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MHD.Psych > Childhood Developmental Disorders and Autism > Flashcards

Childhood Developmental Disorders and Autism Flashcards

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1
Q

Attention-Deficit Hyperactivity Disorder

A
  • 3 - 5 % of preschool and school-age children
  • Childhood onset; often lasts into adulthood
  • Disrupts functioning across settings (at school AND home)
  • Exact causes unknown
  • Combination of nature and nurture
  • RF: FHx, prenatal risks, environmental toxins, differences in brain structure (*FAS)
    • different neuroimaging, ADHD kids’ brains develop slower
  • Boys > Girls (10:1)
    • manifest (impulsive) sx more
  • Symptoms:
    • Inattention
    • Impulsivity
    • Hyperactivity
  • Lower DA levels
  • Tx:
    • Stimulants: methylphenidate, dextro-amphetamine
    • Non-stimulants: atomoxetine
      • if pt has low BMI or its mostly attentive, use NON-stim
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2
Q

What are the common s/s of ADHD-ATTENTION (1/3)

A
  • trouble paying attention or listening
  • inattention to details, careless mistakes
  • losing things (e.g., school supplies)
  • forgetting to turn in homework
  • trouble finishing assignments
  • trouble following multiple adult commands
  • difficulty playing quietly
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3
Q

What are the common s/s of ADHD-HYPERACTIVITY (2/3)

A
  • fidgeting
  • inability to stay seated
  • running or climbing excessively
  • always “on the go”
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4
Q

What are the common s/s of ADHD-IMPULSIVITY (3/3)

A
  • no forethought prior to behavior
  • talks too much
  • interrupts or intrudes on others
  • blurts out answers
  • impatience
  • difficult to redirect
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5
Q

Diagnosis of ADHD

A
  • Symptom onset: prior to 12 years
  • Symptom duration: > 6 months
  • 2 or more settings (school, home, work)
  • Use of rating scales (Conners, Vanderbilt)
    • have teacher and parents complete eval, will give feedback to help adjust dose accordingly
  • 3 presentations:
    • Combined-many s/s from both categories; tx is the same
    • Predom. inattentive
    • Predom. hyperactive/impulsive
  • Educating the parents is v. important
  • exercise helps fight inner restlessness
  • when they are nder stress or have a task they enjoy they are better able to focus
  • when untreated see comorbid depression and anxiety
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6
Q

ADHD vs. Bipolar Disorder

A
  • often co-morbid (~ 40-90% est. prevalence)
  • Similarities:
    • distractibility
    • increased energy
  • Characteristic of bipolar d/o:
    • elevated mood
      • periods of sadness or negative mood
    • severe problems regulating emotions
    • flight of ideas
    • decreased need for sleep
    • bursts of energy, exuberant or destructive
      • some cyclicity
  • hypersexuality
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7
Q

ADHD vs. Oppositional Defiant Disorder (ODD)

A
  • often loses temper (disproportionately to the problem)
  • argues with adults
  • ***hostile, defiant behavior towards authority figures (parents, teachers, clergy)
  • ***blames others for own mistakes
  • annoys people deliberately
  • touchy and easily annoyed by others
  • often spiteful and vindictive
  • ***pattern of anger-guided disobedience
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8
Q

ADHD vs. Conduct Disorder

A
  • Repetitive/persistent pattern of behavior-pattern gets in the way of functioning
    • (Think of it as a more severe form of ODD.)
  • Violates others’ basic rights or major age-appropriate societal norms/rules
  • Childhood-onset (<10-yo) vs. Adolescent-onset
  • Often bullies, threatens others
  • Cruel to animals
  • Destroys property, sets fires
  • Often starts fights
  • Often lies and lacks remorse
  • Skips school, runs away
  • Often stays out at night, despite parental rules
  • child may develop anti-social personality disorder if it continues
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9
Q

What is the definition of a tic?

A
  • Sudden
  • Rapid
  • Recurrent
  • Non-rhythmic motor movement or vocalization
  • ***involuntary, worsens under stress
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10
Q

Tourette’s Disorder-Tic CP

A
  • Multiple motor and vocal tics:
    • Tics occur many times every day or intermittently for > 1 year
    • Tics can be:
      • simple (rapid, repetitive contractions)
      • complex (appear as more ritualistic and purposeful)
    • Simple tics appear first-can develop into complex
    • onset before 18 years
    • intensity may wax/wane
      • stress: sleep deprivation, hormonal changes with puberty
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11
Q

