Disruptive, Impulse Control, and Conduct Disorders; Neurodevelopmental Disorders Flashcards by Alice Richards

what are the neurodevelopmental disorders (2)

ADHD
autism spectrum disorder

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3 hallmarks of ADHD

problems paying attention
excessive activity
diffiulty controlling behavior

that are not appropriate for person’s age

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dsm 5 for ADHD

-hyperactivity, impulsivity, or inatentiveness manifesting prior to 12 yo
- >6 symptoms of inattention, hyperactivity-impulsivity that developmentally inappropriate and last > 6 months
-symptoms occur in more than 1 setting (ex school AND home)

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for dx, symptoms of ADHD must occur prior to age

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tx for ADHD

stimulants:
methylphenidate
mixed amphetamine salts

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features commonly associated w. ADHD

-low self esteem
-dpn
-demoralization
-lack of ability to take responsibility for actions

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common social characteristics of ADHD kids (7)

-immature
-bossy
-intrusive
-loud
-uncooperative
-out of synchrony w. expectations
-irritating to peers and adults

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t/f: ADHD kids are more likely to sustain injuries

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mc person to make dx of ADHD

schoolteacher

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ddx for ADHD

-adjustment d.o
-anxiety d.o
-bipolar d.o
-mental retardation
-specific developmental d.o
-drugs
-systemic d.o (hyperthyroidism)
-odd or conduct d.o

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bipolar d.o in kids often manifests as a chronic mixed affective state marked by (3)

irritability
overactivity
difficulty concentrating

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what 2 drugs are associated w. ADHD symptoms in kids

phenobarbital (sz)
theophylline (asthma)

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t/f: rates of ADHD are higher in preschool kids than school-age kids

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when is ADHD mc in boys?
when is it mc in girls?

boys: childhood
girls: young adulthood

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2 mainstay stimulants of ADHD

methylphenidate
dextroamphetamine

96% of kids respons positively

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available doses of methylphenidate

short acting - ritalin
intermediate-acting - ritalin SR
long acting - concerta

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available doses of dextroamphetamine

short acting
long acting

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distractor ADHD drug that was removed from the market due to liver toxicity

pemoline

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ADHD is specified by severity based on

social/occupational functional impairment

mild vs mod vs severe

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3 types of ADHD

prdominantly inattentive
predominantly hyperactive/impulsive
combined

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inattentive sx

-lacks attention to details/makes careless mistakes
-difficulty sustaining attention in tasks
-does not listen to what is being said
-does not follow through on instructions/does not finish tasks
-difficulty organizing tasks/activities
-avoids undesireable tasks
-often loses things necessary for tasks
-easily distracted by external stimuli
-forgetful in ADLs

-pt must have 6 x 6 mo

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hyperactive/impulsive sx of ADHD

-fidgeting or tapping
-leaving seat often
-running/climbing inappropriately
-difficulty w. leisure/relaxation
-can’t sit still
-excessive talking
-blurting out answers
-can’t wait in line
-interrupting/intruding on others

-6 sx x at least 6 mo

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t/f: ADHD is one of the most heritable psychiatric disorders

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t/f: diet, esp sugar, is a cause of ADHD

f!!

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comorbidities associated w. ADHD

*antisocial personality d.o *substance use disorder other developmental d.o conduct d.o/odd bipolar tourette syndrome pervasive developmental d.o mental retardation

t/f: stimulants are more effective than CBT for ADHD

t! but stimulants + CBT is most effective first line tx

autism spectrum disorder (ASD) encompasses (4)

-autistic disorder -childhood disintegrative disorder -pervasive developmental disorder - not otherwise specified -asperger disorder

what do you think when you see a child w. normal cognitive development but poor relationships who does not spontaneously seek activities w. others

asperger d.o

disruption of social interaction and languate at age 3 or earlier

autistic disorder

patients diagnosed w. autism spectrum disorder present with developmental delay in (3)

socialization language cognition

dsm 5 for ASD

1. social communication and social interaction deficit in many contexts such as: -lack of social-emotional reciprocity -lack of nonverbal communicative behaviors -impairment in developing, maintaining, and understanding relationships 2. restricted or repetitive patterns of behavior, interests or activities such as -motor movements that are stereotyped or repetitive -inflexibility to change -restricted and fixated interests -hyper or hyporeactivity or unusual interest in sensory stimulus 3. sx must be present in early developmental period w.o other etiology (ex hearing dysfxn) 4. sx can not be explained by other condition

