: The primary difference between the two models is that the diathesis-stress model emphasizes the role of biological diatheses (e.g., genetic, birth trauma) while the traumagenic neurodevelopmental model argues that environmental diatheses (e.g., abuse, neglect, childhood trauma) can also play a role in causing the disorder (rather than just being a stress) because of their ability to result in neurobiological abnormalities and sensitivities.

Page Reference: 362-363; Objective 9.4

Summarize the primary differences between first-generation or typical antipsychotics and second-generation or atypical

Answer: First-generation or typical antipsychotics are generally believed to exert their effects through the blocking of dopamine receptors and work best for the positive symptoms of Schizophrenia. By comparison, second-generation or atypical antipsychotics are believed to exert their effects through altering the activation of a variety of neurotransmitters and appear to be effective in decreasing both positive and negative symptoms associated with Schizophrenia. Second-generation antipsychotics are also generally associated with fewer side effects so are usually preferred over first-generation antipsychotics.

Page Reference: 367-368; Objective 9.5

Identify four major areas of the mental status examination (MSE) in which you would be most likely to notice indicators of Schizophrenia in your CYC practice. For each major area, provide a couple of examples of specific indicators.

Answer: General areas of the mental status exam include: appearance, mood/affect, flow of speech, content of thought, cognition and intellectual resources, insight and judgment, perception, and orientation. Specific examples for each major area will vary (for detailed summary of indicators for each area, refer to text pages 372-374).

Page Reference: 372-374; Objectives 9.6

Summarize the relevance of psychoeducation and individual counselling when working with youth diagnosed with psychotic disturbances.

Answer: Ongoing counselling and support are important. In particular, the CYCP should establish a supportive therapeutic relationship with the young person and psychoeducation can focus on helping youth understand all aspects of psychosis. Explaining the prognosis, possible effects on school, social relationships, and career plans are important. Staying focused on the surface level of thoughts, emotions, and behaviour is recommended over insight-approaches to individual counselling that probe into deeper emotional layers of the mind which may exacerbate psychotic symptoms for some youth. Thus, focusing on tasks of daily living, reality checking, and symptom management is recommended.

Page Reference: 378-379; Objective 9.7

Identify specific barriers that arise against youth taking their medication for psychotic disturbances.

Answer: Specific barriers include: forgetting, outright refusal (due to stigma, side-effects, etc.), side effects (weight gain in particular, tremor), cost of medication, and lack of results/effectiveness.

Page Reference: 378; Objective 9.8

Essay Questions

Describe the five major areas of psychotic symptoms. Identify specific behavioural indicators for each area. For each area, identify a specific communication strategy that might be utilized in CYC practice.

Suggested answer: The five major areas of symptoms include delusions, hallucinations, disorganized thinking, disorganized motor behaviour, and negative symptoms. Specific examples of behavioural indicators for each area will vary (see pages 374-376 for detailed summary) as well specific communication strategies for CYC intervention (see Box 9.5 on text page 381 for summary of communication strategies).

Page Reference: 350; 374-376; 381; Objectives 9.6 and 9.8

Summarize social skills training and its use in interventions for those diagnosed with Schizophrenia. Is it effective? Describe what is meant by a multimodal treatment package for Schizophrenia. What do we know about the effectiveness of these strategies for youth?

Suggested answer: Social skills training attempts to reduce the impact of negative symptoms (e.g., social withdrawal) by providing models of appropriate behaviour and social communication (e.g., conversational skills, assertiveness training) followed by opportunities to model and rehearse the desired behaviour in the context of a safe environment in which the therapist provides specific feedback. Studies have found social skills training to effectively improve social skills and result in the development of independent living skills and enhanced functioning in the community. Therefore, it is considered an important component in the overall treatment of Schizophrenia.

A multimodal treatment package includes pharmacotherapy, family and individual counselling (which can include social skills training), psychoeducation, and an assessment of social and educational needs. Although this multimodal approach represents current best practice, few, if any, nonpharmacological interventions have been systematically evaluated in adolescent Schizophrenia. Therefore, we do not know as much as we would like to about the components of the multimodal treatment package and whether they are effective for youth.

Page Reference: 369; 377; Objectives 9.5 and 9.7

Chapter 10: Substance Misuse and Addictions

Multiple Choice Questions

Learning Objective 10.1 – Distinguish between substance use, abuse, misuse, intoxication, tolerance, and withdrawal.

