Common Developmental and Behavioral Issues - Exam 3 Flashcards
sleep disorders are common in up to ___% of healthy kids younger than 5 and up to ___% of kiddos with special needs
Up to 25% of healthy kids younger than 5
Up to 80% of children with special needs
When are day/night patterns developed? When is the adult pattern of sleep established?
usually by 4 months
usually by 3 years old
What are the 2 stages of sleep? How long do infants need to sleep?
REM and NREM
Infants sleep 16-20 hours per day, then transition to 9-12 hour blocks with a nap in between
What is the common sleep disorder for children under 12?
Difficulty initiating or maintaining sleep that is viewed as a problem by child or caregiver
______ is linked to inadequate sleep
obesity
How should an infant sleep?
Infant fed in parents’ arms then placed in crib to sleep
and Put to bed when moderately tired to reduce resistance and help develop self-soothing techniques
When can an infant start to sleep through the night 6+ hours?
Around 12 weeks infant can and should sleep through night 6+ hours
What is the tx for night awakenings for trained night feeding?
night time awakenings around 5-6 mos and appearing genuinely hungry are probably ready for solids
OR
need to increase volume of formula/breast milk throughout the day
At around ____ don’t go into room at first sound of rustling or fussiness. Allow to return to sleep without parental intervention
4 months old
What are some causes of trained night awakening when the goal is NOT feeding? What age range?
Begins when child gets ill, travels, or any change in routine
May persist b/c child gets secondary reward of parents attention
4-8 months
What is the parental education for night awakenings?
need to practice patience!!
re-establish bedtime routines
bedding with parent scent and into bed while awake
daytime naps should NOT be longer than 2 hours
“scheduled visiting”
touch, but DO NOT pick up or cuddle
When is a common time for kiddo to experience developmental night awakenings? What is the pt education?
6 mo well-child
try night light
give a couple minutes to let child self-soothe
go into room and reassure child that they are okay and can lay down beside bed/crib in the child’s eyesight and go to sleep there
What is the parent education for bedtime fears?
Check for monsters with flashlight
Don’t let watch movies/play video games that are scary (at any time)
Nightlights
Parental reassurance
_______ are unusual behaviors or experiences that occur during sleep or the transition between sleep and wake
Parasomnias
Do children remember parasomnias? Are they fully awake? When will it resolve?
Child is NOT fully awake and may or may not remember the event the next morning
generally resolves spontaneously
_____ are when the child may sit up, scream, and appear terrified. Are they awake? Will they remember it? Are they responsive to their environment?
night terrors
partial awakened from sleep
does NOT remember anything
Usually unresponsive to parental comforting
When are night terrors more likely to occur? What is the pattern?
first 1/3rd of the night
Occur in bouts for weeks at a time, then disappear, then reappears
What is the tx for night terrors? What age?
Parental reassurance of benign nature
Resolve 95% of the time by age 8
Empty bladder before bedtime, keep room dark and quiet
Can wake child up 15 min before expected episode for a week and may take 30-60 minute afternoon nap
When can kiddos start to dream clearly? What time of night? What age range are nightmares the most common?
around 14 months
last 1/3 of night
Most common between 3 and 6 years
In nightmares the dream content is ______ and can be _______
recalled
can be comforted and responds to parental reassurance
What are nightmares associated with? What is the tx for very severe nightmares?
Can be associated with stress, PTSD, anxiety, and sleep deprivation
If very severe, can give trazodone or Benadryl with the idea of deep sleep to sleep through
When does trust develop? What is the result if the infant mistrusts more than trusts?
Trust develops in the first year to the extent that the infant learns that the caregiver is a predictable and reliable provider of essential physical/emotional needs
ends to be more clinging and demanding as a result of insecurity of caregiver’s availability
What is the tx for separation anxiety?
reassurance that you will be back
When does stranger anxiety typically start? Is it normal?
around 6-8 months and can last up to 24 months
YES, natural phase of development
What is considered aggression? ____ play a role. MC in _____
One who kicks, bites, hits, bullies, destroys, and/or demands
genetics play a role
MC in boys!!
What is the tx for aggression? When do you need to seek professional help?
