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MSII - Behavioral Science > Child Psychiatry > Flashcards

Child Psychiatry Flashcards

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1
Q

what are the criteria to diagnose ADHD?

A
  1. persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development
  2. several symptoms present before age 12 (~6th grade)
  3. several symptosm present in 2+ settings
  4. symptoms interfere with or reduce quality of socail, academic, or occupational functioning
  5. symptoms not better explained by another disorder
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2
Q

what are inattention symptoms in ADHD?

A

6+ for >6 mo (or 5+ if over 17 yo), “often”

  • fails to give close attention to details/careless mistakes
  • difficulty sustaining attention in tasks or play
  • doesn’t listen when spoken to directly
  • doesn’t follow instructions or fails to finish activities
  • difficulty organizing tasks/activities
  • dislikes/avoids tasks that need sustained mental effort
  • loses things for tasks/activities
  • easily distracted by extraneous stimuli
  • forgetful in daily activities
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3
Q

what are hyperactivity symptoms in ADHD?

A

6+ for >6 mo (or 5+ if over 17 yo), “often”

  • fidgets (fingers), taps hands/feet, squirms (trunk)
  • leaves seat when supposed to sit (adults look uncomfortable)
  • runs around or climbs inappropriately
  • unable to play or work quietly
  • is often “on the go” or “driven by a motor”
  • talks excessively
  • blurts out answers
  • difficulty waiting turn
  • interrupts or intrudes on others
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4
Q

what are behavioral ADHD treatments?

A
  • direct contingency management (rewards/punishments)
  • teacher training
  • parent management training (PMT)
  • -focus on parent-child interactions
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5
Q

what are oppositional defiant disorder criteria?

A
  1. pattern of angry/irritable mood, argumentive/defiant behavior, or vindictiveness lasting > 6 mo
  2. disturbance in behavior is associated with distress in the individual or others in his/her immediate social context, or impacts negatively on social, educational, occupational, or other important areas of functioning
  3. don’t occur during course of psychotic, substance use, depressive, or bipolar disorder
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6
Q

do adults get ODD?

A

no, it becomes a personality disorder

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7
Q

what is disruptive mood dysregulation disorder?

A

if one is disruptive + ODD

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8
Q

what are symptoms for ODD?

A

must have 4+ symptoms in any category, occuring with at least 1 person who is not a sibling

  1. angry/irritable mood
    - often loses temper
    - often touchy or easily annoyed
    - often angry and resentful
  2. argumentive/defiant disorder
    - often argues with authority figures or adults
    - often actively defies or refuses to comply with requests from authority figures or with rules
    - often deliberately annoys others
    - often blames others for his/her mistakes or behavior
  3. vindictiveness
    - has been spiteful or vindictive at least 2x within 6 mo
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9
Q

what is the severity of ODD?

A

mild - symptoms confined to one setting
moderate - some symptoms present in at least 2 settings
severe - some symptoms present in 3+ settings

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10
Q

what is treatment for ODD?

A
  1. parent child interaction therapy (PCIT)
    - uses both attachment and social learnign principles
    - teaches authoritative parenting - nurturing, good communication, firm control
    - differential social attention to shape behavior
  2. problem-solving skills training (PSST)
    - focus on cognitive process
  3. parent management training (PMT)
    - only the parent, not the child
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11
Q

what is hostile attribution bias?

A

seen in ODD; child immediately assumes others are against him, thus acts hostile toward said person

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12
Q

what are conduct disorder criteria?

A
  1. repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by at least 3 symptoms in the past 12 mo (but at least 1 present in past 6 mo)
  2. disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning
  3. if the individual is >18 yo, criteria are not met for antisocial personality disorder
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13
Q

what are the symptoms seen in CD?

A
  1. aggression to people and animals
    - often bullies, threatens, or intimidates others
    - often initiates physical fights
    - has used a weapon that causes serious harm
    - has been physically cruel to people
    - has been physically cruel to animals
    - has stolen while confronting a victim
    - has forced someone into sexual activity
  2. destruction of property
    - has deliberately engaged in fire setting to cause serious damage
    - has deliberately destroyed others’ property
  3. deceitfulness
    - has broken into someone else’s house, building, or car
    - often lies to obtain goods or favors, or to avoid obligations
    - stolen items of nontrivial value without confronting victim
  4. serious violations of rules
    - often stays out at night despite parental prohibitions (before age 13)
    - has run away from home overnight at least twice, or once without returning for a lengthy period of time
    - is often truant from school (before age 13)
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14
Q

what is the onset of conduct disorder?

