Psychiatry-Childhood Disorders

Question 1

Bobby is always late turning in his assignments. He needs to be told things repeatedly and he has poor grades. His parents say that they have to sit next to him to help him complete his homework. What is your diagnosis? What are the criteria for this diagnosis?

Answer 1

ADHD: inattentiveness, impulsivity and hyperactivity for at least 6 months, before age 12 and affects child in 2 separate settings.

Question 2

ADHD specifiers

Answer 2

Combined symptoms of inattentiveness and impulsivity or stronger one way or the other

Question 3

ADHD risk factors

Answer 3

Low birth weight, smoking and being male

Question 4

Things to rule out when considering ADHD

Answer 4

Medications, thyroid disorder, malnutrition, abuse, environmental (lead), hunger, constipation etc.

Question 5

ADHD DDx

Answer 5

Bipolar, oppositional defiant, conduct and learning disorders. Psychosocial considerations.

Question 6

ADHD Tx

Answer 6

Environmental changes, Stimulants (DA agonists), behavioral changes

Question 7

Why it is necessary to treat ADHD in childhood

Answer 7

30%, resolve by adulthood, 30% residual, 30% worsen.

Question 8

Poor prognosis for ADHD

Answer 8

Early presentation, co-morbid conduct disorder and worsening symptoms in adolescence

Question 9

12-year-old boy set fires at school, beat up the neighbors kid and killed the class pet. Nothing has changed despite 200 hours of community service. What is your diagnosis?

Answer 9

Conduct disorder: characterized by aggression, destruction of property, deceitfulness, theft and serious violation of rules before age 13. Kid must be < 18 years old and have 12 months of symptoms.

Question 10

Types of conduct disorders

Answer 10

Childhood onset (1 criterion b/f age 10), Adolescent onset (no criterion b/f age 10) and Unspecified onset. They are also characterized as mild, moderate and severe.

Question 11

Conduct disorder specifiers

Answer 11

Limited pro-social emotions: lack of remorse, calloused and unconcerned about others.

Question 12

Conduct disorder prognosis

Answer 12

40% go on to antisocial personality, high co-morbidity with ADHD. Worse prognosis w/early onset and greater frequency of events.

Question 13

Conduct disorder Tx

Answer 13

Psychotherapy and drugs (mood stabilizers, beta-blockers and neuroleptics)

Question 14

Charlie is rude, disobedient and cheeky. He throws tantrums and breaks things when confronted. He swears at his teachers and has been suspended from school. What is your diagnosis?

Answer 14

Oppositional defiant disorder. Must be < 18 yrs old, with six months of angry mood, defiant behavior and vindictiveness

Question 15

Etiologies of oppositional defiant disorder

Answer 15

Inconsistent parenting, family history

Question 16

Tx of oppositional defiant disorder

Answer 16

Similar to conduct disorder

Question 17

Tim makes noises like barking and clearing his throat. What is your diagnosis?

Answer 17

Tic Disorder (can be motor or vocal). This is characterized by rapid recurrent movements or vocalizations preceded by an urge to do the tic. Note that functional impairment is not required to make this diagnosis.

Question 18

Criteria for Tourette’s disorder

Answer 18

Motor and vocal tic. Occurs many times a day. > 1 year duration without > 3 months tic free. Onset b/f 18 years old. Not due to other disorder (Huntington, postviral encephalitis, stimulants)

Question 19

Transient tic disorders

Answer 19

4 weeks – 12 months.

Question 20

Prognosis of Tourette’s disorder

Answer 20

1/3 recover by adolescence, 1/3 improve by adulthood, 1/3 stay the same or get worse

Question 21

Tic Tx

Answer 21

Psychoeducation, drugs if bad (alpha-1 agonists, neuroleptics are the drug of choice)

Question 22

Kid poops on mom’s pillow all the time

Answer 22

Encopresis: > 4 years old passage of feces into inappropriate places for at least 3 months

Question 23

Kid wets the bed all the time

Answer 23

Enuresis: 2x/week for 3 consecutive months older than 5 years old.

Question 24

Tx for elimination disorders

Answer 24

“Bell” sleeping pad that rings whenever it gets wet. Encopresis is treated w/behavioral modification.

Question 25

Kid is overly concerned about mom’s safety

Answer 25

Separation anxiety disorder

Question 26

8 year old girl talks to friends and family, but refuses to talk at school

Answer 26

Selective mutism

Question 27

Risk factor that goes with separation anxiety disorder?

Answer 27

Future anxiety disorders

Question 28

5-year-old kid doesn’t play with other kids. Likes to line up his toys methodically and only wears clothes with no tags, laces or belts. What is your diagnosis?

Answer 28

Autism Spectrum Disorder: deficits in social communication, restrictive repetitive behavior, early in development.

Question 29

Autism spectrum disorder specifiers

Answer 29

With or w/o intellectual impairment. With or w/o language impairment. Genetic association. Other disorder association. With catatonia.

Question 30

Autism spectrum disorder children with highest need

Answer 30

Level 3

Question 31

Typical age of presentation of autism spectrum disorder

Answer 31

Age 2

Question 32

Risk factors for autism

Answer 32

Advanced paternal age, family history and low birthweight

Question 33

Autism spectrum disorder poor prognosis

Answer 33

Intellectual disability, additional mental health disorders and epilepsy. Language by age 5 is a good prognosis.

Question 34

Common comorbidities w/autism spectrum disorder

Answer 34

Other psychiatric disorder, anxiety disorder, intellectual impairment, ADHD and depression

Question 35

Autism disorder Tx

Answer 35

Speech pathologist, PT, behavioral therapy, sleep specialist and treat with drugs when kids are aggressive (neuroleptics)