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Child & Adolescent Psychiatry Review > CAP3 > Flashcards

CAP3 Flashcards

1
Q

When is the neuronal density in the brain the greatest?

A

There is a dramatic decrease right before birth and steady decrease to 6 to 15 months and then there are adult values

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2
Q

When is synaptic density the greatest?

A

Increases before birth until 8 months in the visual cortex; 3 years in the auditory cortex; 1 to 3 years in the prefontal cortex. It then decreases to adult values from the age of 12 to mid-adolescence. The dendritic neuronal architecture matures until late adolescence

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3
Q

How late does myelinization last and where?

A

3rd decade of life in the intracortical association areas

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4
Q

How much does an infant sleep at birth?

A

16 hours

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5
Q

How much does an adolescent sleep?

A

8 hours

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6
Q

What is the percent of time spent in REM sleep at birth and at adulthood?

A

50% at birth. 20% at age 3 (adult values)

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7
Q

Infants enter REM sleep right away. At what age is sleep onset without REM?

A

2 1/2 months

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8
Q

Does sensory inhibition increase or decrease with age?

A

Increase

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9
Q

At what age is REM identified?

A

28 to 30 weeks (prenatally)

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10
Q

Describe neuronal synapses before and after puberty

A

Before puberty there is formation and elimination (competitive elimination). After puberty, learning and memory depend on strength of already existing synapses

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11
Q

What is the chromosomal deletion in Williams Syndrome?

A

7

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12
Q

Wiliams Syndrome is characterized by what clinical presentation?

A

Intellectual disability, cardiovascular disease, adequate verbal skills, cannot integrate complete picture; play instrument. 1/20,000

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13
Q

What chromosome is affected in Angelman Syndrome?

A

15 (deletion or two copies)

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14
Q

What are the clinical characteristics of Angelman Syndrome?

A

Intellectual disability, no speech, large mandible with open mouth expression, hypotonia, motor delays. 1/10,000

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15
Q

What is the clinical presentation of Prader-Willi?

A

Obesity, temper tantrums, aggression, OCD. 1/10,000

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16
Q

What chromosome is affected in Prader-Willi?

A

Chromosome 15 q11-q13 deletion from father. Two copies also a cause

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17
Q

What is lissencephaly?

A

Most common disorder of normal migration of neurons. There are 4 cortical layers instead of the normal 6. There is a smooth cortical surface

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18
Q

What percentage of those with the Fragile X gene are not intellectually impaired?

A

20%

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19
Q

What gene is affected in Fragile X?

A

FMR-1

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20
Q

Which repeat defect is there in Fragile X?

A

CGG (200-1000 vs. 29 found normally)

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21
Q

What is often the first clinical symptom of Rett’s disorder?

A

Loss of purposeful hand movements

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22
Q

What chromosome is affected in Rett’s?

A

Xq28

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23
Q

Which protein is implicated in Rett’s?

A

MECP2 (a mutation leads to inappropriate gene expression and its protein product)

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24
Q

When a young child learns two languages they are represented by a single language center or two?

A

A single language center. In adults, a new language is represented by a new language center separate from the primary language center

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25
Q

How many genes are there in a person?

A

80,000

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26
Q

How many genes are present in the CNS?

A

30,000

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27
Q

Do the anterior cingulate and hippocampus show increased or decreased regional blood flow in PTSD?

A

Decreased

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28
Q

Is reading dysfunction located in the left or right hemisphere?

A

Left hemisphere

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29
Q

Which brain area has shown an incraese in size in PANDAS?

A

Basal ganglia

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30
Q

Are the basal ganglia increased or decreased in size in Tourette’s disorder?

A

Decreased, especially putamen and globus pallidus. There is also reduced assymetry

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31
Q

Is cortical blood flow and metabolism increased or decreased in the basal ganglia in Tourette’s?

A

Decreased

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32
Q

Which area of the brain shows increased activity during efforts at tic suppression?

A

Right caudate nucleus

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33
Q

Obsessive-compulsive disorder shows an increase or decrease in caudate volume?

A

Decrease

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34
Q

Patients with OCD show an increase or decrease in glutamate?

A

Increased glutamate in the caudate, which normalizes with treatment in one study

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35
Q

In patients with OCD is there an increase or decrease in the thalamus?

A

Increase

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36
Q

What is the most consistent finding in childhood onset schizophrenia?

