Rosenthal - Childhood Psych Flashcards
How does the timing of onset of disorders reflect their etiology?
- Disorders of INFANCY, coming early in the individual’s developmental course, reflect greater influence of GENETIC and biological predisposition
- Disorders of CHILDHOOD and adolescence reflect INC influence of environmental, SOCIAL, and experiential factors with age
How prevalent are childhood psychiatric conditions?
- 5-15% of children experience a psychiatric disturbance sufficiently severe to require tx or to impair their functioning during the course of a year
What are some of the differences between adult and child psychiatry?
- Consideration of developmental level
- Techniques of assessment
- INC role of non-physicians in the health care team
- Frequent occurrence of psychiatric comorbidity
What are the features and categories of intellectual disability?
- Significantly sub-average intellectual functioning (IQ)
- Significant limitations in adaptive functioning
- Communication
- Self-care
- Life skills
- Health and safety skills
- MILD: 55-70; MODERATE: 40-55; SEVERE: 25-40; PROFOUND: under 25
- NOTE: IQ exhibits a bell curve distribution
What are the features of mild intellectual disability?
- IQ: 55-70
- 85% of individuals with intellectual disability
- Educable with special education assistance
- Read, write, and simple math
- Concrete thinkers
- Expect to be able to hold a job, and live independently
What are the features of moderate intellectual disability?
- IQ: 40-55
- 10% of individuals with intellectual disability
- Talk, recognize names, basic hygiene, do laundry, handle small change
- Minimal academic progress
- Live with family, or in supervised group home
- Work in sheltered workshop or supervised activities
What are the features of profound/severe intellectual disability?
- Severe IQ: 25-40; Profound: under 25
- Unable to complete self-help
- Likely to require care in an institutionalized setting
What is the epi of intellectual disability?
- Affects 1-2% of the population
- Mild 0.37-0.5%
- Mod/severe/profound 0.3-0.4%
- Mild more common in lower SES due to INC likelihood of experiencing exposure to toxins (lead), malnutrition, and poor prenatal care
- Mod/severe profound equally common across SES
- Male to female ration 2:1
Does intellectual disability usually have an identifiable cause?
- Mod/profound/severe usually have identifiable cause
- Mild often does NOT have identifiable cause, and is likely developed through combo of genetic and other factors
What are the most common etiologies of intellectual disability?
- MCC: FETAL ALCOHOL SYNDROME
- Most common chromosomal cause: Down syndrome
- Most common heritable form: fragile X syndrome
- Inborn errors of metabolism (e.g., Tay-Sachs) account for small % of cases
What are the prenatal and perinatal/postnatal factors that can contribute to intellectual disability?
- PRENATAL: substance use/abuse, maternal malnutrition and illness, exposure to mutagens
- PERINATAL/EARLY POSTNATAL: traumatic delivery/brain injury, infections, head injury, exposure to toxins, malnutrition -> this is why mild ID is more prevalent in low SES families
What are some of the comorbidities associated with ID?
- Attention deficit hyperactivity disorder (ADHD)
- Disruptive behavior disorders
- Mood disorders
- Anxiety disorders
- Habit disorders and stereotypes
- Seizure disorders
- NOTE: ppl with ID can also get depressed or anxious, and they should be tx’d just like normally developing kids
What things do you need to make sure you consider before assigning a diagnosis of ID?
- Remember to always look at the child’s environmental situation, poverty level, and cultural factors -> these factors are likely to impact a child’s level of functioning
- A child who has been neglected, or comes from a poor, non-stimulating envo, may appear to have ID, but in fact simply not have been exposed to enough words, teachings, and pre-academic opportunities to perform at age-appropriate level
- Such a child may perform at more age-appropriate level once his/her ENVIRONMENT IS IMPROVED
What is the tx for ID?
- ID itself is NOT treated or cured
- Treat problematic behaviors
- Treat comorbid conditions
- Teach independent living skills
- Provide special education assistance
What are learning disorders? Dx? Tx? Provide some examples.
- Inability to achieve in a particular academic area at the level predicted by one’s cognitive abilities
- Generally borderline IQ or above
- DX requires standardized IQ AND achievement testing for the individual subjects
- TX through special education services
- EX: reading disorder, mathematics disorder, disorder or written expression -> disability can be in 1 or more areas
What is the prevalence of learning disorders?
