Ped's ADHD, Genetic disorders, Autism, Abuse Flashcards
1
Q
What two domains does Autism disorder affect ?
A
- Social interaction & communication
2. restricted repetitive patterns of behavior, interests and activities
2
Q
What causes Austim?
A
unknow
likely due to multiple genes we well and enviromental modifiers or “2nd hit factor”
3
Q
Does having a sibling with Autism increase the risk the other child will develop Autism?
A
yes, although wide range of phenotypic expression
4
Q
What gender is most common with Autism
A
Males > females 4:1
5
Q
what increases your risk for Autism development
A
male
sibling with Autism
maternal use of VALPOIC ACID
older parents
6
Q
What medication is thought to be linked to autism
A
maternal use of VALPOIC ACID
7
Q
What are DSM 5 criteria for symptoms of Autism
A
- Presisent communication and social interaction across multiple areas that cant be explained by development delays
- social-emotional
- nonverbal communication for social interaction
- cants develop, maintain or understand relationship - Restricted repetitive patterns of behavior, interests and activities that have 2
- sameness, inflexibility in routines, same patterns with verbal and non verbal behavior
- fixated interested
- unusual interests in hearing, seeing, texture around - early in development
- impairment of school, job, life
8
Q
Parents may report what development, behaviors in a child with suspected Autism
A
- normal development until 1-2 years old then sudden or slow decline
- most common is a language delay
- not making eye contact
- interest just with mouth, texture, will not interact with other children, not cuddly
9
Q
what is the most common presenting symptom of Autism
A
most common is a language delay
10
Q
What are some physical exam signs that a child may have Autism
A
large head circumference great than the 97%
not tracking with eyes
not cuddly
wont interact with you or mom
fixated on toy will not involve you or mom
11
Q
What are screening tests used for Autism spectrum disorder
A
Autism behavior checklist- ABC
Gilliam autism rating scale-2 GARS-2
12
Q
If you think a child may have Autism spectrum disorder
what things do you need to rule out first?
A
Hearing deficit
chromosomal abnormality
congenital or metabolic disorder like PKU
13
Q
Red flag for Autism at 6 months
A
no big smiles or joyful expressions
*regression at any age
14
Q
Red flag for Autism at 9 months
A
no back-and-forth sharing of sounds
no smiles
no facial expressions
*regression at any age
15
Q
Red flag for Autism at 12 months
A
no babbling
*regression at any age
16
Q
Red flag for Autism at 16 months
A
No words
*regression at any age
17
Q
Red flag for Autism at 24 months
A
No two word combinations
*regression at any age
18
Q
what are the AAP guidelines for screening Autism
A
screen with the modified checklist for autism in toddlers- MCHAT
18 and 24 months
19
Q
If the MCHAT is concerning what is the next step?
A
Refer to “Help me grow”
early intervention
developmental pediatric specialist
20
Q
What are the long term “prognosis or expectations” of a child with Autism
A
Intellectual disability 80% low IQ some have savant skills in one area Anxiety ADHD Seizures 25%
21
Q
Treatment for Autism
A
- early intervention
- intensive behavior interventions
- Applied behavior analysis - ABA will encourage positive behavior and discourage negative behavior
- Structure
- Speech therapy
- occupation therapy
- medications
22
Q
What are some medications give with Autism
A
No certain medicaiton
- anti psychotics for aggression, agitation and self injury
- SSRI for anxiety, compulsions and depression
- ADHD component- Stimulants
23
Q
What 3 areas does attention-deficit hyperactivity disorder have?