A

Decreased brain size (especially frontal-temporal) and increased ventricles

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37
Q

Is the NAA (N-acetylaspartate) to Cr (creatine-phosphocreatine) ratio increased or decreased in schizophrenia?

A

Decreased

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38
Q

Which area in the temporal lobe fails to light up in autism in facial recognition tasks?

A

Fusiform gyrus

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39
Q

Velocardiofacial syndrome has which chromosomal deletion?

A

22q11.2

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40
Q

What percentage of patients with velocardiofacial sydnrome have schizophrenia?

A

30%

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41
Q

Do patients with velocardiofacial syndrome have increased or decreased brain size?

A

Decreased

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42
Q

Children born weighing less than 1500 g have a decreased IQ score by how much?

A

15 points (1 SD)

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43
Q

What percentage of children born weighing less than 1500 g repeat a grade by age 8?

A

20% (although, in preemies, age based on birthdate rather than ‘due date’ means developmentally younger for age)

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44
Q

What are the components of the basal ganglia?

A

Caudate nucleus, putamen, globus pallidus, subthalamic nuclei, substantia nigra.

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45
Q

What does the basal ganglia do?

A

Influences movement and muscle tone and also mediates higher cognitive functions

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46
Q

The frontal, parietal, temporal, and occipital gray matter each peak at what age?

A

Frontal gray, 11 year old for females and 12 year old for males and then decreases in adolescence; same for parietal gray; temporal gray peaks at age 16; occipital grey increases mildly through childhood and adolescence. This differing gray matter development is uniquely human

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47
Q

What does magnetic resonance spectroscopy do?

A

Measures concentrations of chemical compounds in the brain. It has poor temporal and spatial resolution

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48
Q

What is diffusion tensor imaging?

A

MRI technology that looks at orientation of fiber tracks. Useful in strokes and multiple sclerosis.

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49
Q

Which is the correct order of spatial resolution for MRI, CT, PET, SPECT?

A

MRI>CT>PET>SPECT

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50
Q

When are testicular hormones first secreted?

A

8th week of fetal life

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51
Q

In Tourette’s Disorder and OCD, neuronal circuits fail in what way?

A

They reverberate rather than switch off (failure to self inhibit)

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52
Q

Which major anatomical areas of the brain have deficits in schizophrenia?

A

Frontal and temporal

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53
Q

Is brain size increased or decreased in Down’s syndrome?

A

Decreased by 25% but not so until age 3 to 5

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54
Q

Which gender exhibits more lateralization of the brain?

A

Males

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55
Q

What is the function of the amygdala?

A

It is a/w with fear provoked aggression. Lesions result in decreased control, spontaneity, flexibility, affect, cognition

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56
Q

Do children with one psychotic parent or one depressed parent and a healthy other parent have increased psychopathology?

A

No [what about genetic contribution?]. Absence of hostility is a key factor

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57
Q

Who appears more affected by an ill parent, boys or girls?

A

Boys

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58
Q

Is suicidality heritable?

A

Yes

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59
Q

Is mental illness of a parent or overall family function the greater mediator of mental illness or difficulties in a child?

A

Family function and not parent illness per se

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60
Q

Parent child conflict is usually characterized by what strategies?

A

Negative, insensitive, harsh (rather than reassuring, negotiating, and compromising)

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61
Q

Mothers in high conflict marriages use what technique with their children?

A

Guilt and anxiety inducing ones

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62
Q

What percent of mothers of preschool children have reported depressive symptoms?

A

40%

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63
Q

How many substantiated reports of child maltreatment are there per year?

A

1,000,000 (with 1000 deaths per year)

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64
Q

What year were special education laws revised to mandate special services for 3 to 5 year olds and allow states early intervention from 0 to 3?

A

1986

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65
Q

What is the most widely used neonatal test?

A

Brazelton Neonatal Behavioral Assessment Scale

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66
Q

What is the most widely used infant and toddler test?

A

Bayley Scales of Infant Development (1 to 42 months)

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67
Q

What infant/toddler screening test can be used with language and visually impaired children?

A

DASI. Developmental Activity Screening Inventory

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68
Q

What is subacute sclerosing panencephalitis?

A

Chronic progressive encephalitis. Persistent infection of measles virus. Occurs rarely after one has had measles. Symptoms emerge 4 to 15 years later. There is personality change, poor school function, myoclonic seizures, involuntary movements, ataxia, dementia. 1/1,000,000

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69
Q

Most children with HIV infection obtain it how?

