Childhood and Adolescents Flashcards
1
Q
What checklists are used for screening children?
A
- Use a preset list of key questions, for each age group
- Pediatric Symptom Checklist (PSC-17) or Pictorial 3. Pediatric Symptom Checklist (PPSC-35)
- Parent-child interaction in the office is an excellent indicator of problems at home
2
Q
What are 2 ways to interview young children?
A
- Drawing Pictures
2. Sentence Completion Game
3
Q
What is included in the beyond the physician child parent triad?
A
You must interview the day care providers, baby-sitters and close relatives
4
Q
What is early adolescence?
A
ages 11-14
5
Q
What is middle adolescence?
A
ages 15-17
6
Q
What is late adolescence?
A
ages 18-24
7
Q
What happens in early adolescence?
A
- Physical
A. Physical and body growth - Social
A. Peer group involvement increases and family involvement decreases - Cognitive
A. Transition from concrete to abstract thinking begins
B. Daydreaming is common
8
Q
What happens in middle adolescence?
A
- Physical
A. Physical and body growth - Social
A. Independence, identity an autonomy struggles intensify
B. Peer group become more important than family; increasing teen-parent conflict
C. Experimentation with alcohol, drugs, an sex is common
D. A sense of invincibility and impulsivity leads to high rates of MVC
E. Suicide increases due to failed relationships or poor-self esteem
F. Expression of individuality (body piercing or tattoos) - Cognitive
A. Improved reasoning and abstraction allow for closer interpersonal relationships
B. Academic and vocational plans are important
9
Q
What happens in late adolescence?
A
- Physical
A. Body growth is no longer a concern
B. Time to become comfortable with one’s physical appearance will continue - Social
A. Development of monogamous interpersonal relationships, less time seeking peer group support
B. Making decisions based on individualized value system, by setting limits and compromise - Cognitive
A. Vocational goals should be set
B. Realistic expectation about education and work
10
Q
What is included in the general health risk factor assessment?
A
- Accidents
- Interpersonal violence
- STI (HIV)
- Nutrition
- Pregnancy
- Substance abuse
- Exercise
- Sleep
- Learning
- Mental Health issues
11
Q
What is the HEADS format?
A
- Home
- Education
- Activities
- Drugs
- Sex
- Suicide
12
Q
What is the goal of asking about the home?
A
- Goal
A. Determine household structure, family structure, and function, conflict-resolution skills, the possibility of domestic violence, and presence of chronic illness in the family - Questions
A. Who lives where you live?
B. What happens when people argue in your home?
C. Does anyone get hurt during argument?
D. Have you ever seen your mother hit by anyone?
E. Are there guns in your home?
13
Q
What is the goal of asking about education?
A
- Goal
A. Identify ADHD and other learning disabilities, school performance, cognitive ability, and vocational potential - Questions
A. What grade are you in?
B. What type of grades to you get?
C. How do they compare with your grades from last year?
D. Have your ever been told you have a learning problem?
E. Can you see the blackboard?
14
Q
What is the goal of asking about activities?
A
- Goal
A. Evaluate the patient’s social interactions, Internet use and purposes of use, interests, and self-esteem - Questions
A. What do you do for fun?
B. Are you involved in school, community, or religious activities?
15
Q
What is the goal of asking about drugs?
A
- Goal
A. Evaluate the patient’s current habits or patterns of use. Distinguish between those who drink because of social, cultural, and peer pressure, those who are genetically predisposed, and those who drink or use illicit drugs because of co-morbid mental health problems. - Questions
A. Are you aware of alcohol or drug use at your school?
B. Do any of your friends drink or use drugs?
C. Have you ever tried alcohol or drugs?
D. CRAFFT questions can be asked for teenagers suspected of substance abuse. Two or more YES answers on the CRAFFT indicate a significant problem
16
Q
What are the CRAFFT questions?
A
- Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
- Do you ever use alcohol/drugs to RELAX, feel better about yourself, or fit in?
- Do you ever use alcohol/drugs while you are by yourself, ALONE?
- Do your family or FRIENDS ever tell you that you should cut down on drinking or drug use?
- Do you ever FORGET things you did while using alcohol or drugs?
- Have you gotten into TROUBLE while you were using alcohol or drugs?
17
Q
What is the goal of asking about sex?
A
- Goals
A. Determine the level of patient’s sexual involvement and sexuality, use of birth control, protection against STIs, and history of abuse - Questions
A. Have you ever been sexually involved with anyone?
B. Have you ever been touched sexually when you did not want to be?
18
Q
What is the goal of asking about suicide?
