Flashcards in Psychiatric Disorders in Children Deck (46):
Pervasive developmental disorders of childhood are characterized by:
1. Failure to acquire.
2. The early loss of social skills and difficulties with language.
3. Resulting in lifelong problems in social and occupational functioning.
The pervasive developmental disorders are reversible?
Management of pervasive developmental disorders of childhood involves?
Behavioral therapy to:
1. Increase social and communicative skills.
2. Decrease behavior problems (eg self injury).
3. Improve self-care skills, as well as supportive therapy and counseling to parents.
Autism spectrum disorders (ASD) - Characteristics of autistic disorder, a severe form of ASD, include:
1. Significant problems with communication (despite normal hearing).
2. Significant problems forming social relationships (including those with caregivers).
3. Restricted range of interests; do not play imaginative games.
4. Repetitive purposeless behavior (eg spinning, self-injury).
5. Below-normal intelligence in 25-75% of children with autistic disorder.
6. Unusual abilities in some children (eg expectional memory or calculation skills) = Savant skills.
Asperger disorder is ...?
A MILD FORM OF ASD.
Asperger disorder involves:
1. Significant problems forming social relationships.
2. Repetitive behavior and intense interest in obscure objects (eg models of 1940s farm tractors).
In CONTRAST to autistic disorder, in Asperger disorder there is ...?
NO DEVELOPMENTAL LANGUAGE DELAY.
--> Conversational language skills are often impaired.
Occurrence of ASD:
About 13 children per 10.000.
ASD - They begin before age ...?
ASD - The disorders are ... times more common to boys.
Abnormalities that give clues for the neurobiological etiology (no psychological causes have been identified) of ASD include:
1. Cerebral dysfunction - 25% develop seizures.
2. A history of perinatal complications.
3. A genetic component (eg higher concordance rare in monozygotic twins than in dizygotic twins).
4. Evidence of total brain as well as AMYGDALE overgrowth during the first few years of life.
5. Abnormalities in the hippocampus, fewer Purkinje cells in the cerebellum.
6. Less circulating OXYTOCIN + Dysregulation of serotonin synthesis.
Other pervasive developmental disorders - Rett disorder involves:
1. Diminished social, verbal, and cognitive development after up to 4 years of normal functioning.
2. Occurrence ONLY IN GIRLS (Rett disorder is X-linked, specifically Xq28, and affected males die before birth).
3. Stereotyped, hand-wringing movements, ataxia.
4. Breathing problems.
5. Mental retardation.
6. Motor problems later in the illness.
Childhood disintegrative disorder involves:
1. Diminished social, verbal, cognitive, and motor development after at least 2 years of normal functioning.
2. Mental retardation.
ADHD + The disruptive behavior disorders (eg conduct disorder and oppositional defiant disorder) are characterized by ...?
Inappropiate behavior that causes difficulties in social relationships and school performance.
ADHD - Is there mental retardation?
NO MENTAL RETARDATION.
ADHD - Common or uncommon?
UNCOMMON - Often seen in boys.
DDx of ADHD includes?
1. Mood disorders.
2. Anxiety disorders.
ADHD - If the behavioral abnormalities ...?
Occur only in one setting (eg only at home or only at school), these disorders are not diagnosed, rather, relationship problems (eg with either parents or teachers) must be explored.
ADHD - Characteristics (Must be present in at least 2 settings, eg at home and at school):
5. Propensity for accidents.
6. History of excessive crying, high sensitivity to stimuli, and irregular sleep patterns in infancy.
7. Symptoms present before age 7.
Conduct disorder - Characteristics (must be present in at 2 settings, eg, at home and at school):
1. Behavior that grossly violates social norms (eg torturing animals, stealing, truancy, fire setting).
2. Can begin in childhood (ages 6-10) or adolescence (no symptoms prior to age 10).
Oppositional defiant disorder - Characteristics (Must be present in at least 2 settings, eg at home and at school):
1. Behavior that, while defiant, negative, and concompliant, does NOT grossly violate social norms (eg anger, argumentativeness, resentment toward authority figures).