_________________refers to the changes in mood, perception, sensation, need and behaviour associated with changes in the central nervous system following use of a substance.
1. withdrawal
2. substance use
3. tolerance
4. intoxication

Answer: D

Page Reference: 386

Skill: factual; Difficulty: easy

The occasional, inappropriate use of either a social or a prescription drug is referred to as
1. substance misuse
2. substance abuse
3. substance use
4. intoxication

Answer: A

Page Reference: 386

Skill: factual; Difficulty: easy

In the DSM-5, substance misuse is defined in relation to
1. the amount of substance used
2. the period of time the substance has been used for
3. the degree of impairment associated with substance use
4. the age at which substance use began

Answer: C

Page Reference: 386

Skill: factual; Difficulty: challenging

_________________is a general term used to define the use of any drug use that is disapproved of by members of the society in which it occurs.
1. substance misuse
2. substance abuse
3. substance use
4. intoxication

Answer: B

Page Reference: 386

Skill: factual; Difficulty: easy

Valerie is feeling extremely relaxed, a bit dizzy, and a bit confused after drinking vodka. This best illustrates
1. substance misuse
2. substance abuse
3. substance use
4. intoxication

Answer: D

Page Reference: 386

Skill: applied; Difficulty: moderate

The need for greater and greater amounts of a substance to achieve the desired effect is defined as
1. tolerance
2. withdrawal
3. substance abuse
4. intoxication

Answer: A

Page Reference: 387

Skill: factual; Difficulty: moderate

Ken hasn’t used Oxycontin in over week and feels agitated, anxious, and can’t sleep. This best illustrates
1. tolerance
2. withdrawal
3. substance abuse
4. intoxication

Answer: B

Page Reference: 387

Skill: applied; Difficulty: easy

Together, tolerance and withdrawal define
1. physical dependence
2. psychological dependence
3. intoxication
4. substance misuse

Answer: A

Page Reference: 387

Skill: conceptual; Difficulty: moderate

Ben can’t stop thinking about his next alcoholic drink. Although he has tried to stop drinking, he feels unable to reduce his drinking even though he has had to give up playing hockey because of it. This best illustrates
1. physical dependence
2. psychological dependence
3. intoxication
4. substance misuse

Answer: B

Page Reference: 387

Skill: applied; Difficulty: moderate

Learning Objective 10.2 – Distinguish between Substance Use and Substance-Induced Disorders as described in the DSM-5. Why is Gambling Disorder included in the category of Substance-Related and Addictive Disorders?

In order to be more neutral in its discussion of substance-related disorders, the DSM-5 has removed the term___________from its discussion of substance-related disturbances.
1. disorder
2. addiction
3. intoxication
4. abuse

Answer: B

Page Reference: 388

Skill: factual; Difficulty: moderate

Which of the following groups of disorders is associated with cognitive, behavioural, and physiological symptoms resulting from continued use of a substance?
1. Substance Use Disorders
2. Substance-Induced Disorders
3. Substance Abuse Disorders
4. Substance Misuse Disorders

Answer: A

Page Reference: 388

Skill: factual; Difficulty: moderate

Cathy has been diagnosed with depressive disorder as a result of her continued substance use. Which of the following would she most likely be diagnosed with?
1. A Substance Use Disorder
2. A Substance-Induced Disorder
3. A Substance Abuse Disorder
4. A Substance Misuse Disorder

Answer: B

Page Reference: 388

Skill: applied; Difficulty: challenging

In the DSM-5, which diagnosis is considered to be a non-Substance-Related Disorder?
1. Gaming Disorder
2. Shopping Disorder
3. Hoarding Disorder
4. Gambling Disorder

Answer: D

Page Reference: 388

Skill: factual; Difficulty: easy

Each of the following is one of the ten major classes of drugs identified in the DSM-5 to which the diagnosis of Substance Use Disorder can be applied EXCEPT
1. Cannabis
2. Inhalants
3. Caffeine
4. Tobacco

Answer: C

Page Reference: 389

Skill: factual; Difficulty: challenging

What do all of the ten major classes of drugs identified in the DSM-5 to which the diagnosis of Substance Use Disorder can be applied have in common?
1. They are illegal substances
2. The have a direct impact on the brain reward system
3. They have all been associated with brain damage
4. They are all related to over-arousal of the nervous system

Answer: B

Page Reference: 389

Skill: conceptual; Difficulty: moderate

Substance-Induced Disorders include each of the following EXCEPT
1. Tolerance
2. Intoxication
3. Withdrawal
4. Other psychological disorders that result from use of a psychoactive substance

Answer: A

Page Reference: 390

Skill: factual; Difficulty: challenging

Learning Objective 10.3 – Define the major conceptual models for understanding substance abuse, including the harm-reduction approach.

