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Pediatrics > Pediatric Psych > Flashcards

Pediatric Psych Flashcards

1
Q

Manifestations of ADHD

A

Hyperactivity
Impulsivity
Inattention

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2
Q

Symptoms of ADHD

A 
Cognitive functioning
Academic functioning
Behavioral functioning
Emotional functioning
Social functioning
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3
Q

Hyperactive ADHD Male to Female Ratio

A

4:1

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4
Q

Inattentive ADHD Male to Female Ratio

A

2:1

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5
Q

Comorbid Disorders of ADHD

A 
Oppositional defiant disorder
Conduct disorder
Depression
Anxiety disorder
Learning disabilities
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6
Q

Pathogenesis of ADHD

A

Genetic imbalance of catecholamine metabolism in cerebral cortex
Environmental factors

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7
Q

Cerebral & Functional Abnormalities in ADHD Result in

A

Impaired executive functions

Impulsivity

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8
Q

Impaired Executive Functions in ADHD

A

Forward planning
Abstract reasoning
Mental flexibility
Working memory

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9
Q

Dietary influences on ADHD

A 
Food additives
Refine sugar intake
Food sensitivity
Essential fatty acid deficiency
Iron & zinc deficiency
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10
Q

Associations with ADHD

A 
Prenatal exposure to tobacco
Prematurity
Low birth weight
Prenatal exposure to alcohol
Head trauma in young children
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11
Q

Symptoms of ADHD

A

Inattentiveness
Impulsivity
Hyperactivity

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12
Q

Diagnosis of ADHD

A

Persistence, pervasiveness, and functional complications of the behavioral symptoms

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13
Q

Criteria for ADHD

A

Present in more than one setting
Persist for 6+ months
Present before age 12
Impair function in academic, social, or occupational activities
Excessive for developmental level of the child
Other mental disorders

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14
Q

Symptoms of Hyperactivity ADHD

A

Excessive Fidgetiness
Difficulty remaining seated when sitting is required
Feelings of restlessness or inappropriate running around or climbing
Difficulty playing quietly
Difficult to keep up with

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15
Q

Symptoms of Impulsivity ADHD

A

Excessive talking
Difficulty waiting turns
Blurting out answers too quickly
Interruption or intrusion of others

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16
Q

When are hyperactive ADHD symptoms typically observed?

A

By the time child reaches 4
Increase up to 7-8
After 8, symptoms decline
Adolescent- may not be noticeable

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17
Q

When are impulsive ADHD symptoms usually observed?

A

Persist throughout life

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18
Q

Symptoms of Inattention ADHD

A

Failure to provide close attention to detail, careless mistakes
Difficulty maintaining attention in play, school, or home activities
Seems not to listen, even when addressed
Fails to follow through
Difficulty organizing tasks, activities, & belongings
Avoids tasks that require mental effort
Loses objects required for tasks or activities
Easily distracted by irrelevant stimuli
Forgetfulness in routine activities

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19
Q

Description of the Inattentive Subtype of ADHD

A

Sluggish cognitive tempo and frequently appear to be daydreaming or “off task”

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20
Q

ADHD Symptoms Impair Function in 3 Areas

A

Academic
Social
Occupational

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21
Q

Evaluation of a Child with ADHD

A

Medical
Developmental
Educational
Psychosocial evaluation

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22
Q

Medical Evaluation of ADHD

A 
School- learning, happy, behavioral problems, completing assignments
Prenatal exposures
Perinatal complications or infections
CNS infection
Head trauma
Recurrent OM
Meds
Family Hx of similar behaviors
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23
Q

PE of ADHD Children

A 
Measurements
Dysmorphic features
Neurocutaneous abnormalities
Neuro exam
Observation of behavior
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24
Q

Developmental & Behavioral Assessment of ADHD child

A 
Onset, course, functional impact
Emotional, medical,& developmental events
Developmental milestones
School abscess
Psychosocial stressors
Observation of parent-child interactions
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25
Q

Narrow Band Scales for ADHD

A

Establish presence of core symptoms

Depends on age of child, scale used, & informant

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26
Q

Broadband Scales Assess What for ADHD

A

Internalizing behaviors
Externalizing behaviors other than ADHD
Identify coexisting condition & narrow DDx

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27
Q

Educational Evaluation of ADHD

A

Teacher completes ADHD specific rating scale
Narrative summary of classroom behavior & interventions, learning patterns, & functional impairment
Copies of report cards & schoolwork
Review multidisciplinary evals

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28
Q

DSM-5 Criteria for ADHD

A

6+ symptoms of hyperactivity & impulsivity OR inattention
17+ years is 5+ symptoms of hyperactivity & impulsivity OR inattention

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29
Q

Hyperactivity/Impulsivity or inattention must do what according DSM-5 criteria?

