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Child Flashcards

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1
Q

Percentage of ADHD types in kids

A

Mixed 50-75%
Attentive 20-30%
Hyperactive <15%

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2
Q

Percentage of ADHD types in adults

A

Attentive 50-60%
Mixed 30-40%
Hyperactive 5%

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3
Q

ADHD into adulthood percentage?

A

60%
REGARDLESS OF RESPONSE TO TREATMENT
Increased risk if family history ADHD, conduct/mood/anxiety co-morbidity, psychosocial adversity

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4
Q

ADHD genetics

A

Heritability = 75%
RR 2-3 if 1st degree parent
40-60% parents with ADHD will have a kid with ADHD
25% of kids with ADHD have a parent with ADHD
DAT1, DRD4, DRD5, SNAP25

RISK IF BORN IN SEPTEMBER

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5
Q

ADHD neurobiology

A

Dopamine + norepinephrine
Smaller brain (10%) - especially basal ganglia, frontal lobe, cerebellum
Increased THETA on EEG

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6
Q

Rule-out if suspected ADHD?

A

Epilepsy, thyroid abnormalities, hypoglycaemia

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7
Q

Percentage co-morbidities kids?

A 
31% ONLY ADHD
ODD (40%)
Anxiety (33%)
Conduct (14%)
Tics (11%)
Mood (4%)

50% SUD teens have ADHD

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8
Q

Percentage co-morbidities adults?

A 
14% ONLY ADHD (adults have MORE co-morbidities)
Anxiety (50%) 
Alcohol (34%)
Drugs (30%)
Mood (25%)
Panic (15%)
OCD (13%)

2 TIMES MORE LIKELY to have SUD
(25% SUD adults have ADHD)

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9
Q

Response rate to psychostimulants?

A

80%

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10
Q

Which psychostimulant class causes more increased tics?

A

Amphetamines

Stimulants + Wellbutrin worsen tics in 33%

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11
Q

Atomoxetine is which CYP substrate?

A

2D6

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12
Q

Atomoxetine mechanism?

A

Blocks recapture of NE

Useful if co-morbid epilepsy

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13
Q

Intuniv XR

A

For 6-12 year old
Selective alpha 2 agonist (not as strong as clonidine)
Better tolerated than clonidine
Takes several weeks to work
Watch BP and tachycardia rebound if stopped abruptly

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14
Q

Impact of treating ADHD on future SUD?

A

Treating ADHD in adolescence decreases or delays substance use but NOT TRUE FOR ADULTS

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15
Q

Gilles de la Tourette co-morbidities?

A

ADHD (50%)
OCD (20-40%)
Learning d/o
Mood/anxiety d/o

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16
Q

Most common first tic?

A

Eye blinking

Obscene sx not common <10%

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17
Q

Gilles de la Tourette prognosis?

A

50-60% remission

Peaks later in childhood and decreases in adolescence

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18
Q

Gilles de la Tourette treatment

A

1st line = Intuniv, Clonidine
2nd line = Risperdal, Abilify
3rd line = Haldol, Ziprasidone, Fluphenazine, Zyprexa, Tetrabenazine
CLOZAPINE DOES NOT WORK

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19
Q

Clonidine mechanism?

A 
Presynaptic alpha 2 agonism (decreases NE)
Can give depression
No weight gain, no seizures
Hot flash in menopause
Hypersialorrhea in clozapine
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20
Q

Clonidine doses?

A

0.3mg max in kids in divided doses
0.3-1.2mg max in adults in divided doses
INTOXICATION RESEMBLES THAT OF OPIOIDS
INTERACTS WITH BETA-BLOCKERS (they EXACERBATE withdrawal from Clonidine)

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21
Q

ASD co-morbidity?

A 
70% have one mental disorder
40% have at least 2 mental disorders
ADHD (50%)
ID (30%)
Epilepsy (10-35%)
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22
Q

ASD epidemiology

A

Prevalence 1%
4M : 1F
Girls more likely to have intellectual disability (possibly because those without go unrecognized as ASD)

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23
Q

ASD heritability?

A

90%

If one child has ASD, 5-10% chance sibling will as well

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24
Q

ASD associated genetic conditions?

