psych disorders in children Flashcards
Kaufman Assessment Battery for Children
intelligence test for ages 2-12
Wechsler intelligence scale for children-revised
determines IQ for ages 6-16
mental retardation (intellectual disability) definition
IQ less than 70; deficits in adaptive skills approp for age; onset must be before age 18
MR is more common in males than females
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mild, moderate, severe, profound MR cutoffs
mild is 55-70; moderate is 40-55; severe is 25-40; profound is less than 25
genetic causes of MR
Down syndrome, fragile X syndrome; PKU, prader-willi, williams syndrome, angelman syndrome, tuberous sclerosis
prenatal causes of MR
Torch infections (toxo, other, rubeella, CMV, herpes)
def of learning disorder
achievement in reading, math or writing that is signif lower than expected; cannot be explained by sens deficits, poor teaching, or cultural factors; often due to deficits in cognitive processing
oppositional defiant disorder
at least 6 mos of negativistic, hostile, and defiant behavior during which at least 4 of the criteria have been present
criteria for oppositional defiant disorder
freq loss of temper; arguments with adults; defying adults rules; deliberately annoying people; easily annoyed; anger and resentment; spitefulness; blaming others for mistakes or misbehaviors
when does oppositional disorder usually present?
can begin as early as age 3, but usually around age 8
prognosis of oppositional conduct disorder
twenty five percent of kids will grow out of it; in persistent cases, may progress to conduct disorder
treatment for oppositional defiant disorder
pychotherapy; parent management skills training
conduct disorder def
most serious; basic rights of others or social norms are violated, as evidenced by at least 3 of 15 described behaviors during the past year;
behaviors of conduct disorder grouped into four categories
aggresion toward people and animals; destruction of property; decietfulness or theft; serious violations of rules
epi of conduct disorder
many times more common in boys
risk factors for conduct disorder
punitive parenting; psychosocial adversity; hx of being abused; biological predisposition
prognosis for conduct disorder
up to forty percent will go on to develop antisocial personality disorder in adulthood
treatment for conduct disorder
consistent rules and consequences; family involvement; meds can be useful adjunct inf aggression is present (antipsychotics, mood stabilizers, SSRIs)
three subcategories of ADHD
predominently inattentive type, predominantly hyperactive-impulsive type, and combined type
diagnosis of ADHD
at least six sx of either inattentiveness, hyperacitivity, or both that have persisted for at least 6 mos, present at a degree that is maladaptive, onset before age 7
prognosis of ADHD
up to 60% will have sx into adulthood (more impulsiveness than hyperactivity)
neurochemical factors that may contribute to ADHD
dysregulation of noradrenergic systems
neuropsych factors that can be demonstrated inADHD
certain patients with abnormal EEG patterns or PET
pharmacologic treatements of ADHD
CNS stimulants are first line (methylphenidate, dextroamphetamine, and amphetamine salts; atomoxetine is nonstim that works too; alpha 2 ags
alpha 2 ags for ADHD
can be used if stimulants cannot be tolerated due to side effects; clonidine, guanfacine
nonpharm treatments for ADHD
psychotherapy; parent education; educational interventions
pervasive developmental disorders
disorders that involve problems with social skills, language, and behaviors; impairment is noticeable at an early age of life and involves multiple areas of development
examples of pervasive developmental disorders
autistic disorder, asperger disorder, Rett disorder, childhood disintegrative disorder; PDD NOS
definition of Autistic disorder
at least six sx must be present by age 3, with at least two from category 1 and at least one from categories 2 and 3
category 1 problems in autistic disorder
problems with social interaction
category 2 problems in autistic disorder
impairments in communication
category 3 problems in autisitc disorder
repetitive and stereotyped behavior and activities
seventy percent of individuals with autism meet criteria for MR
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autistic disorder is assoc with
fragile X, tuberous sclerosis, and seizures
predictors of adult outcome in kids with autism
level of intellectual functioning and communicataive competence
Asperger disorder
same impairments seen in autism inovoling social interactin and restricted or stereotyped interests but differs in that no delay in language, cognitive delveopment, self-help skills or curiosity about environment
Rett disorder
normal physical and psychomotor development during the first 5 mos after birth followed by decr rate of head growth and loss of learned hand skills
Rett disorder kids will then develop
