8. Psychiatric d/o in children Flashcards
What is the Kaufman Assessment Battery for Children (K-ABC)?
Intelligence test for ages 2-12
What is the Wechsler Intelligence Scale for Children-Revised (WISC-R)?
Determines IQ for ages 6-16
What is the criteria for mental retardation/intellectual disability (3)?
- IQ < 70
- deficits in adaptive skills appropriate for the age group
- onset before age 18
IQ definition of profound, severe, moderate, and mild MR?
- profound = IQ < 25
- severe = IQ 25-40
- moderate = IQ 40-55
- mild = IQ 55-70
Genetic causes of MR (2 most common)
Down syndrome
Fragile X syndrome (M>F)
Other genetic causes of MR (6)
- phenylketonuria
- familial mental retardation
- Prader-Willi
- Williams syndrome
- Angelman syndrome
- Tuberous sclerosis
Prenatal cause of mental retardation?
- TORCH infections
Perinatal causes of MR (5)
- anoxia (no O2)
- prematurity
- birth trauma
- meningitis
- hyperbili
Postnatal causes of MR (5)
- hypothyroidism
- malnutrition
- toxin exposure
- trauma
- psychosocial causes
What % of MR has no identifiable causes?
50%
What is the def of learning disorders?
Achievement in reading, math, or written expression that is sig lower than expected for chronological age, level of education, and level of intelligence
Learning disorders are often due to _______?
deficits in cognitive processing (ex. abnormal attention, memory, visual perception etc)
What is the most common learning disorder?
reading disorder
What is the most common INHERITED form of mental retardation?
Fragile X syndrome
Common associated symptom of Fragile X syndrome?
large testicles
What are the 2 disruptive behavior disorders?
ODD, CD
Unlike conduct disorder, ODD does not involve ___ (2)?
physical aggression or violation of basic rights of others
How many months of symptoms qualify for diagnosis of ODD?
at least 6 months
What age is ODD usually observed by?
age 8
Increased incidence of which comorbid psych illnesses? (4)
- substance abuse
- mood disorders
- ADHD
- in persistent cases, may progress to CD
Difference b/w boys and girls w/ CD
- boys: higher risk of fighting, stealing, fire setting, vandalism
- girls: higher risk of lying, running away, sexually acting out
Prevalence of CD in boys vs. girls?
- 4-12x more common in boys
Risk factors for CD? (4)
- punitive parenting
- psychosocial adversity
- hx of being abused
- biological predisposition
High incidence of comorbid ____(2)?
- ADHD (up to 70%)
- learning disorders
Up to what % will develop antisocial PD?
40%
Which medication can be useful adjunct if aggression is present in CD? (3 classes)
- antipsychotics
- mood stabilizers
- SSRIs
How do you distinguish ADHD from learning disorders and MR?
- ADHD do not tend to have lower IQ or have specific difficulty with academic skills
- but their ADHD symptoms may affect academic performance
What are the 3 subcategories of ADHD?
- Predominantly inattentive type
- Predominantly hyperactive-impulsive type
- Combined type
ADHD must have onset prior to age ___?
age 7
Prevalence of ADHD in school-age children?
5-12%
ADHD have high incidence of other comorbid psych illnesses, including? (5)
- mood disorders
- anxiety disorders
- personality disorders
- conduct disorder (30-50%)
- ODD (30-40%)
What is 1st line pharm treatment of ADHD?
CNS stimulants
What can be used if first-line tx of ADHD can’t be used? (due to intolerable s/e or ineffectiveness)?
alpha-2 agonists (clonidine, guanfacine)
What are pervasive developmental disorders?
Conditions that involve problems w/ social skills, language, and behaviors
What disorders are included in the PDD class? (4)
- autistic disorder
- asperger disorder
- Rett disorder
- Childhood disintegrative disorder
For autistic disorder, symptoms must present by age ___?
age 3
Autistic disorder is associated with which other syndromes/illnesses? (3)
- fragile X syndrome
- tuberous sclerosis
- seizures
Siblings of autistic person are at a greater than ____time risk of autism than general population?
