Disruptive, Impulse Control, and Conduct Disorders; Neurodevelopmental Disorders Flashcards
what are the neurodevelopmental disorders (2)
ADHD
autism spectrum disorder
3 hallmarks of ADHD
problems paying attention
excessive activity
diffiulty controlling behavior
that are not appropriate for person’s age
dsm 5 for ADHD
-hyperactivity, impulsivity, or inatentiveness manifesting prior to 12 yo
- >6 symptoms of inattention, hyperactivity-impulsivity that developmentally inappropriate and last > 6 months
-symptoms occur in more than 1 setting (ex school AND home)
for dx, symptoms of ADHD must occur prior to age
12
tx for ADHD
stimulants:
methylphenidate
mixed amphetamine salts
features commonly associated w. ADHD
-low self esteem
-dpn
-demoralization
-lack of ability to take responsibility for actions
common social characteristics of ADHD kids (7)
-immature
-bossy
-intrusive
-loud
-uncooperative
-out of synchrony w. expectations
-irritating to peers and adults
t/f: ADHD kids are more likely to sustain injuries
t!
mc person to make dx of ADHD
schoolteacher
ddx for ADHD
-adjustment d.o
-anxiety d.o
-bipolar d.o
-mental retardation
-specific developmental d.o
-drugs
-systemic d.o (hyperthyroidism)
-odd or conduct d.o
bipolar d.o in kids often manifests as a chronic mixed affective state marked by (3)
irritability
overactivity
difficulty concentrating
what 2 drugs are associated w. ADHD symptoms in kids
phenobarbital (sz)
theophylline (asthma)
t/f: rates of ADHD are higher in preschool kids than school-age kids
t!
when is ADHD mc in boys?
when is it mc in girls?
boys: childhood
girls: young adulthood
2 mainstay stimulants of ADHD
methylphenidate
dextroamphetamine
96% of kids respons positively
available doses of methylphenidate
short acting - ritalin
intermediate-acting - ritalin SR
long acting - concerta
available doses of dextroamphetamine
short acting
long acting
distractor ADHD drug that was removed from the market due to liver toxicity
pemoline
ADHD is specified by severity based on
social/occupational functional impairment
mild vs mod vs severe
3 types of ADHD
prdominantly inattentive
predominantly hyperactive/impulsive
combined
inattentive sx
-lacks attention to details/makes careless mistakes
-difficulty sustaining attention in tasks
-does not listen to what is being said
-does not follow through on instructions/does not finish tasks
-difficulty organizing tasks/activities
-avoids undesireable tasks
-often loses things necessary for tasks
-easily distracted by external stimuli
-forgetful in ADLs
-pt must have 6 x 6 mo
hyperactive/impulsive sx of ADHD
-fidgeting or tapping
-leaving seat often
-running/climbing inappropriately
-difficulty w. leisure/relaxation
-can’t sit still
-excessive talking
-blurting out answers
-can’t wait in line
-interrupting/intruding on others
-6 sx x at least 6 mo
t/f: ADHD is one of the most heritable psychiatric disorders
t!
t/f: diet, esp sugar, is a cause of ADHD
f!!
comorbidities associated w. ADHD
*antisocial personality d.o
*substance use disorder
other developmental d.o
conduct d.o/odd
bipolar
tourette syndrome
pervasive developmental d.o
mental retardation
t/f: stimulants are more effective than CBT for ADHD
t!
but stimulants + CBT is most effective first line tx
autism spectrum disorder (ASD) encompasses (4)
-autistic disorder
-childhood disintegrative disorder
-pervasive developmental disorder - not otherwise specified
-asperger disorder
what do you think when you see a child w. normal cognitive development but poor relationships who does not spontaneously seek activities w. others
asperger d.o
disruption of social interaction and languate at age 3 or earlier
autistic disorder
patients diagnosed w. autism spectrum disorder present with developmental delay in (3)
socialization
language
cognition
dsm 5 for ASD
- social communication and social interaction deficit in many contexts such as:
-lack of social-emotional reciprocity
-lack of nonverbal communicative behaviors
-impairment in developing, maintaining, and understanding relationships - restricted or repetitive patterns of behavior, interests or activities such as
-motor movements that are stereotyped or repetitive
-inflexibility to change
-restricted and fixated interests
-hyper or hyporeactivity or unusual interest in sensory stimulus - sx must be present in early developmental period w.o other etiology (ex hearing dysfxn)
- sx can not be explained by other condition
tx for ASD
refer
audiology eval
behavioral therapy
second gen antipsychotics
+/- 1st gen antipsychotics
SSRIs
+/- EEG
what are second gen antipsychotics used to treat in ASD (2)
aggression/hyperactivity
mood lability
what are SSRIs used to treat in ASD
stereotyped/repetitive behavior
what is echolalia
involuntary repetition of a word or sentence just spoken by another person
echolalia might mask
deficiency in language skills in autistic pt
common findings in autistic patients (8)
lower IQ
language
symbolic thinking
sterotypic behaviors
self-stimulation
self-injury
seizures
mental retardation
what are sterotypic behaviors
-repetitive non productivemovements of hands and fingiers
-rocking
-meaningless vocalizations
t/f: most autistic patients are in the mentally retarded range
t!
