Childhood and Adolescent Disorders Flashcards
ADHD history and exam
Excessive inattention and/or hyperactivity/impulsivity.
More in males. Typically presents between ages 3 and 13. Often shows familial pattern.
Must show symptoms in 2 or more settings (home, school)
Diagnosis requires 6 or more symptoms from each category for 6 or more months in at least 2 settings leading to significant social and academic impairment. Some symptoms MUST be present before age 7.
1) Inattention - exhibits poor attention span in schoolwork/play; displays poor attention to detail or careless mistakes; does not listen when spoken to; has difficulty following instructions or finishing tasks; loses items needed to complete tasks; forgetful and easily distracted
2) Hyperactivity/impulsivity: Fidgets; leaves seat in classroom; runs around inappropriately; cannot play quietly; talks too much; does not wait for his or her turn; interrupts others.
Treatment of ADHD
1) Initial tx may be nonpharm (behavior mods), sugar and food additives are NOT considered etiologic factors
2) Pharm treatment includes:
a) Psychostimulants (methylphenidate, dextroamphetamine, mixed salts of dextroampletamine and amphetamine, atomoxetine, pemoline). Adverse effects include insomnia, irritability, reduced appetite, tic exacerbation and lower growth velocity (normalizes when med is stopped)
b) Antidepressants (SSRIs, nortriptyline, bupropion) and alpha2 agonists (clonidine)
First line is methylphenidate and dextroamphetamine.
Second line is atomoxetine. This is a Norepi reputake inhibitor with fewer side effects and less risk of abuse.
prefrontal cortex
On Step 2CK, atomoxtine is usually chosen over the first line treatments given side effect profile.
Pervasive Developmental Disorders (PDD)
Group of disorders (Autistic disorder, Asperger’s, childhood disintegration disorder, Rett) associated with delays in socialization, communication and behavior.
More in boys usually. Symptom severity and IQ vary widely
History and exam for PDD
1) Characterized by abnormal or impaired social interaction and communication together with restricted activities and interests, evident before age 3
2) Patients fail to develop normal social behaviors (social smile, eye contact) and lack of interest in relationships
3) Development of spoken language is delayed or absent
4) Children show stereotyped speech and behavior (hand flapping) and restricted interests (preoccupation with parts of objects)
Types of PDD
1) Autistic disorder - impaired social interactions and communication with significant language and cognitive delays, together with characteristic repetitive or restricted behaviors
2) Asperger’s - An autism-like disorder of social impairment and repetitive activities, behaviors, and interests without marked language or cognitive delays
3) Rett - Genetic neurodegenerative disorder of females with progresssive impairment (language, head growth, coordination) after 5 months of normal development
4) Childhood disintegrative disorder - severe developmental regression after more than 2 years of normal development (language, motor skills, social skills, bladder/bowel control, play)
If you see PDD think about associated congenital conditions like tuberous sclerosis and fragile X
Tx for PDD
1) Intensive special ed, behavioral management, and symptom-targeted meds (neuroleptics for aggression, SSRI for stereotyped behavior)
2) Family support and counseling are crucial
Conduct Disorder
Repetitive, persistent pattern of violating the basic rights of others or age-appropriate societal norms or rules for 1 year or more.
Behaviors may be aggressive (rape, robbery, animal cruelty). May progress to antisocial personality disorder in adulthood
More in boys than girls. And in kids whose parents have antisocial personality disorder and alcohol dependence. Only given the dx if under 18 years old.
Tx - behavioral intervention using rewards for prosocial and nonaggressive behavior. If aggressive, antipsychotic meds may be used.
Individual and family therapy
Oppositional Defiant Disorder
Pattern of negativistic, defiant, disobedient and hostile behavior toward authority figures (losing one’s temper, arguing) for 6 or more months. May progress to conduct disorder
Usually noted by age 8. Seen more in boys before puberty. equal after puberty.
Tx - teach parents appropriate child management skills and how to less the oppositional behavior.
Individual and family therapy
Disruptive Mood Dysregulation Disorder (DMDD)
Seen more in boys age 6-10. Should not be diagnosed before the age of 6 or after age 18. Children with DMDD usuayly do NOT develop bipolar in adulthood. They are more likely to develop depression or anxiety
Chronic, severe, persistent irritability with temper outbursts and angry, irritable or sad mood between outbursts.
These occur almost every day, are noticeable by others, and are out of proportion to the situation
Outbursts inconsistent with developmental issues. Symptoms occur year-round. No period lasting 3 or more consecutive months without all symptoms.
Symptoms are severe enough to interfere with home, school or peers.
Tx - individualized to the needs of the child and his/her family. It may include individual therapy as well as work with the child’s family and/or school. It may also include the use of medication to address specific symptoms
Intellectual disability
Associated with boys, chromosomal issues, congenital infections, teratogens, inborn errors of metabolism, and alcohol/illicit substances during pregnancy
Patients have significantly subaverage intellectual functioning (IQ less than 70) with deficits in adaptive functioning (hygiene, social skills); onset is before age 18
Levels of severity are mild (IQ 50-70, 85% of cases), Moderate (IQ 35-49) and severe (20-34), and profound (less than 20)
Mild intellectual disability
Reaches 6th grade level of education, can work and live on own. Needs help in difficult or stressful situations
Moderate intellectual disability
Reaches 2nd grade level of education, may work with supervision and support. Needs help in mildly stressful situations
Severe intellectual disability
Little or no speech. Very limited abilities to manage self-care
Profound intellectual disability
Needs continuous care and supervision
Tx of intellectual disability
1) Primary prevention with educating general public about possible causes of mental retardation and providing optimal prenatal screening to mothers.
2) Treatment measures include family counseling and support; speech and language therapy; occupational/physical therapy; behavioral interventions; educational assistance; social skills training.