A

Vertical (maternal) transmission

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70
Q

How does one diagnose lyme disease?

A

IgM antibodies to B. Burgodoferi or by polymerase chain reaction

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71
Q

What fraction of children have lyme neuroborreliosis when infected?

A

1/620. Psychosis can be seen

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72
Q

When is syphilis most likely to be acquired by a fetus?

A

4 to 7 months gestation. General paresis occurs 6 to 21 years later. Treatment is with Penicillin G

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73
Q

What percent of survivors of meningitis have sequelae?

A

50%. Lower IQ, hearing loss. The sequelae are worse for infants and if treatment is delayed

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74
Q

What is most common cause of meningitis in those greater than a month old?

A

S. Pneumoniae, N. Meningitidis, B. Hemolytic Strep, Listeria. Starts with an upper respiratory infection

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75
Q

What is the most common type of psychiatric disorder after a traumaic brain injury?

A

Postconcussive–>labile, aggressive, disinhibited

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76
Q

What do prospective studies of traumatic brain injury outcomes show about psychopathology?

A

After accounting for premorbid psychopathology, severe but not mild TBI increases risk of psychopathology

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77
Q

What is post-concussional syndrome?

A

Headache, dizziness, fatigue, decreased concentration, memory, irritability, anxiety, insomnia, hypochondriasis, hypersensitivity to noise, photophobia, seizure like symptoms

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78
Q

Traumatic brain injury incidents peak at what age?

A

15 years

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79
Q

What is the definition of a concussion?

A

Transient but widespread loss of neuronal function

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80
Q

What is the most common lesion on MRI after closed head injury?

A

Diffuse axonal injury. Clinical sign is loss of consciousness. There are small focal injuries in white matter tracts. The second most common finding on MRI is cortical contusion

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81
Q

What brain area is involved in the acquisition of emotional memories?

A

The amygdala

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82
Q

What area of the brain constrains impulsive acts?

A

Orbital-frontal cortex

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83
Q

What area of the brain is involved in delay gratification

A

Ventromedial prefrontal cortex

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84
Q

Behavioral inhibition is related to what four executive neuropsychological functions?

A

Working memory, self-regulation, internalization of speech, reconstruction. Separation of affect as well

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85
Q

Is there a correlation between IQ and suicidal behavior?

A

No. Mood disorder, alcohol use, personality disorder, and impulsive-aggressive traits are correlated

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86
Q

What does the evidence suggest regarding the use of lithium in adults with major depressive disorder and bipolar and suicide?

A

Reduced the rate by 9 times (discontinuing lithium led to 7 times more attempts and 9 times more completions). Tondo et al. 1997 reviewed 28 studies involving 17,000 patients. More recent evidence supports this, too, Song et al. 2017

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87
Q

What is the outcome for children with depression?

A

Based on 10 to 15 year follow-up of pre-pubertally depressed children, the outcome was 3 times an increase of suicide attempts, bipolar disorder, and adult depression (when psychopathology continued)

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88
Q

Is there a gender difference for severity or recurrence of childhood depression?

A

No

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89
Q

At what age does a gender difference emerge for depression?

A

15 to 18 years of age

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90
Q

What symptoms of depression are present equally in children and in adolescents?

A

Decreased mood, decreased concentration, insomnia, suicidal thinking.

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91
Q

What are the differences in children and adolescents in their manifestation of depression?

A

Child: depressed appearance, somatic, psychomotor agitation, separation anxiety, phobias. Adolescents: drug use, hopelessness, hypersomnia, anhedonia, weight changes. Both groups have decreased mood and concentration, insomnia, suicidal thinking

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92
Q

What percentage of OCD patients respond to OCD treatment

A

50% have 25 to 40% reduction in symptoms

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93
Q

What percent of children 12 and under who are raped know the attacker?

A

96%. 20% are fathers, 16% are relatives; 50% are friends or acquaintances; others less known/close; 4% are strangers

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94
Q

When child sexual abuse involves abuse by females what percentage is by mother only?

A

3.8%. 12% by both parents. 11% by mother with others. 2.2% by female relative.

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95
Q

When are children most vulnerable for sexual abuse?

A

8 to 12 years of age

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96
Q

What percentage of child sexual abuse offenders are adolescents?

A

50%

97
Q

What percentage of child sexual abuse reports are concluded to be false?

A

2% (6% for adult reports).

98
Q

What percentage of children recant statements of sexual abuse?

