Pediatric Psychiatry Flashcards
A preschooler misses his long-term nanny who has recently moved away. To help this child, the parents should: (2x)
SHOW THE CHILD PICTURES OF THE NANNY
Newly married college graduate now needing more parental support with decisions
PHASE OF LIFE PROBLEM
Adopted kid, shy and clings to mother, difficulty at school
REACTIVE ATTACHMENT DISORDER
Secure attachment in an infant is associated with which of the following outcomes?
EMOTIONAL AND SOCIAL COMPETENCE
2 y/o M has been preoccupied with a small blanket for several months, carries it w/ him everywhere and becomes upset if anyone tries to take it away. He refused to stay w/ a baby-sitter until it was retrieved. The psychiatrist should:
EXPLAIN THIS IS NORMAL AND CHILD WILL EVENTUALLY GIVE IT UP ON HIS OWN.
10 month old child distressed when parents leave him with the babysitter. The parents say goodbye and leave quickly without display of affection. What is most likely to observed later in life?
INCREASED CLINGING AND AVOIDANT BEHAVIOR TOWARDS BEHAVIOR
Adult’s patterns of interacting with others predicted by what according to object relations and attachment theory
CAPACITY TO PERCEIVE AND THINK ABOUT THE INTENTIONS OF OTHERS
Infants are more likely to have insecure attachment with poor child care if primary caretakers are also:
UNRESPONSIVE TO THEIR INFANT’S NEEDS
Hormone shown to be critical to the development of maternal-infant bonding in animals:
OXYTOCIN
In contrast to attachment, “bonding” is associated with
THE NATURE OF A PARENT’S RELATIONSHIP TO AN INFANT
Key characteristic of preschoolers who are securely attached
TRUST AND RECIPROCITY
What has been found regarding infants’ attachment to their parents?
STRENGTH OF INFANT’S ATTACHMENT IS A FUNCTION ONLY OF THE AMT OF INTERACTION WITH THE PRIMARY PARENT
5 y/o child with behavioral problems in school, in and out of foster care for the first 2 years of life. Friendly and affectionate with others even with strangers. Parents don’t feel “close” to the child and doesn’t seem to have enduring friendships. Diagnosis:
REACTIVE ATTACHMENT DISORDER
4 yo raised in Multple foster homes, minimally smiles , does not seek comfort
REACTIVE ATTACHMENT DISORDER
Toddler soothed at night by inner memory of secure relationship with mother. Called what (in attachment theory):
OBJECT CONSTANCY
10-month old infant becomes distressed when parents leave child w/ babysitter without affection. Which subsequent behavior pattern is likely?
CLINGY AND AVOIDANT TOWARD PARENTS
18 month old shows a marked awareness of vulnerability to separation and seems to be constantly concerned about the mother’s actual location is exhibiting Mahler’s stage of?
OBJECT CONSTANCY
5 y/o adopted at age 4 now hugging strangers, age appropriate vocabulary, doesn’t respond well to limits, easily frustrated.
REACTIVE ATTACHMENT D/O
3 y/o with diminished appetite, slow speech development, poor social interactions; parents are detached from him. After 2 weeks in hospital is improving and friendly with staff members. Dx?
REACTIVE ATTACHMENT D/O
20-month child repeatedly returns to her mom when playing w/ other 2-y/o children. This is:
RAPPROCHEMENT
The term rapprochement in Mahler’s developmental theory refers to the:
RECONCILIATION FOLLOWING A BRIEF ATTACHMENT RUPTURE BETWEEN TODDLERS AND PARENTS
Final phase of Mahler’s separation — ability to maintain positive emotional attachment in face of frustration
OBJECT CONSTANCY
Following a brief separation from the parents, a securely attached toddler is most likely to do which of the following:
SEEK CONTACT EAGERLY
According to operant conditioning, behavior decreases in frequency if (5x)
INCOMPATIBLE WITH A POSITIVELY REINFORCED BEHAVIOR
Pt with cocaine addiction experiences cravings for cocaine whenever passing by a “crack house”. This reaction exemplifies: (3x)
CLASSICAL CONDITIONING
A form of learned fear in which a person or an experimental animal learns to respond strongly not only to a harmful stimulus, but also to a sub-threshold stimulus, refers to: (3x)
SENSITIZATION
Most important protective factor determining preschool child’s reaction to disaster (2x)
PARENTAL FUNCTIONING
Risk factor influencing psychological outcome of child following death of parent: (2x)
PRIOR CONFLICTUAL RELATIONSHIP BETWEEN CHILD AND DECEASED PARENT
Behavioral frequency altered by application of positive and negative consequences (2x)
OPERANT CONDITIONING
An operant conditioning reinforcement schedule that is used in casino slot machines and may play a role in the development of pathological gambling: (x2)
VARIABLE-RATIO
Pt works near a train and soon doesn’t notice the noise anymore. What’s this called?
HABITUATION
Effect of prompts for tobacco use on provider behaviors
BEHAVIORS INCREASE
In behavioral psychology, extinction is defined as :
WEAKENING OF CONDITIONED RESPONSE DUE TO WITHDRAWAL OF STIMULUS
A 10-yo child is afraid of dogs and has exposure therapy to the point where he can tolerate a small dog. A week later, he encounters a large dog. What is his response?
GIVEN THE NON-CLINICAL SETTING, THE REACTION IS IMPOSSIBLE TO PREDICT
Child is shown a rat and does not react. Then show child rat w a loud noise. After several pairing of rat and noise, the child then becomes fearful when just rat presented. In Pavlovian conditioning, what is the conditioned stimulus in this case?
THE RAT
In biofeedback, the autonomic nervous system can come under voluntary control through which of following mechanisms?
