child and adolescent psychiatry Flashcards by M K

of children will experience a psychiatric disturbance that is sufficiently severe to require treatment or to impair their functioning during the course of a year

5% - 15%

How well did you know this?

Not at all

Perfectly

Significantly sub-average intellectual functioning (IQ)
Significant limitations in adaptive functioning
Communication
Self-care
Life skills
Health and safety skills

Mental Retardation (DSM-IV)/Intellectual Disability (DSM-V)

How well did you know this?

Not at all

Perfectly

range of mild ID

moderate?

severe?

profound?

Mild ID 55 - 70
Moderate ID 40 - 55
Severe ID 25 - 40
Profound ID under 25

How well did you know this?

Not at all

Perfectly

85% of individuals with Intellectual Disability
Educable with special education assistance
Read, write, simple math
Concrete thinker
Expect to be able to hold a job, live independently

Mild Intellectual Disability

How well did you know this?

Not at all

Perfectly

10% of individuals with Intellectual Disability
Talk, recognize name, basic hygiene, do laundry, handle small change
Minimal academic progress
Live with family or in supervised group home
Work in sheltered workshop or supervised activities

Moderate Intellectual Disability

How well did you know this?

Not at all

Perfectly

Unable to complete self help
Likely to require care in an institutionalized setting

Profound and SevereIntellectual Disability

How well did you know this?

Not at all

Perfectly

Affects 1%-2% of the population
Mild: .37% to .5% of population
Moderate/Severe/Profound: .3%-.4%

Mild more common in lower SES, Moderate/Severe/Profound are equally common across SES

Male to female ration 2:1

Intellectual Disability Epidemiology

How well did you know this?

Not at all

Perfectly

what are the MC cause of mental retardation?

most common chromosomal cause?

most common heritable cause?

Fetal Alcohol Syndrome most common cause
Down Syndrome most common chromosomal cause
Fragile X Syndrome most common heritable form of mental retardation
Inborn errors of metabolism (e.g., Tay-Sachs) account for a small percentage of cases

How well did you know this?

Not at all

Perfectly

t/f. Moderate/Profound/Severe often have identifiable cause

true

How well did you know this?

Not at all

Perfectly

what causes mild MR?

Mild often does not have an identifiable cause and is likely developed through a combination of genetic and other factors

How well did you know this?

Not at all

Perfectly

name 3 prenatal factors that may cause intellectual disability?

Prenatal factors
Substance use/abuse
Maternal malnutrition and illnesses
Exposure to mutagens

How well did you know this?

Not at all

Perfectly

name 5 perinatal factors and early postnatal factors

IT HEM

Perinatal and Early Postnatal factors
Traumatic delivery/brain injury
Infections
Head injury
Exposure to toxins
Malnutrition

How well did you know this?

Not at all

Perfectly

Attention Deficit/ Hyperactivity Disorder
Disruptive Behavior Disorders
Mood Disorders
Anxiety Disorders
Habit disorders and stereotypies
Seizure Disorder

all the above disorders are _______

Intellectual Disability Comorbidity

How well did you know this?

Not at all

Perfectly

what are three factors that can impact a child’s level of functioning?

Child’s level of functioning can be impacted by:
Environmental stimulation
Poverty in environment
Cultural factors

How well did you know this?

Not at all

Perfectly

can intellectual disability be cured?

intellectual disability tx?

Intellectual Disability itself is not treated or cured

Treat problematic behaviors
Treat comorbid conditions
Teach independent living skills
Provide special education assistance

How well did you know this?

Not at all

Perfectly

Inability to achieve in a particular academic area at the level predicted by an individual’s cognitive abilities
Generally Borderline IQ or above
Diagnosis requires standardized IQ and achievement testing
Disorder is “treated” through special education services

Learning Disorders

How well did you know this?

Not at all

Perfectly

Reading Disorder
Mathematics Disorder
Disorder of Written Expression
Disability can be in one or more areas
In DSM-V, child is diagnosed with Specific Learning Disorder, with impairment in reading, written expression, or mathematics
2-8% of children
Male to female ratio 2-4:1

what are learning disorders

How well did you know this?

Not at all

Perfectly

what are three learning disorder comoribidities?

ADHD
Mood Disorder
Truancy, School Refusal, Substance Abuse
These may be associated with frustration due to school difficulty and failure

How well did you know this?

Not at all

Perfectly

Expressive Language Disorder
Mixed Receptive-Expressive Language Disorder
- Combined into Language Disorder in DSM-V

Phonological Disorder
Speech Sound Disorder in DSM-V

Stuttering
Childhood Onset Fluency Disorder in DSM-V
Communication Disorder NOS

what are communication disorders

How well did you know this?

