Developmental Psych Flashcards

1
Q

Attention-Deficit/Hyperactivity Disorder (ADHD)

General
Subtypes
Time of Sx onset

A

3 subtypes
ADHD, predominantly hyperactive/impulsive type
ADHD, predominantly inattentive type (formerly ADD)
ADHD, combined type

Symptoms must be present before the age of 12
Must have symptoms in at least 2 settings (school, home, work, etc)
Must interfere with functioning
Not explained by other mental disorder (Ddx: anxiety, depression, substance use, insomnia, mania)

Prevalence:
○5-9% children
○3-5% adults - about half “grow out” of disease
○Males > females

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2
Q

ADHD

comorbidities

A

50-90% of school-aged children with ADHD have at least one other comorbid psychiatric disorder (anxiety disorders, oppositional defiant disorder, and language disorders)

In adolescents, tic disorders (50-90%) are highly comorbid.

85% of adults with ADHD meet criteria for comorbid mood disorders (both depression and bipolar disorder), and substance use disorders.

Associated with poor grades, truancy and worse social, occupational, financial and health related outcomes.

2x likely to have accidental injuries (think MVAs)

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3
Q

ADHD

Inattentive Criteria

A

need 6+ sxs (5 or kids) for >6 months

  • fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate)
  • has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading)
  • does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction)
  • does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked)
  • has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines)
  • avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers)
  • loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
  • often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts)
  • is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments)
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4
Q

ADHD

Hyperactive/Impulsive

A

6+ sxs (5 or kids) for >6 months

  • fidgets with or taps hands or feet or squirms in seat
  • leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place)
  • runs about or climbs in situations where it is inappropriate - note: in adolescents or adults, may be limited to feeling restless
  • unable to play or engage in leisure activities quietly
  • is “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with)
    talks excessively
  • blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation)
  • has difficulty waiting his or her turn (e.g., while waiting in line)
  • interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing)
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5
Q

ADHD

Scales/testing
Kids vs adults

A

Kids - Vanderbilt screenings for parents and teacher

Adults - self and observer rating scales (Conner’s, Brown, ASRS, WURS, etc), objective testing (QB check), check differentials, evaluate severity and first age of onset (<12yo)

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6
Q

ADHD

Stimulant Tx

A

Stimulants
Amphetamines
MOA: releases and blocks reuptake of norepinephrine and dopamine
“Stronger” but can be too stimulating or increase anxiety

Methylphenidate
MOA: blocks reuptake of norepinephrine and dopamine
SE: headache, insomnia, appetite suppression, increased anxiety, irritability, aggression, hypertension
Contraindications: glaucoma, tics, MAOI use, agitation, structural cardiac abnormalities, uncontrolled hypertension, +/- hyperthyroidism
Potential abuse

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7
Q

ADHD

Non-stimulant

A

Intuniv (guanfacine) and Kapvay (clonidine ER)
antihypertensive
Approved in kids only
Side effects: fatigue, headaches, dizziness, abdominal pain, hypotension
Monitor BP/Pulse
Don’t start if patient’s bp is < 90/50

Strattera (atomoxetine) and Qelbree (viloxazine)
SNRI
Ages 6+
BBW 25 and under

Good for pt’s with hx of SUD. Provide more “even” coverage.

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8
Q

ADHD Tips

A

Consider ADHD for anxiety, depression, eating disorder, etc.
ADHD can look different in women

Can affect much more:
Emotional dysregulation
Executive dysfunction
Object permanence
Difficulty making decisions, increases anxiety
Easily overstimulated
Poor self-image
Financial trouble (overspending, forgetting to cancel subscriptions, etc)

If one class of meds is ineffective → try the other (ie. Adderall to Ritalin)
You can often add non-stimulants to stimulants if needed
When in doubt, refer out! (to neuropsych)

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9
Q

Autism Spectrum Disorder

Must have for diagnosis

A

Must have:
deficits in social-emotional reciprocity since childhood
abnormal social approach, failure of normal back-and-forth conversation, reduced sharing of interests, emotions, or affect, failure to initiate or respond to social interactions)

deficits in nonverbal communicative behaviors used for social interaction
poor verbal and nonverbal communication; abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication

deficits in developing, maintaining, and understanding relationships
difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers)

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10
Q

ASD

Plus 2+ of the following

A

Plus 2+ of the following:

  • stereotyped or repetitive motor movements, use of objects, or speech
    simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases
  • insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
    extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day
  • highly restricted, fixated interests that are abnormal in intensity or focus
    strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest
    hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment
    apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement
  • symptoms must be present in the early developmental period but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life
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11
Q

ASD

General

A

May or may not have intellectual impairment

Spectrum of symptoms from mild to impaired

Typically diagnosed age 2-3yo, 4:1 M>F

Risk factors: advanced maternal age, low birth weight, exposure to depakote, family hx (NOT vaccines)

70% are comorbid: anxiety, depression, ADHD, motor disorders

self -injury and aggressive/disruptive behavior can (MEDS!)

