Child Psychiatry Flashcards
(46 cards)
1
Q
what are the criteria to diagnose ADHD?
A
- persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development
- several symptoms present before age 12 (~6th grade)
- several symptosm present in 2+ settings
- symptoms interfere with or reduce quality of socail, academic, or occupational functioning
- symptoms not better explained by another disorder
2
Q
what are inattention symptoms in ADHD?
A
6+ for >6 mo (or 5+ if over 17 yo), “often”
- fails to give close attention to details/careless mistakes
- difficulty sustaining attention in tasks or play
- doesn’t listen when spoken to directly
- doesn’t follow instructions or fails to finish activities
- difficulty organizing tasks/activities
- dislikes/avoids tasks that need sustained mental effort
- loses things for tasks/activities
- easily distracted by extraneous stimuli
- forgetful in daily activities
3
Q
what are hyperactivity symptoms in ADHD?
A
6+ for >6 mo (or 5+ if over 17 yo), “often”
- fidgets (fingers), taps hands/feet, squirms (trunk)
- leaves seat when supposed to sit (adults look uncomfortable)
- runs around or climbs inappropriately
- unable to play or work quietly
- is often “on the go” or “driven by a motor”
- talks excessively
- blurts out answers
- difficulty waiting turn
- interrupts or intrudes on others
4
Q
what are behavioral ADHD treatments?
A
- direct contingency management (rewards/punishments)
- teacher training
- parent management training (PMT)
- -focus on parent-child interactions
5
Q
what are oppositional defiant disorder criteria?
A
- pattern of angry/irritable mood, argumentive/defiant behavior, or vindictiveness lasting > 6 mo
- disturbance in behavior is associated with distress in the individual or others in his/her immediate social context, or impacts negatively on social, educational, occupational, or other important areas of functioning
- don’t occur during course of psychotic, substance use, depressive, or bipolar disorder
6
Q
do adults get ODD?
A
no, it becomes a personality disorder
7
Q
what is disruptive mood dysregulation disorder?
A
if one is disruptive + ODD
8
Q
what are symptoms for ODD?
A
must have 4+ symptoms in any category, occuring with at least 1 person who is not a sibling
- angry/irritable mood
- often loses temper
- often touchy or easily annoyed
- often angry and resentful - argumentive/defiant disorder
- often argues with authority figures or adults
- often actively defies or refuses to comply with requests from authority figures or with rules
- often deliberately annoys others
- often blames others for his/her mistakes or behavior - vindictiveness
- has been spiteful or vindictive at least 2x within 6 mo
9
Q
what is the severity of ODD?
A
mild - symptoms confined to one setting
moderate - some symptoms present in at least 2 settings
severe - some symptoms present in 3+ settings
10
Q
what is treatment for ODD?
A
- parent child interaction therapy (PCIT)
- uses both attachment and social learnign principles
- teaches authoritative parenting - nurturing, good communication, firm control
- differential social attention to shape behavior - problem-solving skills training (PSST)
- focus on cognitive process - parent management training (PMT)
- only the parent, not the child
11
Q
what is hostile attribution bias?
A
seen in ODD; child immediately assumes others are against him, thus acts hostile toward said person
12
Q
what are conduct disorder criteria?
A
- repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by at least 3 symptoms in the past 12 mo (but at least 1 present in past 6 mo)
- disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning
- if the individual is >18 yo, criteria are not met for antisocial personality disorder
13
Q
what are the symptoms seen in CD?
A
- aggression to people and animals
- often bullies, threatens, or intimidates others
- often initiates physical fights
- has used a weapon that causes serious harm
- has been physically cruel to people
- has been physically cruel to animals
- has stolen while confronting a victim
- has forced someone into sexual activity - destruction of property
- has deliberately engaged in fire setting to cause serious damage
- has deliberately destroyed others’ property - deceitfulness
- has broken into someone else’s house, building, or car
- often lies to obtain goods or favors, or to avoid obligations
- stolen items of nontrivial value without confronting victim - serious violations of rules
- often stays out at night despite parental prohibitions (before age 13)
- has run away from home overnight at least twice, or once without returning for a lengthy period of time
- is often truant from school (before age 13)
14
Q
what is the onset of conduct disorder?
