Pediatric Behavioral Medicine

Question 1

What is colic?

Answer 1

inconsolable crying in a young infant without known cause (diagnosis of exclusion)

Wessel’s Rule of 3s

crying for more than 3 hours per day for more than 3 days per week for more than 3 weeks

Question 2

what is the definition of a temper tantrum?

Answer 2

out of control behavior, including screaming, stomping, hitting, head banging, falling down and other violent displays of frustration

normal human developmental stage 18 months-4 years

Question 3

what are the different types of breath holding spells?

Answer 3

cyanotic - screaming or crying, breath-holding and turning blue, arch and pass out

pallid - startled or frightened children stop breathing and drop (fainting)

Question 4

when is an EEG indicated in a breath holder?

Answer 4

where there is a period of seizure-like activity for more than 2 minutes

Question 5

when does breath holding end?

Answer 5

many stop by 4

almost all stop by 7 or 8

Question 6

when does the AAP recommend you perform developmental screening?

Answer 6

9, 18, and 30 months

Question 7

what are the different types of developmental delay

Answer 7

isolated - one area (usually speech-language)

global - delay in three or more areas

atypical - asynchronous or “out of order” (ASD)

Question 8

What is the DSM-5 definition of ASD?

Answer 8

A. Persistent deficits in social communication and social interaction accross contexts, not accounted for by general develop. delays (and all three of the following):

1. problems in social-emotional reciprocity
2. deficits in non-verbal communicative behavior used for social interaction
3. deficits in developing and maintaining relationships appropriate to developmental level

and B. presence of restricted, repetitive , stereotyped behavior and activities (and at least two of the following):

1. stereotyped speech
2. excessive adherence to routines, ritualized behavior, resistance to change
3. highly restricted, fixated interests that are abnormal in intensity or focus
4. hyper- or hypo-reactivity to sensory input or usual interest in sensory aspects of the environment

Question 9

what are the speech intelligibility guidelines?

Answer 9

50% at 2 years

75% at 3 years

100% at 4 years

Question 10

what medications are approved treatments for ADHD?

Answer 10

stimulant medications - mixed amphetamine sals, dextroamphetamine, lisdexamphetamine, methylphenidate, dexmethylphenidate

non-stimulant medications - amoxetine, long-acting alpha agonsists (guanfacine, clonidine)

Question 11

what are the subtypes of ADHD?

Answer 11

inattentive - more females, suspected diagnosed later (20%)

hyper/impulsive type (15%)

mixed (65%)

Question 12

what are some common co-morbidities with ADHD?

Answer 12

• learning disorders
• oppositional defiant disorder
• language disorders
• anxiety disorders
• mood disorders
• conduct disorder
• smoking
• substance use disorder

Question 13

what is failure to thrive?