Pediatric Psychology Flashcards
Potential Roles of Primary Care Clinicians
Prevention Early identification/screening Early intervention/engagement Referral/collaborative care Monitoring progress in care Care coordination
Barriers of Mental Health Care in Primary Care Settings
Ambivalence/variability Discomfort Time constraints Poor payment Variable access to MH specialty resources Administrative barriers to MH services Limited information exchange with MH specialists Stigma
Assisting a Parent Caring for a Child with a Disability
Seek the assistance of other parent Know that you are not alone Rely o positive resources in your life Take it one day at a time Seek information Do not be intimidated Maintain a positive outlook Find programs for your child Take care of yourself Keep daily routines as normal as possible KEEP YOUR SENSE OF HUMOR
What is important in the assessment of a psychiatric condition in a pediatric patient?
Developmental milestones
Approach to the Adolescent Mental Health Patient
No judgements or assumptions
Rules of confidentiality: outline the rules, not absolute, ask them to explain confidentiality, alone time with the patient
HEADSSS assessment
Define HEADSSS
H: home E: education A: activities D: drugs S: sex S: suicide/depression S: safety
Define Intellectual Disability
Neurodevelopment disorder with multiple etiologies that encompass a broad spectrum of functioning, disability, and strengths
Define Global Developmental Delay
Children under 5 who fail to meet expected developmental milestones and have significant impairments in several areas of functioning
Two Components of Intellectual Disability
Adaptive behavior
Intellectual functioning
Define Adaptive Behavior
Collection of conceptual, social, and practical skills that all people learn in order to function in their daily lives
Define Intellectual Functioning
Reasoning, learning, and problem solving
Clinical Features of a Patient with an Intellectual Disability
Parent concerns
Younger sibling overtakes an older sibling
Fails to meet expected developmental milestones
Immature behavior
Difficulty learning
Severely affected
Causes of Intellectual Disability
Genetic
Embryonic development
Congenital infections
Congenital hypothyroidism
Teratogens: alcohol, lead & valproate
Environmental deprivation (Abuse/neglect)
Hereditary abnormalities
Screening Tools for Intellectual Disability
Ages and Stages Questionnaires (ASQ): 4-60 months
Bayley Infant Neurodevelopment Screener (BINS): 4-25 months
Brigance Screens-II: 4-90 months
Infant-Toddler Checklist for Language and Communications: 6-24 months
Parent’s Evaluation of Developmental Status (PEDS)
DSM V for Intellectual Disability Criteria
IQ = 70
Deficits or impairments in adaptive function in at least 2 of the following: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, safety
Onset before age 18 years old
Treatment of Intellectual Disability
Early intervention program
Multidisciplinary team support
Family support & counseling
Typical Learning Disabilities
Dyslexia
Dyscalculia
Dysgraphia
Epidemiology of Dyslexia
Boys > Girls
Run in families
Often in patients with ADHD
Signs/Symptoms of Dyslexia
Delayed language production
Speech articulation difficulties
Difficulties remember letters, numbers, & colors
Reversals or visual confusions (b/d, m/w, h/n)
Common Problems with Individuals with Dyslexia
Processing & understanding what they hear
Difficulty comprehending rapid instructions
Following more than one command at a time
Remembering the sequence of things
Reversals of letters (b/d)
Reversal of words (saw/was)
May read from right to left
May fail to see/hear similarities & differences in letters & words
May not recognize spacing between words
May be unable to sound out pronunciation of an unfamiliar word
Dyslexia Screening & Diagnosis
Medical exam Cognitive exam Sensory processing Educational Psychological factors Vision Hearing Neurologic Psychologic assessment
Treatment of Dyslexia
Remedial education
Testing can reveal areas to work on
Use several senses to learn
No way to correct underlying brain malfunction
Dyslexia Prognosis
Tutoring each week
Progress may be slow
Milder forms: read well enough to succeed in school
Severe forms: may never be able to read well
Define Dyscalculia
Difficulty performing math calculations
Signs/Symptoms of Dyscalculia
Difficulty understanding number lines, carrying/borrowing numbers, word problems, & counting change or money
Strategies for Dyscalculia
Allow use of fingers & scratch paper
Use diagrams & draw math concepts
Provide peer assistance
Suggest use of graph paper
Define Dysgraphia
Learning disability resulting from the difficulty in expressing thoughts in writing
Dysgraphia Difficulties
Handwriting
Grammar & syntax
Formulating, expressing, & organizing ideas in writing
Ability to use sound-letter relationships effectively
Who can diagnose dysgraphia?
