First Aid: Psychiatric Disorders in Children Flashcards
1
Q
What intelligence test can be used in children ages 2.5-12?
A
Kaufman Assessment Battery for Children (K-ABC)
2
Q
What test can be used to assess IQ in patinets 6-16?
A
Weschler Intelligence Scale for Children-Revised (WISC-R)
3
Q
What test is used to assess academic achievement?
A
Peabody Individual Achievement Test
4
Q
What is the DSM-IV criteria for mental retardation?
A
- Significant subaverage intellectual functioning with IQ of 70 or below
- Deficits in adaptive skills appropriate for age group
- Onset before age 18
5
Q
What percentage of the population are mentally retarded?
A
2.5%
6
Q
What gender is more commonly mentally retarded?
A
males
7
Q
What is considered mild retardation?
A
IQ 50-70
8
Q
What is considered moderate retardation?
A
IQ 40-50
9
Q
What is considered severe mental retardation?
A
IQ 25-40
10
Q
What is considered profound mental retardation?
A
IQ under 25
11
Q
What is the most common severity of mental retardation?
A
mild (80%)
12
Q
What are the two major genetic causes of mental retardation?
A
Trisomy 21
Fragile X
13
Q
What prenatal infections can cause mental retardation?
A
TORCH
- Toxoplasmosis
- Other (syphilis, AIDS)
- Rubella
- CMV
- HSV
14
Q
What are some perinatal causes of mental retardation?
A
Anoxia
Prematurity
Birth trauma
15
Q
What are some postnatal causes of mental retardation?
A
- Hypothyroidism
- Malnutrition
- Toxin exposure
- Trauma
16
Q
What must always be ruled out before diagnosing a learning disorder?
A
Hearing and visual deficits
17
Q
What are the 3 areas (DSM-IV) that can have learning deficits?
A
-Reading
-Mathematics
-Written expression
(and NOS)
18
Q
Learning deficits are often due to what?
A
cognitive processing
19
Q
What learning disorder affects 4% of school age children and is 3-4X more common in boys?
A
reading disorder
20
Q
What learning disorder affects 5% of school age children and may be more common in girls?
A
mathematics disorder
21
Q
What learning disorder affects 3-10% of school age children and has unknown gender ratio?
A
disorder of written expression
22
Q
What is the treatment for learning disorders?
A
Remedial education tailored to child’s specific needs
23
Q
List the 2 disruptive behavioral disorders.
A
Conduct d/o
Oppositional defiant d/o
24
Q
What is the most common diagnosis in outpatient child psych clinics?
A
conduct disorder
25
What is the DSM-IV criteria for conduct d/o?
A pattern of behavior that involves violation of the basic rights of others or of social norms and rules, with at least 3 acts within the following categories during the past year:
- Aggression toward people or animals
- Destruction of property
- Deceitfulness
- Serious violations of the rules
26
What is the prevalence of conduct d/o?
- 6-16% in boys
| - 2-9% in girls
27
What is the prognosis for conduct d/o?
- 40% develop antisocial personality disorder in adulthood
| - increased comorbid mood disorders, substance abuse and criminal behavior in adulthood
28
What is the common comorbidities seen in conduct d/o?
ADHD
| Learning disorders
29
What is the most effective treatment for conduct d/o?
Multimodal treatment approach (structured home environment, psychotherapy focusing on behavior modificaiton and problem solving, adjunctive pharmacotherapy)
30
What pharmacotherapy may be useful in conduct d/o?
- Aggression (antipsychotics, lithium)
| - Impulsivity, irritability, and mood lability (SSRIs)
31
What is the DSM-IV criteria for diagnosing oppositional defiant disorder?
At least 6 months of negativistic, hostile, and defiant behavior during which at least 4 of the following have been present:
- Frequent loss of temper
- Arguments with adults
- Defying adults' rules
- Deliberately annoying people
- Easily annoyed
- Anger and resentment
- Spiteful
- Blaming others for mistakes or misbehaviors
32
How does ODD differ from conduct disorder?
ODD does not involve violation of the basic rights of others
33
What is the prevalence of ODD?
16-22%
34
When does ODD usually begin?
by age 8
| onset before puberty more common in boys, onset after puberty equal in boys and girls
35
What are the common comorbidities with ODD?
Substance abuse
ADHD (2/3 with ADHD have it)
Mood disorders
36
What is the prognosis for ODD?
Remits in 25% of children
| May progress to conduct d/o
37
What is the treatment for ODD?