autism is mc in _ (girls or boys),
and mc presents before age _
boys
1 yo
CT-H finding of autism
enlarged ventricles
EEG findings of autism
normal
most autistic children are brought to provider because of poor
speech development
what are the disruptive, impulse control, and conduct disorders (2)
conduct disorder
oppositional defiant disorder
what do you think when you see a child who was referred to your office for unusual animal cruelty and bullying at school
conduct disorder
definition for conduct disorder
repetitive and persistent pattern of behavior in which the basic rights of other or major age-appropriate social norms or rules are violated
dsm 5 for conduct disorder
-at least 15 symptoms from 4 of the following categories in the past 12 months (one must be present w.in the last 6 months):
1. aggression to people and animals
2. destruction of property
3. deceitfulness or theft
4. serious violations of rules
conduct disorder is often seen as the precursor to
antisocial personality disorder
most effective tx for conduct disorder is one that seeks to
integrate individual, school, and family settings
treatment for conduct disorder should also address
familial conflicts
ex marital discord or maternal dpn
what do you think when you see a child who back talks and resists following instructions from parents or authorities - but is not aggressive towards people or animals, does not destroy property, and does not show a pattern of theft or deceit
oppositional defiant disorder (odd)
3 hallmark characteristics of odd
angry/irritable mood
argumentative/defiant behavior
vindictiveness
dsm 5 for odd
at least 4 sx for 6 months from any of the following categories exhibited during interaction w. at least on person who is NOT a sibling:
-frequent temper tantrums
-arguments w adults/authority
-does not conform to rules/regulations
-intentional exasperation of others
-easily annoyed by others
-revenge-seeking/vindictiveness
-angry attitude
-harsh and unkind
tx for odd
CBT
family therapy
peer groups
mood stabilizers
antipsychotics
stimulants
common comorbidity w. odd
ADHD
2 antipsychotics that have been shown to be effective for odd
haldol
thiordazine
what are the behaviors included in conduct d.o (11)
- stealing
- running away from home
- staying out after dark w.o permission
- lying as to “con” ppl
- setting fires
- repeatedly being truant before 13 yo
- vandalizing
- animal cruelty
- bullying
- physical aggression
- forcing sexual activity
for dx of conduct d.o, _ behaviors must be present
3
main characteristic of behaviors included in conduct d.o
they violate the rights of others
adolescents who have conduct d.o are predisposed to the development of what other 2 disorders
antisocial personality
ADHD
AUD
what factors are thought to contribute to the development of conduct d.o (9)
- temperament
- parents who provide attention to problem behaavior and ignore good behavior
- association w. a delinquent peer/group
- a parent “role model” of impulsivity and rule-breaking behavior
- genetic predisposition
- marital disharmony
- placement outside the home as an infant/toddler
- poverty
- low intelligence quotient or brain damage
CBT is the mainstay of tx for conduct d.o, but what are some drugs that are used
alpha agonists
mood stabilizers
bb
antipsychotics
pharm for conduct d.o targets what 2 symptoms
aggression
agitation
a child has normal cognitive development, poor relationships, and does not spontaneously seek activities w. others
asperger
disruption of social interaction and languate at age 3 or earlier
autism
a child is referred to your office for unusual animal cruelty and bullying at school
conduct d.o
a child is found to back talk and resist following instruction from parents or authorities
oppositional defiant d.o
an 8 yo who is disruptive in class, always fidgeting, has difficulty concentrating, and does not complete assignments
ADHD
