Class 3

Question 1

Prevalence ADHD

Answer 1

5-8% 2M=1W intensity of sx, ability to cope differs depending on SES. 50% still have the dx in adulthood. Don’t dx under age 5 yo. Remission of sx: adolescence- early adulthood

Question 2

Etiology ADHD

Answer 2

GENETIC: Significant contribution (40-90%). If patient affected: risk increased by 2 to 8 times.
NON GENETIC: Environmental factors, e.g.: Low birth weight or preterm birth. Exposure to cigarettes or alcohol during pregnancy. Predisposed temperament (low inhibition), heavy metals, immaturity in prefrontal cortex, traumatic brain injury, epilepsy, hypoxic brain injury
NEURONAL CIRCUITS: Dysfunction of several systems involving neurotransmitters, especially NA and DA (low)

Question 3

Comorbid ADHD

Answer 3

conduct disorder, depression, ODD, bipolar disorder, SUD, anxiety disorder, learning disorder, antisocial personality disorder, learning disorder, ASD, tics, BPD, OCD

Question 4

Medical dx mimic ADHD

Answer 4

hyperthyroidism, lead, hearing/ visual diff, anemia, sleep disorders, benign tumors

Question 5

Assessment ADHD

Answer 5

Conner’s, SNAP (parent and teacher), Weiss functional impairment. Ado: autoévaluation.

Question 6

Contre-indications psychostimulants

Answer 6

seizures, history of sudden death in the family, episodes of sudden loss of consciousness

Question 7

Specific learning disorder prevalence

Answer 7

5-15% school age children, reading (5-12%), writing (7-15%), math (3-6%)

Question 8

3 types specific learning disorder

Answer 8

Reading (word reading, rate, comprehension), written expression(spelling, grammar, organization), math (numbers, memorizing, reasoning, calculations)

Question 9

Etiology specific learning disorder

Answer 9

heritable, poverty, lack of educational support, atypicalities of brain maturation and function, drugs/ not proper nutrition/ROH in pregnancy, lead poisoning, any trauma during delivery

Question 10

comorbidities specific learning disorder

Answer 10

ADHD, disruptive behavior disorder, anx and depression

Question 11

Dx criteria specific learning disorder

Answer 11

1) Have difficulties in at least one of the following areas for at least six months despite targeted help:
1. Difficulty reading (e.g., inaccurate, slow and only with much effort)
2. Difficulty understanding the meaning of what is read
3. Difficulty with spelling
4. Difficulty with written expression (e.g., problems with grammar, punctuation or organization)
5. Difficulty understanding number concepts, number facts or calculation
6. Difficulty with mathematical reasoning (e.g., applying math concepts or solving math problems)
2) Have academic skills that are substantially below what is expected for the child’s age and cause problems in school, work or everyday activities.
3) The difficulties start during school-age even if in some people don’t experience significant problems until adulthood (when academic, work and day-to-day demands are greater).
4) Learning difficulties are not due to other conditions, such as intellectual disability, vision or hearing problems, a neurological condition (e.g., pediatric stroke), adverse conditions such as economic or environmental disadvantage, lack of instruction, or difficulties speaking/understanding the language.

Question 12

Depression prevalance

Answer 12

2-3% in children, 8% adolescents (more females).

Question 13

Risk factors depression

Answer 13

genetic (2-4x), environment: parental depression, bereavement, bullied/bulliers, sexual minority, insomnia, anxiety, ADHD, ODD, conduct disorder, epilepsy, migraine, asthma, IBD, steroids, interferon, cortisol, inflammatory, neurocoginitive (short serotonin transporter), attachment difficulties, depression during pregnancy, psychosocial adversities (conflicts between parents, maltreatment, abuse, parent engaged in criminal activity, SUD), chronic illness, parental rejection, temperament (fearfulness, beck triad, emotional regulation diff, decrease hr variability, increased cortisol), first nation, intergenerational trauma, learned helplessness, neuroticism

Question 14

Protective factors depression

Answer 14

support system, good family dynamics, self-esteem, engaged in school/activities

Question 15

Signs depression in children

Answer 15

Externalised behaviours (opposition, temper tantrums, psychomotor agitation), irritability, sadness, isolation, anhedonia, somatic complaint, regression
Compared to adults: less psychotic sx, melancholic sx, suicidal attempts

Question 16

Signs depression in adolescents

Answer 16

Opposition, antisocial behaviour, abusing drugs and rot, irritability, sadness, isolation, anhedonia, deficient personal hygiene, desperation, suicide attempt, psychomotor slowing or agitation

Question 17

Comorbidities depression

Answer 17

ADHD, anxiety disorder, conduct disorder, ODD, SUD, eating disorder, PTSD

Question 18

Risk factors and warning signs for suicidal behaviour in children and adolescents

Answer 18

psychiatric dx (MDD, SUD, MAB, anxiety, eating, schizo), chronic suicidal self-injury, BPD, ASPD, narc, schizoid, sexual minority, adverse childhood experience, cultural affiliation problems, peer suicide, physical problems at birth, respiratory distress for more than an hour after birth, no antenatal care before 20 weeks of pregnancy, childhood medical illness, family history of suicide, hopelessness, psychological vulnerability, access to firearms, large doses of Rx, impulse control issues, neurobio, sleep disturbances, social media, say it to friends, morbid, leave more signs than adults

Question 19

Anxiety prevalance

Answer 19

25%, mean age 11 yo 2F=1M + common psychiatric disorder in children

Question 20

Risk factors anxiety

Answer 20

learning, physical/sexual abuse, parental loss, early life stressors, parental overprotectiveness, over controlling parental behavior, ambivalent attachment, genetic (20-50%), neuroticism, behavioral inhibition, shyness

Question 21

Comorbid anxiety

Answer 21

other anxiety disorder, mood disorder (especially depression), conduct disorder ODD, ADHD, SUD

Question 22

Initial sx of social anxiety:

Answer 22

want to stay with their parents, avoidance, tremors, palpitations, sweating, GI disturbances, sensitive to criticism, negative self-esteem

Question 23

Sx anxiety in children

Answer 23

Overly concerned with natural disasters, crying tantrums, freezing, clinging, seek reassurance, regress, somatic complaints, behavior, withdrawal in adolescents, school refusal, nightmares, trouble sleeping, perfectionistic tendencies, conformism, low self-esteem