A
- Inattention
- Hyperactivity
- immpulsivity
24
Q
Who is most common to be affected with ADHD
A
10% of population
- males
- higher risk if family history
- exposed to alcohol or nicotine in utero
- damage to CNS from infection or trauma
25
What is the difference between a Male with ADHD and a female with ADHD
males- hyperactive and impulsive
| females are more likely inattentive
26
What is the usual age of diagnosis ADHD
before age 6
persists into adulthood 60-80% of the time
most adults will have impulsivity and inattention
27
what is the DSM-V criteria for the types of ADHD
1. Inattentive
2. Hyperactive-impulsive
3. A combination
28
What is the DSM-V creiteria for diagnosis ADHD
1. At least 6 symptoms of one area (inattentive, hyperactive,impulsive)
2. At least 6 months
3. Most symptoms before age 12
4. At least two different areas- school, social, work
(symptoms cant be due to other psychiatric issue)
29
What are symtoms of ADHD- predominantly Inattention
1. Difficulty paying attention to detail or making careless mistakes
2. difficulty following instructiosn
3. gets distracted during activites
4. avoids activites that require mental effort
5. difficulty organisng tasks or activites
6. often loses things necessary for daily activity
7. often does not listen when spoken directly to
30
What are symtoms of ADHD- predominantly Hyperactivity
1. often talks excessively
2. often leaves his/her seat
3. fidgets with hands, feet or squirms in seat
4. runs, climbs excessively in situations which its inappropriate
5. "on the go" or "driven by a motor"
6. difficulty playing or engaging in leisure activities quietly
31
What are symtoms of ADHD- predominantly Impulsivity
1. often blurts out answers before the questions are completed
2. often has difficulty waiting their turn
3. often interrupts or intrudes on others
32
what are some screening tools for ADHD
1. Vanderbilt
| 2. Connor forms
33
What things do you need to consider before making a diagnosis of ADHD
developmental problems
neurologic problem or gentic disorder
acute stress or like- divorce or bullying a move
34
what are the main Treatment areas for ADHD
1. behavior management- limit distractions, postive reinforcement, small goals, consisent routines, homework
504 plans at school, dial reports, planners
2. Medications - stimulants or non-stimulants
3. Parent-child therapy
35
What is Oppositional defiant disorder ?
pattern of angry irritable mood with
arguing
vindictiveness
36
What is the criteria to diagnosis Oppositional defiant disorder
6 months of a least 4 symptoms of:
1. angry or moody
2. argues or defiant
3. vindictiveness
- all have to occur with someone other than sibling
- impact negative on social, education, job or other important areas of life
- impacting self or others
37
What is Conduct disorder?
A repetitive and persistent pattern of behavior that violates the rights of others, social norms or rules
aggression toward people or animals, theft, destroying property
38
What is DSM V criteria needed to diagnosis Conduct disorder
12 months of 3 symptoms and 1 has to be in the last 6 months
1. Aggression to people and animals
2. destroying property
3. deceitfulness or theft
4. serious violations of rules
impacts cause significant impariements of social, academia or job functioning
39
What are all the drug classes used for ADHD
1. amphatamines
2. amphatamines- like
3. norepinephrine reuptake inhibitors
4. central alpha-agonist
5. anti-depressant
40
```
Adderall
Dexedrine
Procentra
vyvanse
desoxyn
are all what drug class?
```
Amphetamines
| amphetamine-like drugs
41
MOA of this drug- alters levels of neurotransmitters in the brian (norepi, dopamine)
simulates peripheral recepors that lead to increase BP, mild bronchodilation
Amphetamines
42
MOA of this drug- inhibits reuptake of Norepi and dopamine and results in increase in neurotransmitters at the synaptic cleft therefore increases CNS activity
Methylphenidate
43
What drugs are category II and need to be hand written?
Amphetamines
44
Side effects of this drug- decreased appetite, insomnia, increase anxiety/irritabiltiy, mild stomach ache, weight loss, growth suppression
Amphetamines
45
What is the black box warning of Amphetamines
SUDDEN DEATH with HEART issues
has been reported in association with CNS stimulant treated at usual dose with structural cardiac abnormalities or other heart problems
46
Atomoxetine- Strattera is what drug class?
non-stimulant
| Norepinephrine reuptake inhibitor
47
MOA of this drug- selective inhibiton of Norepinephrine re-uptake and increases extracellular concentration of Norepinephrine
Atomoxetine- Strattera
| non-stimulant
48
Side affects of this drug- insomnia, dry mouth, decrease appetitis, fatigue, consiptation
Atomoxetine- Strattera
| non-stimulant
49
what is the black box warning for Atomoxetine- Strattera
increased risk of Suicidal idealization
50
Guanfacine - tenex, Intuniv
Clonidine - kapvay
are all what type of drug class
for ADHD
Central alpha-agonists
can use these alone or with other drugs
51
MOA for this drug- stimulation of alpha-2 adrenerigic receptors in the prefrontal cortex results in enhaced executive functioning, increased attentiveness and improves working memory
Central alpha-agonists
52
What type of Central alpha-agonists binds to a specific alpha-2 receptors
Guanfacine - tenex, Intuniv
53
What type of Central alpha-agonists binds to a general alpha-2A, B, C
Clonidine - kapvay
54
side effects of this drug- most common sedation
Central alpha-agonists
| Guanfacine is more specific so less sedation than clonidine
55
```
IF a child with ADHA cant not tolerate
stimulants
norepinephrine reutake inhibitors
central alpha-agonist
what is another option ?
