Child Psychiatry I Flashcards
What are the 5 criteria for Dx of ADHD?
- Persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with function or development
- Several Syx present by agee 12
- Several Syx in 2+ settings
- Evidence that Syx interfere with or reduce quality of social, academicc, or occupational fn
- Syx not better explained by another disorder
What are the DSM criteria for inattention?
> 6 for > 6 months (> 5 for 17+)
- Fails to give close attention to detail
- Difficulty sustaining attention in tasks/play
- Does not listen
- Does not follow instruction/finish activity
- Difficulty organizing
- Dislikes/avoids sustained mental effort
- Loses things for tasks/acitivites
- Easily distracted
- Forgetful in daily activities
What are the DSM criteria for hyperactivity?
> 6 for > 6 months (> 5 for 17+)
- Fidgets, taps, squirms
- Leavs seat in situations where supposed to sit
- Unable to play/work quietly
- Often on the go
- Talks excessively
- Blurts out
- Difficulty waiting turn
- Interrupts/intrudes on others
What is ADHD combined presentation?
Both inattention AND hyperactivity criteria met
What is the Dx if DSM criteria for inattention but not hyperactivity met?
ADHD predominantly inattentive presentation
What is the Dx if the criterion for hyperactivity but not inattention met for ADHD?
ADHD predominantly hyperactive/impulsive presentation
What is the criteria for Oppositional Defiant Disorder (ODD)
- Patter of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting > 6 months including > 4 Syx and occurs with at least one person who is not a sibling
- Associated with distress in individual or others or impacts negatively on social, edu, occupational areas
- Behavior do not occur due to other conditions
How is ODD gauged?
- Mild - Syx confined to 1 setting
- Moderate - Syx present in at least 2 settings
- Severe - Syx present in > 3 settings
What are the Syx of ODD and how many of them must one have to reach a Dx?
> 4 Syx of the following
- Lost temper
- Touchy/Easily Annoyed
- Angry/Resentful
- Argues with authority/adults
- Actively defies authority figures/rules
- Deliberately annoys others
- Often blames others for his/her mistakes/misbehaviors
- Spiteful or vindictive in last 6 months
What are the Tx options for ODD?
- Parent Child Interaction
- Parent Management Training - teaches authoritative parenting
- Problem-Solving Skills Training (PSST) - retrain cognitive processes
What is the difference between authoritarian and authoritative parenting?
Authoritarian - High expectations, low warmth
Authoritative - High expectations - high warmth
What is the DSM criteria for conduct disorder?
- Repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms/rules are violated as manifested by > 3 instances in past 12 months
- Disturbance in behavior causes clinically significant impairment
- If patient > 18 yo, criteria are not met for antisocial personality disorder
What are the DSM instances that suggest conduct disorder? How many of them do you need to make Dx? For how long?
> 3 for past 12 months, at least one present in past 6 months
- Bullies, threatens, intimidates
- Initiates physical fighting
- Used a weapon to cause serious phyiscal harm
- Phsyicall cruel to people
- Physically cruel to animals
- Stolen while confronting victim
- Forced someone into a sexual act
- Deliberately engaged in fire setting with intention of causing serious damage
- Deliberately destroyed others’ property (non-fire)
- Broken into someone else’s property
- Lies to obtain goods/favors/avoid obligation
- Stolen items of nontrivial value without confronting a victim
- Often stays out at night despite parental prohibitions
- Run away from home > 2x
- Truant from school (beginning before 13)
Specifications of conduct disorder
Onset:
- Childhood - 1 Syx at < 10yo
- Adolescent - no Syx at < 10yo
- Unspecified
Limited prosocial emotions: Display 2+ of following persistently over > 12 months in multiple relationships/settings
- Lack of remorse/guilt
- Callous - lack of empathy
- Unconcerned about performance
- Shallow or deficient affect
Conduct Disorder Tx?
- Multisystemic Tx - Addresses multiple risk factors at multiple levels
- Multidimensional Tx Foster Care - Community based alternative to residential Tx, child lives in foster care for 6-9 months while parents receive PMT
- Functional Family Tx - Family systems approach
- Anger control training
- PSST
- PMT
