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Summary Notes Royal College > Developmental Milestones And Stages > Flashcards

Developmental Milestones And Stages Flashcards

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1
Q

Birth-2 years

A 
Freud: Oral Stage mouth and feeding
Erikson: Trust vs Mistrust
Piaget (Cognitive): Sensorimotor -Perception of events is centered on the body. Objects are extensions of self
(Object Permanence).
Mahler (individuation):
1) Normal autism (0-1mo)
2) Symbiosis (1-5mo)
3) Differentiation (5-8mo)
4) Practicing (8-16mo)
5) Rapprochement
(16-24mo)
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2
Q

2-3 years

A 
Freud: Anal stage (toileting)
Erikson: Autonomy vs. Shame & Doubt
learn either to be self-sufficient
(toileting, feeding, walking,
exploring, talking) or doubt their
own abilities
Piaget: Pre-conceptual
Self-centered.
Explores environment.
Associates words with objects.
Mahler: Object constancy (24 -36 mo)
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3
Q

3-6 years

A 
Freud: Phallic stage - boys areproud of their penis,
and girls wonder why they don’t have one.
• Oedipal Conflict
Erikson: Initiative vs. Guilt
Children want to undertake
many adult-like activities,
sometimes overstepping the
limits set by parents and
feeling guilty.
Kholberg (Moral): 
Preconventional
Morality is good
or bad, based
on a system of
punishments.
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4
Q

7-11 years

A

Freud: Latency (not a stage) Dormant sexual needs
and focus on activities(schoolwork, sports)
Ego and superego develop
Erikson: Industry vs. Inferiority Children busily learn to be competent and productive in mastering new skills, or
feel inferior/inability to do well.
Piaget: Concrete Operations - Solves concrete problems. Begins to understand relationships such as size. Understands right and left.
Kholberg: Conventional level - Morality seen as following rules of society.

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5
Q

12-18 years

A

Freud: Genital (sexual intercourse)
Erikson: Identity vs role confusion “Who am I”
Piaget: Formal operational - abstract reasoning

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6
Q

20-40 years

A

Erikson: Intimacy vs Isolation
Young adults seek
companionship or become
isolated by fearing rejection

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7
Q

40-65 years

A

Erikson: Generativity vs. Stagnation
performing meaningful work or
become stagnant

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8
Q

65 years - death

A

Integrity vs. Despair
try to make sense out of their lives,
life as meaningful or weary of
goals never reached

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9
Q

What is assimilation ?

A

Applying an existing schema to a new

experience

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10
Q

What is accommodation ?

A
  • Modifying an existing schema to fit a new

experience

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11
Q

Chess and Thomas

A

Temperament - 9 traits RA(4) TQID
Regularity, activity level, approach, adaptability, attention, threshold for sensitivity, quality of mood, intensity of emotional response, distractibility

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12
Q

Temperament types of children

A

Easy Children generally are in a positive mood, quickly
establish regular routines & adapt to new experiences
▪ Difficult Children tend to react negatively, cry frequently, engage in irregular daily routines
▪ Slow-to-Warm Up Children have a low activity level,
somewhat negative, show low adaptability & are slow to accept new situations

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13
Q

Motor Development - Age 3

A 
Pour milk
▪ Can ride tricycle
▪ Button clothes; can dress themselves
▪ Begin to attend to their own toileting
▪ Can copy circle
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14
Q

Motor Development - Age 4

A

Cut with scissors
▪ Copy letters
▪ Can copy cross

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15
Q

Motor development - Age 5

A 
String beads
▪ Hold pencil well
▪ Run easily; skip; heal to toe walk
▪ Throw with accuracy
▪ Can copy triangle/square
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16
Q

Most common congenital cause ID

A

rubella

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17
Q

Global developmental Delay

A

reserved for children under age of 5
•individual fails to meet expected developmental milestones
in several areas of intellectual functioning
• individuals who are unable to undergo systematic
assessments of intellectual functioning

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18
Q

Fragile X

A

Most common inherited cause of ID
Mutation of FRMI gene - CGG repeat
Macrorchidism, short stature, strabismus, joint laxity
ADHD (80%), ASD

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19
Q

FASD

A 
most common cause of preventable ID
1/100
smooth-flattened philtrum
evidence of impairment in 3 or more identified neurodevelopmental domains
prenatal alcohol exposure confirmed
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20
Q

Down Syndrome

A 
Trisomy 21
Most common genetic disorder
short stature, single transverse palmar crease
Medical issues:
-hearing loss
- eye disease, OSA
dementia > 45 age
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21
Q

Prader- Willi Syndrome

A 
15q11 deletion (70% paternal)
hyperphagia 
central obesity
small feet
Obsessions, compulsions - hoarding
High rates - behavior problems
increased risk for OCD, affective, impulse control disorders
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22
Q

Angelman Syndrome

A

deletion 15q11-13 (maternal origin)
90% epilepsy
microcephaly 25%
happy, paroxysmal

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23
Q

Williams Syndrome

A 
AD* - 7q11.23
elfin like face
Renal, cardiovascular and thyroid
problems; Hypercalcemia**
• Poor visual acuity; musical skills in some
• Mild to moderate MR
• Anxiety and hyperactivity
• Shallow sociability (drawn to faces)
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24
Q

Turner Syndrome

A

• Cubitus valgus; coarctation of the aorta; infertility; absence of
secondary sex characteristics
• Rare ID

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25
Q

Cornelia de Lange

A

Severe – Profound MR
• Cranio-facial defects: continuous eyebrows, thin down
turning upper lip, anteverted nostrils

26
Q

DiGeorge Syndrome

A

• CATCH 22: Cardiac Anomaly, T-cell deficits, Cleft Palate
and Hypocalcemia
• 25% develop Schizophrenia

