Valerie Crandall, MDPediatric Behavior Medicine

Johns Hopkins UniversityBaltimore, MD

Disruptive behavior Apprehension—false starts Indecision Withdrawal Brief physical contacts—touch and

release Hyperactivity

Non-compliance Recurrent abdominal pain—RAP

(no organic basis) Asthma Pruritis Facial expressions

Neatness-- +/- Friendship retention

Nature / Nurture Nature reflects social capacity on an

organic basis—brain centers Nurture reflects patterning, rearing,

learning, physical and emotional security

Co-morbidities—(transient) Situations Losses Missed opportunities (games, trips, etc.)

Chronic illness Cancer Diabetes Cystic fibrosis Epilepsy “I’m different”

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

anxiety/depression

EmotionalPhysical

Situational

Self esteemSelf image—physical health

Stability/consistency…security

Bedwetting—outgrow by age 4, familial Night terrors (Pavo Nocturnus) Night walking—outgrow in 6 mos.

…all believed to reflect CNS immaturity

Remove stress—especially for night terrors Reassure—still “clearly wrong”; concentrate Emotional security

Increased volume of Superior Temporal Gyrusass’d with increased anxiety

Posterior right hemisphereass’d with GAD (generalized anxiety disorder)

Amygdala/Hippocampus (Fear and fear-related centers)

Larger and more electrically active…ass’d with increased anxiety states

in turn, influences social behaviorin turn, programs frontal lobe

…factors influencing social development

(Pediatric Social Security)

Clues (all ages): Peer relationships Dating relationships Pain—especially chronic No victimization

Think about security Promotes self-control

…..self discipline

Anger Anger management

BE CALM…..NOT CONFRONTATIONAL

Examples: Breath holding Stomping Screaming

List of options: Ignore Give child some space Offer a diversion Investigate what is frustrating the child Enhance communication by pointing to possibilities Hug to reassure…but don’t invade space if needed Speak calmly, preferably eye-to-eye Laugh…don’t mock Relocate

…..if not, question a possible mental cause

Asberger’s syndrome Bipolar disorder (2% of adults)

Hormone rages Responses are learned

…so, self examination is a good idea

Time Personal space

Depression, Anxiety, Rage Social development

physical, emotional, situational

Children mimic…model from parents and

teachers