Child Specific Notes: Deck 1 (Neurodev, SCZ, Mood) Flashcards
1
Q
Name four psychological tests of intelligence
A
- WPPSI–> Wechsler Preschool and Primary Scale of Intelligence
- WISC–> Wechsler Intelligence Scale for Children
- WAIS–> Weschler Adult Intelligence Scale
- WIAT–> Weschler Individual Achievement Test
2
Q
What does the WPPSI test for?
A
FSIQ
verbal and performance intelligence
3
Q
what is the age range within which the WPPSI is validated?
A
2.5 years - 7.5 years roughly
4
Q
what does the WISC test for?
A
verbal comprehension
visual spatial
fluid reasoning
working memory
processing speed
5
Q
what is the age range within which the WISC is validated?
A
ages 6-16
6
Q
what does the WAIS test for?
A
verbal and performance intelligence
verbal–> working memory and verbal comprehension
performance–> perceptual organization, processing speed
7
Q
what is the age range within which the WAIS is validated?
A
ages 16-90 years
8
Q
what does the WIAT test for?
A
areas of academic schoolwork–> reading, writing, math, oral language
9
Q
what is the age range within which the WIAT is validated?
A
ages 4-19 years
10
Q
beyond the WPPSI, WIAT, WAIS and WISC, list three other tests for IQ
A
- Stanford Binet Intelligence Scale –> can be used starting age 2
- Kaufman Assessment Battery for Children–> 2-12 years old
- Kaufmann Adolescent and Adults Intelligence Test–> 11-85 years old
11
Q
for what ages is the Stanford Binet Intelligence Test validated?
A
starting at age 2
12
Q
what is the age range within which the Kaufmann Assessment Battery for Children is validated?
A
ages 2-12 years
13
Q
what is the age range within which the Kaufmann Adolescent and Adult Intelligence Test is validated?
A
ages 11-85 years
14
Q
list two adaptive functioning scales that can be used in assessment
A
- Vineland Adaptive Behaviour Scale (VABS)
- Adaptive Behaivour Assessment System (ABAS II)
15
Q
what is the age range within which the VABS is validated?
what does it test for?
A
birth to adulthood
communication
ADLs
social
motor
maladaptive behaviours
16
Q
what is the age range within which the ABAS is validated?
A
birth to 89 years old
teacher/parent/caregiver reports
conceptual (reading, writing, math)
social
practical (ADLs, iADLs, school org)
17
Q
list four behaviour rating scales you can use in assessment
A
- Aberrant Behaviour Checklist (ABC)–> can be used in the full range of ID and can be used to assess med response and treatment effects
- Behaviour Problem Inventory (BPI)
- Developmental Behaviour Checklist (DBC)–> can be used in the full range of ID, and daily monitoring forms are available
- Reiss Scales for Children’s Dual Diagnoses (RSCDD)–> psychiatric comorbidities vs norms w ID
18
Q
what might you consider using to treat OCD in down syndrome
A
maybe memantine
19
Q
what is the most common genetic disorder associated wtih ASD
A
Fragile X
20
Q
how does intellectual functioning change over time in Fragile X
A
there is an intellectual functional decline in puberty
21
Q
why might you consider acamprosate when treating someone with fragile X
A
open label trials show benefit of acamprosate in ADHD and language in fragile X–> this is the med of choice in fragile X and AUD
22
Q
what medication has been shown to improve secondary language outcomes in those with Fragile X + ASD
A
sertraline–> in early childhood
23
Q
what % of those with Prader Willi have ADHD
A
80%
24
Q
are there any medications that have been shown to reduce food intake in prader willi
A
no–> must be environmental tx
25
what % of kids with DiGeorge have ADHD? anxiety? ASD?
