Disorders of Childhood and Adolescence

Question 1

Causes of Mental Retardation

Answer 1

• Genetic
  
  • Down syndrome: Trisomy 21 (1/700 live births)
  • Fragile X syndrome
  • Phenylketonuria
  • Familial MR
  • Prader-Willi syndrome, Angelman syndrome
  • Williams syndrome
  • Tuberous sclerosis
• Prenatal
  
  • Infection and toxins (TORCH)
    
    • Toxoplasmosis
    • Other (syphilis, AIDS, alcohol/illicit drugs)
    • Rubella
    • CMV
    • Herpes simplex
• Perinatal
  
  • Anoxia
  • Prematurity
  • Birth. trauma
  • Meningitis
  • Hyperbilirubinemia
• Postnatal
  
  • Hypothyroidism
  • Malnutrition
  • Toxin exposure
  • Trauma
  • Psychosocial causes

Question 2

Leading preventable cause of MR

Answer 2

FAS

1. Growth retardation
2. CNS involvement
3. Facial dysmorphology (smooth philtrum, short palpebral fissures, thin vermillion border)

Question 3

How. to dx ADHD (criteria)

Tx?

Answer 3

• Dx < 12 yo
• Sx present in two or more settings (i.e. school, home)
• Present for at least 6 mo

First line therapy = stimulants (methylphenidate, dextroamphetamine)

Second line = atomoxetine (norepi reuptake inhibitor), clonidine, guanfacine (alpha 2 agonists)

Question 4

Tourette’s disorder

Dx:

Treatment:

Answer 4

most severe of tic disorders

characterized by multiple motor tics and at least one vocal tic for 1 year

Tx:

psychoeducation / behavioral interventions: habit reversal therapy

Question 5

Pharmacotherapy for: Enuresis

Answer 5

1. Desmopressin (DDAVP)
2. Imipramine (TCA)

Question 6

5 yo difficulty paying attn. in school: Fidgets, squirms, will not stay still.

At home, talks excessively and has difficulty waiting his turn.

Language/motor skills are appropriate for his age.

Dx?

Answer 6

ADHD

Question 7

4 yo girl brought to her pediatrician b/c parents think she does not seem to be “developing normally.” The girl’s mother states that her daughter seemed normal for at least the first 2-3 years of her life. She was walking and beginning to speak in sentences. She was able to play with her mother and older sister. Mother has been noticing that over the past 2 mo, her daughter has lost these previously acquired abilities. She will no longer play with anyone else and has stopped speaking entirely. She has lost all bowel control, when previously she had. not needed a diaper for at least a yr. Dx?

a. Rett disorder
b. Childhood disintegrative disorder
c. Autism
d. Asperger disorder
e. Pervasive developmental disorder

Answer 7

b. Childhood disintegrative disorder

Rett would be dx much earlier (6 mo)

you dont see normal then decline in c-e

Question 8

13 yo girl grunts and clears her throat several times in an hour, and her conversation is often interrupted by random shouting. She also performs idiosyncratic complex motor activities such as turning her head to the R while she shuts her eyes and opens her mouth. She can prevent these mvmts for a brief period of time, with. effort. Which of the following is the most appropriate tx?

a. Individual psychodynamic psychotherapy
b. Lorazepam
c. Methylphenidate
d. Haloperidol
e. Imipramine

Answer 8

d. Haloperidol

Vocal tics are characteristic of Tourette syndrome. Pharmacological tx includes neuroleptics and alpha agonists (clonidine, guanfacine).

Question 9

6 yo boy has been dx with ADHD and started on Ritalin. Which of the following serious side effects should the doctor warn. the boy’s parents?

a. Tics
b. Cardiac conduction abnormalities
c. Choreiform mvmts
d. Leukopenia
e. Hepatitis

Answer 9

a. Tics

Common side effects of methylphenidate include: loss of appetite and weight, irritability, oversensitivty and crying spells, headaches, and abdominal pain.

Tics are less common.

Question 10

A 5 yo boy shows no interest in other children and ignores adults other than his parents. He spends hours lining up his toy cars or spinning their wheels but does not use them for “make-believe” play. He rarely uses speech to communicat and his parents tate that he has never done so. Physical exam indicates that his head is of normal circumference and his gait is normal. Which of the following is the most likely dx?

a. OCD
b. Asperger syndrome
c. Childhood disintegrative disorder
d. Autism
e. Rett disorder

Answer 10

d. Autistic disorder

Severely. impaired verbal and nonverbal communication (vs pts with asperger show no clinically significant delay in spoken or receptive language)

Question 11

Autism Spectrum Disorders are associated with what type of prenatal or perinatal infections?

Answer 11

Rubella or CMV

Question 12

ASDs are associated with a higher incidence of …

Answer 12

Seizures

Question 13

What FDA-approved drugs can be used to treat irritability in ASDs?

Answer 13

Risperidone and aripiprazole

Question 14

ADHD is associated with lower levels of what neurotransmitter?

Answer 14

Dopamine

Question 15

What is the first sx to disappear after ADHD medication is given?

What are the side effects of methylphenidate and dextroamphetamine?

What is the second line tx?

Answer 15

Hyperactivity

Side Effects:

• Insomnia
• Decreased appetitie
• GI disturbances
• Increased anxiety
• Headache

2nd line tx: atomoxetine (usually chosen over first-line tx, given side-effect profiles of tx)

Question 16

DMDD

Epidemiology

Features

Tx

Answer 16

Epi:

• Seen more frequently i boys age 6-10 yrs
• Should not be dx before age 6 or after age 18
• More likely to develop depression or anxiety

Features:

• Chronic, severe, persistent irritability with temper outbursts and angry, irritable, or sad mood between outbursts
• Occur almost every day and are out of proportion to situation
• Sx occur year-round

Tx:

• Individualized

Question 17

What neurobiological abnormality is associated with autistic spectrum disorders?

Answer 17

Decreased formation of Purkinje cells in cerebellum

Question 18

Only FDA-approved drug for treatment of tics?

Answer 18

Haldol and pimozide