Flashcards in Ped Psychiatry Deck (50)
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
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
WHat are the barriers to enhancing MH care in primary care settings?
- time constraints
- poor payment
- variable access to MH speciality resources
- administrative barriers to MH services
- limited information exchange with MH specialists
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
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
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
How do you approach an adolescent pt?
- no judgements or assumptions
- lay down rules of confidentiality:
ask them to explain what they think it means and have alone time with pt
- HEADSSS assessment
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?
Define intellectual disability?
- neurodevelopmental disorder with multiple etiologies that encompass a broad spectrum of fxning, disability, and strengths
- usually presents b/f 18
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
2 components to intellectual disability? What are the clinical features?
- clinical features:
younger sibling overtake an older child
fails to meet expected developmental milestones
- difficulty with learning or immaturity, if severly affected - present b/f 2
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
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!
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:
use of community resources
fxnl academic skills
- onset b/f 18
Tx of intellectual disability?
- early intervention program
- multidisciplinary team support
- family support and counseling
What are the typical learning disabilities?
- anomic aphasia
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
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)
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
Screening and dx for dyslexia?
- no single test
- dx involves an eval of:
- vision, hearing, and neuor exams
- other evals: psychological assessment
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
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
What does dyscalculia mean?
- math disability - difficulty performing math calculations
Signs and sxs of dyscalculia?
- difficulty understanding:
carrying and borrowing numbers
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
What is dysgraphia?
- learning disability resulting from the difficulty in expressing thoughts in writing
- DSM V: impairment in writing expression
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
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
How is dysgraphia dx and tx?
- dx: licensed psychologist who specializes in learning disabilities
remediation (use graph paper)