Not at all

Perfectly

An impairment in the comprehension and/or use of a spoken, written or other verbal symbol system
Receptive-taking information in
Expressive- getting information out

Language Disorders

How well did you know this?

Not at all

Perfectly

Poor articulation or pronunciation
Substitution- wight for right, toat for coat aminal or animal
Distortions-brlu for blue, crat for cat
Omissions- oke for joke, ining for signing
Additions- aluminininum for aluminum

Phonological Disorder

How well did you know this?

Not at all

Perfectly

Repetitions & prolongation of sound, syllables or words, that interrupt the flow of speech
Occasional secondary characteristics or tics such as stamping the foot or throwing the head out to get the sound out.

Stuttering

How well did you know this?

Not at all

Perfectly

what are 4 assessment issues in speech?

Concomitant retardation or learning disability
Dialect
Regionalism
Facial structure (cleft palate etc.)

How well did you know this?

Not at all

Perfectly

what are the 5 pervasive developmental disorders that are

In DSM-V, these are subsumed under Autism Spectrum Disorder

Autistic Disorder

**Rett’s Disorder- **only in females;6 months of normal development, followed by regression

Childhood Disintegrative Disorder
At least 2 years of normal development, followed by regression

Asperger’s Disorder

PDD NOS (pervasive developmental disorder not otherwise specified)

How well did you know this?

Not at all

Perfectly

Qualitative impairment in social interaction and social communication Restricted repetitive and stereotyped patterns of behavior, interests, and activities Symptoms are present in the early developmental period

Autism Spectrum Disorder

Parents may notice problems with social interaction in first few months of life May not develop normal pattern of smiling or responding to cuddling Failure to develop spoken language often leads parents to seek medical attention Range from complete lack of speech to mildly deviant speech and language patterns Intense and rigid commitment to maintaining specific routines ## Footnote

Autism Spectrum Disorder

70% show some evidence of mental retardation 25% have comorbid seizure disorder Prevalence: 10-15 per 10,000 individuals More common in males, 3:1 or 4:1 Only 2-3% are able to progress normally through school or live independently Etiology unknown No link to childhood immunizations has been proven Early diagnosis and early intervention leads to best outcome Universal screening at 18 months is recommended

Autism Spectrum Disorder (con’t)

how to do you tx autisim spectrum disorder?

Special education intervention Speech and Language Therapies Usually done by speech therapists Social Skills Training Sensorimotor Therapies Usually done by occupational therapists Intensive Behavior therapy Start as early as possible Home-based approach seems best Pharmacotherapy Does not alter the natural history and course of autistic disorder, but can be helpful in controlling specific symptoms (aggression, sleep problems, etc.) Many categories of medications are used, including antipsychotics, SSRIS, stimulants, anticonvulsants, and alpha-adrenergic agonists

Often referred to as “mild,” “high-functioning” autistic disorder Impairment in social interaction Restricted, repetitive and stereotyped patterns of behavior, interests and activities No clinically significant delay in language development No clinically significant delay in cognitive development

Asperger’s Disorder

If an individual has marked deficits in social communication with no additional criteria of Autism Spectrum Disorder, consider evaluation for \_\_\_\_\_\_\_\_, a new disorder in DSM-

Social (Pragmatic) Communication Disorde

how is asperger's diagnosed?

Asperger’s Disorder is no longer in DSM-V, but subsumed under Autism Spectrum Disorder. Autism Spectrum Disorder is diagnosed with **specifiers:** Level of Severity With or Without Intellectual Impairment With or Without Language Impairment

all subtypes of: Combined Type Predominately Inattentive Type Predominately Hyperactive-Impulsive Type ADHD NOS

Attention-Deficit/Hyperactivity Disorder

Significant difficulty focusing and maintaining attention Significant hyperactivity and impulsivity Symptoms present for **_at least 6 months_** **_Onset before age 7 (age 12 in DSM-V_**) Impairment occurs in at least two settings

Attention-Deficit/Hyperactivity Disorder

-Frequent mistakes/Failure to pay close attention -Difficulty sustaining attention -Does not listen when spoken to directly -Fails to finish work/Does not follow instructions -Lacks organizational skills -Avoids sustained mental effort -Misplaces items -Easily distracted -Forgetful

ADHD- Primarily Inattentive

Often fidgets or squirms Leaves seat Difficulty being quiet in leisure activities On the go, as if driven by a motor Talks excessively Shouts answers out of turn Runs instead of walks Difficulty waiting for turn Interrupts or intrudes