Psychologist who specializes in learning disabilities
Treatment of Dysgraphia
Accommodations
Modifications: essays shorter or put in question form
Remediations: writing practice
Define Enuresis
Repeated voiding of urine during the day or night into bed or clothing
Define Encopresis
Repeated passage of feces into inappropriate places
Define Primary Enuresis
Never have had a dry night
Define Secondary Enuresis
Child is completely potty trained and then has a patch where the child wets the bed
Common Causes of Enuresis
Failure to arouse
Increase production of urine while asleep
Overactive bladder
Enuresis & Psychiatry/Psychology
Stressors: family crises, new school, new sibling
Become withdrawn & anxious
Etiology of Daytime Incontinence
Overactive bladder
Constipation
Diagnosing Enuresis
H&P
Voiding diary
UA with PVR
Abdominal X-ray
What is included in a voiding diary?
Timing of daytime voids
Volume of voided urine
Lower urinary tract symptoms
Treatment of Enuresis
Stop fluids before bed
Scheduled night waking
Alarms: underwear or bedding
Medications
Medication Options for Enuresis
Desmopressin acetate (DDAVP)
Oxybutynin
Imipramine
Two Types of Encopresis
Primary
Secondary
Define Primary Encopresis
Has always soiled their pants
Define Secondary Encopresis
Completely potty trained & then returns to soiling themselves
Physical Cycle of Encopresis
Stool retention
Intestinal walls & nerves stretch
Retained stool becomes harder
Liquid stool passes around retained feces
Clinical Presentation of Encopresis
Repeated soiling of underwear
Child denies visible & olfactory signs of soiling
Psychological Effects of Encopresis
Struggle within the family
Conflict in other areas of child’s life
Homework with suffer
Chores may be ignored
Diagnostics of Encopresis
Abdominal X-ray
Management of Encopresis
Educate child on bowel function
Behavior or reward systems
Psychological counseling
Treatment Goals for Encopresis
Establish regular bowel habits
Reduce stool retention
Restore normal physiological control over bowel function
Diffuse conflicts and reduce concerns
Initial Treatment Phase of Encopresis
Enemas
Strong laxatives
Maintenance Phase of Treatment of Encopresis
Schedules toilet times
Daily laxative
Proper diet: lots of fiber
Define Autism
Neurodevelopment disorder that affects the functioning of the brain- primarily communication & social interaction
Classic Autistic Disorder
Limited emotional connection Very into their own world Constant routines Deeply effected by noises, bright lights, & smells Generally low functioning
Key Diagnostic Features of Autism
Severe deficits in social responsiveness & interpersonal relationships
Abnormal speech & language development
Repetitive, rigid, or stereotypes interests or behaviors
Onset before age 3
Difficulty feeding
Focus on one thing at a time
Key Features in Infancy for Autism
Delayed/absent social smile
Failure to anticipate interaction with parents
Lack of attention to parent’s face
Key Features in Toddlers for Autism
Deficiencies in imitative play
Lack of interest in interactions with others
Language development delay
Communication Symptoms of Autism Spectrum Disorder
Avoid eye contact
Act as if deaf
Develop language, then abruptly stop talking
Fail to use spoken language, without compensating by gesture
Exploration of Environment Symptoms of Autism Spectrum Disorder
Remain fixated on a single item or activity
Repetitive actions like rocking or hand-flapping
Sniff or lick toys or put unusual objects in mouth or need toys to chew on
Show no sensitivity to burns or bruises, & engage in self-mutilation
Intensely preoccupied with a single subject, activity, or gesture
Show distress over change
Insist on routine or rituals with no purpose
Lack fear
Social Relationships of Autism Spectrum Disorder
Act as if unaware of the coming & going of others
Are inaccessible
Fail to seek comfort
Fail to develop relationships with peers
Have problems seeing things from another person’s perspective
May physically attack & injure others without provocation
Complications of Autism
30% develop seizure disorder
Higher cognitive individuals may become depressed as they become aware of their deficits
Some adults live in 24 hour care centers
Specifications fo Autism Spectrum Disorder
With/without accompanying intellectual impairment
With/without accompanying language impairment
Associated with a known medical or genetic condition
Associated with another neurodevelopment, mental, or behavioral disorder
With catatonia
Rankings of Autism Spectrum Disorder
1: requiring support
2: requiring substantial support
3: requiring very substantial support
Treatment for Autism Spectrum Disorders
Require specialized therapy, special schooling
Special techniques & psychotherapeutic approaches
Sometimes antipsychotic drugs & antidepressants
Specialized Therapeutic & Teaching Approaches for Autism Spectrum Disorders
Applied behavior analysis (ABA)
Picture exchange communication system (PECS)
Early start Denver model (ESDM)
More than words
Treatment & educations of autistic & communication related handicapped children (TEACCH)
Child’s talk
Screening Tools for Autism Spectrum Disorder
Checklist for Autism in Toddlers (M-CHAT)
Screening Tool for Autism in Toddlers & young children (STAT)
Child look & point when they want you to see something?
Child look when you point to something?
Child use imagination to play?