From a CYC perspective, one problem with the DSM-5 approach to substance-related disturbances for youth is that it
1. Ignores the impact of legal substances, focusing solely on illegal substances
2. Fails to consider that experimentation with substances is a normal part of development
3. Fails to consider the severity of substance use, ranging from mild to extreme
4. Puts the blame of the disorder on parents

Answer: B

Page Reference: 391

Skill: conceptual; Difficulty: challenging

Samantha says, “Drinking is a sign of a weak character. All someone has to do is make the choice to quit drinking and they should be able to.” This best illustrates which view of addiction?
1. brain dysfunction theory
2. harm-reduction model
3. the moral model
4. the genetic model

Answer: C

Page Reference: 393

Skill: applied; Difficulty: moderate

According to your text, which model of addiction remains the predominant view of most people in Canada?
1. brain dysfunction theory
2. harm-reduction model
3. the moral model
4. the genetic model

Answer: C

Page Reference: 393

Skill: factual; Difficulty: moderate

According to the disease model of addiction, the only ‘cure’ for alcoholism is
1. social skills training
2. medication
3. brain retraining
4. abstinence

Answer: D

Page Reference: 393

Skill: factual; Difficulty: moderate

According to your text, which model of addiction fits best with a CYC approach?
1. brain dysfunction theory
2. harm-reduction model
3. the moral model
4. the genetic model

Answer: B

Page Reference: 393

Skill: conceptual; Difficulty: moderate

Which of the following is true regarding the harm reduction model of addiction?
1. it takes a firm stand on the issue of abstinence
2. it emphasizes the ultimate goal of a drug-free society
3. it focuses on reducing risks and consequences, rather than the substance use itself
4. it assumes that drug-related problems are the result of the drugs themselves

Answer: C

Page Reference: 394

Skill: conceptual; Difficulty: moderate

Learning Objective 10.4 – Describe the extent of substance misuse among youth in Canada, with a focus on out of the mainstream youth.

The likelihood of developing personal and social issues related to substance use is higher for youth
1. who experiment with drugs at a younger age
2. who live with a single parent
3. in lower socioeconomic environments
4. who begin experimenting later in adolescence

Answer: A

Page Reference: 395

Skill: factual; Difficulty: easy

Each of the following is one of the substances most frequently first used by mainstream youth EXCEPT
1. Tobacco
2. Cannabis
3. Alcohol
4. Opiates

Answer: D

Page Reference: 395

Skill: factual; Difficulty: easy

According to the Canadian Centre on Substance Abuse, ____________is by far the most common substance used by youth.
1. Tobacco
2. Cannabis
3. Alcohol
4. Opiates

Answer: C

Page Reference: 395

Skill: factual; Difficulty: moderate

Each of the following is true regarding adolescent substance use and the brain EXCEPT
1. Substance use alters brain pathways, resulting in deficits in executive functioning
2. Substance use reduces the brain’s ability to control substance use or inhibit behavior
3. Substance use alters brain development only for those with a genetic predisposition
4. Heavy substance use in adolescence results in impaired memory and attention

Answer: C

Page Reference: 396

Skill: factual; Difficulty: moderate

Which of the following is true regarding the out-of-mainstream youth population and substance misuse?
1. They are at increased risk for substance misuse
2. They are at decreased risk for substance misuse
3. They are at no greater risk for substance misuse than other youth
4. They have not been studied to determine their level of risk for substance misuse

Answer: A

Page Reference: 398

Skill: factual; Difficulty: easy

Learning Objective 10.5 – Compare and contrast primary psychological explanations (biological, behavioural, cognitive, psychodynamic, and sociocultural) for substance use and substance-related disorders.

