First Aid CH10 Children Psych

Question 1

methods of info gathering for pediatric PsE

Answer 1

play therapy: symbolic play, storytelling, drawing to understand expression of emotions and experiences

Classroom observation: functioning at school

Formal testing: IQ test (context here), K-ABC, WISC-R

Question 2

intellectual disability (ID), no longer MR d/t US law (Rose’s law)

Answer 2

severely impaired cognitive and adaptive/social functioning, severity based on adaptive functioning (indicates how much support is req)

IQ test is not sole determinant

Question 3

physical features of Trisomy 21

Answer 3

epicanthic folds, flat nasal bridge, palmar crease

- MC CAUSE

Question 4

physical features of Fragile X syndrome

Answer 4

macrocephaly, joint hyperlaxity, macro-orchidism in post-pubertal males
- 2nd MC CAUSE, MC inherited form!

Question 5

physical features of Prader-Willi syndrome

Answer 5

obese, small stature, almond-shaped eyes

Question 6

how many cases of ID are idiopathic?

Answer 6

50%

Question 7

global dev delay

Answer 7

failure to meet expected dev milestones in several areas of intellectual functioning, diagnosis for pts < 5yo who can’t be reliably assessed via testing, re-eval required down the road

Question 8

leading preventable cause of ID? features

Answer 8

fetal alcohol syndrome (FAS)

• growth retardation
• CNS involvement (structural, functional)
• facial dysmorphology (smooth philtrum, short palpebral fissures, thin vermillion border)

Question 9

palpebral fissures

Answer 9

height and width of eye opening

Question 10

specific learning disorder, what do they frequently occur with?

Answer 10

delayed cognitive dev in a particular academic domain (reading, writing, math), ADHD

Question 11

what percentage of school-age children are affected by a specific learning disorder?

Answer 11

5-15%

Question 12

risks for specific learning disorder (SLD)?

Answer 12

prematurity, prenatal nicotine use, first-degree relatives have a SLD

Question 13

specific learning disorder tx

Answer 13

IEP

Question 14

list the communication disorders, tx

Answer 14

language disorder: acquiring and using
speech sound disorder (phonological disorder): articulation issues
childhood-onset fluency disorder (stuttering)
social (pragmatic) communication disorder (verbal and non-verbal)

speech and language therapy, family counseling, IEP

Question 15

what should be ruled out before diagnosing a learning disorder?

Answer 15

sensory deficits

Question 16

what are the two sx domains of ADHD?

Answer 16

inattentive vs hyperactive/impulsive

Question 17

how long much ADHD sxs be present for dx?

Answer 17

> 6 months and present in two settings

Question 18

does ADHD have a genetic component?

Answer 18

yes

Question 19

what are the comorbid dxs of ADHD?

Answer 19

oppositional defiant disorder
conduct disorder
specific learning disorder

Question 20

etiology of ASD and associations

Answer 20

multifactorial: prenatal insults, advanced paternal age, genetic mutation (15%), Fragile X syndrome (MC single gene cause of ASD), T21

ID, epilepsy

Question 21

two most important predictors of adult outcome in ASD are

Answer 21

intellectual functioning level

language impairment

Question 22

ASD treatment

Answer 22

no cure
early intervention
remedial education
behavioral therapy
low-dose anti-psychotic meds

Question 23

define tics and their etiology

Answer 23

sudden, rapid, repetitive, sterotyped movements or vocalizations that help release tension

genetic, old paternal age, obstetrical complications, maternal smoking, stressful life events

Question 24

when do tics diminish?

Answer 24

adolescence and into adulthood

Question 25

tic tx

Answer 25

behavioral interventions (habit reversal therapy)
alpha-2 agonists: guanfacine (first choice)

Question 26

other tic disorders

Answer 26

persistent motor
persistent vocal
provisional tic disorder (Tourette’s sxs occurring less than one year)

Question 27

ODD onset

Answer 27

preschool years, can precede CD (most do not)

Question 28

ODD tx

Answer 28

behavior modification (coping training), parent management training (PMT) to help establish consistent rules and limits, no pharm

Question 29

conduct disorder tx

Answer 29

behavior modification, parent management training (PMT), pharm for co-morbid sxs (SSRIs, guanfacine, propranolol, antipsychotics)

Question 30

elimination disorder tx

Answer 30

high spontaneous remission rate, psychoeducation, waterproof mattress

• enuresis: limit fluid intake and caffeine at night, urine alarm, desmopressin (antidiuretic hormone analogue)
• encopresis w/o constipation: bowel retraining
• encopresis d/t constipation: bowel blowout w/ stool softeners/enema, high-fiber diet, toileting routine

Question 31

types of child abuse

Answer 31

physical, sexual, emotional, neglect

- prolonged trauma and adversity = toxic stress, causes dev disruption

Question 32

how many girls are exposed to sexual abuse?

Answer 32

25%

Question 33

define neglect

Answer 33

failure to provide adequate food, shelter, supervision, medical care, education, affection
- reason to contact social services

Question 34

what does abuse often lead to?

Answer 34

PTSD, anxiety, depression, self-destructive behaviors, substance abuse, inc risk of continuing abuse cycle with own children

Question 35

MC drug of abuse by adolescents

Answer 35

ETOH > cannabis

Question 36

red flags for physical abuse

Answer 36

delayed medical care for injury, inconsistent explanation of injury, multiple injuries in various stages of healing, spiral bone fxs, cigarette burns, head injuries