Child/Adolescent

Question 1

General guidelines for assessment of Child/Adolescents

Answer 1

The assessment usual takes more time.

Interview child and parent separately

Question 2

Fantasy vs reality

Answer 2

By age 4, kids have some of understanding of what’s real and what’s pretend

Question 3

Memory test for school age kids

Answer 3

They should be able to do the 3 object recall after 5 minutes

Question 4

Abstract thinking in kids (in general)

Answer 4

Kids under 12 are more concrete and not expected to have abstract thinking

If they don’t have abstract thinking, you can’t use proverb testing

Question 5

A variety of effective treatments for kids/adolescents

Answer 5

Play therapy
Bibliotherapy
Orative therapy

Art therapy
Behavior therapy
Interpersonal
Cognitive
Milieu
Meds

Question 6

Oppositional defiant disorder

Answer 6

Enduring pattern of anger, arguing, defiant, vindictive behavior that lasts for at least 6 months, with at least 4 of these:
Bad temper
Easily annoyed
Angry
Argues
Breaks rules 
Blames other
Deliberately annoys others
Spiteful

Question 7

ODD etiology

Answer 7

possibly from temperament, crazy parents, trauma, unresolved conflicts

Question 8

ODD prevalence and demographics

Answer 8

More common with parents who had ODD, conduct disorder, ADHD, antisocial personality disorder

30% will develop conduct disorder

Question 9

ODD labs

Answer 9

There’s nothing specific, but you can do the regular panel, check for drug toxicity, and screen for illegal drugs

Question 10

Meds for ODD

Answer 10

There’s nothing specific, and it’s not the 1st line treatment.
If you use meds, it’s to target mood or aggression.

Question 11

Non pharm intervention for ODD

Answer 11

Therapy is the mainstay

It can be individual, family based, and problem solving skills training is an evidence based approach.

Question 12

Conduct disorder

Answer 12

They violate the rights of others, norms and rule are violated.
They have 3 of these in the last 12 months, and 1 in the past 6 months:
-Aggression
-Destroys property
-Deceit or theft
-Serious violation of rules (staying out late or runs away from home before age 13)
-Child onset is before 10, Adolescent onset is after 10

Question 13

Conduct disorder prevalence

Answer 13

More common when the parents are antisocial, alcoholics, mood disorders, schizophrenia
Also, if the kids has a low IQ, is abused, or rejected by the family

Question 14

Conduct disorder labs

Answer 14

Drug screen and the regular labs

Question 15

Pharm treatment of Conduct Disorder

Answer 15

There’s no specific meds, but you can treat symptoms with antipsychotics, mood stabilizers, SSRIs, and alpha agonists

Question 16

Non pharm treatment of conduct disorder

Answer 16

Behavioral therapy, individual, family

Question 17

ADHD etiology

Answer 17

Problems with executive functioning

Abnormalities in the fronto-subcoritical pathways (frontal cortex, basal ganglia)

Abnormalities of the RAS

Structural abnormalities that cause DA and NE dysfunction

Question 18

ADHD incidence and demographics

Answer 18

5% of kids, 2.5% of adults.

More common in boys.

60% of kids persist into adulthood

Question 19

ADHD risk factors

Answer 19

pregnancy complications including alcohol use
family conflict
low birth weight
neglect

Question 20

Physical exam findings of ADHD patients

Answer 20

Hypertelorism (eye far apart)
High arched palate
Low set ears
Injuries from accidents

Question 21

Side effects of stimulants

Answer 21

Cramps

psychosis (but very rarely)

Question 22

Common comorbidities with ADHD

Answer 22

MDD
BP
Anxiety 
ODD
Substance abuse disorder
Tic disorder
Learning disorder

Question 23

ASD

Answer 23

Problems with social communication, specifically social reciprocity, nonverbal communication, having relationships

There is also restricted, repetitive behavior, insistence on sameness, fixed/restricted interests, hyper/hyposensory input

It starts before age 3

Question 24

ASD prevalence

Answer 24

More common in families in which other members have ASD or pervasive developmental disorders

1%

60% change a twin will have it

10% of ASD people will also have a genetic or chromosomal condition like Down’s or Fragile X

Question 25

ASD causes

Answer 25

The etiology is unknown, but it might related be to serotonin, glutamate, and GABA They have abnormalities in the amygdala, hippocampus, and cerebellum (decreased Purkinje cells in the cerebellum) Intellectual disability is a risk factor

