childhood psych

Question 1

symptoms and stress in kids

Answer 1

Symptoms can masquerade, I dont want to go to school, may mask:
trouble learning (learning disability, vision/ hearing problems

Social problems- Autism, bullying, awkwardness

Embarrassment (family discord, bullying

Trauma (new or re-experiencing

Anxiety- social, separation, general, panic

Mood-depressed, irritable

Boredom- too easy

Being overwhelmed
Think about intellectual disability, may not be able to articulate specifically what is upsetting, they just know they are upset

Infant cant tell you he is cold, hungry, in pain–> he just cries

my tummy hurts,

Question 2

Stress/distress clues

Answer 2

behavioral clues- developmental context, aggression (verbal/physical), avoidance/refusal- hiding making excuses, isolating/withdrawing, oppositional, sleep/ appetite changes

Usually folks get better at recognizing and articulating distress first, dealing with it is more complex

Question 3

Affect changes

Answer 3

Mood is our subjective experience

Affect is the objective- Distressed, anxious, crying, hiding, difficult to console, irritable

Somatic sx- GI, Headache (most common), aches and pains

Stress makes you regress to an earlier stage

Question 4

With development, capacity to manage stress changes

Answer 4

2 yo + limit setting = temper tantrum (typicla)

Keep in mind when emotional or language development lags, kids may look older but act younger- including how they communicate distress

13 yo + limit setting= temper tantrum (atypical)

Question 5

Children dont develop in vacuums

Answer 5

Child is influenced by factors such as - parent, family, school and peers, extra curriculars, society at large

Question 6

Stress in kids can take may forms

Answer 6

is it developmentally appropriate, if the child had sufficient skill to manage it, what would that look like

is the stressor necessary- resilience, cannot shield children from never experiencing pain, anxiety, distress, disappointment–> development is learning and adaptation

Question 7

most psychiatric illness has component of distress

Answer 7

symptoms must cause clinically significat impairment or distress

Question 8

a mental disorder

Answer 8

a syndrome characterized by clinically significant disturbance in an individuals cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental process underlying mental functioning

Question 9

Neurodevelopmental disorders (things that stick with you thru life), COMMUNICATION and motor skills disorders

Answer 9

Speech- expressive production of sounds including articulation, fluency, voice, resonance quality

Language- form function and use of symbols (spoken words and signs ) in a rule goverend manner for communication

Communication- any verbal or non verbal behvior that influences the behavior ideas or attidudes of another individual

Question 10

Stuttering now called fluency disorder

Answer 10

Abnormalities in fluency and time patterning of speech, in a bout 60% of cases stuttering remits on its own

Question 11

Language disorder

Answer 11

lumps this as diffiuculties in acquisition and use of language across modalities due to deficits in comprehension or production

Expressive language disorder- can understand/comprehend, but you cant use spoken language to communicate

Mixed receptive expressive language disorder- cant understang and use spoken language

Question 12

Clinical relevance of language disorder

Answer 12

How does your pt give you a history, how does your pt learn, how do they retain information, how do you do pt teaching in ght office

Question 13

Learning disorders (LDs)

Answer 13

Considerably lower than expected achievement on a standardized test in reading, mathematics or written expression (2 SDs between achievement and IQ)

Must be differentiated from a lack of opportunity, poor teaching, cultural factors, intlecetual disability, ASD, sensory deficit

must substanitally impede academic achievement or daily living activities that require the deficient skill

Requires IQ test and test of specific ability

Reading- problems with word recognition, reading comprehension, oral reading (omissions, distortions, substitution), Dyslexia is a specific type of reading disorder

Math (dyscalculia)- problems with understanding or naming mathematical operations (carrying numbers, multiplication tables)

Written expression- problems with punctuation, spelling paragraph organization

No way to treat, just work around it

Question 14

Clinical relevance of learning disability

Answer 14

following directions on prescriptions,follow up etc

Question 15

Neurodevelopmental disorders within motor disorders- tic disorders

Answer 15

Tic disorders- sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization

Tourettes disorders, chronic motor or vocal tic disorder, transient tic disorders

Question 16

Tourettes disorder

Answer 16

both multiple motor and >1 vocal tic occuring multiple times a day for more than a year

no mor than 3 consecutive mo without sx

Onset before 18, <10% of cases involve coprolalia, boys> girls 7-10 yrs old

wax and wanes with stress, temporarily can be toned down high OCD co morbid

Question 17

ADHD (attention deficit hyperactivity disorder)