2. Gradual onset, usually BEFORE AGE 8.
ADHD - Prognosis:
1. Hyperactivity is the 1st symptom to disappear as the child reaches adolescence.
2. Risk for conduct disorder and oppositional defiant disorder.
3. Most children show remission by adulthood.
Conduct disorder - Prognosis:
1. Risk for criminal behavior, antisocial personality, substance abuse, and mood disorders in adulthood.
2. Most children show remission by adulthood.
Oppositional defiant disorder - Prognosis:
1. A significant number of cases progress to conduct disorder.
2. Most children show remission by adulthood.
ADHD - Etiology - Genetic factors:
Relatives of children with conduct disorder and ADHD have an increased incidence of these disorders and of ANTISOCIAL PERSONALITY DISORDER + SUBSTANCE ABUSE.
ADHD - Etiology - Structural brain lesions?
Although evidence of serious structural problems in the brain is NOT present, children with conduct disorder + ADHD may have MINOR BRAIN DYSFUNCTION.
ADHD - What is likely to be seen in PARENTS of these children?
1. Substance abuse.
2. Serious parental discord.
3. Mood disorders.
--> The children are more likely to be abused by parents or caretakers.
Is there a scientific basis for claims of an association between ADHD and either improper diet (eg excessive sugar intake) or food allergy (eg artificial colors or flavors)?
ADHD - Management - Pharmacologic?
1. Methylphenidate (Ritalin, Concerta).
2. Dextroamphetamine sulfate (Dexedrine).
3. Combination of amphetamine/dextroamphetamine (Adderall).
4. Dexmethylphenidate (Focalin).
5. Atomoxetine (Strattera) = NE reuptake inhibitor.
For ADHD, CNS stimulants apparrently help reduce ...?
1. Reduce activity level.
2. Increase attention span and the ability to concentrate.
3. Antidepressants may also be useful.
For ADHD - Stimulant drugs decrease ...?
Appetite, they may inhibit growth and lead to FAILURE TO GAIN WEIGHT.
--> Both growth and weight usually return to normal once the child stops taking the medication.
What is the MOST EFFECTIVE MANAGEMENT for conduct disorder and oppositional defiant disorder?
Separation anxiety disorder - Often incorrectly called?
SCHOOL PHOBIA - Because the child refuses to go to school.
Separation anxiety disorder - Characterized by ...?
An overwhelming fear of loss of a major attachment figure, particularly the MOTHER.
Separation anxiety disorder - The child often complains of ...?
Physical symptoms (eg stomach pain or headache) to AVOID GOIND TO SCHOOL AND LEAVING THE MOTHER.
Separation anxiety disorder - The most effective management:
To have the mother accompany the child to school and then, when the child is more comfortable, gradually decrease her time spent at school.
Individuals with a history of separation anxiety disorder in childhood are at ...?
Greater risk for anxiety disorder in adulthood, particularly AGORAPHOBIA.
Children (more commonly GIRLS) with this RARE disorder speak in some social situations (eg at home) BUT NOT IN OTHERS (eg at school).
--> The child also may WHISPER or COMMUNICATE WITH HAND GESTURES.
Selective mutism - Must be distinguished from?
Elimination disorders - Enuresis and encopresis - Typically most children are bowel and bladder trained by age ...?
The elimination disorders encopresis (soiling) and enuresis (wetting) are NOT DIAGNOSED UNTIL after age ... and ... years, respectively.
4 and 5 years, respectively.
After medical factors (eg UTI) are ruled out, the MCC of enuresis is ...?
Management of enuresis (in order of utility) includes?
1. Restricting fluids after dinner.
2. Use of a bell and pad apparatus.
3. Use of pharmacologic agent such as DESMOPRESSIN ACETATE (a synthetic analog of ADH) or a cyclic antidepressant such as IMIPRAMINE at bedtime.
Management of enuresis - What is the bell and pad apparatus?
A pad that can sense moisture is placed under the child at night.
--> If the pad becomes wet, a buzzer goes off which eventually wakens the child.
--> By NEGATIVE REINFORCEMENT the child eventually wakes before wetting at night.
What is the role of the desmopressin acetate and imipramine?
BOTH agents reduce nocturnal urine output --> Desmopressin is preferred because it has fewer side effects.