OPERANT CONDITIONING
Repeated presentation of a conditioned stimulus without being paired with its unconditioned stimulus will result in what?
PARTIAL REINFORCEMENT
Pt who was in frightening MVA, consults psychiatrist for fears of driving, made car travel impossible. Behavior intervention is planned: psychiatrist will ride in traffic with pt and remain with pt until physical signs of fear diminished. What learning tx?
CLASSICAL CONDITIONING
In Operant Conditioning, a partial or intermittent reinforcement schedule results in:
MAINTAINING A BEHAVIOR THAT IS RESISTANT TO EXTINCTION.
What type of reinforcement is most effective for maintaining behavior that is resistant to extinction?
PARTIAL
If a response inhibitory to anxiety occurs in the presence of anxiety-evoking stimuli, it weakens the connection between the stimuli and the anxiety. This is called:
RECIPROCAL INHIBITION
A 79yr old man seeks therapy following stress due to uncontrolled online shopping, patient begins to understand how each purchase improved mood and improved loneliness, this best explains what learning theory?
OPERANT CONDITIONING
As result of a MVA a pt feeling panic before have to drive and has begun to avoid it. Example of mechanism of fear development:
DIRECT CONDITIONING
Pt undergoing chemotherapy. Commonly becomes nauseated and vomits in waiting room prior to the treatment. Reaction is ex of?
CLASSICAL CONDITIONING
Pt ate meat loaf then had a severe GI virus; develops a strong aversion to meat loaf.
CLASSICAL CONDITIONING
IV heroin user upon seeing the needle during a blood draw develops intense craving is an example of:
CLASSICAL CONDITIONING
Systematic desensitization is derived from
CLASSICAL CONDITIONING THEORY
Which of the following terms was developed by Rene Spitz to describe a common outcome following sudden or prolonged separation of otherwise normally attached infants?
ANACLITIC DEPRESSION
18 m/o is vulnerable to separation and constantly concerned about mother’s actual location. This is representative of Mahler’s stage of:
RAPPROCHEMENT
2 y/o does not want to let go of wool blanket and resists going anywhere without it. Attachment type is:
TRANSITIONAL OBJECT
What is true regarding infant attachments when comparing the strength of bond with each parent?
INFANTS CAN FORM MULTIPLE ATTACHMENTS, BUT THE STRENGTH OF THOSE ATTACHMENTS MAY DIFFER
Explanation for child’s anxiety from operant conditioning model? Child anxious about getting on bus and irrationally fears it will crash.
“HOW DO YOUR PARENTS RESPOND WHEN YOU ARE AFRAID OF THE BUS?”
Which of the following is most important protective factor in building resilience in children? Social skills, cognitive ability, quality of parenting, easy temperament, socioeconomic status
QUALITY OF PARENTING
Person afraid of loud noises has a panic attack in grocery store after shelving unit hits floor, person takes lorazepam after hearing a loud noise, person then avoids grocery store. according to classical conditioning, what is the conditioned stimulus?
GROCERY STORE
7 y/o with temper tantrums, refuses to go to school. Stomachaches and headaches on school days. Nightmares about being kidnapped, fears parents will die. Dx? (4x)
SEPARATION ANXIETY D/O
An example of parallel play: (4x)
A 2 YO CHILD SITS NEAR ANOTHER TODDLER WITH A TRUCK AND PICK UP A CAR.
Children demonstrate a preference for the human voice and speech over other sounds at what age? (3x)
BIRTH
Core gender identity is typically established by what age? (3x)
3 YEARS
An infant who engages in an interactive game of peek-a-boo most closely demonstrates the concept of which cognitive ability? (3x)
OBJECT PERMANENCE
The “strange situation” in child development is used to assess the infant’s in attachment theory: (2x)
SECURITY OF ATTACHMENT
Which ages of children are interested in secrets, collecting, and participating in organized games? (2x)
ELEMENTARY SCHOOL
Parents report 3 y/o has not begun to talk. Since birth child has been distractible. Also report child seems to have problem empathizing with siblings. What question should the Psych MD ask first? (2x)
“HAS YOUR CHILD’S HEARING BEEN TESTED?”
2 y/o clings to mother when introduced to a new child, refusing to join in play during 1st visit. On 2nd visit, child plays behind mother, and on 3rd visit, she seems to continue her usual activities while warily eyeing the new child. What temperamental traits or constellations best describes this child’s behavior? (2x)
SLOW-TO-WARM-UP
A 5 year old child whose mother was in a minor car accident believes he is responsible for causing the accident because he yelled “I hate you” in protest when his mother left him with a baby sitter an hour earlier. This belief represents which of the following? (x2)
AGE APPROPRIATE EGOCENTIC THINKING
3 1⁄2 y/o girl has increasingly become interested in dressing up in her mother’s clothes and shoes, with increased remarks about being a girl. It would be most consistent with a social learning theory explanation of psychosexual development to say that her behavior is (2x):
BASED ON MATERNAL MODELING AND BEHAVIOR
Integration of clinical and experimental observations in early childhood development supports what statement about infant/parent interactions (2x)?
INFANTS ARE BORN WITH SOPHISTICATED PERCEPTUAL ABILITIES THAT FACILITATE ATTACHMENT
The father of a 3 1⁄2 year old boy who attends preschool reports that on several occasions the boy has come into the bathroom while the father is in the shower interested in observing his father’s genitals asking once “why is it so fat?” This behavior most likely is an indication of? (2x)
NORMAL PRESCHOOL AGE SEXUAL INTEREST
A 10 yo child remains sad and angry about his parent’s divorce but no longer believes that he caused the separation. This cognitive change is example of what mechanism? (2x)
DECENTRATION
The age at which children typically first use sentences of 2 or more words is: (X2)
24 MONTHS
School aged boy, plays BBall and w/ boys, not w/ girls. What Freud’s psychosexial stage?