Answer 17

At least 6 sx of either 1 or 2

Inattention- fails to give close attn to details, makes careless errors, difficulty sustaining attn, lack of follow thru, difficult organizing, avoids mentally effortful tasks, forgetful, loses things, distracted by irrelevant stimuli

Hyperactivity-impulsivity- fidgets, leaves seat, runs excessively, trouble playing quietly, on the go as if driven by a motor, talks excessively, impatient interrupts others, blurts out answers

Sx must be present ber 12 yo, have persistent for 6 mo, and present in 2 or more settings, and cause significant impairment

Question 18

ADHD types

Answer 18

Combined type- 6 or more sx of inattention AND hyperactivity-impulsivity

Predominanly inattentive type (ADD)- 6 in attn sx, fewer HI sx

Predominantly HI type- 6 HI, but fewer inattn

5% of all kids meet the criteria, 4-9x more common in boys than girls, high comorbidity (25% of hyperactive also have emotional disorder), (20% also diagnosed with a LD)

Not treating–> selfesteem issue, academic, social relationships, substance use

Question 19

ADHD etiology

Answer 19

brains of kids with ADHD are 3-4% smaller (prefrontal cortex, and basal ganglia), brain development parallels normal

MZ (65%)>DZ (33%)

Neurotransmitters- Decreased DA availability (psychomotor activty, reward seaking behavior- stimuli functioning less effectively as reinforcers)

Question 20

ADHD pharmacotherapy

Answer 20

Stimulants (methylphenidate or amphetamine based derivatives increase DA availability)

Benefits- effective for majority of cases, rapid acting (15-20 min lasts 2-4 hrs), long release

limitations- not all children improve, undesirable side effects- somatic, growth suppression)
Changes only persist as long as drug regimen continues

Dopamine increase–> psychosis

non stimulants- to some extent increase NorE, atomoxetine, guanfacine, clonidine, bupropion

Question 21

ADHD behavioral therapy

Answer 21

Parent management training and educational interventions
Behavior mod techniques- consistency- increase positive engagement, modify environment, use rewards and penalty (tangible, rather than social)

Question 22

Disruptive, impusle control, and conduct disorders can be comorbid with ADHD

Conduct disorder

Answer 22

The kid wihtout any empathy, IMMORAL

Conduct disorder (CD)- chornic violation of the rights of others or rules as manifested by 3 or more of the following in the past year with at least one criteria in the past 6 months

Aggression to people and animals- bullies, threatens, physical fights, use of a weapon, physical cruelty stealing with confrontation, forced sexual activity

Destruction of property- fire setting with intent, deliberately destroyed property

Deceitfulness or theft- B E, lies to gain or avoid, stealing without confrontation

Serious violation of rules- breaks curfew, run away from home, truancy

If 18 yo rule out antisocial personality disorder

Question 23

Oppositional defiant disorder (odd)

Answer 23

I have morals but im going to push the button
sx are similar but less severe than those of CD

Pattern of negativistic, hostile, and definat behavior lasting at least 6 mo, during which 4 or more of the following are present, you cant tell me what to do

Loss of temper, argumentativeness with adults, refuses to comply with rules, deliberately annoys others, blames others, easily annoyed, angry and resentful, spiteful and vindictive

Question 24

ODD etiology

Answer 24

prevalence about 3.3%, boys> girls prior to adolescence, not after

Temperamental factors, environmental factors (harsh parenting), genetic and physiological factors

ADHD often comorbid

DDx- CD, DMDD, ADHD, ID, lanuage, anxietty

Question 25

ODD, CD treatment

Answer 25

Combination of behavior therapy and family therapy, medication- mixed findings, almost never sufficient, must be used with other interventions

Clinical relevance- ODD can cause significant disruption in function, labels follow kids

CD into antisocial personality disorder- the cold, calloused individual- behavioral consequences (prison) often more effective than emotional (it makes someone feel bad)

Question 26

Depressive disorders- DMDD (disruptive mood dysregulation disorder)

Answer 26

Status irritabilicus
Severe recurrent verbal/behavior temper outbursts out of proportion to situation or provocation

Inconsistent with developmental level, temper outbursts on average 3+/wk

Mood between outbursts is persistently angry or irritable

12 month, no more than 3 month sx free

2/3 setting and severe in at least 1 setting

Age of onset before 10 yrs

Do not dx<6 y or after 18 y

exclude MDD, never more than 1 day where (aside from duration) met mania hypomanid

