BMB 3 - Childhood Behavioral Disorders; Autism Spectrum Disorders; ADHD & Disruptive Behavior Disorders Flashcards
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
What is the girl-to-boy ratio of pediatric major depressive disorder in children?
And in adolescence?
1: 1
2: 1
What is the lifetime prevalence of pediatric major depressive disorder in children?
And in adolescents?
2%
7%
Describe some common presentations for prepubertal children with pediatric major depressive disorder.
Irritability, anxiety, and somatic complaints (headaches or stomachaches, etc.)
Describe some common presentations for adolescents with pediatric major depressive disorder.
Behavioral problems become more likely
(fewer neurovegetative problems like eating or sleeping issues)
What is the diagnostic criteria for pediatric major depressive disorder?
Depression and/or anhedonia
+
≥ 4 S/Sy of SIG-E-CAPS
What are the components of SIG-E-CAPS?
Sleep changes
Interest changes
Guilt
Energy changes
Concentration
Appetite changes
Psychomotor agitation
Suicidality
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
Name a few protective factors against pediatric major depressive disorder.
Supportive caregiving/adults and prosocial peers
High IQ
Engagement in activities
In 2013, > _____% of high school adolescents seriously considered suicide.
In 2013, > 20 % of high school adolescents seriously considered suicide.
Name two treatment options for children with mild forms of pediatric major depressive disorder.
Cognitive behavioral therapy (CBT)
Interpersonal psychotherapy (IPT)
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
What is the best treatment plan for adolescents with moderate-to-severe forms of pediatric major depressive disorder.
Fluoxetine
+
CBT
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)
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
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)
What temporal event does pediatric bipolar disorder require for diagnosis?
≥ 1 week manic episode
What are the components of DIG FAST?
Distractibility
Irritability
Grandiosity
Flight of ideas
Activity increase
Sleep deficit
Talkativeness
What is typically the initial presenting feature of pediatric bipolar disorder?
Depressive episode
(the episodic nature of the disease is prominent)
True/False.
Pediatric bipolar disorder is most likely to arise in children with a family history of bipolar disorder.
True.
Which portends a less severe disease course of pediatric bipolar disorder, younger age at onset or older age at onset?
Older age at onset
________ is the hallmark feature of bipolar disorder.
Mania is the hallmark feature of bipolar disorder.
What form of treatment plays a more prominent role in pediatric cases of bipolar disorder than in adult cases?
Psychosocial treatments
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
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:
< ___% good outcomes
> ___% fair outcomes
> ___% poor outcomes
> ___% very poor outcomes
The outcomes of autism spectrum disorder:
< 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;
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.
(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.)
