Developmental, Behavioral and Mental Health #1 Flashcards
What is the most ideal parenting style?
Authoritative
What is bullying?
A repetitive and aggressive peer abuse where there is power imbalance
How can children that are being bullied present?
Vague somatic complaints and an increase in school absenteeism
Characteristics of bullies
Impulsive, easily frustrated, and positive attitude toward violence
Bullying Management
-Introduce concept to parents @6 year visit
-NO group therapy, mediation, or suspension
-Parents should not confront parents of bully
What is the most common ACE (adverse childhood event)?
Economic hardships and divorce/separation of caregivers
What is ASD?
Developmental disorder that affects communication/ behavior (generally appear in the first 2 years of life)
ASD etiology and incidence?
Etiology: Genetic/EV, highly inheritable
4x more common in boys
ASD presentation:
Delays in language/play/social interactions before 3 years considered diagnostic criteria
ASD diagnostic criteria:
- Persistent deficit in social comm/interaction across multiple settings
- Lack of social reciprocity
- Lack of nonverbal comm (gestures, facial expressions, abnormal eye contact)
- Repetitive movements
- Inflexible adherence
- Highly fixed interests
- Over-response or lack of to EV stimuli
ASD Diagnostics:
- EEG for seizures/lang delay
- CMO or WES
- Urine AA+organic acids; met screen for PKU
- DNA probe for Fragile X
ASD Treatment:
Screening, developmental surveillance, developmental screening @9/18/30 mos, ASD specific screening @18/24 mos
What are some ADHD risk factors?
- Delayed CNS maturation
- Genetics
- Pre/post- natal trauma/illness
- Dysfunction of catecholamine neurotransmitters
- Preemies, LBW, prenatal tobacco exposure
Does a child’s impulsivity and hyperactivity persist into adolescence?
No, but inattention does
ADHD Diagnostic Criteria (INATTENTION):
Frequently…
- does not pay attention to details, careless mistakes
- trouble paying attention
- appears to not be listening
- difficulty completing instructions or finishing activities
- trouble organizing tasks and activities
- avoid tasks requiring sustained mental effort
- loses necessary objects
- easily distracted
- forgetful
ADHD Diagnostic Criteria (HYPERACTIVITY AND IMPULSIVITY):
Frequently…
- fidgets
- will climb/ run inappropriately
- unable to quietly play or partake in leisurely activities
- “on the go”
- blurt out answer before end of question
- cannot wait for their turn
- will interrupt others during conversation/game playing
ADHD diagnostics:
History and PE (full neuro exam), lead, genetics, standardized tools
ADHD Standardized assessment tools
- Connor’s abbreviated parent-teacher questionnaire
- Vanerbilt
- SNAP-IV
- ACTeRS (teachers and parents)
- CHild behavior Checklist
- BASC
- ADHD Rating scale-ICV
- Brown ADD scales
ADHD Treatment:
Behavioral therapy and medication, structured environment
ADHD Pharmacotherapy:
- Methylphenidate: 20-30 min before meals and NO PM dose
- Dextroamphetamine: rapid response
- Atomoxetine: NONSTIMULANT and LESS INSOMNIA
What are the unacceptable side effects of ADHD medications?
Insomnia and growth retardation
What is Separation Anxiety Disorder (SAD)?
Fearful of separation from attachment figures
What risk factors are related to SAD?
A significant life stressor, genetics, personality, overprotective parents
What is General Anxiety Disorder (GAD)?
A disorder where a child is anxious or worried
What are possible treatment options for GAD?
Developmental history/early intervention; CBT, parent-child interaction therapy, SSRI’s
What is Social Anxiety Disorder (social phobia)?
Persistent fear of embarrassment, ridicule, or humiliation in social settings
What are possible treatment options for Social Anxiety Disorder (social phobia)?
Developmental history/early intervention; CBT, parent-child interaction therapy, SSRI’s
What is Panic Disorder?
Unexpected and repeated periods of intense fear or discomfort
What are possible treatment options for Panic Disorder?
Developmental history/early intervention and utilize Spence Children’s Anxiety Schedule; CBT, parent-child interaction therapy, SSRI’s
Characteristics of Depression
Behavioral pattern lasting at least 2 weeks characterized by irritability, social withdrawal and decreased pleasure
MDD
Significant distress/interference with normal function lasting at least 2 weeks
Depression Diagnostics
History, PE-neuro eval, early screening (MFQ-I, PHQ-A)
Depression Treatment
Screening questionnaires, psychotherapy, pharmaco (SSRI’s - fluoxetine and escitalopram)
Suicidal Behavior Diagnostics
History, observation; screening tools ASQ (10-21), RSQ (8-18), C-SSRS (7+), MFQ-SI (7-17), PHQ-A (12-18)
What is the SAFE-T assessment?
- ID risk factors
- ID protective factors
- Conduct suicide inquiry
- Determine risk level and intervention
- Document
ODD is characterized as
Anger/irritable mood with defiant/argumentative behaviors for >6 mos
When evaluating ODD what is key to evaluate the behavior?
History
ODD treatment:
Parent management therapy and CBT
IED is characterized as
Children 6+ years that have behavioral outbursts leading to verbal and physical aggression
IED Treatment:
CBT and relaxation techniques
IED presentation
Outbursts last <30min and occur following a minor provocation
Conduct disorder
A group of problematic behaviors
CD management
- DO NOT prescribe antipsychotics unless they have psychosis
- Parent management therapy
Can we diagnose a child with PICA <2 years of age?
NO, it is developmentally appropriate
PICA management
FIRST-LINE assess for nutrient and mineral deficiencies
