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
Narrow Band Scales for ADHD
Establish presence of core symptoms | Depends on age of child, scale used, & informant
26
Broadband Scales Assess What for ADHD
Internalizing behaviors Externalizing behaviors other than ADHD Identify coexisting condition & narrow DDx
27
Educational Evaluation of ADHD
Teacher completes ADHD specific rating scale Narrative summary of classroom behavior & interventions, learning patterns, & functional impairment Copies of report cards & schoolwork Review multidisciplinary evals
28
DSM-5 Criteria for ADHD
6+ symptoms of hyperactivity & impulsivity OR inattention 17+ years is 5+ symptoms of hyperactivity & impulsivity OR inattention
29
Hyperactivity/Impulsivity or inattention must do what according DSM-5 criteria?
``` Occur often Present in 2+ settings Persist for 6+ months Present before 12 years Impair function in academic, social, or occupational activities Be excessive ```
30
3 Subtypes of ADHD
Predominantly inattentivie Predominantly hyperactive-impulse Combined
31
Treatment of ADHD
Behavioral interventions Medication School-based interventions Psychological interventions alone or in combination
32
Treatment goals of ADHD
Improved relationships with parents, teachers, siblings, or peers Improved academic performance Improved rule following
33
Indications for ADHD Referral
Coexisting psychiatric conditions Coexisting neurologic or medical conditions Lack of response to controlled trial of stimulant therapy or atomoxetine
34
Who to Refer ADHD Patients to?
``` Developmental behavioral pediatrician Child neurologist Psychopharmacologist Child psychiatrist Clinical child psychologist ```
35
Criteria for Initiation of Pharmacotherapy in Children with ADHD
``` 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
Medical Therapy for ADHD
``` Dextroamphetamine (S) Methylphenidate (S) Atomoxetine (Strattera) [NS} Buproprion (Wellbutrin) [NS] TCAs [NS] SSRIs [NS] MAOIs [NS] Alpha adrenergic agonists [NS] ```
37
Pretreatment work-up for ADHD
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
First Line Stimulant Agents for ADHD
``` Ritalin Methylin Ritalin SR Metadate ER Methylin ER Ritalin LA Metadate CD Concerta Daytrana Dextrostate Dexedrine Spansule Adderall Adderall XR Focalin ```
39
Second Line Stimulant Agent for ADHD
Atomoxetine (Strattera)
40
Third Line Stimulant Agents for ADHD
``` Bupropion (Wellbutrin) Imipramine (Tofranil) Desipramine (Norpramin) Clonidine (Catapres) Guanfacine (Tenex) ```
41
Medication Management of ADHD
Start with short acting Start low & titrate up "Drug holidays"
42
ADHD Medication Black Box Warning for Stimulants
Increased risk of sudden death CV problems Drug dependency
43
ADHD Medication SE
``` Appetite suppression Abdominal pain Headache Insomnia Irritability Tics Associated with growth delay ```
44
Medication for Preschool Children with ADHD
Methylphenidate
45
3 Types of Autism Spectrum Disorders
Autistic disorder Asperger syndrome Pervasive developmental disorder not otherwise specified
46
Prevalence of Autism Spectrum Disorders
1:88 US children | Male > Female
47
Etiology of Autism Spectrum Disorders
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
3 Main Areas of Function Affected by Autism Spectrum Disorders
Social interaction Communication Behaviors & interests
49
Autistic Behavior
Development delayed from birth | Sudden loss of social or language skills after normal development
50
Asperger's Syndrome
``` 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
Pervasive Development Disorder not Otherwise Specified (PDD-NOS)
``` Between Autism & Asperger's Symptoms vary Impaired social interaction Fewer repetitive behaviors Later age of onset ```
52
Autism Impairments
``` Social functioning Language Repetitive behaviors Mental retardation Seizures ```
53
Risk Factors for Surveillance for Autism Spectrum Disorder
``` Sibling with ASD Parent concern Inconsistent hearing Unusual responsiveness Caregiver concern Pediatrician concern ```
54
Routine Screening for Autistic Spectrum DIsorder
Screen specifically at 18-24 months MCHAT- modified checklist for autism in toddlers STAT- screening tool for autism in toddlers & young children
