Mood disorders in children Flashcards
1
Q
Mental health marked by acheivement of milestones in
A
Cognition Emotional stability Socially acceptable coping skills Appropriate socialization within and outside the family
2
Q
An emotional problem exists if behavioral manifestations…
A
Are not age appropriate
Deviate from cultural norms
Create deficits or impairments in
adaptive functioning
3
Q
Majority of psych disorders in children are (what kind)
A
Anxiety disorders
4
Q
Effects of environment and development
A
Environment and development may improve or worsen but in some disorders with identified genetic components (autism, bipolar, schiz., ADHD) may occur in “normal environments”.
5
Q
General risk factors
A
Genetics
Biochemical
Pre and post natal: drugs, alcohol, toxins,infection, malnutrition, birth hypoxia, leadpoisoning, CNS infections, brain injuries, abuse
Temperament: “style of behavior used to
cope with the environment” is genetic and
modified by parent-child relationship (+ or-)
6
Q
Family risk factors
A
Severe family discord, low socioeconomic status, large families and overcrowding, parental criminality, maternal psychiatric disorders, foster care placement. NOTE: The greater the number of stressors, the greater the risk
7
Q
Resilience
A
Most children “at risk” still develop normally.
They have resilience.
The temperament to adapt to change
The ability to form nurturing relationships
with other adults if parent is unavailable.
The ability to distance themselves from
emotional chaos of parent or family.
Good social intelligence
The ability to problem solve
8
Q
Data collection
A
Important part of initial interview is observing interactions
Non-structured interview with child Screening (neurological, psychological, intelligence) Observing and interacting with child History- parents, caregivers, family members Structured questionnaires and behavior checklists for teachers and parents. Games, puppets, drawing, free play for young children
9
Q
Autism Spectrum disorder def
A
A disorder that is characterized by impairment in social interaction skills and interpersonal communication and a restricted repertoire of activities and interests (Black and Anderson, 2011) The diagnosis is adapted to each individual by clinical and associated features (severity, verbal ability, intellectual disability,etc.) APA, 2013
10
Q
Autism general facts
A
Is a developmental disability. Children and adults exhibit atypical, repetitive behaviors and deficits in social and communication skills. Diagnosed before 3 yrs. 4 – 5 X’s more prevalent in boys Prevalence: 1 in 88 children No racial, ethnic, or social boundaries Characterized by withdrawal into self
70% have some mental retardation
11
Q
Autism - difficulty with social interaction
A
Do not reach out to others to share
information or feelings
Often do not know how to engage in
simple social interactions
12
Q
Autism- difficulty with communication
A
A delay in or a lack of development of spoken language • Common speech abnormalities include echolalia, unconventional word use, and unusual tone, pitch inflection. Difficulty understanding common nonverbal cues such as body language, facial expressions, and eye contact
13
Q
Autism - unusual behaviors
A
Restricted range of interest Peculiar sustained play activities Very resistant to change in routine Savant abilities (less than 2%)
14
Q
Autism neuro
A
Neurological: “The neurobiological dysfunction appears to be quite diffuse and no clear primary deficit is found in most autistic individuals” (Popper) Genetics Perinatal: pregnant women with asthma and allergy
15
Q
General autism pharma
A
Two meds are approved by the FDA Resperidone Aripiprazole (Abilify) Targeting the following symptoms: Aggression Deliberate self-injury Temper Tantrums Quickly changing moods Dosage based
16
Q
Resperidone s/e
A
Drowsiness Increased appetite Nasal congestion Fatigue Constipation Drooling Dizziness Weight gain
17
Q
apiprazole s/e
A
Sedation Fatigue Weight gain Vomiting Somnolence Tremor
18
Q
Aspergers
A
shares the social
deficits and behaviors of autism but
do not have a history of substantial
cognitive or communication delays.
19
Q
ADHD - Attention Deficit Hyperactivity Disorder
A
Persistent pattern of inattention or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development. 3 X’s more common in boys. Occurs in 9% of school age children. Difficult to dx before age 4.
20
Q
ADHD General info
A
Highly distractible, unable to handle stimuli, excessive motor activity, failure to attend to detail, careless mistakes, not listening, not finishing schoolwork, avoiding or delaying tasks, impulsivity. At risk for accidents, injuries.
21
Q
ADHD etiology
A
Unknown Genetics Biochemical – decrease in dopamine and norepinephrine Pre, peri, and postnatal factors Environmental-Lead Psychosocial Diet
22
Q
Comorbidity with ADHD
A
As many as 2/3rds of children with ADHD have a comorbid condition, such as Oppositional defiant disorder Conduct disorder Learning disorders Anxiety Depression Bipolar disorder Substance use disorders
Comorbid conditions must also be treated Anxiety and depression concurrently with ADHD. Substance addiction must be stabilized before treating the ADHD. Bipolar symptoms must be controlled with mood stabilizers before stimulants can be prescribed for ADHD.