A 
Fragile X (x-linked)
PKU (recessive)
Tuberous Sclerosis (dominant)
Neurofibromatosis (dominant)
Angelman (dominant)
Cri du chat (dominant)

15% have known genetic mutation (not fully penetrant)

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25
Perinatal factors associated with ASD?
``` Advanced paternal age Perinatal complications Low birth weight First born Premature < 24 weeks ```
26
IQ tests
WPPSI 3-7yo (Weschler preschool and primary) WISC 6-17yo (Weschler intelligence scale for children) WAIS 17yo and adults (Weschler adult intelligence scale)
27
Rx in ASD?
NO EVIDENCE FOR SSRI in treating anxiety/rigidity Risperdal, Haldol, Abilify, Zyprexa Stimulants not efficacious and poorly tolerated overall (methylphenidate better than amphetamine)
28
Vineland scale ASD?
``` Measures adaptive behaviour in 4 areas: communication daily life skills socialisation motricity ```
29
Language domains? (4)
Phonology Grammar Semantic Pragmatic
30
Expressive language d/o co-morbidities?
ADHD (19%) Anxiety (10%) ODD/CD (7%)
31
Childhood onset fluency disorder (stuttering) criteria?
NEED ONE out of 7 INTERJECTIONS IS NOT A CRITERIA RR 3 if first degree relative has it 65-85% recover; severity at 8yo good prognostic factor NOT ASSOCIATED WITH LANGUAGE DISORDER
32
Social (Pragmatic) Communication disorder
Associated with language disorder (unlike stuttering), ADHD, behavioural d/o, learning d/o
33
Learning disorder risk factors?
Prematurity Low birth weight Prenatal NICOTINE
34
Learning disorder epidemiology?
Prevalence 10% in kids, 4% in adults | 2-3M : 1F
35
Most common cause of language delay?
Intellectual deficit
36
Enuresis
Must be at least 5 YEARS OLD Nocturnal 80%, more boys Diurnal, more girls Primary at 5 years old, secondary 5-8 years old Higher risk if father had history than mother
37
Encopresis
Must be at least 4 YEARS OLD | Usually due to constipation (80%)
38
Impact of parental separation?
20-25% problems with adaptation in adolescence 33% develop psych problems More problems than if parent deceased
39
AN severity?
``` BMI <18.5 needed for diagnosis Mild >17 Moderate 16-16.99 Severe 15-15.99 Extreme <15 ```
40
AN-Restrictive specifier?
No recurrent binge/purge x 3 MONTHS
41
Post-prandial vomiting?
Superior mesenteric artery syndrome
42
Bulimia timing?
Binge + purge happening on average 1x per week x 3 MONTHS
43
Bulimia severity?
Mild 1-3 behaviours/week Moderate 4-7 Severe 8-13 Extreme 14 and more
44
Binge eating disorder timing?
1x / week x 3 MONTHS
45
Rumination disorder
Repeated regurgitation x 1 MONTH Associated with ASD and ID Treatment with HABIT REVERSAL (not aversive techniques)
46
PICA
Persistent eating non-nutritive non-food substances for at least ONE MONTH CANNOT DIAGNOSE BEFORE AGE 2 Watch out for iron and zinc deficiencies Associated with ASD, ID, negligence, pregnancy
47
Other specified eating disorders?
Atypical anorexia nervosa (normal BMI) Bulimia nervosa of low frequency or short duration Binge eating disorder of low frequency or short duration Purging disorder (in absence of binges) Night eating syndrome (have awareness and recall)
48
Risk factors for ED?
Female, adolescent, DM1 (RR2), homosexuality (MEN ONLY, protective for women), oriental culture (bulimia ONLY), athletes, family history, dysfunctional family, overprotective family, childhood/parental obesity
49
Indications for hospitalization in ED?
``` HR < 40 or > 110 BP < 90/60 (80/50 adolescent) Orthostatic changes Hypoglycemia < 3.3 Hypokalemia < 3 (2.5 adolescent) Hyponatremia < 125 Hypothermia < 36 Dehydrated, organ problems, low PO4, low Mg SI with plan and intetion Weight < 85% healthy weight Low tx motivation NG feeding/supervision (better to give continuous, better tolerated) Familial conflict ```
50
AN co-morbidities
MDD 65% OCD 25% (before ED) Cluster C traits
51
Bulimia co-morbidities
MDD 50% GAD, SAD, OCD, PD SUD 30% Cluster B, BPD
52
AN good prognostic factors
EARLY START (<15 years old) < 3 years of symptoms Normal weight within 2 years Good relationship with parents
53
AN treatment
