Mood and Anxiety Disorders in Children Flashcards
DSM criteria for ADHD:
- ___out of 9 inattention OR hyper-impulsive symptoms OR both that caused impairment before age of 12, AND
- Symptoms are present in two or more settings, AND
- Symptoms significantly impair social, academic or occupational functioning.
- 6 out of 9 inattention OR hyper-impulsive symptoms OR both that caused impairment before age of 12, AND
- Symptoms are present in two or more settings, AND
- Symptoms significantly impair social, academic or occupational functioning.
Inattention symptoms (6/9 for ADHD)
Inattention: at least 6 out of 9 of for 6mo+:
- Fails to give close attention to details or makes careless mistakes
- Has difficulty sustaining attention
- Does not seem to listen when spoken to directly
- Does not follow through on instruction and fails to finish tasks
- Has difficulty organizing
- Avoids, dislikes or is reluctant to engage in task that require sustained effort
- Loses things necessary for tasks/activities
- Easily distracted
- Forgetful in daily activity
Hyperactivity-Impulsivity symptoms (6/9 for ADHD)
Hyperactivity-impulsivity: at least 6 out of 9 for 6mo+:
- Fidgets with hands or feet or squirms
- Leaves the seat in classroom or other situations
- Runs about or climbs excessively in situations that are inappropriate
- Difficulty playing or engaging in activities quietly
• “on the go”
- Talks excessively
- Blurts out answers before questions have been completed
- Difficulty awaiting turn
• Interrupts or intrude on others
Depressive Disorder in Pediatrics
Differences from adults:
Major depressive episode: ___ mood may substitute for depressed mood, failure to make expected weight gains may substitute weight loss or gain
Persistent depressive disorder: duration is ___ year(s) (instead of ___ year(s) in adults)
Differences from adults:
Major depressive episode: irritable mood may substitute for depressed mood, failure to make expected weight gains may substitute weight loss or gain
Persistent depressive disorder: duration is 1 year (instead of 2 years in adults)
Disruptive Mood Dysregulation Disorder
o Severe recurrent temper outbursts which are inconsistent with developmental level (3+ times a week).
o Between outbursts, their mood is persistently angry or irritable.
o At least 12months and no periods greater than 3mo without symptoms
o Present in at least 2 settings and severe in at least 2 settings
o Cannot make dx before age of 6yo and after the age of 18yo; onset before the age of 10
o Never a period lasting greater than 1d in which full criteria for hypomania/mania have occur
Bipolar Disorder in Pediatrics
Differences: Exact same as diagnostic criteria as in adults (ex/ mania lasts 1+ week DIGFAST symptoms).
However, children have more __, increase __, increase rates of ___, increase __ symptoms, more functional impairment, higher rate of mixed episodes
Bipolar Disorder in Pediatrics
Differences: Exact same as diagnostic criteria as in adults.
However, children have more episodes, increase suicidality, increase rates of violence, increase psychotic symptoms, more functional impairment, higher rate of mixed episodes
risk factors to bipolar disorder in peds
Risk Factors: genetics (8-10 fold higher, 80% heritability), low SES, exposure to negative events, high expressed emotion
bipolar disorder can be confused with ADHD in the peds population. Contrast the two.
Contrast with ADHD:
bipolar is More common than ADHD
Especially if over 10 and “adhd” appears rapidly– probs bipolar
bipolar disorder is refractory to stimulant treatment
No mania symptoms like DIG FAST
If there is a strong family history of bipolar disorder
specific criteria for social phobia in children
Social Phobia
o Same duration as in adults
o Must occur in peer settings (not just with adults)
o Fear may be represented by crying, tantrums, freezing or clinging
o Clinical: extreme shyness, school avoidance, trouble eating in public
Pediatric OCD:
- mean age of onset is ____ years, with 25% of cases starting by 14.
- if onset under 10 years old, it’s more common in ___, fam history is __, and may be sudden, especiailly if following a period of __ __.
treatment is __, both __ and __ prevention, +/- an ___ (sertraline, fluoxetine or fluvocamine)
Pediatric OCD:
- mean age of onset is 19.5 years, with 25% of cases starting by 14.
- if onset under 10 years old, it’s more common in males, fam history is significant, and may be sudden, especiailly if following a period of high stress.
treatment is CBT, both expsoure and repsonse prevention, +/- an SSRI (sertraline, fluoxetine or fluvocamine)
Definition: age inappropriate stubborn, hostile and defiant behaviours
Epi: usually appears by age 8, second peak at age 14-15 yo; prevalence 1-7%.
Higher in boys in childhood
Symptoms: requires 4+ over at least 6mo; at least one individual is not a sibling and leads to impairment in academic/social/occupational functioning:
• Often loses temper
• Often angry or resentful
• Touchy or easily annoyed
• Deliberatively annoys others
• Actively defy or refuse to complex
• Often argues with authority figures
• Often blames others for mistakes
• Spiteful or vindictive at least twice within past 6mo
Subtypes: mild, moderate vs severe specifier Etiology: terrible twos that persists. Combo of parenting practices and parenting
Definition: age inappropriate stubborn, hostile and defiant behaviours
Epi: usually appears by age 8, second peak at age 14-15 yo; prevalence 1-7%.
