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Child & Adolescent Psychiatry Review > CAP5 > Flashcards

CAP5 Flashcards

1
Q

Define affective instability

A

Emotional dysregulation as exaggerated reactions to negative or frustrating stimuli (unlike in impulsivity there is a rush of affect)

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2
Q

Emotional regulation involves what circuitry?

A

Orbital frontal cortex, amygdala, anterior cingulate, cerebellum (temporal)

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3
Q

What brain structures are involved in anxiety/hyperarousal?

A

Limbic system perceives stress resulting in the hypothalamus releasing CRF which stimulates the pituitary to release ACTH which stimulates the adrenals to release glucocorticoids. CRF = corticotropin releasing factor. ACTH = adrenocorticotrophic hormone

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4
Q

Acute stimulation of 5HT2a in the brainstem leads to what?

A

Myoclonus, disrupted slow wave sleep, and nocturnal awakenings

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5
Q

What is the data on tricyclic antidepressants in ADHD?

A

They are effective, albeit more for behavior than cognition perhaps

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6
Q

What percentage of those with Tourette’s disorder have ADHD?

A

For those 6 to 18 years old, 50 to 60% (Cohen and Leckman 1989)

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7
Q

What is noradrenergic deficiency syndrome?

A

Depression that is associated with fatigue, apathy, notable cognitive disturbance, impaired concentration, problems with sustaining and focusing attention, slow information processing, and decreased working memory

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8
Q

Acute stimulation of 5HT2a in the mesocortical pleasure center leads to what?

A

Decreased dopamine, which can lead to apathy or decreased libido

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9
Q

Acute stimulation of 5HT2a in the spinal cord leads to what?

A

Inhibition of the spinal reflexes of orgasm and ejaculation

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10
Q

Acute stimulation of 5HT2a in the basal ganglia leads to?

A

Akathisia, psychomotor retardation or agitation, parkinson’s, dystonia (because serotonin inhibits dopamine release)

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11
Q

Acute stimulation of 5HT2a and 2c in the projection from the raphe nuclei to the limbic cortex results in?

A

Acute mental agitation, anxiety, panic attacks

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12
Q

Projection of 5HT neurons from the raphe nuclei to which area leads to therapeutic action?

A

Frontal cortex

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13
Q

What does the presence of serotonin in the synaptic space lead to?

A

Postsynaptic receptors become desensitized (2a, 2c, 3). These receptors send information to the cell nucleus of the postsynaptic neuron resulting in the instruction to downregulate these receptors. The time course for this to happen corresponds to the tolerance of side effects.

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14
Q

The increased ratio of serotonin to serotonin receptors after antidepressant treatment as a mechanism of action is supported by what evidence among other?

A

Deceased suicidal and otherwise depressed patients have had more 5-HT2A receptors than normal patients. These considerations suggest that 5-HT2A overactivity is involved in the pathogenesis of depression.

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15
Q

What serotonin receptor does trazadone block?

A

5HT2a receptor. It also blocks reuptake but less so than other agents

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16
Q

By what process does trazodone effet sleep?

A

By inhibiting histamine H1 leading to sedation and by inhibiting 5HT2a which induces and restores slow wave sleep

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17
Q

When selective serotonin reuptake inhibitor treatment is initiated where does serotonin first rise?

A

Cell bodies in the raphe nuclei and not at the axon terminal where the re-uptake pump is located (somatodendritic autoreceptors 5HT1a)

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18
Q

Increased serotonin at the somatodendritic autoreceptor 5HT1a leads to?

A

Downregulation and densitization. Once desensitized and down regulated it can no longer efffectively inhibit its own release and the serotonin neuron is disinhibited. This correlates with time of onset of anti-depressant action

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19
Q

Mirtazapine blocks which alpha receptors?

A

Alpha 2

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20
Q

Mirtazapine inhibits which serotonin and histamine receptors?

A

2a, 2c, 3, H1

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21
Q

Mirtazapine’s blockade of which receptor contributes to its antidepressant effect?

A

5HT2a

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22
Q

Mirtazapine’s blockade of which receptors leads to anxiolysis and relaxation?

A

5HT2a, 5HT2c and H1

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23
Q

Mirtazapine’s blockade of which receptors mitigates side effects?

A

5HT2a, 5HT2c, 3

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24
Q

Mirtazapine’s blockade of which receptors leads to sedation?

A

5HT2a and H1

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25
Q

Mirtazapine’s blockade of which receptors leads to weight gain?

A

5HT2c and H1

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26
Q

Mirtazapine’s blockade of 5HT2a, 5HT2c, and 5HT3 leads to preferential stimulation of which receptor?

A

5HT1a and therefore anxiolysis, antidepressant effects

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27
Q

How does alpha 2 antagonism increase the release of serotonin?

A

The locus coeruleus has norepinephrine neurons stimulating alpha 1 receptors in the midbrain which stimulates release of serotonin. When alpha 2 is antagonized this disinhibits release of norepinephrine. The norepinephrine stimulates alpha 1 which stimulates serotonin release

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28
Q

What is the most significant parental factor in the incidence of child psychopathology?

A

Presence of conduct disorder in one or both parents (Rutter and Quinton)

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29
Q

What is the general outcome for gifted (IQ 130-150) individuals who are deaf?

A

52% college grad, 30% unemployed, 40% have had psychotherapy and 9% hospitalized

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30
Q

What is the prevalence of emotional and behavioral problems in children who are deaf compared to the general pediatric population?