A

childhood: show at least 1 symptom before age 10
adolescent: show no symptoms before age 10
unspecified: criteria are met, but not enough info to determine if onset was before or after age 10

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15
Q

specify conduct disorder with limited prosocial emotions

A

must display 2+ of the following persistently over at least 1 year in multiple relationships/settings:

  • lack of remorse/guilt
  • callous (lack of empathy)
  • unconcerned about performance
  • shallow or deficient affect
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16
Q

treatment for conduct disorder?

A
  1. multisystemic therapy (MST)
    - addresses and intervenes on multiple risk factors at multiple levels
    - focus on understanding behavior in context
  2. multidimensional treatment foster care (MTFC)
    - community based alternative to residential treatment
    - child lives in foster care for 6-9 mo while parents receive PMT
  3. functional family therapy
    - family systems approach: understands function of misbehavior
  4. anger control training (more effective in children than adolescents
  5. PSST
  6. PMT
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17
Q

what is pervasive developmental disorder (autism spectrum disorder)?

A

neurological disorders characterized by “severe and pervasive impairment in several areas of development” (social interaction, communication)

  • autism spectrum disorder (autistic and Asperger’s disorder)
  • childhood disintegrative disorder
  • Rett’s disorder
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18
Q

what is the definition of autism?

A
  • abnormal or impaired development in social interaction and communication
  • restricted repertoire of interests
  • manifestations of disorder vary greatly depending on developmental elvel and age
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19
Q

what is the prevalence of autism?

A

typically diagnosed within first 3 years

  • 1:68 individuals, and 4x more prevalent in boys than girls
  • not affected by SES, lifestyle, and educational levels
  • growing at 10-17% per year (1-2/1000 a decade ago)
20
Q

what are characteristics of autism?

A
  1. speech
    - doesn’t babble or coo by 12 mo
    - doesn’t gesture by 12 mo
    - doesn’t say single words by 16 mo or two-word phrases by 24 mo
    - has any loss of any language or social skill at any age
  2. social interaction
    - doesn’t pretend play or show interest in other children
    - doesn’t point at objects to indicate interest, or bring and show objects to parents
    - doesn’t enjoy peek-a-boo, hide-and-seek, or other social games
  3. personality
    - insistence on sameness and routines
    - difficulty in expressing needs
    - repeating words or phrases instead of normal language
    - showing emotion for reasons not apparent to others
    - prefers to be alone; aloof manner; don’t want to cuddle
    - tantrums, self-injurious, aggressive
    - inappropriate attachments to or engagement with objects
21
Q

what is Asperger’s syndrome?

A

now part of Autism spectrum disorder

  • impairments in social interactions (eye contact, motor behavior, posture, facial expressions)
  • restricted range in interests, behavior, activities
  • no delays in language or other communication problems
  • tend to have above average IQ (may be very smart)
22
Q

what is childhood disintegrative disorder?

A

marked regression in multiple areas following 2 years of normal development

  • normal speech, play, social and adaptive behavior
  • after 2 yo, lose at least 2 (but usually all) previously held skills
  • -language, social skills, toileting, play, motor skills
  • at this point, disorder resembles autism
23
Q

what is Rett’s disorder? does it happen in girls or boys more?

A

development of specific deficits after a period of normal functioning following birth

  • normal prenatal and first 5 mo development
  • after 5 mo, head growth rate decelerates
  • lose previously acquired hand skills
  • -gradual over 5 to 30 mo; hand wringing
  • develop problems with social interaction, locomotion, and language
  • occurs only in girls
24
Q

what is the assessment of autism?

A

no medical tests to diagnose, so must be based on observation of individual’s communication, behavior, and developmental levels

25
Q

treatment of autism

A

for symptoms

  1. discrete trial instruction (DTI) is most effective method of acquiring new behavior (teach how to copy adults)
    - AKA applied behavior analysis
  2. reinforcement-based treatments most effective for decreasing problematic behavior
    - functional analysis
  3. new forms of antipsychotic meds and stimulant meds are most commonly prescribed
26
Q

what are the criteria for intellectual disability?