FBT 1st line (Structural = Minuchin, Strategic = Haley) CBT not as good as in bulimia but good after normal weight Zyprexa (level B) Risperdal, Seroquel (level C) SSRIs only work once NORMAL weight CAREFUL QT PROLONGATION Weight gain 1kg/week inpatient, 0.5kg/week OPD
54
Bulimia treatment
CBT first line IPT, Psychodynamic, Family/Couple, DBT ``` SSRIs (Prozac 60-80mg, Zoloft, Celexa) NO WELLBUTRIN (risk of seizures) ```
55
Refeeding syndrome
Day 4-14 Increased glucose, increased insulin Increased metabolism (requires PO4, Mg, K) Increased risk if <70% normal weight and enteral feeding Careful with carbohydrates ATP NEEDS PO4 Monitor daily x 5 days then q2d x 3 weeks
56
Bulimia abnormalities
Metabolic ACIDOSIS with laxatives Metabolic ALKALOSIS with vomiting (low K, low Cl) Trousseau + Chvostek sign (hypocalcemia) Russel (abrasions on back of hand)
57
Osteoporosis
Normal 1.5 to -1.5 Osteopenia -1.5 to -2.5 Osteoporosis < -2.5
58
Lab changes in EDs?
INCREASED Urea, amylase, cortisol, cholesterol, AST/ALT, carotene, T3, GH, CRH DECREASED FSH/LH, electrolytes, glucose, T4, vit B12, folic acid, Hg, WBC, Plts, thiamine, niacin, albumin, estrogen/testosterone
59
ODD criteria?
Lasting 6 months At least 4 symptoms (out of 8 in categories of angry/irritable mood, argumentative/defiant, vindictiveness), at least one person other than sibling If < 5yo would expect on most days If > 5yo would expect at least once per week Severity depending on number of settings mild 1 setting moderate 2 settings severe 3 or more settings M>F before adolescence and EQUAL after adolescence
60
ODD co-morbidities?
ADHD 30-65% Anxiety 14% Mood 15-20% (MDD 9%) Learning and language disorder
61
ODD prognosis?
33% will develop CD 10% will develop ASPD 66% no longer meet criteria at 3yo Significant predictor of future mental disorders
62
CD criteria?
At least 3/15 in past 12 months At least 1/15 in last 6 months ``` 4 categories Aggression to people or animals Destruction of property Deceitfulness or theft Serious violation of rules ``` For stays out past curfew and skips school (if < 13yo) Runs away overnight x 2 or longer period x 1
63
CD specifiers?
Childhood < 10 yo Adolescent > 10 yo With limited prosocial emotions AT LEAST 2 in 12 months - lack of remorse/guilt - lack of empathy - unconcerned about performance - shallow affect Severity
64
CD co-morbidities?
``` ADHD (36%) Anxiety (22-33%) Mood (15-31%) SUD Dissociation Somatoform (MORE FEMALE PRESENTATION) Learning d/o (30-40%, especially READING and verbal capacity) ID TBI Seizures ```
65
CD risk factors?
``` Young mother Large chaotic family, low supervision Hostility in divorced parents Genetic (hx ASPD or CD) Anxious-avoidant attachment Chronic illness (RR3), neuro illness (RR5) Dense population (urban) ```
66
CD neurobiology
``` DECREASED SEROTONIN (low 5-HIAA in CSF) Less conversion of dopamine to NE (low dopamine B-hydroxylase) Low cortisol in saliva Increased testosterone Slow cardiac rhythm ``` MZ twins = 50% DZ twins =25%
67
CD prognosis?
40% convert to ASPD (30-50% if childhood onset, 25% if adolescent onset) GIRLS HAVE WORST PROGNOSIS
68
CD treatment?
Tx ADHD also decreases sx of CD Stimulant > Strattera = Intuniv > Clonidine If no ADHD, Risperdal or Epival If also impulsivity and tics, 2nd generation AP DON'T USE BENZO = disinhibition + paradoxical response DON'T USE LITHIUM, TEGRETOL, SEROQUEL OR HALDOL
69
IED criteria?
Either - verbal/physical aggression not resulting in harm 2x/week x 3 months OR - behavioral outburst resulting in damage (to property or person) x 3 in last 12 months Not premeditated or for secondary gains Have to be AT LEAST 6 YEARS OLD Usually show REMORSE
70
IED tx?
Anticonvulsant, Lithium, Antipsychotics, Trazodone, Buspirone
71
Congenital causes of heart anomalies?
1. Trisomy 21 | 2. Di George
72
Trisomy 21 risk?
1/1000 if < 45 yo 1/50 if > 45 yo Non-dysfunction (95% of cases) Mosaicism (1-2%) Translocation (2-3%)
73
Trisomy 21 issues?
Intellectual deficiency Alzheimer's dementia (4th decade, increased b-amyloid, 21q21.1) Epilepsy
74
Most frequent preventable cause of ID?
Fetal alcohol syndrome
75
Most common cause of malformation and intellectual deficit due to maternal infection?
Rubella

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