Pediatrics Flashcards
What are the core features required to make a diagnosis of mental retardation?
- significantly subaverage intellect (often IQ < 70)
- deficits in adaptive skills
- with onset before age 18
What is the most common inherited form of mental retardation? What features accompany this?
fragile X syndrome, which includes macroorchidism and a long face
When evaluating patients for a learning disorder, it is important to rule out what other disease process?
a sensory deficit
How does ODD differ from conduct disorder?
ODD does not involve physical aggression or the violation of the basic rights of others as is the case with conduct disorder
What symptoms characterize oppositional defiant disorder?
- frequent loss of temper
- arguments with adults
- defying adults’ rules
- deliberately annoying people or being easily annoyed
- anger, resentment, or spitefulness
- blaming others for mistakes or misbehaviors
If kids get along with their peers but will not comply with expectations from parents or teachers, what diagnosis should come to mind?
oppositional defiant disorder
What is the treatment for ODD?
psychotherapy with family involvement and a focus on parent management skills training
What are the diagnostic features of conduct disorder?
- a pattern of behavior that violates the rights of others or social norms
- this may include aggression, destruction of property, deceitfulness or theft, and serious rules violations
Children with ODD and conduct disorder have a high rate of what comorbidities?
- substance abuse
- mood disorders
- ADHD and learning disorders
What is the treatment for conduct disorder?
- implementation of consistent rules and consequences
- medications for aggression as necessary
To be diagnosed with ADHD, symptoms must have been present before what age?
before age 12
Describe the treatment algorithm for ADHD.
- CNS stimulants are first line agents
- atomoxetine is a non stimulant that has been approved
- a2-agonists guanfacine and clonidine can be used as second line agents or adjuncts to stimulants
- psychotherapy with a focus on behavior modification
What are the core features of autism?
- problems with social interaction
- impairments in communication
- repetitive and stereotyped patterns of behavior and activities
What is the treatment for autism?
- remedial education
- behavioral therapy
- antipsychotics for aggression, hyperactivity, and mood lability
Describe Rett disorder?
- it is a developmental disorder most often seen in girls
- patients develop normally for the first 5ish months before regressing and losing purposeful use of their hands
- treatment is supportive
What is childhood disintegrative disorder?
a disorder in which children develop normally in the first 2 years of life and then regress before age 10, often with a comorbid seizure disorder
What are the diagnostic criteria for Tourette disorder?
- at least one vocal and one motor tic
- with onset prior to age 18 and at least one year of symptoms almost every day
How is Tourette disorder treated?
- atypical neuroleptics and alpha 2 agonists are preferred
- typical neuroleptics may be required for severe cases
Describe the presentation and treatment of selective mutism.
- a refusal to speak in certain situations
- treat with psychotherapy, behavior therapy, and anxiety management
What is the treatment for separation anxiety?
family therapy, CBT, and low-dose antidepressants
What features in a child would be suggestive of sexual abuse?
- presence of an STD
- anal or genital trauma present on exam
- knowledge about specific sexual acts
- initiation of sexual activity with others
- sexual play with dolls