ADHD – Primarily Hyperactive/Impulsive

Planning Organizing Starting and stopping activity Managing behavior Persisting on tasks Problem solving Working memory

Executive Functioning Deficits in ADHD

Lack of will power Inadequate parenting Lack of motivation Lack of intelligence Laziness

things that do not cause ADHD

3% – 10% of children Male to Female ratio 3:1 Occurs in all cultures

ADHDEpidemiology

**ADHD prognsois **

At least half of all children with ADHD have a good outcome, completing school Persistence into adolescence and adulthood 1/3 continue to meet full criteria 1/3 have some symptoms 1/3 full remission

Academic failure Relationship problems Legal difficulties Smoking and Substance Abuse Injuries Motor vehicle accidents Occupational/vocational problems

ADHD is associated with increased incidence of:

Girls have a stronger family history than boys Associated with familial mood disorders, learning disorders, substance abuse, and antisocial personality disorder Genes related to dopamine have been implicated

ADHD genetics

Maternal smoking, alcohol and drug abuse, complications during delivery, exposure to toxins, viral infections, maternal malnutrition

nongenetic factors relating to ADHD

neuroimaing in ADHD?

Not currently being used to diagnose ADHD or to guide treatment selection

this disorders are all examples of: Oppositional Defiant Disorder (60%) Anxiety Disorder Depressive Disorder Learning Disability Conduct Disorder Substance Use Disorder

ADHD Comorbidity

3 tx of ADHD?

Behavior Modification with child and parent(s) Classroom/Workplace Accommodations Medications

Preferential seating Shorter assignments Closer supervision Clearer instructions Help in getting started on assignments Daily report card program Allow time for movement Extra set of books Environment with fewer distractions during tests

Classroom Accommodationsfor ADHD

2 stimulants used for ADHD tx?

methylphenidate amphetamine/dextroamphetamine

Atomoxetine (Strattera) used in what?

ADHD

which two alpha adrenergic agonists used to tx ADHD?

clonidine (brand name: Catapres) guanfacine (brand name:Tenex)

which two anti-depressants used for tx of ADHD?

bupropion (brand name: Wellbutrin) tricyclic antidepressants imipramine (brand name: Tofranil)

t/f. Treatment with stimulant medications has been associated with a **_decreased_** risk for substance abuse

true

4 ADEs for ADHD meds?

**Decreased appetite (anorexia)- Most common side effec**t Growth retardation Tics Black box warnings for high abuse potential and serious cardiovascular adverse events and sudden death

**A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:** often loses temper often argues with adults often actively defies or refuses to comply with adults' requests or rules often deliberately annoys people often blames others for his or her mistakes or misbehavior is often touchy or easily annoyed by others is often angry and resentful is often spiteful or vindictive

Oppositional Defiant Disorder

3%-15% of children Male to Female ratio 3:1 Commonly comorbid with ADHD Usually diagnosed before age 8, almost always before adolescence

Oppositional Defiant Disorder Epidemiology

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated Three (or more) criteria in the past 12 months; with at least one criterion present in the past 6 months Childhood-onset type begins prior to age 10

Conduct Disorder

Often bullies, threatens, or intimidates others Often initiates physical fights Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) Has been physically cruel to people Has been physically cruel to animals Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) Has forced someone into sexual activity

Conduct Disorder Aggression to People & Animals

Destruction of Property, Deceitfulness or Theft, Serious Violation of Rules Deliberate fire setting Deliberately destroyed others' property Broken into someone else's house, building, or car Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others) Has stolen without confronting a victim Often stays out at night, beginning before age 13 years Run away from home overnight at least twice Is often truant from school, beginning before age 13 years

Conduct Disorder

6-16% in boys, 2-9% in girls ## Footnote Ratio of males to females with conduct disorder: 3:1 - 12:1 1. 2:1 status offenses 2. 5:1 minor theft 4. 5:1 robbery

Conduct Disorder Epidemiology

Conduct disorder can be a precursor to Antisocial Personality Disorder in adulthood almost half of kids with CD develop significant APD symptoms number of CD symptoms and early age of onset predict the development of APD Conduct disorder may be associated with early death, unemployment, marital conflict, financial instability, and poor interpersonal relationships in adulthood

Conduct DisorderPrognosis

Conduct DisorderComorbidity

Learning Disorders ADHD Mood Disorder Substance Abuse

Inconsistent discipline Poor supervision Low IQ High family conflict Low family warmth and supportiveness Low parental acceptance and affection Parental criminality, alcoholism, and drug abuse Parental psychopathology

Risk factors for the Disruptive Behavioral Disorders

Behavior management training for parents and child Social skills training Problem solving skills Conflict management Multisystemic Therapy (MST)

Treatment for the Disruptive Behavior Disorders

three feeding and eating disorders

**Pica** Persistent eating of nonnutritive substa**nces for a period of at least 1 month** **Rumination Disorde**r Repeated regurgitation and rechewing of food for a period of **at least 1 month following a period of normal functioning** Feeding Disorder of Infancy or Early Childhood

what are three tic disorders?