What can be concluded regarding genetics and substance-related disorders?
1. One specific gene appears to determine one’s risk for substance disorders
2. Genetics do not seem to play a role in these disorders
3. Genetics alone determines one’s risk for substance disorders
4. Genes that determine the sensitivity of the brain reward system are involved

Answer: D

Page Reference: 399

Skill: factual; Difficulty: moderate

The_________________has been found to be one of the key structures of the brain reward system.
1. hippocampus
2. amygdala
3. nucleus accumbens
4. prefrontal cortex

Answer: C

Page Reference: 399

Skill: factual; Difficulty: moderate

The neurotransmitter__________has been found to be associated with amphetamine and cocaine use while the neurotransmitter______________has been found to be associated with alcohol use.
1. dopamine; serotonin
2. serotonin; dopamine
3. dopamine; epinephrine
4. acetylcholine; dopamine

Answer: A

Page Reference: 399

Skill: factual; Difficulty: moderate

According to the psychodynamic paradigm, substance misuse is related to
1. an overinflated ego
2. self-centeredness
3. emotional suffering
4. a weak superego

Answer: C

Page Reference: 400

Skill: conceptual; Difficulty: moderate

Fran is feeling very distressed and anxious. After having a couple of alcoholic drinks, Fran feels less anxious. According to the behavioural paradigm, this best illustrates the role of______________in substance use.
1. Classical conditioning
2. Positive reinforcement
3. Aversive conditioning
4. Negative reinforcement

Answer: D

Page Reference: 400

Skill: applied; Difficulty: challenging

Josh expects that he will feel really good if he smokes marijuana so he continues to use it. Josh’s use of marijuana is best explained by
1. classical conditioning
2. expectancy outcome theory
3. self-medication theory
4. brain reward theory

Answer: B

Page Reference: 400

Skill: applied; Difficulty: moderate

Of all family factors, ______________appears to be one of the most significant factors in determining youth substance use.
1. ethnicity
2. permissive behavioural control
3. high parental self-monitoring
4. parental substance use

Answer: D

Page Reference: 401

Skill: factual; Difficulty: moderate

Learning Objective 10.6 – Summarize the risk and protective factors related to substance misuse in youth.

According to Gabor Mate, the core objective of substance misuse is
1. self-soothing deep-seated sadness, fears, and discomfort
2. to harm oneself due to irrational feelings of guilt
3. to harm significant others due to unresolved anger
4. to rebel against society

Answer: A

Page Reference: 401

Skill: factual; Difficulty: moderate

CYCPs supporting those with addictions should first try to understand
1. the adolescent’s view of self
2. why the adolescent is using
3. how to best convince the youth to stop using
4. the youth’s attachment style

Answer: B

Page Reference: 402

Skill: applied; Difficulty: easy

From an ecological approach, risk factors for youth substance misuse can be grouped into five major categories which include each of the following EXCEPT
1. Community risk factors
2. School-related risk factors
3. Genetic risk factors
4. Peer risk factors

Answer: C

Page Reference: 402

Skill: conceptual; Difficulty: easy

The individual risk factor that is the strongest determinant of substance-related difficulties later in life is
1. impulsivity
2. age of onset
3. sensitivity to sensation
4. attitudes and beliefs about the risks of use

Answer: B

Page Reference: 403

Skill: factual; Difficulty: moderate

One important community risk factor for substance use and misuse is
1. availability of substances
2. food security
3. deviant peers
4. negative attitudes toward substance use

Answer: A

Page Reference: 403

Skill: conceptual; Difficulty: moderate

Who is most at risk for poly-drug use?
1. Males
2. Out-of-the-mainstream youth
3. Older adolescents
4. Females

Answer: B

Page Reference: 404

Skill: factual; Difficulty: easy

Learning Objective 10.7 – Compare and contrast the various psychological approaches to preventing and treating substance-related disturbances.

Biological approaches to treatment for substance-related disorders focus on
1. improving diet and increasing exercise to counteract negative effects of substances
2. using computer technology to alter brain reward system pathways
3. surgical procedures that alter brain pathways responsible for addictive behaviour
4. using medications that decrease intoxication and withdrawal symptoms

Answer: D

Page Reference: 406

Skill: conceptual; Difficulty: easy

Kara has been undergoing therapy for a substance-related disorder. In her sessions, she is encouraged to explore her feelings of helplessness and lack of control. Kara is undergoing
1. Psychodynamic treatment
2. Contingency management
3. Cognitive-behavioural therapy
4. Behavioural therapy

Answer: A

Page Reference: 407

Skill: applied; Difficulty: challenging

Which approach to treatment for substance-related disorders uses principles of reinforcement and punishment to increase adaptive behaviour?
1. Psychodynamic treatment
2. Contingency management
3. Cognitive-behavioural therapy
4. Social skills training

Answer: B

Page Reference: 407

Skill: conceptual; Difficulty: easy

According to the National Alcohol Strategy Working Group (2007), each of the following is one of the four areas in which broader cultural change can result in decreased substance use EXCEPT
1. Safer communities
2. Availability
3. Resiliencies
4. Health impacts and treatment

Answer: C

Page Reference: 409

Skill: factual; Difficulty: moderate

Learning Objective 10.8 – Outline various assessment and intervention strategies to use in CYC practice with youth who are misusing substances.