Early developmental delays and.or loss of language/social skills - RED FLAG!

R/O ddx - neuropsychological testing

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12
Q

ASD

non pharm Treatment

A

Speech, physical and occupational therapy

Applied Behavior Analysis (ABA) therapy

Social skills training

AAP recommends 1 year minimum of focused and challenging learning activities for 25 hours weekly, small class sizes, training for families, high degree of structure, and curriculum that focuses on self-help, social skills, and cognition

Earlier is better! Starting in toddler yeats can improve cognitive and language skills

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13
Q

ASD

Pharm Tx

A

Treatment for aggression, irritability, anger, self-harm only:

Risperdal (risperidone)
Ages 5+
Risk for hyperprolactinemia
Check metabolic labs q 6 months

Abilify (aripiprazole)
Ages 6+
BBW for increased suicidality
Check metabolic labs q 6 months

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14
Q

Intellectual Disability

general

A

Low IQ AND inability to adapt to social and developmental standards
Deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience

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15
Q

intellectual disability

Criteria

A

Must have:
Deficits in intellectual functions confirmed by both clinical assessment and individualized standardized IQ testing
Deficits in adaptive functioning that result in failure to meet developmental and socio-cultural standards for personal independence and social responsibility.
Onset during developmental period
3-4% comorbid schizophrenia

Global Developmental Delay: < 5yo and cannot undergo standardized testing and/or severity cannot be assessed due to early childhood

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16
Q

intellectual disability

Tx

A

Tx: PT/OT/ST, antipsychotics for agitation

17
Q

Specific Learning Disability

General and types

A

Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties

Dyslexia
Dysgraphia
Dyscalculia

Tx: school accomodations, tutors

18
Q

Dyslexia

A

Inaccurate or slow and effortful word reading (e.g. - reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words).
Difficulty understanding the meaning of what is read (e.g. - may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read).
Difficulties with spelling (e.g. - may add, omit, or substitute vowels or consonants).

19
Q

Dysgraphia

A

Difficulties with written expression (e.g. - makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity).

20
Q

Dyscalculia

A

Difficulties mastering number sense, number facts, or calculation (e.g. - has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures).

Difficulties with mathematical reasoning (e.g. - has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems).

21
Q

Intermittent Explosive Disorder (IED)

general and Tx

A

Age of onset is 13 yo, 2:1 M>F

Typically life-long
Recurrent behavioural outbursts that are out of proportion, representing a failure to control aggressive impulses including: Verbal aggression (e.g. - temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals, or other individuals.

Occurs 2x/week for 3+ months OR 3 outbursts in 1 year that involve destruction of property and/or physical assault against animal or people.

Mood is euthymic in between episodes!
The recurrent aggressive outbursts are not premeditated (i.e. - they are impulsive and/or anger-based) and are not committed to achieve some tangible objective (e.g. - money, power, intimidation). They have remorse for actions.

Tx: Behavioral interventions, family/parenting therapy, SSRI’s

22
Q

Disruptive Mood Dysregulation Disorder (DMDD)

General and tx

A

New to DSM-5
severe temper outbursts (episodes) out of proportion in intensity or duration to the situation
outbursts occur at least three times per week for at least 1 year
must be at least 6yo but symptoms begin before 10yo

outbursts are inconsistent with developmental level
is persistent irritability or anger most of the day, nearly every day, in between temper outbursts, and observed by others - poor mood is present in between episodes!
has trouble functioning in more than one place (e.g., home, school and/or with friends)
Is impulsive, has remorse after events

Tx: Behavioral therapy, tx underlying mood, SSRI’s are helpful

23
Q

Oppositional Defiant Disorder (ODD)

general

A

3% of children, 2:1 M>F
Onset: Age 6-8yo

a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months

often loses temper
is often touchy or easily annoyed
is often angry and resentful
often argues with authority figures (or for children and adolescents, often argues with adults)
often actively defies or refuses to comply with requests from authority figures or with rules
often deliberately annoys others (not just siblings)
often blames others for mistakes or misbehavior (not just siblings)
They are typically aware of behavior and can lack remorse.
30% go on to develop Conduct Disorder