50% have ADHD
20% have anxiety or ASD
26
what med is first line for treatment of ADHD in those with neurofibromatosis
MPH--> positiev RCT
27
what combo of meds was significantly superior to stimulants alone when treating disruptive behaviour + ADHD
risperidone + stimulant
28
when gender has more ID when dx with ASD
females with ASD tend to have more ID
29
what is a red flag for autism
no two word sentence by age 2
30
how should you treat the repetitive/ritualistic behaviours associated with ASD
NO evidence for general use of SSRIs for this
haldol and risperidone were better than placebo for repetitive behaviours and social withdrawal
if severe, some evidence for ECT
31
name two tools that can be used to screen to autism
1. Social Communication Questionnaire
--> can use in age 4+, 96% sensitivity, 80% specificity
2. Social Responsiveness Scale
32
name 2 genes associated with ADHD per CADDRA
DRD4
DAT-1
33
name 5 specific genetic disorders associated with ADHD
22q11.2 deletion syndrome
tuberous sclerosis
smith-magenis
fragile X
prader willi
34
list 6 medical conditions that have higher incidence/risk in those with ADHD
obesity
asthma
T1DM + T2DM
sleep disorders
epilepsy
dementia
35
what % of those with ADHD will respond to any stimulant
70%
36
what % of those with ADHD will respond to at least one stimulant
90%
37
why might you choose one stimulant over the other
AMP has bigger effect sizes but MPH is better tolerated
38
what ADHD med can cause tic EMERGENCE (not just tic worsening)
atomoxetine
39
what is 1st, second and third line when treating ADHD in someone with bipolar
1st line--> buproprion
2nd line--> mixed amphetamine salts, MPH, modafinil, CBT
3rd line--> atomoxetine, venlafaxine, lisexamphetamine
40
what did the MTA trial show in terms of recommendations for treatment of ADHD
combined med and behavioural treatment is EQUAL to medications alone, and both of these are better than behavioural alone, which is sequentially better than treatment as usual
41
list 3 factors that are associated with high risk of conversion from prodrome to psychosis
1. negative sx
2. cognitive impairment
3. poor functioning
42
why might you recommend use of a long acting injectible to treat SCZ
30% lower risk of death compared to PO agents
43
prevalence of SCZ increases rapidly after what age
age 14
represents 25% of all psych admissions ages 10-18
44
early onset of SCZ is associated with what outcomes
early onset of SCZ is associated with:
1. more severe pathology
2. higher suicide risk
3. more delays
4. worse prognosis
*30% of early onset pop will require long term intensive supports
45
what are the only two AP approved for use in SCZ in ages under 18
Aripiprazol
Lurasidone (very recent)
46
name a study that specifically looked at SCZ treatment in youth and kids
TEOSS (2007)
47
what were the results of the TEOSS study
looked at treatment of early onset SCZ in ages 8-19
no difference in efficacy between olanzapine, risperidone, molindone
higher than anticipated suicide rates
at 12 months, only 12% were on meds
earlier intervention resulted in better neurocognitive scores
48
how do youth with bipolar disorder present differently than adults
1. more psychosis
2. more irritability
3. more mixed states than adults
49
how does long term prognosis change for youth dx with bipolar vs adults
long term prognosis is the same
50
earlier onset of bipolar disorder increases risk for what outcomes
earlier onset of bipolar disorder increases risk for:
longer delay to tx
greater depressive symptom severity
more comorbid anxiety
more comorbid SUD
51
what is the switch rate from MDD to bipolar disorder for youth with MDD
28%
52
what are risk factors that predict switch from MDD to bipolar disorder?
family history of bipolar disorder
presence of dysregulation
subthreshold manic sx
cyclothymia
atypical depression with or without psychosis
early age of onset of first depressiev episode
53
in C&A populations:
first line for treatment of mania
1. lithium (level 1)
2. risperidone (level 1, if not obese, or if have adhd)
3. abilify (level 2)*
4. asenapine (level 2)
5. quetiapine (level 2)
*only ABILIFY is HC approved for adolescents with mania/mixed episodes
54
in C&A populations:
second line treatment for mania
1. olanzapine (level 2)
2. ziprasidone (level 2)
3. adjunctive quetiapine (level 3)
55
in C&A populations:
third line treatment for mania
divalproate (level 4)
56
in C&A populations:
first line treatment for bipolar depression
1. lurasidone (level 2)--> FDA approved
57
in C&A populations:
second line treatment for bipolar depression
1. lithium (level 4)
2. lamotrigine (level 4)
58
in C&A populations:
third line treatment for bipolar depression
1. olanzapine + fluoxetine (level 1)
2. quetiapine (level 2)
59
in C&A populations:
first line treatment for bipolar maintenance
1. apripiprazole (level 2)
2. lithium (level 2)
3. divalproate (level 2)
4. adjunctive lamotrigine (level 2--> if older than 13)
*often combo of Li + risperidone/dvp/carbamazepine
60
in C&A populations:
second line treatment for bipolar maintenance
none
61
in C&A populations:
third line treatment for bipolar maintenance
1. asenapine (level 4)
2. quetiapine (level 4)
3. risperidone (level 4)
4. ziprasidone (level 4)
blah blah i wont remember the rest to be honest
62
name a study that focused specifically on treatment of child and adolescent mania
what were the results?