LATENCY
2-3 y.o. Capacity to tolerate frustration influenced by
ABILITY TO INTERNALIZE SOCIAL NORMS
Difficulty with which physical task is most concerning in elementary school aged kid?
JUMPING AND HOPPING
Innate feelings
MOST STRONGLY INFLUENCE GENDER ID
Four yo meeting all milestones. What on PE will raise concern about development?
WALKING ON TOES
Developmental period with highest level of response to rewards in nucleus accumbens
ADOLESCENCE
Developmental stage w/ max. number of axons and synapses?
INFANCY
Piaget’s major contribution to development theory explain…
HOW INDIVIDUALS LEARN ABOUT AND UNDERSTAND THE WORLD
Identity diffusion describes
LACK OF CONTINUITY IN HOW THE SELF IS EXPERIENCED IN RELATIONSHIPS OVER TIME
Piaget’s model limitations include
DOES NOT INCLUDE EMOTIONAL FACTORS RELEVANT TO LEARNING
will there be clowns in the parade like the circus?, this is an example of
USE OF PREVIOUS EXPERIENCES TO THINK CATEGORICALLY
2 year old development language
TWO-WORD OR LONGER PHRASES
stage of development with peak of DA-R in striatum, increased reward response
ADOLESCENCE
stage of development of maximal pruning of cortical synapses
ADOLESCENCE
flavor preference determined by
COGNITIVE ASSOCIATION
Developmental concept of mother responding to baby seeking attention
ATTACHMENT
Child enjoys opposite gender stuff. If patient gets symptoms of gender dysphoria what’s the course
RESOLVES SPONTANEOUSLY BY ADULTHOOD
Developmental task of school-age stage
BEGIN TO ESTABLISH PEER RELATIONSHIPS AND PURSUE GROUP ACTIVITIES
Adolescent M aroused by other males, but attracted to F
THESE FEELINGS ARE COMMON AND HIS SEXUAL PREFERENCE WILL CONTINUE TO SOLIDIFY
What is the likely course for a child’s development after their parents divorce?
CHILDREN DO WELL IN ONE PARENT HOMES PROVIDED STABLE PARENTAL FUNCTIONING AND FINANCIAL SECURITY
Which is a basic emotion, learned directly or inferred by infants in 1st year of life?
FEAR
First marker of impending puberty in females?
ACCELERATION OF LINEAR GROWTH
When do cortisol level peak in healthy children?
MORNING
Two 4-yr olds playing, one makes loud noise, the other does not want to play any more. Why?
PLAY PRODUCED EXCESSIVE ANXIETY FOR CHILD
Which of the following parent behavior is most important to toddlers language development?
ENGAGING IN FREQUENT CONVERSATION AND THINKING ALOUD
Pretend play, based on ability to symbolize, typically appears at which of the following stages of development?
TODDLERHOOD
Cognitive strategy of typically developing school-age children in response to their environment?
GRADUALLY INTEGRATING THESE NEW EXPERIENCES INTO PRE-EXISTING MENTAL CONSTRUCTS
Which of the following is characteristic of preadolescent children’s physical growth?
THE GROWTH RATE FOR BOYS LAGS BEHIND THE GROWTH RATE FOR GIRLS
Stage of development associated w/ setting up clubs, making rules
LATENCY
Ability of preschool children to regulate emotions is most strongly enhanced by the development of:
LANGUAGE
At what developmental stage due kids first exhibit ability to recognize their thoughts and feelings are their own, and that others may think and feel differently?
PRE-SCHOOL AGE
Starting around age 3 years, children spontaneously use language in which of the following ways?
DESCRIBE PAST EVENTS
Compared to preschool-age children, a school-age child with normal language development will demonstrate what ability?
CONSTRUCTING SENTENCES WITH MULTIPLE CLAUSES
Preschool children with imaginary friends are:
FAIRLY NORMAL
The parents of a 3 y/o child are concerned because she has not begun speak intelligently. The child’s hearing is normal. Doctor’s response:
EXPRESS SOME CONCERNS BC MOST CHILDREN THIS AGE CAN EFFECTIVELY MAKE THEMSELVES UNDERSTOOD.
Ability of an infant to utilize symbolic representation at age 18 months allows for:
USING LANGUAGE PROFICIENTLY
Child holds toy telephone to face and speaks to Daddy. This behavior is called?
SYMBOLIC REPRESENTATION
Which of following parental tasks becomes important during toddlerhood?
LIMIT SETTING
2.5 y/o observes mother take an apple from the refrigerator, mother briefly turns back to the child and beings eating, when mother turns toward child he animatedly grabs for the apple and say, “my apple, not Mommy’s.” This behavior is best described as which developmental achievements?
AWARENESS OF BEING A SEPARATE SELF
Adolescent who was previously getting along with parents is now becoming more resistant to parental control and insistent about making his own decisions about daily life. Feeling irritated with parents and guilty after minor arguments. Feelings of guilt are likely explained by?
A WISH TO SEVER THE PARENT-CHILD RELATIONSHIP
A child with temper tantrums at home begins to have better control over her outbursts following which intervention by parents?
HAD NEGATIVE REINFORCEMENT OF THE TANTRUMS REMOVED
The parents of a toddler are concerned about a rent increase in the frequency, intensity and duration of the child’s temper tantrums. The parents report that the toddler gets on the floor, kicks and screams when they set limits. The child’s health and developmental history is unremarkable. FMHx significant for mood disorders and ADHD and ODD. Which of the following would be most appropriate as next step?
EXPLORE THE PARENTS’ CONCERNS ABOUT SEEMINGLY NORMAL BEHAVIOR
In 8-11 y/o kids, which moral skill is the 1st one to fully develop?
