Behave And Develop Lec. 6

Question 1

When is crying most frequent and normal

Answer 1

Late in the afternoon

Question 2

What is normal premies crying pattern

Answer 2

Premature infants cry less before 40 wks gestational age but cry more than term infants at 6 wks corrected age

Question 3

Wessels rule of threes

Answer 3

Wessel’s rule of threes
 (starts at about 3wks of age ):
Crying >3 hrs/day
Crying at least 3 days/wk
Crying longer than 3 wks
Typically resolves around 3mo of age

This defines colic

Question 4

If crying last longer than 20 minutes

What is the complication to the mother

Answer 4

Higher risk for post partum

Question 5

When are tantrums normal

Answer 5

Age 1-4 years old

Question 6

When are tantrums abNML

Answer 6

Past age 4

Wanting to injure themselves

Lasting longer than 15 min

Persist negative mood between tantrums

Question 7

W/u for tantrums

Answer 7

Sleep hx
Feeding

Hearing? Language delay?

Iron deficiency? Lead screening?

Parent education starting at 12 months

Question 8

What is the workup for breath holding spells?

Answer 8

Check for iron deficiency and treat if present

Otherwise: Ignore! Without reinforcement, the episodes usually will stop

Question 9

What is the best approach to special needs mgmt

Answer 9

Medical home model

Provides level of autonomy to family by having direct communication with team and more “control” over care

Question 10

Define intellectual disability

Answer 10

Definition: used for children over age 5**

Significantly subnormal general intellectual functioning for a child’s developmental stage

Based on an administered test with scores >2 SD below the mean

IQ tests avg is 100, SD is 15, therefore IQ test <70

Question 11

Define Global developmental delay

Answer 11

DSM-5: Global Developmental delay (GDD)
children under age 5 
Significant delay (>2 SD) in multiple developmental milestones

Question 12

What is the difference between

Answer 12

Mild ID (IQ 50-70)

• Higher association with environmental influences
• Highest risk among low socioeconomic status

Severe ID (IQ <50)
-More frequently linked to biological and genetic causes

Question 13

Intellectual Disability investigation

Answer 13

Labs/Tests to consider
Urinalysis
-Screen for amino/organic acids

Inborn errors of metabolism screens
-Verify newborn screen performed and reviewed

TSH, free T4

Chromosomal analysis

EEG

Question 14

Cerebral palsy

Answer 14

Group of non-progressive, but often changing, motor impairment syndromes

Secondary to anomalies or lesions of the brain arising before or after birth

Question 15

What are the major causes of Cerebral Palsy

Answer 15

80% antenatal factors causing abnormal brain development

• Preterm, low birth weight, congenital malformations, kernicterus
• Less than 10% with intrapartum asphyxia

Intrauterine exposure to maternal infection

Question 16

A pt that is stiff or floppy at 3 months, with head lag, no rolling at 6 months, or only uses one hand
Lopsided crawling, or knee, butt scooting

Think

Answer 16

Cerebral palsy

Conduct :

Vision and hearing eval
Urine screen for amino/organic acidurias
Genetic screening
Refer to Neurology

Question 17

Define ASD

Answer 17

Autism spectrum D/o

Persistent deficits in social communication and social interaction

Restricted, repetitive patterns of behavior, interests, or activities

(Lining up toys, echolalia)

Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior

Hyper- or hyporeactivity to sensory input

Question 18

When must S/s be present for ASD

Answer 18

Symptoms must be present in the early developmental period

Question 19

When is MCHAT-R used for ASD

Answer 19

18 and 24 months

Question 20

ADHD in pts under 16

Answer 20

at least 6 symptoms of inattention OR 6 symptoms of hyperactivity-impulsivity

Question 21

ADHD in children older than 17

Answer 21

at least 5 symptoms of inattention OR at least 5 symptoms of hyperactivity-impulsivity

Question 22

When must S/s present for ADHD

Answer 22

Symptoms present prior to age 12
For at least 6 months
In 2 or more environments

Clinically significant impairment in social, academic or work settings

Question 23

What is the checklist to eval ADHD

Answer 23

Conners or vanderbilts

Question 24

What is the tx approach to ADHD

Answer 24

Behavior MGMT

Structure and routine

Stimulants 1st line:
Methylphenidate
Amphetamine

2nd line:
 Norepinephrine-reuptake inhibitor 
-Atomoxetine (Strattera)
Alpha agonists—helpful adjuncts for tics, sleep problems, agression
-Clonidine
-Guanfacine

Question 25

ADE of ADHD meds

Answer 25

Appetite suppression
-Evaluate with growth chart—weight loss

Sleep disturbance

Heart palpitations

Hypertension

Tremors/tics

Nausea*

Headache*

Asses every 3-6 months
(1-3 when 1st starting meds)

Question 26

Define opp. Defiant disorder

Answer 26

Frequent & persistent pattern of:
Angry/irritable mood
Argumentative/defiant behavior
Vindictiveness

Question 27

Define conduct disorder

Answer 27

Aggression to people & animals
Destruction of property
Deceitfulness or theft
Serious violations of rules

major age-appropriate societal norms or rules are violated

Can progress to antisocial personality disorder