Psychiatric Disorders in Children Flashcards
What are the diagnostic criteria for mental retardation or intellectual disability?
IQ less than or equal to 70
deficits in adaptive skills appropriate for the age group
onset before 18
What are the two most common genetic causes for mental retardation?
down syndrome trisomy 21
fragile x
Learning disorders are most common in what subject?
reading
What should you always rule out before diagnosing a learning disorder?
sensory deficits
What are the diagnostic criteria for oppositional defiant disorder?
at least 6 months of negativistic, hostile and defiant behavior during which at least 4+ of the following have been present:
- frequent loss of temper
- arguments with adults
- defying adults rules
- deliberately annoying people
- easily annoyed
- anger and resentment
- spitefulness
- blaming others for mistakes or misbehaviors
What is lacking in oppositional defiant that is present in conduct disorder?
physical aggression or violation of the basic rights of others
What is the typical age of onset of oppositional defiant?
can begin as early as age 3 and typically before age 8
What percentage of cases will not longer meet criteria in later years?
25%
What is the general treatment for oppositional defiant?
psychotherapy that focuses on behavior modification
also parent management skills training for families
What are the diagnostic crtieria for conduct disorder?
persistent pattern of behavior in which the basic rights of others or social norms are violent with at least 3 out of 15 behaviors grouped within the following categories:
- aggression toward people and animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
What are some risk factors for conduct disorder?
punitive parenting psychosocial adversity history of abuse biological predisposition male gender
What percentage of people with conduct disorder will have comorbid ADHD?
70%
What percentage of kids with conduct disorder will go on to develop antisocial personality disorder in adulthood?
40%
What are the three subcategories of adhd?
predominantly in attentive
predominantly hyperactive-impulsive
combined type
What are the disgnostic criteria for ADHD?
at least 6 symptoms of either inattentiveness, hyperactivity or both that have persisted for at least 6 months, are present at a degree that is maladaptive, with an onset before age 7
What is the prevalence of ADHD?
5-12%
What percentage of people with ADHD will have symptoms lasting into adulthood?
60%
What are some pharmacological treatment options for ADHD?
stimulants are first line: methylphenidate, dextroamphetamine and amphetamine salts
atomoxetine (nonstimulant)
alpha-2 agonists second line
What are the diagnostic criteria for autism?
at least 6 symptoms present by age 3 with at least two in problems with social interaction and a least 2 in either impairment in communication or repetitive/stereotyped patterns of behavior and activities
What percentage of individuals with autism also meet criteria for mental retardation?
70%
What are the two most important predictors of adult outcome in autism?
level of intellectual functioning
communicative competence
How does asperger differ from general autism?
people with aspergers will have normal language acquisition and cognitive development, but will still have the issues with social interactions and stereotyped interests/behaviors
Describe Rett syndrome.
it’s characterized by normal physical and psychomotor development during the first 5 months after birth, followed by a decreasing rate of head growth and loss of previously learned purposeful hand skills between 5 and 30 months
then develop stereotyped hand movements, impaired language and psychomotor retardation.
cognitive development never progresses beyond that of the first year of life
What are the diagnostic criteria for tourette disorder?
multiple motor and one+ vocal tics that are not attributable to CNS disease
onset prior to 18 years
tics occur many times a day almost every day for over 1 year with no tic-free periods lasting over 3 months
change in anatomic locations and character of tics over time
What is the usual disease progression in tourettes/
waxing/waning course with tic episodes occurring in bouts
one half to two thirds will experience marked reduction of symptoms by their late teans with many becoming virtually asymptomatic in adulthood
What are some pharmacological treatment options for tourettes?
atypical neuroleptics like risperidone
alpha-2 agonists like clonidine
typical neuroleptics for severe cases
How bad does bed-wetting need to be before we call it enuresis?
after age 5:
at least 2x per week for at least 3 months
When do we give a diagnosis of encopresis?
involuntary or intentional passage of feces in inappropriate places by age 4 at least once a month for at least 3 months
What is the typical course for enuresis?
usually resolves spontaneously by age 7