tx for ASD

refer audiology eval behavioral therapy second gen antipsychotics +/- 1st gen antipsychotics SSRIs +/- EEG

what are second gen antipsychotics used to treat in ASD (2)

aggression/hyperactivity mood lability

what are SSRIs used to treat in ASD

stereotyped/repetitive behavior

what is echolalia

involuntary repetition of a word or sentence just spoken by another person

echolalia might mask

deficiency in language skills in autistic pt

common findings in autistic patients (8)

lower IQ language symbolic thinking sterotypic behaviors self-stimulation self-injury seizures mental retardation

what are sterotypic behaviors

-repetitive non productivemovements of hands and fingiers -rocking -meaningless vocalizations

t/f: most autistic patients are in the mentally retarded range

autism is mc in _ (girls or boys), and mc presents before age _

boys 1 yo

CT-H finding of autism

enlarged ventricles

EEG findings of autism

normal

most autistic children are brought to provider because of poor

speech development

what are the disruptive, impulse control, and conduct disorders (2)

conduct disorder oppositional defiant disorder

what do you think when you see a child who was referred to your office for unusual animal cruelty and bullying at school

conduct disorder

definition for conduct disorder

repetitive and persistent pattern of behavior in which the basic rights of other or major age-appropriate social norms or rules are violated

dsm 5 for conduct disorder

-at least 15 symptoms from 4 of the following categories in the past 12 months (one must be present w.in the last 6 months): 1. aggression to people and animals 2. destruction of property 3. deceitfulness or theft 4. serious violations of rules

conduct disorder is often seen as the precursor to

antisocial personality disorder

most effective tx for conduct disorder is one that seeks to

integrate individual, school, and family settings

treatment for conduct disorder should also address

familial conflicts ex marital discord or maternal dpn

what do you think when you see a child who back talks and resists following instructions from parents or authorities - but is not aggressive towards people or animals, does not destroy property, and does not show a pattern of theft or deceit

oppositional defiant disorder (odd)

3 hallmark characteristics of odd

angry/irritable mood argumentative/defiant behavior vindictiveness

dsm 5 for odd

at least 4 sx for 6 months from any of the following categories exhibited during interaction w. at least on person who is NOT a sibling: -frequent temper tantrums -arguments w adults/authority -does not conform to rules/regulations -intentional exasperation of others -easily annoyed by others -revenge-seeking/vindictiveness -angry attitude -harsh and unkind

tx for odd

CBT family therapy peer groups mood stabilizers antipsychotics stimulants

common comorbidity w. odd

ADHD

2 antipsychotics that have been shown to be effective for odd

haldol thiordazine

what are the behaviors included in conduct d.o (11)

1. stealing 2. running away from home 3. staying out after dark w.o permission 4. lying as to "con" ppl 5. setting fires 6. repeatedly being truant before 13 yo 7. vandalizing 8. animal cruelty 9. bullying 10. physical aggression 11. forcing sexual activity

for dx of conduct d.o, _ behaviors must be present

main characteristic of behaviors included in conduct d.o

they violate the rights of others

adolescents who have conduct d.o are predisposed to the development of what other 2 disorders

antisocial personality ADHD AUD

what factors are thought to contribute to the development of conduct d.o (9)

1. temperament 2. parents who provide attention to problem behaavior and ignore good behavior 3. association w. a delinquent peer/group 4. a parent "role model" of impulsivity and rule-breaking behavior 5. genetic predisposition 6. marital disharmony 7. placement outside the home as an infant/toddler 8. poverty 9. low intelligence quotient or brain damage

CBT is the mainstay of tx for conduct d.o, but what are some drugs that are used

alpha agonists mood stabilizers bb antipsychotics

pharm for conduct d.o targets what 2 symptoms

aggression agitation

a child has normal cognitive development, poor relationships, and does not spontaneously seek activities w. others

asperger

disruption of social interaction and languate at age 3 or earlier

autism

a child is referred to your office for unusual animal cruelty and bullying at school

conduct d.o

a child is found to back talk and resist following instruction from parents or authorities

oppositional defiant d.o

an 8 yo who is disruptive in class, always fidgeting, has difficulty concentrating, and does not complete assignments

ADHD

Disruptive, Impulse Control, and Conduct Disorders; Neurodevelopmental Disorders Flashcards

(68 cards)