- Individual psychotherapy that focuses on behavior modification and problem solving
- Parenting skills training
38
What are the 3 subcategories of ADHD?
- Inattentive type
- Hyperactive-Impulsive type
- Combined
39
What are features of the inattention of ADHD?
- Problems listening, concentrating, paying attention to details, or organizing tasks
- Easily distracted
- Often forgetful
40
What are features of hyperactivity-impulsivity in ADHD?
- Blurting out
- Interrupting
- Figeting
- Leaving seat
- Talking excessively
41
What is the DSM-IV criteria for diagnosing ADHD?
- At least 6 symptoms involving inattentiveness, hyperactivity or both that have persisted for at least 6 months
- Onset before age 7
- Behavior inconsistent with age and development
42
What is the prevalence of ADHD in school aged children?
3-5%
43
What is the gender difference in ADHD?
3-5X more common in boys
44
What are the common comorbidities of ADHD?
- Mood disorders
- Personality disorders
- ODD
- Conduct disorder
45
What is the prognosis for ADHD?
- Most cases remit in adolescence
| - 20% have symptoms into adulthood
46
What neurochemical factors are involved in ADHD?
Dysregulation of peripheral and central noradrenergic systems
47
What is considered first-line therapy for ADHD?
methylphenidate (Ritalin)
48
What is the rate of improvement for patients on methylphenidate?
75%
49
What type of drug is methylphenidate?
stimulant
50
What other stimulants are used to treat ADHD?
- Dextroamphetamine (Dexedrine)
| - Pemoline (Cylert)
51
What other drug classes are used as adjunctive therapy in ADHD?
SSRIs
| TCAs
52
What is a manifestation of depression more common in children or adolescents?
-Irritableness
53
What is the name for the group of conditions that involve problems with social skills, language and behaivors that is noticed at an early age in life and involves multiple areas of development?
Pervasive Developmental Disorders
54
List 4 Pervasive Developmental Disorders
Autistic disorder
Asperger's disorder
Rett's disorder
Childhood disintegrative disorder
55
What is the DSM-IV diagnostic criteria for autistic disorder?
At least 6 symptoms for the following categories must be present:
- Problems with social interactions (at least 2)
- Impairments in communication (at least 1)
- Repetitive and stereotyped patterns of behavior and activities (at least 1)
56
What are examples of problems with social interactions?
- Impairment in nonverbal behaviors (facial expression, gestures, etc)
- Failure to develop peer relationships
- Failure to seek sharing of interests or enjoyment with others
- Lack of social/emotional reciprocity
57
What are examples of impairments in communication?
- Lack of or delayed speech
- Repetitive use of language
- Lack of varied, spontaneous play (and so on)
58
What are examples of repetitive and stereotyped patterns of behavior and activities?
- Inflexible rituals
| - Preoccupation with parts of objects (and so on)
59
What is the incidence of autism in children under 12?
.02-.05%
60
Which gender is more commonly autistic?
males 3-5X higher
61
At what age does autism almost always develop?
before age 3 (fail to develop milestones)
62
What conditions are associated with autism?
- Fragile X
- Tuberous sclerosis
- Mental retardation (70% of autism patients)
- Seizures
63
What percentage of autistic patients can function completely independently as adults?
1-2%
64
What drug class can be used to control aggression, hyperactivity and mood lability in autistic patients?
neuroleptics
65
What drug class can be used as adjunctive therapy to help control stereotyped and repetitive behaviors in autistic patinets?
SSRIs
66
What are s/s of Rett's disroder?
- Normal prenatal and perinatal development
- Normal psychomotor development during first 5 months after birth
- Normal head circumference at birth but decreasing rate of head growth between 5-48 months
- Loss of previously learned purposeful hand skills between ages 5-30 months, followed by development of stereotyped hand movements
- Early loss of social interaction, usually followed by subsequent improvement
- Problems with gait or trunk movements
- Severely impaired language and psychomotor development
- Seizures
- Cyanotic spells
67
The cognitive development in Rett's disorder never progresses beyond what age?
the first year of life
68
What is the cause of Rett's disroder?
MECP2 gene mutation on X chromosome
69
What is the DSM-IV criteria for childhood disintegrative disorder?
- Normal development in the first 2 years of life
- Loss of previously acquired skills in at least 2 of the following areas: language, social skills, bowel/bladder control, play, motor skills
- At least 2 of the following: impaired social interaction, impaired use of language, restricted, repetitive, and stereotyped behaviors and interests
70
At what age does childhood disintegrative disorder develop?
age 2-10
71
What gender more commonly develops childhood disintegrative disorder?
males 4-8X more likely
72
Involuntary movements or vocalizations.
