Child Psych Flashcards
List the inattentivity symptoms in ADHD
Require >=6 for >=6 months (or >=5 for those >17)
- fail to provide close attention to detail
- difficulty sustaining attention
- does not listen
- does not follow through on instruction
- difficulty organizing tasks
- avoids tasks requiring sustained mental effort
- often loses things
- Easily distracted
- Forgetful
List the hyperactivity symptoms in ADHD
Require >=6 for >=6 months (or >=5 for those >17)
- Fidgets or taps hands/feet
- leave seat when should remain seated
- often runs about or climbs when not appropriate
- inability to engage in leisure activities
- often on the go
- talks excessively
- often blurts out answer
- difficulty waiting turn
- interrupts
List the diagnostic criteria for ADHD
- persistent inattention and/or hyperactivity than interfere with functioning
- symptoms present before age 12
- symptoms present in more than 2 settings
- interference with psychosocial function
- other disorder ruled out
List the medications most commonly used for ADHD
Medications necessary for behavioural treatment
- Adderal XR 5-10mg qAM titrated by 5mg every 7 days until max 30mg
- Biphentine: 10-20 qAM titrated by 5mg every 7 days until max 60mg
- Concerta 18mg qAM titrate by 9-18mg every 7 days until make 72mg
- Vyvanse 20-30mg qAM titrating by 10mg every 7 days until max 60mg
- prodrug so no ability for abuse
Second Line
- short acting psychostimulants
3rd Line:
- antidepressants
List the side effects and contraindications of psychostimulants
Side Effects
- headache, stomachache, anorexia, insomnia
- risk of abuse
- rebound psychosis
- arrhythmia, hypertension
Contraindications
- any child with hypertension, heart disease/abnormality, hyperthyroidism
- require screen of cardiac symptoms and family history
- if screen positive require ECG
List the psychosocial intervention for ADHD
Behavioural Intervention Psychotherapy - CBT - IPT - Family therapy Social Intervention Education/Vocational Accomodations
List the risk factors for oppositional deviant disorder
- maternal depression
- family history of disruptive behaviour
- parenting style with inconsistent and severe discipline
- multiple caregivers
- family discord
- low income
List common comorbidities with ODD
- ODD increase risk of ADHD
- 25-30% of ODD with develop conduct disorder and is usually more serious and risk of developing antisocial personality disorder
List the diagnostic criteria for ODD
- Angry/irritable mood, argumentative/defiant behaviour or vindictiveness for >=6 months with >=4 symptoms with interactions with more than 1 person that is not a sibling
- disturbance in behaviour leads to distress in people around individual and impair psychosocial function
- substance use or other disorder ruled out
List the angry/irritable mood, argumentative/defiant behaviour and vindictive symptoms
Angry/Irritable - often loses temper - easily annoyed - often angry or resentful Argumentative/Defiant - argue with authority figure - actively defies or refuses to comply with rules or request from authority - often deliberately annoys others - often blames others for mistakes Vindictiveness - spiteful or vindictive >=2 times in last 6 months
List the frequency of symptoms in ODD
- <5yo then symptoms most days for >=6 months
- >5 yo then symptoms weekly for >=6months
List the treatment for ODD
- medication usually not helpful unless comorbid ADHD Psychosocial - anger mangement - CBT - family counselling - parent training Prevention - parents and school training
List the risk factors for conduct disorder
- family member with conduct disorder
- parent history of substance abuse or mental health disorder
- marital conflict
- exposure to antisocial behaviour
- inconsistent parental discipline
- delinquent peer group
- exposure to violence
List the diagnostic criteria for conduct disorder
- Repetitive and persistent behaviour that violates basic rights of others or major age-appropriate social norms with >=3 of the following symptoms in past 12 months and >=1 in past month
- aggression to people or animals
- destruction of property
- deceitfulness or theft
- serious violation of rules - disturbance in behaviour impair psychosocial function
- > 18 and antisocial criteria not met
List the limited prosocial emotion criteria in conduct
>2 in following 12 months - lack of remorse or guilt - callous lack of empathy - unconcerned about performance - shallow or deficient affect Usually associated with childhood onset and is more severe
Discuss the management of conduct disorder
Medication for comorbidities - hyperactivity with psychostimulants - impulsivity with mood stabilizer, neuroleptic or clonidine Psychosocial - CBT - Parent management training - family therapy - Multi-systemic therapy
Discuss the differential for those children with disruptive disorders
- Impaired language comprehension
- intellectual disability
- mood disorder
- social phobia
Discuss the screening for autism
Evaluation required if miss developmental milestones
- 12 months with no babbling, gesturing, or response to name
- 16 months does not speak
- 24 months does not speak 2 word phrases
- Any age have loss of language or social skill
- Any age have abnormal eye contact, no interactive play, lack of interest in other children
List the diagnostic criteria for autism
- Persistent deficit in social communication and interaction in multiple contexts:
- deficit in social emotional reciprocity (abnormal social approach to failure to initiate contact)
- deficit in nonverbal communication behaviour (poor verbal/non-verbal communication to total lack of facial expression)
- deficit in developing, maintaining, and understanding relationships (difficulty adjusting to social behaviour to absence of interested in peers)
- Restricted and repetitive behaviour
- stereotyped motor movements, use of an object, or speech
- insistance on sameness, inflexible adherence to routine
- highly restricted and fixated interests
- hyper or hypo-activity to sensory input - symptoms present in early developing years (age 4)
- symptoms impair psychosocial functioning
- intellectual disability and global developmental delay ruled out
List the goals of therapy for autism
- require multimodal treatment in order to improve and promote social interaction and conversational language
- normalize sensory responses and mitigate self-stimulatory behaviour
Discuss the management for autism
Psychotherapy
- applied behaviour analysis which teaches new behaviour by explicit reinforcement of those behaviours
