Week 9 Flashcards
1
Q
Autism Spectrum Disorder (ASD) (2)
A
- neurodevelopmental disorders characterized by deficits in social communication and interations,
- with restrictive, repetitive patterns of behaviours, interests, activities
2
Q
Autism - co morbidities
A
- likely to have co-occuring mental health disorder
- less likely to have a medical home (no ‘autism clinic’`
3
Q
Autism spectrum disorder - communication
A
- deficit in communication manifested by delay or abnormal language approx 18-24 months
- child with autism may initially be mute, have a significant delay in language acquisition, or may have a regression in language
- if child is speaking, he may only exhibit echolalia (repetitive language)
4
Q
AUtism Spectrum disorder - s and s
A
- trouble with relationships in same aged peers
- social deficits = hard to maintain joint attention
- inability to point to desired object at 18 months
- pull their caregiver by hand to desired object by hand guiding, may avoid eye contact
- repetitive and restrictive behaviours
- strongly desire rigid routine, upset with deviation
- repetitive motor movements, hand flapping, spining wheels, etc
- may have difficulty with sleep, restricted food preferences, hypersensitivity to any of 5 senses
5
Q
Autism - treatment
A
- high service use rates due to complexity of disorder
- many may have co-occuring disruptive behaviours (aggression, tantrums, self-injury)
- several established behavioural and educational therapies to treat symptoms
6
Q
Comorbidities of AUtism
A
- anxieties and phobias 1/2 of children with ASD (medication rarely required in clinical practice unless anxiety is debilitating)
- obsessive-compulsive disorder = second most common, fairly easy to ask parents about, treat with SSRI
- ADHD - inattentive, hyperactive, combined, treat with stimulants
7
Q
Screen used with children with ASD (3)
A
- SEC resource
- sensory, emotional, communication screening
- determines approach with a child
8
Q
Tourette syndrome (3)
A
- neurodevelopmental disorder
- chronic vocal and motor tics causing distress and functional impairment
- presence of both vocal and motor tics over 12 months for tourrette syndrome diagnossis (if one or the other, chronic tic disorder is used)
9
Q
ADHD - medication and what (2)
A
inattentive, hyperactive, combined,
= treat with stimulants
10
Q
OCD - what, treatment
A
- obsessive-compulsive disorder = second most common, fairly easy to ask parents about, treat with SSRI
11
Q
Trisomy 21 - what (4)
A
- most common chromosomal birth defect
- three instead of two copies of chromosome 21
- intelectual disability
- physical signs
12
Q
Trisomy 21 - risk for other health conditions (8)
A
- cardiac defects
- hearing loss
- strabismus (shaky eyes)
- GI problems
- orthodontic conditions
- thyroid disease
- dermatologic conditions
- leukemia
13
Q
Trisomy 21 - signs and symptoms (14)
A
- congenital cataracts
- flat nose
- small low set ears
- protruding tongue
- short broad hands
- single transverse palm crease
- small head (microcephaly)
- flattened forhead
- wide short neck
- epicanthal eye folds
- white spots on eye iris
- wide space between first and second toes
- hearing loss
- increased incidence of diabetes, congenital heart defect, leukemia
- hypotonia
14
Q
Intellectual disability - categories (3)
A
- Prenatal errors in development of CNS
- prenatal or postnatal changes in the biological environment of the person
- external forces leadning to CNS damage
15
Q
Intellectual disability (4)
A
severe limiting in cognitive function
manifested by diffrence in social, life skills, adaptive functioning
before age 18
16
Q
Global developmental delay
A
GDD = developmental milestone delay in regard to : motor, speech, language, cognition, social funcitoning, ADLs
- under 5 years of age developmental disability
17
Q
Global Developmental Delay - diagnosis (7)
A
- genetic, molecular, metabolic tests to detect hereditary types of global developmental delay
- allow for evaluation of abnormalities in body chemistry contributing to developmental delay
- chromosome testing
- Rett syndrome (high ranking GDD among girls)
- test for lead poisoning
- test for imbalance of thyroid hormone
- neuroimaging (CT/MIR) –> posible CNS injury
18
Q
Developmental dysplasia of the hip - what
A
- femoral head and acetabulum not aligned causing unstable connection (instability, dislocation, subluxation, dysplasia)
- gestational event 12-18 weeks
19
Q
Developmental dysplasia of the hip - signs and symptoms
A
- limited abduction of affected hip
- assymetry of gluteal and thigh fat folds
- telescoping or pistoning of the thigh
- significant limp in older children (r/t pistoning)
20
Q
Developmental dysplasia of the hip - assessment
A
- allis sign
- one knee lower than other when knees are flexed
21
Q
Developmental dysplasia of the hip - clinical therapy
A
- pavlik harness
- surgery (bryant traction)
22
Q
Pavlik harness (3)
A
- Developmental dysplasia of the hip
- <6mo infant
- dynamic splint (hip flexion and abduction, prevents hip extension or adduction