Question 26

Things that you might find when assessing an ASD patient

Answer 26

``` They don't spontaneously seeking enjoyment No cooing by age 1, no single words by 16 months, no 2 words by 24 months Loss of language skills at any time No imaginary play Little interest in playing with other children Short attention span Doesn't respond when called No eye contact Intense tantrums Fixations Appetite and or sleep problems Self injurious ```

Question 27

Screening tools for development delays and ASD

Answer 27

M-CHAT (modified checklist for autism in toddlers) ADOS-G (autism diagnostic Observation Schedule Generic) ASQ (Ages and Stages Questionnaires)

Question 28

Pharm management of ASD

Answer 28

Antipsychotics can help with agitation, self injury, hyperactivity, and stereotypes Antidepressants, naltrexone, clonidine, and stimulants can help with self injury, hyperactivity, and obsessions

Question 29

Nonpharm management of ASD

Answer 29

Pivotal response training other obvious stuff

Question 30

Rett Syndrome

Answer 30

They start out normal after birth, but later develop deficits.

Question 31

Rett Syndrome etiology

Answer 31

It's compatible with probable metabolic disorder, and usually associated with ID It's more common in girls Seizure disorder is a risk factor Genetic mutation is suspected

Question 32

Assessment of Rett Syndrome

Answer 32

Head growth slows after 5 to 48 months They used to have purposeful hand movements but regress to stereotypes Early loss of social engagement Poor coordination Impaired language Psychomotor retardation Scoliosis Seizures Irregular breathing Nonspecific changes to EEG/brain images

Question 33

Anorexia

Answer 33

refused to maintain normal weight | Restrict calories

Question 34

Bulimia

Answer 34

g

Question 35

Binge eating disorder

Answer 35

The binging occurs at least twice a week for 6 months

Question 36

Eating disorder etiology

Answer 36

may be linked to decreased hypothalamic NE activation, dysfunction of lateral hypothalamus, and decreased serotonin Increased risk if a 1st degree relative has an eating disorder, mood disorder, and substance disorder

Question 37

Anorexia assessment

Answer 37

weight is less than 85% of normal weight Restricting type is when they don't binge or purge Binging or purging type is where they binge or purge ``` Bradycardia Hypotension Inverted T wave ST segment depression Prolonged QT Yellow skin (carotenemia) Dry skin Brittle hair/nails Peripheral edema ```

Question 38

Bulimia assessment

Answer 38

The binging and compensation happens at least twice a week for 3 months. One of the compensations might be taking stimulants and also fasting can be used in bulimia

Question 39

Lab findings for anorexia

Answer 39

``` Normochromic, normocytic anemia Leukopenia/Neutropenia Thrombocytopenia Hypokalemia Hypomagnesemia Hypoglycemia Decreased LH and FSH ```

Question 40

Lab findings for bulimia

Answer 40

``` Hypotension Bradycardia Hypokalemia/Hyponatremia/Hypochloremia/Hypomagnesemia Acidosis or alkalosis Elevated amylase ```

Question 41

Pharm treatment for eating disorders

Answer 41

Fluoxetine is FDA approved for bulimia Other SSRIs and TCAs can reduce the frequency of binging and purging

Question 42

Non pharm treatment of eating disorders

Answer 42

besides the obivous, there are 12 step programs

Question 43

Intellectual Disability

Answer 43

It starts in the developmental period and includes low intellect and low adaptive functioning It has to occur before 18 years old It is based on adaptive functioning and NOT based on IQ IQ does provide some insight, but less so at the lower range

Question 44

Etiology of Intellectual Disability

Answer 44

5% of cases are hereditary: Inborn errors of metabolism (Tay-Sachs) Single gene abnormality (tuberous sclerosis) Chromosomal aberrations (Down's, Fragile X) 30% are early alterations of embryonic development: Prenatal exposure to toxins ``` 10% are pregnancy and perinatal problems Fetal malnutrition Premature birth Fetal hypoxia Birth trauma ``` 5% are general medical conditions acquired during infancy or childhood Infections Brain trauma Toxins (lead poisoning) And for 30% to 50% there's no clear etiology

Question 45

Fetal alcohol syndrome

Answer 45

It is the most preventable cause of Intellectual Disability ``` They have: Epicanthal skin folds Low nasal bridge Short nose Indistinct philtrum Small head Small eyes Wide-set eyes Thin upper lip ```

Question 46

Physical assessment of Intellectual Disability person

Answer 46

``` Oblique eye folds Small, flat skull Large tongue Broad hands with stubby fingers Single transverse palm crease Abnormal finger and toe prints High cheek bones Small height Spot of iris Cryptorchidism Early dementia Hypothyroidism ```

Question 47

Pharm treatment for Intellectual Disability

Answer 47

Treat whatever comobidities they have, like ADHD, depression, etc. Aggression and self injurious behavior can be treatede with antipsychotics and mood stabilizers

Question 48

Disruptive Mood Dysregulation Disorder

Answer 48

Depressive disorder where they have to be 6 to 18 years old Chronic dysregulated mood Tantrums Irritability

Question 49

Pharm treatment of Disruptive Mood Dysregulation Disorder

Answer 49

SSRIs, mood stabilizers, and 2nd gens