Behavior/Mental Flashcards
Aggression
Aggressive behaviors in children have been associated with prenatal exposure to substances including cocaine, alcohol, and tobacco.
Aggression is influenced by the interaction between the prefrontal cortex, which can inhibit actions, and the limbic system, where emotional arousal resides.
Children who have anxiety may demonstrate reactive aggression when their anxiety is triggered and the child is unable to cope.
Benign Sleep Myoclonus of Infancy
Benign sleep myoclonus of infancy is characterized by jerking movements of the limb that only occur when the infant is asleep. The jerking may move from 1 limb to another and then back to the first limb. There is no alteration in breathing.
- VS. benign infantile myoclonic epilepsy in which you have myoclonic SEIZURES both asleep and awake.
Motor tics typically start around age 5 years and almost never before 2 years.
Tics have an associated premonitory urge which can differentiate them from motor stereotypies (which is like hand flapping, lib trembling behaviors).
Thumb and Finger sucking - what do you do?
Most children will spontaneously OUTGROW behavior by 4 years of age.
So do nothing, unless he/she is older than 4 years
Home Visiting Programs
Home visits by skilled professionals (eg, nurses, social workers, early childhood educators) empower parents by building parenting skills and knowledge.
A call to the 2-1-1 resource and information helpline may identify community-based services that cover a range of essential needs including food, housing, health care, disaster services, and employment.
These exist… -.-
Head start is after 3 years/during preschool
EI is birth to 3 years with dev delay
WIC is nutrition
How to address bullying in school
More adult supervision on school grounds!
Bullying most commonly occurs at school and in less supervised settings (eg, playground, hallways).
Effective antibullying programs incorporate improved student supervision, SCHOOL WIDE rules and antibullying policies, parent training, and collaboration between schools and families.
Zero-tolerance policies are ineffective in decreasing bullying; removing the bully from school (eg, suspension, expulsion) can unintentionally reward and thereby reinforce bullying behavior.
Most effective type of therapy
CBT!!!
Depressed children may not express sadness or a depressed mood, but may present with irritability, declining academic achievement, social withdrawal, poor self-esteem, difficulty concentrating, or disruptive behaviors.
Moderate to severe depression is best treated with a combination of psychotherapy and medication. Treatment with CBT combined with medication is more effective than either treatment alone for adolescent depression.
Intellectual Disability
Fragile X:
Boys - Moderate ID
Girls - Mild
Downs: Mild-Moderate
Prader Willi: Mild-Moderate
Angelman: Severe
Autism vs. Language delay
Diagnosis of autism spectrum disorder includes deficits in social communication and interactions, along with restricted, repetitive patterns of behavior, interests, or activities.
The child with isolated language delay typically has a strong interest in engaging socially and will effectively use nonverbal communication (eg, eye contact, gestures, facial expressions, body language). Pretend play and joint attention remain intact.
What type of communication method is best for children with hearing loss?
Oral communication method
- emphasizes listening skills and speech articulation
- uses hearing, speech, and lip reading to develop spoken language
- good for those wiht residual hearing
VS.
Manual communication - signing and fingerspelling
Manual English - ASL + english grammar conventions to facilitate reading and writing in english
Total language communication - is using any means available to communicate (speech, signs, gestures, writing, pictures)
Androgenic Steroids Side effects
LIVER: High serum concentrations of liver enzymes and Cholestatic jaundice, and drug-induced hepatitis
OTHER:
altered ventricular wall mass
oligospermia associated with testicular atrophy gynecomastia in males
erythrocytosis
premature epiphyseal closure
tendon rupture
increase in mood disorders and aggressive behaviors
Side effects of Risperidone
Used in Autism for aggressive, disruptive, self injury
- approved for > 5 years old
Side effects
- Elevated prolactin: dopamine antagonist -> increases prolactin
- Dyslipidemia
Others:
- weight GAIN
- LFTS
- insulin resistance and hyperglycemia
- increase in BP, prolongation QTc
Ibuprofen can cause a false positive Urine drug screen of what?
PCP!
Urine drug screens are sensitive (rule out) but not specific.
- Most drugs detectable within 24-48 hours
- PCP up to 2 wks
- Cannabis up to 4-6 wks
- Inhalants not detectable
What drug to treat tics in ADHD kid on methylphenidate?
Clonidine!
Best advice to help children sleep better
Put them in crib awake.