A

22%. Recantation should be viewed as part of disclosure process since the allegations rarely prove false

99
Q

In confirmed cases of sexual abuse, what percentage of time do children intially deny it or are tentative in disclosing?

A

The vast majority

100
Q

In the Isle of Wright cross sectional study, what percentage of 11 year olds have school phobia?

A

3%

101
Q

What is the percentage of adoptees in the population?

A

3.50%

102
Q

Are adoptees more likely to be referred for treatment?

A

Yes, for externalizing behaviors. 20% of inpatients are adoptees

103
Q

According to the U.S. Department of Health and Human Services parent surveys, what percentage of children who require treatment for emotional, developmental, or behavioral problems receive it?

A

0-5 yo, 40%; 6 to 11, 60% ; 12 to 17, 65%. This differs from other methods which shows lower figures.

104
Q

What is the percent genetic contribution to anorexia nervosa?

A

56%. 5% is shared environment, 38% is unique environment (Bulik 2006; based on 31,000+ twins in Sweden)

105
Q

The rate of diagnosable psychiatric disturbances among children of depressed parents can be as high as?

A

50%

106
Q

What are the different types of family therapy?

A
  1. Intergenerational (Bowen family systems; Boszomenyi-Nagy contextual) 2. Systems/Community (Minuchin structural; strategic, narrative; triadic based 3. Psychodynamic 4. Experiential 5. Behavioral
107
Q

What do meta-analyses show about group treatment?

A

73% better off than those in control group

108
Q

How many inpatient discharges per year are there for children and adolescents.

A

143,000

109
Q

What factors are associated with a negative outcome in residential facility treatment?

A

Psychosis, lower IQ, antisocial and bizarre behavior, dysfunctional family, inadequate duration for consolidation of gains, stay of less than one month

110
Q

In a 10 year follow-up study of adolescents and adults who had received residential vs. adolescent day hospital care, what difference was shown?

A

No difference in social-personal adjustment. There was improvement at follow-up in 65% of subjects

111
Q

What percentage of children live in poverty?

A

20% or more

112
Q

What percentage of mothers with children less than 6 years of age are working?

A

65%. 55% return to work within weeks of birth

113
Q

What percentage of chronic school absentees have a psychiatric disorder?

A

50%

114
Q

What did the 1997 amendment of the IDEA (Individuals with Disabilities Education Act) do regarding dangerous behaviors and drugs and alcohol?

A

A child who brings a weapon or who uses, sells, or buys drugs at school or a school function may be removed immediately and placed in an alternate setting. School officials may suspend a child for 10 days for conduct disordered behaviors and the placement changed if it is determined there is a danger to self or others

115
Q

What is the prevalence of one or more psychiatric disorders in community surveys of children and adolescents?

A

11% (18-22% if functional impairment is not included)

116
Q

What percentage of adolescent probands with OCD have first degree relatives with OCD?

A

30%

117
Q

What are the most common compulsions in OCD?

A

Cleaning > repeating (do/undo) > checking

118
Q

What is the most common obsession in OCD?

A

Contamination/cleanliness (dirt and germs)

119
Q

Is OCD more common in males or females?

A

It is equal but males have earlier onset

120
Q

What is the prevalence of OCD?

A

0.5 to 3%

121
Q

Do students with previous suicide attempts respond well or poorly to programs about suicide?

A

Poorly

122
Q

What are the classifications of prevention?

A

Universal: target the whole population, not selected by risk. Selective: target individuals who have elevated risk Indicated: target high risk individuals who display early precursors or signs of the disorder or have symptoms predicting the disorder

123
Q

What are families like in patients with recurrent abdominal pain?

A

They tend to reward illness behavior (but there are no difference in rates of negative life events or family functioning)

124
Q

What is recurrent abdominal pain (RAP)?

A

Three episodes of abdominal pain over 3 months severe enough to affect the activities of the child

125
Q

Conversion disorder in children usually resolves in how much time?

A

3 months

126
Q

Is conversion disorder more common in males or females?

A

Females in all age groups

127
Q

What disorders cluster with somatization disorder?

A

Antisocial personality disorder; ADHD; Alcoholism

128
Q

What should be considered in somatization disorder found in a child?

A

Sexual abuse

129
Q

How soon does phototherapy work in seasonal affectiver disorder?

A

1 to 2 weeks. Adults exposed to 10,000 lux daily for 30 minutes have a response rate of 75 to 80%; as such 2 week treatment is recommended. Children respond to lower intensities and shorter exposures

130
Q

What is the epidemiology of seasonal affective disorder?