**Tourette’s disorder- **Both motor and vocal tic **Chronic Motor or Vocal Tic Disorder-**Doesn’t meet criteria for Tourette’s because either motor or vocal tics are present, but not both **Transient Tic Disorder** Doesn’t meet criteria for Tourette’s because it hasn’t lasted long enough

Both **multiple motor and one or more vocal tics occur during the illness, but not necessarily concurrently.** A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization Tics occur many times a day nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months The onset is before 18 years Not due to the direct physiological effects of a substance (e.g., stimulants), or a general medical conditions (e.g., Huntington’s disease or postviral encephalitis)

Tourette’s Disorder

Affects from 1 to 10 school children per 10,000 between the ages of 6 and 17 Up to 20% of children experience transient simple tics Male-to-female ratio of 3:1 Motor tics typically begin between the ages of 3 and 8, several years before the appearance of vocal tics Symptoms peak in adolescence 20% of people have a remission of symptoms in their 20’s

Tourette’s Disorder (con’t)

how do you tx tourette's? two alpha-adrenergic and two neuroleptics

**a-adrenergic agents** clonidine guanfacine **Neuroleptics** Haloperidol (brand name: Haldol) Pimozide (brand name: Orap)

what are the two elimination disorders?

**_Enuresis_** Chronological age of at least 5 years Behavioral treatments **Enuresis alarms – THE MOST EFFECTIVE TREATMENT** Medications **Deamino-8-D-arginine vasopressin (DDAVP) or desmopressin** imipramine **_Encopresis_** Chronological age of at least 4 years Treatment is more complex

what is the behavioral and medication tx for enuresis?

**Behavioral treatments** Enuresis alarms – THE MOST EFFECTIVE TREATMENT Medications **Deamino-8-D-arginine vasopressin (DDAVP) or desmopressin imipramine**

Separation Anxiety Disorder Selective Mutism Reactive Attachment Disorder Stereotypic Movement Disorder Disorder of Infancy, Childhood or Adolescence NOS

Other Disorders of Infancy, Childhood, or Adolescence

\_\_\_\_\_\_\_anxiety is a normal maturational experience – develops at 9 months

Separation

** is a level of anxiety beyond that expected for child’s developmental level** Causes impairment Lasts at least 4 weeks

Separation Anxiety Disorder

**Three or more of the following:** Excessive distress when separation from home or major attachment figures occurs or is anticipated Worry about losing, or about possible harm befalling, major attachment figures Worry that an untoward event will lead to separation from a major attachment figure (such as kidnapping) Reluctance or refusal to go to school or elsewhere because of fear of separation Fearful of being alone or without major attachment figures Reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home Repeated nightmares involving the theme of separation Physical symptoms when separation is anticipated or occurs

Separation Anxiety DisorderCriteria

Consistent failure to speak in specific social situations, where there is an expectation for speaking, despite speaking in other situations Children with \_\_\_\_\_\_\_\_\_\_often will speak at home but nowhere else Prevalence: \<1%

Selective Mutism

Disturbed and developmentally inappropriate social relatedness that begins before age 5 Associated with grossly pathological care **Inhibited:** child fails to initiate and respond to social interactions in a developmentally appropriate way **Disinhibited:** child exhibits indiscriminate sociability or a lack of selectivity in the choice of attachment figures

Reactive Attachment Disorder of Infancy or Early Childhood

Motor behavior that is repetitive, seemingly driven, and nonfunctional Interferes with normal activities or results in self-inflicted bodily injury that requires medical treatment ## Footnote Most commonly associated with Intellectual Disability

Stereotypic Movement Disorder

1- only in females;6 months of normal development, followed by regression ## Footnote 2.At least 2 years of normal development, followed by regression

**1. Rett’s Disorder**- only in females;6 months of normal development, followed by regression ## Footnote **2. Childhood Disintegrative Disorder** At least 2 years of normal development, followed by regression

1. Persistent eating of nonnutritive substances for a period of at least 1 month ## Footnote 2. Repeated regurgitation and rechewing of food for a period of at least 1 month following a period of normal functioning

**Pica** Persistent eating of nonnutritive substances for a period of at least 1 month ## Footnote **Rumination Disorder** Repeated regurgitation and rechewing of food for a period of at least 1 month following a period of normal functioning