23
Q
Developmental dysplasia of the hip - surgery <6mo
A
- surgery with closed reduction
- post-op application of hip-spica cast
24
Q
Developmental dysplasia of the hip - surgery >18 mo
A
- bruant traction to stretch pre-op
- open or closed reduction surgery and casting
- bracing may also be required
25
Spica cast (6)
- hard cast from nipples to ankles
- prevents any movement of hips
- skin integrity is important
- urinary elimination and constipation rt lack of movement
- decreased apetite
- g+D delay r/t limited mobility
26
Muscular dystrophies - what (3)
- inherited disease characterized by muscle fiber degeneration adn muscle wasting
- begin early or late in life, onset at birth or gradual
- terminal disorder can progress over quick or years
27
Duchenne muscular dystrophy (3)
- most common pediatric
- missing code for dystrophin protein needed to muscle stabilizer
- leads to necrosis in fibres and muscle wasting
28
Duchenne muscular dystrophy - clinical manifestation (4)
- muscle weakness (lower limbs early childhood, compensate with upper arms)
- middle teen years:
- unable to walk
- scoliosis, cardiomyopathy, difficulty taking food orally,
resp distress
29
Duchenne muscular dystrophy - complications (4)
- scoliosis,
- cardiomyopathy,
- difficulty taking food orally,
- resp distress
30
Duchenne muscular dystrophy - clinical therapy (5)
- no treatment *
- prednisone = preserve muscle and pulmonary function
- prone for respiratory infection
- PT/OT
- mental health consults
31
Scoliosis (4)
- curvature of spine, creating S or C shape rather than straight line
- child vertebrae curves side to side
- both vertebrae and spinous process rotate to face opposite directions in curvature = decrease growth
- as curve progresses it makes change to child's shoulders, ribcage, pelvis, waist, shape of back
32
What causes scoliosis (4)
- mostly idopathic
- believed to be hereditary (runs in families)
- less common causes =
- neuromuscular conditions (CP, muscular dystrophy)
- birth defects that affect spine development
33
Diagnosis of scoliosis (5)
- confirmed by X ray, most cases are asymptomatic
- Cobb method
- patient is diagnosed when spine curves greater than 10 degreees
- mild, moderate, and severe classifications
- forward bend test
34
Types of scoliosis
- s-shape (double scoliosis)
- c-shape
35
S-shape scoliosis (3)
- more common and dangerous
- hard to diagnose
- Two curves - upper cervicothoracic back, and lower thoracolumbar back bending in opposite directions
36
C-shape scoliosis (3)
- harder to manage
- bending in one direction = C-shaped curve
- types = 1) dextro-scoliosis (right curve, backwards C), and levo-scoliosis (left curve, C shaped)
37
Mild scoliosis - treatment (3)
- physiotherapy
- exercise
- muscle building
38
Moderate scoliosis - treatment (1)
- bracing (boston brace, miluwakee brace)
39
Severe scoliosis treatment
- surgery
40
6 domains of mental health
- depression
- anxiety
- irritability
- hyperactivity
- obsessions/compulsions
41
Mental health - Children of all ages - pandemic
70% children 6-18 experienced deterioration in one of 6 domains
- 66% children 2-5 experience deterioration of one of 6 domains
42
Depression
- major depression = 6-8% of adolescents
- major morbidity and a recurrence rate of 60-80 after adolescence
- only half are diagnosed appropriately, half of those diagnosed are treated
- 25% FN youth report feeling depressed for 2 weeks in a row during the year
43
Diagnosis of depression
- interview with adolescent and family/cargiver
- investigate DSM-5
44
Diagnosis of depression - pre-pubertal children (4)
- somatic concerns (due to inability to label emotions)
- psychomotor agitation
- mood congruent hallucinations
- phobias, separation anxiety, increased worrying and rumination (crying, irritability, loneliness)
45
Diagnosis of depression - adolescents (8)
- change in appetite, weight, sleep pattern
- guilt
- refusal to attend school/poor school performance
- delusions
- suicidal ideation or behaviours
- substance use
- low self-esteem, apathy, boredom
- antisocial
46
Treatment of depression
- counselling for both child and caregivers
- SSRIs
47
Anxiety vs anxiety disorder (3)
- anxiety and worry are common in normal children
- normally, youger children and females tend to have more anxiety symptoms than older children or males
- an anxiety disorder is distinguished by having persistent symptoms that impair daily functioning
48
Anxiety disorder - risk factors (5)
- family history of mental illness (esp anxiety)
- personal history of childhood anxiety
- stressful of traumatic event
- female
- comorbid psychiatric disorder (depression ex)
49
Self injury (3)
- deliberate and often repetitive destruction or alteration of one's own body tissue without suicidal intent
- ex = skin cutting, burning, self-hitting, interfering with wound healing, severe scratching, hair pulling, inserting objects into body, bone breaking
- sites usually chosen so they can be covered (arms, legs, chest, etc.)