A

1 to 2% of the general population. A recent study 2017 questioned the validity of the disorder.

131
Q

What time of year is the onset of seasonal affective disorder?

A

Sept - Nov. Presents with atypical depression symptoms

132
Q

What is risk of fatal hepatotoxicity for children taking valproate?

A

Close to zero after age 10. It is greatest less than 2 years of age

133
Q

What is the rate of bipolar disorder in family members of prepubertal compared to adolescent probands with bipolar disorder?

A

3 times the rate for the prepubertal children

134
Q

What percent of children who are depressed develop bipolar disorder?

A

20 to 30%. The risk is greatest if the depression included rapid onset, psychosis, psychomotor retardation, family with mood disorders, and a history of drug induced mania

135
Q

In one study of patients with pediatric bipolar disorder, what percentage endorsed suicidality?

A

25% (Geller)

136
Q

What percentage of patients with pediatric bipolar disorder report psychotic symptoms?

A

60% (Geller study of 93 patients). Most common is grandiose delusion

137
Q

How do younger children present with bipolar disorder?

A

Irritability and emotional lability

138
Q

What predicts lack of recovery, chronicity and recurrence of depression in children?

A

The level of depression at baseline; the self-reported level of parent-child conflict at baseline and follow-up

139
Q

What is the Self-Control Model for depression?

A

This model assumes that depressed individuals have deficits in self-reinforcement, -evaluation, and -monitoring. Often they focus on the short- rather than long-term consequences of their actions. They often misattribute personal success to external forces and personal failure to themselves

140
Q

What is the Cognitive Triad in depression?

A

The negative view of the self, world, and future

141
Q

Do all children of parents who are depressed do poorly?

A

No. Beardslee (1988) found that at 2.5 year follow-up 15 of 18 adolescents were doing well if the following were present: self-understanding, problem-solving ability, commitment to relationships, action orientation, thinking and acting separately from the depressed parent

142
Q

What age do infants recognize their mother’s voice (vs. another’s)?

A

3 days

143
Q

When do babies smile?

A

By 1 month

144
Q

When do babies smile and laugh in response to speech?

A

By 3 months

145
Q

When do infants vocalize in response to sounds?

A

By 4 months

146
Q

What brain structure is associated with implicit memory?

A

Basal ganglia, amygdala, and perhaps motor and somatosensory cortices

147
Q

What brain structure is associated with expicit memory?

A

Medial temporal lobe including hippocampus

148
Q

What are 4-5 valid temperamental categories according to the evidence?

A

High and low reactivity, irritability, activity, frequency of smiling, laughter

149
Q

What percentage of high reactive, inhibited children will develop a profile associated with an anxiety disorder?

A

33% (the reactivity is key)

150
Q

What are the two primary temperamental dimensions in infants, according to Mary Rothbart?

A

Ease of arousal (reactivity) and self-regulation

151
Q

What are the stages of the Strange Situation?

A
  1. Intro 2. Mother and infant 3. Mother and infant and stranger (stranger plays with infant) 4. Infant and stranger 5. Mother and infant (mother enters stranger departs) 6. Infant alone 7. Infant and stranger 8. Infant and mother (mother enters stranger departs). Studied in 11 to 24 months of age
152
Q

Who developed the Strange Situation?

A

Mary Ainsworth in the 1970s

153
Q

What author found that prn meds may be no more effective than placebo for agitation?

A

Vitiello et al. 1991 Ages 5 to 13, diphenhydramine vs. placebo. IM of placebo or diphenhydramine more effective than oral agents. One can only truly conclude that diphenhydramine was no more effective than placebo; but it wouldn’t be surprising if this extends to other agents

154
Q

What is a theory of dopamine in Tourette’s disorder?

A

Post synaptic D2 receptors are hypersensitive

155
Q

What is the prevalence of tic disorders?

A

1 to 2%

156
Q

What are smooth pursuit deficits in childhood onset schizophrenia (COS)

A

Decreased tracking and increased anticipatory saccades

157
Q

What is the clinical picture like for childhood onset schizophrenia?

A

Very rare in general, especially before 5 years of age. There are non-psychotic disturbances by age 4.6. Psychosis emerges at 6.9 years of age. Full disorder by 9.5 years (Russell 1994)

158
Q

What is the concordance rate for twins in Tourette’s disorder?