INTERNALIZATION OF PARENTAL VALUES
17 1⁄2 y/o pt mentions drinking “a few beers” at parties and smoking THC “sometimes with friends.” The adol is doing well in school. Has close friends and has no significant conflicts at home. Adol’s use of substance is best characterized as:
TYPICAL ADOLESCENT BEHAVIOR
When asked to describe why a same-age, same-sex peer is a “best friend,” an 11-year-old child is most likely to cite which of the following as most important?
FEELING CARED ABOUT BY THE OTHER CHILD
Ask a child, “What makes a train go?” He replies, “The smoke makes it go.” This is:
PRE-OPERATIONAL THINKING
Learning triangular relationships
OEDIPAL STAGE
Following divorce, which behaviors in non-residential father contributes most positively to child’s future mental health?
TRADITIONAL PARENTING SUCH AS HELPING WITH HOMEWORK OR CELEBRATING HOLIDAYS TOGETHER
4 1⁄2 y/o child insists there is a small monkey who shares the child’s room. He talks to monkey, asks others to converse with monkey and insists that monkey have a seat at dinner table. Parents ask if they should be concerned, best response:
BEHAVIOR TYPICAL FOR PRESCHOOLERS
A difficult child, according to Thomas and chess’s categories of temperament, expect what characteristics?
INTENSE EXPRESSION OF MOOD
According to neuroimaging studies of adol, the prefrontal cortex at this age:
PREFRONTAL CORTEX DEVELOPS LATER THAN OTHER AREAS OF BRAIN
Capacity to inhibit behavioral responses improves over course of adolescence most likely because of
MATURATION OF PREFRONTAL CORTEX
Pretend play in preschool-age depends upon children’s increasing ability in which skills
USE OF ONE OBJECT TO REPRESENT ANOTHER
When toddler attributes a symbolic meaning to stuffed animal (e.g. teddy bear), imbuing it with the quality of being alive, this is referred to as:
ANIMISM
At what age do children begin to guide their actions in ambiguous situations using cues from the mother’s facial expression or in her tone of voice?
12 MONTHS
Aggressive behavior in preschoolers w otherwise NML development usually due to:
LIMITED VERBAL ABILITIES
Vocabulary growth and pre-literacy language skills in preschoolers appear to be most associated with:
AMOUNT OF TALK DIRECTED TO THE CHILD
A child recently becomes adept at running and jumping, in using a pincer grasp, and knowing the day and year is most likely to be at what age?
6 YEARS OLD
Infant who engages in an interactive game of peek-a-boo most closely demonstrates the concept of which of the following cognitive abilities?
OBJECT PERMANENCE
Parents of a 16 y/o boy discover he’s been visiting adult sex sites, spending up to 1hr every few wks looking at naked women and heterosexual sexual activities. Boy likes several female classmates but is shy and spends most of his time with a mixed gender group of friends. What is the explanation of his interest in these sites?
DEVELOPMENTALLY APPROPRIATE CURIOSITY
Long term emotional well being of a child following divorce depends most upon which post-divorce factor?
CESSATION OF CONFLICT BETWEEN PARENTS
Phase of child development (Melanie Klein) where they are able to integrate good & bad elements of caregiver into one unified ‘object’
DEPRESSIVE POSITION
Child engaged with imaginative play with therapist, states dollhouse on fire, therapist pretends to call 911, child says it’s not actually a fire it’s just pretend, what transition in Piaget’s model of cognitive development is this child demonstrating?
PRE-OPERATIONAL TO CONCRETE OPERATIONAL STAGE
According to Vygotsky , objects and interactional experiences should be within the infant’s …
ZONE OF PROXIMAL DEVELOPMENT
A young girl says “I am going to stay a girl no matter what, even if I wear blue or have short hair”. What capacity does this demonstrate?
GENDER CONSTANCY
Process by which children modify existing schemas to adapt to new experiences is:
ACCOMMODATION
Cognitive developmental tasks of adolescence include acquiring the capacity for:
MORE COMPLEX UNDERSTANDING OF CAUSALITY & MULTILEVEL REALITIES
Earliest age infant likes to look more at strongly patterned shapes like faces?
1 WK
What age can infant recognize mothers face as distinct from other faces?
1 MONTH
The primary psychological task of school-age children is achieving:
COMPETENCE
13 y/o male tells psych MD “I’m tired of being the shortest boy in my class.” Pt reports many of the girls are taller than he is. Both of the parents are tall. What is the most appropriate initial approach for the psychiatrist to take?
REVIEW WITH THE PT THE TYPICAL COURSE OF PUBERTY IN MALES
5 y/o child experiences death of grandmother. Child asks, “When can I talk to Grandma again?” This reflects an incomplete understanding of what concept of death?
IRREVERSIBILITY
What characteristic present in a 2 y/o is most likely to persist into adult life?
INHIBITION
3 y/o boy wants to play with his mom, but she is tired and it is naptime. What explanation would he best understand?
“IT’S NAPTIME NOW.”
In combo w growth hormone (GH), what is required to initiate adolescent growth spurt?
GONADAL HORMONES
Maturation of basal ganglia/cortical motor circuits is most closely assoc w development of:
SOCIAL SMILE
Father is concerned about 6 y/o son because child is rubbing genitals while in bathtub. This has not occurred at school or in public. Explanation of behavior?
NORMAL BEHAVIOR.
As children progress through school age development, they begin to
RECOGNIZE ETHNIC AND RACIAL STEREOTYPES
In 8-11 y/o kids, which moral skill is the 1st one to fully develop?
INTERNALIZATION OF PARENTAL VALUES
After a stranger says “hello,” a 12-month-old child turns and looks at his mother before responding. When the mother smiles and nods her head, the infant laughs and smiles in response to the stranger:
SOCIAL REFERENCING
The formation of small peer groups who share values, speech patterns, and manners is first seen around what age?
