Child and Adolescent Disoders Flashcards
Anxiety Disorders is Children
Separation
Epidemiology - 4% in kids, 1.5% in adolescents
- highly heritable: 73% concordance in twins
Risk factors: sudden ___ disruption, __ or ___ parenting
Diagnosis - developmentally inappropriate and excessive fear/anxiety about separation from attachment figures
Selective Mutism
Epidemiology: - Prevalence is 0.03% to 1%
- No difference with __ or __
- Highly comorbid with __ __disorder
Diagnosis - Failure to ___ in social situations that have expectations for speaking
- Interferes with ___ achievement or __ function
- Duration at least ___
- Not attributable to lack of knowing/comfort with ___
- Not attributable to communication disorder or ASD or psychosis
Social Anxiety Disorder
Epidemiology - 2-7% 12 months prevalence
-___ pre-dominance (2:1), maybe even higher in adolescents
Diagnostic Differences From Adults
- Anxiety must occur with __, not just adults
- Fear/anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, failing to speak
OCD
Epidemiology - approx. 1-2% of population - heritable:
___x higher risk if 1st degree relative with OCD. 10x higher risk is relative’s onset was in ___
- highly comorbid with ___’s disorder
Diagnostic Difference from Adults - Kids may not be able to ___ the aims/goals of __
-___ are more likely to say their OCD does not bother them
Treatment
- Psychotherapy - CBT
- Medication
- ___s: __ and ___
- TCA: ___
PTSD
____ (adverse childhood events)
- Abuse, Neglect or Household Dysfunction
Outcomes (from highest odds ratio to lowest) - Suicide attempt
- Injection of drugs
- Depression past year
- Ever had STD
- Current smoker
- Severe obesity
PTSD diagnostic Differences from Adults - Separation of criteria for under ___yo: may not show __ with intrusions, reenactments
- Exposure to trauma not just through electronic media
- Intrusive memories or dissociation (flashbacks) may be through repetitive __ ___
- ____ may be frightening w/o discernment of actual content/themes
Treatment
- CBT - trauma-focused CBT
- Medication - ____ (an ___ adrenergic agonist) is effective for reducing __
Anxiety Disorders is Children
Separation
Epidemiology - 4% in kids, 1.5% in adolescents
- highly heritable: 73% concordance in twins
Risk factors: sudden separation disruption, overprotective or helicopter parenting
Diagnosis - developmentally inappropriate and excessive fear/anxiety about separation from attachment figures
Selective Mutism
Epidemiology: - Prevalence is 0.03% to 1%
- No difference with gender or ethnicity
- Highly comorbid with social anxiety disorder
Diagnosis - Failure to speak in social situations that have expectations for speaking
- Interferes with educational achievement or social function
- Duration at least 1 month
- Not attributable to lack of knowing/comfort with language
- Not attributable to communication disorder or ASD or psychosis
Social Anxiety Disorder
Epidemiology - 2-7% 12 months prevalence
- Female pre-dominance (2:1), maybe even higher in adolescents
Diagnostic Differences From Adults
- Anxiety must occur with peers, not just adults
- Fear/anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, failing to speak
OCD
Epidemiology - approx. 1-2% of population - heritable:
2x higher risk if 1st degree relative with OCD. 10x higher risk is relative’s onset was in childhood
- highly comorbid with Tourette’s disorder
Diagnostic Difference from Adults - Kids may not be able to explain the aims/goals of compulsions
kids are more likely to say their OCD does not bother them
Treatment
- Psychotherapy - CBT
- Medication
- SSRIs: fluoxetine and sertraline
- TCAs: Clomipramine
PTSD
ACE (adverse childhood events)
- Abuse, Neglect or Household Dysfunction
Outcomes (from highest odds ratio to lowest) - Suicide attempt
- Injection of drugs
- Depression past year
- Ever had STD
- Current smoker
- Severe obesity
PTSD diagnostic Differences from Adults - Separation of criteria for under 6yo: may not show distress with intrusions, reenactments
- Exposure to trauma not just through electronic media
- Intrusive memories or dissociation (flashbacks) may be through repetitive play reenactment
- nightmares may be frightening w/o discernment of actual content/themes
Treatment
- CBT - trauma-focused CBT
- Medication - prasozin (an alpha adrenergic agonist) is effective for reducing nightmares
ODD
Background
1. Angry/irritable mood
- Often loses ___
- Touchy/easily annoyed
- Angry/resentful
2. Argumentative/defiant
- Argues with __
- Refuses to comply
- Deliberately __ others
- Blames others for ___
3. Spiteful or vindictive
- at least ___x in the past ___
ODD
Background
1. Angry/irritable mood
- Often loses temper
- Touchy/easily annoyed
- Angry/resentful
2. Argumentative/defiant
- Argues with adults
- Refuses to comply
- Deliberately annoys others
- Blames others for mistakes
3. Spiteful or vindictive
- at least 2x in the past 6 months
Conduct Disorder
Background
1. Aggression to __ and __
- bullies, threatens,intimidates
- initiates physical fights
- uses weapons
- physically cruel to people or animals
- steals while confronting victim
- forced sexual activity
2. Destruction of ___
- fire-setting with intension
- deliberately destroys other people’s property
3. Decietfulness/___
- broken into house, car, business, etc.