Tourette’s Disorder-Characteristics

A
  • Prevalence is (0.5-1) per 1,000
  • Mean age of onset is 7 (onset must be age < 18)
  • MALE to female ratio is 3:1
  • Evidence of genetic transmission: ~ 50% concordance in monozygotic twins
  • Associated with increased levels of DA
  • Associated with ADHD and OCD
    • ​ADHD tx may have SE of tics
  • Tx: haloperidol, pimozide, or clonidine
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12
Q

Anxiety Disorders

A
  • High prevalence rates: (6-20%)-especially middle school kids
  • Include:
    • specific phobia
    • **selective mutism-sometimes anxiety is so overwhelming
    • social phobia-not limited to social speaking
  • Developmentally inappropriate or excessive fears
  • Sequelae:
    • interpret ambivalent situations negatively
    • underestimate competencies
  • Tx: CBT to restructure negative automatic thoughts, 12-16/18 wks-helps with self-esteem
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13
Q

Anxiety Disorders-Nml Things to Afraid of (ITSA)

A
  • Infants
    • large noises
    • being startled
    • strangers
  • Toddlers:
    • imaginary creatures
    • darkness
    • normative separation anxiety
  • School-age
    • bodily injury
    • natural events
  • Adolescents
    • school performance
    • social competence
    • health issues
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14
Q

***Separation Anxiety Disorder***-General

A
  • Affects 4%-5% of U.S. kids ages 7-11 yo
  • Fear, anxiety, avoidance is persistent (> 1 month)
  • Develops after significant stressful or traumatic event
    • parent deployed, borth of sibling, loss of pet, friend moving away
  • Children with over-protective parents
    • child can detect and absorb parents emotions
  • May be a manifestation of parental separation anxiety
  • Vulnerability to the disorder may be inherited
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15
Q

***Separation Anxiety Disorder***-Symptoms

A
  • Constant thoughts, intense fears about safety of parents
  • School refusal-afraid something bad will happen to their parents if they go
  • Frequent somatic complaints
  • Extreme worries about sleeping away from home
  • Being over clingy
  • Panic, tantrums when separating from parents
  • Trouble sleeping or nightmares (some dying or being left alone)
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16
Q

Therapy Modification Based on Classical Conditioning-Systemic Desensitization

A
  • Begins with imagining oneself in a progression of fearful situations and using relaxation
  • Often used to tx anxiety and phobias
    • ​start with least frightening things and work way up to most frightening
  • When the person is relaxed in the presence of the feared stimulus, objectively, there is no more phobia
  • Works by replacing anxiety with relaxation (visual, breathing, muscle relaxation)
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17
Q

Therapy Modification Based on Operant Conditioning-Biofeedback (neurofeedback)

A
  • use external feedback to modify internal physiologic states
  • pts see that they have control over these things and improve in time
  • use trial and error learning and repeated practice to make it effective
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18
Q

General Patterns in Human Development-Milestones

A
  • Milestones are simply normative markers at median ages
  • Some children develop slower and some faster
  • The ages of the milestones are an approximate-progression is important!!!
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19
Q

Developmental Trajectory

A
  • Family problems experienced in childhood and adolescence affect brain development and can lead to mental health issues in later life.
  • Brain imaging technology used to scan teenagers aged (17-19)
    • Those who experienced (mild to mod) family difficulties from birth-11 yo had developed a smaller cerebellum (associated with skill learning, stress regulation, sensory-motor control)
    • smaller cerebellum may be a risk indicator of psychiatric disease later in life, as it is consistently found to be smaller in virtually all psychiatric illnesses.
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20
Q

Infants Trajectory-Smiling

A
  • smile develops from an innate reflex present at birth
  • An infant shows exogenous smiling in response to a face at 8 wks
  • A preferential social smile (to the mother’s rather than another’s face) appears about 12-16 wks
21
Q

Infants Trajectory-Physical Development

A
  • Hands and feet are the first parts of the body to reach adult size
  • Motor development follows set patterns:
    • Grasp precedes release
    • Palm up maneuvers occur before palm down maneuvers
    • Proximal to distal progression. Ulnar to radial progression
  • first words-10 mo; first steps-13 mo
22
Q

Infants-Key Developmental Issues

A
  • Brain-growth spurt: “critical period” of great vulnerability to environmental influence
  • Size of cortical cells and complexity of cell interconnections undergo their most rapid increase
  • Earliest memories, roughly ages 2-4
  • **Stranger anxiety - distress in the presence of unfamiliar people:
    • Appears at 6 mo, peak at 8 mo, disappears after 1yr
    • Can occur even when child is held by parent
  • **Separation anxiety - distress of infant following separation from a caretaker:
    • At 8-12 mo (1). Begins to disappear at 20-24 mo (2)
    • Continued separation (especially prior to 12 months) leads to withdrawal and risk of anaclitic depression
    • ***School phobia (Separation Anxiety Disorder) is failure to resolve separation anxiety.
      • Tx: focuses on child’s interaction with parents, not on activities in school
23
Q