Each of the following is one of the four critical characteristics that youth believe would constitute effective programming for substance-related disorders EXCEPT
1. a friendly, welcoming, understanding environment Availability
2. having staff with life experiences similar to their own
3. having youth work with them
4. having access to a mental health professional

Answer: D

Page Reference: 409

Skill: factual; Difficulty: moderate

Each of the following is true regarding the levels of involvement (LOI) framework for substance use EXCEPT
1. It considers substance use on a continuum ranging from low to high involvement
2. It focuses on behaviour rather than labelling the individual
3. Although an interesting model, it does not appear to be an effective tool for CYCPs
4. It identifies five different levels of involvement

Answer: C

Page Reference: 411-412

Skill: conceptual; Difficulty: moderate

According to the levels of involvement (LOI) framework for substance use, each of the following is one of the behavioural indicators for harmful and dependent substance use EXCEPT
1. Adverse consequences
2. Withdrawal distress
3. Preoccupation
4. Avoidance

Answer: D

Page Reference: 412-413

Skill: factual; Difficulty: easy

Learning Objective 10.9 – Describe universal approaches to prevention programs for youth substance use.

Which of the following is one of the key principles of trauma-informed practice?
1. Cognitive insight
2. Emphasis on independence
3. Trauma awareness
4. Focus on reinforcements

Answer: C

Page Reference: 414

Skill: conceptual; Difficulty: moderate

Carly is attempting to avoid situations that are associated with drug use in order to reduce the likelihood of using. This illustrates which of the following behavioural techniques?
1. Relapse prevention
2. Stimulus control
3. Urge control
4. Social control

Answer: B

Page Reference: 414

Skill: applied; Difficulty: challenging

Lisa is taking a medication that blocks the effects of heroin. Lisa is receiving what type of medical treatment?
1. Antagonist drug treatment
2. Drug substitution
3. Aversive drug treatment
4. Relapse prevention

Answer: A

Page Reference: 415

Skill: applied; Difficulty: easy

Which evidence-based technique in the addictions field helps clients understand the discrepancy between their current behaviour and their treatment goal by supporting the client’s self-efficacy?
1. Stimulus control
2. Multidimensional family therapy (MDFT)
3. Motivational interviewing
4. Relapse prevention

Answer: C

Page Reference: 416

Skill: conceptual; Difficulty: easy

Alexandra has mixed feelings about quitting her use of cannabis. She is most likely in the __________stage of the Stages of Change Model.
1. action
2. preparation
3. precontemplation
4. contemplation

Answer: D

Page Reference: 417

Skill: applied; Difficulty: moderate

____________approaches to interventions for young people focus on interventions that apply to everyone with a substance-related disorder.
1. Universal
2. Targeted
3. Specialist
4. Inclusive

Answer: A

Page Reference: 418

Skill: applied; Difficulty: moderate

Which of the following is most likely to be an effective intervention approach with youth with substance-related disturbances?
1. Medication
2. Forced abstinence
3. Psychosocial interventions
4. Universal interventions

Answer: C

Page Reference: 418-419

Skill: conceptual; Difficulty: challenging

Short-Answer Questions

Describe the difference between physical dependence and psychological dependence. Provide examples of each.

Answer: Physical dependence is defined by increased tolerance (e.g., needing more alcohol in order to experience the same degree of intoxication) and withdrawal symptoms (e.g., sleep disturbance, nausea, anxiety). Psychological dependence includes the behavioural, emotional, and cognitive aspects of dependence (e.g., persistent desire to use the substance, unsuccessful efforts to reduce substance use, giving up social or occupational activities because of substance use).

Page Reference: 387; Objective 10.1

For any one of the drug classes associated with Substance Use Disorders, the DSM-5 organizes specific criteria in relation to four general areas. Identify each of these four areas.

Answer: The four areas include: (1) impaired control with respect to substance use; (2) impaired social functioning; (3) risky use; and (4) tolerance and withdrawal.

Page Reference: 389; Objective 10.2

Explain why a harm-reduction model for you in Canada is controversial.

