Mental Health Flashcards

Question

What is the first-line intervention for children with significant disruptive behaviours?

Answer 1

Consider evidence-based parent-training programs as a first-line intervention for children with significant disruptive behaviours.

Answer 2

``` Significant delay (at least 2 SDs below the mean with standardized tests) in at least two developmental domains from the following: Gross or fine motor Speech/language Cognition Social/personal Activities of daily living Reserved for children <5 years old ```

Answer 3

Intellectual disability (intellectual developmental disorder)*: The following three criteria must be met: Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing. Deficits in adaptive functioning that result in failure to meet developmental and socio-cultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation and independent living, across multiple environments, such as home, school, work and community. Onset of intellectual and adaptive deficits during the developmental period.

Answer 4

prenatal intrinsic- genetic, metabolic prenatal extrinsic- toxins/teratogens, infections perinatal- asphyxia, prematurity postnatal- neglect, infections, toxins, trauma 55% from perinatal

Answer 5

1. History and physical 2. Audiology 3. Ophthalmology 4. EEG if seizures 5. refer to rehabilitation services while awaiting results

Answer 6

1. chromosomal microarray 2. Fragile x- testing 3. Tier 1 testing 4. Brain MRI if abnormal neurological exam, seizures, macrocephaly or microcephaly 5. Consider MECP2 in girls with Mod-Severe GDD

Answer 7

1. Brain MRI 2. Genetics/Metabolics referral- Tier 2 testing, gene panels 3. Consider referral to neurology

Answer 8

Complete blood count Glucose Blood gas Urea, creatinine Electrolytes (to calculate anion gap) AST, ALT TSH Creatine kinase Ammonia Lactate Amino acids Acylcarnitine profile, carnitine (free and total) Homocysteine Copper, ceruloplasmin** - not by recommended AAP but in TIDE protocol Biotinidase*** - clinica expert recommendation only Ferritin, vitamin B12 when dietary restriction or pica are present Lead level when risk factors for exposure are present

Answer 9

Chromosomal microarray and Fragile X DNA testing

Answer 10

Family history of IEM or developmental disorder or unexplained neonatal or sudden infant death Consanguinity Intrauterine growth retardation Failure to thrive Head circumference or stature growth abnormality (>2 SD above or under the mean) Recurrent episodes of vomiting, ataxia, seizures, lethargy, coma History of being severely symptomatic and needing longer to recover with benign illnesses (e.g., upper respiratory tract infection) Unusual dietary preferences (e.g., protein or carbohydrate aversion) Regression in developmental milestones Behavioural or psychiatric problems (e.g., psychosis at a young age) Movement disorder (e.g., dystonia) Facial dysmorphism (e.g., coarse facial features) Organomegaly Severe hypotonia Congenital nonfacial anomalies Sensory deficits, especially if progressive (e.g., cataracts, retinopathy) Noncongenital progressive spine deformities Neuro-imaging abnormalities

Answer 11

``` ODD and CD- as high as 90% with ADHD Anxiety- 30% Mood disorder- depressive symptoms, bipolar disorder substance use disorder Tic disorder Developmental coordination disorder (DCD) ASD Specific learning disorder Eating disorders (Especially females) ```

Answer 12

``` predominantly inattention presentation predominantly hyperactive-implusive presentation combined type (criteria are met for inattention and hyperactive) ```

Answer 13

before age 12 and persist >6 months

Answer 14

``` fidgets leaves seat runs/climbs no quiet play on the go/motor talks excessively blurts not wait turn interrupts/intrudes ```

Answer 15

``` close attention/mistakes sustaining attention not listen not follow through poor organization sustained mental effort lose things easily distracted forgetful ```

Answer 16

Persistent pattern of hyperactivity-impulsivity and/or inattention that interferes with functioning or development and negatively impacts social/academic/occupation

Answer 17

Parent Behaviour Training

Answer 18

``` extended release stimulant either methylphenidate class or amphetamine class ```

Answer 19

rebound hypertension and tachycardia

Answer 20

Straterra (Atomoxetine)-norepinephrine reuptake inhibitor | Intuniv (Guanfacine XR)- alpha 2 agonist

Answer 21

``` psychoeducation shared decision making parent behavior training classroom management daily report card behaviour peer interventions diet exercise ``` others: social skills training, organizational skills training, cognitive training, EEG neurofeedback

Answer 22

ID prematurity ASD

Answer 23

combined inattention/hyperactivity increased symptom severity comorbid major depressive or other mood disorder high comorbidity (>3 additional DSM disorders) parental anxiety parental antisocial personality disorder

Answer 24

irritability and emotional outbursts

Answer 25

an IQ above 50 predicts a better response to stimulants

Answer 26

difficult-to-manage behaviours relate to symptoms associated with ADHD: inattention, internalizing disorders (anxiety, depression, withdrawal, somatic complaints), and social difficulties Disruptive behaviour disorders, such as oppositional defiant disorder, conduct disorder, and hyperactive/impulsive presentation in ADHD, are seen less frequently