A

Three times greater. There can be impulsivity, hyperactivity, rigidity, suspiciousness, immaturity [as a gross stereotype]

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31
Q

What are the classifications for children with hearing impairment?

A

Hard of hearing, hearing impaired, or deaf. Prelingual deafness is when it occurs at less than 2 years of age

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32
Q

What percentage of those with ADHD have another disruptive behavior disorder?

A

50%

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33
Q

What do many schools for children with deafness use as a communication method?

A

A teacher articulates and uses sign language

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34
Q

How many children in the U.S. have joint deafness-blindness?

A

7 to 8,000

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35
Q

Most reading disorders involve an inability to do what?

A

Segment the written word into its underlying phonologic components

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36
Q

What is the most prevalent type of communication disorder?

A

Phonologic

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37
Q

What is the outcome of preschoolers with speech and language impairment who do not speak in full sentences at by age 6?

A

There can be an intellectually disabled range of IQ even if was in the normal range when in preschool

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38
Q

What are examples of environmental contributions to language difficulties?

A

Fetal alcohol syndrome, cocaine exposure, maltreatment (especially neglect)

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39
Q

How many known genetic causes of intellectual disability are there?

A

750+ if not more at the time of this writing. Half of those with an intellectual disability have a known organic cause

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40
Q

Focal lesions in the CNS affect language if on which side of the brain?

A

Left

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41
Q

What is the behavioral profile of William’s syndrome?

A

Social disinhibition, anxiety, fear, inattention, hyperactivity, hyperacusis, cardiac problems

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42
Q

What is the behavioral profile of Down’s syndrome?

A

Non-compliance, stubborness, inattention, depression, dementia

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43
Q

What is the behavioral profile of Prader-Willi?

A

Hyperphagia, non-food OCD, skin picking, tantrums

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44
Q

What is the behavioral profile of Fragile X?

A

Social anxiety, shyness, gaze aversion, inattention, hyperactivity, autism/PDD

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45
Q

What percentage of those with an intellectual disability have psychiatric difficulties?

A

25%

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46
Q

Stimulants which increase dopamine can lead to what?

A

Stereotypies

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47
Q

In autism, does facilitated communication work?

A

No

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48
Q

What is the purported advantage of the KABC over the WISC?

A

Focuses more on problem-solving and less on verbal abilities and acquired knowledge

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49
Q

What are common soft neurological findings in schizophrenia?

A

Perceptual-sensory, motor coordination, right-left orientation, balance, motor overflow

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50
Q

What percentage of those with schizophrenia have EEG changes?

A

25%

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51
Q

What are some easy ‘physical exam’ tests for problems with the frontal lobes?

A
  1. Smooth pursuit: follow finger smoothly, left to right. Abnormal is discontinuous jerks (saccadic) or deviation (looking away). 2. Tapping forehead. If tap = or > 3 times and blinking persists, it suggests inflexibility 3. Antisaccade test: 5x: 2x left, 2x right, 1x left 3. 2 stepped Luria, palm, fist hand. The most sensitive and specific are the smooth pursuit and the Luria.
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52
Q

Describe the 3 step Luria task, used to explore frontal lobe probolems?

A

With fingers fully extended and the patient following, the examiner places his right hand with a cutting motion on his right knee or on a table, then in a fist with the knuckles down, and then palm down with fingers extended. Examiner and patient then repeat this three more times. The hand motions could be reinforced by counting from 1 to 3 along with each segment, or by saying “cut, fist, and slap.” Patients are then asked to repeat the movements unguided by the examiner A score of 0 is recorded if the patient is unable to mimic the movement or complete three independent cycles. Performance on the Luria test is scored as normal or abnormal. The test is judged to be abnormal if the hand motions differed in type or sequence from that of the examiner. A common error was having the fingers flexed instead of extended for the first movement. (Weiner et al. 2011)

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53
Q

Describe the antisaccade test

A

The examiner faces the patient, holds his or her hands to either side of the patient’s eyes, and asks the patient to look at the examiner’s nose. She instructs the patient to deviate her eyes to the side of the examiner’s briefly raised index finger and then return his or her gaze to the examiner’s nose. Alternately, the examiner moves her right and then left index fingers. The patient looks towards the moving finger and then back at the examiner’s nose. Once it is clear to the examiner that the patient has mastered this and looks to the moving finger and then back to the examiner’s nose, the examiner asks the patient to look toward the opposite side, toward the side that does not move. Patients with frontal damage have trouble suppressing the urge to look at the moving finger and first look there before correcting. This test uncovers impulsivity and inattentiveness in children. It is performed five times, twice to the left, twice to the right, and then once to the left. Two or more failures count as an error. (Lewis et al. 2002)

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54
Q

Describe the smooth pursuit task to explore frontal lobe function

A

The examiner asks the patient to follow the examiner’s smoothly moving finger as it goes slowly from left to right horizontally in front of the patient. An abnormal response would be visual tracking in brief, staccato, discontinuous (saccadic) jerks or inattentiveness with brief deviations of the patient’s eyes from the examiner’s finger rather than smooth movements. A normal response would be smooth visual tracking of the moving finger. The patient should also be able to stare for 30 seconds at the examiner’s stationary finger without deviating his or her gaze. This helps to demonstrate an ability to concentrate. (Lewis et al. 2002)

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55
Q

The Mullen Scales can be given from what age range?

A

2 to 69 months

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56
Q

What is a drawback of the Bayley Scales of Infant Development

A

There is no language assessment

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57
Q

What age range does the Millon Adolescent Personality Inventory Cover?