- 2-8% of children
- M:F or 2-4:1
What are some of the learning disorder comorbidities?
- ADHD
- Mood disorder
- Truancy, school refusal, substance abuse -> these may be associated with frustration due to school difficulty and failure
What are some of the communication disorders children experience?
- Expressive language disorder
- Mixed-receptive expressive language disorder
- Phonological disorder
- Stuttering
- Communication disorder NOS
What are the features of phonological disorder? 4 types?
- Poor articulation or pronunciation
- Substitution: wight for right, toat for coat, or aminal for animal
- Distortions: brlu for blue or crat for cat
- Omissions: oke for joke, ining for signing
- Additions: aluminininum for aluminum
- NOTE: these may be described as articulation disorders
What are the features of language disorders?
- Impairment in comprehension and/or use of a spoken, written, or other verbal system
- RECEPTIVE: taking info in
- EXPRESSIVE: getting info out
What is stuttering?
- Repetitions and prolongations of sound, syllables, and words that interrupt the FLOW of speech
- Occasional secondary characteristics or tics, such as stamping the foot or throwing the head out to get the sound out
What are some of the assessment issues in speech?
- Concomitant retardation or learning disability
- Dialect
- Regionalism
- Facial structure (cleft palate, etc.)
What are the pervasive development disorders (5)?
- Autistic disorder
- Rett’s disorder: ONLY IN FEMALES; 6 months of normal development, followed by regression
- Childhood disintegrative disorder: at least 2 years of normal devo, followed by regression
- Asperger’s disorder
- PDD NOS
What are the DSM criteria for autistic disorder?
- Qualitative impairment in social interaction
- Qualitative impairments in communication
- Restricted, REPETITIVE, and stereotyped patterns of BEH, interests, and activities
- Delays or abnormal functioning in at least 1 of the following areas, with ONSET PRIOR TO AGE 3:
- Social interaction
- Language as used in social communication
- Symbolic or imaginative play
- Disturbance is not better accounted for by Rhett’s or Childhood Disintegrative Disorder
How does autistic disorder typically present?
- Parents may notice PROBLEMS W/SOCIAL INTERACTION in the FIRST FEW MOS of life: may not devo normal pattern of smiling, or responding to cuddling
- FAILURE TO DEVO SPOKEN LANG often leads parents to seek medical attention: range from complete lack of speech to mildly deviant speech and language patterns
- Pts show intense and rigid commitment to maintaining specific ROUTINES
- May play with toys in an unusual fashion
What are the prevalence, prognosis, and etiology of autism? Screening?
- PREV: 10-15 per 10,000 and more common in M -> 3-4:1
- PROGNOSIS: only 2-3% are able to progress normally through school or live independently
- ETIOLOGY: unknown -> NO LINK to childhood immunizations has been proven
- Universal SCREENING recommended at 18m bc early dx and intervention leads to best outcome
What comorbidities are associated with autism disorder?
- 70% show some evidence of mental retardation
- 25% have comorbid seizure disorder
How is autism disorder treated?
- Special education intervention
- Speech and language therapies, usually done by speech therapists
- Social skills training
- Sensorimotor therapies, usually done by OT’s
- Intensive behavior therapies: start as early as possible, and home-based tx seems best
- Pharmacotherapy: doesn’t alter natural hx and course of autistic disorder, but can be helpful in controlling specific symptoms (aggression, sleep problems, etc.)
- Many categories of meds used, incl. antipsychotics, SSRI’s, stimulants, anticonvulsants, alpha-adrenergic agonists
What are the features of Asperger’s disorder? Tx?
- MILDER version of autistic disorder, or “high-functioning” autism
- Impairment in social interaction
- Restricted, repetitive, and STEREOTYPED patterns of behavior, interests, and activities
- NO clinically significant delay in language OR cognitive development
- Some of the same txs used for autistic disorder, especially social skills training
- NOTE: this is NO LONGER A CLINICAL DIAGNOSIS (in DSM-V)
What are the ADHD (types) and disruptive behavior disorders?
- ADHD: combined, predominantly inattentive, and predominantly hyperactive types
- ADHD NOS
- Conduct disorder
- Oppositional defiant disorder
- Disruptive behavior disorder NOS