Pediatric & Adolescent Related Disorders Flashcards
What is conduct disorder?
a disorder in which mostly peds pts have difficulty recognizing and respecting the rules and rights of others leading to trouble at home, school, and the law
Most common psychiatric disorder in children and adolescents?
conduct disorder
What causes conduct disorder?
multifactoral w/ no clear etiology
What are 3 risk factors for conduct disorder
low social achievement, parental conflict, large family size
Conduct disorder is often associated with?
other disorders like ADHD, Post-traumatic stress
What is the DSM 5 criteria for conduct disorder?
presence of at least 3 of 15 criteria within last 12 mo, w/ at lease 1 in past 6 months
How does DSM 5 define conduct disorder?
a repetitive & persistent pattern of behavior in which the basic rights of others of major age appropriate social norms or rules are violated
What are the 4 DSM 5 categories?
Aggression to people and animals
Destruction of property
Deceitfulness or Theft
Serious Violations of Rules
What are two things that must be included in DSM5 for conduct disorder?
1) disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning
2) age 18 or older, criteria are not met for antisocial personality disorder
If symptoms go untreated, behavioral problems will begin to be seen as??
part of the child’s personality and not as a treatable symptoms
Undiagnosed and untreated conduct disorder can lead to what in children?
pessimism and potentially hopelessness
What is important for early management of conduct disorder?
early intervention, addressing risk and individual features of the disorder
warrants use of a multiprofessional team with effective networking facilites?
comprehensive intervention
Parent management of conduct disorder?
Develop parenting skills, group parent training useful for changing behavior in children <3 y/o
Who are important partners in parent management of conduct disorders?
social service/child welfare services
What therapy is the best for conduct disorder?
behavioral and cognitive-behavioral individual or group therapy
What medication is the best for conduct disorder?
Risperidone (age 5-18 w/ disruptive behavior disorders in the short term)
What is the prognosis for conduct disorder?
40% of childhood onset develops into adult antisocial personality disorder
What is ADHD?
Attention deficit/hyperactivity disorder, developmentally inappropriate lack of attention and/or hyperactivity and impulsivity that interferes with a patient life
Most common neurobehavioral condition in children
ADHD
What does a MRI show in ADHD?
different morphology in prefrontal lobes, smaller, volume of the white matter of the right frontal lobe, and smaller volume of the left caudate head
DECREASED metabolic activity in the frontal lobe
What are 5 Risk factors for developing ADHD?
Inheritability (76% based on twin studies)
Exposure to lead
Low birth weight
Prenatal exposure to alcohol and/or nicotine
Traumatic brain injury
How does DSM5 define ADHD?
A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes w/ functioning or development characterized by at least one:
- Inattention
- Hyperactivity and impulsivity
What is the DSM5 criteria for ADHD?
at least inattention OR hyperactivity and impulsivity
PLUS
least 6 symptoms within one category persisting for >6mo
To what degree must ADHD symptoms be inconsistent until?
inconsistent w/ developmental level & negatively impacts social, academic, or occupational activities
What are the FOUR DSM 5 symptom criteria for ADHD?
1) several inattentive or hyperactive impulsive symptoms were present <12y/o
2) are present in two or more settings (home, school, work, w/ friends or relatives)
3) CLEAR EVIDENCE THAT THE SYMPTOMS INTERFERE with or reduce quality of social, academic, or occupational functioning
4) Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder
Most effective tool in diagnosing ADHD?
Connors Abbreviated Symptom Questionnaire
What is the first line management for ADHD?
Psychostimulants
How is the dosage given for ADHD?
start low dosage and titrate as needed in 2 week to 4 week intervals
What happens at a follow up appointment for ADHD?
monitoring outcomes and side effect such as weight loss, anorexia, and insomnia
What happens if they fail to respond to a stimulant?
Try another one
T/F “Drug holidays” are routinely recommended because ADHD is chronic and pervasive disorder
FALSE, it is NOT, only on a case-by-case basis
HELPFUL Complimentary/ Alternative management of ADHD?
Yoga (helpful for boys stable on meds)
Melatonin (3-6mg @ bedtime)
NON-HELPFUL Complimentary/ Alternative management of ADHD?
Mediation
Acupuncture
Magnesium
Megavitamins (INEFFECTIVE AND POTENTIALLY DANGEROUS)
Food Coloring (increases global hyperactivity in some 3-4yo and 8-9yo)
What does ASD stand for?
Autism Spectrum Disorder (ASD)
What is ASD?
biologically based neurodevelopmental disorder w/ persistent deficits in social communication and social interaction and restricted, repetitive patterns of behavior, interests, and activities
What are ICD-10 classification subtypes?
Childhood autism
Atypical autism
Asperger syndrome
Prevalence theories of ASD?
unclear if its a true increase in incidence OR broadened diagnostic criteria, heightened awareness, and diagnostic substitution
What causes ASD?
complex heritable disorders that involves the interplay of multiple genes and environmental factors
What are 6 risk factors for ASD?
Sibling w/ autism
Advanced maternal age
Advanced paternal age
Prenatal valproic acid
Maternal history of pregnancy-related bleeding or gestational diabetes
Maternal history of rheumatoid arthritis or celiac dx
What are 3 NON RISK factors for ASD?
MMR vaccine or thimerosal containing vaccines
Labor induction
1ST trimester antidepressant use
What is DSM-5 criteria for ASD symptoms?
must be present in the early developmental period
What is childhood autism?
abnormal or impaired development is evident before the age of 3 years in at least one of 3 areas
What are the 3 areas of classifying autism?
- Receptive or expressive language as used in social communication
- Development of selective social attachments or of reciprocal social interaction
- Functional or symbolic play
What is Asperger syndrome?
lack of any clinically significant general delay in spoken or receptive language or cognitive development
What symptoms present in the 1st year of life in ASD?
reduced response to name and reduced frequency of looking at faces
What symptoms present in the 2nd year of life in ASD?
difficulties sharing experiences, interests or attention with others
What is the role of the PCM in ASD?
suspect and screen for kids w/ abnormalities in social interaction
What are the 11 red flags of ASD?
1.Parent concerns about deficits in social skills
2. Parent concerns about language skills or behavior
3. Parent concerns about frequent tantrums or intolerance to change
4. Delayed language or social communication skills
5. No babbling by 9 mo
6. No pointing or gestures by 12mo
7. Lack of orientation to name by 12 mo
8. No single words by 16 mo
9. Lack of pretend or symbolic play by 18mo
10 No spontaneous, meaningful two word phrases by 24mo
11. Any loss of any language or social skills at any age
Screening for ASD?
recommends all kids are screened at 18-24 mo
> 24 mo only if there are concerns for ASD
What screening questionnaire is used for 4-11yo?
Autism Spectrum Quotient Child (AQ-Child)
What screening questionnaire is used for 7-16 yo?
Autism Spectrum Screening Questionnaire (ASSQ)
Positive screen for ASD parental education?
appropriate schools, respite facilities, parent groups and other community based support systems
What age should a early intervention specialist be referral for ASD?
<3 yo
What age should a public school be referral for ASD?
> 3 yo
What 4 things can be done for a positive ASD screen?
- Parental education
- Referrals
- Audiological evaluation
- Genetic counseling