A
childhood: show at least 1 symptom before age 10
adolescent: show no symptoms before age 10
unspecified: criteria are met, but not enough info to determine if onset was before or after age 10
15
Q
specify conduct disorder with limited prosocial emotions
A
must display 2+ of the following persistently over at least 1 year in multiple relationships/settings:
- lack of remorse/guilt
- callous (lack of empathy)
- unconcerned about performance
- shallow or deficient affect
16
Q
treatment for conduct disorder?
A
- multisystemic therapy (MST)
- addresses and intervenes on multiple risk factors at multiple levels
- focus on understanding behavior in context - multidimensional treatment foster care (MTFC)
- community based alternative to residential treatment
- child lives in foster care for 6-9 mo while parents receive PMT - functional family therapy
- family systems approach: understands function of misbehavior - anger control training (more effective in children than adolescents
- PSST
- PMT
17
Q
what is pervasive developmental disorder (autism spectrum disorder)?
A
neurological disorders characterized by “severe and pervasive impairment in several areas of development” (social interaction, communication)
- autism spectrum disorder (autistic and Asperger’s disorder)
- childhood disintegrative disorder
- Rett’s disorder
18
Q
what is the definition of autism?
A
- abnormal or impaired development in social interaction and communication
- restricted repertoire of interests
- manifestations of disorder vary greatly depending on developmental elvel and age
19
Q
what is the prevalence of autism?
A
typically diagnosed within first 3 years
- 1:68 individuals, and 4x more prevalent in boys than girls
- not affected by SES, lifestyle, and educational levels
- growing at 10-17% per year (1-2/1000 a decade ago)
20
Q
what are characteristics of autism?
A
- speech
- doesn’t babble or coo by 12 mo
- doesn’t gesture by 12 mo
- doesn’t say single words by 16 mo or two-word phrases by 24 mo
- has any loss of any language or social skill at any age - social interaction
- doesn’t pretend play or show interest in other children
- doesn’t point at objects to indicate interest, or bring and show objects to parents
- doesn’t enjoy peek-a-boo, hide-and-seek, or other social games - personality
- insistence on sameness and routines
- difficulty in expressing needs
- repeating words or phrases instead of normal language
- showing emotion for reasons not apparent to others
- prefers to be alone; aloof manner; don’t want to cuddle
- tantrums, self-injurious, aggressive
- inappropriate attachments to or engagement with objects
21
Q
what is Asperger’s syndrome?
A
now part of Autism spectrum disorder
- impairments in social interactions (eye contact, motor behavior, posture, facial expressions)
- restricted range in interests, behavior, activities
- no delays in language or other communication problems
- tend to have above average IQ (may be very smart)
22
Q
what is childhood disintegrative disorder?
A
marked regression in multiple areas following 2 years of normal development
- normal speech, play, social and adaptive behavior
- after 2 yo, lose at least 2 (but usually all) previously held skills
- -language, social skills, toileting, play, motor skills
- at this point, disorder resembles autism
23
Q
what is Rett’s disorder? does it happen in girls or boys more?
A
development of specific deficits after a period of normal functioning following birth
- normal prenatal and first 5 mo development
- after 5 mo, head growth rate decelerates
- lose previously acquired hand skills
- -gradual over 5 to 30 mo; hand wringing
- develop problems with social interaction, locomotion, and language
- occurs only in girls
24
Q
what is the assessment of autism?
A
no medical tests to diagnose, so must be based on observation of individual’s communication, behavior, and developmental levels
25
treatment of autism
for symptoms
1. discrete trial instruction (DTI) is most effective method of acquiring new behavior (teach how to copy adults)
- AKA applied behavior analysis
2. reinforcement-based treatments most effective for decreasing problematic behavior
- functional analysis
3. new forms of antipsychotic meds and stimulant meds are most commonly prescribed
26
what are the criteria for intellectual disability?