A

The MAPI has 150 T-F questions. 13-18 year olds, 20 minutes

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58
Q

What age range applies to the Behavior Assessment System (BASC), Third Edition for children, which is commonly used in schools?

A

2:0 to 21:11 year

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59
Q

What are the instructions for the Kinetic Family Drawing, KFD?

A

The KFD involves the examiner instructing the child to draw a picture of themselves and everyone in his or her family doing something.  

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60
Q

What is the Rotter Incomplete Sentence Blank?

A

It comes in three forms, for different age groups, and comprises 40 incomplete sentences, usually only 1-2 words long such as “I regret …”. The subject is asked to complete the sentence. It is a projective test.

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61
Q

What are the instructions for the Machover Draw-A-Person ?

A

In administering the DAP, the examiner always starts by providing the examinee with a blank sheet of paper and a pencil with eraser. The examiner then instructs the examinee to ‚Äúdraw a person‚Äù, thus, the name of the test. After drawing one person, the examinee then proceeds to draw another person of the opposite sex with the first one. The exam ends with the examinee narrating a story that features the figures he or she has drawn as characters. The figure of the same sex with that of the examinee is seen to be reflective of impulses the examinee finds acceptable while the unacceptable instincts are portrayed by the figure of the opposite sex Use 8 1/2 x 11” paper; pencil and eraser.

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62
Q

What functional domains are assessed by the Vineland Adaptive Behavior Scales?

A

Communication, Daily Living, Socialization, Motor Skills

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63
Q

What is the age range for the KABC-II?

A

3 to 18

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64
Q

The Kaufman Brief Intelligence Test, Second Edition (KBIT-2) can be administered to what ages?

A

4 to 90 

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65
Q

What is the Leiter International Performance Scale?

A

Widely used today, Leiter devised an experimental edition of the test in 1929 to asses the intelligence of those with hearing or speech impairment and with non English speaking examinees. For ages 2 to 20

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66
Q

What are some difficulties to bear in mind about the DISC-IV?

A

The Diagnostic Interview Scale for Children is a widely used and useful structured self-report diagnostic assessment.  The issues are that unusual symptoms are over-endorsed (OCD, psychosis) and that diagnoses based on symptom report are unusually high. 

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67
Q

What are the prevalences of reading disorder, math, and disorder of written expression?

A

4%, 1%, 4%

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68
Q

At what age is handedness consolidated? Footedness?

A

5, 7

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69
Q

At what age can a child successfully touch their left hand to their opposite, right ear (or vice versa) when instructed to do so?

A

7 (they can touch their left hand to their left ear or right to right by 6)

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70
Q

What did Klein and Young (1979) say regarding hyperactivity? 

A

It is the combination of hyperactivity with high disruptiveness that distinguishes ADHD from typical.  Children in free play look same; the structured sitting situations bring out the children with ADHD

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71
Q

What is the data on child sexual abuse victims and incidence/prevalence?

A

Cases known to and reported to authorities: U.S. Department of Health and Human Services reports that 88,656 children, or 1.2 per 1,000 children, were sexually abused in 2002, according to cases reported to authorities. Limit: only known to authorities A national survey of youth and caretakers suggested that about 4.6 children per 1,000, or 320,400 children were sexually abused or assaulted in a year. Limit: those willing to report. National surveys of adults suggest that between 9-32% of women and 5-10% of men report that they were victims of sexual abuse and/or assault during their childhood. 

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72
Q

What does trend data over time show about sexual abuse and assault?

A

It has declined

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73
Q

What percentage of child sexual offenses are committed by juveniles?

A

29 to 41%

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74
Q

Child sexual abuse and sex crimes are committed by which group the most, family, acquaintances or strangers?

A

Acquaintances, then families, then strangers

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75
Q

What did one group of researchers find about rates of offense in non-incestuous pedophiles first entering treatment?

A

The non-incestuous pedophiles who molested boys had committed an average of 282 offenses against 150 victims (Rossman et al. 1999). Someone with pedophilia has an exclusive interest in boy or girls, i.e.  children, as opposed to child sex offenders who do not

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76
Q

One study found what percentage of fathers or stepfathers found to have committed extrafamilial abuse had also molested their own children?

A

50% (Glasser and Kovin 2001)

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77
Q

What does Kagan emphasize?

A

Biogenetic tendencies and their contributions to development

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78
Q

If a man is involved in the physical care of his child before the age of 3 what drops dramatically?

A

Sexual abuse of his and another’s children

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79
Q

What percentage of married women with children under 6 years of age are in the labor force?

A

74% in 2017, 65% in 1999, 20% in 1960. Employedfathers with younger and older children were about equally likely to work full time, 95.7% (Bureau of Labor Statistics 2017)

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80
Q

What percentage of the population identifies as lesbian, gay, bisexual or transgender?

A

4.5% (Gallup 2018)

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81
Q

Who has greater left hemisphere specializataion, men or women?

A

Men. Ostensibly, and grossly, this leads to more affective skills for women, and more logical, analytic, visual-spatial for men

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82
Q

Who has a transactional view of infant development?

A

Sameroff (each impacts other)

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83
Q

2-week-old infants have what visual acuity?

A

20/500. At 5 1/2 months they have 20/70. At birth, infants are aware of high contrast features

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84
Q

By what age does auditory location ability reach adult ability?

A

6 months

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85
Q

What at 6 months predicts intellectual development at 3 years of age?

A

Maternal involvement, verbal responsiviity, organization of physical environment, variey in daily stimulation, and play materials

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86
Q

What are the frequencies of hallucations for the different senses when hallucinations are present?

