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1
Q

What is ADHD

A

A NEURODEVELOPMENTAL disorder

Difficulty maintaining attention, executive functioning (initiating/organizing/maintaining tasks), and impulsivity

Doesn’t always occur with hyperactivity (ADD)

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2
Q

Inattentive type of ADHD

A

Easily distracted and bored, difficulties completing tasks

more common in girls

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3
Q

Hyperactive-impulsive type of ADHD

A

Difficulty sitting still, blurts things out, impatient

more common in boys

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4
Q

What is the most common type of ADHD

A

Combination of inattentive and hyperactive-impulsive type

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5
Q

What causes ADHD

A

Unclear, large link to GENETICS, potential link to ENVIRONMENT (smoking/etoh during pregnancy, high levels of lead exposure)

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6
Q

How is ADHD diagnosed

A

Rule out other medical causes for behaviours (vision/hearing deficits, undetected seizures, learning disabilities)

ADHD symptoms checklist

Impairment rating scale

Physical exam

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7
Q

Common comorbidities with ADHD

A

ODD, CD, ANXIETY, MOOD DISORDER, SUD, TOURETTES, TIC DISORDER, LEARNING DISORDER

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8
Q

What age group are ADHD medications approved for?

A

6+ is recommended, can be given under 6 if behavioural intervention doesn’t work (severe cases, not approved by FDA)

can cause slower growth rates

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9
Q

Behavioural interventions for kids with ADHD

A
  • create a schedule, stick to routine
  • create organizational systems
  • limit choices
  • clear and specific directions
  • help the child plan
  • small, realistic goals
  • reward positive behaviours
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10
Q

Immediate release vs extended release stimulants

A

Immediate release are quick onset, changes seen within 15-20 minutes and lasts for 4 hrs

Extended release are given once in the morning and last for 10-12 hrs

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11
Q

What are the most common stimulants given for ADHD in children

A

ADDERALL (amphetamine)
CONCERTA (methylphenidate)
DEXEDRINE (amphetamine)
DAYTRANA (methylphenidate)
QUILIVANT XR (methylphenidate)
RITALIN (methylphenidate
Vyvanse (amphetamine)

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12
Q

Is it safe to stop stimulants abruptly?

A

yes

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13
Q

Stimulant side effects

A
  • decreased appetite/weight loss give meds after meals
  • decreased sleep
  • stomach aches/headaches
  • growth issues drug holidays reduces effect
  • rebound effect of aggression when short acting stimulant wears off
  • may exacerbate/develop tics
  • appear “flat” or “zombie-like”
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14
Q

What is the most common non-stimulant medication given for kids with ADHD

A

ATOMOXETINE (Strattera)

SNRI that works by increasing norepinephrine in the brain, works for 24 hrs

50% efficacy

given for those at risk for substance dependency of stimulants

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15
Q

Other ADHD medications

A

Clonidine, guanfacine

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16
Q

Neurofeedback

A

Computer-based behaviour training that allows a patient to self-regulate aspects of the brain activity

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17
Q

What is autism spectrum disorder?

A

A NEURODEVELOPMENTAL disorder characterized by impaired social communication and restricted/repetitive patterns of behaviour or interests

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18
Q

Causes of autism

A

Not clear
- genetics (fragile X syndrome)
- environmental stresses in conjunction with genetic predisposition
- advanced parental age at time of conception (mother and father)

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19
Q

Symptoms of ASD

A

Learning delays, difficulty concentrating, difficulties in social situations, attachment to unusual interests, difficulties understanding emotions, troubles with transitions, sleep problems, insufficient impulse control

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20
Q

Early signs of autism in young children up to 36 months

A

Limited speech, difficulty understanding simple instruction, little interest in ‘pretend’ play, little interest in other children, sensitive to sound/light/smell/taste

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21
Q

Process for diagnosing autism

A

Interview with both child and parents

MSE and ADOS

Children seen by BC Autism Assessment Network which allows the diagnosis to be recognized and funded by the MCFD