A

50% MZ, 10% DZ. If chronic motor tics are included it is 90% for MZ and 30% for DZ

159
Q

Children with HIV tend to become symptomatic quickly (if untreated). 70% can be symptomatic by 1 year. The bimodal distribution of symptom emergence is called what?

A

Slow progressor and rapid progressor

160
Q

What percent of children obtain HIV through sexual abuse?

A

0.30%

161
Q

What number of death in children are associated with burns?

A

1,500 annually. Fires and burns are the 3rd leading cause of death in children 1 to 4 and the 4th leading cause in children 1 to 19

162
Q

What are the three levels of moral development according to Lawrence Kohlberg?

A
  1. Pre-moral 2. Conventional Role Conformity 3. accepted Moral Principles
163
Q

What are the two stages of pre-moral development according to Kohlberg?

A
  1. obedience and punishment 2. egocentricity
164
Q

What are the two stages of conventional role conformity, according to Kohlberg’s theory of moral development?

A
  1. Be a good person 2. Follow the social order
165
Q

What are the two stages of self-accepted moral principles in Kohlberg’s theory of moral development?

A
  1. Legalistic 2. Universal principles
166
Q

As infants grow older, mothers tend to smile more with male or female infants?

A

Males. They show more range with females, and respond more to females’ cries

167
Q

What percentage of children have an imaginary friend?

A

33%

168
Q

When does adrenarche begin?

A

6 to 8 years old. There is increased skeletal growth and body hair

169
Q

What percentage of kids have problems with terrors?

A

1 to 3%. It is a disorder of impaired arousal

170
Q

What percentage of teens abuse drugs and alcohol?

A

10% (as opposed to experimentation)

171
Q

What cognitive functions contribute to a child’s representational world and hence to personality?

A

Attention, memory, affect modulation, and spatial orientation

172
Q

What percentage of high school seniors meet criteria for a substance use disorder by survey?

A

15% (31,000 HS seniors surveyed; this is not a clinically based assessment)

173
Q

What percentage of adolescents with substance use disorders have comorbid psychiatric disorders?

A

40 to 90%

174
Q

What are some basal ganglia diseases in children?

A
  1. Parkinson’s (juvenile form); emerges at 10 to 15 years old with pill rolling tremor, bradykinesia, rigidity, intellectual decline 2. Huntington’s disease presents 1 to 3% in childhood (3 years of age youngest); the juvenile form is usually from the father 3. Dystonia Musculorum Deformans (5 years old) 4. Wilson’s disease; decreased BG function, liver cirrhosis; presentation: hepatitis, +/- dystonia and gait disturbance; mid childhood
175
Q

What is Sturge-Weber Syndrome?

A

Facial port wine stain in trigeminal nerve distribution; intractable seizures with time; intellectual disability; dementia

176
Q

What are findings in neurofibromatosis?

A

Cafe au lait spots, Schwann cell tumors; intracranial tumor (optic gliomas); learning disorders, hyperactive, visual spatial declines. Autosomal dominant, but half by new mutation. Chromosome 17. Intellectual disability can be present

177
Q

Describe tuberous sclerosis

A

Hypopigmented nevi (ash leaf spots); shagreen patches (raised leathery skin); cardiac, renal, lung lesions; sclerotic nodules in CNS that can lead to seizures, developmental delays; up to 50% have autism; some have average IQ; autosomal dominant. Psychiatric findings include aggression, obsessions, hyperactivity, psychosis, poor social skills and poor communication

178
Q

What is Ataxia-Telangiectasia?

A

Cerebellar degenerative disorder. Telangiectasia of conjunctivae. Emerges at age 4 years. Ocular motor apraxia; intention tremor; ataxia; immune dysfunction; lymphomas. Death early 20s

179
Q

What is Duchenne Muscular Dystrophy?

A

X-linked recessive; 1/3 new mutation; there is no dystrophin; appears at age 4; delayed motor milestones

180
Q

What is the association of IQ and Seizure Disorder?

A

Decreased IQ compared to healthy controls (except for classical absence seizures); there are also decreased verbal and attention skills and increased learning disorders. If EEG is subclinical when overt seizures stop, the IQ is decreased; if there is treatment, IQ improves

181
Q

What is the epidemiology of seizures?

A

1% prevalence. Highest prevalence of seizures is less than 5 years old and the second peak is puberty

182
Q

What neuropsychological findings are most consistent in Tourette’s disorder?