Medication
- atypical antipsychotics (risperidone or aripiprazole) to treat irrability, tantrum, aggression, and self-injurious behaviour
List the differences in depressive symptoms between children and adolescents
Onset
- sudden with stressors in adolescents (switching schools, social pressures, biological changes, loss of loved one)
Mood
- irritable, behavioural problem in children
- hopeless in adolescent
Behaviour
- school refusal, social withdrawal and aggression in children
- substance abuse, truancy, promiscuity and hypersensitivity in adolescents
Sleep and Appetite
- no affect in children
- hypersomnia and hyperphagia on adolescents
Psychosis
- auditory hallucinations in childrne
- delusions in adolescents
Somatic
- yes in children
List good and poor prognosticators for depression
Good - acute stressor - child well equipped to cope with feelings - support from home, school and social Poor - genetic susceptibility - chronic and recurring stresses - child/adolescent has poor coping skills - early onset depression
Discuss MSIGECAPS with common symptoms in children
Must meet >=5 criteria for at least 2 weeks where mood and interest must be included Mood - depressed or irritable or vague physical complaints Sleep - insomnia or hypersomnia Interest - loss of interest in peer play Guilt/Worthlessness - self-depreciation Energy - lack of peer play, school refusal, or frequent abscense Concentration - lead to behavioural difficulties Appetite - not gaining weight Pscyhomotor agitation/retardation - hyperactive behaviour Suicide - non-verbal cues
Work up for depression in children and adolescents
- CBC for anemia
- Electrolytes
- Metabolic workup for hypercalcemia, hypo/hyperglycemia, B12
- kidney function
- liver funtion
- TSH for hypothyroidism
Discuss the management of depression in children
- mild to moderate depression have CBT or IBT first line and then SSRI second line
- severe require SSRI first line with CBT
- first episode require treatment for at least 6 months
- second episode treat for 1 year
- > 2 episodes treat 1-3 years or indefinitely
Discuss the medication used for depression in children
- Fluoxetine only one approved for children <12yo
- Sertaline, Citalopram or Escitalopram used off label
- when starting medication require safety plan and close monitoring with weekly meetings for first month and then every 2 weeks for 2nd month
- those with psychotic features have increased risk of suicide so require admission
- also require antipsychotics
Discuss assessment of suicide in children
Suicide plan - active vs passive - chronic vs acute - frequency and intrusiveness - sense of control and reasoning Previous Suicide Attempt - greatest risk for future suicide attempt Rapport and Engagement Risk Factors - age 15-25 - female - Abnoriginal, White, Hispanic - psychiatric or physical disorder Protective Factors - close attachment - problem solving skills - support system - remorseful regarding attempt
List the diagnostic criteria for disruptive mood dysregulation disorder
- Severe recurrant temper outburst
- Temper outburst inconsistent with behavioural level
- Temper outburst >=3 times per week
- Mood between temper is consistently irritable or angry
- Present for >1 year, where never symptom free for >3 months
- present in >= 2 settings
- symptom onsent <10, with diagnosis not made on first time between 6-18
- no manic episodes
- no other psychiatric or substance disorder
List the risk factors for anxiety in children
- early temperamental trait of passivity and shyness between 3-5
- behavioural inhibition: show fear or withdrawal in new situation
- insecure mother-child attachment in infancy
- imitation of parents poor habits
- parental concerns regarding seperation
- close relationship with mother only
Define anxiety disorder in children
Anxiety that is
- inappropriate for developmental age
- prolonged or recurrent
- distressful for children
- impairing pscyhosocial function
- specific symptoms
Discuss the management of anxiety disorders in children
Pscyhosocial intervention
- pscyhoeducation
- IPT
- CBT
- school intervention
Medication
- SSRI
- atypical antipsychotic or benzodiazepine used as last line
- for specific phobia can use benzo PRN
- for selective mutism CBT
School Intervention
- address bullying
- remediation for missing class
- school psychoeducationList the diagnostic criteria for separation anxiety disorder
- Developmentally inappropriate and excessive fear concerning separation from those patient is attached with >=3 of the following
- distress when anticipating or experiencing separation
- persistant worry about losing attachment figures
- persistant worry about experiencing event that cause separation
- reluctance to go out due to fear of separation
- reluctance of being alone or without major attachment figure
- reluctance to sleep away for attachment figures
- repeated nightmares regarding separation
- complaints of physical symptoms when separated - persistent >4 weeks in children <18 or >6 months in adults
- disturbance leads to distress and impairs psychosocial function
- not other disorder
Differentiate between truancy and school refusal for school absence
Truancy
- child and teens with antisocial tendancies
- skipping due to lack of interest or refusing to conform
- no underlying anxiety with school
- conceal absences
School Refusal
- emotional distress about attending school
- Do not conceal absences
- Willingness to complete work from home
List the factors associated with school refusal
School factors - specific fears that occur in school - escape from social situation - academic underachievement Home Factors - separation anxiety - attention seeking - pursue another activity by being away from school - recent stressor Psychiatric Factor Medical Factors
Discuss the presentation of school refusal
- usually occur following few days off schools (vacation, weekend)
- occur following significant stress
- fearfulness, tantrum, self-harm
- somatic symptoms
Discuss the short and long term impacts of school refusal
Short Term - difficulty maintaining peer relationships - difficult family relationships - poor academic performance Long Term - academic underachievement - employment difficulties - Increased comorbid psychiatric issue
Discuss the management of school refusal
- identify factors leading to refusal
- early return to school is primary goal
- education of family and patient
- behaviour strategies
- psychotherapy
- SSRI for anxiety or benzo short term
- provide support by liasing with school