A
  1. subaverage intellectual functioning (IQ at or below 70)
  2. deficits in adaptive functioning (2+)
    - communication, self-care, social skills, self-direction, academics, work, safety, etc.
  3. onset before age 18
27
Q

what is mild intellectual disability?

A

IQ 50-70

  • most people with it (~90%)
  • similar to non-ID kids for first few years of life
  • achieve ~6th grade academic level
  • can support self with minimal supervision
28
Q

what is moderate intellectual disability?

A

IQ 35 to 50

  • academic skills up to 2nd grade
  • benefit from extensive social and vocational training
  • can perform unskilled or semi-skilled tasks under supervision
29
Q

what is severe intellectual disability?

A

IQ 20 to 35

  • 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
30
Q

what is profound intellectual disability?

A

IQ below 20

  • may have difficulty with simple tasks, even under close supervision
  • need significant training to develop vocational, self-care, and communication skills
  • function best in highly-structured settings
31
Q

what is the course of intellectual disability?

A

chronic - person with MR may eventually not meet diagnostic criteria with sufficient training

  • lack of age-appropriate interest in activities
  • 1-3% of population
  • about twice as common in males
32
Q

what are causes of intellectual disability?

A
  • unknown: 30-40%
  • Xmal abnormalities: 30%
  • environment or other mental disorders: 15-20%
  • pregnancy problems: 10%
  • heredity: 5%
  • medical conditions: 5%
33
Q

what is challenging behavior seen in autism?

A
  1. repetitive behaviors are “essential” feature - stereotyped movements
  2. display “associated” feature of disorder
    - self-injury, aggression, property destruction, pica
34
Q

what are negative consequences of challenging behavior in autism/

A
  1. social isolation
  2. impact on educational/vocational training
  3. tissue damage due to self-damage
  4. infection
  5. blindness and self-amputation
  6. death
35
Q

self-injurious behavior

A

autistic person deliberately produces physical damage to his/her own body
-stereotypic movement disorder results in bodily damage that requires specific treatment, or would if protective measures weren’t used

36
Q

what are criteria for pica?

A
  1. eating one or more nonnutritive substances on a persistent basis for a period of at least 1 month
  2. eating is inappropriate to person’s developmental level
  3. eating item is not culterally sanctioned practice
37
Q

destructive behavior in challenging behavior?

A

acts in which an individual physically harms another person (aggression) or immediate environment (disruption)

  • no specific DSM code for this behavior when associated with autism
  • -often coded as disruptive behavior disorder
38
Q

what are most common medications for autism?

A

stimulants, then antipsychotics, then SSRIs

  • only 27% of children take medication (rates increase with age)
  • complementary and alternative medicine are growing in popularity when younger, but rates decrease with age
39
Q

what are the medications considered if repetitive behavior, behavioral rigidity, and O/C symptoms?

A

SSRIs, atypical antipsychotics, valproic acid

40
Q

what are the medications considered if hyperactivity, impulsivity, inattention?

A

stimulants, A2 agonists, atomoxetine, atypical antipsychotics

41
Q

what are the medications considered if aggression, explosive outbursts, self-injury?

A

atypical antipsychotics, A2 agonists, anticonvulsants, SSRIs, B-blockers

42
Q

what are the medications considered if sleep dysfunction?

A

melatonin, ramelteon, A2 agonists, mirtazapine

43
Q

what are the medications considered if anxiety?

A

SSRIs, buspirone, mirtazapine

44
Q

what are the medications considered if depressive phenotype?

A

SSRIs, mirtazapine

45
Q

what are the medications considered if bipolar phenotype?

A

anticonvulsants, atypical antipsychotics, lithium

46
Q

behavioral treatment for autism?

A

focuses on identifying and modifying environmental correlates of problem behavior

  • process of functional behavior assessment
  • -identified as ‘best practice” for ASD by AAP
  • behavioral treatments have been effective, particularly if non-responders
  • treatment is intensive, expensive, and rare
  • involves extensive data collection

MSII - Behavioral Science (18 decks)

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