8. Psychiatric d/o in children Flashcards
1
Q
What is the Kaufman Assessment Battery for Children (K-ABC)?
A
Intelligence test for ages 2-12
2
Q
What is the Wechsler Intelligence Scale for Children-Revised (WISC-R)?
A
Determines IQ for ages 6-16
3
Q
What is the criteria for mental retardation/intellectual disability (3)?
A
- IQ < 70
- deficits in adaptive skills appropriate for the age group
- onset before age 18
4
Q
IQ definition of profound, severe, moderate, and mild MR?
A
- profound = IQ < 25
- severe = IQ 25-40
- moderate = IQ 40-55
- mild = IQ 55-70
5
Q
Genetic causes of MR (2 most common)
A
Down syndrome
Fragile X syndrome (M>F)
6
Q
Other genetic causes of MR (6)
A
- phenylketonuria
- familial mental retardation
- Prader-Willi
- Williams syndrome
- Angelman syndrome
- Tuberous sclerosis
7
Q
Prenatal cause of mental retardation?
A
- TORCH infections
8
Q
Perinatal causes of MR (5)
A
- anoxia (no O2)
- prematurity
- birth trauma
- meningitis
- hyperbili
9
Q
Postnatal causes of MR (5)
A
- hypothyroidism
- malnutrition
- toxin exposure
- trauma
- psychosocial causes
10
Q
What % of MR has no identifiable causes?
A
50%
11
Q
What is the def of learning disorders?
A
Achievement in reading, math, or written expression that is sig lower than expected for chronological age, level of education, and level of intelligence
12
Q
Learning disorders are often due to _______?
A
deficits in cognitive processing (ex. abnormal attention, memory, visual perception etc)
13
Q
What is the most common learning disorder?
A
reading disorder
14
Q
What is the most common INHERITED form of mental retardation?
A
Fragile X syndrome
15
Q
Common associated symptom of Fragile X syndrome?
A
large testicles
16
Q
What are the 2 disruptive behavior disorders?
A
ODD, CD
17
Q
Unlike conduct disorder, ODD does not involve ___ (2)?
A
physical aggression or violation of basic rights of others
18
Q
How many months of symptoms qualify for diagnosis of ODD?
A
at least 6 months
19
Q
What age is ODD usually observed by?
A
age 8
20
Q
Increased incidence of which comorbid psych illnesses? (4)
A
- substance abuse
- mood disorders
- ADHD
- in persistent cases, may progress to CD
21
Q
Difference b/w boys and girls w/ CD
A
- boys: higher risk of fighting, stealing, fire setting, vandalism
- girls: higher risk of lying, running away, sexually acting out
22
Q
Prevalence of CD in boys vs. girls?
A
- 4-12x more common in boys
23
Q
Risk factors for CD? (4)
A
- punitive parenting
- psychosocial adversity
- hx of being abused
- biological predisposition
24
Q
High incidence of comorbid ____(2)?
A
- ADHD (up to 70%)
- learning disorders
25
Up to what % will develop antisocial PD?
40%
26
Which medication can be useful adjunct if aggression is present in CD? (3 classes)
- antipsychotics
- mood stabilizers
- SSRIs
27
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
28
What are the 3 subcategories of ADHD?
1. Predominantly inattentive type
2. Predominantly hyperactive-impulsive type
3. Combined type
29
ADHD must have onset prior to age ___?
age 7
30
Prevalence of ADHD in school-age children?
5-12%
31
ADHD have high incidence of other comorbid psych illnesses, including? (5)
1. mood disorders
2. anxiety disorders
3. personality disorders
4. conduct disorder (30-50%)
5. ODD (30-40%)
32
What is 1st line pharm treatment of ADHD?
CNS stimulants
33
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)
34
What are pervasive developmental disorders?
Conditions that involve problems w/ social skills, language, and behaviors
35
What disorders are included in the PDD class? (4)
- autistic disorder
- asperger disorder
- Rett disorder
- Childhood disintegrative disorder
36
For autistic disorder, symptoms must present by age ___?
age 3
37
Autistic disorder is associated with which other syndromes/illnesses? (3)
- fragile X syndrome
- tuberous sclerosis
- seizures
38
Siblings of autistic person are at a greater than ____time risk of autism than general population?
22x
39
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
40
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
41
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
42
Female vs. male prevalence of Rett d/o
- seen in girls predominantly
| - most likely lethal in utero for males
43
What is the gene mutation associated w/ Rett disorder?
- MECP2 gene mutation on X-chrom
44
Treatment for Rett disorder?
supportive
45
Diff. between childhood disintegrative d/o and Rett? (2)
- in CDD, head growth does NOT slow
| - also, no unusual hand movements
46
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
47
Girls vs. boys prevalence of CDD?
- 4-8 x higher incidence in boys
48
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)
49
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
50
Tourette disorder has onset before age ___ ?
age 18
51
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
52
Time criteria for diagnosis of Tourette?
almost every day for over 1 year (with no tic-free period greater than 3 months)
53
When do symptoms peak in severity for Tourette?
b/w age 8-12
| - symptoms decreases with puberty
54
Tourettes has high comorbidity with which other psych illnesses? (2)
OCD (40%), ADHD (50%)
55
Neurochemical factors for the etiology of Tourettes?
Impaired regulation of dopamine in the caudate nucleus
56
Pharmacological treatment for Tourettes?
- Atypical neuroleptics (risperidone)
- alpha-2 agonists (clonidine, guanfacine)
- typical neuroleptics (haloperidol, pimozide) in severe cases
57
Use of ____ is controversial in ADHD associated w/ tic disorder b/c?
stimulants; b/c of concern for exacerbation of tics
58
Tx of OCD pts with comorbid tics?
SSRI augmentation of antipsychotics
59
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
60
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
61
What is primary vs. secondary elimination disorders?
```
primary = never established continence
secondary = continence achieved for a period and then lost
```
62
Physiological etiology of encopresis (2)
- lack of sphincter control
| - constipation w/ overflow incontinence (75% of cases)
63
Physiological etiology of enuresis (2)
- small bladder
| - low nocturnal levels of ADH
64
Childhood separation anxiety disorder may be a risk factor for the development of _____(2) as adult
- panic disorder
| - agoraphobia
65
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)