Answer: Harm reduction for you in Canada is controversial, given that promoting harm-reduction approaches with under aged youth presents a difficult challenge for those who have a duty of care. The Criminal Code of Canada identifies young persons as a vulnerable subgroup of the population, and the law embeds abstinence as the response toward alcohol and other drug use for youth. Harm reduction as a universal intervention targeting under aged youth needs to be informed by the legal and policy constraints placed on schools and school boards.

Page Reference: 394; Objective 10.3

According to your text, what do CYCPs need to know about cannabis use in youth?
1. Answer: It’s important for CYCPs to know that cannabis use has been linked to low mood, depression, and anxiety. Early marijuana use in adolescence has been shown to have significant long-term effects on later cognitive functioning, particularly self-management strategies. And in young people with pre-existing vulnerabilities, marijuana use can trigger or unmask psychiatric difficulties, including Schizophrenia, psychosis, and depression.

Page Reference: 395; Objective 10.4

Describe the brain reward system and explain its role in substance-related disorders.

Answer: Activation of the brain reward system appears to be responsible for the persistent behaviours associated with both substance and behavioural (i.e., gambling) disorders. the brain reward system consists of specific brain pathways that, when activated, regulate our feelings of pleasure and reward. The nucleus accumbens is one of the key structures associated with these pleasurable sensations. Release of the neurotransmitter dopamine also plays a role.

Page Reference: 399; Objective 10.5

Identify the five main categories of risk factors for youth substance misuse. Provide a specific example for each.

Answer: The five categories include: individual risk factors, family risk factors, peer risk factors, school-related factors, community risk factors. Specific examples for each area will vary (for detailed summary of indicators for each area, refer to text pages 402-403).

Page Reference: 402-403; Objectives 10.6

Identify the four areas in which broader cultural change can result in decreased substance use according to Canada’s National Alcohol Strategy Working Group (2007).

Answer: The four areas include: health promotion, prevention, and education, health impacts and treatment, availability, and safer communities. (This question may be modified to require a description for each of the four areas).

Page Reference: 409; Objective 10.7

Identify the four critical characteristics that youth believe would constitute effective programming for substance-related disorders.

Answer: The four critical characteristics include: a friendly, welcoming, understanding environment; having staff with life experiences similar to their own; the opportunity to express their opinion about, and have an influence on, the program; having youth work with them.

Page Reference: 410; Objective 10.8

Essay Questions

Identify the five key principles in contingency management and provide a specific example for each. How applicable are these components to CYC practice? Explain.

Suggested answer: The five key principles include: schedule of reinforcement, magnitude of reinforcement, type of consequence, monitoring, and targets. Specific examples will vary but may include: using frequent reinforcement, use high magnitude reinforcers, allow client to select reinforcers, verify target using biochemical or other objective measure, and select achievable targets. (Refer to Figure 10.2 on text page 408 for additional examples.)

Student answers to applicability will vary but should include a rationale for their response.

Page Reference: 407-408; Objective 10.5

Identify and describe each of the stages of the Stages of Change Model. For each stage, describe a specific strategy that might be utilized in CYC practice.

Suggested answer: The five stages include: (1) precontemplation, not yet considering change or resistant or unmotivated; (2) contemplation, where one is uncertain about change and has mixed feelings, (3) preparation stage, where one is considering or has a desire for change; (4) action, where one is putting a plan into action and establishing new habits; (5) maintenance, where continued commitment to new habits is observed. CYC strategies associated with each of the stages include: (1) validation, rapport building, motivational interviewing; (2) motivational interviewing, affirm ambivalence, focus on strengths; (3) identify supports/resources, outline steps for change, empathic support/feedback; (4) motivational interviewing, affirm commitment, celebrate successes; (5) continued support, celebrate successes, refer to relapse prevention.

Page Reference: 416-417; Objective 10.8

Appendix 1: Understanding Suicide

Multiple Choice Questions

Learning Objective A1.1 – Summarize the psychological and CYC perspectives of youth suicide.

