childhood psych Flashcards
symptoms and stress in kids
Symptoms can masquerade, I dont want to go to school, may mask: trouble learning (learning disability, vision/ hearing problems
Social problems- Autism, bullying, awkwardness
Embarrassment (family discord, bullying
Trauma (new or re-experiencing
Anxiety- social, separation, general, panic
Mood-depressed, irritable
Boredom- too easy
Being overwhelmed
Think about intellectual disability, may not be able to articulate specifically what is upsetting, they just know they are upset
Infant cant tell you he is cold, hungry, in pain–> he just cries
my tummy hurts,
Stress/distress clues
behavioral clues- developmental context, aggression (verbal/physical), avoidance/refusal- hiding making excuses, isolating/withdrawing, oppositional, sleep/ appetite changes
Usually folks get better at recognizing and articulating distress first, dealing with it is more complex
Affect changes
Mood is our subjective experience
Affect is the objective- Distressed, anxious, crying, hiding, difficult to console, irritable
Somatic sx- GI, Headache (most common), aches and pains
Stress makes you regress to an earlier stage
With development, capacity to manage stress changes
2 yo + limit setting = temper tantrum (typicla)
Keep in mind when emotional or language development lags, kids may look older but act younger- including how they communicate distress
13 yo + limit setting= temper tantrum (atypical)
Children dont develop in vacuums
Child is influenced by factors such as - parent, family, school and peers, extra curriculars, society at large
Stress in kids can take may forms
is it developmentally appropriate, if the child had sufficient skill to manage it, what would that look like
is the stressor necessary- resilience, cannot shield children from never experiencing pain, anxiety, distress, disappointment–> development is learning and adaptation
most psychiatric illness has component of distress
symptoms must cause clinically significat impairment or distress
a mental disorder
a syndrome characterized by clinically significant disturbance in an individuals cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental process underlying mental functioning
Neurodevelopmental disorders (things that stick with you thru life), COMMUNICATION and motor skills disorders
Speech- expressive production of sounds including articulation, fluency, voice, resonance quality
Language- form function and use of symbols (spoken words and signs ) in a rule goverend manner for communication
Communication- any verbal or non verbal behvior that influences the behavior ideas or attidudes of another individual
Stuttering now called fluency disorder
Abnormalities in fluency and time patterning of speech, in a bout 60% of cases stuttering remits on its own
Language disorder
lumps this as diffiuculties in acquisition and use of language across modalities due to deficits in comprehension or production
Expressive language disorder- can understand/comprehend, but you cant use spoken language to communicate
Mixed receptive expressive language disorder- cant understang and use spoken language
Clinical relevance of language disorder
How does your pt give you a history, how does your pt learn, how do they retain information, how do you do pt teaching in ght office
Learning disorders (LDs)
Considerably lower than expected achievement on a standardized test in reading, mathematics or written expression (2 SDs between achievement and IQ)
Must be differentiated from a lack of opportunity, poor teaching, cultural factors, intlecetual disability, ASD, sensory deficit
must substanitally impede academic achievement or daily living activities that require the deficient skill
Requires IQ test and test of specific ability
Reading- problems with word recognition, reading comprehension, oral reading (omissions, distortions, substitution), Dyslexia is a specific type of reading disorder
Math (dyscalculia)- problems with understanding or naming mathematical operations (carrying numbers, multiplication tables)
Written expression- problems with punctuation, spelling paragraph organization
No way to treat, just work around it
Clinical relevance of learning disability
following directions on prescriptions,follow up etc
Neurodevelopmental disorders within motor disorders- tic disorders
Tic disorders- sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization
Tourettes disorders, chronic motor or vocal tic disorder, transient tic disorders
Tourettes disorder
both multiple motor and >1 vocal tic occuring multiple times a day for more than a year
no mor than 3 consecutive mo without sx