8 YEARS
Which event precipitates midlife crisis?
RECOGNITION OF UNATTAINABLE GOALS
What Freudian stage of development is characterized by an intensification of libidinal drive, separation from one’s parents, and achievement of mature sense of self?
GENITAL
Fine motor task mastered last?
TYING SHOELACES
According to Erikson, the predominant emotional issue in school-age children is?
PERSONAL WORTH AND COMPETENCE
10yo son is “girly boy,” has female friends, prefers playing house and w/ dolls, no distress or impairment, what is dx?
NONCONFORMITY TO GENDER ROLE
The peak age of exhibiting typical sexual behaviors: 3,5,7,9,11?
FIVE YEARS
22-month old shows which type of play when moving a block back and forth on train tracks?
SYMBOLIC
Decreased late-life prevalence of ____ is due to typical psychosocial maturation
PERSONALITY DISORDERS
What is the best example of a second stage or “self conscious” emotion believed to develop towards the end of 2 years old?
ENVY
In a normal full-term baby, by what age are adult-like circadian sleep rhythms generally established?
6 MONTHS
Parents of a two year old girl are concerned because she’s playing with trucks, likes to wear boys clothes, and likes to play w/ boys. They’ve tried to change her but she has been resistant. When asked by a physician, the child insists she’s a girl. What is the most likely diagnosis?
NORMAL DEVELOPMENT
Children understand the difference between inner life and outer reality (theory of mind) by what age?
FOUR YEARS
Freudian stage of latency is correlated with Erikson’s stage of:
INDUSTRY VS INFERIORITY
Children older than six have more difficulty than younger children with what, due to slowed growth of neural language synapses?
LEARNING A NEW LANGUAGE
Most common fear amongst preschool children faced with terminal illness
SEPARATION FROM CAREGIVER
Earliest age by which 90% of girls reach menarche
14 YO
Parental loss due to external cause during childhood most increases risk for depression as a young adult when the loss occurs at what age?
EARLY CHILDHOOD
Fetal Alcohol Syndrome is associated with: (5x)
FACIAL DYSMORPHISMS, POSTNATAL GROWTH RETARDATION, INTRAUTERINE GROWTH RETARDATION AND LEARNING DIFFICULTIES.
Child w IQ of 68 will likely have adjustment issues and struggles w which developmental stage?
ADOLESCENCE
Most common genetic abnormality leading to intellectual disability
DOWN’S SYNDROME
4 y/o girl developed normally in the 1st 18 months of life, but afterwards developed decelerated head growth, loss of purposeful hand movements, midline upper extremity stereotypies (e.g. hand-wringing), severe psychomotor retardation and social withdrawal:
RETT DISORDER
Person w/ MR who achieves 1st grade education fits which diagnostic classification?
MODERATE MENTAL RETARDATION
6 y/o child in 1st grade is doing very poorly. WISC-R IQ score is 60. Compared with other children his age he has sig. impairment in social skill, dressing, language, and feeding. What is the Dx?
MILD MENTAL RETARDATION
Medications for Tx of aggression in an individual w/ MR
LITHIUM, THIORIDAZINE, HALDOL, PROPANOLOL (NOT CLONAZEPAM)
10 y/o IQ 69. Findings that would confirm Dx of MR?
DEFICITS IN SELF-CARE AND SOCIAL SKILLS
The non-genetic cause of mental retardation in the US is:
FETAL ALCOHOL SYNDROME
A child with mod-sev mental retardation wakes frequently at night, claps at inappropriate times, and has bouts of paroxysmal laughter. Syndrome?
ANGELMAN’S SYNDROME
4 y/o child is brought in for an evaluation. The child iis demonstrating developmental delays, foraging for food, and having many temper tantrums. Which of the following is the most likely diagnosis?
PRADER-WILLI SYNDROME
An individual with a full scale IQ of 65 could be expected to plateau at what level of academic functioning?
6TH GRADE
17 y/o pt with IQ 65 and commensurate deficiencies in activities of daily living, communication, and motor skills can be expected to function on which academic level?
6TH GRADE
10 y/o child learned to clean his room without being asked. The parents achieved this by reinforcing this behavior with a one-dollar bill every third time the child cleaned the room without being asked. This type of reinforcement schedule is known as: (4x)
FIXED-RATIO
30 y/o morbidly obese pt refuses to change eating and exercise habits, “I’ll worry about my health when I am 65.” One month later his father, also obese, dies of a myocardial infarction. The now obvious disparity between pt’s current behavior and knowledge of the circumstances surrounding his father’s death is an example of which learning theory process? (x2)
COGNITIVE DISSONANCE
Learning from consequences of one’s actions (2x)
OPERANT CONDITIONING
Example of learned helplessness is a child who stops all attempts to improve after being punished for failing or failing no matter how hard the child tries? (2x)
FAILING NO MATTER HOW HARD THE CHILD TRIES.
22 y/o experiences a earthquake (7.0) during a seminar. In the months that follow he develops fearful reaction to sudden or loud noises. Pt avoids classes in the same building that the seminar was in. What is the mechanism of the behavior? (2x)
AVERSIVE CONDITIONING
Child who fears bike riding becomes less fearful after watching other children having fun while bike riding. Which learning principle? (2x)
IMPRINTING
What learning pattern is demonstrated by a patient (w/ panic disorder a/w public places) leaving an area when panic attack begins, and experiencing cessation of sx (2x)?
NEGATIVE REINFORCEMENT
To be eligible for special ed, must have?
DOCUMENTED DISABILITY
Reinforcing behavior w reward every third time a behavior is done is called:
FIXED RATIO
Cognitive-behavioral explanation of trichotillomania suggests hair pulling reduces an uncomfortable tension that the child is experiencing. What is this an example of?
