Child Psych Lecture Flashcards
ADHD triad?
Hyperactivity
Inattention
Negative behavioral impulsivity
Difficulty listening, sustaining attention
Difficulty with organization
Avoidance of cognitively challenging activities
Forgetfulness
Distractibility
Inattention aspect of ADHD
*MC in girls
Blurting out answers
Difficulty waiting for turn
Interrupting others
Impulsivity aspect of ADHD
Fidgetiness
Running about inappropriately
Difficulty being quiet
Excessive talking
MC in preschool and elementary aged kids
hyperactivity aspect of ADHD
True or false..
With ADHD, hyperactivity tends to decline as child gets older, but inattentive symptoms will persist into adulthood
True
Teens will report “internal restlessness” which leads to thrill seeking behavior
ADHD
Decrease caudate nucleeus, globus pallidus, posterior brain regions
Genes involved:
Human thyroid receptor beta gene on chromosome 3
Dopamine transporter gene (DAT) on chromosome 5
Dopamine receptor D4 gene on chromosome 11
ADHD
think of what NT when it comes to ADHD?
Dopamine
3 aspects must be present for this dx:
- IQ under 70 on individually administered test
- impairment in present adaptive functioning in at least 2 domains
- Onset before age 18
Intellectual disability (formerly called mental retardation)
For an intellectual disability dx, IQ must be under…
below 70
What is the IQ range for mild intellectual disability?
(educable, need assistance under stress)
IQ of 50-70
*this is about 85% of cases!
What is the IQ range for moderate intellectual disability?
(communication deficits)
IQ range 35-49
10% of cases
What is the IQ range for severe intellectual disability?
(motor and communication deficits, may live in homes)
IQ 21-34
4% cases
What is the IQ range for profound intellectual disability?
(noticeable at birth, needs help with basic skills)
IQ <20
1-2% cases
Impairment in social interaction
Impairment in communication-language delays
Repetitive, stereotyped patterns of behavior, interests
Onset prior to age 3 yrs.
Genetic origin
Autistic disorder
Impairment in Social Interaction
Restricted, stereotyped patterns of behavior
No language delays but the “Odd Professor,” pedantic speech.
More boys than girls
Higher functioning than Autistic Disorder
Asperger’s (aka autism spectrum disorder)
Traumatic Event has occurred
Re-experiencing, (flashbacks)
Avoidance/Numbing
Increased states of arousal
Duration at least 1 month
Impairment of functioning
PTSD
True or False…
untreated ADHD is a significant risk factor for substance abuse in adolescence and adulthood
True
Comorbid Disorders:
Learning disabilities Oppositional defiant disorder(50%) Anxiety disorders(30%) Depressive disorders(25%) Bipolar disorder(15%)
ADHD
Diagnosis of ADHD is largely made through….
history
The Vanderbilt Scale and the The Connors’ Rating Scale are most common in screenig of…
ADHD
Reuptake inhibition of NE & DA
Cause increased release of presynaptic NE/DA
Amphetamine promotes passive diffusion of NE and DA into synaptic cleft
Amphetamine promotes release of NE and DA from cytoplasmic pools
Amphetamine & Methylphenidate are mild inhibitors of MAO
MOA of stimulants (used to treat ADHD)
Amphetamine promotes passive diffusion of _____ and ____ into synpatic cleft
NE and DA
(also causes release of NE and DA from cytoplasmic pools)
_____% of pts with ADHD will respond to a single stimulant (DEX/MPH), ____% respond if both tried
70% with one
90% if both
Decreased appetite
Weight loss
Insomnia
G.I. Complaints
Headaches
Check for tics
SE of stimulants used in ADHD tx
How should you dose stimulant drugs when treating ADHD
start low, can titrate up if needed
diagnosed before age 8
high comorbidity with abuse DOs, mood DOs, ADD/ADHD
at least 6 months of negativistic, hostile and defiant behavior
Oppositional defient disorder
At least 4 of the following needed for dx:
- frequent loss of temper
- arguments with adults
- defying adult’s rules
- deliberately annoying others
- easily annoyed
- anger and resentment
- spitefulness
- blaming others
(for at least 6 months)
Oppositional defient disorder
40% risk of developing anti-social personality DO in adulthood
*high co-morbidity with ADD, ADHD, learning disability, mood DO, substance abuse
Conduct disorder
Violation of basic rights of others or of social norms with at least 3 acts of:
- aggression towards people or animals
- destruction of property
- deceitfulness
- serious violation of rules
Conduct disorder
(oppositional defient DO can turn into this if not treated)
For a major depressive episode, 5 or more depression symptoms must be present during the same ________ period
2 week
True or False..
There is marked functional impairment in a major depressive episode
True
Irritable or cranky mood most of the day
Preoccupation/identification with poetry/songs about death.
describes depressed mood in a(n)….
child!
(vs an adult, who have a depressed mood throughout the day)
True or False…
a depressed kid will often go to the school nurses office for complaints like a stomach ache
true
Biggest risk factor for major depression?
Genetics
MC way of suicide in kids
Fire arms
a) the presence of one or more diagnosable mental disorders – particularly a depressive disorder or aggressive disorder, occurring alone or co-morbid with alcohol or drug use disorder, and:
b) a prior suicide attempt.
2 risk factors for suicide
The duration of an antidepressant trial must continue for minimum of 6 weeks before maximum response can be determined.
If response is positive, medication trial should be continued for a minimum of….
4-6 months
T or F…
you would have to treat 10 pediatric pts with SSRIs to help 1?
true
