Child/Adolescent Flashcards
General guidelines for assessment of Child/Adolescents
The assessment usual takes more time.
Interview child and parent separately
Fantasy vs reality
By age 4, kids have some of understanding of what’s real and what’s pretend
Memory test for school age kids
They should be able to do the 3 object recall after 5 minutes
Abstract thinking in kids (in general)
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
A variety of effective treatments for kids/adolescents
Play therapy
Bibliotherapy
Orative therapy
Art therapy Behavior therapy Interpersonal Cognitive Milieu Meds
Oppositional defiant disorder
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
ODD etiology
possibly from temperament, crazy parents, trauma, unresolved conflicts
ODD prevalence and demographics
More common with parents who had ODD, conduct disorder, ADHD, antisocial personality disorder
30% will develop conduct disorder
ODD labs
There’s nothing specific, but you can do the regular panel, check for drug toxicity, and screen for illegal drugs
Meds for ODD
There’s nothing specific, and it’s not the 1st line treatment.
If you use meds, it’s to target mood or aggression.
Non pharm intervention for ODD
Therapy is the mainstay
It can be individual, family based, and problem solving skills training is an evidence based approach.
Conduct disorder
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
Conduct disorder prevalence
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
Conduct disorder labs
Drug screen and the regular labs
Pharm treatment of Conduct Disorder
There’s no specific meds, but you can treat symptoms with antipsychotics, mood stabilizers, SSRIs, and alpha agonists
Non pharm treatment of conduct disorder
Behavioral therapy, individual, family
ADHD etiology
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
ADHD incidence and demographics
5% of kids, 2.5% of adults.
More common in boys.
60% of kids persist into adulthood
ADHD risk factors
pregnancy complications including alcohol use
family conflict
low birth weight
neglect
Physical exam findings of ADHD patients
Hypertelorism (eye far apart)
High arched palate
Low set ears
Injuries from accidents
Side effects of stimulants
Cramps
psychosis (but very rarely)
Common comorbidities with ADHD
MDD BP Anxiety ODD Substance abuse disorder Tic disorder Learning disorder
ASD
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
ASD prevalence
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
ASD causes
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
Things that you might find when assessing an ASD patient
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
Screening tools for development delays and ASD
M-CHAT (modified checklist for autism in toddlers)
ADOS-G (autism diagnostic Observation Schedule Generic)
ASQ (Ages and Stages Questionnaires)
Pharm management of ASD
Antipsychotics can help with agitation, self injury, hyperactivity, and stereotypes
Antidepressants, naltrexone, clonidine, and stimulants can help with self injury, hyperactivity, and obsessions
Nonpharm management of ASD
Pivotal response training
other obvious stuff
Rett Syndrome
They start out normal after birth, but later develop deficits.
Rett Syndrome etiology
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
Assessment of Rett Syndrome
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
Anorexia
refused to maintain normal weight
Restrict calories
Bulimia
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Binge eating disorder
The binging occurs at least twice a week for 6 months
Eating disorder etiology
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
Anorexia assessment
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
Bulimia assessment
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
Lab findings for anorexia
Normochromic, normocytic anemia Leukopenia/Neutropenia Thrombocytopenia Hypokalemia Hypomagnesemia Hypoglycemia Decreased LH and FSH
Lab findings for bulimia
Hypotension Bradycardia Hypokalemia/Hyponatremia/Hypochloremia/Hypomagnesemia Acidosis or alkalosis Elevated amylase
Pharm treatment for eating disorders
Fluoxetine is FDA approved for bulimia
Other SSRIs and TCAs can reduce the frequency of binging and purging
Non pharm treatment of eating disorders
besides the obivous, there are 12 step programs
Intellectual Disability
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
Etiology of Intellectual Disability
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
Fetal alcohol syndrome
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
Physical assessment of Intellectual Disability person
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
Pharm treatment for Intellectual Disability
Treat whatever comobidities they have, like ADHD, depression, etc.
Aggression and self injurious behavior can be treatede with antipsychotics and mood stabilizers
Disruptive Mood Dysregulation Disorder
Depressive disorder where they have to be 6 to 18 years old
Chronic dysregulated mood
Tantrums
Irritability
Pharm treatment of Disruptive Mood Dysregulation Disorder
SSRIs, mood stabilizers, and 2nd gens