Tx: therapy, parent therapy. Meds not helpful

24
Q

Conduct Disorder

General and Tx

A

1% of children
< 10yo, 4:1 M>F
often bullies, threatens, or intimidates others
often initiates physical fights

has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
has been physically cruel to people
has been physically cruel to animals
has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
has forced someone into sexual activity
has deliberately engaged in fire setting with the intention of causing serious damage
has deliberately destroyed others’ property (other than by fire setting)
has broken into someone else’s house, building, or car
often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)
has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)
often stays out at night despite parental prohibitions, beginning before age 13 years
has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
is often truant from school, beginning before age 13 years
40% develop antisocial personality disotder

Tx: behavior modification, parent training and family therapy. Meds not helpful

25
Q
A
26
Q

Other Treatment tips

A

Be weary of abuse
It can be situational only (ex. Foster care)
Be cautious with dx - is reaction truly out of proportion?
Treat other comorbid disorders (ex. ADHD)
Therapy&raquo_space;> Meds

27
Q

Child Fluency Disorder (Stuttering)

general

A

has interruptions in normal fluency and time patterning of speech (unsuitable for the individual’s age) - this can include any of these:

sound and syllable repetitions
sound prolongations
interjections
broken words (such as breaks within a word)
audible or silent blocking (filled or unfilled gaps in speech)
circumlocutions (word substitutions to evade challenging words)
words formed with an overload of physical tension
monosyllabic whole-word repetitions

the interruptions in fluency get in the way of academic or occupational accomplishments or with social communications

send to speech therapist

28
Q

Social (pragmatic) communication disorder

general

A

New in DSM-5, used to be classified as sxs of ASD
Ages 4-5
Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:

Defects in using communication for social purposes, such as greeting and sharing info, in a manner than is socially appropriate - has trouble making friends

Impairment of the ability to change communication to match context - difficulty maintaining conversation

Difficulties following rules for conversation and storytelling - **trouble staying on topic **

Difficulties understanding what is not explicitly stated and nonliteral or ambiguous meanings of language - does not understand sarcasm

Results in functional limitations, onset during early developmental period, and not attributable to another condition. Not better explained by other mental health dx.

send to speech therapist

29
Q

Speech Sound Disorder

general

A

Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages.

Must interfere with social participation, academic achievement, or occupational performance

Onset during early developmental period

Not attributable to congenital or acquired conditions (CP, Cleft palate, deafness or hearing loss, TBI, or others)
Trouble saying the words

send to speech therapist

30
Q

Language Disorder

general

A

Persistent difficulties in the acquisition and use of language across modalities due to deficits in comprehension or production that include the following:

Reduced vocabulary (word knowledge and use)

Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology)

Impairments in discourse (ability to use vocab and connect sentences to explain or describe a topic or series of events or have a conversation)

Onset during developmental period, language abilities are substantially and quantifiably below those expected for age, and are not attributable to hearing or other sensory impairments, motor function or other medical or neuro condition

Trouble with the words themselves

send to speech therapist

31
Q

Provisional Tic Disorder

general

A

Single or multiple motor or vocal tics have been present during the illness, but NOT both motor and vocal
< 1 year in duration
Onset must be before age 18

Not attributable to substance or medical condition

Send to physical and occupational therapy !

32
Q

Persistent Vocal Tic

general

A

Single or multiple motor or vocal tics have been present during the illness, but NOT both motor and vocal
> 1 year, but may wax and wane
Onset must be before age 18
Not attributable to substance or medical condition

Send to physical and occupational therapy !

33
Q

Tourettes

general and Tx

A

BOTH multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.
Tics may wax and wane but have persisted for more than 1 year
Onset before age 18

Not attributable to substance or medical condition (huntington’s, postviral encephalitis)
Up to 90% have co-morbid ADHD

Tx: antipsychotics(decrease dopamine), stimulants, adrenergic inhibitors (guanfacine, clonidine) and SSRIs (anxiety/mood can worsen tics)

34
Q

Developmental Coordination Disorder

general and tx

A

The acquisition and execution of coordinated motor skills is substantially below that expected give patients age and opportunity for skill learning and use. (clumsy kids!)

Manifested by:
Clumsiness as well as slowness and inaccuracy of performance of motor skills
Significantly and persistently interfere with ADLs

Onset in early developmental period

Tx: PT

35
Q

Stereotypic Movement Disorder

general

A

Repetitive, seemingly drive, and apparently purposeless motor behavior, which interferes with social or academic functioning

Examples: Rocking, hand waving, self-biting, hitting head with fist repeatedly

Specifiers:
with self-injurious behavior
without self-injurious behavior
associated with a known medical or genetic condition, neurodevelopmental disorder, or environmental factor (Lesch-Nyhan syndrome, ID, IU alcohol exposure)
Mild
Moderate
severe (continuous monitoring and protective measure are required to prevent serious injury)