Tics
73
What is the most severe tic disorder?
Tourette's disorder
74
What is the DSM-IV criteria for Tourette's disorder?
- Multiple motor and vocal tics (both must be present)
- Tics occur many times a day, almost every day, for > 1 year (no tic free periods for >3 months)
- Onset prior to age 18
- Distress or impairment in social/occupational functioning
75
Which usually comes first, motor or vocal tics?
motor
76
What are the most common forms of motor tics?
Face and head tics (ex. blinking)
77
What is coprolalia?
repetitive speaking of obscene words (uncommon in kids)
78
What is echolalia?
exact repetition of words
79
What is the prevalence of Tourette's in children?
.05% of children
80
What is the gender difference in Tourette's?
boys 3X more likely
81
What is the typical age of onset of Tourette's?
between ages 7 and 8
82
What are the common comorbidities with Tourette's?
- OCD
| - ADHD
83
What is the neurochemical factor of Tourette's?
- Impaired regulation of DA in the caudate nucleus
| - Possibly impaired regulation of endogenous opiates in noradrenergic system
84
What is the treatment for Tourette's?
Haloperidol
| Pimozide
85
What is the MOA of haloperidol and pimozine?
DA receptor antagonist
86
When in urinary continence usually established?
-Before age 4
87
What is primary enuresis?
child never established continence
88
What is secondary enuresis?
incontinence occurring after period of urinary continence
89
At what age does secondary enuresis usually develop?
5-8
90
What does diurnal enuresis mean?
includes daytime episodes
91
What is the DSM-IV diagnosis of enuresis?
- Involuntary voiding after age 5
| - Occurs at least twice a week for 3 months or with marked impairment
92
What is the prevalence of enuresis?
7% of 5 year olds (decreases with age)
93
What leads to enuresis?
- Genetics
- Small bladder
- Low nocturnal levels of ADH
- Psychological stress
94
What is the typical prognosis for enuresis?
majority of cases spontaneously remit by age 7
95
What are the treatment options for enuresis?
- Behavior modification (buzzer, wet sensor)
| - Pharmacotherapy (DDAVP or TCAs like imipramine)
96
At what age is bowel control usually achieved?
age 4
97
What conditions should be ruled out before diagnosing encopresis?
- Hypothyroidism
- Lower GI problems
- Dietary factors
98
What is the DSM-IV criteria for encopresis?
- Involuntary or intentional passage of feces in inappropriate places
- Must be at least 4 yo
- Has occurred at least once a month for 3 months
99
What are causes of encopresis?
- Psychosocial stressors
- Lack of sphincter control
- Constipation with overflow incontinence
100
What is the prevalence of encopresis in 5 yo?
1%
101
What other psych conditions are associated with encopresis?
- Conduct disorder
| - ADHD
102
What is the rare condition characterized by not speaking in certain situations?
selective mutism
103
What gender more commonly has selective mutism?
girls
104
What age is selective mutism usually seen?
5-6
105
What may trigger selective mutism?
stressful life event
106
What is the excessive fear of leaving one's parents or other major attachment figures?
separation anxiety disorder
107
What may children with separation anxiety disorder complain of?
Physical symtpoms (to avoid having to go to school)
108
What do children with separation anxiety disorder worry about?
losing parents forever
109
What is the prevalence of separation anxiety disorder in school age children?
4%
110
When is the typical onset for separation anxiety disorder?
7
111
What disorders are common in parents of children with separation anxiety disorder?
anxiety disorders
112
What may be done (other than contacting authorities) if a physician expects child abuse?
the child may be admitted without parental consent
113
What are examples of evidence of sexual abuse in a child?
- STDs
- Anal or genital trauma
- Knowledge about specific sexual acts (inappropriate for age)
- Initiation of sexual activity with others
- Sexual play with dolls (inappropriate for age)
114
What conditions are more common in adults who were abused as children?
- Anxiety disorders
- Depressive disorders
- Dissociative disorders
- Substance abuse disorders
- PTSD
115
True or false: adults who were abused as children are more likely to abuse their own children
true
116
Are most people who sexually abuse children pedophiles?
no
117
At what age are children most commonly sexually abused?
between 9 and 12
118
What percentage of adults have reported being sexually abused as children?
- 25% of women
| - 12% of males
