Behaviors & Mental Health Flashcards
4 components of anxiety management in a teen with school avoidance
1) Psychoeducation
2) School plan - gradual return to school
3) Medication
4) Psychotherapy (CBT)
2 non-pharmacological interventions for behavior disorders
Parent education and training programs (Triple P Parenting)
Family therapy
Multimodel interdiscimplinary care (coordinated with school, therapist, home, medical)
3 drugs NOT to use in treatment of violent behaviors
carbamazepine
Lithium
haloperidol
ABC stand for in challenging behaviors
A - antecedent
B - behavior
C - consequence
Child with aggressive outbursts, angry in between outbursts, what is the diagnosis?
Disruptive mood dysregulation disorder –DSM-V TR
Name 2 school strategies for aggressive behavior at school for child with NDDs
Identify and minimize triggers
Avoid inadvertent reinforcement
positive reinforcement alternatives
4 symptoms of separation anxiety?
4 antecedents of behavior?
SEAT
Sensory - feels good
Escape - undesired situation or demand
Attention - gain attention
Tangible - seek a desired object
5 treatable causes of problem behavior
Sleep disturbance
Pain
Constipation
GERD
Dental abscess
Headache
Fracture
6 symptoms of panic disorder
Obsession vs normal thought
adaptive response vs compulsion
Diagnostic criteria for OCD
Difference between MDD in children from adults
Irritable mood in kids/adol instead of depressed
Failure to make expected weight gain (instead of change in weight/appetite)
Criteria for MDD?
Plus:
B- causing significant impairment
C - episode is not attributed to physiological effects of substance or other condition
D- not better explained by schizoaffective disorder
E- no history of mania or hypomania
What is the first line treatment for MDD if mild vs mod to severe ?
mild-mod: Psychotherapy
Mod-sev: Rx + therapy
2 medications to treat depression in kids and 4 side effects of this class of medication
Fluoxetine
Sertraline or citalopram (second line)
SSRI S/E:
- Sleep disturbances
- GI upset
- restlessness
- Headache
- Appetite changes
- Mania or hypomania
- increase suicidal thought
- seratonin syndrome
- QT prolongation
5 comorbidities for children with bipolar or DMDD
Anxiety
ADHD
Substance use disorder
Personality disorders (borderline, antisocial, schizotypal)
Conduct disorder
MDD
DMDD CANNOT co-exist with ODD, IED or bipolar
3 risk factors for PICA in ASD+IDD
3 strategies to treat
nutritional deficiency (iron) - due to restricted diet
Sensory seeking/oral exploring
lack of inhibition / lack of supervision
- alternative sensory (chew toy)
- increase supervision
- treatment of iron deficiency
- distraction
- limit access
- OT
4 syndromes associated with high levels of self injury behaviors
Fragile X
Prader Wili
Angelman syndrome
Lesch Nyhan
Cornelia de Lange syndrome
3 causes of self-injurous behavior in ASD?
social attention
lack of communication
Escape from demands
sensory/pain/discomfort
Non-pharm tx of self-injury
minimize reinforcement
routine/visual schedule
improve communication
treat underyling cause (pain)
Normal sexual beahviors in children 2-6 (list 4)
name 3 psychological diagnosis in children with history of abuse or sexual behaviors
PTSD, Depression, Anxiety
3 treatments for gender dysphoria (medical)
luperon (GnRH agonist)
Hormonal replacement (testosterone, estrogen)
Surgery
Differential dx for ODD
Anxiety
Depression
DMDD
ADHD
IDD
SLD
Sleep disturbances
Conduct disorder
Bipolar disorder
ASD
IED
Language disorder
Define GAD vs social phobia
5 negative consequences of conduct disorder
- school suspension or expulsion,
- problems in work
adjustment, - legal difficulties,
-sexually transmitted diseases,
-unplanned pregnancy, - physical injury from accidents or fights.
3 risk factors for aggressive behaviors in a child (long term)
maltreatment/abuse
witness violence or parental violence
parental use of physical discipline
media exposure
poor parental mental health or substance use
low SES
Neglect
young maternal age
disability (ADHD, ASD, IDD)
3 evidence based options for treatment of behavior concerns?
Parental education. &training
psychotherapy
medication
quetionaires for depression? name 3
PHQ-9
BASC 3
Columbia Depression rating scale
treatment approach for self injurous beahviors
ABC
- A -remove triggers
- B - reward/reinforce good beahviors
- C - extinction of negative reinforcing strategies
Dx criteria for Pica
2 standardized tests for language in school aged child
CELF-5 (clinical evaluation of language fundamentals)
OWLS-II (oral and written language scales)
PPVT-4 (Peabody picture vocabulary test)
preschool - Bayley 4 or CELF-P2, or PPVT-4
14yo girl with ASD and anxiety. Based on the 2016 ATN toolkit, name 4 things to discuss with parents regarding anxiety management.