A 
Occur often
Present in 2+ settings
Persist for 6+ months
Present before 12 years
Impair function in academic, social, or occupational activities
Be excessive
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30
Q

3 Subtypes of ADHD

A

Predominantly inattentivie
Predominantly hyperactive-impulse
Combined

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31
Q

Treatment of ADHD

A

Behavioral interventions
Medication
School-based interventions
Psychological interventions alone or in combination

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32
Q

Treatment goals of ADHD

A

Improved relationships with parents, teachers, siblings, or peers
Improved academic performance
Improved rule following

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33
Q

Indications for ADHD Referral

A

Coexisting psychiatric conditions
Coexisting neurologic or medical conditions
Lack of response to controlled trial of stimulant therapy or atomoxetine

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34
Q

Who to Refer ADHD Patients to?

A 
Developmental behavioral pediatrician
Child neurologist
Psychopharmacologist
Child psychiatrist
Clinical child psychologist
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35
Q

Criteria for Initiation of Pharmacotherapy in Children with ADHD

A 
Confirmation of ADHD
6+ years
Parents approval
School cooperation
No sensitivity to med
Normal HR & BP
Seizure free
Not have Tourette syndrome
Not have pervasive developmental delay
Not have significant anxiety
Substance abuse not a concern
36
Q

Medical Therapy for ADHD

A 
Dextroamphetamine (S)
Methylphenidate (S)
Atomoxetine (Strattera) [NS}
Buproprion (Wellbutrin) [NS]
TCAs [NS]
SSRIs [NS]
MAOIs [NS]
Alpha adrenergic agonists [NS]
37
Q

Pretreatment work-up for ADHD

A

Comprehensive, CV focused patient hx, family hx, and PE
Vitals & assess growth
Pretreatment baseline for SE
Substance use/abuse
Prescribed to help with self-control & ability to focus
Review risks & benefits
Explanation of process & length of time
Frequency of follow-up
Information needed at follow up appt.
Behaviors/SE that family should monitor

38
Q

First Line Stimulant Agents for ADHD

A 
Ritalin
Methylin
Ritalin SR
Metadate ER
Methylin ER
Ritalin LA
Metadate CD
Concerta
Daytrana
Dextrostate
Dexedrine
Spansule
Adderall
Adderall XR
Focalin
39
Q

Second Line Stimulant Agent for ADHD

A

Atomoxetine (Strattera)

40
Q

Third Line Stimulant Agents for ADHD

A 
Bupropion (Wellbutrin)
Imipramine (Tofranil)
Desipramine (Norpramin)
Clonidine (Catapres)
Guanfacine (Tenex)
41
Q

Medication Management of ADHD

A

Start with short acting
Start low & titrate up
“Drug holidays”

42
Q

ADHD Medication Black Box Warning for Stimulants

A

Increased risk of sudden death
CV problems
Drug dependency

43
Q

ADHD Medication SE

A 
Appetite suppression
Abdominal pain
Headache
Insomnia
Irritability
Tics
Associated with growth delay
44
Q

Medication for Preschool Children with ADHD

A

Methylphenidate

45
Q

3 Types of Autism Spectrum Disorders

A

Autistic disorder
Asperger syndrome
Pervasive developmental disorder not otherwise specified

46
Q

Prevalence of Autism Spectrum Disorders

A

1:88 US children

Male > Female

47
Q

Etiology of Autism Spectrum Disorders

A

Secondary to environmental, biologic, and genetic factors
Prenatal exposure to Valproic acid or thalidomide
Prematurity or low birth weight
Born to older parents
Co-occurs with other developmental, psychiatric, neurologic, chromosomal & genetic diagnosis

48
Q

3 Main Areas of Function Affected by Autism Spectrum Disorders

A

Social interaction
Communication
Behaviors & interests

49
Q

Autistic Behavior

A

Development delayed from birth

Sudden loss of social or language skills after normal development

50
Q

Asperger’s Syndrome

A 
Mildest form of autism
Boys > Girls 3:1
Interested in single object/topic
Impaired social interaction
Normal to above average intelligence
High risk for anxiety and depression
51
Q

Pervasive Development Disorder not Otherwise Specified (PDD-NOS)

A 
Between Autism & Asperger's
Symptoms vary
Impaired social interaction
Fewer repetitive behaviors
Later age of onset
52
Q

Autism Impairments

A 
Social functioning
Language
Repetitive behaviors
Mental retardation
Seizures
53
Q

Risk Factors for Surveillance for Autism Spectrum Disorder

A 
Sibling with ASD
Parent concern
Inconsistent hearing
Unusual responsiveness
Caregiver concern
Pediatrician concern
54
Q

Routine Screening for Autistic Spectrum DIsorder

A

Screen specifically at 18-24 months
MCHAT- modified checklist for autism in toddlers
STAT- screening tool for autism in toddlers & young children

55
Q

MCHAT Screening

A 
16-48 months
Questionnaire
Interest in other children
Index finger to point/ indicate interest in something
Oversensitive to noise
Child imitate you
56
Q

Red Flags for Autistic Spectrum Disorder

A 
Regression
"In their own world"
Lack of showing, sharing interest or enjoyment
Using caregivers hands to obtain needs
Repetitive movements with objects
Lack of appropriate gaze
Lack of response to name
Unusual prosody/pitch of vocalizations
Repetitive movements or posturing
57
Q

