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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?

- 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


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:
outline rules
not absolute
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?

- 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


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:
home living
social/interpersonal skills
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?

- dyslexia
- dysgraphia
- dyscalculia
- ageometria
- anarithmia
- 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:
sensory processing
psychological factors
- 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:
number lines
carrying and borrowing numbers
word problems


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
- tx:
remediation (use graph paper)


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


Who does enuresis affect?

- 5 mill kids in US
- usual ages 4-5
- primary or secondary


What are common causes of enuresis?

- failure to arouse
- increase production of urine while asleep
- overactive bladder
(can be genetic - usually from father)

other causes:
psychiatry/psychology -
stressors (social - new sibling)
become withdrawn and anxious

daytime incontinence -
bladder overactive


How do you dx enuresis?

- hx
- PE
- voiding diary:
timing of daytime voids, vol of voided urine, lower urinary tract sxs
- UA with PVR (can child empty bladder)
- abdominal x-ray


Tx of enuresis?

- stop fluids b/f bedtime
- scheduled night waking
- alarms

- meds:
DDAVP - first line

* positive reinforcement encouragement - give the kid a sticker!


How common is encopresis?

- affects 1.5% of young school kids
- 80% of kids have underlying constipation
- 2 types:
primary - never was potty trained


How does encopresis occur?

- stool retention in the colon
- intestinal walls and nerves stretch
- retained stool becomes harder
- liquid stool passes around retained hard feces


Clinical presentation of encopresis?

- repeated soiling of their underwear
- child denies both the visible and olfactory signs of soiling


Psychological effects of encopresis?

- struggle within the family
- conflict in other areas of child's life


Dx encopresis?

- abdominal x-ray
(see stool in colon)


Management and tx of encopresis?

-educate child on bowel fxn
- behavior or reward systems
- psychological counseling

4 goals - *est regular bowel habits, *reduce stool retention, *restore normal physiological control over bowel fxn, *defuse conflicts and reduce concerns
- initial phase: enemas/strong laxatives
- maintenance phase: 2 -3 months, scheduled regular toilet times, daily laxatives, proper diet: fiber


How common is autism? Etiology?

- prevalence in US 1-68 kids
- 4x more common in males
- etiology unclear: genetic and non-genetic factors
- no consistent psychopathologic pattern has been reported in parents of autistic children
- 90% concordance in monozygotic twins


What is autism?

recognized as neurodevelopmental disorder that affects the fxning of brain:
-not bad parenting
-it is not a behavioral, emotional, or conduct disorder
- there are no medical tests that can be used to dx autism


What is classic autistic disorder?

- very limited emotional connection with anyone and they are very into their own world
- they want everything to be the same all of the time (routine for everything)
- can be deeply effected by noises, bright lights, and smells
- generally considered to be low fxning


Key dx factors of autism?

- severe deficits in social responsiveness and interpersonal relationships
- abnormal speech and language development
- verbal and nonverbal communication impairment
- repetitive, rigid, or stereotyped interests or behaviors
- onset before age 3 yrs


What will you see in first year of life and toddlers that have autism?

- severe deficits in reciprocal social interaction (huge emotional toll on parents)
1st year of life:
delayed or absent social smile
- failure to anticipate interaction with parents
- lack of attention to parent's face
-deficiences in imitative play
-lack of interest in interactions with others
- language development delay


Sxs of kids with autism spectrum disorder?

- communication: avoid eye contact, act as if deaf, develop language, then abruptly stop talking, fail to use spoken language w/o compensating by gesture
- exploration of enviro:
remain fixated on single item or activity, repetive actions like rocking or hand flapping, sniff or lick toys or put unusal objects in mouth or need toys to chew on, show no sensitivity to burns or bruises, show distress over change, lack fear
- social relationships: act as if unaware of the coming and going of others, are inaccessible, as if in a shell, fail to seek comfort, fail to develop relationships with peers, have problems seeing things from others preson's perspectivies, leaving child unable to predict or understand other people's actions, may physically attack and injure others w/o provocation


Complications of autism?

- 30% eventually develop seizure disorder
- those with higher cognitive abilities may become depressed as they become aware of their deficits
- some adults live in 24 hr care facilities or reqr immense community support


DSM 5 autism spectrum disorder levels of rank?

- rank level of severity by how much support is needed in communication and behavior
- level 1: requiring support
- level 2: reqring substantial support
- level 3: reqring very substantial support


Tx of autism spectrum disorders?

- autistic kids reqr specialized therapy and special schooling and residential schooling although attempts of integrations are also started
- special techniques for teaching autistic kids and special psychotherapeutic approaches were developed
- sometimes antipsychotic drugs and antidepressants are used to cope with aggressive behavior and depression or to tx co-morbid psychiatric diagnoses

specialized therapeutic and teaching approaches:
-applied behavioral analysis (ABA)
- picture exchange communication system (PECS)
- early start denver model (ESDM)
- more than words
- tx and education of autistic and communication related handicapped kids (TEACCH)
- child's talk


What is your job as primary care provider with peds pts?

- screen and refer!!!
- M-CHAT (checklist for autism in toddlers - 18-24 months of age)
- STAT: screening tool for autism in toddlers and young kids
- surveillance at q visit by asking 3 questions: does you child look at you and pt when he/she wants to show you something?
Does your child look when you pt to something?
Does your child use imagination to pretend play?