Generally able to have coping skills to remain calm and cooperative by school age
By kindergarten age, if threat to self/others, may need professional help
Young kids who exhibit aggression when they are young, as they age can start to exhibit worse antisocial behaviors including:
Conduct disorder
Oppositional defiant disorder
Substance abuse
What are things that may help manage aggression?
Praise for socially acceptable behaviors
Establish rules
Has anything in this child’s life changed or increased stress? Acute family stressors (maternal depression, marital conflict, frequent family moves, birth of a sibling
When are temper tantrums common? How often do they occur?
Very common between ages of 12 months-4 years
Can occur ≥1 time per week
Why do temper tantrum occur? What are they considered?
Due to limited motor and language skills, impulsiveness, or parental restrictions, they flip out
Tantrums are considered a reflection of immaturity
What are ways to deal with temper tantrums in the 15-18 month population?
Offer alternatives
Nap time renews energy for parent and toddler
praise cooperation
give choices and decision making (green or blue shirt)
If severe, frequent, and disruptive outside of normal tantrums, ______ may be needed
psychologist/psychiatrist referral
What are the 2 different types of breath holding spells? What are each precipitated by?
cyanotic or pallid
cyanotic: precipitated more by anger and frustration
pallid: preceded by minor injury or fear
_____ the child emits a short, loud cry, takes a deep breath, and holds it. What are the 2 outcomes for resolution? What can happen in rare instances?
cyanotic: approximately 30 seconds until cyanosis
Either the episode terminates or they become rigid or limp and lose consciousness
mild seizure-like movements of extremities can occur
_______ Initial cry is brief or silent, then spell proceeds as cyanotic. ____ can happen in rare instances
pallid breath-holding spells
seizure like movements in extremities
There is an association between ______ and ______
breath-holding spells
iron-deficiency anemia
When does the kiddo become aware that they need to use the toilet?
12-18 months: Begins to associate fullness with elimination that follows
When does the kiddo have the ability to briefly control sphincter muscles?
18-24 months old
How common are toilet accidents and regression?
VERY common but most of the time it does not last but a few weeks!!!
never punish a kid for a toilet accident
What are some triggers that lead a child to thumb suck? When does it usually stop?
Usually occurs during time of fear, stress, boredom, and when sleepy
Usually stops by age 4 (preschool years)
What can thumb sucking lead to? What is one way to discourage it?
can lead to dental malocclusion (misalignment of teeth) - like overbite or underbite
Bitter tasting commercial preparations applied to thumbnails Combo of aversive taste treatment and reward system appears to be most effective
_____ is considered an extension of thumb sucking
nail biting
Although hard to accept, ____ and _____ are signs of maturity. ______ wants to more grown up than crying about them. Experts say whining peaks in a child’s development when they are feeling _____ or _____
whining and complaining
announcing
overwhelmed/out of control
What are ways to combat whining?
Do change subject or distract
and sometimes they just need to let their frustrations out!! and that is okay!!
Lacking enough positive interaction, a child can develop _____ to re-engage adults. Should ______ but not the child
negative tactics
Ignore the misbehavior, but not the child and be consistent!!
Exploratory and masturbatory activity can begin around _____, peaking around ______ and starts again around ______
2 months
4 years of age
adolescence
What is the pt education around exploration?
We need to counsel parents about these practices and emphasize that this is a normal, harmless, healthy practice
Avoid punishing or shaming child
If parents observe activity, suggest inappropriateness of manipulating their genitalia in public or in front of others
______ and _____ are 2 additional self-stimulating behaviors. When are they most observed? What age?
head banging and rocking
Observed most commonly at bedtime or at times of fatigue or stress
Most commonly during preschool years
_____ and ____ are also commonly found in mentally disturbed, hearing or sight impaired, or kids with severe mental retardation
head banging and rocking
What does head banging and rocking represent?
a compensatory reaction for a lack of stimuli or inability to integrate stimuli
What will the PE and neuro exams of a kiddo with head banging/rocking reveal?
both will most likely be normal
What is the parent education for head banging and rocking? What is the pattern of regression?
Treatment is assuring parents that this does not cause brain injury
Most fade over time and resolves by age 3 yr
What is encopresis defined as? What is it a result from? What age?
Defined as the repeated passage of stool into inappropriate places (such as underpants) by a child who is chronologically or developmentally >4
90% of cases are the result of constipation
between 5 and 6
Does encopresis have to be intentional? What are the 2 different types?
