Pediatric Psych

Question 1

HEADSSS

Answer 1

Home: including people living in the home

Education: grades, missing school

Activities: sports, job, friends

Drugs: smoke/ETOH/drugs - any trouble w/ substance abuse @ home

Sex

Suicide/depression

Safety: home/school/neighborhood - any abuse physical/sexual

Question 2

Intellectual Disability (ID)

Answer 2

Neurodevelopmental disorders with multiple etiologies

Broad spectrum of functioning, disabilities, speech

Usually present before 18 yo, may grow out of it

Global Developmental Delay (GDD) is the big one

Question 3

Global Developmental Delay (GDD)

Answer 3

Children <5 yo who fail to meet expected developmental milestones

-Have significant impairments in several areas of functioning

Multiple screening tools - if any suggest delay refer pt on

Treatment: early intervention w/ multidisciplinary team and family support/counseling

Question 4

Global Developmental Delay (GDD) two main components

Answer 4

Adaptive behavior - home or school

Intellectual functioning - conceptual, social, practical

Question 5

Global Developmental Delay DSM-V Criteria

Answer 5

IQ less than or equal to 70 (intellectual dysfunction)

with concurrent deficits/impairments in adaptive functioning (2 or more):

Communication

Self-care

Home living

Social-interpersonal/community resource skills

Self-direction

Functional academic/work skills

With onset before 18 yo

Question 6

Dyslexia

Answer 6

Males, often concomitant w/ ADHD

Delayed language production, speech articulation, remembering letters/number/color

Screen: evaluate medical, cognitive, sensory, education, psych

Tx: remedial education - identify areas of improvement

• Frequent instruction by reading specialist using multisensory methods
• Cannot correct underlying brain malfunction

Question 7

Dyscalculia

Answer 7

Math disability

Difficulty w/ number lines, carrying/borrowing numbers, word problems

Tx: allow finger/scratch paper use, diagrams, and math concepts, peer assistance, suggest graph paper use

Question 8

Dysgraphia

Answer 8

Writing disability

Difficulty expressing thoughts in writing

Difficult w/ grammar/syntax, formulating/expressing/organizing thoughts in writing, spelling (encoding)

Dx: only by learning disability psychologist

Tx: Accommodation, modification, remediation

Question 9

Enuresis Medical therapy

Answer 9

Desmopressin acetate (DDAVP) - 1st line

Oxybutynin with daytime incontinence from overactive bladder

Imipramine with urinary sphincter control

Question 10

Encopresis

Answer 10

Repeated stool passage in inappropriate places

Stool retention with wall and nerve stretching - 80% have constipation

Initial treatment - enema, strong laxatives

Maintenence (2-3 mo) scheduled toilet time, daily laxatives, proper diet

Question 11

Autism Spectrum Disorders

Answer 11

Neurodevelopmental disorder affecting brain functioning

Classic: very limited emotional connection, routine for everything, affected by noises, bright lights

Onset before 3 years old

Seizure disorder, depression are common complications

Tx: Integration and special techniques at school

Question 12

Autism screening

Answer 12

M-CHAT: 18-24 months

STAT: for toddlers and young kids

Surveillance @ every visit - 3 questions -> does your child….?:

• Look at you and point to show you something
• Look where you point
• Use imagination to play pretend