BMB 3 - Childhood Behavioral Disorders; Autism Spectrum Disorders; ADHD & Disruptive Behavior Disorders Flashcards by Jason Worley

Name a few common chief complaints seen in children with pediatric major depressive disorder.

Irritability (fighting at school, talking back, etc.)

Self-injurious activities (more common in adolescents)

School problems

Withdrawal (from friends and/or family)

Weight loss / growth failure

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What is the girl-to-boy ratio of pediatric major depressive disorder in children?

And in adolescence?

1: 1
2: 1

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What is the lifetime prevalence of pediatric major depressive disorder in children?

And in adolescents?

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Describe some common presentations for prepubertal children with pediatric major depressive disorder.

Irritability, anxiety, and somatic complaints (headaches or stomachaches, etc.)

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Describe some common presentations for adolescents with pediatric major depressive disorder.

Behavioral problems become more likely

(fewer neurovegetative problems like eating or sleeping issues)

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What is the diagnostic criteria for pediatric major depressive disorder?

Depression and/or anhedonia

≥ 4 S/Sy of SIG-E-CAPS

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What are the components of SIG-E-CAPS?

Sleep changes

Interest changes

Guilt

Energy changes

Concentration

Appetite changes

Psychomotor agitation

Suicidality

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Name some of the main risk factors for pediatric major depressive disorder.

Family history (MDD, bipolar disorder, substance abuse, etc.)

Bullying

Trauma

Prior mood disorder and/or impulsivity

Parent-child conflict

Negative temperment

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Name a few protective factors against pediatric major depressive disorder.

Supportive caregiving/adults and prosocial peers

High IQ

Engagement in activities

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In 2013, > _____% of high school adolescents seriously considered suicide.

In 2013, > 20 % of high school adolescents seriously considered suicide.

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Name two treatment options for children with mild forms of pediatric major depressive disorder.

Cognitive behavioral therapy (CBT)

Interpersonal psychotherapy (IPT)

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Name the one treatment option that has strong evidence and a high safety profile for prepubertal children with moderate-to-severe forms of pediatric major depressive disorder.

Fluoxetine

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What is the best treatment plan for adolescents with moderate-to-severe forms of pediatric major depressive disorder.

Fluoxetine

CBT

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What should be done when an adolescent is started on fluoxetine for their major depressive disorder?

Have parents observe for a short time

(antidepressants may increase risk of suicidality in a select few — 4/100 instead of 2/100 — but this is preferable to the suicidality if left untreated)

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You start a 15-year-old girl on fluoextine for her major depressive disorder. The parents come back 6 months later and say that it hasn’t helped at all.

What do you do?

Switch the SSRI

add CBT

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How long should treatment be maintained in an adolescent patient with major depressive disorder?

6 - 9 months

(reduce risk of relapse and also help get them through the unoccupied Summer months)

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What temporal event does pediatric bipolar disorder require for diagnosis?

≥ 1 week manic episode

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What are the components of DIG FAST?

Distractibility

Irritability

Grandiosity

Flight of ideas

Activity increase

Sleep deficit

Talkativeness

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What is typically the initial presenting feature of pediatric bipolar disorder?

Depressive episode

(the episodic nature of the disease is prominent)

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True/False.

Pediatric bipolar disorder is most likely to arise in children with a family history of bipolar disorder.

True.

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Which portends a less severe disease course of pediatric bipolar disorder, younger age at onset or older age at onset?

Older age at onset

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________ is the hallmark feature of bipolar disorder.

Mania is the hallmark feature of bipolar disorder.

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What form of treatment plays a more prominent role in pediatric cases of bipolar disorder than in adult cases?

Psychosocial treatments

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A father brings his 9-year-old son in to see you in clinic. He reports that his son has been in a persistently bad mood for the past year and throws wild tantrums multiple times per week that are hugely out of proportion to the scenario.

What do you suspect?

Disruptive mood dysregulation disorder

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What is disruptive mood dysregulation disorder?

A pediatric disorder characterized by severe, recurrent temper outbursts (out of proportion to the instigating factor) that may be verbal and/or physical

How long must the S/Sy of disruptive mood dysregulation disorder be present before diagnosis? It must first arise in children younger than what age in order to meet the diagnosis?

1 year 10 years of age

Disruptive mood dysregulation disorder is most common in what group?

Younger boys (less common in girls and/or adolescents)

**True/False**. Disruptive mood dysregulation disorder and pediatric bipolar disorder show fairly equal levels of mania.

**False**. Disruptive mood dysregulation disorder ***shows less mania than*** pediatric bipolar disorder.

How is disruptive mood dysregulation disorder treated?