A

Visual-motor integration and visual-graphic difficulties

183
Q

What is the familial risk for reading disorder in first degree relatives of children with reading disorder?

A

35 to 45%.

184
Q

Do ADHD and reading disorder commonly co-occur?

A

Yes

185
Q

What are child and adolescent responses to divorce?

A
  1. Preschool children: regress, irritable, demanding, aggressive 2. 5 to 8: grief, fear of replacement, hard to believe permanent, decreased school function; little girls believe father will come back and loves them best. 3. 8.5 to 12: fierce anger, one parent good other bad; lonely, anxious, humiliating sense of powerlessness 4. Adolescents: depression, anger, acting out. These are possible findings and depend on other factors
186
Q

What seems to influence outcome in children of divorce?

A

Whether the child felt rejected by the father

187
Q

When did child psychiatry ‘formally’ begin in the U.S.?

A
  1. Dr. Wiliam Healy formed a child guidance cliinic, the Juvenile Psychopathic Institute in Chicago
188
Q

What is the most common kind of child abuse?

A

Neglect 54%. Physical abuse 23%. Sex abuse 11.5%. 25% experience more than one type

189
Q

Who tends to abuse prepubertal children?

A

Single parent, ethnic minority, low income

190
Q

Who tends to abuse adolescents?

A

White, middle class, two parent families

191
Q

Who physically abuses pre-pubertal children?

A

Mothers do so more

192
Q

Who physically abuses adolescents?

A

Fathers do so more

193
Q

What percentage of those who were abused, maltreat their offspring?

A

33% (Kaufman & Zigler)

194
Q

What ages are appropriate for the administration of the Wechsler Preschool Primary Scale of Intelligence (WPPSI)?

A

2 years 6 months to 7 years 7 months of age

195
Q

What are the cognitive consequences of cancer treatment?

A

Decreased performance skills, arithmetic, perceptual motor skills, visual processing, visual motor integration, sequencing ability, short term memory. Adverse events may not be seen for years

196
Q

What percentage of children with cancer are non-adherent to oral meds?

A

33% if less than 13 and 59% of adolescents

197
Q

How many infants die of SIDS each year?

A

3,000. Peak is at 2 to 4 months. 95% by 6 months. Rare for full term infants

198
Q

Doses of 5 to 40 mg of prednisone do what?

A

Impair explicit memory

199
Q

Transmission of HIV to infant from mother during birth is reduced by what protocol?

A

infant receives zidovudine within 6 to 12 hours of birth. Mother continues to take HIV medications during pregnancy, and if there is a high viral load at birth, zidovudine IV and C-Section are considered. Breast milk can transmit HIV.

200
Q

How is information processed in the brain?

A

Input: receive and record the information (perception) Integration: understand the information (sequenced, abstracted/contextualized, organized input (auditory or visual) Memory: Storage and retrieval (short-term) Output: Info is communicated from the brain (language, muscles)

201
Q

What is the legal definition of blindness?

A

20/200 or less in the better eye with corrective glasses

202
Q

The NEPSY is applicable for what ages?

A

3 to 12 years of age, Developmental NEuroPSYchological Assessment for attention and executive functions, language, sensorimotor, visual-spatial, learning and memory, social perception

203
Q

The Child Personality Questionnaire is for what ages?

A

8 to 12 years of age. It is primarily used to counsel pre-adolescents in school or clinical settings. The report reveals important information about academic achievement, leadership potential, and the tendency toward disciplinary problems. The CPQ report also provides narrative interpretations relative to traits such as creativity, emotional stability, self-concept level, excitability, and apprehension, as well as derived scores and predictions for extraversion, anxiety, and other broad trait patterns.

204
Q

What is the most highly developed pictorial interview?

A

Dominic R (6 to 11 years of age). Allows assessment of of younger children, in a non-auditory based manner.

205
Q

What is the K-SADS?

A

The Kiddie Schedule for Affective Disorders and Schizophrenia. Administered to 6 to 17 year olds. It is a semi-structured interview assessing a wide range of disorders

206
Q

What is the CAPA?

A

Child and Adolescent Psychiatric Assessment. The Child and Adolescent Psychiatric Assessment is an interviewer-based structured diagnostic interview with versions for use with children (ages 9-18) and their parents.

207
Q

What is the prevalence of autism?

A

Jan-59

208
Q

What is Landau Klefner Syndrome?

