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Flashcards in Ped Psychiatry Deck (50)
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1

What do ped mental illnesses result in? How can this be prevented?

- these are very common and results in sig. morbidity and mortality
- profound long term consequences
- early dx for kids with new onset mental illness essential in order to maximize clinical outcomes

2

How can primary care clinicians help make an impact on ped mental illnesses?

They have a critical role:
- for prevention
- early ID/screening
- early intervention/engagement
- referral/collaborative care (w/ MH professionals)
- monitoring progress in care
- care coordination

3

WHat are the barriers to enhancing MH care in primary care settings?

- ambivalence/variability
- discomfort
- time constraints
- poor payment
- variable access to MH speciality resources
- administrative barriers to MH services
- limited information exchange with MH specialists
- stigma

4

How can we help with mental illnesses at the individual family level?

- form a trusting relationship
- understand the emotional turmoil
- teach how to access MH services
- provide resources
- family advocacy organization

5

What advice can you give the parents with a child with a disability?

- seek the assistance of other parents
- know that you are not alone
- rely on positive resources in your life (church, counselors)
- take it one day at a time
- seek information (internet, support groups, bright futures book - set of prinicples and strategies that are theory-based, evidence-driven that can be used to improve health and well-being of all children)
- don't be intimidated
- maintain a positive outlook
- find programs for your child
- take care of yourself
- keep daily routines as normal as possible
- most imptly - keep your sense of humor

6

The child's existence and emotional development depends on what?

- family or care givers - cooperation with family members...need written consent
- use of psych-pharmacotherapy is less common in comparison to adult psychiatry
- the developmental stages are very impt assessment of dx

7

How do you approach an adolescent pt?

- no judgements or assumptions
- lay down rules of confidentiality:
outline rules
not absolute
ask them to explain what they think it means and have alone time with pt
- HEADSSS assessment

8

What does HEADSSS stand for?

- Home: how are things going at home, do you get along with everyone?
- Education: what school do you attend? How are your grades? How many days have you missed?
- Activities: what do you do after school? DO you have a job, best friends?
- Drugs: do any of your friends smoke, drink alcohol, use drugs? Have you ever tried? Any family troubles with alcohol or drugs?
- Sex: do you have a sig. other? how long have you been going out? Do you get along? Have you had sex? Do you know how to protect yourself from preg., STIs, AIDS?
- Suicide/depression: how have your moods been? Do you ever feel down or depressed? Have you ever felt like hurting yourself or suicide? Do you know of anyone who has committed suicide?
- Safety: are things safe in your home, at school, in neighborhood? Has anyone tried to hurt you? Physically, sexually?

9

Define intellectual disability?

- neurodevelopmental disorder with multiple etiologies that encompass a broad spectrum of fxning, disability, and strengths
- usually presents b/f 18

10

Define global developmental delay?

- term applied to kids under 5 who fail to meet expected developmental milestones and have significant impairments in several areas of fxning
- these kids may grow out of this

11

2 components to intellectual disability? What are the clinical features?

- components:
adaptive behavior
intellectual fxning

- clinical features:
parent concerns
younger sibling overtake an older child
fails to meet expected developmental milestones
- difficulty with learning or immaturity, if severly affected - present b/f 2

12

What are the causes of intellectual disability?

- genetic in more than 50% (down syndrome most common)
- embryonic development
- prenatal causes include congenital infections, congenital hypothyroidism, and teratogens including alcohol, lead and valproate
- envior deprivation ( hypoxia, trauma)
- heriditary abnormalities

13

Screening tools for intellectual disability?

- ages and stages questionnaire
- bayley infant neurodevelopmental screener (BINS)
- brigance screens-II
- infant toddler checklist for language and communications
- parent's eval of developmental status (PEDS)
* if any of the tools suggest developmental delay a multidisciplinary approach is recommended - refer on!

14

DSM V criteria for intellectual disability?

- IQ = 70 or less (defecits in intellectual fx)
- concurrent deficits or impairments in adaptive fxning in at least 2 of the following areas:
communication
self-care
home living
social/interpersonal skills
use of community resources
self-direction
fxnl academic skills
work
leisure
health
safety
- onset b/f 18

15

Tx of intellectual disability?

- early intervention program
- multidisciplinary team support
- family support and counseling

16

What are the typical learning disabilities?

- dyslexia
- dysgraphia
- dyscalculia
- ageometria
- anarithmia
- anomic aphasia

17

How common is dyslexia? What pop does it affect the most?

- 15% of public shool kids
- more often found in boys than girls
- tends to run in families
- often occurs in people with ADHD

18

Signs and sxs of dyslexia?

- delayed language production
- speech articulation difficulties
- difficulties remembering the names of letters, numbers and colors
- reversals or visual confusion can occur (was becomes saw, -on - no, m-w)

19

Individuals with dyslexia commonly have what problems?

- processing and understanding what they hear
- they may have difficulty comprehending rapid instructions
- following more than one command at a time
- remembering the sequence of things
- reversals of letters (b-d)
- reversal of words (saw for was)
- may try to read from R to L
- may fail to see (and occasionally to hear) similarities and differences in letters and words
- may not recognize the spacing that organizes letters into separate words
- may be unable to sound out ponunciation of an unfamiliar word

20

Screening and dx for dyslexia?

- no single test
- dx involves an eval of:
medical
cognitive
sensory processing
educational
psychological factors
- vision, hearing, and neuor exams
- other evals: psychological assessment

21

Tx of dyslexia?

- no known way to correct the underlying brain malfxn that causes dyslexia
- tx is by remedial education
- psychological testing will help ID the areas pts need to work on
- may use techniques involving hearing, vision, and touch to improve reading skills. Helping an individual to use several senses to learn - ex: listening to taped lesson and tracing with a finger the shape of the words spoken - can help them process the info
- most impt teaching approach may be frequent instruction by a reading specialist who uses these multisensory methods of teaching

22

Prognosis of dyslexia?

- tutoring may involve several individual or small-group sessions each week
- progress may be slow
- milder forms of dyslexia: often eventually learn to read well enough to succeed in school
- severe dyslexia: may never be able to read well and may need training for vocations that don't reqr strong reading skills

23

What does dyscalculia mean?

- math disability - difficulty performing math calculations

24

Signs and sxs of dyscalculia?

- difficulty understanding:
number lines
carrying and borrowing numbers
word problems

25

Strategies for improvement of dyscalculia?

- allow use of fingers and scratch paper
- use diagrams and draw math concepts
- provide peer assistance
- suggest use of graph paper

26

What is dysgraphia?

- learning disability resulting from the difficulty in expressing thoughts in writing
- DSM V: impairment in writing expression

27

What do kids have difficulties with in dysgraphia?

- handwriting (fine motor or graphomotor)
- grammar and syntax
- formulating, expressing, and organizing ideas in writing
- spelling "encoding" - ability to use sound-letter relationships effectively

28

Dysgraphia results in what?

- in irregular letter sizes and shapes, mix of upper and lower case letters, or print and cursive letters
- contributes to difficulties in using writing as communication tool
- causes writing fatigue
- interferes with communication of ideas in writing
- results in unfinished letters and letter inconsistencies

29

How is dysgraphia dx and tx?

- dx: licensed psychologist who specializes in learning disabilities
- tx:
accommodations
modifications
remediation (use graph paper)

30

What are the 2 elimination disorders commonly seen in kids?

- enuresis: repeated voiding of urine during day or night into bed or clothes
- encopresis: repeated passage of feces into inappropriate places