peds: behavior problems Flashcards
what are the 5 most common pysch disorders in kids?
ADHD conduct disorder depression pervasive developmental disorders autism spectrum disorders
history for peds behavior problem: never underestimate _____ ______
parents denial
Timmy is 4 years old. He likes to make up stories and act them out with his action figures. His mother encourages his play and listens to his stories. Timmy is likely to successfully master the tasks in which of Erikson’s stages of development?
Initiative versus Guilt
stages of development: piaget
0-18mo: sensorimotor 18mo-3yrs: symbolic (pre-operational) 3-5 yrs: intuition (per-operational) 6-12 yrs: concrete operational 12-18 yrs: formal operational
what is “temperment”?
Genetically influenced behavioral disposition – stable over time and age.
Response to external stimulus – how the child interacts with the environment
who describes temperment as “The “how” of behavior, as opposed to the “why” (motivation) and the “what” (ability)”
thomas & chess
Temperment: 8 ways they can respond to external stimulus (kinda weeds)
Activity level
Rhythmicity (predictability of appetite, bowels, sleeping)
Approach & Withdrawal (responding to new stimulus)
Intensity (responding to a situation – negative or positive)
Adaptability (ease of change)
Sensory Threshold (amount of stimulation required for a child to respond)
Mood (positive or negative)
Distractibility/Attention Span
8 Common Adjustment/Coping/Defense Strategies of Kids (kinda weeds)
Attention Getting (e.g. breath holding, tantrums etc.)
Identification (e.g. “I’m big and strong like Daddy.”)
Projection (e.g. “That rug is always tripping me.”)
Regression (e.g. sudden recurrence of bed wetting)
Denial (e.g.“I didn’t do it.”)
Rationalization (e.g. “I broke my bike, but I didn’t like it anyway.”)
Conversion (e.g. “I can’t go to school, my tummy hurts.”)
Fantasizing (e.g. excessive daydreaming to avoid fearful activities/feelings)
what is the biggest help with feeding problems?
good food choices by parent example
3 general possible causes of food refusal
- sign of depression
- sign of developmental conflict with caregiver (parent)
- medical
when is lowered, sporadic food intake normal?
Towards the end of the first year of life
Avoidant/Restrictive Food Intake Disorder (DSM-5) (4 parts)
an eating or feeding disturbance
- significant weight loss
- nutrient deficient
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
what is “pica” ? DSM V criteria
- eating non-nutritive, non-food items (lotion, dirt, paper, etc.)
- inappropriate of development level (>2yo)
- > 1 month
excessive eating disorder may be indicative of what?
- emotional distress, especially if food is being hidden
- family dynamics
Sleeping habits are often determined as ____
infants
parasomnia: define and 4 types
-arousal from sleep Sleep terrors Nightmares Sleepwalking Sleeptalking
dysomnia: define and 3 parts
-going or staying asleep
Sleep onset association disorder
Insomnia
Night waking
nightmare disorder vs sleep terror
nightmare disorder: awake with fearful images
sleep terror:Difficult to awaken and have little memory; wake up screaming
nightmare disorder vs sleep terror : occur when in the night?
nightmare disorder: last 1/2 of night (in REM)
sleep terror: first 1/3 of night (in stage 4)
nightbare disorder vs sleep terror: inheritance?
nightmare disorder: not inherited
sleep terror: familial
mgmt of sleep terrors
Scheduled awakenings may help
Avoid sleep deprivation (prolongs deep sleep)
Avoid stress
Reassurance by parents
mgmt of nightmare disorder
Usually self-limited and need little treatment
Can be associated with stress, trauma, anxiety
what is Somnambulism?
sleepwalking
sleepwalking occurs when in the night? do you wake them?
- first 1/3 of the night
- awakening the sleepwalker can be difficult and leave them briefly disoriented
- deep sleepers
- lower incidence of dream reporting
mgmt of sleepwalking
bell on child’s door; scheduled awakenings if “regular” time; safe environment free of obstacles with locked doors
Jimmy is 5 years old. He falls asleep most nights without trouble, at his regular bedtime. However, at least once a week within an hour or two after falling asleep, he sits up in bed screaming, thrashing about, and exhibiting rapid breathing, tachycardia, and sweating. In the mornings, he doesn’t remember it. Jimmy probably has…
sleep terrors
thumb sucking is normal until when?
in the first year of life
mgmt of thumb sucking
Distraction is the best approach. Aversive thumb coatings usually not helpful.
what is Onchophagia?
nail biting
bedwetting (enuresis) more common in boys or girls?
boys
mgmt for bedwetting
Behavior therapy: regular awakenings and blanket alarms most effective
meds: Imipramine, Oxybutinin, and DDAVP (synthetic antidiuretic hormone) can be helpful
what is the term for this? “Repeated passage of stool into inappropriate places” (DSM) – involuntary or intentional
Encopresis (Stool Soiling)
most common cause of stool soiling
constipation
what may stool soiling be indicative of?
can indicate severe emotional problems (sexual abuse, severe stress, divorce, etc).
-pysch eval if no pathology and > 4yo
Anger out of proportion/rage may be an early sign of ______ _______!
antisocial behavior and should not be disregarded – refer!
disobedience: Almost every child tests limits of independence between age ___ and ___ years.
2-4 yo
One of the most common cause of physical complaints in the school-aged child?
school phobia : Results from separation fears, frustration with schoolwork, and poor self-image.
mgmt of school phobia
“No fever = no absence” rule may be helpful if parent is unsure.
Somatization
is a pattern of conversion of overwhelming mental distress into physical complaints.
most common: GI upset
less common: blindness, paralysis, (conversion disorder)
illness anxiety disorder: may be caused by what 3 things?
- imitation of adult behavior
- an attempt to control
- an expression of unhappiness.
oppositional defiant disorder: characterized by what 3 things?
- angry/irritable
- argumentative/ defiant
- vindictive/ spiteful
oppositional defiant disorder: Dx based on age.
Younger than 5: most days for 6 months
Over 5: at least 1x/wk for 6 months
conduct disorder : characterized by what 4 things
Aggression to people and animals Destruction of property Deceitfulness or theft Serious violations of rules * Serious disorder, poor prognosis, earlier the referral (intervention) the better
conduct disorder can be a precursor to what ?
Precursor to antisocial personality disorder
depression: ______ scale is helpful for symptom history:
SIG E CAPS
what is SIGECAPS? (what do they stand for, how many for a dx? )
Sleep disturbance Irritable Guilt Energy, motivation Concentration Appetite Psychophysical slowing, agitation or pain exacerbation, Suicide risk. * Four or more positives makes depression likely.
Janey is 12 years old. She often worries that her stomach aches are a sign of cancer, or that if she gets a headache, she has brain cancer. She often asks her mom to make doctor’s appointments for her to make sure she doesn’t have something serious wrong with her. Janey probably has…
Illness Anxiety Disorder
erikson stage : 0-18 mo
trust vs mistrust
erikson stage 18mo-3yrs
autonomy vs shame/doubt
erikson stage 3-5
initiative vs guilt
erikson stage 6-12
industry vs inferiority
erikson stage 12-18
identity vs role confusion
erikson stage: early adulthood
intimacy vs isolation
erikson stage: adulthood
generativity vs stagnation (contribution)
erikson stage: old age
integrity vs despair