A

Expressive and receptive language deficits accompanied by seizures after a period of normal development. Onset is at 4 to 7 years of age. Leads to permanent aphasia

209
Q

What is the DISC?

A

Diagnostic Interview Schedule for Children 9 to 18 years of age. The computerized Diagnostic Interview Schedule for Children (C-DISC) is a comprehensive, structured interview that covers 36 mental health disorders for children and; adolescents.

210
Q

What is post irradiation syndrome?

A

Somnolence, anorexia, lethargy within 4 to 8 weeks of treatment. (There is also decreased growth hormone resulting in decreased growth, hypothyroidism, hearing deficits)

211
Q

What are the symptoms of craniopharyngioma?

A

Growth retardation, delayed sexual maturation, obesity, somnolence, visual and olfactory hallucinations

212
Q

What is the 5-year survival rate of children with low grade astrocytoma after excision and irradiation?

A

70%

213
Q

What is the the epidemiology of brain tumors in children?

A

2-5/100,000 children less than 15 years of age are affected. Infratentorial tumors predominate. The second most common cancer after leukemia.

214
Q

What is the most common cancer in children?

A

Leukemia

215
Q

What percentage of patients with Non-epileptifrom seizure disorder have a bona fide seizure disorder?

A

15 to 50%

216
Q

Who first conducted systemic studies on tics?

A

Itard 1825; Gilles de la Tourette 1885. Tics were also recognized in antiquity, of course

217
Q

At what age does an infant recognize the mother’s face?

A

1 month. Moving eyes are of interest at 2 months. There is adult visual acuity level at 6 months

218
Q

What percentage of Rett’s cases is familial?

A

1% is familial, usually from the father. Most cases are spontaneous mutations

219
Q

What genes have been identified in Rett’s disorder?

A

MEPC2, CDKL5 and FOXG1 (the latter two, uncertain of role)

220
Q

What did John Dewey believe?

A

In progressive and functional education. School should prepare for life outside; a practical education instead of a classical education

221
Q

What did Erikson believe regarding education?

A

If a child is given the chance to explore and undertake projects on his own, the sense of initiative will be stronger than guilt

222
Q

What did Montessori believe?

A

Young children should always be exposed to an object’s property or quality before before given the name (i.e. sensory learning should precede symbolic learning)

223
Q

What are school dropout rates in large urban centers?

A

50% (and are two years behind those from better educated families)

224
Q

What are the three main mechanisms/groupings of the Yale School Development Program (Comer Program)

A
  1. Government and management team 2. Mental health team 3. Parent team
225
Q

Are children with our without siblings more affected by school avoidance?

A

There is no difference

226
Q

Who is more affected by school avoidance, boys or girls?

A

The rates are equal

227
Q

Do children who are truant usually have conduct disorder?

A

No

228
Q

What are definitions of special needs in adoption through public agencies?

A

Greater than 10 years of; serious physical, intellectual, or emotional problems; member of a large sibling group. The most common special needs are emotional disturbance and intellectual disability

229
Q

What works better generally, open or closed adoption?

A

Open leads to better behavioral function. Adoptive mothers who have prenatal contact with the bio-mother had a better attitude to both the child and the bio-mother. Public agencies tend to have fewer open adoptions than private agencies. Open adoption may not be possible nor recommended in certain circumstances

230
Q

What does data show on transracial adoptions show?

A

Adjustment is no different

231
Q

Does a child’s initial response predict outcome in divorce?

A

No

232
Q

How many children of divorce experience a second divorce?

A

Up to 50%

233
Q

Does custody arrangement impact psychological health?

A

No. Nor did frequency of access and visitation with father (as long as the father is involved).

234
Q

What most impacts the psychological health of children of divorce?

A

Prior psychological functioning of the parents and the amount of postdivorce conflict

235
Q

What are recidivism rates for sexual offenders who receive treatment vs. those who do not in adults?

A

11% with treatment, 18% without (Alexander 1999)

236
Q

Who edited DSM III, which was considered the transition to a more scientific approach in the DSM?

A

Spitzer

237
Q

What did Clifford Beers write?

A

“A Mind That Found Itself” in 1908. It contributed to the mental health hygiene movement. (Beers was a Yale student who ended up in psychiatric hospitals–with presentations of psychosis.)

238
Q

What are good age ranges for groups?

A

Generally, 4 to 6, 6-10, 10-14, 14-19. Mixed sex is fine except in early adolescence, because of pubertal issues

Child & Adolescent Psychiatry Review (6 decks)

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