Peds Psychiatry Flashcards
When is HEADSSS a useful tool? what do we use it for?
Used in screening for depression in children. H- home E- education A- activities D- Drugs S- sex S- suicide S- safety at home/school/neighborhood
Intellectual disability
- definition
- clinical features
- causes
Global Developmental Delay:
-definition
Intellectual disability: neurodevelopmental disorder with multiple etiologies that encompass a broad spectrum of functioning, disability, and strengths.
Clinical features:
- parental concerns: language delays
- younger sibling overtake an older child
- fails to meet expected developmental milestones.
Causes:
- genetic (more than 50%)
- Congenital infections, hypothyroidism, and teratogens including alcohol, lead, and valproate
- environmental deprivation (neglect)
- hereditary abnormalities
Global Developmental Delay:
-applied to children under 5 who fail to meet expected developmental milestones and have significant impairments in several areas of functioning, usually outgrow this by age 5.
Screening Tools for Intellectual Disability
- Ages and Stages Questionnaires (ASQ)* (4-60mo of Age)
- Bayley Infant Neurodevelopment screener (BINS)* (fine motor, language, reflexes, and cognitive processes)
- Brigance Screens-II (speech & language)
- Infant-Toddler Checklist for Language and Communications (6-24mo)
- Parents Evaluation of developmental status (PEDS) (birth-8yrs)
DSM V criteria for Intellectual Disability
Tx for Disability
-IQ =70 or below
- concurrent deficits or impairments in adaptive functioning in at LEAST 2 of the following areas:
- -communication
- -self care
- -home living
- -social/interpersonal skills
- -use of community resources
- -self direction
- -functional academic skills
- -work
- -leisure
- -health
- -safety
- -onset before 18YO
Tx: -early intervention program -multidisciplinary team support -family support and counseling (PT, OT, ST)
What are the following learning disabilities?
- Dyslexia
- Dysgraphia
- dyscalculia
- ageometria
- anarithmia
- anomic aphasia
-@ what age do we start noticing these disabilities?
Dyslexia: problems with reading, writing, spelling, pronunciation
Dysgraphia: deficiency in the ability to write, primarily handwriting, but also coherence. Difficulty with handwriting, grammar/syntax, formulating, expressing, organizing ideas, spelling encoding (ability to use sound-letter relationships effectively)
Dyscalculia: difficulty in learning or comprehending arithmetic.
Ageometria: deficiency in geometry
Anarithmia: loss of the ability to count
Anomic Aphasia: inability to produce words for things they want to talk about.
Dyslexia:
- MC in boys or girls?
- signs and sx
- common problems
- screening and dx
- tx
- prognosis
MC in boys
Signs and Sx:
- delayed language production
- speech articulation difficulties
- difficulties remembering the names of letters, numbers, and colors
- reversals or visual confusion
Problems:
- difficulty comprehending rapid instructions and following more than one command at a time
- remembering the sequence of thing s
- may try to read from right to left
- may be unable to sound out the pronunciation of an unfamiliar word.
Screening and Dx:
- no single test; involves medical, cognitive, sensory processing, education, and psychological factors
- vision, hearing, and neuro exam
Tx:
- remedial education
- no known way to correct the underlying brain malfunction
- may use techniques to involve hearing, vision and touch to improve reading skills. (using multiple sense to learn)
Prognosis:
- milder forms: often eventually learn to read well enough to succeed in school
- severe: may never be able to read well
Dyscalculia:
- signs and sx
- tx
Signs and sx:
-difficulty understanding number lines, carrying and borrowing numbers, word problems.
Tx:
none really,
-allow use of fingers and scratch paper, use diagrams and draw math concepts, provide peer assistance, suggest use of graph paper
Dysgraphia
- signs and sx
- tx
Signs and sx:
-irregular letter sizes and shapes, mixture of upper and lowercase letters, or print of cursive letters
- difficulties using writing as communication tool,
- unfinished letters
- causes writing fatigue
Tx:
- accomodations
- modifications
- remediation
Define:
- enuresis
- -cause
- encopresis
By what age as enuresis usually stopped?
Enuresis: repeated voiding of urine during the day or night into bed or clothes
- -cause:
- failure to arouse
- increased production of urine while asleep
- overactive bladder
Encopresis: repeated passage of feces into inappropriate places.
Usually enuresis controlled by age 5.
Enuresis:
- dx
- tx
Dx:
- hx
- PE
- voiding diary; timing of voids, volume of urine, UTI sx?
- UA with PVR
- Abd X-Ray
Tx:
- stop fluids before bedtime
- schedulred night time awakening
- alarms
- meds: DDAVP, Oxybutynin (reduces muscle spasm or bladder)
- Impiramine (TCA and for enuresis)
Encopresis:
- pathophysiology
- Presentation
- Dx
- Tx
Patho:
-stool retention in colon, intestinal walls and nerves stretch so lose sensation to go, retained stool becomes harder & hurt so they hold it in more, liquid stools passes around retained hard feces.
Presentation:
- repeated soiling of their underwear
- child denies both the visible and olfactory signs of soiling
Dx: abd xray
Tx:
- enemas/strong laxatives (first 2wks)
- scheduled regular toilet times
- daily laxatives
- proper diet
Autism:
- MC in boys or girls?
- etiology
- what type of disorder is this?
- sx
MC in boys
Etiology: unclear but maybe genetic.
Type of disorder: Neurodevelopmental disorder not behavioral, emotional, or conduct disorder.
Sx:
- limited emotional connection with anyone (delayed/absent social smile, lack of attention to parents face)
- deeply effected by noises, bright lights, and smells
- low functioning
- severe deficits in social responsiveness and interpersonal relationships
- abnormal speech and language development
- verbal/nonverbal communication impairment
- repetitive, rigid, or stereotypes interests or behaviors
- onset before 3YO
- deficiencies in imitative play
- self-mutilation
- unusual objects in the mouth
- insist on routine or rituals w/ no purpose
Autism:
- complications
- DSM V dx criteria
- Tx
Complications:
- 30% develop seizure disorder
- depression
- live in 24hr care facilities
DSM V:
- w/ or w/o intellectual impairment
- w/ or w/o accompanying language impairment
- associated with a known medical or genetic condition
- associated with another neurodevelopmental, mental, or behavioral disorder
- with catatonia
Tx:
- specialized therapy and schooling
- antipsychotic drugs and antidepressants used to cope with aggressive behavior and depression
Autism:
-screening
M-CHAT (Checklist for Autism in TOddlers) 18-24mo
STAT (screening tool for autism in toddlers and young children): asks these questions:
- -does your child look at you and point when eh/she wants to show you something?
- -does your child look when you point to something ?
- -does your child use imagination to pretend play?
