Developmental Milestones And Stages

Question 1

Birth-2 years

Answer 1

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)

Question 2

2-3 years

Answer 2

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)

Question 3

3-6 years

Answer 3

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.

Question 4

7-11 years

Answer 4

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.

Question 5

12-18 years

Answer 5

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

Question 6

20-40 years

Answer 6

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

Question 7

40-65 years

Answer 7

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

Question 8

65 years - death

Answer 8

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

Question 9

What is assimilation ?

Answer 9

Applying an existing schema to a new

experience

Question 10

What is accommodation ?

Answer 10

• Modifying an existing schema to fit a new

experience

Question 11

Chess and Thomas

Answer 11

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

Question 12

Temperament types of children

Answer 12

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

Question 13

Motor Development - Age 3

Answer 13

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

Question 14

Motor Development - Age 4

Answer 14

Cut with scissors
▪ Copy letters
▪ Can copy cross

Question 15

Motor development - Age 5

Answer 15

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

Question 16

Most common congenital cause ID

Answer 16

rubella

Question 17

Global developmental Delay

Answer 17

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

Question 18

Fragile X

Answer 18

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

Question 19

FASD

Answer 19

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

Question 20

Down Syndrome

Answer 20

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

Question 21

Prader- Willi Syndrome

Answer 21

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

Question 22

Angelman Syndrome

Answer 22

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

Question 23

Williams Syndrome

Answer 23

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)

Question 24

Turner Syndrome

Answer 24

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

Question 25

Cornelia de Lange

Answer 25

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

Question 26

DiGeorge Syndrome

Answer 26

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

Question 27

Lesch Nyhan Syndrome

Answer 27

* X-linked recessive; hyperuricemia | * Severe self-biting behaviour

Question 28

Klinefelter's

Answer 28

Tall male with gynecomastia

Question 29

Cri du chat

Answer 29

``` 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 ```

Question 30

Thomas and Chess

Answer 30

``` TQRDA4 threshold of responsiveness Quality of mood Rhymicity Distractibility Adaptability Activity Attention span Approach/withdrawal ```

Question 31

Mahler's Stages

Answer 31

``` NASDPRO Normal Autism Symbiosis Differentiation Practicing Rapproachment Object Constancy ```

Question 32

Fragile X- common comorbidity

Answer 32

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

Question 33

Self mutilation

Answer 33

Lesh Nyann | Fragile X

Question 34

X linked recessive

Answer 34

Lesh Nyann

Question 35

Tuberous Sclerosis

Answer 35

multiple benign tumor

Question 36

Cornelia de Lange

Answer 36

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

Question 37

Tuberous sclerosis

Answer 37

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

Question 38

Predictors of persistence of ADHD into adulthood

Answer 38

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

Question 39

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

Answer 39

Conduct disorder | Substance use disorder

Question 40

Comorbidity most common with Tourettes

Answer 40

ADHD

Question 41

Comorbidity most common with ADHD

Answer 41

ODD

Question 42

When is guanfafine indicated for ADHD

Answer 42

``` Comorbidity Tic disorders Significant comorbid anxiety Oppositional behaviors Aggression ```

Question 43

Comorbidity in bipolar mania in children

Answer 43

1. ADHD 2. Conduct 3. Anxiety d/o

Question 44

Encoporesis

Answer 44

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

Question 45

Bipolar - mania in children | Treatment

Answer 45

Level 1 - lithium, risperidone | Level 2 - aripiprazole, asenapine, quetiapine

Question 46

Most common reason for children to be referred to child psych

Answer 46

Conduct disorder

Question 47

Risk factors for bipolar in adolescents

Answer 47

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

Question 48

Adolescent onset mania

Answer 48

Adolescents are more likely than adults to have delusions or hallucinations

Question 49

Odd criterion

Answer 49

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

Question 50

Kids with schizophrenia | Most common symptom?

Answer 50

Auditory hallucinations

Question 51

Mixed expressive receptive language d/o

Answer 51

Onset before age 4

Question 52

Poor prognosis - youth with MDD

Answer 52

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

Question 53

ODD < 5 years old

Answer 53

Most days for 6 months

Question 54

ODD > 5 years old

Answer 54

Once a week for at least 6 months

Question 55

Most common comorbid condition among youth with early onset bipolar disorder

Answer 55

ADHD

Question 56

Treatment for Major Depressive Disorder in children/youth

Answer 56

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

Question 57

Reactive attachment disorder - min age

Answer 57

9 months at least | Evident before age = 5 years old

Question 58

Stereotypical movements compared to tics:

Answer 58

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

Question 59

ASD CRITERION

Answer 59

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.

Question 60

ASD + Irritability tx

Answer 60

Risperidone, Abilify | Abilify = self injurious

Question 61

Hyperactivty tx - ASD

Answer 61

Atomoxetine