Mental And Behavioal Health Flashcards
A 3-year-old boy is frequently reaching for his genitalia; his face becomes flushed; he is sweating and starts to breathe irregularly, stops when parents distract him
Masturbation (distract the child to stop)
A 2-year-old girl frequently postures her lower extremities and keeps crossing her legs in a repetitive movement; she stops when her mother is distracting her; the mother is concerned about her having a seizure
Masturbation (seizure will not stop with distraction)
What is the best management of masturbation in children?
Guide the child to limit the behavior. Otherwise, it is a normal behavior
A 2-year-old boy is sucking his thumb mostly when he is tired, hungry, or sad. What is the best recommendation?
Reassurance (most children will outgrow the habit by 4years of age)
A 6-year-old boy with thumb sucking behavior. He is bullied and teased in school. He has dental malocclusion. What is the best recommendation?
Positive reinforcement, aversive techniques, competitive responses, and orthodontic devices (intervention if >4years of age)
A 6-year-old boy wakes up in the middle of the night scared; he remembers a giant dinosaur was trying to eat him
Nightmares—reassurance (television viewing should be avoided for about 2h prior to bedtime)
The parents of a 4-year-old girl have noted episodes of screaming, intense fear, with difficulty of arousal that occur several times per week; she does not remember the episodes
Night terrors—reassurance (preemptive awakening before the episodes and safety precautions)
Adolescent female presents with numbness and difficulty moving her legs. All lab results and imaging studies are normal. The patient has been feeling stressed as a result of school
Conversion disorder
A 7-year-old boy exposed to a horrific car accident; father died in the accident. Boy has difficulty sleeping, a flashback of the event, recurrent distressing dreams for 3weeks after the accident
Acute stress disorder 3days to 1month after exposure
A 7-year-old boy exposed to a horrific car accident; father died in the accident. Boy has difficulty sleeping, a flashback of the event, recurrent distressing dreams for 6months after the accident
Post-traumatic stress disorder (6months after exposure)
Two siblings are jealous of each other and are always fighting each other in front of their parents. “Sibling rivalry.” What is the best approach?
Focus on individual needs of each child, giving each the time and attention needed, to feel loved and secured
Exposure to which substances during the prenatal period is associated with aggressive behaviors in children?
Cocaine, alcohol, and tobacco
Two siblings are fighting and hurting each other physically
They should be separated, and told violence is not allowed
What is the best way to discipline a 3-year-old boy who is misbehaving?
Time out—1min for each year of age
Ensuring that the reward is developmentally appropriate
Corporal punishment is NOT recommended as a method of discipline
What is the best method of discipline recommended for an adolescent?
Limit privileges and establish boundaries
A 2-year-old boy is crying hysterically and banging his head while the mother and father are in a restaurant
Acknowledge his frustration, take him in safe place letting him ride out the tantrum
Mother is worried about autism in the above instance because of headbanging and frequent outbursts
Headbanging in isolation with a tantrum is not a red flag of autism
A 4-year-old boy is frightened of dogs
Show him pictures of dogs, then videos, then toy dog, then finally a real dog
Child is adaptable to new situations, regular sleeping, and eating patterns, less demanding, and cheerful
Easy temperament
Child with intense emotional reactions adapts poorly to new situations, unpredictable, lower sensory threshold, moody and negative
Difficult temperament
Child initially withdraws from new situations, observes hesitantly before entering a new activity, moderate negative response, and gradually warms up to the new situations
Slow to warm temperament
What is the best management of temperaments?
Reassurance (will learn to moderate their own temperamental reactions as they grow older)
Adolescent with 2weeks of depressed or irritable mood, decreased pleasure, still going to school and doing homework, no suicidal thoughts. What is the best initial treatment?
Cognitive behavioral therapy (CBT)
Adolescent with 2weeks of depressed, irritable mood, decreased pleasure, lack of interest in activities, and suicidal thoughts. What is the best initial treatment?
Cognitive behavioral therapy (CBT) and medication
What are the SSRI medications approved by the US Food and Drug Administration (FDA) for the treatment of depression in adolescents?
Fluoxetine and escitalopram
What does CBT aim to achieve?
To reframe present negative thoughts into healthier thoughts, resulting in more positive feelings and behaviors
A 6-year-old boy with significant receptive and expressive language problems; he is in special education classes, has difficulty with changes and sensory sensitivity. He bites his hands frequently and avoids eye contact. What is the most likely underlying condition?