TEAM trial
for acute mania, risperidone was better than VPA/Li
63
how does diagnosis differ bwteen adults and kids for cyclothymic disorder
time criteria for adults = 2 years
for C&A, time criteria is only ONE year
64
list the features of atypical depression
mood reactivity PLUS 2+ of:
hypersomnia
hyperphagia
interpersonal rejection sensitivity
leaden paralysis
65
first line treatment for mild to moderate depression in C&A
CBT
IPT
internet based psychotherapy
66
are there any meds approved by health canada for treatment of depression in teens/kids
no--> all AD meds are off label for use in C&A in canada --> HC only approved for above age 18
67
what is the black box warning for SSRIs
1.5-2% risk of of suicidal thoughts and behaviours--> NO deaths reported
68
second line treatment for depression in kids and teens
fluoxetine (FDA for above 8)
escitalopram (FDA above 12)
sertraline
citalopram
69
third line treatment for depression in kids and teens
venlafaxine (above age 12 only)
**increased self harm and SI rates if history is +ve
TCAs
70
what do you do if there is a minimal or no response to depression treatment in C&A
1. add SSRI to CBT/IPT
2. switch to another SSRI
3. venlafaxine XR or TCA
71
how do you treat treatment-resistant depression in C&A
1. SSRI + psychotherapy
2. switch to another SSRI
3. venlafaxine, TCA, ECT or rTMA (with lots of caution)
no evidence for MAOIs
72
name the 2 trials that focused on treatment of depression in C&A
TORDIA
TASA
TADS
73
what did the TADS trial show
combo of fluox + CBT = fluox alone > CBT > placebo initially but all treatments converged at 36 weeks
SI was lower with combo or CBT > monotherapy
74
what did the TASA trial show
Teens w/MDD & 90d Hx of SA x 6mo. Rx w/meds, CBT, or meds + CBTàrandomized or
youth chose. Combo had improvement & remission vs teens w/MDD but no SA. Rx focus targets SI, family
cohesion, & sequelae of previous abuse. 40% of events w/in 4 wks of intake (so early contact important).
75
list predictors of poor med response in teen depression
history of abuse
family conflict
comorbidity with SUD, anxiety
76
what did the TORDIA trial show
12-18yo; Rx options for teens after one SSRI trial: 60% respond to initial. Poor Rx response
predictors: Hx abuse, family conflict, comorbid SUD/anxiety (36% anxiety d/o, 29% dysthymia, 14% ADHD,
10% ODD/CD) à conclusion: switch to other SSRI or venlafaxine (∅ diff) or add CBT to either. Combo > meds.
Fluox w/limited evidence in comorbid AUD. Remission from MDE assoc’d w/↓ in anxiety, ADHD, ODD
77
what is prolonged grief disorder
*Prolonged grief disorder [DSM-5TR]àclassified under Trauma and Stressor-Related Disorders
* Bereavement of individual occurring at least 1y ago (6mo for C&A) w/grief responses at least daily, 1 of: intense
yearning/longing for deceased person, or preoccupation w/thoughts/memories of deceased person (C&A – preoccupation may
focus on circumstances of death).
* At least daily, 3+ of relating to the death: identity disruption since, disbelief about, avoidance of reminders, intense emotional
pain related to, difficulty reintegrating into one's relationships & activities after, emotional numbness as a result of, feeling that
life is meaningless as a result of, intense loneliness as a result of.
* Significant distress. ∅ other mental, sociocultural or religious norms.
78
how does diagnosis of prolonged grief disorder differ between C&A and adults
shorter time criteria (6mo vs 1 year)
also, preoccupation may focus on circumstances of the loved ones death
79
with regard to persistent depressive disorder, earlier onset reflects higher likelihood of what other conditions
comorbid PD
SUD
80
name a rating scale that can be used in PDD
cornell dysthymia rating scale
81