A

AH 80 to 100%, VH 30 to 80%, Olfactory 20%, Tactile 35%

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87
Q

What are reliable, valid and specific measures in schizophrenia?

A

Illogical thinking and loose associations (note children, under 7 are illogical and loose to an extent)

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88
Q

What are the most commonly found signs and symptoms in adolescent depression?

A

Decreased mood, hopelessness, social withdrawal, agitation, nihilistic ideas

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89
Q

In fear states, projection neurons rely on what neurotransmitter?

A

Glutamate. Thalamus –> amygdala –> effector organs. GABA mediates glutamate in the amygdala

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90
Q

What brain structure plays a key role in fear conditioning?

A

Nuclei in the amygdala, a medial temporal lobe structure anterior to the hippocampus

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91
Q

Who said a period of semi-criminality is normal for all healthy boys?

A

Stanley Hall 1904

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92
Q

What percentage of adolescents have diagnosable clinical disorders?

A

20%

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93
Q

At what age do feelings of sexual awareness and attraction make their conscious appearance?

A

10 (perhaps linked to rising adrenal androgens). This is also true for same sex attraction

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94
Q

In synaptic pruning how many synapses are pruned per second?

A

30,000. Persons lose half of the cortical synapses present before puberty, mostly excitatory synapses

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95
Q

What are the initial manifestations of puberty in boys?

A

Growth of penis and testes

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96
Q

What are the initial stages of puberty in females?

A

Breast development (9) and pubic hair (9)

97
Q

What marks puberty proper (hormonally)

A

Pulsatile release of gonadotropin-releasing hormone (GnRH) leads to increased pituitary follicle-stimulating hormone (FH) and luteinizing hormone (LH), leading to increased gonadal hormones (testosterone for men and estrogen for females)

98
Q

The effects of a model pre-school disappear when?

A

3 to 6 years after children enter public school (they have fewer special education needs)

99
Q

Sociometric studies of children reveal which 5 groups?

A

Popular, average, rejected, neglected, controversial The rejected: a) undervalued type–i.e. low self-esteem b) those with a positive view of self but who are seen as defensive and aggressive

100
Q

The opinions and descriptions we form of ourselves by what age are thought to continue throughout life?

A

10 years of age

101
Q

What is “hitting the cultural wall”?

A

According to Gilligan, pre-adolescent girls discern that society values appearance more than accomplishment and they become self-critical (Gilligan 1990)

102
Q

What is the corresponding percentage of adult brain weight achieved at birth, age 5, and age 14?

A

10%, 90%, 100%

103
Q

At what age do infants stop automatically crying in response to their peers’ cries and instead attend to their distress?

A

6 months of age

104
Q

According to Ainsworth, what percentage of infants are securely attached?

A

65% (2/3); 20% are avoidant; 15% are ambivalent

105
Q

By what age do infants display all the facial expressions of adults?

A

9 months. The last to occur is fear

106
Q

Make believe play emerges at what age?

A

2.5 years of age

107
Q

Describe imaginative play’s purpose

A

Key to cognitive and emotional development; means by which the uncontrollable qualities of one’s physical and social environment can be gradually miniaturized and manipulated; serves purpose of individuation and self-definition; the capacity to create miniature possible worlds is a critical feature of healthy development.

108
Q

Do children who want transitional objects have more difficulty?

A

They have better sleep, are more self-confident, independent, affectionate, attractable

109
Q

How is the emergence of imaginative play related to attachment?

A

Early optimal attachment predicts later emergence of pretend play

110
Q

Children can produce all sounds of their language correctly by what age?

A

7 (if past this, they have a speech disorder). Kids understand the basic rules of language by age 5

111
Q

Vocabulary grows at a rate of how many words per day in the school years?

A

9

112
Q

By age 5 how many utterances are spent on a single topic?

A

5

113
Q

What are aspects of pragmatic language skills?

A

Taking turns, responding appropriately to others, self-correcting speech, recognizing taboo words, providing clarification when requested (emerges 3 to 5)

114
Q

What was Freud’s view on moral development

A

A harsh superego leads to feelings of guilt and thus antisocial acts (I am bad, guilty and therefore do bad things; or I do acts to set up punishment). In a contrary vein, Freud also thought a harsh superego could lead one to be unduly virtuous

115
Q

What did Damasio believe about moral development?

A

We are born with the neural propensity to generate somatic states accompanied by pleasant or unpleasant emotions in response to stimuli concerning personal and social behaviors

116
Q

What is the impact of maternal depression in moral development?

A

Boys despite being more empathic and prosocial advocate aggression as problem solving (Hay 1994). Zahn-Waxler showed maternal depression in the toddler years led to an exaggerated sense of guilt later

117
Q

What was one of the things Patterson showed about the emergence of aggression in a classroom of 4 year old boys?

A

In an unstructured nursery with little intervention from teachers, 4 year old middle class boys learn to become ever more aggressive in imitation of other assertive children, when they see such behavior rewarded with success (i.e.others getting what they want)

118
Q

At what age do children start to feel proud our ashamed of themselves without an external audience?

A

8 years of age

119
Q

At what age does empathy manifest?

A

By 9 months, children can locate a feeling in others. In the first year they respond to distress as if it were happening to themselves. From 1 to 2 years of age they can offer sympathy. From 2 to 3 years of age, veridical empathy emerges based on their knowledge that others have thoughts and feelings. (At 18 months children understand how to hurt and comfort.) Hoffman 2000

120
Q

What is convention versus morality?

