Mental Health + Development Flashcards
Conditions assoc w disruptive behaviour
ADHD, ODD, conduct disorder, anxiety, mood disorders, cognitive and language disabilities
what age do temper tantrums peak?
3yo
First line for management of behaviour problems
Parent training programs
Treatment for depression
Fluoxetine
How frequently to monitor when start SSRI
weekly x 4 wk, then q2wk x 4wk; at 12 wk, then as clinically indicated
What SSRI has a concern for Prolonged QT?
Citalopram
Factors affecting child’s wellbeing when parents are separating
Quality of Parenting
Quality of parent-child interaction
Degree/frequency/intensity of hostile conflict
How to children react to diverse at
4-5 years
school age
At 4-5 yoa – blame themselves and become clingy with separation anxiety
School age – may take sides and have loyalty conflicts
Family risk factors during divorce
- Ongoing conflict between parents (especially if it is abusive and/or focused on children)
- Diminished capacity to parent or poor parenting
- Lack of monitoring children’s activities
- Multiple family transitions
- Parent mental health problems
- Chaotic, unstable household
- Impaired parent-child relationships
- Economic decline
Family protective factors during divorce
- Protection from conflict between parents
- Cooperative parenting (except in cases of domestic violence)
- Healthy relationships between child and parents
- Parents’ psychological well being
- Quality, authoritative parenting
- Household structure and stability
- Supportive sibling relationships and extended family relationships
- Economic stability
Risk factors to screen for on H&P before starting a stimulant
Personal or Fam Hx of: Sudden death FamHx non-ischemic heart disease FamHx/Personal Hx Long QT or arrythmia WPW Cardiomyopathy Heart transplant Pulm HTN Defibrillator
Personal History
SOB with exercise without explanation (asthma)
Poor exercise tolerance without other explanation
Fainting/Seizures with exercise, or fright
Palpitations with exercise
Exam:
Hypertension
Murmur
Sternotomy incision
Dx of global developmental delay
age
Significant delay (at least 2 SD below mean) in at least 2 developmental domains:
- Gross of fine motor
- Speech/Language
- Cognition
- Social/Personal
- Activities of daily living
Age <5yo
Dx of intellectual disability
age
all 3:
1. deficits in INTELLECTUAL FUNCTIONING (reasoning, problem solving, planning, abstract thinking, judgement, academic learning and learning from experience) confirmed by both clinical assessment and individualized, standardized intelligence testing
- deficits in ADAPTIVE FUNCTIONING
result in failure to meet developmental and socio-cultural standards for personal independence and social responsibility. - Onset of intellectual and adaptive deficits DURING THE DEVELOPMENTAL PERIOD
Tier 1 blood work for investigation of GDD
Blood 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** Biotinidase*** Ferritin, vitamin B12 when dietary restriction or pica are present Lead level when risk factors for exposure are present
Urine Organic acids Creatine metabolites Purines, pyrimidines Glycosaminoglycans
Conditions commonly misdiagnosed as ADHD
Learning disorder Sleep disorder Oppositional defiant disorder Anxiety disorder Intellectual disability Language disorder, mood disorder, tic disorder, conduct disorder Autism spectrum disorder Developmental coordination disorder
DDX ADHD
Mood disorders – depression, anxiety, bipolar
Low or high IQ
ASD or Tourette movements
OSA, IBD (causing fatigue or pain)
Sensory (hearing, vision)
Chronic health conditions effecting school attendance
Neurological (seizures, concussion)
Higher prevalence of ADHD in epilepsy (more inattentive)
Genetic – turners, Fragile X, TS, BF, 22q11
Developmental coordination disorder
Specific learning disorder
Eating disorders
Comorbidities of ADHD
Other neuropsychiatric disorders Disruptive behavioral disorders OCD and CD; 90% comorbidity Anxiety and OCD May be difficult to participate in therapy, ADHD stimulant may worsen anxiety Mood disorders – Bipolar Substance use disorder Tic disorder – association with stimulants may be incidental
Non pharmacological management of ADHD
Organization skills training Physical exercise Behavioral interventions - Daily report card Classroom management Psychoeducation Shared decision making Parent Behaviour Training First line for children < 6 yoa with ADHD
First line mgmt of ADHD in <6yo
Parent Behaviour Training
First line mgmt for ADHD
Extended release stimulant
Methylphenidate or Dextroamphetamine class
Is tic d/o a c/I to stimulants?
no
Second line treatment for ADHD
non stimulants
Strattera and Intuniv XR
Concerning S/E of Intuniv
rebound hypertension and tachycardia if stopped suddenly
Syndromes with features of ASD + ADHD
fragile X, Williams Syndrome, Tuberous Scleorosis, 22q11 deletion
Wha comorbidities are more likely to be nonresponders in ADHD
ASD and ID