Fragile X syndrome
At what age are the dysmorphic features of fragile X syndrome, such as a long face, prominent jaw, and macroorchidism, usually seen?
Around the time of puberty
What is the most common cause of inherited intellectual disability?
Fragile X syndrome
What is the most likely cognitive deficit in boys with a full mutation (>200 CGG repeats) in cases of fragile X syndrome?
Moderate ID (average IQ ~41), girls are more mildly affected
What is the best test to confirm the diagnosis of fragile X syndrome
Fragile X DNA analysis
Mother is concerned about possible speech delay in her 2-year-old, who is currently exposed to 2 languages at home
No significant difference between 1 and 2 languages exposure in speech development
Mother is concerned because her 6-year-old has a problem with certain speech sounds, but the child’s speech is 100% intelligible to strangers
Reassurance (certain speech sounds may not be well articulated until 8years of age)
Child with speech and language delay. What is the next best step?
Formal audiology evaluation
A 2-year-old boy presents with speech delay, no eye contact, does not share any activities with other children. Physical examination is normal. What is the next best step?
Refer the child to early intervention (EI) for evaluation of autism spectrum
A 3-year-old boy presents with speech delay, no eye contact, does not share any activities with other children. Physical examination is normal. What is the next best step?
Refer to the school district for evaluation of autism spectrum
What is the mainstay of autism spectrum disorder treatment?
Applied behavioral analysis (ABA), speech and occupational therapies
What is the etiologic workup in classic cases of autism spectrum disorders?
None; it is a clinical diagnosis
What is the etiologic workup in cases of autism spectrum disorders associated with intellectual disability or global developmental delay?
DNA analysis for fragile X syndrome and a chromosome microarray analysis
Adolescent with several antisocial behaviors, defiance, rule-breaking, vandalism, and aggression. What is the best management?
Cognitive behavioral therapy, family therapy, and behavior management training
An 8-year-old boy is struggling academically, no specific learning disability has been identified by the school. What is the next best step?
Summer school, after school programs, tutoring, and early reading programs
What is the disadvantage of grade retention in students who are struggling academically?
High risk of dropping out of high school, and ultimately employment problems
A 10-year-old girl is struggling in school; parents are concerned because of her poor grades. What is the next best step?
Psychoeducational evaluation request in writing from parents to her school
What is the role of pediatricians in children with learning disabilities upon diagnosis?
Review the initial psychoeducational evaluation and child’s report card with the family.
Make sure that the child is receiving remediation, accommodations, modifications, and therapies.
Investigate for related disorders, such as attention deficit hyperactivity disorder (ADHD), adjustment disorder, or anxiety disorder.
An example of a child who may benefit from the 504 plans
Child with ADHD.Section 504 (Accommodation) of the US Rehabilitation Act of 1973 covers kids with disabilities who do not require specialized instruction (504 school accommodations for peanut allergy is another example)
Examples of accommodations in school under 504 for children with ADHD
Preferential seating, extended time for testing, modifications in classroom assignments
Which child may benefit from the US Individuals with Disabilities Education Act (IDEA), providing qualified children with an Individualized Education Program (IEP)?
Specific learning disability, e.g., dyslexia, dysgraphia, dyscalculia Others, e.g., autism, deafness, vision impairment, intellectual disability
Can a child with ADHD qualify for IEP?
Yes, if he or she requires specialized instructions
The first-line treatment of ADHD
Stimulant medications, e.g., methylphenidate
Indications of non-stimulant medications (e.g., atomoxetine, guanfacine, clonidine) in the treatment of ADHD
Preference of parents Poor response or significant side effects with stimulant medications Concerns about substance/stimulant abuse or significant tics
What is the significance of IQ test scores greater than 2 SD below the mean (
Intellectually disabled range
An 8-year-old girl underwent psychoeducational testing, and her aptitude test score in IQ was within normal range, her academic achievement scores were within normal in reading, and writing, but in math her score was
Specific learning disability in math
The girl in the previous example qualifies for which of the following: 504 plan or IEP?
IEP special education program
Participation of children with and without disabilities in the same educational settings
Educational inclusion
What are the benefits of educational inclusion?
Promotes tolerance, empathy, and collaboration among students
Independent in personal care and activities of daily living with minimal support, education level up to sixth grade, independent employment with a possible need for minimal support or supervision
Mild intellectual disability (ID)
Can care for personal needs and activities with limited support, education level up to third grade; difficulty understanding time and money, supportive living such as in a group home, supported, or supervised job, unskilled or semiskilled work
Moderate ID