The term________________is a general term which refers to ideas, thoughts, and acts associated with intentionally taking one’s own life.
1. suicide
2. suicidal behaviour
3. suicidal ideation
4. suicidal attempt

Answer: B

Page Reference: 424

Skill: factual; Difficulty: easy

Suicidal behaviour is included in what category of the DSM-5?
1. Impulsive behaviour disorders
2. Mood Disturbances
3. Conditions for Further Study
4. None of the above—suicidal behaviour is not discussed in the DSM-5

Answer: C

Page Reference: 425

Skill: factual; Difficulty: moderate

When it comes to the DSM-5 and suicidal behaviour, which of the following is true?
1. It is possible to be diagnosed with Suicidal Behaviour Disorder
2. Suicidal behaviour is discussed in every chapter of the DSM-5
3. Suicidal Behaviour Disorder no longer appears in the DSM
4. The diagnostic category of Suicidal Behaviour Disorder has not yet been verified by research

Answer: D

Page Reference: 425

Skill: factual; Difficulty: challenging

Suicidal behaviour is often categorized on the basis of each of the following EXCEPT
1. age of the individual
2. the degree of impulsivity associated with the behaviour
3. medical consequences of the act
4. violence of the method

Answer: A

Page Reference: 425

Skill: factual; Difficulty: moderate

From a CYC approach, suicide is best viewed as
1. a private, individual, and personal problem
2. a problem that arises from structural/societal forces
3. the responsibility of the individual
4. a problem associated with particular personality traits

Answer: B

Page Reference: 426

Skill: conceptual; Difficulty: moderate

What can be concluded regarding genetics and suicide?
1. Little research has been done to investigate the role of genetics in suicidal behaviour
2. Genetics do not seem to play a role in suicidal behaviour
3. There appears to be a genetic diathesis for suicidal behaviour
4. Evidence suggests that genes play a role in suicidal behaviour for males but not for females

Answer: C

Page Reference: 430

Skill: conceptual; Difficulty: moderate

The_________________has been found to be associated with suicide.
1. hippocampus
2. amygdala
3. nucleus accumbens
4. prefrontal cortex

Answer: D

Page Reference: 430

Skill: factual; Difficulty: moderate

Levels of the neurotransmitter__________has been found to be associated suicide.
1. dopamine
2. serotonin
3. epinephrine
4. oxytocin

Answer: B

Page Reference: 431

Skill: factual; Difficulty: moderate

According to the ______________paradigm, suicidal behaviour is a way to release the intense anger experienced toward a lost love object.
1. Psychodynamic
2. Behavioural
3. Cognitive
4. Sociocultural

Answer: A

Page Reference: 431

Skill: conceptual; Difficulty: moderate

According to the cognitive paradigm, an important factor in relation to suicidal behaviour is
1. anger turned inward
2. social isolation from peers
3. pessimistic thinking
4. insecure attachment

Answer: C

Page Reference: 432

Skill: conceptual; Difficulty: moderate

From a CYC perspective, it is important to be aware of ________________factors when considering youth suicide.
1. predisposing, precipitating, contributing, and protective
2. universal, specific, targeted, and social
3. independent, passive, negative, and avoidant
4. neurotic, dependent, attachment, and coping

Answer: A

Page Reference: 434-435

Skill: factual; Difficulty: easy

The basic requirements for strength-based supportive responses from CYCPs engaged with youth who may be suicidal include each of the following EXCEPT
1. A nonjudgmental approach
2. A sense of caution when helping
3. A willingness to initiate dialogue
4. Genuine concern

Answer: B

Page Reference: 437

Skill: conceptual; Difficulty: easy

Learning Objective A1.2 – List the risk factors and the signs and symptoms of suicide.

Each of the following facts about suicide in Canada is true EXCEPT
1. First Nations youth are at increased risk of suicide
2. LGBTT youth are at increased risk for suicide
3. The choice of less lethal methods results in fewer girls successfully completing suicide
4. Youth with previous attempts are less likely to attempt or contemplate suicide

Answer: D

Page Reference: 427-428

Skill: factual; Difficulty: easy

According to your text, which of the following is the most significant risk factor for suicide?
1. Being male
2. Mental health issues
3. Being an adolescent
4. Being female

Answer: B

Page Reference: 428

Skill: conceptual; Difficulty: challenging

Travis’ parents have noticed that he seems to be putting his affairs in order—smoothing over troubled relationships and giving away things that are important to him. This indicates that Travis may be
1. about to run away from home
2. feeling better about himself
3. contemplating suicide
4. engaged in self-harm behaviour

Answer: C

Page Reference: 428

Skill: applied; Difficulty: easy

Learning Objective A1.3 – Explain how to complete a risk or lethality assessment and a safety plan.