A

Convention, is a standard way of doing things, such as calling a teacher by their last name. Morality is about more universal matters; e.g. pushing a child off the swing is always bad

121
Q

At what age does a sense of winning and losing emerge?

A

> 33 months. Pride emerges at 21 months

122
Q

What is a critique of Gilligan’s work?

A

Limitation of sampling and lack of clarity of analyses

123
Q

At what age does conflict over personal space and toys emerge?

A

1+ year

124
Q

What percentage of abortions are performed in adolescents?

A

3-Jan

125
Q

What percentage of adolescents masturbate?

A

For 14 to 17 year olds, the percentage of those who had masturbated at least once was 80% for boys and 58% for girls (National Survey of Sexual Health and Behavior 2011)

126
Q

By what age are children capable of describing mixed emotions?

A

8 to 10 (7 year olds can be aware of two emotions if they do not appear incompatible and are directed to the same event). 10 year olds may have a difficult time with two emotions if they are incompatible about the same event; they can be aware/describe two emotions that are incompatible about different events (e.g. thrilled about airplanes, scared being away from home). By 12 years of age children can be aware of fully contradictory emotions toward the same event (e.g. upset that coach yelled but glad that she was honest)

127
Q

By what age can children accept negative feelings like sadness rather than denying or distancing themselves from such feelings?

A
  1. Children under 7 are more likely to deny and distance themselves from negative feelings and present uniformly happy self-portraits. Children between 7 and 11 tend to project negative feelings onto others while they deny their own. Children even under 7 can explain and label emotions (e.g. why the puppet is crying) and think about what makes it better, just not their own feelings.
128
Q

What can be said about a pre-adolescent child and the discussion of negative feelings?

A

It is relatively rare for a pre-adolescent child to discuss negative feelings

129
Q

What are 5 areas children and adolescents cite as most important to them?

A

School achievement, athletic skill, peer acceptance, good behavior, and physical attractiveness (not necessarily in that order) Harter 1993

130
Q

There is no consensus on the definition of metabolic syndrome in children. What is the definition of metabolic syndrome in adults?

A

1) Elevated waist circumference based on population and country-specific definitions;2) Systolic blood pressure (BP) of 130 mmHg or more and/or diastolic BP of 85 mmHg or more or on treatment for hypertension;3) Fasting blood glucose of 100 mg/dL or more or on treatment for hyperglycemia;4) Triglycerides of 150 mg/dL or more or on treatment for elevated triglycerides;5) HDL cholesterol less than 40 mg/dL in males and less than 50 mg/dL in females or on treatment for reduction of HDL cholesterol.

131
Q

What controlled trial showed bupropion to be effective for ADHD?

A

Casat et al. 1987; 1989. N = 72, multisite

132
Q

Avoidant and defended children do what regarding attachment?

A

Carers are anxious and rejecting when others place demands on them. Children cope by excluding attachment based feelings and behavior from conscious processing. Displays of need, weakness, dependency, vulnerability in the self or others make them anxious and avoidant. To be acceptable and increase others’ availability they become emotionally self contained and are observant about feelings and behaviors in others. More extreme cases (abused) do not seek safety or comfort when ill, upset, vulnerable, or frightened. They have learned that care and protection are not unconditionally available and a state of need only seems to make matters worse. Attachment will trigger anxiety, distress, aggression. Rx: Adults acknowledge, explore, and reflect on their own feelings, especially of need and vulnerability.

133
Q

What antipsychotic agents have the best metabolic profile?

A

In regard to glucose metabolism in order: ziprasidone, lurasidone, aripiprazole, risperidone, quetiapine, paliperidone, asenapine, haloperidol, clozapine, olanzapine (Zhang et al. 2017)

134
Q

Heller’s review of the literature showed what about those resilient to the effects of maltreatment?

A

Above average IQ; higher self esteem; internal locus of control; external attribution of blame (when warranted); presence of spirituality; ego resilience; higher ego control; family cohesion (including competent foster care); positive school experience (Heller 1999)

135
Q

What do children with ambivalent stances (resistant, dependent) show behaviorally?

A

Carers are inconsistent and poor at recognizing other people’s needs and attachment signals. Children cope and adapt by maximizing their distress and attachment behavior to increase their chance of getting noticed. They have high anxiety around being ignored and left alone with their needs unmet and their arousal unregulated. They have little confidence in their own abilities to bring about change and get what they need. They have an angry, dissatisfied, demanding, needy, pleading, provocative approach to relationships. They have a drive to be noticed, valued, acknowledged, and recognized. Often in a crisis state and never satisfied. Rx: help children stop and reflect, help re-structure so they feel valued and worthwhile, and help them think through their feelings and behaviors.

136
Q

Attachment based therapies aim to do what?

A

Affective regulation is key to all interventions. Develop the capacity for empathy, mind-mindedness, and reflective function. Help get in touch with feelings, to recognize them, consider their impact on self and others, and begin to process them in a more reflective, congenial, and regulated way

137
Q

What are the 5 subtypes of agression according to Sudgen

A

Impulsivity, affective instability, anxiety/hyperarousal, cognitive disorganization, predatory/planned/instrumental

138
Q

The amygdala is implicated in what?

A

Development and retrieval of emotional memory; learning of nonverbal motor patterns, trigger of flight or fight; threat detection; production of fear and anxiety

139
Q

Which authors have found that stimulants do not increase tics?

A

Gadow 1995; Nolan and Gadow 1997; Castellanos 1997 among others

140
Q

How do children with disorganized attachment behave?

