Peds & Adolescents Flashcards
1
Q
Psychosocial Theory: Erikson
A
- Trust vs. Mistrust (0-18); receiving and giving
- Automony vs. Shame (18 m- 3): self confidence
- Initiative vs. Guilt (3-6): inadequacy
- Industry v. Inferiority (6-12): peer recognition, self-esteem, interpersonal relations
- Identity vs. Role Confusion (12-20)
- Intimacy v, Isolation (21-40)
- Generative vs. Stagnation (40-60)
- Integrity vs. Despair (60+)
2
Q
Moral Theory: Kohlberg
A
- preconventional, infancy/preschool : motivated by avoidance of punishment
- conventional, school aged: motivated by adherence to rules and norms
- post-conventional, adolescent and on: motivated by ethical procliples
3
Q
Cognitive Theory: Piaget
A
- Sensorimotor (0-2): differentiating self from others, action/reaction
- Preoperational (2-7): No abstract reasoning, only in present, egocentric. magical thinking
- Concrete operations (7-11): reasoning beyond self, think about past and present
- Formal operations (11 plus): future thinking, abstract and complex thought
4
Q
Theory of Object Relations: Mahler
Emphasized role of relationship in producing change and individuation
A
- Normal Autism (0-2 months): no recognition of others
- Symbiosis (3-5 months): perceived caretaker as an extension of self
- Differentiation (5-8 months): separateness of mother begins
- Practicing (8-16 months): explores environment, checks in with caretaker
- Rapprochment (16-25 months): acute awareness of separateness: anxiety
- Object constancy (25-36 months): assurance by evocation of memory of caretaker
5
Q
Temperament Theory
A
- Rothbart: Extraversion/surgency, negative affectivity, effortful control
- Thomas & Chess: goodness of fit
6
Q
Autism Spectrum Disorder, includes all previous DSM IV diagnoses
A
- Childhood Disintegrative Disorder: Deterioration in social and physical function after age 10
- Pervasive Developmental Disorder: Intellectual and language skills are preserved
- Asperger Syndrome: Intelligence is not compromised
- Rett Syndrome: neurodegenerative beginning between 5-30 months
7
Q
Autism screening
A
MCHAT: 18 and 24 months
8
Q
Disruptive Mood Dysregulation
A
- Severe recurrent verbal or behavioral outbursts
- 3 or more times per week
- Diagnosed in children ages 6-18
9
Q
Persistent Depressive Disorder (Dysthymia)
A
- Duration of at least a year
* Children may appear irritable
10
Q
Pediatric Treatment of Mood Disorders
A
- Antidepressants: fluoxetine, fluvoxamine, sertraline (7 and older)
- Mood stabilizers: divalproes sodium (2 y), carbamazepine (6 y), Lithium (12y)
11
Q
ADHD
A
- Symptoms usually present before age 7, as late as 12
- Persist for 6 months
- Interfere with functioning in 2 settings
- More boys 6:1
- Co-morbidities: anxiety, depression, conduct disorder, oppositional defiant disorder
12
Q
ADHD Treatment
A
- Methylphenidate (Ritalin)
- Dextroamphetamine (Dexedrine)
- Lisdexamfetamine (Vyvanse): reduced abuse potential
- Atomoxetine (Strattera): SSRI
- Guanfacine (Tenex/Intuniv): Alpha 2 adrenergic receptor agonist
13
Q
Oppositional Defiant Disorder
A
- Angry/Irritable, argumentative/defiant, vindictive
- Typically begins around 8, precursors noted 3-7
- Pharmacotherapy not first line
- Some evidence for: Lithium, methylphenidate, clonidine for aggressiveness
14
Q
Conduct Disorder
A
- Violates basic rights of others, aggression, stealing, truancy,
- Formal diagnosis after age 7 and before age 18
- Multisystemic family therapy
- Pharmacotherapy for explosive aggression
15
Q
Tic Disorders
A
- Onset between 4-6 years; males > females
- Provisional tic disorder: 4 months - 1 year
- Chronic tic disorder: More than 1 year
- Tourette’s: multiple motor and one or more vocal tics, present for > 1 year, never tic free for > 3 months, inset of tics before age 18
- High comorbidity: ADHD, OCD
16
Q
Tic Disorder: Pharmacotherapy
A
- Haloperidol
* Clonidine
17
Q
Encopresis
A
- In children who should be toilet trained (age 4)
* At least one time/month for three months
18
Q
Encopresis: Diagnositcs
A
- Anorectal manometry
- Child Behavior Checklist
- X-ray of the abdomen
- Barium enema to rule out Hirschsprung’s disease
- EMG of external anal sphincter
19
Q
Encopresis: Management
A
- Positive behavior reinforcement
- Toilet sitting for at least 10 minutes twice a day
- Increase activity/fluids/fiber
- Stool softeners
- Laxatives
20
Q
Enuresis
A
- Involuntary urination after age 5
- Previous enuretic father
- African American
- Deep sleepers
- Small bladder capacity
- Neuro delay
- Antidiuretic hormone regulation
21
Q
Enuresis Management
A
- Reassurance
- Behavioral treatment
- Desmopressin (DDAVP)
- Imipramine
- Oxybutynin
22
Q
Gender Dysphoria
A
- Profound disturbance in sense of gender for at least 6 months
23
Q
Adolescent Suicide
A
