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Behavioral Med: Test 3 > Child & Adolescence > Flashcards

Child & Adolescence Flashcards

1
Q

Examples of how to interview young children

A
  1. Drawing Pictures

2. Sentence Completion Game

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2
Q

What are the 3 stages of development and age ranges?

A 
Early Adolescence (Ages 11 – 14)
Middle Adolescence (Ages 15 – 17)
Late Adolescence (Ages 18 – 24)
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3
Q

Early Adolescence Stage

A 
1. Physical
A. Physical and body growth
Social 
2. Peer group involvement 
A. increases and family involvement decreases
3. Cognitive
A. Transition from concrete to abstract thinking begins
B. Daydreaming is common
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4
Q

Middle Adolescence Stage

A
  1. Physical (No Change)
  2. Social
    A. Independence, identity and autonomy struggles intensify
    B. Peer group become more important than family; increasing teen-parent conflict
    C. Experimentation with alcohol, drugs, and sex is common
    D. A sense of invincibility and impulsivity leads to high rates of MVC
    E. Suicide increases due to failed relationships or poor-self esteem
    F. Expression of individuality (body piercing or tattoos)
    3.Cognitive
    A. Improved reasoning and abstraction allow for closer interpersonal relationships
    B. Academic and vocational plans are important
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5
Q

Late Adolescence Stage

A
  1. Physical
    A. Body growth is no longer a concern
    B. Time to become comfortable with one’s physical appearance will continue
  2. Social
    A. Development of monogamous interpersonal relationships, less time seeking peer group support
    B. Making decisions based on individualized value system, by setting limits and compromise
  3. Cognitive
    A. Vocational goals should be set
    B. Realistic expectation about education and work
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6
Q

The Medical Interview: General Health Assessment should include Risk Factors for?

A
  1. Accidents
  2. STI (HIV)
  3. Pregnancy
  4. Exercise
  5. Learning
  6. Interpersonal violence
  7. Nutrition
  8. Substance abuse
  9. Sleep
  10. Mental Health Issues
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7
Q

What is the HEADSS Format?

A
  1. Home
  2. Education
  3. Activities
  4. Drugs
  5. Sex
  6. Suicide
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8
Q

What are the goals & questions regarding home?

A
  1. Goal
    A. Determine household structure, family structure, and function, conflict-resolution skills, the possibility of domestic violence, and presence of chronic illness in the family
  2. Questions
    Who lives where you live?
    What happens when people argue in your home?
    Does anyone get hurt during argument?
    Have you ever seen your mother hit by anyone?
    Are there guns in your home?
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9
Q

What are the goals and questions regarding education?

A
  1. Goal
    A. Identify ADHD and other learning disabilities, school performance, cognitive ability, and vocational potential
  2. Questions
    What grade are you in?
    What type of grades to you get?
    How do they compare with your grades from last year?
    Have your ever been told you have a learning problem?
    Can you see the blackboard?
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10
Q

What are the goals and questions regarding activities?

A
  1. Goal
    A. Evaluate the patient’s social interactions, Internet use and purposes of use, interests, and self-esteem
  2. Questions
    What do you do for fun?
    Are you involved in school, community, or religious activities?
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11
Q

What are the goals and questions regarding drugs?

A
  1. Goal
    A. Evaluate the patient’s current habits or patterns of use. Distinguish between those who drink because of social, cultural, and peer pressure, those who are genetically predisposed, and those who drink or use illicit drugs because of co-morbid mental health problems.
  2. Questions
    Are you aware of alcohol or drug use at your school?
    Do any of your friends drink or use drugs?
    Have you ever tried alcohol or drugs?
    CRAFFT questions can be asked for teenagers suspected of substance abuse. Two or more YES answers on the CRAFFT indicate a significant problem
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12
Q

How many yes answers on the CRAFFT indicate a significant problem?

A

2 or more

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13
Q

What are the CRAFFT Questions?

A
  1. Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
  2. Do you ever use alcohol/drugs to RELAX, feel better about yourself, or fit in?
  3. Do you ever use alcohol/drugs while you are by yourself, ALONE?
  4. Do your family or FRIENDS ever tell you that you should cut down on drinking or drug use?
  5. Do you ever FORGET things you did while using alcohol or drugs?
  6. Have you gotten into TROUBLE while you were using alcohol or drugs?
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14
Q

What are the goals and questions regarding sex?

