Developmental Psych Flashcards
Attention-Deficit/Hyperactivity Disorder (ADHD)
General
Subtypes
Time of Sx onset
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
ADHD
comorbidities
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)
ADHD
Inattentive Criteria
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)
ADHD
Hyperactive/Impulsive
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)
ADHD
Scales/testing
Kids vs adults
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)
ADHD
Stimulant Tx
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
ADHD
Non-stimulant
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.
ADHD Tips
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)
Autism Spectrum Disorder
Must have for diagnosis
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)
ASD
Plus 2+ of the following
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
ASD
General
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
ASD
non pharm Treatment
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
ASD
Pharm Tx
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
Intellectual Disability
general
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
intellectual disability
Criteria
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
intellectual disability
Tx
Tx: PT/OT/ST, antipsychotics for agitation
Specific Learning Disability
General and types
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
Dyslexia
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).
Dysgraphia
Difficulties with written expression (e.g. - makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity).
Dyscalculia
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).
Intermittent Explosive Disorder (IED)
general and Tx
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
Disruptive Mood Dysregulation Disorder (DMDD)
General and tx
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
Oppositional Defiant Disorder (ODD)
general
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
Conduct Disorder
General and Tx
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
Other Treatment tips
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»_space;> Meds
Child Fluency Disorder (Stuttering)
general
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
Social (pragmatic) communication disorder
general
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
Speech Sound Disorder
general
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
Language Disorder
general
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
Provisional Tic Disorder
general
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 !
Persistent Vocal Tic
general
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 !
Tourettes
general and Tx
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)
Developmental Coordination Disorder
general and tx
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
Stereotypic Movement Disorder
general
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)