NEGATIVE REINFORCEMENT
The evolution of addiction from an impulsive to a compulsive act is characterized by the increasing importance of which of the following factors?
NEGATIVE REINFORCEMENT
The evolution of addiction from an impulsive to a compulsive act is characterized by the increasing importance of which of the following factors?
INTELLECTUAL POTENTIAL AND PERFORMANCE
Worsening temper tantrums in 3 y/o. First occurred in grocery store and child was quieted with candy. The tantrums would occur at home and would escalate until given candy. Psychiatrist tells parents not to give candy during a tantrum under any circumstances. Outcome?
TANTRUMS WILL INCREASE THEN DECREASE
The most common learning disability found in school-age children
READING DISORDER
What is most common learning/communication D/O in kids receiving special ed?
READING DISORDER
A 4th grade child is falling behind peers. Child has IQ of 92, but lower than expected scores on achieve tests and adaptive functioning. Teacher reports child voices understanding of material, but struggles with homework, what is child’s diagnosis?
LEARNING DISABILITY
A medical student takes amphetamines to stay awake while studying for an exam. When she takes the exam without any medication, she finds that she has much greater difficulty than usual remembering the material. What is this an example of?
STATE-DEPENDENT LEARNING
Which of the following is an example of semantic memory in a child?
REMEMBERING THAT THE TOWN PARADE OCCURS EVERY JULY 4TH
Imitating one’s valued mentor while performing psychotherapy is an example of what type of learning?
SOCIAL LEARNING
Form of learned fear in which a person or an animal learns to respond more strongly to an otherwise innocuous stimulus is:
SENSITIZATION
A child practices violin to prevent parents nagging, what does this describe?
NEGATIVE REINFORCEMENT
A mother gives an 8 y/o a “time out” for five min in the bedroom because of his misbehavior. This is an example of what behavioral technique?
PUNISHMENT
The most common deficit underlying reading disorder in English-speaking children is deficit in:
PHONOLOGICAL FUNCTIONING
In learning theory, the presentation of an aversive stimulus that is contingent upon the occurrence of a particular response is known as:
PUNISHMENT
Child who fears bike riding becomes less fearful after watching other children having fun while bike riding. Which learning principle?
MODELING
The operant procedure in which a desirable behavior pattern is learned by the successive reinforcement of approximations to that behavior is called:
SHAPING
Pt receives $20 for negative drug test, but locked out of reward after a positive test until 3 negative tests, this is an example of which behavioral technique?
CONTINGENCY MANAGEMENT
When compared to adol, 8-12 y/o children with depression most often show which symptom? (3x)
SOMATIC COMPLAINTS
AACAP Diagnosis of Bipolar I in children requires (3x)?
A DISTINCT PERIOD OF ABNORMAL MOOD AND EPISODIC SYMPTOMS
Which of the following is the initial treatment of choice for mild anxiety disorders in children? (2x)
PSYCHOTHERAPY ALONE
Instead of depressed mood, children w MDD may primarily show: (2x)
IRRITABILITY
The treatment for adolescents with depression study recommended which of the following treatments for patients with moderate to severe depression? (2x)
FLUOXETINE AND CBT
16 y/o boy treated as outpatient for Schizophrenia after recent inpatient first break. Parents concerned re: anhedonia, withdrawn. No psychosis. Goal of outpatient eval: (2x)
ADDRESS PT’S FEELINGS OF DEPRESSION AND SCREEN FOR SI
When compared with adult-onset schizophrenia, children with schizophrenia have: (2x)
SIMILAR DEFICITS IN ATTENTION, LEARNING AND ABSTRACTION
Longitudinal studies have shown that obesity in later childhood, adol and adulthood can be predicted most commonly by presence of which psychiatric d/o in childhood and adol? (2x)
DEPRESSIVE
Primary advantage of treating childhood enuresis with behavioral methods vs desmopressin (2x)
LOWER RATES OF RELAPSE
Which concerns is the most common reason for referral of children and adol (6-16 y/o) to mental health professionals? (2x)
DISRUPTIVE BEHAVIOR
Most distinguishable aspect of childhood separation anxiety d/o when compared to other childhood anxiety disorders (2x)
FEAR THAT SOMETHING BAD WILL HAPPEN TO THEM OR THEIR PRIMARY CARETAKER
Most commonly reported SE of stimulants in kids (2x)
APPETITE SUPPRESSION AND SLEEP DISTURBANCES
An association has been reported in adol with BPD between serotonin dysregulation, suicidal behavior, aggression and … (2x)
IMPULSIVITY
8yo p/w “always worried” and fearing getting lost or being kidnapped, frequently insisting on sleeping in parents room (does well academically & interacts with circle of friends, but frequently c/o HA and visiting school nurse office to call parent) (2x)
SEPARATION ANXIETY DISORDER
9 yo with prior urinary continence at 4 years starts wetting bed at 6, he is difficult to arouse and has enuresis at different times, male relatives wet bed until 10 year old, clue to psychiatric comorbidity
HAVING PREVIOUS PERIOD OF CONTINENCE
Dx for 9yo boy w/ irritability and aggression, failing grades, and hearing a voice saying he is bad.
MDD
7yo child w/ emotional outbursts at school and stomachaches, reluctance, and complaining at school time, but well-behaved at home, without stressors. Next step?
PERMISSION TO SPEAK WITH TEACHER
Schizophrenia with onset in childhood is different from adult-onset because…
IT IS MORE LIKELY TO HAVE A GRADUAL ONSET
What are the characteristics of childhood-onset schizophrenia?