Goals of Autistic Spectrum Disorder Treatment

A

Minimize core features
Maximum functional independence
Maximize QOL
Maximize family function

58
Q

Comprehensive Treatment

A

Intervention immediately
25 hours/week year round in “systematically planned, developmentally appropriate educational activities”
Low student:teacher ratio
Inclusive experience with developing peers

59
Q

Educational Interventions for Autistic Spectrum Disease

A 
Applied behavioral analysis
Structured teaching
Developmental
Relationship focused
Speech & language therapy
Social skills instruction
OT
60
Q

Common Behavioral Issues in Autistic Spectrum Disorder

A 
Disruption/aggression
Self-injurious
Eating
Sleeping
Toileting
61
Q

Medical Management of Autistic Spectrum Disorder

A

Challenges in routine health care due to difficulties wit social interaction, communication, & negotiating a new & unfamiliar environment
Visit time x2
Strategies in office to promote familiarity

62
Q

Associated Medical Conditions

A

GI: chronic constipation/diarrhea
Recurrent abdominal pain
Seizures
Sleep problems

63
Q

Define Oppositional Defiant Disorder (ODD)

A

Psychiatric disorder that is characterized by aggressiveness and tendency to purposefully bother & irritate others
Negative, manipulative, hostile, & deviant behavior

64
Q

Etiology of Oppositional Defiant Disorder (ODD)

A

Family history

65
Q

DSM-5 Criteria for ODD

A

Four symptoms from categories (angry & irritable mood, argumentative & deviant behavior, vindictiveness)
Occurs with 1+ individuals who is not a sibling
Causes problems at work, school, or home
Occurs on its own
Lasts at least 6 months

66
Q

Symptoms of Angry & Irritable Mood in ODD

A

Often loses temper
Often touchy or easily annoyed by others
Often angry & resentful

67
Q

Symptoms of Argumentative & Defiant Behavior in ODD

A

Often argues with adults or people in authority
Often actively defies or refuses to comply with adults’ requests or rules
Often deliberately annoys people
Often blames others for mistakes or misbehavior

68
Q

Symptoms of Vindictiveness in ODD

A

Often spiteful or vindictive

Shown spiteful or vindictive behavior at least twice in 6+ months

69
Q

Prognosis of ODD

A

Some outgrow this
May turn into something else
May have without anything else
ODD + comorbid anxiety, ADHD, or depressive disorders

70
Q

Treatment for ODD

A

Referral to pediatric psychiatrist
Meds for co-morbid disorders
Behavioral therapy
Parental therapy for setting clear boundaries

71
Q

Define Conduct Disorder (CD)

A

Group of behavioral and emotional problems in children
Significant difficulty following rules & behaving in a socially acceptable way
“Bad” kids or delinquents

72
Q

Factors that Contribute to Conduct Disorder (CD)

A 
Brain damage
Child abuse
Neglect
Genetic vulnerability
School failure
Traumatic life experiences
73
Q

Conduct Disorder vs. ODD

A

Conduct disorder worse version of ODD
ODD have worse social skills
ODD do better in school
CD most serious childhood psychiatric disorder

74
Q

Co-morbid Conditions Associated with CD

A 
Depression/anxiety disorders
PTSD
Substance abuse
ADHD
Learning problems
Bipolar disorder
Tourette's syndrome
75
Q

Conduct Disorder Characterized by

A

Aggression to people & animals
Destruction of property (arson)
Deceitfulness, lying or stealing
Serious violations of the rules

76
Q

Characteristics of CD for Aggression to People & Animals

A 
Bullies, threatens or intimidates
Physical fights
Use of weapons to harm others
Physically cruel to people or animals
Steals
Forces others into sexual acts
77
Q

Treatment for Conduct Disorder

A

Referral to Psychiatrist for behavioral therapy, psychotherapy, parental support & training, meds for comorbid conditions

78
Q

Prognosis of Conduct Disorder

A

Similar problems into adulthood
Likely to have personality disorder
Abuse of substances 4 years later
Cigarett smoking

79
Q

DSM-5 for Depression

A

Depressed mood
Diminished interest or loss of pleasure in almost all activities
Sleep disturbance
Weight change
Appetite disturbance
Failure to achieve weight gain
Decreased concentration or indecisiveness
Suicidal ideation
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or appropriate guilt

80
Q

Medical Evaluation to Rule Out Etiologies

A 
Infection
Medication
Endocrine disorder
Tumor
Neurologic disorder
Misc. disorders
81
Q

Acronym for Signs/Symptoms of Major Depression

A

SIG
E
CAPS

82
Q

Signs & Symptoms of Major Depression

A 
S- sleep disturbance
I- interests
G- guilt
E- energy
C- concentration problems
A- appetite change
P- pleasure
S- suicidal though/actions
83
Q

Treatment for Depression

A

Psychotherapy
Medical therapy
Combination of both

84
Q

Medical Treatment of Depression with SSRIs

A

Fluoxetine (Prozac)

Escitalopram (Lexapro)

85
Q

SSRI Black Box Warning

A

Increase suicide risk

Weigh risks vs. benefit

Pediatrics (23 decks)

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