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PSYCHIATRY > 8. Child Psych > Flashcards

8. Child Psych Flashcards

1
Q

IQ for mild ID

A

55-70

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2
Q

IQ for moderate ID

A

40-55

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3
Q

IQ for severe ID

A

25-40

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4
Q

IQ for profound ID

A

<25

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5
Q

What are the features of a patient with mild ID?

A

educable with special assistance (can read, write and do simple math); can hold a job and live independently

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6
Q

What are the features of a patient with moderate ID?

A

Can talk, recognize name, perform basic hygeine,do laundry, and handle small change; need to live in supervised group or with family

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7
Q

What are features of severe or profound ID?

A

unable to complete self help; likely to require institutionalization

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8
Q

In what 4 areas do patients with ID have limitations?

A
  • Communication
  • Self-care
  • Life skills
  • Health and safety skills
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9
Q

Mild ID is more common in what group?

A

low SES (more common to have exposures to lead, malnutrition, poor prenatal care, etc)

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10
Q

True or false: the cause of moderate/profound/severe ID is often unidentifiable

A

FALSE: mild ID often does not have an identifiable cause

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11
Q

What is the most common cause of ID overall?

A

FAS

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12
Q

What is the most common chromosomal cause of ID?

A

Down Syndrome

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13
Q

What is the most common heritable form of mental retardation?

A

Fragile X Syndrome

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14
Q

What prenatal factors can lead to ID?

A

substance use and abuse; maternal malnutirion and illness; exposure to mutagens

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15
Q

What perinatal and early postnatal factors lead to ID?

A

traumatic delivery, brian injury, infecitons, head injury, exposure to toxins, malnutrition

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16
Q

What are common comorbidities of ID?

A 
ADHD
Disruptive behavior disorders
mood disorders
anxiety disorders
seizures
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17
Q

True or false: the prognosis of patients with ID can be improved by changes in environment

A

TRUE

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18
Q

Definition: inability to achieve in a particular academic area at the level predicted by an individual’s cognitive abilities

A

Learning Disorders

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19
Q

How do you properly diagnose someone with a learning disorder?

A

require standardized IQ and achievement testing

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20
Q

What areas can a specific learning disorder fall under?

A

reading
written expression
math

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21
Q

What gender more commonly gets a learning disorder?

A

males 2-4X > females

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22
Q

What are the comorbidities of learning disorders?

A

ADHD
Mood Disorders
Truancy, school refusal and substance abuse (possibly associated with frustration due to school difficulty and failure)

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23
Q

How do you “treat” a learning disorder?

A

special education

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24
Q

Definition: impairment in comprehension and/or use of a spoken, written or other verbal symbol

A

Language disorder

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25
Q

How do receptive and expressive language disorders differ?

A

receptive (taking info in); expressive (getting info out)

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26
Q

Definition: poor articulation or pronunciation

A

speech sound disorder

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27
Q

Example: wight for right, toat for coat

A

substitution

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28
Q

Example: crat for cat; brlu for blue

A

distortions

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29
Q

Example: oke for joke; inging for singing

A

omissions

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30
Q

Example: aluminininum for aluminum

A

additions

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31
Q

What is the proper term for stuttering?

A

child onset fluency disorder

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32
Q

What may be seen in children with child onset fluency disorder?

A

occasional secondary characteristics or tics like stamping foot to get word out

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33
Q

Definition: qualitative impairment in social interaction and social communicaiton due to restricted, repetitive and stereotyped patterns of behavior, interests, and activities

A

autism spectrum disorder

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34
Q

When do symptoms of ASD usually develop?

A

usually in early development (parents notice problems with social interactions in first few months of life–no developing pattern of smiling or responding to cuddling)

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35
Q

What symptom commonly leads parents to seek medical attention?

A

failure to develop spoken language

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36
Q

What gender more commonly has ASD?

A

males 3-4X more likely

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37
Q

True or false: the majority of ASD patients have some mental retardation

A

true (70%)

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38
Q

True or false: the majority of ASD patients have seizures

A

false (25% have comorbid seizure disorder)

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39
Q

What are some signs that may suggest ASD in children?