Assessment:
multi-method approach
check for anxiety symptoms that may be related to the core symptoms of ASD
assess for and treat possible medical and psychiatric conditions that are contributing to symptoms
assess for psychosocial stressors, adequate behaviour and educational supports
Treatment:
psychoeducation and care-coordination is always first-line - delineate goals of treatment
CBT can treat and modify anxiety - parents can be involved
medications can help - SE of meds
referral to mental health practitioner may be necessary if severe or interventions are not working - safety and elopement plan
4 most important effects of marijuana to counsel teenager with autism and anxiety who is using:
Intoxication - doubles risk of MVC
Associated with cannabis disorders (Cannabis Use Disorder and Cannabis Withdrawal Disorder)
Associated with depression, and possibly anxiety
Associated with psychosis and schizophrenia
Increased risk of poor academic performance
Sleep impacts
AAP sleep guidelines recommended sleep duration for 3-year-old
Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health.
Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours
Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours
Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours
Teenagers 13 to 18 years of age should sleep 8 to 10 hours
2 differentials for childhood apraxia? vs fluency difficulties?
Dysarthria (weak oral muscles)
Articulation Disorder (specific speech sounds)
Stuttering
Dysfluency
= Speech Sound Disorders (rather than language disorders)
Child drops the last consonant of words. What is the name of this speech disorder
Speech sound disorder
4 components of SLP assessment?
Expressive language
Receptive language
Phonological awareness
Social pragmatics
SLP assessments for language impairment in FASD?
PPVT-4 - receptive language
Test of narrative language (EVT) - expressive language
CELF-5 - social/pragmatics
Developmental dysfluency vs stuttering (childhood onset fluency disorder)
3-year-old with developmental delay. Mild hypotonia on exam. Genetics normal. Keeps waking up at night and is very upset and cannot be consoled. Parents have tried sleep hygiene with no help. What is the next step in your evaluation?
ddx?
Sleep diary
EEG
Polysomnography
iron studies
DDx
parasomnias
seizures
OSA /sleep disordered breathing
sleep association
restless leg
4 strategies to support language development in a child with ESL/multiple language exposures and expressive delay?
Speak the language the family is most comfortable with
Do not mix languages
other same as expressive language delay (langauge rich, repeat, face to face, etc.)
4 strategies to support a child with developmental dysfluency
3 areas to support child with language disorder?
School
Home
SLP therapy
4 challenges in school (risk for later) in a child with dysarthria in preschool? (normal EL/RL)
Social challenges
Academic difficulties (difficulty expressing their knowledge and participating in discussion)
Emotional and behavioral issues (low self-esteem)
Continued speech difficulties
Criteria of restless leg syndrome?
urge to move legs at rest
relieved by movement
worse at night/evening
3x/week or more for >3 months
distressing
not attributed to other medical/behavioral dx or effects of drug/medication
Ix for restless leg other than iron studies?
Iron studies, ferritin
kidney function (elevated BUN or creatinine)
Glucose (peripheral neuropathy in DM can mimic)
tsh (hypothyroid)
Vitamin D level
Magnesium levels
Treatment for restless leg other than iron
melatonin
clonidine
gabapentin
benzodiazepines
nonbenzo hypnotics - zoplicone (adolescents not children)
2 groups of children at risk for low literacy?
Immigrants
Indigenous Canadians
Family history
Low SES/social determinants of health risks
late talkers are at risk for what 4 diagnosis?
ASD
ADHD
IDD
SLD
4 classical findings on history that pre-date a child diagnosed with childhood apraxia of speech?
- feeding difficulties
- limited early vocalization/babbling
- gross motor coordination issues
- irregular or inconsistent speech production patterns
A 8 year old boy you just diagnosed with ADHD complains of early morning headaches and non-refreshing sleep. His only medication is Strattera 25 mg daily. He sleeps in his own room and goes to bed after reading at 9pm. He wakes twice to go the washroom. He needs to be woken by his parents at 8am. He has no evidence of tonsillar hypertrophy. His ENT and respiratory exam are normal. His blood pressure is 80/50 and his BMI is 25.
Polysomnography
Polysomnography results AHI = 10
what are the next steps?
what is a normal result?
AHI <1, 1-5 is mild
weight loss
ENT referral
Nasal steroids
then consider CPAP
Child with ADHD and poor sleep onset, most likely dx?
Restless leg syndrome
(also review behaviors/sleep routine)
What are the three most important factors affecting child and youth resilience during parental separation or divorce?
Effective parenting
parent-child relationships
Controlling conflict
Counseling for parents on separation by age group of child
- infant
- preschool
- school-age
- teens
Infants – attachment issues; insecure and disorganized attachment styles
Preschoolers – blame themselves, separation anxiety, fear of abandonment, externalizing;
School-age – strong moral duty, tend to take side;
Teens – parents not as important as peer group but important support, limit setting
3 components of family resilience
Belief system
Organizational patterns (routines that promote connection, social & economic resources)
Communication processes (clear, open, and consistent communication - listen to each other and solve problems together)
4 skills a child should have to enter school in speech and language
100% intelligible
Understand multipart instructions
Retelling an experience in a sequence
Defining words by use