50
Self injury - reason (4)
- ineffective coping mechanism providing rapid relief from psychological distress
- can do it to feel emotions more intensely, or to punish themselves for being bad
- most often these individuals seek to feel better
- most of these individuals are not suicidal, but we cannot assume that those who self-harm will never be suicidal
51
Self injury warning signs (5)
- unexplained frequent injuries
- wearing long pants and sleeves in warm weather
- low self esteem
- difficulty in relationships
- difficulty handling emotions
52
self injury - goals of treatment
- early diagnosis = sucessful outcomes
- medical treatment as needed
- ensure counselling is provided (psychologists, family involvement as needed)
53
Suicidal behaviour - factors that contribute (3)
- excessive stress levels
- issues with self esteem
- substance and domestic abuse
54
Suicidal behaviour + indigenous people (2)
- suicide rate much higher under 14
- one in 5 FN youth report a close friend or family member committing suicide in the past year
55
Suicidal behaviour - history
- history taking (what happened over past week, has child hurt themself or treid to?)
- should be deferred if adolescent's life is in imminent danger
56
Suicidal behaviour - nonpharmacologic interventions (3)
- individual treatment for children and adolescents
- aim = self esteem and sence of importance
- suicide threats = most often communicate despair, frustration, unhappiness = understand sense of distress
57
Psychosis (3)
- a distortion of reality or loss of contact with reality (affects thinking feeling percieving acting)
- first incidence usually occurs before 25, males experience younger
- cause is unkown, but psychoactive substacnes can increase risk
58
Psychosis - management (2)
- outcomes improved if psychosis is diagnosed early and treatment is started promptly.
- all areas are management are same for an acute phase of schizophrenia
59
Eating disorders
-increasing in anada
- 12-30% of girls, 9-25% of boys
- eating disorders = 2-4 times greater than type 2 diabetes
60
Eating disorders - early warning signs (11)
- irritability, depression, social withdrawal
- excessive preoccupation with calories or healthy eating
- frequent negative comments about their weight and shape
- restriction of food intake
- make excuses to avoid eating
- significant weight loss or gain
- compulsive exercising
- frequent eating excessive food in short period
- consuming food alone at night or secretely
- laxatives or diet pills
- going to bathroom immediately after eating
61
Eating disorders and mortality (3)
- highest mortality of any mental illnesss (10-15%)
- suicide is second leading cause of death after cardiac disease among those with anorexia nervosa
- 20% of anorexia nervosa and 35% of bulimia nervosa attemmpt suicide
62
Anorexia nervosa (3)
- restriction of energy intake relative to requirements
- intense fear of becoming fat, persistent behaviour that interferes with weight gain
- disturbances in which body weight or shape is experienced with lack of recognition
63
Bulimia nervosa (4)
- recurrent episodes of binge eating
- eating in discrete amount of time that is larger than normal
- sense of lack of control or overeating
- followed by recurrent inappropriate compensatory behaviour to prevent weight gain (vomiting, laxatives, etc)
64
Bulimea nervosa diagnosis
- binge eating and compensatory behaviours both occur at least once a week for three months
65
Binge eating disorder
- recurrent episodes of binge eating
- eating in discrete amount of time that is larger than normal
- sense of lack of control