A
  • Rigid commitment to maintaining special routines
  • Lining up toys
  • Odd way of playing with a toy (focus on tiny part and not use toy the way it is meant to be used)
  • Hand flapping
  • Unresponsive to emotions of others
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40
Q

Definition: seen only in females and characterized by 6 months of normal development followed by regression

A

Rett’s disorder

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41
Q

Definition: 2 years normal development followed by regression

A

Childhood disintegrative disorder

42
Q

Definition: mild or high functioning autistic disorder (impairment in social interactions with NO clinically significant delay in language or cognitive developments)

A

Asperger’s Disorder

43
Q

When and how do you screen for ASD?

A

18 months (screen with IQ and speech development by age 2)

44
Q

What is Social (Pragmatic) Communication Disorder?

A

-Marked deficits in social communication with NO additional criteria for ASD

45
Q

True or false: you can use pharmacotherapy to treat autism

A

FALSE: you CANNOT TREAT AUTISM, but you can help with symptoms like seizures, sleep problems, aggression, etc

46
Q

When should you begin intense behavioral therapy with autistic children?

A

as early as possible (from home)–leads to best outcome

47
Q

What are risk factors for disruptive behavior disorders?

A

inconsistent discipline, poor supervision, high family conflict, parental criminality/ alcoholism/ drug abuse/psychopathology, low family warmth or supportiveness, low parental acceptance, low IQ

48
Q

How do you treat disruptive behavior disorder?

A
  • Behavioral management training for parents and child

- Multisystemic therapy

49
Q

Definition: significant difficulty focusing and maintaining attention + significant hyperativity and impulsivity

A

ADHD

50
Q

What are the diagnostic restrictions on ADHD?

A

symtpoms present before age 12

impairment occurring in at least two areas

51
Q

What gender more commonly has ADHD?

A

males 3X more common

52
Q

Does ADHD have a genetic component?

A

yes! it runs in families (genes related to DA have been implicated–girls have stronger family history than boys and it is associated with familial mood disorder, learning disorder, substance use and antisocial personality disorder)

53
Q

What are non-environmental risk factors for ADHD?

A
  • Maternal smoking, ETOH and drug abuse
  • Complications during delivery
  • Exposure to toxins or viral infections
  • Maternal malnutrition
54
Q

True or false: ADHD is associated with increased incidence of academic failure, relationship problems, legal problems, substance abuse, injuries, MVAs, and job problems

A

TRUE

55
Q

Examples: difficulty in planning, starting or stopping activities, managing behavior, persisting on tasks, etc.

A

executive functioning deficits

56
Q

Examples: frequent mistakes/failure to pay close attention, difficulty sustaining attention, fails to finish work or follow directions, unorganized, misplaces items, easily distracted

A

Inattention

57
Q

Examples: figiting or squirming, leaves seat, difficulty being quiet in leisure activities, talks excessively, shouts out answers out of turn (and can’t wait turn), interrupts, runs instead of walks

A

hyperactivity/impulsivity

58
Q

What are some comorbidities of ADHD?

A
  • Oppositional Defiant Disorder (60%)
  • Anxiety disorder
  • Depressive disorder
  • Learning disability
  • Conduct disorder
  • Substance use disroder
59
Q

True or false: 50% of ADHD have good outcome and complete school

A

TRUE

60
Q

What is the prognosis for ADHD?

A

33% have it for life
33% have some symptoms for life
33% have full remission by adolescence and adulthood

61
Q

How do you treat ADHD?

A
  • Behavioral modification with child and parents
  • Classroom accommodations
  • Medications (stimulants)
62
Q

Definition: a pattern of negativeistic, hostile and defiant behavior lasting at least 6 months, during which 4 (or more) characteristic factors are present

A

Oppositional defiant disorder

63
Q

What are some characteristic factors of oppositional defiant disorder?

A
  • Often loses temper
  • Often argues with adults
  • Often actively defies or refuses to comply with adult’s requests or rules
  • Often deliberately annoys people
  • Often blames others for their mistakes or behavior
  • Often is touchy or easily annoyed by others
  • Often is angry and resentful
  • Often is spiteful or vindictive
64
Q

When is ODD usually diagnosed?

A

before age 8 (almost always before adolescence)

65
Q

What gender has ODD more commonly?

A

males 3X > females

66
Q

What is required for diagnosis of ODD?

A

-Demonstration of a clear pattern of negativistic and defiant behavior over a significant period of time (to a much greater degree than most children their age)

67
Q

ODD is commonly comorbid with what condition?

A

ADHD

68
Q

Definition: repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated

A

Conduct disorder

69
Q

What gender more commonly gets conduct disorder?

A

males (with gender ratio widening as offenses get more serious)

70
Q

When does child onset conduct disorder begin?

