Final Exam: Lectures (Mod 6/7) Flashcards
Theory of development:
Children gradually acquire the ability to understand the world around them through active engagement with it
Piaget’s theory/intellectual development
Theory of development:
Development occurs as a series of stages influenced by interpersonal connections
Freud and Erikson
Definition:
Repertoire of traits with which a child is born
Temperament
Can temperament be changes or adjusted?
Yes it can be modified by the interaction with caregivers, peers, their environment
-Biological influences
-Psychosocial factors
-Family history
-Genetics
-Effects of parental depression
-Stressful life events
-Childhood maltreatment
-Peer and/or sibling influences
Risk factors for the development of childhood mental health disorders
Child, parent, teachers, care providers, medical records, neuropsychological testing
Sources for gathering information about the child’s well-being
Most common disorder of childhood
Boys > girls
Generally diagnosed prior to age 7
S/S occurring for at least 6 months
Increased risk of conduct disorder, anxiety, depression, learning disabilities
ADHD
Symptoms:
Attention problems
Distractibility
Impulsive behaviors
Hyperactivity
ADHD
6 y/o M presents to the office today with his father. Dad reports ongoing concern for inconsistency with homework, trouble concentrating during baseball practice, and often having to repeat instructions to the child to get him to complete a task. The child’s last report card noted the child is talkative in class and is often needing to be reminded to sit in his seat and not talk when the teacher is talking. Dad initially thought this was just “boys being boys” but wants to confirm. You complete a Vanderbilt Rating Scale with concern for:
ADHD
6 y/o M presents to the office today with his father. Dad reports ongoing concern for inconsistency with homework, trouble concentrating during baseball practice, and often having to repeat instructions to the child to get him to complete a task. The child’s last report card noted the child is talkative in class and is often needing to be reminded to sit in his seat and not talk when the teacher is talking. Dad initially thought this was just “boys being boys” but wants to confirm. A tool you can have dad complete today and send a copy home with the family to be filled out by the child’s teacher is:
Conner’s Parent/Teacher Rating Scales
After investigation, you diagnose the 6 y/o M with ADHD. What are next steps that are appropriate in his management?
Educating the parents on behavior management
Referral to therapy for the child
504 plan for school
Medications: Ritalin, Concerta, Adderral, Strattera
You prescribe the 6 y/o M Ritalin XR to be taken once a day. When educating dad on administration, what is an appropriate frequency for this mediction?
Every day before school with breaks on weekends and during school holiday
The 6 y/o M is to start Ritalin XR tomorrow prior to school. When would you like to see him back in the office for follow up?
In 2-4 weeks from initiation of medication. If he is stable at that visit, then change to every 3 months.
At the follow-up appointment at 3 weeks, the 6 y/o M presents with mom. She states that he is doing better in school, but the first few days he was not interested in eating much and coming home most days with a full lunchbox. What will you advise mom on?
Anorexia is a side effect of the stimulant medication. The extended release should diminish this side effect, if it persists can seek alternative medication options.
-Anorexia with weight loss
-Insomnia
-Headaches
-Abdominal pain
-Nervousness, jittery feelings
-Dizziness, HTN, tachycardia
-Skin rashes
-Abnormal LFTs
-Urinary retention
Side effects of ADHD stimulant medications
You are considering starting your patient with newly diagnosed ADHD on a stimulant medication. What diagnostic would you run prior to starting medication?
EKG
Males > Females
Possible genetic connection
Generally presents by age 3
Autism Spectrum Disorder
Symptoms:
-Delayed or not met developmental milestones
-Parental concern for development
-Language and communication deficits
-Lack of eye contact or facial expression
-Lacking social relationship development (with peers or others)
-Tolerance of non-goal directed behaviors
-Rocking, hand-flapping, self-injury, sleeping/eating problems, sensory impairments
Autism Spectrum Disorder
RED FLAGS:
-Failure to meet developmental milestones
-No eye contact
-No single words by 16 months
-No babbling, pointing or gesturing by 12 months
-No spontaneous 2 word phrases by 24 months
-Loss of language or social skills at any age
Autism Spectrum Disorder
When considering a diagnosis of Autism in a child with lack of language skills, you should consider auditory studies for what reason?
Language is developed primarily through sound interaction, if the child cannot hear they may have a delay in language skills
A newly 3 y/o F comes into the office today for her annual well-child appointment. She has been in day care since she was 6 months old, both her parents work full-time, and she has 2 older brothers who developed typically. Mom is concerned that over the past 2 months, the patient has become less social with her peers that she had previously interacted with. Prior to this visit, she has met all her milestones and has had no hearing impairments noted. She can repeat single words, only uses 1-2 word phrases and points to indicate what she would like. When assessing her, you note that she will track you in the room, but does not want to make eye contact when you address her specifically. She has previously not been a shy child. What is a leading differential to consider?
Autism Spectrum Disorder
You have a 3 y/o M with PMH Autism Spectrum Disorder presenting today with his father. Dad wants to get the child into a childcare setting. What is a program you can refer them to?
Birth to 3 through the State of CT
When caring for a child with Autism, who are some interdisciplinary team members that can be helpful?
Neuro
Psychiatry/LCSW
Parental support groups
Care coordinators
Community social worker
Incidence increases with age
Girls > boys after puberty
Low rate of patients who actually seek treatment
RF: FH, female, stressful events, loss, substance use, chronic illness, trauma, abuse, neglect, ADHD, anxiety, cigarette smoking
Depression