A

Carers are the direct cause of distress. When there is abuse, children suffer the worst elements of both avoidant and ambivalent caregiving environments. They experience both unpredictable danger and abandonment. Emotional arousal remains acutely and chronically activated. They focus on securing safety rather than pleasure in interactions with the caregiver. Parents do not attune with the child’s mental state resulting in the child not having mental representations of their own or others’ psychological makeup; therefore such children have difficulty regulating their own arousal; with maturation they are less helpless. They take control of their own safety and needs resulting in controlling strategies including compulsive compliance, compulsive caregiving, compulsive self-reliance, and coercion (threatening/aggression vs. helplessness/disarming). The coping strategies breakdown under stress, resulting in fright, anger, sadness, dysregulation. Rx: Feel safe to recognize, acknowledge, and process their emotions. Help them see that they feel safe in anxious control but that this denies understanding of others’ and their minds.

141
Q

What does Schore say?

A

Young minds develop in the context of relationships

142
Q

What does Fonagy say about children’s minds?

A

Parents’ capacity to observe the child’s mind seems to facilitate the child’s general understanding of minds and hence self-organization through secure attachment

143
Q

What is a social milestone at 6 weeks?

A

Social smile

144
Q

What is a social milestone at 2 months?

A

Recognizing mother

145
Q

What is a social milestone at 8-10 months?

A

Peek a boo; stranger anxiety

146
Q

What is a social milestone at 12 months?

A

Drinking from a cup

147
Q

What is a social milestone at 14-18 months?

A

Imitating housework

148
Q

What is a social milestone at 24 months?

A

Playing interactive games

149
Q

What is a social milestone at 4 years of age?

A

Dressing with supervision

150
Q

What is a social milestone at 5 years of age?

A

Dressing alone

151
Q

What are common personality traits in children?

A

Egocentricity, inhibition, cautiousness, self-confidence; sociability; activity; resentfulness; oppositionality

152
Q

What are language milestones?

A

6 weeks response to bell; 4 months cooing; 6 months laughs; 8-10 dada/mama non-specific; 12 months dad/mom specific; 14-18 months combines two different words; 24 months knows 50 words; 36 months gives first and last names; 4 years recognizes colors

153
Q

When can a child give his first and last name?

A

36 months

154
Q

When can a child name colors?

A

4 years of age

155
Q

When does a child say dada/mama non-specifically?

A

8-10 months

156
Q

When does a child say dada/mama specifically?

A

12 months

157
Q

When does a child combine two different words?

A

14-18 months

158
Q

When does a child know 50+ words?

A

24 months

159
Q

When does a child respond to a bell?

A

6 weeks

160
Q

When does a child coo?

A

4 months

161
Q

When does a child laugh?

A

6 months

162
Q

What domains are typically considered in the neuropsychological evaluation of children?

A

Cognitive function, motor function, perception, visuomotor integration, language, learning and memory, academic abilities, executive function

163
Q

What is a pre-morbid course of schizophrenia when looking at childhood function?

A

One-half to three-quarters had motor, language, social disturbances prior to psychosis (from several studies). In one study Alaghabad-Rad et al, many had repeated a grade prior to psychosis, 50%; 65% had special education; 35% had a specific learning disability

164
Q

What percentage of children aged 3 with aggression have aggression at 8 years of age?

A

68%

165
Q

What are gross motor milestones for 2 mo, 4 mo, 6 mo, 8-10 mo, 12 mo, 14-18 mo, 24 mo, 48 mo olds?

A

2 mo sits with head steady; 4 mo rolls over; 6 mo sits alone; 8-10 mo stands, creeps; 12 mo walks; 14-18 mo throws ball overhand; 24 mo rides tricycle; 4 yrs hops on one foot

166
Q

What are the communication disorders in DSM-5?

A

Language disorder; speech sound disorder; childhood-onset fluency disorder; social (pragmatic) communication disorder; unspecified communication disorder

167
Q

What are four major concepts related to death?

A

Irreversibility, finality (non-functionality), causality, inevitability (universality). Irreversibility, Finality, and Universality are known by 5 to 7 years of age (earlier than previously thought)

168
Q

Juveniles with four or more arrests commit what percentage of violent crimes by juveniles

A

Close to half

169
Q

What is working memory?

A

Attention-like central executive in the dorsolateral prefrontal cortex (DPFC) that manages both an articulatory loop a/w reception of phonological info and production of speech and a visual-spatial scratch pad for encoding images (Eysenck 1990)

170
Q

What is Piaget’s sensorimotor stage?

A

Sensorimotor 0 to 18-24 mo. Physical to psychological stage. Primary circular reactions: getting feedback from one’s own body. Secondary circular reactions, external world provides feedback. Tertiary circular reactions, novelty for its own sake. Symbolic stage

171
Q

What is Piaget’s pre-operational stage?

A

Age 2 to 5-7. Object permanence, magical thinking, one attribute is focus (cannot decenter); egocentrism

172
Q

What is Piaget’s concrete operations?

A

Ages 6 to 11. Classification, seriation, conservation

173
Q

What is Piaget’s formal operations?

A

Age 11 to adult. Hypothetico-deductive: what could be

174
Q

When is the genital-narcissistic phase

A

36 to 48 months

175
Q

When is the anal phase?

A

18 to 36 months

176
Q

When is the oral phase?

A

0 to 18 months

177
Q

Describe aspects of the oedipal phase

A

4 to 6 years. Capacity for neurosis, internal struggle between opposing forces (wishes vs. values, desires vs. parental attitudes and opposing desires)

178
Q

Describe the latency phase

A

7 to 10 years. Rules of the game, sense of right and wrong, empathy

179
Q

What does temperament refer to?