stereotyped hand movements (hand wringing, hand washing), impaired language, and psychomotos retardation and problems with gait or trunk movements
features of Rett disorder
onset between 5 and 48 mos; seen in girls; genetic testing; EEF abnormal and seizures are common; patients become nonambulatory due to motor problems and scoliosis
gene in Rett syndrome
MECP2 gene mutation on X chrom
tretment for Rett syndrome
supportive
childhood disintegrative disorder
normal development in the first 2 years but loss of acquired skills before age 10 in at least two areas (lang, social skills, or adaptive behavior, bowel or bladder control, play, motor skills, and in at least two of social, communic, restricted behaviors/interest)
childhood disintegrative disoder onset
onset after age 2, usually between ages 3 and 4, must be before age 10
childhood disintegrative disorder other features
more common in boys; etiology unknown; high rates of EEG abnormality and seizure disorder; assoc with various general med conditions
treatment for childhood disintegrative disorder
supportive, with a focus on helping kids relearn basic skills
tourette disorder
tics disorder characterized by multiple daily motor and some vocal tics with onset before age 18
examples of vocal tics in tourette disorder
coprolalia (repetitive speaking of obscene words); echolalia (exact repitition of words)
diagnosis of tourette’s syndrome
multiple motor and one or more vocal tics (not necessarily concurrently) that are not attributable to CNS disease; onset before age 18; tics occur many times a day, almost every day for at least a year
tics in tourettes
many times a day, almost every day for at least a year; no tic free period greater than 3 mos; change in anatomic location and character of tics over time;
both motor and vocal tics must be present to dx Tourettes
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tourette symptoms peak in severity at what age
between 8 and 12, decreasing with puberty
prognosis of tourettes
many exerience marked reduction of sx by their late teens, with one third to one half becoming virtually asymp in adulthoo
tourettes has high comorbidity with OCD and ADHD
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neurochemical factors that may contribute to tourettes
impaired red of dopamine in the caudate nuc (and possibly impaired reg of endogenous opiates and the noradrenergic system)
tourettes psych factors
symptom exacerbations follow stressful life events, fatigue, extremes of temp, and external simuli
nonpharm treatment for tourettes
supportive and behavioral therapy
pharm treatment of tourettes
atypical neuroleptics (risperidone), alpha 2 ags (clonidine, guanfacine), typical neuroleptics (haloperidol, pimozide) for severe cases
OCD patients with comorbid tics have good response to
SSRI augmentation of antipsychotics
when is continence (both urinary and bowel) usually achieved by?
age 4
enuresis
urinary incontinence after age 5 (at least twice a week for at least 3 consec mos or with marked impairment)
encopresis
fecal incont greater than age 4 (at least once a month for at least 3 mos);
treatment for bowel and/or bladder incontinence
high spontaneous remission rate; psychotherapy; behavior modification, DDAVP, TCAs, bowel catharsis and stool softeners
selective mutism
refusal to speak in certain situations for at least 1 mo
onset of selective mutism
around age 2-5; not noticed until time of entry into school
treatment for selective mutism
psychotherapy, management of anxiety
separation anxiety disorder
excessive fear for greater than 4 weeks of leaving one’s parents or other major attachment figures
treatment for separation anxiety
therapy and low dose antidepressants
at what age are kids most at risk for sexual abuse?
between ages 7 and 13
a diagnosis of MR cannot be made with just a low IQ
deficits in adaptive skills must also be present
FMR-1 gene defect
fragile X syndrome, the most common inherited form of MR
difference between conduct disorder and oppositional defiant disorder
ODD does not involve physical aggression or violation of basic rights of others
kids who have no difficulties getting along with peers but will not comply with expectations from parents or teachers
think oppositional defiant disorder
cruelty to animals
think conduct disorder
how is asperger disorder different from autism
kids with asperger disorder have normal language acquisition and cognitive development
difference between Rett disorder and childhood disintegrative disorder
in childhood disintegrative disorder, head growth does not slow, and the unusual hand movements are not present
tic disorders are ne of the few psych disorder in which a dx can be given without sx causing signif distress
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when is separation anxiety age approp
from 7 mos to 6 years
when does stranger anxiety peak
8-12 mos of age
