Psych 7 - Developmental Flashcards
What are some r/f’s for ADHD?
FHx
Prenatal risks
Environmental toxins
Differences in brain structure
ADHD:
M or F more commonly affected?
*What NT is altered?
10x M > F
- Lower dopamine levels
ADHD: treatment?
- Stimulants (eg methylphenidate, dextroamphetamine) +/- CBT
Alternative non-stimulants: atomoxetine
In ADHD, what are the 3 different presentation categories?
- Inattentive
- Hyperactive/compulsive
- Combined
Describe the ADHD sx of “inattention.”
- trouble paying attention or listening (Esp. w/multiple step directions)
- inattention to details, careless mistakes
- losing things (e.g., school supplies)
- forgetting to turn in homework
- trouble finishing assignments
- trouble following multiple adult commands
- difficulty playing quietly
Describe the ADHD sx of “hyperactivity.”
- fidgeting
- inability to stay seated
- running or climbing excessively
- always “on the go“
Describe the ADHD sx of “impulsivity.”
- talks too much
- interrupts or intrudes on others
- blurts out answers
- impatience
- difficult to redirect
For diagnosing ADHD, by what age must sx onset occur?
How long must sx duration be? (not tested)
- Prior to 12 years old
- > 6 months duration
Which is more severe: conduct disorder or oppositional defiant disorder?
Conduct disorder
What severe psychiatric disease is ADHD co-morbid w/quite often? (40-90% of the time)
BAD
What are some similarities b/w ADHD and BAD?
What about differences?
Similarities:
- distractibility
- increased energy
Differences (characteristics of BAD only):
- elevated mood
- periods of sadness or negative mood
- severe problems regulating emotions
- flight of ideas
- *decreased need for sleep
- bursts of energy, exuberant or destructive
- hypersexuality
What are the characteristics of oppositional defiant disorder? (ODD)
1st aid: “Enduring pattern of hostile, defiant behavior towards authority figures in the absence of serious violations of social norms.”
- often loses temper
- argues with adults
- hostile, defiant behavior towards authority figures
- blames others for own mistakes
- annoys people deliberately
- touchy and easily annoyed by others
- often spiteful and vindictive
- pattern of anger-guided disobedience
How is ODD generally treated?
How is conduct disorder treated?
How is antisocial personality disorder treated?
Psychotherapy (eg CBT)
What are the characteristics of conduct disorder?
Repetitive and pervasive behavior violating the basic rights of others or societal norms. (s/p age 18, many will meet criteria for antisocial personality disorder). Repetitive/persistent pattern of behavior (Think of it as a more severe form of ODD.)
Childhood-onset (<10-yo) vs. Adolescent-onset
- Often bullies, threatens others
- Cruel to animals
- Destroys property, sets fires
- Often starts fights
- Often lies and lacks remorse
- Skips school, runs away
- Often stays out at night, despite parental rules
What is the definition of a tic?
Sudden, rapid, recurrent, non-rhythmic motor movement or vocalization
Define Tourette syndrome.
How long must it occur for, and how frequently during that time?
What age must onset be before?
Multiple motor and vocal tics
- Tics occur many times every day or intermittently for > 1 year
- Onset before age 18
What are the 2 types of tics seen in Tourette syndrome?
Tics can be simple (rapid, repetitive contractions) or complex (appear as more ritualistic and purposeful)
- Simple tics appear first
What is the mean age of onset for Tourette?
M or F more common?
What NT is it a/w?
What 2 psych disorders is it commonly co-morbid w/?
- 7 y/o
- M > F
- A/w increased DA
- OCD, ADHD
What is the tx for Tourette syndrome?
- Psycho-education, behavioral therapy
- When meds indicated: high potency antipsychotics: haloperidol, pimozide; clonidine, guanfacine (also tetrabenzine, per 1st aid)
What can exacerbate anxiety disorders in the following age groups:
- Infants
- Toddlers
- School-age
- Adolescence
- Infants: large noises, being startled, strangers
- Toddlers: imaginary creatures, darkness, normative separation anxiety
- School-age: bodily injury, natural events
- Adolescence: school performance, social competence, health issues
Separation anxiety disorder:
- Common age range of onset?
- What is the disorder? How long must it last?
- What triggers it?
- Which children are more prone to it?
- 7-9 y/o
- Overwhelming fear of separation from home or loss of attachment figure. Fear, anxiety, avoidance is persistent (> 1 month)
- Develops after significant stressful or traumatic event
- Children with over-protective parents; may be a manifestation of parental separation anxiety
Describe the s/s seen in separation anxiety disorder.
- Constant thoughts, intense fears about safety of parents
- School refusal
- Frequent somatic complaints
- Extreme worries about sleeping away from home
- Being overly clingy
- Panic, tantrums when separating from parents
- Trouble sleeping or nightmares (usually about safety)
How is separation anxiety disorder treated?