A

Sources of variation in affect, mood, and action influenced by genetic processes in early life

180
Q

What are specific areas that clinicians should observe in language?

A

Inner language (look for play); comprehension (follow conversation); production; phonation (pitch, volume, intonation, prosody); pragmatics (effective communication); metaphoric language

181
Q

How many females get polycystic ovary syndrome with valproic acid?

A

80% (Isojarvi 1993) of the women who started VPA for epilepsy before age 20 developed PCOS.

182
Q

What metabolic syndrome is shown by VPA?

A

Obesity, hyperinsulinemia, lipid abnormalities, PCOS, hyperandrogenism

183
Q

What fine motor milestones are seen at 6 wks, 2 mo, 4 mo, 6 mo, 8-10 mo, 14-18 mo, 24 mo, 3 yo, 4 yo, 5 yo

A

6 wk follows past midline; 2 mo reaches for object; 4 mo holds a rattle; 6 mo passes cube hand to hand; 8-10 mo thumb finger grasp; 14-18 mo four cube tower; 24 mo 8 cube tower; 3 yo copies circle; 4 yo copies cross, draws man in 3 parts; 5 yo copies a square

184
Q

Who found that omega-3 fatty acids may have atherapeutic benefit in childhood depression?

A

Nemets et al. 2006; n = 28 aged 6 to 12 (controlled double blind pilot study). Perhaps reasonable agent to use for families who can afford it and who are initially concerned about psychopharmacology, especially given the benefits of placebo response in addition to supplement effect.

185
Q

What are goals of treatment besides symptom relief?

A

Restore psychological development to normal path; increase management of anxiety; enhance affect regulation; improve self esteem; increase frustration tolerance; increase age appropriate autonomy; increase capacity for pleasure; improve relationship with peers

186
Q

What are phase I reactions?

A

Hydroxylation, reduction, hydrolysis

187
Q

What are phase 2 reactions?

A

Conjugation of metabolites generated in phase I (with glucuronic acid and sulfate)

188
Q

What is the triple-pathway model to describe the development of violent behavior?

A

Overt pathway: minor aggression leads to physical fighting leads to personal violence, assault, rape, murder. Covert/reactive: non-confrontational behaviors: lying, shoplifting leading to property damage (vandalism, fire setting). Authority conflict pathway: defiant stubborn behavior, out at night, run away, truancy

189
Q

What happens after 8 hours of fasting?

A

Corticotropin-releasing hormone (CRH) increases, a potent anorexic agent

190
Q

How does abuse lead to aggression?

A

Deficits in verbalization, the putting of feelings into words; decreased empathy; misperception of threats; turning anger into action

191
Q

What is IDEA?

A

Individual with Disabilities Act (Succeeded Public Law 94-142 passed 1975)

192
Q

What is transductive reasoning?

A

Things related in time and space are believed to be related casaully

193
Q

What is the legal criterion for disclosure in the context of medical practice?

A

“Material Risk”. Standard for this is what a ‘reasonable person’ would view as material

194
Q

What is the purpose of the Adoption Assistance and Child Welfare Act of 1980 (Public Law 96-272).

A

The Adoption Assistance and Child Welfare Act of 1980 requires that child protective services (CPS) agencies make reasonable efforts to avoid unnecessary removal of children from their homes and to reunify children in foster care with their families whenever possible.

195
Q

What are two civil rights laws that prohibit discrimination on the basis of disabilities?

A

American Disabilities Act of 1990 (allows for accommodations). Section 504 of the Rehabilitation Act of 1973

196
Q

Family Preservation and Support Services was enacted by Congress what year?

A
  1. Originally named the Family Preservation and Family Support (FP/FS) Services program, the program’s scope was expanded in 1997 and was reauthorized as the Promoting Safe and Stable Families (PSSF) program. The primary goals of Promoting Safe and Stable Families (PSSF) are to prevent the unnecessary separation of children from their families, improve the quality of care and services to children and their families, and ensure permanency for children by reuniting them with their parents, by adoption or by another permanent living arrangement. The programs include: family support, family preservation, time-limited family reunification and adoption promotion and support services. (OPRE 2002)
197
Q

The EAHCA (Education for All Handicapped Children Act) was revised to the Individuals with Disabilities in Education Act (IDEA) in 1990 for what main reason?

A

To address children with serious emotional disturbance (SED) who were underserved. (SED later became ED so that the barrier to services was not overly restrictive.)

198
Q

Which Congressional Act led to a right for an appropriate education?

A

The Education for All Handicapped Children Act (EAHCA) 1975.

199
Q

What is the academic benefit of retaining a student versus promoting them?

A

None according to best evidence (Mattison 2000)

200
Q

What did the Cambridge-Somerville study show?

A

That treatment intervention can be detrimental

201
Q

When and where the first partial hospital programs?

A

Russia late 1930s for adults; Canada 1940s; England 1950s; USA 1950s. The MHC Act of 1963 mandated services including PHP for children and adolescents.

202
Q

What do we know about the effect of time in psychotherapy?

A

Most gain is within the first 10-20 sessions. Effect size increases if time is limited. Effect may decrease with longer periods of therapy

203
Q

How does parental harshness weaken the superego?

A

Punishment that hurts the child leads the child to focus on external struggle and is distracted from the internal struggle with shame, guilt or remorse

204
Q

What are the most common delusions in children?

A

Persecutory and somatic

205
Q

What are the four symptom categories of conduct disorder?

