Child Psychiatry 2

Question 1

Pervasive Developmental Disorders include

Answer 1

1. Autism Spectrum Disorder (austistic and Asperger’s disorder)
2. Childhood Disintegrative Disorder (CDD)
3. Rett’s Disorder

Question 2

Autism:

Answer 2

1. Abnormal or impaired development in social interaction and communication
2. restricted repertoire of interests
3. Manifestations of disorder vary greatly depending on developmental level and age of individual

Question 3

Prevalence of Autism

Answer 3

1. Usually diagnosed within first 3 years
2. Usually boys > girls
3. Not affected by income level, lifestyle, educational levels
4. It’s growing at a higher rate than before

Question 4

Characteristics of Autism (16)

Answer 4

1. Not babbling or cooing by 12 mos
2. Not gesturing (point, wave, grasp) by 12 mos
3. Not saying single words by 16 months or 2-word phrases by 24 months
4. Any loss of any language or social skill at any age
5. Not displaying pretend play (drinking from toy cup)
6. Not pointing at objects to indicate interest
7. Not showing interest in other children
8. Not enjoying peek-a-boo hide-and-seek, or other games
9. Not bringing and showing objects to parents
10. Insistence on sameness
11. Difficulty in expressing needs
12. Repeating words or phrases instead of normal language
13. Showing emotion for reasons not apparent to others
14. Prefers to be alone; aloof manner; don’t want to cuddle
15. Tantrums, self-injurious, or aggressive
16. Inappropriate attachments to or engagement with objects

Question 5

Asperger’s

Answer 5

1. Now part of Autism spectrum disorder
2. Impairments in social interactions (eye contact, motor bx, posture, facial expressions)
3. Restricted range of interests, bx, activities
4. No delays in language or other comm problems
5. Tend to have above average IQ (could be really smart)

Question 6

Childhood Disintegrative Disorder:

Answer 6

1. Marked regression in multiple areas following 2 years of normal development (normal speech, play, social bx, adaptive behavior)
2. After 2 years, lost at least 2 previously held skills (language, social skills, toileting, play, motor skills; usually lose skills in all areas)
3. At this point, disorder resembles autism

Question 7

Rett’s Disorder

Answer 7

1. Development of specific deficits after period of normal functioning following birth (normal prenatal development and normal devel during first 5 mos of life)
2. After 5 mos head growth rate decelerates
3. Lose previously acquired hand skills (gradual over 5-30 mos)
4. Develop problems with social interaction, locomotion, language
5. ONLY GIRLS!!!

Question 8

Assessment of Autism:

Answer 8

No med tests for diagnosing autism;

1. Autism diagnostic interview-R (ADI-R)
2. Home and/or school observation
3. Video analysis of behavioral observation
4. Recent genetic studies have shown approx 15-20 genes

Question 9

How to treat autism symptoms

Answer 9

1. Discrete trial instruction most effective method of acquiring new behavior (applied behavior analysis)
2. Reinforcement-based treatments are most effective for decreasing problematic behavior (functional analysis)
3. New forms of antipsychotic meds and stimulant meds are most commonly prescribed

Question 10

Diagnosis of MR:

Answer 10

Need the three:

1. Subaverage intellectual functioning (IQ at or below 70)
2. Deficits in adaptive functioning (2 or more): comm, self-care, social skills, self-direction, academics, work, safety
3. Onset before age 18

Question 11

Severity of MR: Mild

Answer 11

(50-55 to 70): most people with MR at this level; similar to non-MR kids for first few years of life; achieve about 6th grade level of academic level; can support self with minimal supervision

Question 12

For moderate MR

Answer 12

(35-40 to 50-55): academic skills up to 2nd grade; benefit from extensive social and vocational training; can perform unskilled or semi-skilled tasks under supervision

Question 13

For severe MR

Answer 13

(20-25 to 35-40): can acquire some basic self-help skills (self-feeding); can learn to count or “read”; can perform simple tasks under close supervision; require assistance for most activities and daily life

Question 14

For profound MR

Answer 14

(<20-25): can have difficulty even with simple tasks, even under close supervision; need significant training to develop vocational, self-care, and comm skills; function best in highly-structured settings

Question 15

Course of MR:

Answer 15

1. Chronic (might eventually not meet diagnostic criteria with sufficient training)
2. Lack of age-appropriate interest in activities
3. 1-3% of population
4. About twice as common in males (2:1)

Question 16

Challenging behavior in autism; negative consequences:

Answer 16

associated feature of the disorder (repetitive behaviors):
1. Self-injury: person deliberately does physical damage to his/her own body; stereotypic movement disorder is one that results in bodily damage that requires specific treatment or would result in bodily damage if protective measures not used

2. Pica (eat one or more nonnutritive substances on persistent basis for period of at least one mo)
3. Destructive behavior: acts in which an individual physically harms another person (aggression) or immediate environment (disruption); if associated with autism, coded as disruptive behavior disorder;

social isolation, impact on educational/vocational training, tissue damage, infection, blindness and self-amputation, death

Question 17

Meds for autism:

Answer 17

Most common are stims, then antipsychotics, then SSRIs;

affected by co-morbid disorders (sleep, GI, mood disorders, seizures)

Question 18

Behavioral Treatment for autism:

Answer 18

1. Focus on ID’ing and modifying environmental correlates of problem behavior
2. Process of functional behavior assessment
3. Involves extensive data collection!! (need to use data to assess changes in occurrence of the target behavior)