Psychiatric Disorders in Children

Question 1

What are the diagnostic criteria for mental retardation or intellectual disability?

Answer 1

IQ less than or equal to 70
deficits in adaptive skills appropriate for the age group
onset before 18

Question 2

What are the two most common genetic causes for mental retardation?

Answer 2

down syndrome trisomy 21

fragile x

Question 3

Learning disorders are most common in what subject?

Answer 3

reading

Question 4

What should you always rule out before diagnosing a learning disorder?

Answer 4

sensory deficits

Question 5

What are the diagnostic criteria for oppositional defiant disorder?

Answer 5

at least 6 months of negativistic, hostile and defiant behavior during which at least 4+ of the following have been present:

1. frequent loss of temper
2. arguments with adults
3. defying adults rules
4. deliberately annoying people
5. easily annoyed
6. anger and resentment
7. spitefulness
8. blaming others for mistakes or misbehaviors

Question 6

What is lacking in oppositional defiant that is present in conduct disorder?

Answer 6

physical aggression or violation of the basic rights of others

Question 7

What is the typical age of onset of oppositional defiant?

Answer 7

can begin as early as age 3 and typically before age 8

Question 8

What percentage of cases will not longer meet criteria in later years?

Answer 8

25%

Question 9

What is the general treatment for oppositional defiant?

Answer 9

psychotherapy that focuses on behavior modification

also parent management skills training for families

Question 10

What are the diagnostic crtieria for conduct disorder?

Answer 10

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:

1. aggression toward people and animals
2. destruction of property
3. deceitfulness or theft
4. serious violation of rules

Question 11

What are some risk factors for conduct disorder?

Answer 11

punitive parenting
psychosocial adversity
history of abuse
biological predisposition
male gender

Question 12

What percentage of people with conduct disorder will have comorbid ADHD?

Answer 12

70%

Question 13

What percentage of kids with conduct disorder will go on to develop antisocial personality disorder in adulthood?

Answer 13

40%

Question 14

What are the three subcategories of adhd?

Answer 14

predominantly in attentive
predominantly hyperactive-impulsive
combined type

Question 15

What are the disgnostic criteria for ADHD?

Answer 15

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

Question 16

What is the prevalence of ADHD?

Answer 16

5-12%

Question 17

What percentage of people with ADHD will have symptoms lasting into adulthood?

Answer 17

60%

Question 18

What are some pharmacological treatment options for ADHD?

Answer 18

stimulants are first line: methylphenidate, dextroamphetamine and amphetamine salts

atomoxetine (nonstimulant)

alpha-2 agonists second line

Question 19

What are the diagnostic criteria for autism?

Answer 19

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

Question 20

What percentage of individuals with autism also meet criteria for mental retardation?

Answer 20

70%

Question 21

What are the two most important predictors of adult outcome in autism?

Answer 21

level of intellectual functioning

communicative competence

Question 22

How does asperger differ from general autism?

Answer 22

people with aspergers will have normal language acquisition and cognitive development, but will still have the issues with social interactions and stereotyped interests/behaviors

Question 23

Describe Rett syndrome.

Answer 23

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

Question 24

What are the diagnostic criteria for tourette disorder?

Answer 24

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

Question 25

What is the usual disease progression in tourettes/

Answer 25

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

Question 26

What are some pharmacological treatment options for tourettes?

Answer 26

atypical neuroleptics like risperidone
alpha-2 agonists like clonidine

typical neuroleptics for severe cases

Question 27

How bad does bed-wetting need to be before we call it enuresis?

Answer 27

after age 5:

at least 2x per week for at least 3 months

Question 28

When do we give a diagnosis of encopresis?

Answer 28

involuntary or intentional passage of feces in inappropriate places by age 4 at least once a month for at least 3 months

Question 29

What is the typical course for enuresis?

Answer 29

usually resolves spontaneously by age 7