```
Antidepressants - offlabe
TCA's - imipramine , desipramine
Bupropion
56
What drug is usually used in first line to treat ADHD
Methyphenidate
less abuse potential
best track record
57
What if a patient with ADHD is not responding to Methyphenidate
```
try another drug in same class
if intolerable use other drug class like stimulant or SE
```
58
What is the definition of child abuse
abuse and neglect is act of either commission or omission by a parent or caregiver that results in harm, potential for harm, threat of harm to a child.
59
what are acts of commission or omission
- physical abuse
- emotion abuse
- physical abuse
- intentional words or actions
Comission
60
what are acts of commission or omission
- failure or provide basic needs to protect for harm or portetial harm
Neglect
omission
61
What are risk factors for abuse
```
less an 4 years old
special needs
parental substance abuse
maternal depression
domestic violence
parent suffered with neglect or abuse as a child
transient caregivers in the home
```
62
what % of children are pysicall abused?
| who often does the physcial abuse?
1-2%
1,500 are fatal
mother most often reports it
inflicted by father or boyfriend
63
What are clue that a child may be physically abused?
- history of trayma is denied
- caregiver cant explain injuries
- story of injury changes over time
- self-inflicted trauma does match with injury pattern
- multiple organ systems are involved
64
What is normal for bruises
| what would make you think abuse?
normal- in a walking child on boney prominences
abuse- slap pattern, looks like blet/buckle marks
on torso, butt, ears or neck
especially in a baby who isnt walking
65
What is normal for bruns
| what would make you think abuse?
think of the pattern of injuty
abuse-often when at the age for potty training
-contact burn from ciarette or iron if cicurlar
-think immerision in hot water: clear lines of demarcation, bilateral and symmetric, typically on legs and private parts, lack of splash pattern
66
What is normal for fractures
| what would make you think abuse?
pattern matches injury - usually a walking child!
abuse :
unexplained
occur in young child who cant walk
involve multiple bones and different stages of healing
67
whare are common abuse fracture sites?
RIBS
metaphyseal
scapular
vertebral
68
What about an abdominal injury will make you suspect abuse?
most often blunt trauma to infant or toddler
signs of external bruising
vomiting or fussiness can be only symtoms
69
What about a head injury will make you suspect abuse?
```
intolerance to crying or fussiness
irritable or lethargic
seizures
apnea
coma
sudural hematoma
retinal hemorrhages
from impact or shaking
*if they survive they have risk of permanent neurologic sequelae
```
70
what injury is the leading cause of death in a infant ?
Head injury
71
What is a work up in a 0-6 month old for abuse?
| > 6 months
Head CT
X-ray whole body
>6months = neuroimaging skull fracture no contrast
and a trauma panel
72
what does sexual abuse include?
```
clothed or unclothed
fondling - oral- genital, genital, anal contact
exhibitionism
voyeuirsm
making them watch child pornography
```
73
Who is most likely to be the offender of sexual abuse
male - someone who usually knows the child
| manipulation and threatens them
74
who is most commonly the victim of sexual abuse
girls
boys are under-reported
most cases are self-reported
75
what could be symptoms of child abuse?
hypersexual behavior (could be TV)
unexplained genital or anal injury
Sexually transmitted infeciton
76
what are physical signs of child abuse?
most often normal exam
only 5-10% have abnormal exam
1. if after 72hrs of assault- bursing, bleeding, semen of perineum, oral mucosa, breasts or thighs
2. acute lacterions or redness of hymen, posterior fourcheete or anus
3. complete transectoin of hymen
4. unexplained anogenital scrring
5. pregnancy with report of no sexual history
6. screen for STI
77
What is the definition of emotional abuse?
repeated pattern of damaging interactions between caregiving and child that becomes the typical relationship and conveys the child as flawed, unloved or unwanted
includes: rejection, isolation, terrorinizng, ignoring, corrupting, over-pressuring, verbal assault
78
what type of abuse is the most difficult to diagnosis
Emotional
| difficult to define
79
What is the most common type of abuse?
Neglect
| 1/3 of deaths
80
What is the defintion of neglect?
acts os omission that prevent basic needs from being met
housing, food, clothing, supervision, healthcare, education, nurtance
both actual and potential : not using child safety seat even if the child is not injured
81
What are sign/symtoms of neglect?
```
failure to thrive
starvation
dehydration
poor hygiene
severe untreated dental caries
missing school
injuries due to lack of supervision
```