22x
Difference b/w autism and asperger disorder? (note: DSM 5 got rid of asperger disorder. now it’s autism spectrum disorder)
- in asperger d/o, they have normal dev. in spoken/receptive language, cognitive development, self-help skills, and curiosity about environment
How is Rett disorder progressed in the first 2-3 years of life?
- normal and physical psychomotor dev during first 5 months after birth
- followed by DECREASING rate of head growth and LOSS of previously learned purposeful hand skills b/w age 5-30 months
Symptoms of Rett disorder (6)
- stereotyped hand mvts (hand wringing, hand washing)
- impaired language
- psychomotor retardation
- problems with gait/trunk mvts
- cognitive development doesnt progress beyond that of 1st year of life
- EEG abnormality and seizure common
Female vs. male prevalence of Rett d/o
- seen in girls predominantly
- most likely lethal in utero for males
What is the gene mutation associated w/ Rett disorder?
- MECP2 gene mutation on X-chrom
Treatment for Rett disorder?
supportive
Diff. between childhood disintegrative d/o and Rett? (2)
- in CDD, head growth does NOT slow
- also, no unusual hand movements
Onset of childhood disintegrative d/o vs. Rett?
- CDD = after age 2; usually b/w age 3-4 (MUST be before age 10)
- Rett = usually b/w age 5 months - 2 yrs
Girls vs. boys prevalence of CDD?
- 4-8 x higher incidence in boys
What is CDD?
- normal dev in the first 2 yrs of life
- loss of previously acquired skills before age 10 in at least 2 of following areas (language, social skills, adaptive behavior, bowel/bladder control, play, motor skills)
- and in at least 2 of these (impaired social interaction, impaired communication, restricted repetitive stereotyped behaviors and interests)
Childhood disintegrative disorder has been associated with various general medical conditions such as ___ (5)?
- Landau-Kleffner syndrome (acquired epileptic aphasia)
- neurolipidoses (ex. Tay Sachs)
- mitochondrial deficits
- metachromatic leukodystrophy
- CNS infection
Tourette disorder has onset before age ___ ?
age 18
Tourette disorder is characterized by?
- multiple daily motor and one or more vocal tics
- both must be present at SOME time during illness, but not necessarily concurrently
Time criteria for diagnosis of Tourette?
almost every day for over 1 year (with no tic-free period greater than 3 months)
When do symptoms peak in severity for Tourette?
b/w age 8-12
- symptoms decreases with puberty
Tourettes has high comorbidity with which other psych illnesses? (2)
OCD (40%), ADHD (50%)
Neurochemical factors for the etiology of Tourettes?
Impaired regulation of dopamine in the caudate nucleus
Pharmacological treatment for Tourettes?
- Atypical neuroleptics (risperidone)
- alpha-2 agonists (clonidine, guanfacine)
- typical neuroleptics (haloperidol, pimozide) in severe cases
Use of ____ is controversial in ADHD associated w/ tic disorder b/c?
stimulants; b/c of concern for exacerbation of tics
Tx of OCD pts with comorbid tics?
SSRI augmentation of antipsychotics
Criteria for diagnosis of enuresis?
- involuntary voiding of urine after age 5
- at least 2x/week for at least 3 consecutive months
- or with marked impairment
Criteria for diagnosis of encopresis?
- involuntary or intentional passage of feces in inappropriate places by age 4
- at least 1x/month for at least 3 months
What is primary vs. secondary elimination disorders?
primary = never established continence secondary = continence achieved for a period and then lost
Physiological etiology of encopresis (2)
- lack of sphincter control
- constipation w/ overflow incontinence (75% of cases)
Physiological etiology of enuresis (2)
- small bladder
- low nocturnal levels of ADH
Childhood separation anxiety disorder may be a risk factor for the development of _____(2) as adult
- panic disorder
- agoraphobia
What are the evidences of sexual abuse in a child? (5)
- STDs
- anal or genital trauma
- knowledge about specific sexual acts (inappropriate for age)
- initiation of sexual activity with others
- sexual play with dolls (inappropriate for age)