CHRONIC COURSE, UNFAVORABLE PROGNOSIS, HALLUCINATIONS, DELUSIONS
Not a likely characteristic of childhood-onset schizophrenia:
ACUTE ONSET
9 y/o is evaluated for bedwetting several times a week. Child has never been completely dry. Which Tx modality is likely to be most effective?
BELL AND PAD
Psychiatrist is evaluating a 5 y/o child in kindergarten. Child does well with puzzles and other performance activities. Teacher reports that the child has a limited vocabulary and immature grammar in comparison to the other children. Child interacts well with other children. The child also seems to have some trouble understanding questions. Child’s hearing and vision are normal. Explanation?
MIXED RECEPTIVE & EXPRESSIVE LANGUAGE D/O
12 y/o F not attending school for fear her mom may die in accident. Management?
RETURNING THE GIRL TO HER CURRENT CLASSROOM
7 y/o referred for psych eval due to learning probs. Most helpful info would be family’s approach to and hx
READING WITH THE CHILD
Childhood-onset schizophrenia typically have a course described as:
CHRONIC AND UNREMITTING
In preschool-age children isolated hallucinations are common with:
ANXIETY
A preschooler presents to psychiatrist after being placed on psychotropic med by a PCP. Parents note that since med was started, child has shown irritability, skin picking, decreased appetite, social withdrawal, insomnia. Which med is child taking?
DEXTROAMPHETAMINE
10 y/o child with 2-month h/o irritability, inattention, sleep disturbance, and withdrawal. Child attempted to run in front of a car. No family h/o psychiatric d/o. On examination, no eye contact and has psychomotor agitation. What med?
SSRI
First-line Tx for 9 y/o w/ depression
SERTRALINE
First-line Tx for adolescents w/ major depression
FLUOXETINE
Child must have depressed or irritable mood for what length of time in order to meet criteria for dysthymic do?
ONE YEAR
9 y/o w/ increased irritability and aggression for 3 mons. Used to be easygoing. Grades dropping. No insomnia or poor appetite. AH of voice telling him he is bad. Most likely Dx:
MDD
What is first line tx for PTSD in children and adolescents?
CBT
7 y/o girl dislikes going to her friend’s house, preferring her friends come to her home. She has recently had a stomach ache in the morning before attending school and sometimes cries uncontrollably if her mother insists she attends. Teachers reports after her mom leave she usually settles down and does academically well. Dx?
SEPARATION ANXIETY DISORDER
7 y/o M w/ poor social skills, cognitive, but language wnl. Dx
ASPERGER’S SYNDROME
Adopted children who have a biological parent with alcohol dependence are at increased risk of developing alcohol dependence when compared to their adoptive siblings. This is evidence for which of the following models of substance abuse?
DISEASE MODEL
14 y/o pt with a long-standing h/o of perfectionism has recently developed a fear of talking in class after forgetting her lines in a school play. Pt says, “I don’t like talking to other kids” and practices reading aloud over and over so “I remember what I am saying.” Dx:
SOCIAL PHOBIA
The Child-Adolescent Anxiety Multimodal Study (CAMS) compared sertraline, CBT, and combination therapy in children/adolescents with moderate/severe GAD, SAD, and Social Phobia. Primary findings?
COMBINATION TREATMENT SUPERIOR TO MONOTHERAPY
6 y/o child generally healthy throws a fit every time family goes hiking. Exposure to snake on one hike led child to become loud, agitated. Now child has intense distress when hiking, pleads to stay with parents at all times. Dx?
SPECIFIC PHOBIA
Diagnose a child who persistently refuses to attend school or sleep in bed alone, complaining of somatic symptoms with no physiological origin?
SEPARATION ANXIETY
Which of the following is a manifestation of unresolved grief in a school-age child who has experience the loss of a sibling?
SEPARATION ANXIETY FROM PARENTS
Childhood disorder with greatest genetic association for adult onset panic attacks?
SEPARATION ANXIETY DISORDER
A child w/ selective mutism is most likely to have difficulties in which area?
AT SCHOOL
A 5 year-old bilingual child has progressive refusal to speak in public, being very talkative at home and refusing to speak throughout the day in his kindergarten class. He is diagnosed with selective mutism. What is the appropriate intervention?
BEHAVIORAL TREATMENT TO INCREASE THE CHILD’S TOLERANCE FOR SPEAKING IN PUBLIC
One controversy about pediatric bipolar disorder is whether severe irritability and emotional dysregulation are:
PREDICTIVE OF CLASSIC BIPOLAR DISORDER IN ADULTHOOD
What is considered to be the determining component underlying the sx of selective mutism?
AVOIDANT BEHAVIOR
Which of the following infant and toddler temperamental styles has been shown to have the greatest association with the eventual onset of anxiety symptoms in childhood? (2x)
INHIBITED
Differential Dx in a 6 y/o with daily fecal soiling includes:
ANAL STENOSIS, HYPOTHYROIDISM, HIRSCHSPRUNG’S DZ, SMOOTH MUSCLE DZ
Which med has FDA approval for tx of mania in children 12 years of age or older?
LITHIUM
Unlike adults with bipolar disorder, prepubertal children with bipolar disorder are believed to have:
PREDOMINANTLY CHRONIC MIXED MANIC STATES
Child OCD. Which comorbid diagnosis is associated with poor response to SSRI?
TIC DISORDER
Which of the following is the initial treatment of choice for children with OCD?
CBT ALONE
What infectious agent can exacerbate or cause initial manifestation of OCD in children?
GROUP A BETA-HEMOLYTIC STREPTOCOCCUS
Presence of what disorder puts a child at greatest risk for developing panic disorder as an adult?
SEPARATION ANXIETY DISORDER
10 y/o is seen in outpt clinic w/ hx of extreme fear of using the bathroom at school. He states to be afraid that other children will laugh if they hear or smell him in the bathroom. Dx?