According to the IS PATH WARM mnemonic for the warning signs of suicide, each of the following is a sign to watch for EXCEPT
1. Hopelessness
2. Withdrawal
3. Recklessness
4. Sadness

Answer: D

Page Reference: 439

Skill: conceptual; Difficulty: moderate

Each of the following is an important component of a safety plan/contract EXCEPT
1. Contact professionals and agencies
2. Coping skills
3. Know when to access help
4. Know when to decrease stimulation

Answer: D

Page Reference: 440

Skill: factual; Difficulty: easy

Learning Objective A1.4 – List when, where, and how to refer youth who are suicidal in your jurisdiction.

NOTE: Relevant content for Objective A1.4 will vary by location and is not covered specifically in this text.

Short-Answer Questions

Summarize the role of stressful life events and family influences in suicidal behaviour.

Answer: From a sociocultural perspective, stressful life events (particularly those viewed as being humiliating) are significant risk factors for suicidal behaviour. Research also supports the role of family environment in youth suicidal behaviour with specific risk factors including loss of a parent, poor parent-child relationships, maltreatment, family conflict, and parental psychopathology.

Page Reference: 433; Objective A1.1

Describe how the risk of suicide changes from childhood to adolescence and explain why this occurs.

Answer: Suicide rates tend to increase with age in adolescents. This is partly due to the fact that risk factors for suicide (including Major Depressive Disorder) also increase during adolescence. Social stressors (e.g., relationship and educational challenges, greater expectations) also increase during adolescence.

Page Reference: 428-429; Objective A1.2

Outline the 4 steps of a safety plan/contract including examples for each step.

Answer: The four steps include: know when to access help (e.g., what are my warning signs when I begin thinking of suicide?), coping skills (e.g., what can I do to take my mind off the problem?), socializing with friends and family (e.g., who are my trusted family members?), and contact professionals and agencies (e.g., I agree to contact emergency services if I continue to have suicidal thoughts).

Page Reference: 440; Objective A1.3

Essay Questions

Describe 5 of the 10 strength-based practice approaches that could be incorporated into a CYC holistic conceptual model for understanding youth suicide. Which of these do you believe would be easiest for you to incorporate into your practice and why? Which of these do you believe would be most challenging for you to incorporate into your practice and why?

Answer: Any 5 of the following 10 approaches are appropriate: build a therapeutic relationship, assess risk, plan for safety, treat and monitor suicidal behaviour, assess for and address co-occurring problems, explore cultural contexts, engage parents, engage hard-to-reach young people and families, document, strengthen professional expertise and organizational capacity.

Student responses for easiest and most challenging strategies will vary but should include a detailed rationale for their selections.

Page Reference: 433-434; Objective A.1

Outline the specific indicators you would assess for using either the SAD PERSONS scale or the IS PATH WARM mnemonic.

Suggested answer: Indicators of the SAD PERSONS scale include: sex, age, depression, previous attempts, ethanol or other drug use, rational thinking loss, social support lacking, organized plan, no spouse/partner, sickness. Indicators of the IS PATH WARM mnemonic include: ideation, substance abuse, purposelessness, anxiety, trapped hopelessness, withdrawal, anger, recklessness, mood change.

Page Reference: 438-439; Objective A.2

Abnormal or Exceptional Mental Health Literacy for Child and Youth Care Canadian 1st Edition Gural - Test Bank

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Additional Information

Reviews

Chapter 1 Perspectives: Abnormal or Exceptional?

Multiple Choice Questions

Short-Answer Questions

Chapter 2: Trauma- and Stressor-Related Disorders

Multiple Choice Questions

Short-Answer Questions

Chapter 3: Neurodevelopmental Disorders

Multiple Choice Questions

Short-Answer Questions

Chapter 4: Attention Deficits

Multiple Choice Questions

Short-Answer Questions

Chapter 5: Disruptive Behaviour

Multiple Choice Questions

Short-Answer Questions

Chapter 6: Anxiety, Obsessive-Compulsive, and Related Disturbances

Multiple Choice Questions

Short-Answer Questions

Chapter 7: Mood Disturbances

Multiple Choice Questions

Short-Answer Questions

Chapter 8: Eating Disturbances

Multiple Choice Questions

Short-Answer Questions

Chapter 9: Psychosis and Schizophrenia

Multiple Choice Questions

Short-Answer Questions

Chapter 10: Substance Misuse and Addictions

Multiple Choice Questions

Short-Answer Questions

Appendix 1: Understanding Suicide

Multiple Choice Questions

Short-Answer Questions

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