- child can develop their own methods of soothing themselves and eliminating nocturnal feedings (should stop by 4-6 months)
Time Out
Length of time = 1 minute for each year of age
The child needs to be calm and physically in control by the end of time-out, or it is extended.
Medications for ADHD: Stimulants = FIRST LINE
Stimulants: Methylphenidate or Amphetamines
- promote release and inhibit reuptake of Dopa and NE
- known heart disease precludes treatment
SIDE EFFECTS:
- weight loss
- insomnia** (most common)
- headache
- increased BP and HR
- exacerbation of tics
- irritability
Medications for ADHD: Alpha agonist
Alpha agonist - Guanfacine or Clonidine
SIDE EFFECTS:
- SEDATION
- BRADYCARDIA
- HYPOTENSION
Used to treat tics in pts on stimulants
Medications for ADHD: Atomoxetine
NE reuptake inhibitor
Side effects:
- GI symptoms, liver injury
- poor weight gain
- fatigue, dizziness
- mood swing
- SEDATING -> administer at bedtime.
risk for suicidal ideation
Bath Salts
Stimulant: tachy, HTN, hyperthermia
Hallucinogenic + Paranoia
Amphetamine analogs
Inhalant
Perioral eczematous changes
Euphora, slurred speech, dizziness, ataxia, hallucinations
Excessive lacrimation, rhinorrhea, salivation
Chemical odor
Risk of pneumothorax and pneuomediastinum
Not detected on urine drug screen
Chronic use: heart, liver, kidneys, lungs, brain
Death: cardiac arrhythmia
PCP
Hallucinogen
Nystagmus*
Hyperreflexia associated with clonus, muscle rigidity*
Temp instability
Cardiac arrhythmias
Seizures
What OTC drug is hallucinogenic?
Dextromethorphan
Barbiturates cause?
NYSTAGMUS + normal pupil size
sx like EtOH intoxication (slurred speech, unsteady gait, impaired judgment, poor impulse control)
Brady twins - bradycadia bradypnea
Hypo triplets - hypoTN, hypothermia, hypoactive BS
VS. opiates have pinpoint pupils
Night Terrors vs. Nightmares
Night terrors:
- non-REM sleep, usually first 1/3 of the night
- awakens abruptly wiht loud scream, agitated, frightened
- facial flushing, sweating, tachy is common
- does NOT respond to parental effort to calm
- amnesia for the episode is typical.
Nightmare:
- REM sleep (muscle tone inhibited so mobility does not occur)
- last 1/3 of the night
- easily calmed by parent
- often remember the nightmare
What drug causes dissociation and loss of time perception and identity?
Ketamine
What is an effect from chronic MJ use?
Gynecomastia
MJ effects:
CNS: learning probs, cognitive impairment, “amotivational syndrome”
Acute: 4 “D”s
- dry mouth, dilated pupils, drowsiness, distortion of time
- compromised immune fxn
- tachycardia and increased BP (MJ causes release of catecholamines)
Chronic:
- pulm: lung cancers
- CV: tachy and poor stamina
- GYNECOMASTIA, decreased libido, infertility from oligospermia
- Women: galactorrhea
What is the “Date rape” drug?
GHB
- CNS depressant
- retrograde amnesia
LSD
Sympathomimetic Effects - diaphoresis, mydriasis, flushing, tremor, tachy, HTN, hyperthermia
Hallucinogenic - distortions of sensory perception which are usually euphoric and relaxing (but can also be frightening and upsetting - ‘bad trip”)
NOT nystagmus
ADHD treatment
Behavioral therapy (NOT CBT)
Meds
Classroom accommodations
What to do about gifted child who is bored in class?
Educational enrichment activities!
Not grade level advancement or early kindergarten entry b/c gifted children commonly have asynchronous development; social-emotional development may be less advanced than cognitive development.
Also, be aware that giftedness may come with other conditions such as ADHD, ASD, learning disability.
Breath Holding Spell
6 months to 6 years; most before 18 mo.
- cyanotic form, in which the face becomes cyanotic until breathing returns
- pale form, in which the face turns pale due to vasovagal syncope.
Breath holding can be followed by loss of tone, diaphoresis, and in some cases, brief seizure like activity and bradycardia.
They will resume normal breathing and become fully alert within 1 minute.
Can be associated with iron deficiency anemia
** Reassure that they are harmless and will go away on its own **
Night Terror
Non-REM sleep disorder
Normal Ages for Biting, Head banging, Finger sucking
Head banging - up to 4
Biting - up to 3
Thumb sucking - up to 4