A

Aggression, destruction of property, deceitfulness or theft, serious violation of rules

206
Q

What is the outcome of COS?

A

20% remission, 30% improve, 50% mod-poor outcome (Eggers 1978). 18 with SZP in hospital –> 11/18 still with SZP symptoms 2-7 years later (Asarnow 1994). 15 kids with SZP, 11 still with SZP symptoms (Kidd and Werry 1992)

207
Q

Using 10% increase in body weight as a threshold, what percent of those with clozapine, olanzapine, and risperidone increase their weight by 10%?

A

40% CLZ, 30% OLZ, 10% Ris

208
Q

Green assessed 66 boys with gender stereotypical feminine traits and 56 controls at a mean age of 7.1 years and followed up when they had a mean age of 18.9 years. What were the findings?

A

In the control males at follow up, all had heterosexual fantasies; of those who had sex, one had had bisexual sex, and the rest had heterosexual sex. The other males, 75% were bisexual or homosexual and 25% heterosexual; if had had sex 80% had had bisexual or homosexual sex; only one of the boys attracted to males was considering a sex change.

209
Q

What percentage of boys with gender identity disorder (now gender dysphoria in DSM-5) in one study, applied for sex reassignment surgery?

A

23%

210
Q

Most children and adolescents relapse to drug or alcohol use because of_____?

A

Peer pressure

211
Q

What are the five stages of motivational interviewing?

A

Pre-contemplation, contemplation, preparation, action, maintenance

212
Q

What does the data show regarding 12 step programs for adolescents?

A

2 or more meetings per week leads to 6 times the abstinence at one year compared to those who do not attend

213
Q

What is the drug detection time for stimulants in a urine drug screen?

A

48 hours

214
Q

What is the drug detection time for the cocaine metabolite benzoylecgonine?

A

3 days

215
Q

What is the drug detection time for opiates (morphine, codeine)?

A

2 days

216
Q

What is the drug detection time for barbiturates?

A

1 day

217
Q

What is the drug detection time for diazepam?

A

4 days

218
Q

What is the drug detection time for methaqualone?

A

2 weeks

219
Q

What is the drug detection time for THC?

A

4 days to 1 month

220
Q

What trial showed fluoxetine to be potentially useful in selective mutism?

A

Double blind PBO N=16, 4/6 improved vs 1/9 on PBO. Black and Unde 1994

221
Q

What are the FDA approved ages for OCD for sertraline, fluoxetine, and fluvoxamine?

A

6 years old, 7 years old, and 8 years old

222
Q

What percentage of reduction in symptoms of OCD is there on an SSRI?

A

30-40% reduction. At times it takes 6 to 12 weeks for an effect.

223
Q

How are personality traits defined in the DSM?

A

Enduring patterns of perceiving, relating to, and thinking about oneself and the environment that are exhibited in a wide range of social personal contexts

224
Q

What five types of specific phobias are there?

A

Animal type, natural environment type, blood injection injury type, situational, other

225
Q

When did the U.S. Congress enact legislation restricting confinement of status offenders?

A
  1. A status offense is a crime only by virtue of not being an adult (e.g. drinking under age)
226
Q

The legal case Gault did what?

A

Expanded on Kent requiring due process for all juveniles in delinquency proceedings

227
Q

What did Kent v. US 1966 decide?

A

Due process needed when a child is waived (transferred) to adult court

228
Q

What court decision upheld the practice of parents volunteering their kids into a hospital?

A

Parham vs. JR and JL 1979

229
Q

What does MST (Multisystemic Therapy) show regarding treatment effect?

A

Long term rate of criminal offenses by serious juvenile offenders is decreased; reduced rates of out of home placements; reduced rates of drug use and drug related offenses; improvement in family function; decreased rates of other mental health problems

230
Q

What might be the function of REM?

A

Conversion of short-term memory to long-term of daytime experience

231
Q

Do benzodiazepines work in kids?

A

Not really (Simon 1992 alprazolam; Graae 1994 clonazepam)

232
Q

What meds have been studied (have trials) in anxiety disorder in children?

A

Rynn Rupp Study 2001 N= 22 sertraline for GAD; N 74 2003 Birmaher fluoxetine for GAD, SP, SAD (61% response vs. 35%); a trial of fluvoxamine non-response to fluoxetine with response justifies a medicaton switch

233
Q

What did Kendall show regarding cognitive behavioral therapy for generalized anxiety disorder and social anxiety disorder?

A

High response 65% vs. 5% and 50% vs. 6% response in two studies. Kendall developed the Coping Cat manual

234
Q

What two factos in parenting style may impact the development of an anxiety disorder?

A

Warmth and rejection –> less accepting. Parental control –> granting less autonomy

235
Q

What are the most common symptoms in children with generalized anxiety disorder?

A

Tension, apprehension, reassurance need, irritability, negative self image, physical complaints. Adolescents ruminate and children need reassurance

236
Q

What did Alexander et al., developer of family functional therapy (FFT), find regarding parents of children with juvenile delinquency?

A

Can be more defensive and blaming of others

237
Q

What does Patterson (1989) propose as a reliable sequence of antisocial behavior?

A

Ineffective parenting–>academic failure–>peer rejecrtion–> depressed mood –> deviant peer group

238
Q

What did Connor find about aggression in ADHD?

A

Stimulants are effective for aggression within ADHD as core symptoms of inattention and hyperactivity/impulsivity but there is less effect size if conduct disorder is present

Child & Adolescent Psychiatry Review (6 decks)

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