Child/Adolescent Flashcards

1
Q

General guidelines for assessment of Child/Adolescents

A

The assessment usual takes more time.

Interview child and parent separately

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2
Q

Fantasy vs reality

A

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

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3
Q

Memory test for school age kids

A

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

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4
Q

Abstract thinking in kids (in general)

A

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

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5
Q

A variety of effective treatments for kids/adolescents

A

Play therapy
Bibliotherapy
Orative therapy

Art therapy
Behavior therapy
Interpersonal
Cognitive
Milieu
Meds
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6
Q

Oppositional defiant disorder

A
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
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7
Q

ODD etiology

A

possibly from temperament, crazy parents, trauma, unresolved conflicts

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8
Q

ODD prevalence and demographics

A

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

30% will develop conduct disorder

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9
Q

ODD labs

A

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

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10
Q

Meds for ODD

A

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

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11
Q

Non pharm intervention for ODD

A

Therapy is the mainstay

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

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12
Q

Conduct disorder

A

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

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13
Q

Conduct disorder prevalence

A

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

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14
Q

Conduct disorder labs

A

Drug screen and the regular labs

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15
Q

Pharm treatment of Conduct Disorder

A

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

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16
Q

Non pharm treatment of conduct disorder

A

Behavioral therapy, individual, family

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17
Q

ADHD etiology

A

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

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18
Q

ADHD incidence and demographics

A

5% of kids, 2.5% of adults.

More common in boys.

60% of kids persist into adulthood

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19
Q

ADHD risk factors

A

pregnancy complications including alcohol use
family conflict
low birth weight
neglect

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20
Q

Physical exam findings of ADHD patients

A

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

21
Q

Side effects of stimulants

A

Cramps

psychosis (but very rarely)

22
Q

Common comorbidities with ADHD

A
MDD
BP
Anxiety 
ODD
Substance abuse disorder
Tic disorder
Learning disorder
23
Q

ASD

A

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

24
Q

ASD prevalence

A

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

25
Q

ASD causes

A

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

26
Q

Things that you might find when assessing an ASD patient

A
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
27
Q

Screening tools for development delays and ASD

A

M-CHAT (modified checklist for autism in toddlers)

ADOS-G (autism diagnostic Observation Schedule Generic)

ASQ (Ages and Stages Questionnaires)

28
Q

Pharm management of ASD

A

Antipsychotics can help with agitation, self injury, hyperactivity, and stereotypes

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

29
Q

Nonpharm management of ASD

A

Pivotal response training

other obvious stuff

30
Q

Rett Syndrome

A

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

31
Q

Rett Syndrome etiology

A

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

32
Q

Assessment of Rett Syndrome

A

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

33
Q

Anorexia

A

refused to maintain normal weight

Restrict calories

34
Q

Bulimia

A

g

35
Q

Binge eating disorder

A

The binging occurs at least twice a week for 6 months

36
Q

Eating disorder etiology

A

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

37
Q

Anorexia assessment

A

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
38
Q

Bulimia assessment

A

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

39
Q

Lab findings for anorexia

A
Normochromic, normocytic anemia 
Leukopenia/Neutropenia
Thrombocytopenia 
Hypokalemia
Hypomagnesemia
Hypoglycemia 
Decreased LH and FSH
40
Q

Lab findings for bulimia

A
Hypotension
Bradycardia
Hypokalemia/Hyponatremia/Hypochloremia/Hypomagnesemia 
Acidosis or alkalosis
Elevated amylase
41
Q

Pharm treatment for eating disorders

A

Fluoxetine is FDA approved for bulimia

Other SSRIs and TCAs can reduce the frequency of binging and purging

42
Q

Non pharm treatment of eating disorders

A

besides the obivous, there are 12 step programs

43
Q

Intellectual Disability

A

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

44
Q

Etiology of Intellectual Disability

A

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

45
Q

Fetal alcohol syndrome

A

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
46
Q

Physical assessment of Intellectual Disability person

A
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
47
Q

Pharm treatment for Intellectual Disability

A

Treat whatever comobidities they have, like ADHD, depression, etc.

Aggression and self injurious behavior can be treatede with antipsychotics and mood stabilizers

48
Q

Disruptive Mood Dysregulation Disorder

A

Depressive disorder where they have to be 6 to 18 years old

Chronic dysregulated mood
Tantrums
Irritability

49
Q

Pharm treatment of Disruptive Mood Dysregulation Disorder

A

SSRIs, mood stabilizers, and 2nd gens