Psych disorders in children

Question 1

What are the 3 types of ADHD?

Answer 1

Predominantly inattentive type
Predominantly hyperactive/impulsive type
Combined type

Question 2

How can you dx ADHD?

Answer 2

Inattention + Hyperactivity/impulsivity sx
Duration: 6+ months
Onset: prior to age 12
2+ settings
Cause functional impairment

Question 3

How can you treat ADHD?

Answer 3

Meds + educational/behavioral interventions

Pharmacology:
First line: Stimulants (methylphenidate cmpds, mixed amphetamine salts) –> dop reuptake inhibition, stimul of dopa release

2nd line: Atomoxetine –> NE reuptake inhibitor

Adjunctive: alpha 2 ags (clonidine, guanfacine) –> bind post-synaptic R in prefrontal cortex to increase noradrenergic tone

Question 4

How can you dx ASD?

Answer 4

1. Problems with social communication/interaction
2. Restricted/repetitive behaviors

Causes signif social/occupational impairment
Not better accounted for by ID or global dev delay

Question 5

What is a red flag for ASD?

Answer 5

rapid deterioration of social/language skills during first 2 yrs of life

Question 6

Multifactorial etio of ASD?

Answer 6

• advanced paternal age
• prenatal neuro insults (infection, drugs)
• low birth wt
• most common single gene cause of ASD = Fragile X
• high comorbidity with ID
• assoc with epilepsy

Question 7

What are 2 most imp predictors of adult outcome, in ASD?

Answer 7

1. level of intellectual functioning

2. language impairment

Question 8

How can you dx Tourette’s?

Etiology? (2)

Assoc with?

Tx?

Answer 8

Multiple motor and 1+ vocal tics
duration: >1 year
onset: prior to age 18 (peak = 10-12 yo)
not caused by substance / medical condition

Etio:

• older paternal age
• maternal smoking
• Assoc w/ ADHD, OCD

Mgmt: psychoeducation, behav interventions
Meds ONLY if tics become impairing:
- alpha 2 ag: guanfacine (first chocie), clonidine (sedating)
- if severe: atypicals (risperidone) or typical (pimozide)

Question 9

Other tic disorders?

Answer 9

Persistent motor tic disorder: motor only
Persistent vocal tic disorder: vocal only
Provisional tic disorder: motor +/- vocal, <1 yr (have never met Tourette’s criteria)

Question 10

How dx and manage ODD?

Answer 10

Oppositional Defiant Disorder
4+ sx, duration: 6+ months
- anger/irritable mood
- argumentative/defiant behavior
- vindictiveness
- disturbance assoc with distress in individual or others
** no difficulties w peers, but with not comply w rules from parents or teachers **

• usually in preschool years; boys pre-adolescence
• assoc with substance use, ADHD

Mgmt:

1. Behavior modification
2. Parent management training!

Question 11

How dx conduct disorder?

Answer 11

• violate rights of humans/animals
• lack remorse
• physical/sexual violence

at least 3 behaviors within last yr, at least one in past 6 mo

• aggression to ppl/animals
• destruction of property
• deceitfulness/theft
• serious violation of rights
• comorbid ADHD, ODD
• assoc with anti-social PD

Mgmt:

1. Behavior modification
2. Parent mgmt training

Question 12

How dx and manage enuresis?

Answer 12

ENURESIS: Recurrent urination into clothes or bed-wetting

2x/wk for 3+ consecutive months –> impairment or distress
age: 5+ yrs developmentally

• Nocturnal enuresis: more common in boys
• Diurnal (waking hrs) enuresis: girls
• Consider regression.

Mgmt:
Psychoeducation … only tx if sx are affecting them.
1. Limit fluid intake at night.
2. Urine alarm
3. Pharma: desmopressin (1st line), imipramine (refractory)

Question 13

How dx and manage encopresis?

Answer 13

1+/month for 3+ months
age: 4+ yrs developmentally

*Consider regression.

Mgmt:

1. w constipation –> bowel cleaning, toilet routine
2. w/o constipation –> behav program (“bowel retraining”) for appropiate elimination