Child and Adolescent Development

Question 1

APGAR stands for…

Answer 1

Activity
Pulse
Grimace
Appearance
Respiration

Question 2

APGAR 0

Answer 2

No response, blue-gray, pale all over

Question 3

APGAR 1

Answer 3

Arms and legs flexed
<100bpm
Grimace
NML appearance, except extremities
Slow, irregular respirations

Question 4

APGAR 2

Answer 4

Active movement
>100 bpm
sneeze, cough, pulls away
NML appearance over entire body
Good respirations, crying

Question 5

APGAR scores @ 1 minute

Answer 5

3-4 indicates severe CP depression and requires immediate resuscitation
5-6 indicates mild CNS depression

Question 6

APGAR score @ 5 minutes

Answer 6

score >/= 8 indicates NML CP exam

Question 7

Neonatal reflex where hand closes over finger

Answer 7

Palmar grasp; disappears by 2m

Question 8

Neonatal reflex where when head is turned, the same-side arm and leg are extended and the other-side arm and leg are flexed

Answer 8

Tonic neck/fencing reflex; disappears by 7-8m

Question 9

Reflex where when head is held erect, neonate takes steps

Answer 9

Stepping; disappears by 2-4m

Question 10

Reflex where they’re startled by loud noise or abrupt movement, arms flail out then flex and adduct

Answer 10

Moro; disappears by 3-6m

Question 11

Reflex with extension of toe when sole is stroked

Answer 11

Babinski; disappears by 1y

Question 12

Two principles of child development

Answer 12

Cephalo-caudal: babies gain control of their head before their legs and feet
Proximo-distal: babies have control of large, coarse movement muscle groups before fine motor muscle groups

Question 13

What are developmental characteristics of infancy?

Answer 13

• Piaget’s sensorimotor period (birth to 2)
• 12-18m: object permanence
• Mothereese, babbling, echolalia (repeating what others say), first words
• primitive fine motor movement precedes voluntary (grasp reflex gone by 2m)
• ulnar to radial progression of grasp
• pronation precedes supination
• hand preference develops around 1-3 y

Question 14

What are developmental characteristics of toddlers?

Answer 14

• 18m-3y
• 18m: climb stairs, run awkwardly, telegraphic speech (2 words)
• “walkie-talkie” walk @ 1, talk @ 2
• By 3y - NML conversation
• Play is solitary or parallel
• Bladder by 4 y, bowel by 3 (day time continence is easier/sooner)
• fears: animals, strangers, dark, being lost
• temper tantrums common; toddlers can’t easily delay gratification, suppress anger, see another’s perspective

Question 15

Enuresis

Answer 15

inability to control bladder by age 5

Question 16

Encopresis

Answer 16

Inability to control bowel by age 4

Question 17

Animism example

Answer 17

Clock is buzzing because it’s excited morning is here

Question 18

Artificialism example

Answer 18

windy because a huge fan is blowing

Question 19

Egocentrism example

Answer 19

sun rises to keep me warm

Question 20

Transductive reasoning

Answer 20

child must take medicine because the doctor put otoscope in their ear

Question 21

What are developmental characteristics of preschool/kindergarten kids?

Answer 21

• cooperative play begins
• age 3-6
• animism, artificialism, egocentrism, transductive reasoning
• increasing preference for same age playmates
• increasing sex-stereotyped play
• group and competitive sports introduced
• motor development: 3 - ride tricycle, climb stairs alone, put on shoes; 4 - throw ball overhand, work fasteners, use utensils properly; 5 - skip, hop, complex activities like swimming, skating

Question 22

What are developmental characteristics of school-aged kids?