A
  1. Goals
    A. Determine the level of patient’s sexual involvement and sexuality, use of birth control, protection against STIs, and history of abuse
  2. Questions
    Have you ever been sexually involved with anyone?
    Have you ever been touched sexually when you did not want to be?
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15
Q

What are the goals and questions regarding suicide?

A
  1. Goal
    A. Identify serious mental health problems and distinguish them from normal adolescent affect and moodiness
  2. Questions
    Identify and ask about signs of depression (SIGECAPS)
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16
Q

What are the risk factors for suicide?

A
  1. Prior episode of serious depression or suicide
  2. Family history of suicide or mental health problems
  3. History of victimization
  4. Substance abuse or dependency
  5. Gay or lesbian sexual identity
  6. Availability of handguns
  7. Recent loss of significant friends or family
  8. Extreme family, school, or social stress
17
Q

What is Reactive Attachment Disorder (RAD)?

A

A complex psychiatric illness that can affect young children. It is characterized by serious problems in emotional attachments to others. RAD usually presents by age 5.

18
Q

RAD DSM V Diagnostic Criteria

A
  1. Manifested by BOTH of the following:
    A. The child rarely or minimally seeks comfort when distressed.
    B. The child rarely or minimally responds to comfort when distressed.
  2. A persistent social and emotional disturbance characterized by at least TWO of the following:
    A. Minimal social and emotional responsiveness to others.
    B. Limited positive affect.
    C. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.

The disturbance is evident before age 5 years.
The child has a developmental age of at least 9 months.

19
Q

Describe the presentation of RAD

A

Severe colic and/or feeding difficulties
Failure to gain weight
Detached and unresponsive behavior
Difficulty being comforted
Preoccupied and/or defiant behavior
Inhibition of hesitancy in social interactions
Disinhibition or inappropriate familiarity or closeness with strangers

20
Q

Treatment of RAD

A
  1. Children who exhibit signs of RAD need comprehensive psychiatric assessment and individualized treatment plan
  2. Treatment involves the child and family
  3. Therapist focus on understanding and strengthening the relationship between a child and his or her primary caregivers
  4. Without treatment, this condition can affect permanently a child’s social and emotional development
21
Q

DSM V for diagnosing Enuresis

A
  1. A frequency of AT LEAST TWICE a week for AT LEAST 3 consecutive months.
  2. at least 5 yo
22
Q

Comorbidity for Enuresis

A 
1. Psychological Disorders are 2 to 5 times more frequent in children with enuresis
A. ADHD (most common)
B. Separation Anxiety
C. Social Anxiety
D. Phobias
E. GAD
F. Depression
G. ODD
H. Conduct Disorder
23
Q

What is alarm treatment for enuresis?

A
  1. Maximum of 16 weeks, most require 8 – 10 weeks
  2. After 14 consecutive dry nights the alarm is discontinued
  3. Relapse can happen in up 30% of children
24
Q

What medication can be used for Enuresis Treatment?

A
  1. Desmopressin (DDAVP)
    A. Success in 70% of patients
    B. Taken in evening, start at 0.2 mg and may titrate to 0.4 mg after two weeks if no success
  2. Tricyclic Antidepressants (TCA) (Imipramine)
    A. Many potential side effects
    B. Usually 1 mg/kg/day, average dose 10 mg to 25 mg in evening
    C. Only used in severe therapy-resistant cases
25
Q

DSM V Criteria for Separation Anxiety

A
  1. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least THREE of the concerning Sxs
  2. Fear, anxiety, or avoidance lasting at least 4 weeks in children & adolescents & typically 6 months or more in adults
26
Q

Clinical presentation of separation anxiety disorder

A
  1. Behavioral Symptoms
    A. Crying, clinging, complaining upon separation, and searching or calling for parent after departure
  2. Physical Symptoms
    A. Headaches, abdominal pain, fainting spells, lightheadedness, dizziness, nightmares, sleep difficulties, nausea, vomiting, cramps, muscle aches, palpitations, and/or chest pain
27
Q

Separation Anxiety Comorbitity

A
  1. Anxiety Disorders (most comomon)
  2. Phobias
  3. Major depression
  4. Bipolar disorder
  5. ADHD
28
Q

Separation anxiety treatment

A
  1. First choice
    A. Psychoeducation
    B. Behavioral management
    C. CBT
  2. Second choice
    A. Medications: SSRIs

Behavioral Med: Test 3 (5 decks)

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