A

prior to age 10

71
Q

What is the time line for conduct disorder?

A

3 or more criteria in the past 12 months with at least one criteria present in the past 6 months

72
Q

What are the major characteristics of conduct disorder?

A
  • Aggression to people or animals
  • Destruction of property
  • Serious violation of the rules
  • Deceitfulness or theft
73
Q

What are the comorbidities of conduct disorder?

A

learning disorders
ADHD
mood disorder
substance abuse

74
Q

Amost half of children with conduct disorder develop what in adult hood?

A

antisocial personality disorder (with number of CD symptoms and early age of onset increasing likelihood)

75
Q

Defintion: persistent eating of non-nutritive substances for a period of at least 1 month

A

pica

76
Q

Definition: repeated regurgitation and re-chewing of food for a period of at least 1 month following a period of normal functioning

A

rumination disorder

77
Q

How old do you have to be to be diagnosed with enuresis?

A

at least 5 yo

78
Q

What is the most effective treatment for enuresis?

A

enuresis alarms (behavioral treatments)

79
Q

What medications can be used to treat enuresis?

A

DDAVP or desmopressin

imipramine

80
Q

When do you start giving medicine to treat enuresis?

A

wait until age 6-7 (especially in boys)

81
Q

How old do you have to be to be diagnosed with encopresis?

A

at least 4 yo

82
Q

What is required for diagnosis of Tourette’s Disorder?

A
  • both multiple and 1 or more vocal tic during the illness (not necessarily concurrent)
  • BEFORE 18 yo
  • Occurs many times a day nearly every day or intermittently throughout a period of >1 year and during that period there was never a tic-free period of more than 3 consecutive months
83
Q

True or false: up to 20% of children experience simple tics

A

TRUE

84
Q

When do motor tics typically develop?

A

3-8 yo (and vocal tics several years after)

85
Q

When do symtpoms peak in Tourette’s disorder?

A

in adolescence

86
Q

Definition: does not meet criteria for Tourette’s because either motor or vocal tics are present (not both)

A

chronic motor or vocal tic disorder

87
Q

What do you call it when a child has not had symptoms long enough to classify as having Tourette’s disorder?

A

transient tic disorder

88
Q

How do you treat tic disorders?

A
  • Alpha adrenergic agonists (clonidine, guanfacine)

- Neuroleptics (haloperidol, pimozine)

89
Q

What is the prognosis for Tourette’s disroder?

A

20% have remission in 20s

90
Q

How does separation anxiety differ from separation anxiety disorder?

A

Separation anxiety is a normal developmental feature (at 9 mo). Separation anxiety disorder is a level of anxiety out of proportion for a child’s developmental level

91
Q

How long must symptoms last to diagnose separation anxiety disorder?

A

at least 4 weeks

92
Q

When does separation anxiety disorder more commonly develop?

A

onset as early as preschool; adolescent onset uncommon (may develop after stressful life event

93
Q

How many symptoms are required for diagnosis of separation anxiety disorder?

A

3 or more symtpoms associated with dreams, obsessions, and physical symptoms that center around being separated from or harm befalling major attachment figures

94
Q

Defintion: consistent failure to speak in specific social situations (when there is an expectation for speaking) despite speaking in other situations

A

selective mutism (will often speak at home and nowhere else)

95
Q

What causes selective mutism?

A

often a combination of anxiety and defiance

96
Q

Defintion: childhood trauma/stressor related disorder characterized by disturbed and developmentally inappropriate social relatedness

A

Reactive attachment disorder of infancy or early childhood

97
Q

What are the age restrictions on diagnosis of Reactive attachment disorder of infancy or early childhood?

A

before age 5, symtpoms must occur

98
Q

What is the risk factor for Reactive attachment disorder of infancy or early childhood?

A

grossly pathologic care

99
Q

What are features of an inhibited child with Reactive attachment disorder of infancy or early childhood?

A

child fails to initiate and respond to social interactions in a developmentally appropriate way

100
Q

What are features of a disinhibited child with Reactive attachment disorder of infancy or early childhood?

A

child exhibits indiscriminate sociability or a lack of selectivity in the choice of attachment figures

101
Q

Definition: motor behavior that is repetitive, seemingly driven and non-functional that interferes with normal activities or results in self-inflicted bodily injury that requires medical treatment

A

stereotypic movement disorder

102
Q

What are the comorbidities associated with stereotypic movement disorder?

A

intellectual disability

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