Rates of conversion to bipolar are low and it is far more liekely to convert to anxiety or MDD

Question 27

MDD (major depressive disorder)

Answer 27

Same criteria as adults, irritability, not a low depressed mood, is often the main state for kids and adolescents, this comes out as anger in some

this comes out as anger in some

Significant impact on functioning if untreated– including suicide

Question 28

MDD clinical relevance

Answer 28

MDD is the #1 source of disability worldwide, comorbind conditions sufferp how take DM meds if dont see future

Depressed parents impact kids- early attachment, not to mentions loss of productivity and enjoyment

Question 29

Separation anxiety disorder

Answer 29

developmentally inappropriate, excessive anxiety about separation from home or from an attachment figure evidenced by >3 of the following:
Distress- worry about harm, getting lost, or kidnapping; school refusal, reluctant to be alone, sleep refusal, nightmares with separation theme, somatic complaints

Lasts>4 4weeks in kids, 6 months in adults

Question 30

Selective mutism

Answer 30

failure to talk in particular social situations when there is expectation of speaking (liek school), must last for more than 1 month, not limited to the first month of school, occurs despite talking in other situations and language competence

Question 31

Social ansiety disorder (social phobia)

Answer 31

fear about one or more sociat situatiions where individual may be exposed to scrutiny by others, kids- must occure in PEER setting not just adults

Fears will act in anxious way that will lead to a negative evaluation

Social situaitons almost always provoke fear and anxiety- kids crying, tantrums, freezing, clinking, shrinking, failure to speak

Persistent >6m, fear is out of proportion to actual threat

Question 32

Generalized anxiety disorder

Answer 32

excessive worry most days, at least 6 months, about number of events or activities

Person has a hard time contolling worry

Associated with 3+ (only 1 in kids)- reslessness, feeling on edge, easy fatigue, difficulty concentration/mind going blank, irritability, muscle tension, sleep disturbance, impairment and distress, rulouts

Too much anxiety not good

Question 33

Reactive attachment disorder

Answer 33

consistnet pattern of inhibited, emotionally withdrawn behavior toward adult caregivers

Child has experienced extremes of insufficient care, social neglect or deprivation, repeated changes of primary caregivers, rearing in settings with high child- caregiver ratio

Evident before age 5

Disorder present at least 12 months, exclude ASD

Question 34

Disinhibited social engagement disorder

Answer 34

Pattern of behavior where child actively approaches and interacts with unfamiliar adults- indiscriminate approaching of strangers, overly familiar, not checking back with caregivers

Child has experienced extremes of insufficient care - social neglect, or deprivation, repeated changes of primary caregivers, rearing in setting with high child:caregivers

developmental age of child at least 9 months, disorder present at least 12 months, exclusion criteria

Question 35

PTSD in kids 6y or younger

Answer 35

Exposure to actual or threatened death, serious injury, sexual violence (direct experience/witness/learning of trauma to caregiver

1 or more intrusion symptons since event- intrusive memories, dreams, dissociative reactions (flashbacks), distress of trauma event symbols, physiological reaction to reminders

1 or more avoidance or negative alterations in cognitions- - avoiding activites, places physcial reminders- avoiding people, conversations, interpersonal frequency of negative emotional states, less interest inactivites (include constricted play) social withdrawal, reduction in expression of positive emotions

Alterations in arousal and reactivity, duration of disturbance is >1 month

Question 36

Pica

Answer 36

eating things youre not supposed to

Question 37

feeding disorder of infancy or early childhood

Answer 37

failure to thrive

doesnt eat enough with weight loss or no wt gain for >1 moth

onset at 6 (not a lack of food or other mental disorder)

usuallin in the beging of life but develops as lates as 2 or 3

Can gain weight without

Question 38

Encopresis

Answer 38

Repeated involuntary or sometimes intnetional passage of feces into places not appropriate for that purpos (clothing floor

Must occur>1x/month over 3 months

must be 4 yo

child ofteen feels ashamed/embarrassed

Enuresis- awake/asleep wettings (2x week for 3 months), after 5

Question 39

gender dysphoria

Answer 39

incongruence between sex and gender

across ages- marked incongruence between experienced and assigned gender, 6 months duration

In children - more concrete examples of behaviors

In adolescenece- includes a desire to rid self of primary and/or secondary sex charachteristic

Question 40

Neglect most common form of abuse

Answer 40

physical abues, and sexual abuse, emotional abuse, risk factor for developing other disorders, often by close caregivers