CBT Parent management training

What psychopharmacologic treatments are available for disruptive mood dysregulation disorder?

**None** (only used to treat comorbidites and/or symptoms)

What is autism spectrum disorder?

A _developmental disorder_ that affects **communication**, **reciprocal social interactions** and **play**, **interests**, and **behavior**

**True/False**. Autism spectrum disorder is a lifelong disease that can change over time as one develops and ages.

True.

Symptoms of autism spectrum disorder are present prior to ___ years of age.

Symptoms of autism spectrum disorder are present prior to **_2_** years of age *(early signs may even be evident in the first few months; i.e., through “preverbal” cues)*.

**True/False**. Individuals with autism spectrum disorder often are not aware of their deficits.

**False**. One feels isolated and removed from socialization and language. *(This can be extremely distressing.)*

Describe the learning profile of individuals with autism spectrum disorder in terms of strengths.

Visuospatial skills Attention to detail Long-term memory Rules Memorization Mechanics of reading

Describe the learning profile of individuals with autism spectrum disorder in terms of weaknesses.

Auditory processing Distraction by irrelevant details Organizational skills Fine motor skills Abstract thought Rigidity and flexibility Time management

Which gender is more commonly affected by autism spectrum disorder? Which gender is more severely affected?

**Males** (1/39 v. 1/151) **Females**

What SES and ethnic groups are most affected by autism spectrum disorder?

**All** SES and **all** ethnic groups

Do we know why the incidence of autism spectrum disorder has increased so drastically since the 1980s (1/2500 to 1/59)?

**No**. We do not know whether this is an actual increase or a perceived increase due to broadening of the ASD definition and criteria, increased surveillance, etc

_The outcomes of autism spectrum disorder_: ## Footnote \< \_\_\_% good outcomes \> \_\_\_% fair outcomes \> \_\_\_% poor outcomes \> \_\_\_% very poor outcomes

_The outcomes of autism spectrum disorder_: ## Footnote \< **_15_** % good outcomes \> **_15_** % fair outcomes \> **_15_** % poor outcomes \> **_40_** % very poor outcomes

Although we don't know any of the details, what is the likely general etiology of autism spectrum disorder?

**Genetic** *(in 10% of cases, some association to chromosomal abnormalities --- Down syndrome, fragile X, tuberous sclerosis, Rett syndrome, double-Y males, etc.)*

Although virtually all neurobiology findings related to autism spectrum disorder are controversial, what are some of the proposed findings?

Brain abnormalities have been demonstrated in the cerebral cortex, cerebellum, limbic system, corpus callosum, basal ganglia, and brainstem Grey / white matter abnormalities + increased head circumference have been demonstrated

What neuropeptides/neurotrophins have been found to be abnormally elevated at birth in individuals later diagnosed with autism spectrum disorder?

VIP Brain-derived neurotrophic peptide Neurotrophin-4 Calcitonin gene-related protein

What is the gold standard method diagnosing autism spectrum disorder?

Clinical assessment

What factors are involved in the diagnostic criteria for autism spectrum disorder?

Social communication/interaction deficits Restricted/repetitive behavior or interests Limited capacities Not better explained by intellectual disability or global developmental delay

What should a clinician look for in assessing a patient for diagnosis of autism spectrum disorder?

- No/rare **response** to **name** being called - No/little **interest** in others - **Repetitive movements** - **Joint attention** deficits (initiating and responding) - Deficits in **gestures**, **facial expressions**, **eye contact** - **Meltdown** when **electronic device** is taken away - Lack of ability to maintain a **conversation**

What is 'joint attention' in regards to autism spectrum disorder?

Sharing an experience with another

Give some examples of how to assess a patient's joint attention (in both responding and initiating)?

_Responding_: following the other’s finger with your gaze to see where they are pointing _Initiating_: pointing your finger to indicate something to the other

Autism spectrum disorder is a sliding scale from stage ___ (more mild) to stage ___ (more severe).

Autism spectrum disorder is a sliding scale from stage **_1_** (more mild) to stage **_3_** (more severe).

What are the keys to treating autism spectrum disorder?

**Intervene early** and make it _visual_

Children with autism spectrum disorder tend to think in \_\_\_\_\_\_\_\_, not words.

Children with autism spectrum disorder tend to think in **_images_**, not words.

What are two basic components of treating autism spectrum disorder?

- Applied Behavioral Analysis - Milieu/Day Treatment

For individuals with autism spectrum disorder, name the portion of the brain likely affected in the following disease deficits: **Decrease in executive function** (cortical structure) **Imitation of others** (cortical structure) **Imitating oneself** (cortical structure) **Empathy** (neuron type)

Prefrontal cortex Superior temporal gyrus and left inferior parietal cortex Right inferior parietal cortex Mirror neurons

What test can be used in assessing an individual's theory of mind?