Management/Tx of Developmental Disorders

A
  • Acute Phase vs. Maintenance Phase
  • Psychoeducation
  • Medical work-up
    • rule-out thyroid disease
    • hearing/vision screening
  • Supportive management (restore realistic hope)
  • Psychotherapy (individual, family)
  • Family involvement
  • Cultural competence
  • Liaison with school
  • Medication management
24
Q

Consequences if Untreated (1/2)

A
  • SUICIDE-3rd leading cause of death in youth 15 to 24.
    • More teens and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined.
    • >90% of children and adolescents who die by suicide have a mental illness.
  • States spend nearly $1 billion annually on medical costs associated with completed suicides and suicide attempts by youth up to 20 years of age.
  • School Failure: highest dropout rate of any disability group.
  • Juvenile and Criminal Justice Involvement: 65% of boys, 75% of girls in juvenile detention have at least 1 mental health disorder.
  • Higher Health Care Utilization: incurrence of higher health care costs than other adults.
25
Q

Consequences if Untreated (2/2)

A
  • Childhood adversities and early-onset mental disorders associated with higher rates of
  • chronic physical problems in adulthood.
  • Children with mental illness become adults with mental illness
    • Children with behavioral problems more at risk of inflammation and chronic health problems (heart disease, obesity, diabetes)
26
Q

Early Identification and Intervention

A
  • Can minimize long-term disability
  • Can prevent a significant proportion of delinquent and violent youth from future violence and crime
  • Can enable success in school and social development
  • ***Can promote resilience
27
Q

Child Abuse-General

A
  • WE ARE MANDATED REPORTERS (up to age 18)
  • >6,000 KIDS killed by parents/caretakers each yr in the US
  • >3 million annually are reported abused
    • 50% of these are confirmed by investigation
28
Q

Defining Child Abuse

A
  • Tissue damage
  • Neglect (basic needs not taken care of)
  • Sexual exploitation
  • Mental cruelty
29
Q

Clinical Signs of Child Abuse

A
  • Broken bones in first year of life
    • doesnt make sense since child isnt mobile yet!!
  • STD in young children
  • 92% of injuries are soft tissue injuries (bruises, burns, lacerations)
  • 5% have no physical signs
  • ***Non-accidental burns have a particularly poor prognosis:
    • They are associated with death or foster home placement
    • arms + hands= accident
    • only arms = abuse
  • Shaken baby syndrome: look for broken blood vessels in eyes
30
Q

Children at Risk

A
  • <4 years
  • Special needs populations:
    • intellectual disability (formerly mental retardation)
    • learning disabilities
    • other mental illness
    • chronic physical illness (Ex: cerebral palsy)
31
Q

Children who are abused are more ikely to: (5)

A
  • Be aggressive in the classroom
  • Perceive others as hostile
  • View aggression as a good way to solve problems
  • Have abnormally high rate of withdrawal (girls)
  • Be unpopular with school peers and other children; the friends they do have tend to be younger
    • ​feel safer that they wont get hurt
32
Q

Child Sexual Abuse-General

A
  • 50% of sexual abuse cases are within the family
  • 60% of victims are FEMALE
  • Most victims are aged 9-12 yo
  • 25% of victims <8 yrs
  • Most likely source: uncles and older siblings, although stepfathers are also more likely. In general, males more likely to be sources.
  • Childhood physical abuse is assoc with significantly elevated rates of fxnl somatic syndromes:
    • ​chronic fatigue syndrome, fibromyalgia and multiple chemical sensitivities
  • traumatic childhood experiences are linked to an increased risk of early death
33
Q

Child Sexual Abuse-RF

A
  • Single-parent families
  • Marital conflict
  • History of physical abuse (of the caregiver)
  • Social isolation (less community, more stress)
34
Q

Child Abuse Perpetrators

A
  • Limited understanding of normative development
  • Hx of child maltreatment in parental family of origin
  • SUD and/or untx mental illness
  • Low SES
  • Non-biological, transient caregivers in home
  • Social isolation of family
  • Community violence
35
Q

Intellectual Disability-General

A
  • Significant deficits in intellectual functioning (reasoning, problem solving, planning, abstract thinking, judgment)
    • frontal lobe qualities
  • Diagnosis via clinical assessment and standardized neurocognitive testing (Per DSM-IV, IQ < 70)
  • Significant deficits in adaptive behavior (failure to meet standards for personal independence, social responsibility)
  • Presents as developmental delay
  • Not all children with developmental delay have intellectual disability.
36
Q