A
- Goal
A. Identify serious mental health problems and distinguish them from normal adolescent affect and moodiness - Questions
A. Identify and ask about signs of depression (SIGECAPS)
19
Q
What are the risk factors for suicide?
A
- Prior episode of serious depression or suicide
- Family history of suicide or mental health problems
- History of victimization
- Substance abuse or dependency
- Gay or lesbian sexual identity
- Availability of handguns
- Recent loss of significant friends or family
- Extreme family, school, or social stress
20
Q
Define reactive attachment disorder?
A
RAD is a complex psychiatric illness that can affect young children. It is characterized by serious problems in emotional attachments to others. RAD usually presents by age 5.
21
Q
What are the DSM-V criteria for RAD?
A
- Diagnostic Criteria DSM-V
A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
-The child rarely or minimally seeks comfort when distressed.
-The child rarely or minimally responds to comfort when distressed. - A persistent social and emotional disturbance characterized by at least two of the following:
A. Minimal social and emotional responsiveness to others.
B. Limited positive affect.
C. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers. - The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
A. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
B. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
C. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
-The disturbance is evident before age 5 years.
-The child has a developmental age of at least 9 months.
22
Q
What is the presentation of RAD?
A
- Presentation:
A. Severe colic and/or feeding difficulties
B. Failure to gain weight
C. Detached and unresponsive behavior
D. Difficulty being comforted
E. Preoccupied and/or defiant behavior
F. Inhibition of hesitancy in social interactions
G. Disinhibition or inappropriate familiarity or closeness with strangers
23
Q
What is asst with RAD?
A
- Most children have had severe problems or disruptions in their early relationships.
- Many have been physically or emotionally abused or neglected.
- Experienced inadequate care in an institutional setting or hospital, residential program, foster care or orphanage.
- Multiple or traumatic losses or changes in their primary caregiver
24
Q
What is the treatment for RAD?
A
- Children who exhibit signs of RAD need comprehensive psychiatric assessment and individualized treatment plan
- Treatment involves the child and family
- Therapist focus on understanding and strengthening the relationship between a child and his or her primary caregivers
- Without treatment, this condition can affect permanently a child’s social and emotional development
25
What is the prevalence of enuresis?
5% - 10% among 5 year olds
3% - 5% among 10 year olds
1% among 15 years or older
5 x greater in males than females
26
What is the DSM-V for enuresis?
1. Repeated voiding of urine into bed or clothes, whether involuntary or intentional.
2. The behavior is clinically significant as manifested by either a frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.
3. Chronological age is at least 5 years (or equivalent developmental level).
4. The behavior is not attributable to the physiological effects of a substance (e.g., a diuretic, an antipsychotic medication) or another medical condition (e.g., diabetes, spina bifida, a seizure disorder).
27
What comorbidities are present with enuresis?
1. ADHD (most common)
2. Separation Anxiety
3. Social Anxiety
4. Phobias
5. GAD
6. Depression
7. ODD
8. Conduct Disorder
28
How much more likely are psychological disorders in children with enuresis?
2-5 times more likely
29
What is the alarm treatment for enuresis?
1. Maximum of 16 weeks, most require 8 – 10 weeks
2. After 14 consecutive dry nights the alarm is discontinued
3. Relapse can happen in up 30% of children
30
What meds are used for enuresis?
1. Desmopressin (DDAVP)
| 2. Tricyclic Antidepressants : Imipramine
31
What are the characteristics of desmopressin for desmopressin?
1. Success in 70% of patients
| 2. Taken in evening, start at 0.2 mg and may titrate to 0.4 mg after two weeks if no success
32
What are the characteristics for TCAs/imipramine?
1. Many potential side effects
2. Usually 1 mg/kg/day, average dose 10 mg to 25 mg in evening
3. Only used in severe therapy-resistant cases
33
What is the clinical presentation for separation anxiety?
1. Behavioral Symptoms
A. Crying, clinging, complaining upon separation, and searching or calling for parent after departure
2. Physical Symptoms
A. Headaches, abdominal pain, fainting spells, lightheadedness, dizziness, nightmares, sleep difficulties, nausea, vomiting, cramps, muscle aches, palpitations, and/or chest pain
34
What are the comorbidities for separation anxiety?
1. Anxiety Disorders (most common)
2. Phobias
3. Major depression
4. Bipolar disorder
5. ADHD
35
What is the first line treatment for separation anxiety?
1. Psychoeducation
2. Behavioral management
3. CBT
36
What is the second line treatment for separation anxiety?
Medications
| SSRIs: can start as early as 6 years old