The Sally-Anne test

What is central coherence?

One's ability to see the big picture and anticipating the next steps

**True/False**. Individuals with autism spectrum disorder often struggle with both eye tracking and conversation tracking.

True.

What type of anger is associated with childhood affective instability (e.g. in disruptive mood dysregulation or oppositional defiant disorder)?

Overt / affective / reactive / impulsive

What type of anger is associated with conduct disorder?

Covert / proactive / planned / instrumental

In order for a diagnosis of oppositional defiant disorder to be made, a child must have ≥ ___ S/Sy for ≥ ___ months.

In order for a diagnosis of oppositional defiant disorder to be made, a child must have ≥ **_4**_ S/Sy for ≥ _**6_** months.

Oppositional defiant disorder begins before what event and is more common in which gender?

Puberty; boys

What is a risk factor for oppositional defiant disorder?

Harsh, inconsistent punishment

Name three of the major S/Sy of oppositional defiant disorder.

Losing one's temper, being touchy and easily annoyed, being angry/resentful (also, arguing, refusing requests, blaming others)

**True/False**. 1/3 of patients with oppositional defiant disorder are symptom free within 3 years, and 2/3 develop conduct disorder (and may even progress to antisocial personality disorder!).

**False**. ***2/3*** of patients with oppositional defiant disorder are symptom free within 3 years, and ***1/3*** develop conduct disorder (and may even progress to antisocial personality disorder!).

What is a risk factor for oppositional defiant disorder?

Maltreatment

Conduct disorder is much, much more common in which gender?

Males

What is the basic feature of conduct disorder?

Disruptive behavior that violates the social norms or basic rights of others

Disruptive behavior that violates the social norms or basic rights of others is termed _______________ disorder in children (\< 18 years) and _______________ disorder in adults (≥ 18 years).

Disruptive behavior that violates the social norms or basic rights of others is termed **_conduct_** disorder in children (\< 18 years) and **_antisocial personality disorder_** disorder in adults (≥ 18 years).

90% of patients with conduct disorder are comorbid with \_\_\_\_\_\_\_\_\_\_\_\_\_\_; 90% are comorbid with \_\_\_\_\_\_\_\_\_\_\_\_\_\_; there is also an association with **depression** and **anxiety**.

90% of patients with conduct disorder are comorbid with **_oppositional defiant disorder_**; 90% are comorbid with **_ADHD_**; there is also an association with **depression** and **anxiety**.

In order for a diagnosis of conduct disorder to be made, a child must have ≥ ___ S/Sy within the past _____ months _OR_ ____ S/Sy in the past _____ months.

In order for a diagnosis of conduct disorder to be made, a child must have ≥ **_3**_ S/Sy within the past _**12_** months _OR_ **_1**_ S/Sy in the past _**6_** months.

ADHD is a multifactorial disorder with a strong heritability component (\_\_\_\_%) but environmental factors are very important as well.

ADHD is a multifactorial disorder with a strong heritability component ( **_75_** %) but environmental factors are very important as well.

ADHD is often associated with a ___________ (brain region) abnormality.

ADHD is often associated with a **_prefrontal cortex_** abnormality.

What are the hallmarks of ADHD in terms of school performance and intelligence?

**Poor performance** due to hyperactivity/inattentiveness; ## Footnote **normal intelligence**

In order for a diagnosis of ADHD to be made, onset must have occurred before ____ years of age.

In order for a diagnosis of ADHD to be made, onset must have occurred before **_12_** years of age.

What is the overall incidence of ADHD? It is more common in which sex?

**5%** (5 - 8% in children; 4% in adults); **males** (3:1)

In order for a diagnosis of ADHD to be made, ____ S/Sy must be observed for ____ months.

In order for a diagnosis of ADHD to be made, **_6**_ S/Sy must be observed for _**6_** months. ## Footnote *(_NOTE_: one should also identify comorbid disorders and rule out ADHD mimickers such as hearing/visual impairment, thyroid disorders, sleep disorders, etc.)*

What are the three forms of ADHD as reported by the DSM-V?

Inattentive Hyperactive/impulsive Combined

Name some of the conditions that are often comorbid with ADHD.

Oppositional defiant disorder, conduct disorder, learning disability, anxiety, depression

How is ADHD treated for a child between 6 and 18 years of age?

A stimulant + behavioral therapy

What are the go-to pharmacological options for treating ADHD?

Methylphenidate, amphetamine salts *(_NOTE_: can also try atomoxetine, Wellbutrin, guanfacine, clonidine.)*