Peds Neuro and Trauma Flashcards
what are r/f for childhood mental illness
-family hx (genetics)
-neurobiology
-temperament
-abuse/trauma
-low socioeconomic status
-parenting
what symptoms do children provide better?
internal symptoms
e.g. mood, sleep, SI
What symptoms do parents provide better?
external symptoms
e.g. behavior relationships
what is different about a child/adolescent assessment?
-use simple phrases
-corroborate info with adult
-direct questions not open ending
-use play media
-may not be able to provide accurate time-line
what is important when assessing preschoolers?
use play! have difficulty putting feelings into works
what is important when assessing school agers?
establish a rapport, use competitive games
what is important when assessing adolescents?
have increase egocentric thoughts and behaviors. let them know what information will and will not be shared with parents
what is included in the developmental assessment?
-intellectual function
-gross motor function
-fine motor function
-cognition
-thinking and perception
-social interaction and play
what are the two kinds of communication disorder?
-speech
-language
what does a speech disorder entail?
-problems in making sounds
what does a language disorder entail?
difficulty understanding or using words in context and appropriatley
What are the 3 subtypes of motor disorders?
- developmental coordination disorder
- stereotypic movement disorder
- tic disorders
s/s of a developmental coordination disorder?
- impairments in motor skill development
-coordination below developmental age
s/s of a stereotypic movement disorder ?
repetitive purposeless movements for 4 or more weeks
s/s of a tic disorder?
sudden nonrhythmic and rapid motor movements or vocalizations
what are the 2 types of tic disorder?
- Tourette’s
- persistent motor or vocal (more than a year)
- provisional tic disorder (less than a year)
what are the treatments for tic disorders?
-behavioral techniques
-relaxation strategies
-meds (antipsychotics, clonidine, klonopin. fluoxetine, and sertraline)
-deep brain stimulation
what are the three learning disorders?
- dyslexia (reading)
- dyscalculia (math)
- dysgraphia (written expression)
what areas do those with IDD have deficits in?
-intellectual functioning
-social functioning
-daily functioning
what can increase levels of function in those with IDD?
cognitive and social stimulation if begun before 5 years
what factor determines adult productivity in those with IDD?
Motivational Support
what increases quality of life in those with IDD?
-early identification and intervention
what should be assessed in someone diagnosed w/ IDD?
-delays
-signs of neglect or abuse
what are the main s/s of autism spectrum disorder?
-defecits in social interactions and relationships
-stereotypical speech and behaviors
-fixed interest
-over adherence to routines or rituals
-hyper or hypo reactivity to sensory
-extreme resistance to change
-appears in early childhood
what should be assessed in someone with ASD?
-intellectual/developmental delays
-communication skills
-social skills
-behavioral skills
-parent-child relationship
-abuse
-stereotypic behavior
what is the treatments used with ASD?
-behavior management
-parent teaching
-PT/OT
-2nd gen antipsychotics
-SSRI
-stimulants
Define ADHD?
persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level and effecting 2 of the following: work, social, or educational difficulties before age 12
what are the three types od ADHD?
- hyperactivity-impulsivity
- inattentive
- combined
What is needed to diagnose ADHD hyperactivity-impusilsivity?
six or more of the following for 6 months
Hyperactivity behaviors
* Often fidgets; moves feet; squirms in seat; can’t sit still
* Leaves seat before excused
* Runs about/climbs excessively or at inappropriate times
* Difficulty playing quietly (e.g. Board games)
* Is often “on the go” or often acts as if “driven by a motor”
* Often talks excessively/ non-stop talkers
Impulsivity behaviors
* Often blurts answers before questions finished; speaks before thinking
* Often interrupts or intrudes on others (Butts into conversations or
games)
* Problem waiting for his/her turn
what is needed to diagnose ADHD inattentive?
six or more of the following for 6 months
Does not give attention to details or makes repeated careless
mistakes
* Trouble keeping attention on tasks or activities
* Often does not seem to listen when spoken to directly
* Does not follow through with completion of task/activity
* Often has trouble organizing activities
* Avoids, dislikes doing tasks that involve mental effort
* Loses things, distracted, or forgetful
* Easily bored
* Disorganized
how do we treat ADHS?
-behavior management
-parent training
-increase problem solving and coping skills
-group therapy
-stimulants
-nonstimulants
what are not effective treatments for ADHD?
-play therapy
-CBT
what do stimulants do?
improve attention and FOCUS to decrease hyperactivity
what is important when dosing stimulants in children?
NOT weight dependent
start low and work your way up
what are the long acting stimulants?
-dextroamphetamine/amphetamine
* lisdexamfetamine
* dexmethylphenidate
* methylphenidate
what are the intermediate acting stimulants?
- dextroamphetamine
- methylphenidate
what are the short acting stimulants
- methylphenidate (Ritalin)
- dexmethylphenidate
- dextroamphetamine
- amphetamine sulfate
s/e of stimulants
decreases appetite, h/a, nausea, insomnia, jittery, social withdrawal, tachy or brady, HTN, restlessness
what are the non stimulants?
–atomoxetine (SNRI)
–buproprion (NDRI)
-clonidine
–guanfacine
–imipramine
what is important to monitor for with atomoxetine?
SI
what are some practical tips for someone with ADHD?
-schedule
-organize everyday items
-be specific, clear, and consistent
-give praise when rules are followed
-set and reward small attainable goals
what are the three impulse control disorders?
- oppositional defiant disorder
- conduct disorder
- intermittent explosive disorder
what is the common age of onset for ODD?
~8 years old
what are the clinical features for ODD?
-angry/irritable
-argumentative
-vindictiveness
-recognizes others have rights and rules
-don’t think they are angry and blame others
r/f for ODD
-family hx of mental illness
-neurobiology
-family dysfunction
-adverse childhood events
-temperamental
what is the treatment for ODD?
-parent training
-group therapy
-anger management
-individual and family therapy
-cognitive problem solving training
-divalproex (to control anger and aggression)
when is the onset of conduct disorder?
late childhood/early adolescence
what are the clinical features of conduct disorder?
unimpulsive violation of the rights of others
-aggression to ppl and animals
-destruction of property
-deceitfulness
-rules violation
-does NOT feel guilty
r/f for conduct disorder
-physical and sexual abuse
-lack of supervision
-inconsistent and harsh parenting
-early institutional living
-parental substance abuse
-biology
treatment for conduct disorder
-meds: antidepressant, mood, stimulants, antipsychotics, anticonvulsants, and adrenergic
-family support
-psychosocial
-anger mgmt
-parent training
r/f for intermittent explosive disorder
-neurobiological abnormalitites
-conflict or violence in family
age of onset for intermittent explosive disorder
can be diagnose at age 6
commonly diagnosed 13-21 years
clinical features of intermittent explosive disorder
-impulsive and unwarranted emotional outbursts
-violence
-destruction of property
what helps prevent worsening intermittent explosive disorder?
early treatment
what are some psychosocial interventions of all impulse control disorders?
- Promote a climate of safety for the patient and for others.
- Establish rapport with the patient.
- Set limits and expectations.
- Consistently follow through with consequences of rule-breaking.
- Provide structure and boundaries.
- Provide activities and opportunities for achievement of goals to
promote a sense of purpose.