Onset before 18, <10% of cases involve coprolalia, boys> girls 7-10 yrs old
wax and wanes with stress, temporarily can be toned down high OCD co morbid
ADHD (attention deficit hyperactivity disorder)
At least 6 sx of either 1 or 2
Inattention- fails to give close attn to details, makes careless errors, difficulty sustaining attn, lack of follow thru, difficult organizing, avoids mentally effortful tasks, forgetful, loses things, distracted by irrelevant stimuli
Hyperactivity-impulsivity- fidgets, leaves seat, runs excessively, trouble playing quietly, on the go as if driven by a motor, talks excessively, impatient interrupts others, blurts out answers
Sx must be present ber 12 yo, have persistent for 6 mo, and present in 2 or more settings, and cause significant impairment
ADHD types
Combined type- 6 or more sx of inattention AND hyperactivity-impulsivity
Predominanly inattentive type (ADD)- 6 in attn sx, fewer HI sx
Predominantly HI type- 6 HI, but fewer inattn
5% of all kids meet the criteria, 4-9x more common in boys than girls, high comorbidity (25% of hyperactive also have emotional disorder), (20% also diagnosed with a LD)
Not treating–> selfesteem issue, academic, social relationships, substance use
ADHD etiology
brains of kids with ADHD are 3-4% smaller (prefrontal cortex, and basal ganglia), brain development parallels normal
MZ (65%)>DZ (33%)
Neurotransmitters- Decreased DA availability (psychomotor activty, reward seaking behavior- stimuli functioning less effectively as reinforcers)
ADHD pharmacotherapy
Stimulants (methylphenidate or amphetamine based derivatives increase DA availability)
Benefits- effective for majority of cases, rapid acting (15-20 min lasts 2-4 hrs), long release
limitations- not all children improve, undesirable side effects- somatic, growth suppression)
Changes only persist as long as drug regimen continues
Dopamine increase–> psychosis
non stimulants- to some extent increase NorE, atomoxetine, guanfacine, clonidine, bupropion
ADHD behavioral therapy
Parent management training and educational interventions
Behavior mod techniques- consistency- increase positive engagement, modify environment, use rewards and penalty (tangible, rather than social)
Disruptive, impusle control, and conduct disorders can be comorbid with ADHD
Conduct disorder
The kid wihtout any empathy, IMMORAL
Conduct disorder (CD)- chornic violation of the rights of others or rules as manifested by 3 or more of the following in the past year with at least one criteria in the past 6 months
Aggression to people and animals- bullies, threatens, physical fights, use of a weapon, physical cruelty stealing with confrontation, forced sexual activity
Destruction of property- fire setting with intent, deliberately destroyed property
Deceitfulness or theft- B E, lies to gain or avoid, stealing without confrontation
Serious violation of rules- breaks curfew, run away from home, truancy
If 18 yo rule out antisocial personality disorder
Oppositional defiant disorder (odd)
I have morals but im going to push the button
sx are similar but less severe than those of CD
Pattern of negativistic, hostile, and definat behavior lasting at least 6 mo, during which 4 or more of the following are present, you cant tell me what to do
Loss of temper, argumentativeness with adults, refuses to comply with rules, deliberately annoys others, blames others, easily annoyed, angry and resentful, spiteful and vindictive
ODD etiology
prevalence about 3.3%, boys> girls prior to adolescence, not after
Temperamental factors, environmental factors (harsh parenting), genetic and physiological factors
ADHD often comorbid
DDx- CD, DMDD, ADHD, ID, lanuage, anxietty
ODD, CD treatment
Combination of behavior therapy and family therapy, medication- mixed findings, almost never sufficient, must be used with other interventions
Clinical relevance- ODD can cause significant disruption in function, labels follow kids
CD into antisocial personality disorder- the cold, calloused individual- behavioral consequences (prison) often more effective than emotional (it makes someone feel bad)
Depressive disorders- DMDD (disruptive mood dysregulation disorder)
Status irritabilicus
Severe recurrent verbal/behavior temper outbursts out of proportion to situation or provocation
Inconsistent with developmental level, temper outbursts on average 3+/wk
Mood between outbursts is persistently angry or irritable
12 month, no more than 3 month sx free
2/3 setting and severe in at least 1 setting
Age of onset before 10 yrs
Do not dx<6 y or after 18 y
exclude MDD, never more than 1 day where (aside from duration) met mania hypomanid