1. subaverage intellectual functioning (IQ at or below 70)
2. deficits in adaptive functioning (2+)
- communication, self-care, social skills, self-direction, academics, work, safety, etc.
3. onset before age 18
27
what is mild intellectual disability?
IQ 50-70
- most people with it (~90%)
- similar to non-ID kids for first few years of life
- achieve ~6th grade academic level
- can support self with minimal supervision
28
what is moderate intellectual disability?
IQ 35 to 50
- academic skills up to 2nd grade
- benefit from extensive social and vocational training
- can perform unskilled or semi-skilled tasks under supervision
29
what is severe intellectual disability?
IQ 20 to 35
- can acquire some basic self-help skills (self-feeding)
- can learn to count or "read"
- can perform simple tasks under close supervision
- require assistance for most activities and daily life
30
what is profound intellectual disability?
IQ below 20
- may have difficulty with simple tasks, even under close supervision
- need significant training to develop vocational, self-care, and communication skills
- function best in highly-structured settings
31
what is the course of intellectual disability?
chronic - person with MR may eventually not meet diagnostic criteria with sufficient training
- lack of age-appropriate interest in activities
- 1-3% of population
- about twice as common in males
32
what are causes of intellectual disability?
- unknown: 30-40%
- Xmal abnormalities: 30%
- environment or other mental disorders: 15-20%
- pregnancy problems: 10%
- heredity: 5%
- medical conditions: 5%
33
what is challenging behavior seen in autism?
1. repetitive behaviors are "essential" feature - stereotyped movements
2. display "associated" feature of disorder
- self-injury, aggression, property destruction, pica
34
what are negative consequences of challenging behavior in autism/
1. social isolation
2. impact on educational/vocational training
3. tissue damage due to self-damage
4. infection
5. blindness and self-amputation
6. death
35
self-injurious behavior
autistic person deliberately produces physical damage to his/her own body
-stereotypic movement disorder results in bodily damage that requires specific treatment, or would if protective measures weren't used
36
what are criteria for pica?
1. eating one or more nonnutritive substances on a persistent basis for a period of at least 1 month
2. eating is inappropriate to person's developmental level
3. eating item is not culterally sanctioned practice
37
destructive behavior in challenging behavior?
acts in which an individual physically harms another person (aggression) or immediate environment (disruption)
- no specific DSM code for this behavior when associated with autism
- -often coded as disruptive behavior disorder
38
what are most common medications for autism?
stimulants, then antipsychotics, then SSRIs
- only 27% of children take medication (rates increase with age)
- complementary and alternative medicine are growing in popularity when younger, but rates decrease with age
39
what are the medications considered if repetitive behavior, behavioral rigidity, and O/C symptoms?
SSRIs, atypical antipsychotics, valproic acid
40
what are the medications considered if hyperactivity, impulsivity, inattention?
stimulants, A2 agonists, atomoxetine, atypical antipsychotics
41
what are the medications considered if aggression, explosive outbursts, self-injury?
atypical antipsychotics, A2 agonists, anticonvulsants, SSRIs, B-blockers
42
what are the medications considered if sleep dysfunction?
melatonin, ramelteon, A2 agonists, mirtazapine
43
what are the medications considered if anxiety?
SSRIs, buspirone, mirtazapine
44
what are the medications considered if depressive phenotype?
SSRIs, mirtazapine
45
what are the medications considered if bipolar phenotype?
anticonvulsants, atypical antipsychotics, lithium
46
behavioral treatment for autism?
focuses on identifying and modifying environmental correlates of problem behavior
- process of functional behavior assessment
- -identified as 'best practice" for ASD by AAP
- behavioral treatments have been effective, particularly if non-responders
- treatment is intensive, expensive, and rare
- involves extensive data collection