Disorders Diagnosed in Childhood

A
  • FAS= most common known cause of intellectual disability
  • Facial characteristics:
    • small eye openings
    • smooth philtrum
    • thin upper lip
  • Most common genetic causes:
    • Down syndrome
      • ​flattened nose and face
      • upward slanting eyes
      • weird toes and fingers
    • Fragile-X syndrome
      • ​elongated face, MVP, jaw, ears, eyes
37
Q

Intellectual Disability-MMSP

A
38
Q

PDD (Pervasive Developmental Disorders): (ASD) Autism Spectrum Disorders

A
  • Autistis Disorder
  • Asperger’s Disorder-higher fxn autism
  • Childhood Disintegrative Disorder
  • Rett’s Disorder
  • Pervasive Developmental Disorder-not otherwise specified
39
Q

Autism Spectrum Disorders (ASD)

A
  • Formerly Pervasive Development Disorders
  • 1 of every 150 births
  • Diagnosis before age 3
  • MALES > Females (4:1)
  • Linked to chrom 15, chrom 11
  • Concordance: MZ>DZ
  • 80% have IQs <70
  • FEMALES tend to have greater intellectual disability
  • EEG and seizure disorder (20-25% individuals with autism); comorbid
  • Diverse set of neural systems affected; but, definitive data lacking
40
Q

**ASD-Clinical Signs**

A
  • Deficits in reciprocal social interaction
  • Decreased repertoire of activities and interests
  • Abnormal or delayed language development, impairment in verbal and non-verbal communication
  • No separation anxiety
  • Oblivious to external world
  • Fails to assume anticipatory posture, shrinks from touch
  • Preference for inanimate objects
  • Stereotyped behavior and interests
41
Q

ASD-DSM 5

A
  • Diagnosis: early developmental period; disturbance in 2 domains
  • 1) social relatedness and communication (across multiple contexts)
  • 2) restricted interests/activites
  • symptom severity scale-relates to functioning
42
Q

ASD-Potential Causes

A
  • Association with prenatal and perinatal injury
    • e.g., Rubella in first trimester
  • Increased risk if mother had asthma, allergies, or psoriasis while pregnant
43
Q

ASD-Differential Diagnosis (1/3)

A
  • must rule out:
  • specific developmental disorders (e.g., language d/o)
  • sensory impairments (e.g., deafness)
  • reactive attachment disorder
  • obsessive-compulsive disorder
  • anxiety disorders (selective mutism)
  • childhood-onset schizophrenia
44
Q

ASD-Differential Diagnosis: Rett Syndrome (2/3)

A
  • Genetic mutation (rare)
  • GIRLS > Boys
  • **initial development NML, then, REGRESSION
  • Onset 6-18mo
  • **Hand wringing (stereotyped hand movements)
  • Small hands & feet
  • Microcephaly (decreased rate of head growth)
  • prone to seizures, GI issues, scoliosis
45
Q

ASD-Differential Diagnosis (3/3): Asperger’s Syndrome

A
  • language is nml
  • IQ is nml
  • HIGHER level of functioning
  • suffer with social interactions-dont perceive social cues
46
Q

Special Education Needs

A
  • co-existing learning disabilities
  • co-existing intellectual disability (ID)
    • 50% with severe-profound ID
    • 35% with mild-moderate ID
  • speech/communication delays
  • aggression to self or others
  • affective instability
  • require individual supervision
  • Mandated by federal legislation
  • (Individuals for Disabilities Education Act)
  • Programs vary by school district
  • IEP (Individualized Educational Plan)
    • Speech therapy
    • Occupational therapy
    • Communication assistance devices-learning how to express themselves (ex: by pointing to pictures)
    • Specific teaching technique for autism
47
Q

ASD Tx

A
  • Behavioral techniques
    • Shaping
    • ABA (Applied Behavioral Analysis)
  • Medication management
    • does not change core symptoms
    • adjunctive for behavior management
    • atypical (SGA) antipsychotics (RISPERIDONE)
    • mood stabilizers
    • stimulants
    • SSRIs
    • (when going through puberty may have inappropriate sexual side effects-masturbation, our public exposure)
48
Q

Therapy Modification Based on Operant Conditioning-Shaping

A
  • aka successive approximations
  • Achieves final target behavior by reinforcing successive approximations (reward this) of the desired response
  • Reinforcement is gradually modified to move behaviors from the more general to the specific responses desired
  • e.g., a boy with autism who won’t speak is first reinforced, perhaps with candy, for any utterance

MHD.Psych (9 decks)

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