NO! can be voluntary or involuntary
retentive vs nonrententive
______ Leakage of fecal material involuntarily from an impaction when the constipation has gone approximately _____
retentive encopresis
1 week unrelieved
Why does retentive encopresis occur?
The rectum is so distended with stool that the sacrospinal defecation reflex is no longer energized
mass is so wide that voluntary effort alone can’t force it out
The pressure of the impaction dilates the internal anal sphincter and makes it incompetent and small amounts of the impaction are expelled as a result of gravity, exercise and relaxation
What type of encopresis does the children tend to hold back stool? What PE findings?
retentive encopresis
age 5-6
Some have fissures around rectum that cause pain and can usually feel an abdominal mass
In a pt with suspected encopresis, must perform ______. What will you find?
rectal exam!!
Inspection of anal opening often reveals protruding fecal material in children who are deliberate stool holders. Rectum will be packed with stool
What is the tx for acute retentive encopresis?
enema and Miralax!! and pt needs to have a BM everyday!
What is the tx for chronic retentive encopresis? How long does it take for the bowel to return to normal?
Stool softener, such as miralax or lactulose should be used qd for several months, for a goal of 1-2 bowel mvmts per day
6 months because this is how long it takes for normal muscle/nerve signals to return to normal
When should retentive encopresis follow up?
Have them follow up in 1 week (clean out, start long-term tx)
______ passage of normal bowel movements into their underwear rather than use the toilet
nonretentive encopresis
What is the tx for nonretentive encopresis
Stop all reminders, pressure, lectures, and threatening to punish
Incentives for passing bowels mvmts into toilet - rewards and praise as well
Clean underpants immediately
It may take _____ giving your baby a food before he/she will like it. Should you force your kiddo to eat?
10-15 times
Do not force a child to eat - can become traumatic
What is pervasive developmental disorder characterized by? What age? What will these pts exhibit?
Characterized by impaired reciprocal social interactions, aberrant language development, and restricted behavioral repertoire
before 3-4 years old
Often exhibit idiosyncratic intense interest in a narrow range of activities, resist change, and are not appropriately responsive to the social environment
What are the 3 categories that characterize the s/s of Autism Spectrum Disorder? What sex? What is the underlying cause?
- Qualitative impairment in social interaction,
- Impairment in communication
- Restricted, repetitive, and stereotyped patterns of behavior or interest
MC in boys than girls
genetic basis
What are the 6 behavioral characteristics of ASD?
- Do not exhibit the expected level of subtle reciprocal social skills that demonstrate relatedness to parents and peers
- poor eye contact
- poor nonverbal skills
- May show extreme anger/anxiety when routine is interrupted
- Have a notable deficit in ability to play with peers and make friends
- Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
What are the characteristic communication and language characteristics of ASD?
- Language deviance/delay
- marked inability to initiate or sustain a conversation with others
- Stereotyped and repetitive use of language
- Lack of make believe/imitative play
- pronoun reversal
What is absent in the first year of an autistic child’s life?
exploratory play is absent
Activities and play are often rigid, repetitive, and monotonous
How do you make the ASD dx?
made clinically based upon the history, examination and observations of the behavior
What is the DSM V criteria for ASD dx?
in more than 1 setting and impair function
What are the different levels of social communication/interaction for ASD according to the DSM-5?
What are the different levels of repetitive/restricted behavior for ASD according to the DSM-5?
What is the current tx of choice for ASD?
Educational and behavioral interventions are currently considered the treatments of choice
What is the hallmark of Asperger syndrome?
Hallmark is atypical social development usually noticed after the age of 4
the lack of social awareness/ability
What is Asperger syndrome classified as according to the ASD severity scale?
level 1 severity without intellectual impairment
What is the management of Aspergers?
Goals are to promote social behaviors and peer relationships
Interventions are initiated with the goal of shaping interactions so that they better match those of peers carried out by mental health professionals, developmental pediatricians, and special education personnel
aka therapy
_____ are used in kiddos with ASD to help targeted conditions including ADHD, aggression, self-injury, OCD, depressive symptoms and sleep dysfunction. What drug in particular?
anti-psychotics
Aripiprazole (Abilify) was mentioned in class