Rates of conversion to bipolar are low and it is far more liekely to convert to anxiety or MDD
MDD (major depressive disorder)
Same criteria as adults, irritability, not a low depressed mood, is often the main state for kids and adolescents, this comes out as anger in some
this comes out as anger in some
Significant impact on functioning if untreated– including suicide
MDD clinical relevance
MDD is the #1 source of disability worldwide, comorbind conditions sufferp how take DM meds if dont see future
Depressed parents impact kids- early attachment, not to mentions loss of productivity and enjoyment
Separation anxiety disorder
developmentally inappropriate, excessive anxiety about separation from home or from an attachment figure evidenced by >3 of the following:
Distress- worry about harm, getting lost, or kidnapping; school refusal, reluctant to be alone, sleep refusal, nightmares with separation theme, somatic complaints
Lasts>4 4weeks in kids, 6 months in adults
Selective mutism
failure to talk in particular social situations when there is expectation of speaking (liek school), must last for more than 1 month, not limited to the first month of school, occurs despite talking in other situations and language competence
Social ansiety disorder (social phobia)
fear about one or more sociat situatiions where individual may be exposed to scrutiny by others, kids- must occure in PEER setting not just adults
Fears will act in anxious way that will lead to a negative evaluation
Social situaitons almost always provoke fear and anxiety- kids crying, tantrums, freezing, clinking, shrinking, failure to speak
Persistent >6m, fear is out of proportion to actual threat
Generalized anxiety disorder
excessive worry most days, at least 6 months, about number of events or activities
Person has a hard time contolling worry
Associated with 3+ (only 1 in kids)- reslessness, feeling on edge, easy fatigue, difficulty concentration/mind going blank, irritability, muscle tension, sleep disturbance, impairment and distress, rulouts
Too much anxiety not good
Reactive attachment disorder
consistnet pattern of inhibited, emotionally withdrawn behavior toward adult caregivers
Child has experienced extremes of insufficient care, social neglect or deprivation, repeated changes of primary caregivers, rearing in settings with high child- caregiver ratio
Evident before age 5
Disorder present at least 12 months, exclude ASD
Disinhibited social engagement disorder
Pattern of behavior where child actively approaches and interacts with unfamiliar adults- indiscriminate approaching of strangers, overly familiar, not checking back with caregivers
Child has experienced extremes of insufficient care - social neglect, or deprivation, repeated changes of primary caregivers, rearing in setting with high child:caregivers
developmental age of child at least 9 months, disorder present at least 12 months, exclusion criteria
PTSD in kids 6y or younger
Exposure to actual or threatened death, serious injury, sexual violence (direct experience/witness/learning of trauma to caregiver
1 or more intrusion symptons since event- intrusive memories, dreams, dissociative reactions (flashbacks), distress of trauma event symbols, physiological reaction to reminders
1 or more avoidance or negative alterations in cognitions- - avoiding activites, places physcial reminders- avoiding people, conversations, interpersonal frequency of negative emotional states, less interest inactivites (include constricted play) social withdrawal, reduction in expression of positive emotions
Alterations in arousal and reactivity, duration of disturbance is >1 month
Pica
eating things youre not supposed to
feeding disorder of infancy or early childhood
failure to thrive
doesnt eat enough with weight loss or no wt gain for >1 moth
onset at 6 (not a lack of food or other mental disorder)
usuallin in the beging of life but develops as lates as 2 or 3
Can gain weight without
Encopresis
Repeated involuntary or sometimes intnetional passage of feces into places not appropriate for that purpos (clothing floor
Must occur>1x/month over 3 months
must be 4 yo
child ofteen feels ashamed/embarrassed
Enuresis- awake/asleep wettings (2x week for 3 months), after 5
gender dysphoria
incongruence between sex and gender
across ages- marked incongruence between experienced and assigned gender, 6 months duration
In children - more concrete examples of behaviors
In adolescenece- includes a desire to rid self of primary and/or secondary sex charachteristic
Neglect most common form of abuse
physical abues, and sexual abuse, emotional abuse, risk factor for developing other disorders, often by close caregivers