SOCIAL PHOBIA
Principal aim of treatment of child with school phobia is:
RETURN CHILD TO SCHOOL
9 y/o child w apathy, decreased appetite, irritability, dizziness, confusion, ataxia, and HA. Recently moved to older house in an industrial city. Which lab test helpful for dx?
LEAD SERUM LEVELS
igh social economic status parents of a 16 year old who has met normal developmental milestones are worried that their child is using social media and texting to communicate with peers. They found text messages w/ romantic partners and visits to sexual health related websites. What is the most likely consequence of the adolescents reliance on electronic forms of communication?
CONTINUED SOCIALIZATION WITHIN THE CURRENT PEER GROUP
Strong correlation between Asperger’s and? (7x)
NONVERBAL LEARNING DISABILITY
What is most important when trying to differentiate between autism and Asperger’s? (6x)
LANGUAGE DEVELOPMENT
Which of the following is seen most frequently as a comorbid condition in children with autism? (7x)
MENTAL RETARDATION / INTELLECTUAL DISABILITY
Pharmacological treatment in autism spectrum disorder is most likely to have a positive effect on? (5x)
AGGRESSIVENESS
Decreased attention to social cues is most common among children with: (2x)
AUTISM
Superficial self harm, monotone speech, “too loud,” socially awkward
AUTISM SPECTRUM DISORDER
Most heritable mental disorder
AUTISM
7yo M w aggression was referred by school for eval after IQ of 68 discovered. Pt was temperamentally inhibited and avoidant as an infant, difficulty interacting w peers and preoccupation with trains at age 2. No stereotypes or tic. Which aspect of this presentation is most indicative of autism spectrum disorder?
SYMPTOMS PRESENT BEFORE AGE 3
Which is a symptom of autistic disorder but NOT of Asperger’s?
DELAY OF SPOKEN LANGUAGE OR COMMUNICATIVE GESTURES
The long-term outcome in autism is most closely correlated with?
LANGUAGE DEVELOPMENT
8 y/o boy has marked social delay, difficulty maintaining relationships d/t odd interpersonal style, preoccupied with small electronic devices, talks on and on about them, and excludes other age appropriate interests, has difficulty w/ transitioning from one activity to another, has poor eye contact, and oblivious to personal space. DX?
ASPERGER’S SYNDROME
Abnormality in what domains is the most important in establishing the Dx of autistic do?
INTERPERSONAL RELATIONS
3 y/o not speaking intelligibly. Normal hearing. Parents worried about autism.
EXPRESS SOME CONCERN TO PARENTS
8 y/o is evaluated due to problems at school. Child’s vocabulary is normal and his conversation focuses on video games. He has social difficulties due to insisting on directing play w/ peers and being very controlling. He b/c agitated and disruptive when a substitute teacher is present and if there are even small changes in his daily routine. Dx?
PERVASIVE DEVELOPMENTAL DISORDER NOS
Which of the following is a positive prognostic predictor of overall outcome for children with autism?
COMMUNICATIVE SPEECH BY AGE 5
MC Speech/Language abnormality in autism spectrum disorder
IMPAIRED PROSODY
Autism spectrum disorders in children and adolescents are most highly comorbid with which of the following types of disorder?
ANXIETY
Risk that a subsequent child will be autistic in a family with one autistic child is:
5%
10yo boy primary nocturnal enuresis, is dry during day, no urgency, frequency, dysuria. Father had same at age 12. No other issues, wants to stop bed wetting to go to camp. What is the next step?
TRIAL OF DDAVP
Strategy best grounded in social psychological principles for scenario in which you are a psychiatrist dealing with anti vax parents who think that vaccines cause autism
SHOW HOW VACCINATION CAN BE CONGRUENT WITH THE GROUP’S CORE VALUES
Child argues with mom, is angry and rude. Has no trouble at school and completes schoolwork. Dx? (3x)
OPPOSITIONAL DEFIANT DISORDER
14y/o from juvenile hall, getting aggressive. Long h/o behavior problems but no psych or medical hx. In addition to diagnosing behavior problem, what is first step for psychiatrist? (2x)
EVALUATE THE PATIENT FOR ADDITIONAL PSYCHOPATHOLOGY
What increase risk of conduct d/o?
PARENTAL CRIMINALITY
6 yo w/ breaking curfew, violate parental rules, on edge, inpatient, unkind to sibling.
OPPOSITIONAL DEFIANT
Psychiatric assessment of child or teen should always include
PARENTAL INTERVIEWS
WHO indicated intervention (universal, selective, indicated)
PROVIDING PARENTING TRAINING FOR PARENTS OF CHILDREN WITH CONDUCT PROBLEMS
6 y/o presents with a 3 yrs hx of disruptive behaviors at home and school. Parents report he has difficulty paying attention and completing tasks. Recently pt has b/c more oppositional and angry with adults and peers. He often states, “I am no good.” What comorbid condition is most likely explanation for the child recent behaviors?
DEPRESSION
Diagnosis for child w/ behavioral inhibition
SOCIAL PHOBIA
Sign of pyromania
FEELING RELIEF ON SETTING A FIRE
Which of the following is the most effective evidence-based treatment of oppositional defiant disorder (ODD):
PARENT MANAGEMENT TRAINING
A 10 yo child presents with explosive outbursts at home when asked to complete tasks or when told no. These behaviors are not present while playing with siblings. Which of the following treatments has the largest body of evidence supporting its use to treat this condition?
PARENT MANAGEMENT TRAINING
Treatment of schizophrenia that focuses on social awareness and basic mental processes to help patients understand intellectual capacity, strength, and limitations?
SOCIAL (PRAGMATIC) COMMUNICATION DISORDER