CBT (eg systemic desensitization), play therapy, family therapy
What is systemic desensitization often used to treat?
Describe the process.
- Often used to treat anxiety and phobias
1. Begins with imagining oneself in a progression of fearful situations and using relaxation
2. When the person is relaxed in the presence of the feared stimulus, objectively, there is no more phobia
3. Works by replacing anxiety with relaxation
Based on the counterconditioning or reciprocal inhibition of anxiety responses:
1) Step 1: hierarchy of fear-eliciting stimuli is created, building from least to most stressful
2) Step 2: therapist teaches the technique of muscle relaxation, a response that is incompatible with anxiety
3) Step 3: patient is taught to relax in the presence, real or imagined, of each stimulus on the hierarchy from least to most stressful
What is biofeedback (neurofeedback)?
How does it work?
Using external feedback to modify internal physiologic states
- Humans (and animals) can somewhat control their autonomic NS
- Involves providing the person with info about his internal responses to stimuli and methods to control and/or modify them
- Works by means of trial-and-error learning and requires repeated practice to be effective
What are some conditions that may be treated by biofeedback?
HTN, migraine and muscle-contraction headaches, Raynaud syndrome, torticollis, cardiac arrhythmias, and anxiety
What is the function of a teddy bear to a baby with separation anxiety?
Transitional object
What are developmental milestones?
normative markers at median ages
What cranial abnormality is a risk indicator for psych disease later in life?
Smaller cerebellum
Infant development:
- By what age do they smile?
- By what age do they exhibit exogenous smiling in response to a face?
- By what age does a preferential social smile develop (eg to mother’s face specifically)?
(not tested)
- At birth
- 8 weeks
- 12-16 weeks
Describe the patterns of motor development in infants.
not tested
- Grasp precedes release
- Palm up maneuvers occur before palm down maneuvers
- Proximal to distal progression. Ulnar to radial progression
How old are infants when they have their:
- First words?
- First steps?
(not tested)
- 10 months
then 1st b-day - 13 months
When does the brain undergo its most rapid increase in size?
not tested
From last trimester of pregnancy to 14 months
When do babies develop their earlier memories?
not tested
- 2-4 years
When does stranger anxiety appear in children?
When should it disappear by?
(not tested)
- 6 months
- 12 months
(Can occur even when child is held by parent)
When does separation anxiety normally appear in all people?
When does it normally disappear by?
(not tested)
- 8-12 months
- 20-24 months
Does school phobia (separation anxiety disorder) therapy focus on activities in school or relationship with parents?
Child’s interaction w/parents
Describe what age the following figures are copied:
Circle, cross, diamond, rectangle, square, triangle.
(alphabetical except diamond)
- circle: 3
- cross: 4
- rectangle: 4.5
- square: 5
- triangle: 6
- diamond: 7
List the possible consequences of untreated psych disorders in children.
- Suicide
- School failure
- Criminality
- Higher health care utilization
- Chronic physical problems (heart disease, DM, stroke)
Earlier identification and intervention of childhood psychiatric diseases can promote _________.
Resilience
What are some forms of child abuse?
Tissue damage
Neglect
Sexual exploitation
Mental cruelty
Up to what age are we mandated reporters?
18
What are some signs of childhood abuse?
- Broken bones in first year of life
- Sexually transmitted disease (STD) in young children
- 92% of injuries are soft tissue injuries (bruises, burns, lacerations)
(5% have no physical signs)
Describe how to detect whether an upper extremity burn is more or less likely child abuse.
Non-accidental burns have a particularly poor prognosis:
- They are associated with death or foster home placement
- If burn is on arms and hands, it was likely an accident
- If burn is on arms but not hands, it is more likely abuse
How can you identify shaken baby syndrome?
Look for broken bv’s in eyes
What children are at risk for abuse?
Younger than 4 years
Special needs populations:
- intellectual disability (formerly MR)
- learning disabilities
- other mental illness
- chronic physical illnessChildren who are abused are more likely to:
-The friends they have tend to be (older/younger).
- Be aggressive in the classroom
- Perceive others as hostile
- View aggression as a good way to solve problems
- Have abnormally high rate of withdrawal (girls)
- Be unpopular with school peers and other children; **the friends they do have tend to be younger
What is the age-range of most victims of sexual abuse?
More M or F?
- 9-12 years old most often
- Mostly female (males more likely to be sources)
- Most tend to be by family
What are some r/f’s for childhood sexual abuse?
Single-parent families
Marital conflict
History of physical abuse
Social isolation
Simply define child sexual abuse.
Sex experience before age 18 with a person 5 years older
Describe the shared features of many perpetrators of sexual abuse.
