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T2 - Phase 3 - Brain, Mind, and Behavior > BMB 3 - Childhood Behavioral Disorders; Autism Spectrum Disorders; ADHD & Disruptive Behavior Disorders > Flashcards

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

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1
Q

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

A

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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2
Q

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

And in adolescence?

A

1: 1
2: 1

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3
Q

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

And in adolescents?

A

2%

7%

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4
Q

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

A

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

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5
Q

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

A

Behavioral problems become more likely

(fewer neurovegetative problems like eating or sleeping issues)

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6
Q

What is the diagnostic criteria for pediatric major depressive disorder?

A

Depression and/or anhedonia

+

≥ 4 S/Sy of SIG-E-CAPS

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7
Q

What are the components of SIG-E-CAPS?

A

Sleep changes

Interest changes

Guilt

Energy changes

Concentration

Appetite changes

Psychomotor agitation

Suicidality

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8
Q

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

A

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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9
Q

Name a few protective factors against pediatric major depressive disorder.

A

Supportive caregiving/adults and prosocial peers

High IQ

Engagement in activities

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10
Q

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

A

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

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11
Q

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

A

Cognitive behavioral therapy (CBT)

Interpersonal psychotherapy (IPT)

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12
Q

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.

A

Fluoxetine

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13
Q

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

A

Fluoxetine

+

CBT

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14
Q

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

A

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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15
Q

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?

A

Switch the SSRI

+

add CBT

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16
Q

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

A

6 - 9 months

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

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17
Q

What temporal event does pediatric bipolar disorder require for diagnosis?

A

≥ 1 week manic episode

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18
Q

What are the components of DIG FAST?

A

Distractibility

Irritability

Grandiosity

Flight of ideas

Activity increase

Sleep deficit

Talkativeness

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19
Q

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

A

Depressive episode

(the episodic nature of the disease is prominent)

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20
Q

True/False.

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

A

True.

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21
Q

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

A

Older age at onset

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22
Q

________ is the hallmark feature of bipolar disorder.

A

Mania is the hallmark feature of bipolar disorder.

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23
Q

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

A

Psychosocial treatments

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24
Q

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?

A

Disruptive mood dysregulation disorder

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25
Q

What is disruptive mood dysregulation disorder?

A

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

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26
Q

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?

A

1 year

10 years of age

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27
Q

Disruptive mood dysregulation disorder is most common in what group?

A

Younger boys

(less common in girls and/or adolescents)

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28
Q

True/False.

Disruptive mood dysregulation disorder and pediatric bipolar disorder show fairly equal levels of mania.

A

False.

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

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29
Q

How is disruptive mood dysregulation disorder treated?

A

CBT

Parent management training

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30
Q

What psychopharmacologic treatments are available for disruptive mood dysregulation disorder?

A

None

(only used to treat comorbidites and/or symptoms)

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31
Q

What is autism spectrum disorder?

A

A developmental disorder that affects communication, reciprocal social interactions and play, interests, and behavior

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32
Q

True/False.

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

A

True.

33
Q

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

A

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).

34
Q

True/False.

Individuals with autism spectrum disorder often are not aware of their deficits.

A

False.

One feels isolated and removed from socialization and language.

(This can be extremely distressing.)

35
Q

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

A

Visuospatial skills

Attention to detail

Long-term memory

Rules

Memorization

Mechanics of reading

36
Q

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

A

Auditory processing

Distraction by irrelevant details

Organizational skills

Fine motor skills

Abstract thought

Rigidity and flexibility

Time management

37
Q

Which gender is more commonly affected by autism spectrum disorder?

Which gender is more severely affected?

A

Males (1/39 v. 1/151)

Females

38
Q

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

A

All SES and all ethnic groups

39
Q

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

A

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

40
Q

The outcomes of autism spectrum disorder:

< ___% good outcomes

> ___% fair outcomes

> ___% poor outcomes

> ___% very poor outcomes

A

The outcomes of autism spectrum disorder:

< 15 % good outcomes

> 15 % fair outcomes

> 15 % poor outcomes

> 40 % very poor outcomes

41
Q

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

A

Genetic

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

42
Q

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

A

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

43
Q

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

A

VIP

Brain-derived neurotrophic peptide

Neurotrophin-4

Calcitonin gene-related protein

44
Q

What is the gold standard method diagnosing autism spectrum disorder?

A

Clinical assessment

45
Q

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

A

Social communication/interaction deficits

Restricted/repetitive behavior or interests

Limited capacities

Not better explained by intellectual disability or global developmental delay

46
Q

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

A
  • 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
47
Q

What is ‘joint attention’ in regards to autism spectrum disorder?

A

Sharing an experience with another

48
Q

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

A

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

49
Q

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

A

Autism spectrum disorder is a sliding scale from stage 1 (more mild) to stage 3 (more severe).

50
Q

What are the keys to treating autism spectrum disorder?

A

Intervene early and make it visual

51
Q

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

A

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

52
Q

What are two basic components of treating autism spectrum disorder?

A
  • Applied Behavioral Analysis
  • Milieu/Day Treatment
53
Q

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)

A

Prefrontal cortex

Superior temporal gyrus and left inferior parietal cortex

Right inferior parietal cortex

Mirror neurons

54
Q

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

A

The Sally-Anne test

55
Q

What is central coherence?

A

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

56
Q

True/False.

Individuals with autism spectrum disorder often struggle with both eye tracking and conversation tracking.

A

True.

57
Q

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

A

Overt / affective / reactive / impulsive

58
Q

What type of anger is associated with conduct disorder?

A

Covert / proactive / planned / instrumental

59
Q

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

A

In order for a diagnosis of oppositional defiant disorder to be made, a child must have ≥ 4** S/Sy for ≥ **6 months.

60
Q

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

A

Puberty;

boys

61
Q

What is a risk factor for oppositional defiant disorder?

A

Harsh, inconsistent punishment

62
Q

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

A

Losing one’s temper,

being touchy and easily annoyed,

being angry/resentful

(also, arguing, refusing requests, blaming others)

63
Q

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!).

A

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!).

64
Q

What is a risk factor for oppositional defiant disorder?

A

Maltreatment

65
Q

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

A

Males

66
Q

What is the basic feature of conduct disorder?

A

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

67
Q

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).

A

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).

68
Q

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

A

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.

69
Q

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.

A

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.

70
Q

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

A

ADHD is a multifactorial disorder with a strong heritability component ( 75 %) but environmental factors are very important as well.

71
Q

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

A

ADHD is often associated with a prefrontal cortex abnormality.

72
Q

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

A

Poor performance due to hyperactivity/inattentiveness;

normal intelligence

73
Q

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

A

In order for a diagnosis of ADHD to be made, onset must have occurred before 12 years of age.

74
Q

What is the overall incidence of ADHD?

It is more common in which sex?

A

5% (5 - 8% in children; 4% in adults);

males (3:1)

75
Q

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

A

In order for a diagnosis of ADHD to be made, 6** S/Sy must be observed for **6 months.

(NOTE: one should also identify comorbid disorders and rule out ADHD mimickers such as hearing/visual impairment, thyroid disorders, sleep disorders, etc.)

76
Q

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

A

Inattentive

Hyperactive/impulsive

Combined

77
Q

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

A

Oppositional defiant disorder,

conduct disorder,

learning disability,

anxiety,

depression

78
Q

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

A

A stimulant

+

behavioral therapy

79
Q

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

A

Methylphenidate,

amphetamine salts

(NOTE: can also try atomoxetine, Wellbutrin, guanfacine, clonidine.)

T2 - Phase 3 - Brain, Mind, and Behavior (43 decks)

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