23
Q
ADHD CNS Stiumlants examples
A
dextroamphetamine,methamphetamine,
lisdexamphetamine, methylphenidate,
dexmethylphenidate,dextroamphetamine/ amphetamine mixture.
24
Q
ADHD CNS Stimulants s/e
A
insomnia, anorexia, weight loss, tachycardia, decrease rate of G&D
25
ADHD CNS Stimulants warning
```
• Careful monitoring of cardiovascular
functioning
• Psychiatric symptoms may worsen
Periodic “drug holiday” necessary to
determine effectiveness and need for
continuation.
```
Behavior modification in conjunction
with medication essential.
26
Atomoaxatine (Strattera) for ADHD general
```
Selective norepinephrine reuptake
inhibitor (SNRI)
• Warning!
• Careful monitoring of cardiovascular and
liver functioning
• Psychiatric symptoms may worsen.
```
27
Atomoaxatine (Strattera) for ADHD s/e
```
Headache
N & V, decreased appetite
Upper abdominal pain
Dry mouth
Weight loss, constipation
Insomnia
Increased blood pressure and heart rate
Sexual dysfunction
```
28
Bupropion (Wellbutrin) for ADHD
```
Nonselective reuptake inhibitor
Side effects:
• Tachycardia
• Dizziness; shakiness
• Anorexia, weight loss
• Insomnia
• Nausea
• Constipation
Warning! Individuals with a history of seizures or
eating disorders should not take this medication.
```
29
Conduct disorder
A persistent pattern of behavior in which
the basic rights of others and major ageappropriate
societal norms are violated.
Childhood onset- prior to 10
• More common in boys, physical aggression,
difficult peer relationships, likely to be antisocial
personality disorder after 18.
Adolescent onset
• Less aggressive, more normal relationships
30
Conduct disorder characteristics and factors
```
Bullying, cruelty to animals, fighting,
setting fires, theft, etc.
Predisposing factors: ADHD, parental
rejection, inconsistent parenting with
harsh discipline, early institutional
living, absent father, antisocial or
alcoholic parent
```
31
Oppositional defiant disorder ODD
```
Characterized by a pattern of
negativism, defiant, disobedient, and
hostile behavior towards authority
figures. Begins by age 8.
No violation of the rights of others.
Enuresis, encopresis, mutism, running
away, eating and sleeping problems,
temper tantrums.
```
32
ODD other characteristcs
```
Characterized by passive-aggressive behaviors
Stubbornness
Procrastination
Disobedience
Carelessness
Negativism
Testing of limits
Resistance to directions
Unwillingness to cooperate
Running away
School avoidance
Deliberately ignoring the communication of others
```
33
ODD and Conduct Disorder
| Interventions
```
Maintain safety
Help child develop internal limits thru
problem solving and self-responsibility
Cognitive techniques of self-talk to
decrease impulsivity
De-escalation of aggression
Parental training
Antipsychotics
```
34
Tourettes general info
```
The presence of multiple motor tics
and one or more vocal tics.
Tics may appear simultaneously or at
different periods during the illness.
Presence of tics causes marked
distress.
Onset before 18; more common in
boys
```
35
Tourettes predisposing factors
```
Genetics: single gene with autosomal
dominant transmission
Biochemical: abnormalities in
dopamine, serotonin, dynorphin,
gaba, acetylcholine, norepinephrine
Structural: enlargement in the caudate
nucleus and decreased blood flow in
the left lenticular nucleus
```
36
Tourettes assesment
```
Tics may involve the head, torso, and
upper and lower limbs.
Signs may begin with a single motor
tic, most commonly eye blinking, or
with multiple symptoms.
Palilalia
Echolalia
```
37
Tourettes meds
Antipsychotics :
Haldol, Orap, Risperdal, Zyprexa, Geodon
Alpha agonists:
Clonidine (Catapres)
Tenex, intuniv (Guanfacine)
38
Separation anxiety disorder
```
Excessive anxiety concerning
separation from home or from those to
whom the person is attached.
The anxiety exceeds that expected for
developmental level and interfers with
functioning.
```
39
Separation anxiety disorder factors
```
Genetics – relatives with anxiety
disorders
Stressful life events
Family influences:
Over attachment to mother,
separation conflicts between parent
and child, close-knit family,
overprotection, role-modeling.
```
40
Separation anxiety disorder assessment
```
Anticipation of separation may result in
tantrums, crying, screaming, complaints of
physical problems, and clinging.
School reluctance or refusal
Fear of sleeping away from home
Nightmares
Phobias not uncommon
Fear of harm to self or attachment figure
```
41
Therapeutic Modalities for children and
| adolescents
```
Parental involvement
Group therapy (play)
Milieu therapy
Behavior modification
Removal and restraint – controversial
Time-outs
Therapeutic holding
Play therapy
Dramatic play therapy
Reality-based role play for psychotics
Therapeutic games
“Talking, Feeling, Doing” game
Bibliotherapy
Therapeutic drawing
Music therapy
Movement and recreational therapy
```