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22
Q

ASD - Level 1

A

Requires minimal support

present with impairment in social interaction and unusual repetitive patterns of interest and behaviour

less likely to have same language or cognitive behaviour delays

“odd” or “eccentric”, lacks empathy, one sided conversation

23
Q

ASD - Level 2

A

requires substantial support

may have more pronounced challenges in social communication and adaptive behaviours

may miss nonverbal cues or respond inappropriately

inflexible behaviour, distress with transitions

24
Q

ASD - level 3

A

Requires very substantial support

severe deficits in verbal and non verbal communication skills

require substantial outside support on a daily basis, may require full-time aids or intensive therapy

commonly engage in self injurious behaviour

25
Synaesthesia
Perceives sensory input one way but it gets interpreted in the brain in a different sensory modality eg. They hear a sound but experience it as a colour
26
Masking
Difference between how people seem in social contexts and what's happening to them on the inside may include: - mimicking other behaviours in order to blend in - forcing themselves to make eye contact with people - imitating gestures or expressions they see others using - having a steady stream or pre-prepared response
27
Treatment for ASD
Psychotherapy and CBT for children who are high functioning behavioural management used for challenging behaviours medications for aggression/irritability
28
What two medications are used in ASD for aggression
Risperidone, aripriprazole
29
What is ABA
Applied behaviour analysis teaches children new skills and reduce problematic behaviour such as self-injury created on the premise of operant conditioning
30
Behavioural strategies for parents of children with ASD
- front loading the child: telling them what is going to happen next - bring a transitional object - visual schedules - be concrete and specific
31
Social stories
A tool to rehearse and plan future social situations
32
Psychosis
Cluster of symptoms, loss of touch with reality
33
Causes of psychosis in youth
- medical cause (brain tumour/injury) - sleep deprivation - paternal age - substance use - genetics - trauma/extreme stress - prenatal vitamin deficiencies or infection
34
Prodromal symptoms
Early warning signs - don't always lead to psychosis - withdrawing from friends/family - deteriorating hygiene - changes in sleep/eating patterns - unusual ideas/behaviours - change in personality - anhedonia - difficulties organizing thoughts/speech
35
What are some other psychiatric conditions connected to psychotic symptoms
ASD, bipolar, MDD, personality disorders, OCD, PTSD
36
What are the challenges with diagnosing psychosis in children
Children often minimize/misinterpret symptoms Parents often don't recognize symptoms as abnormal Can see same symptoms in children with ASD
37
Schizophrenia
Impacts thought process, emotions, and behaviours delusions, hallucinations, catatonic behaviour, disorganized speech, negative symptoms symptoms present for most of the time out of 1 month and present decline for at least 6 months
38
Schizophreniform disorder
Similar to schizophrenia but less than 6 months and no decline in functioning required
39
Schizoaffective disorder
Major mood disorder concurrent with psychotic symptoms and delusions/hallucinations for 2+ weeks
40
Brief psychotic disorder
psychiatric symptoms more than a day but less than 1 month with return to premorbid functioning
41
Early-onset schizophrenia age
Ages 13-18 20% of adults with schizophrenia fall ill before 18
42
Childhood onset schizophrenia age
Under age 13 VERY rare
43
Childhood schizophrenia symptoms in infants
- overly relaxed of floppy arms/legs - extensive periods of inactivity or abnormal listenessness - unnaturally still - flat when lying down - unusually sensitive to bright lights or rapid movements
44
Childhood schizophrenia symptoms in toddlers
- CHRONIC HIGH FEVERS - repeating behaviours - extreme degree of fear - weak and slumping posture
45
Childhood onset schizophrenia
Initially more auditory, visual and tactile hallucinations flat affect, social aloofness, lack of motivation loss of grey matter shown in brain imaging studies linking diabetes in pregnancy with COD
46
Warning signs in school aged children
Auditory hallucinations, extreme sensitivity to sound/lights, problems falling asleep, distracted, socially distant, seen talking to themselves, visual halllucinations
47
Safety risk for youth experiencing first episode psychosis
75% commit suicide on their first episode
48
Cannabis induced harms to the adolescent brain
Daily use is associated it's early onset and development of a psychotic illness can increase anxiety, depression, paranoia
49
Cannabis induced psychotic disorder
Hallucinations and/or delusions are present soon after cannabis intoxication
50
Best practice for treatment of psychosis in youth
1. Low doses of antipsychotic medications 2. CBT (reduce distress around symptoms) 3. Family education and support 4. Lifestyle adjustments (sleep, eating, routine) 5. Vocational rehab 6. Reduce or eliminate the use of cannabis
51
Which antipsychotics are used in youth?
ABILIFY (aripriprazole) ZYPREXA (olanzapine) SEROQUEL (quatiapine) RISPERIDAL (risperidone) (atypical) INVEGA (paliperidone) is approved for children 12+
52
Side effects of antipsychotics
Blurred vision, sedation, orthostatic hypotension, dry mouth, sexual side effects, weight gain+, diabetes * aripriprazole has lowest chance for weight gain
53
What is done for treatment resistant psychosis in youth
Do not respond to at least 2 different antipsychotic medications then would use Clozapine or ECT

child & adolescents (3 decks)

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