Higher in boys in childhood
Symptoms: requires 4+ over at least 6mo; at least one individual is not a sibling and leads to impairment in academic/social/occupational functioning:
• Often loses temper
• Often angry or resentful
• Touchy or easily annoyed
• Deliberatively annoys others
• Actively defy or refuse to complex
• Often argues with authority figures
• Often blames others for mistakes
• Spiteful or vindictive at least twice within past 6mo
Subtypes: mild, moderate vs severe specifier Etiology: terrible twos that persists. Combo of parenting practices and parenting
example of limited prosocial emotions in conduct disorder
2+ of lack of remorse/guilt; callous; unconcerned about performance; shallow/deficient affect
Conduct Disorder
Definition: a repetitive and persistent pattern of behaviour in which the basic rights of other and major age appropriate societal norms or rules are violated
Epi: 1-10%; more common in boys (more aggressive behaviour in boys than in girls)
Symptoms: at least ___of the following over the past year and ___ in the past 6mo that causes impairment:
Conduct Disorder
Definition: a repetitive and persistent pattern of behaviour in which the basic rights of other and major age appropriate societal norms or rules are violated
Epi: 1-10%; more common in boys (more aggressive behaviour in boys than in girls)
Symptoms: at least 3 of the following over the past year and 1 in the past 6mo that causes impairment
questionnaires to investigate pediatric ADHD
conner’s, SNAP-IV
first, second and thirdline meds for pediatric ADHD
- stimulants– amphetamines or methylphenidates
- atomoxetine (SNRI)
- alpha -2-receptor agonists guanfacine
if a kid has ADHD and tics, what might be the best pharmacotherapy
Atomoxetine (non-stimulant, 2nd line): SNRI (targets both ADHD and anxiety)
Mechanism: blocks reuptake of NE via NET → increases NE and DA in prefrontal cortex (not in Nacc→ no abuse potential!!)
Side effects: sedation, GI, appetite, irritability, headache, suicidal ideation
Atomoxetine may be good if the person has anxiety or tics in addition to the ADHD
t/f there is abuse potential for SNRIs
false.
Mechanism: blocks reuptake of NE via NET → increases NE and DA in prefrontal cortex (not in Nacc→ no abuse potential!!)
PANDAS
Definition: Lightening-fast onset of symptoms in association with an underlying infectious inflammatory process (usually ___)
PANDAS
Definition: Lightening-fast onset of symptoms in association with an underlying infectious inflammatory process (usually strep)
PANDAS
Criteria: OCD OR eating restrictions AND at least 2 of:
Anxiety
Emotional lability or depression
Irritability, aggression, and/or severely oppositional behaviors
Regression
Deterioration in school performance related to new onset memory deficits OR cognitive changes
New sensory or motor abnormalities
Somatic changes (sleep disturbance, enuresis)
Management: identity and treat the underlying infectious/inflammatory processes. Treat the psychiatric and behavioural symptoms the same as you would otherwise
rating scales for pediatric depression
Becks Children Depression INventory
pediatric depression management
first line type of SSRI for pedatric depression
fluoxetine
rating scales for pedaitric bipolar disorder management
Rating Scales: Young Mania, KSADS Mania, General Behaviour Inventory
when to suspect bipolar in a child who you think has ADHD
Suspect Bipolar in a child with ADHD… ADHD symptoms later in life, abrupt onset, not responding to treatment, mood changes (exaggerated elation, grandiosity, depression, no need for sleep, inappropriate sexual behaviours), hallucinations/delusion, family history of bipolar disorder
medications for pediatric bipolar disorder management
• Medication:
o Mania Phase: 2nd/3rd Generation ___ (peds bipolar is more susceptible than in adults), __, divalproex
o Depressive Phase: __
O Maintenance: continue treatment for 12-24months (high rates of recurrence with or without treatment); consider long-acting injectable medications
• Medication:
o Mania Phase: 2nd/3rd Generation Antipsychotics (peds bipolar is more susceptible than in adults), lithium, divalproex
o Depressive Phase: Lamotrigine
O Maintenance: continue treatment for 12-24months (high rates of recurrence with or without treatment); consider long-acting injectable medications
management for pediatric anxiety disorder
Management:
CBT: graduated exposure to feared stimulus (you need significant family and school involvement)
**for selective mutism: CBT + reward approximation to desired behaviour
Family therapy: increase exposure to feared stimuli, decrease anxiogenic family interactions
School based interventions: decrease school avoidance and refusal
Pharmacologic: in severe cases + CBT → almost never in isolation
SSRI: sertraline, fluoxetine, fluvoxamine
Note: for oppositional defiant disorder and conduct disorder, the first line is psychosocial interventions