27
Q

Lesch Nyhan Syndrome

A
  • X-linked recessive; hyperuricemia

* Severe self-biting behaviour

28
Q

Klinefelter’s

A

Tall male with gynecomastia

29
Q

Cri du chat

A 
Autosomal dominant, deletion 5p15.2
• Prevalence 1/15,000- 1/45,000
• Congenital heart disease, GI anomaly
• Severe MR
• Infantile cat like cry
• Hyperactivity, stereotypies, self-injury
• Facial features: epicanthal folds, slanting
palpebral fissures, broad flat nose,
micrognathia
30
Q

Thomas and Chess

A 
TQRDA4
threshold of responsiveness
Quality of mood
Rhymicity
Distractibility
Adaptability
Activity
Attention span
Approach/withdrawal
31
Q

Mahler’s Stages

A 
NASDPRO
Normal Autism
Symbiosis
Differentiation
Practicing
Rapproachment
Object Constancy
32
Q

Fragile X- common comorbidity

A 
ADHD
autistic and avoidant personality disorder
1 in every 1000 males
1 in every 2000 females
second most common cause of ID
33
Q

Self mutilation

A

Lesh Nyann

Fragile X

34
Q

X linked recessive

A

Lesh Nyann

35
Q

Tuberous Sclerosis

A

multiple benign tumor

36
Q

Cornelia de Lange

A

clinical features include continuous eyebrows (synophrys = unibrow), downturning lip, microcephaly, short stature, small hands and feet, small upturned nose, anteverted nostrils, malformed upper limbs, failure to thrive; behavioural phenotype includes self-injury, limited speech in severe cases, language delays, avoidance of being held, stereotypic movements, twirling, severe to profound intellectual disability

37
Q

Tuberous sclerosis

A 
Autosomal dominant
Epilepsy (60-90%)
Autism (25-50%)
Hyperactivity
Impulsivity
Aggression
Sleep issues
38
Q

Predictors of persistence of ADHD into adulthood

A
  1. Family history of ADHD
  2. Negative life events
  3. Comorbidity with conduct, depression, and anxiety
39
Q

Children with ADHD who’s symptoms persist are at higher likelihood of developing?

A

Conduct disorder

Substance use disorder

40
Q

Comorbidity most common with Tourettes

A

ADHD

41
Q

Comorbidity most common with ADHD

A

ODD

42
Q

When is guanfafine indicated for ADHD

A 
Comorbidity
Tic disorders
Significant comorbid anxiety
Oppositional behaviors
Aggression
43
Q

Comorbidity in bipolar mania in children

A
  1. ADHD
  2. Conduct
  3. Anxiety d/o
44
Q

Encoporesis

A

Repeated passage of feces into inappropriate places
Event occurs each month for at least 3 months
Chronological age at least 4 years

45
Q

Bipolar - mania in children

Treatment

A

Level 1 - lithium, risperidone

Level 2 - aripiprazole, asenapine, quetiapine

46
Q

Most common reason for children to be referred to child psych

A

Conduct disorder

47
Q

Risk factors for bipolar in adolescents

A
  1. Depression with rapid onset, psychomotor retardation, psychotic features
  2. Family history of bipolar disorder
  3. History of mania or hypomania after tx with antidepressants
48
Q

Adolescent onset mania

A

Adolescents are more likely than adults to have delusions or hallucinations

49
Q

Odd criterion

A

Angry/irritable mood
Argumentative/defiant behavior
Vindictiveness

Most days for a period of at least 6 months unless noted
Older than 5 years old, at least once per week for at least 6 months

Mild - one setting
Moderate - at least two settings
Severe - three or more settings

50
Q

Kids with schizophrenia

Most common symptom?

A

Auditory hallucinations

51
Q

Mixed expressive receptive language d/o

A

Onset before age 4

52
Q

Poor prognosis - youth with MDD

A

Younger age of onset
Greater recurrence of multiple episodes
Presence of comorbid disorders

53
Q

ODD < 5 years old

A

Most days for 6 months

54
Q

ODD > 5 years old

A

Once a week for at least 6 months

55
Q

Most common comorbid condition among youth with early onset bipolar disorder

A

ADHD

56
Q

Treatment for Major Depressive Disorder in children/youth

A

First line: CBT/IPT, internet based psychotherapy
Second line: fluoxetine, escitalopram, sertraline, citalopram
Third line: venlafaxine, TCA

57
Q

Reactive attachment disorder - min age

A

9 months at least

Evident before age = 5 years old

58
Q

Stereotypical movements compared to tics:

A

Younger age of onset
Lack of changing anatomical locations
Lack of premonitory “urge”
Decreased response to medication management

59
Q

ASD CRITERION

A

A. Persistent deficits in social communication and social interaction across multiple contexts as manifested by the following:
1. Deficits in social-emotional reciprocity.
2. Deficits in non-verbal communicative behaviors used for social interaction
3. Deficits in developing, maintaining and understanding relationships
B. Restrictive, repetitive pattern of behavior, interests or activities as manifested by at least two of the following:
1. Stereotyped or repetitive movements, use of objects or speech
2. Insistence on sameness and inflexible routines
3. Highly restricted, fixated interests that are abnormal in intensity or focus.
4. Hyper- or hypo- activity to sensory input or unusual interest in sensory aspects of the environment.
C. Symptoms must be present in early developmental period
D. Symptoms cause clinically significant D+I
E. Not better explained by ID, GDD.
Specify if accompanying ID, known medical/genetic condition, a/w another neurodevelopmental d/o, or catatonia.

60
Q

ASD + Irritability tx

A

Risperidone, Abilify

Abilify = self injurious

61
Q

Hyperactivty tx - ASD

A

Atomoxetine

Summary Notes Royal College (16 decks)

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