- lies to “con” others
- shoplifting, forgery
4. Serious __ or __
- stays out at night
- runs away
- truant from school
Treatment
1. ___ training!!!!!
- give effective commands
- improve positive attention and overall monitoring - implement immediate, fair, consistent consequences
2. Individual therapy for __ regulation
3. Medications
- ___
- __ __ __
Conduct Disorder
Background
1. Aggression to people and animals
- bullies, threatens,intimidates
- initiates physical fights
- uses weapons
- physically cruel to people or animals
- steals while confronting victim
- forced sexual activity
2. Destruction of property
- fire-setting with intension
- deliberately destroys other people’s property
3. Decietfulness/theft
- broken into house, car, business, etc.
- lies to “con” others
- shoplifting, forgery
4. Serious __ or __
- stays out at night
- runs away
- truant from school
Treatment
-
parent training!!!!!
- give effective commands
- improve positive attention and overall monitoring - implement immediate, fair, consistent consequences - Individual therapy for mood regulation
3. Medications
- SSRIs
- SGAs
MDD in kids
Same DSM-5 criteria as in adults (SIG E CAPS), but with two exceptions:
- ____ may be predominant instead of sad mood
- Failure to gain appropriate ___ may substitute for weight loss
Epidemiology - Life time prevalence by age 18 is _ to __%!
Genetic Loading - 40-60% heritable
Treatment: 1. ___ is FIRST LINE (CBT, IPT) …if psychotherapy is not working, use…
- Medications = ___s!!!
- ____ (Prozac) - down to age 8
- ___ (Lexapro) - down to age 12
DON’T USE P___ ON KIDS, __ or __!
MDD in kids
Same DSM-5 criteria as in adults (SIG E CAPS), but with two exceptions:
- Irritability may be predominant instead of sad mood
- Failure to gain appropriate weight may substitute for weight loss
Epidemiology - Life time prevalence by age 18 is 10-20%
Genetic Loading - 40-60% heritable
Treatment: 1. Psychotherapy is FIRST LINE (CBT, IPT) …if psychotherapy is not working, use…
- Medications = SSRIs!!!
- Fluoxetine (Prozac) - down to age 8
-Escitaloparm (Lexapro) - down to age 12
DON’T USE PAROXETINE ON KIDS,MAOS OR TCAS!
Bipolar in Kids
Controversial diagnosis in kids and teens
- competing approaches to diagnosis
- narrow phenotype
- broad phenotype (severe mood dysregulation)
Children and teens diagnosed with bipolar are most likely to meet criteria for __ __ __in adulthood.
Treatment
- ___ (12+ y/o)
- Atypical antipsychotics such as:
__,__ and __
Bipolar in Kids
Controversial diagnosis in kids and teens
- competing approaches to diagnosis
- narrow phenotype
- broad phenotype (severe mood dysregulation)
Children and teens diagnosed with bipolar are most likely to meet criteria for generalized anxiety disorer in adulthood.
Treatment
- Lithium (12+ y/o)
- Atypical antipsychotics such as:
risperidone, aripiprazole and quetiapine
DMDD
- __,__ __ outburts
- Inconsistent with __ level
- ___+ per__
- Mood between outbursts is predominantly ___ or __ and observable by others
- Present > __ months, no period of 3 months without meeting criteria
- Present in at least __ settings, severe in at least __
- Onset by age __, but must be diagnosed between __ to __ years old.
Treatment
- ___ to address emotion regulation, coping strategies for anger
2. Mediations
- ___ to target impulsive components of disorder
- ___’s for irritaility/anger as depression equivalent
- ___ if warranted for aggression and emotion dysregulation symptoms
DMDD
- Severe, recurrant, temper outburts
- Inconsistent with developmental level
- three+ per week
- Mood between outbursts is predominantly angry or irritable and observable by others
- Present >12 months, no period of 3 months without meeting criteria
- Present in at least 2 settings, severe in at least 1
- Onset by age 10, but must be diagnosed between 6 to 18 years old.
Treatment
- Psychotherapy to address emotion regulation, coping strategies for anger
2. Mediations
- stimulants to target impulsive components of disorder
- SSRI’s for irritaility/anger as depression equivalent
- Antipsychotics if warranted for aggression and emotion dysregulation symptoms