55
MCHAT Screening
``` 16-48 months Questionnaire Interest in other children Index finger to point/ indicate interest in something Oversensitive to noise Child imitate you ```
56
Red Flags for Autistic Spectrum Disorder
``` 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
Goals of Autistic Spectrum Disorder Treatment
Minimize core features Maximum functional independence Maximize QOL Maximize family function
58
Comprehensive Treatment
Intervention immediately 25 hours/week year round in "systematically planned, developmentally appropriate educational activities" Low student:teacher ratio Inclusive experience with developing peers
59
Educational Interventions for Autistic Spectrum Disease
``` Applied behavioral analysis Structured teaching Developmental Relationship focused Speech & language therapy Social skills instruction OT ```
60
Common Behavioral Issues in Autistic Spectrum Disorder
``` Disruption/aggression Self-injurious Eating Sleeping Toileting ```
61
Medical Management of Autistic Spectrum Disorder
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
Associated Medical Conditions
GI: chronic constipation/diarrhea Recurrent abdominal pain Seizures Sleep problems
63
Define Oppositional Defiant Disorder (ODD)
Psychiatric disorder that is characterized by aggressiveness and tendency to purposefully bother & irritate others Negative, manipulative, hostile, & deviant behavior
64
Etiology of Oppositional Defiant Disorder (ODD)
Family history
65
DSM-5 Criteria for ODD
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
Symptoms of Angry & Irritable Mood in ODD
Often loses temper Often touchy or easily annoyed by others Often angry & resentful
67
Symptoms of Argumentative & Defiant Behavior in ODD
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
Symptoms of Vindictiveness in ODD
Often spiteful or vindictive | Shown spiteful or vindictive behavior at least twice in 6+ months
69
Prognosis of ODD
Some outgrow this May turn into something else May have without anything else ODD + comorbid anxiety, ADHD, or depressive disorders
70
Treatment for ODD
Referral to pediatric psychiatrist Meds for co-morbid disorders Behavioral therapy Parental therapy for setting clear boundaries
71
Define Conduct Disorder (CD)
Group of behavioral and emotional problems in children Significant difficulty following rules & behaving in a socially acceptable way "Bad" kids or delinquents
72
Factors that Contribute to Conduct Disorder (CD)
``` Brain damage Child abuse Neglect Genetic vulnerability School failure Traumatic life experiences ```
73
Conduct Disorder vs. ODD
Conduct disorder worse version of ODD ODD have worse social skills ODD do better in school CD most serious childhood psychiatric disorder
74
Co-morbid Conditions Associated with CD
``` Depression/anxiety disorders PTSD Substance abuse ADHD Learning problems Bipolar disorder Tourette's syndrome ```
75
Conduct Disorder Characterized by
Aggression to people & animals Destruction of property (arson) Deceitfulness, lying or stealing Serious violations of the rules
76
Characteristics of CD for Aggression to People & Animals
``` 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
Treatment for Conduct Disorder
Referral to Psychiatrist for behavioral therapy, psychotherapy, parental support & training, meds for comorbid conditions
78
Prognosis of Conduct Disorder
Similar problems into adulthood Likely to have personality disorder Abuse of substances 4 years later Cigarett smoking
79
DSM-5 for Depression
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
Medical Evaluation to Rule Out Etiologies
``` Infection Medication Endocrine disorder Tumor Neurologic disorder Misc. disorders ```
81
Acronym for Signs/Symptoms of Major Depression
SIG E CAPS
82
Signs & Symptoms of Major Depression
``` S- sleep disturbance I- interests G- guilt E- energy C- concentration problems A- appetite change P- pleasure S- suicidal though/actions ```
83
Treatment for Depression
Psychotherapy Medical therapy Combination of both
84
Medical Treatment of Depression with SSRIs
Fluoxetine (Prozac) | Escitalopram (Lexapro)
85
SSRI Black Box Warning
Increase suicide risk | Weigh risks vs. benefit