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

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