- Limited understanding of normative development
- H/o child maltreatment in parental family of origin
- Substance abuse and/or untreated mental illness
- Low socioeconomic status; community violence
- Non-biological, transient caregivers in home
- Social isolation of family
Define intellectual disability
What are key things that are different about kids w/intellectual disabilities? (mental retardation, formerly)
Significant deficits in intellectual functioning (reasoning, problem solving, planning, abstract thinking, judgment)
- Significant deficits in *adaptive behavior (failure to meet standards for personal independence, social responsibility)
- Presents as *developmental delay
Do all children with developmental delay develop intellectual disability?
No
What is the most common known cause of intellectual disability?
Fetal alcohol syndrome
What are the 2 most common genetic causes of intellectual disability?
- Down syndrome
2. Fragile-X syndrome
Fragile X syndrome:
- Inheritance pattern?
- Gene/mutation type?
- Physical signs?
- X-linked dominant
- Tri-NT repeat (CGG) in FMR1 gene -> methylation -> decreased expression
- Post-pubertal macroorchidism (enlarged testes), long face w/large jaw, large elevated ears, autism, mitral valve prolapse (“Xtra large testes, face, jaw, ears)
Describe the level of functioning in mild, moderate, severe, and profound intellectual disability.
- Mild: Self-supporting w/some guidance (M > F)
- Mod: benefits from vocational training, needs supervision
- Severe: Vocational training not helpful, can learn to communicate, basic self-care habits
- Profound: needs highly structured environment, constant nursing care, supervision
What is the former name for autism spectrum disorder (ASD)?
By what age is it diagnosed?
M or F more?
- Formerly Pervasive Development Disorders
- Diagnosis before age 3
- Males > Females (4:1)
What % of autistic pts have seizure disorder?
20-25%
*Describe the clinical signs of ASD.
Is separation anxiety present in ASD?
1st aid: Characterized by poor social interactions, social communication deficits, repetitive/ritualized behaviors, and restricted interests. Must present in early childhood. May be accompanied by intellectual disability, rarely by unusual abilities (savants).
- Deficits in reciprocal social interaction
- Decreased repertoire of activities and interests
- Abnormal or delayed language development, impairment in verbal and non-verbal communication
- Oblivious to external world
- Fails to assume anticipatory posture, shrinks from touch
- Preference for inanimate objects
- Stereotyped behavior and interests
- *No separation anxiety
Per DSM V, what are the 2 domains that must be disturbed to dx autism?
(1) Social relatedness and communication (across multiple contexts)
- deficits in social-emotional reciprocity
- deficits in nonverbal communicative behaviors
- deficits in developing, maintaining, understanding relationships
(2) Restricted interests/activities
- adherence to nonfunctional routines
- motor mannerisms (hand-flapping, object-twirling)
- persistent fixation on parts of objects
- highly restricted, fixated interests (abnormal intensity or focus)
- hyper- or hyporeactivity to sensory input
Symptom severity scale: “Requiring support; substantial support; or very substantial support”
Risk of autism increased if mother had ________, ________, or ________ while pregnant.
asthma, allergies, or psoriasis
What should be r/o’d before dx’ing autism?
- specific developmental disorders (e.g., language d/o)
- sensory impairments (e.g., deafness)
- reactive attachment disorder
- obsessive-compulsive disorder
- anxiety disorders (selective mutism)
- childhood-onset schizophrenia
Rett syndrome: M or F? Inheritance pattern? When do sx become apparent? Sx? What other conditions are they prone to?
- Females (males die in utero or right after birth)
- X-linked dominant
- Sx become apparent ~ 1-4 y/o (6-18 months, per teacher)
- Sx: regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, stereotyped hand-wringing. Small hands and feet, microcephaly.
- Prone to seizures, GI issues, scoliosis
How was Asperger describe before DSM V?
Now an autism spectrum disorder, but was: - Language is normal - IQ is normal - Higher level of functioning Compared to ASD?
What is an IEP (Individualized Educational Plan), as mandated by some school districts?
IEP (Individualized Educational Plan)
- Speech therapy
- Occupational therapy
- Communication assistance devices
- Specific teaching technique for autism
**Regarding the tx’s for autism,
What 2 behavioral techniques are used?
What medications might be prescribed?
Behavioral techniques
- Shaping
- ABA (Applied Behavioral Analysis)
Medication management
- does not change core symptoms
- adjunctive for behavior management
- atypical antipsychotics (risperidone)
- mood stabilizers
- stimulants
- SSRIs
Describe “shaping,” a behavioral technique to treat autism.
Shaping (or successive approximations):
- Achieves final target behavior by reinforcing successive approximations of the desired response
- Reinforcement is gradually modified to move behaviors from the more general to the specific responses desired
- e.g., a boy with autism who won’t speak is first reinforced, perhaps with candy, for any utterance (food use not encouraged)
Is ASD always an intellectual disorder?
No, MAY be