Answer 22

• Piaget’s stage of concrete operations
• ages 6-12
• concept of conservation, concept of reversibility
• peer contact increases, same sex peer relationships become especially close
• mastery, competition
• brain fully developed by 6
• by 10, adult sleep pattern

Question 23

single most predictive piece of information for development is…

Answer 23

parental concern

Question 24

categories for parental concern

Answer 24

Emotional/behavioral, speech-language, social skills, self-help skills, gross motor, fine motor, global

Question 25

decision making process for developmental screening

Answer 25

1. elicit/probe parent concern 2. categorize 3. screen 4. monitor 5. refer 6. counsel/inform/reassure

Question 26

Adolescent development in girls

Answer 26

Breasts bud by age 8 Pubic, axillary, leg hair by 9/10 Menarche about 2 years after breast budding

Question 27

Adolescent development in boys

Answer 27

Increased testicular volume/penile length by age 9 Pubic, axillary, facial hair by 12 voice change when penis elongates nocturnal emission at about 13

Question 28

transition through adolescence involves mastery of...

Answer 28

Independence, body image acceptance, peer relationships, and identity

Question 29

Co-occuring disorders

Answer 29

Mental health condition and SUD ASD and other mental health dx anxiety and depression serious deficits in other social determinants of health

Question 30

recommendation for mental health screening

Answer 30

asymptomatic children >/= 5 years annually for mental health disorders and impaired psychosocial functioning Additional indications: psychosocial concerns by family, family disruption, poor school performance, behavioral difficulty, recurrent somatic complaints, involvement of social service

Question 31

important elements of a screening tool

Answer 31

reliability, validity, sensitivity, specificity

Question 32

Early adolescence 10-13y

Answer 32

- Independence: less interest in parental activities and reluctance to accept parental advice, emotional lability - Body image: self preoccupation, rapid physical changes, increase interest in sexual anat/phys - Peers; increase dependence on peers, intense same-sex friendships - Identity: increased cognition and abstract thought, idealistic goals, increased privacy need, impulsive need for immediate gratification

Question 33

Middle adolescence 14-17y

Answer 33

- Independence: peak parental conflict - Body image: acceptance of body/efforts to make body more attractive - Peers: peak peer involvement, relationships less exploitive and more sharing - Identity: increased scope of feelings, increased intellectual ability, omnipotence feelings > risk taking

Question 34

Late adolescence 17-21+

Answer 34

- Independence: reacceptance of parental advice and rules - body image: acceptance of pubertal changes - peers: peer group less important, seeks true intimacy - identity: refinement of values, realistic goals, developing ability to set limits, compromise, delay gratification

Question 35

Depression

Answer 35

Period of at least 2 weeks during which there is either depressed mood or loss of interest in nearly all activities + 4 other sx - Anger or hostility - Changes in eating or sleeping habits - Fatigue or lack of energy - Hopelessness - Feelings of guilt or worthlessness - Poor school performance - Lack of motivation - Difficulty concentrating - Tearfulness or frequent crying - Restlessness - Agitation - Unexplained aches or pains - Thoughts of death or suicide (with or without a plan)

Question 36

what quick screening tool is used for depression?

Answer 36

PHQ-2 - over the last 2 weeks, how often have you experienced? 1. little interest or pleasure in doing things 2. feeling down, depressed, or hopeless

Question 37

ADHD

Answer 37

- Neurodevelopmental disorder characterized by hyperactivity, impulsivity, inattention, distractibility - sx present in at least 2 settings - onset of sx before age 12

Question 38

Oppositional defiant disorder

Answer 38

``` -pattern of negative, hostile, and defiant behavior lasting at least 6m Exhibits >/= 4 of... -Arguing with adults -Loss of temper -Defy/refuse to comply with requests -Deliberately annoy people -Blame others for their mistakes -Angry and resentful -Spiteful and vindictive ```

Question 39

Conduct disorder

Answer 39

-Pattern of behavior in which other people's basic rights are violated or social rules and norms are broken 3 of the following in the past 12m and at least 1 in past 6 m -aggression to people and animals (destruction of property) -deceitfulness and theft -serious violations of rules -onset in childhood Antisocial behavior in indiv >18y