Rosenthal - Childhood Psych Flashcards
1
Q
How does the timing of onset of disorders reflect their etiology?
A
- 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
2
Q
How prevalent are childhood psychiatric conditions?
A
- 5-15% of children experience a psychiatric disturbance sufficiently severe to require tx or to impair their functioning during the course of a year
3
Q
What are some of the differences between adult and child psychiatry?
A
- Consideration of developmental level
- Techniques of assessment
- INC role of non-physicians in the health care team
- Frequent occurrence of psychiatric comorbidity
4
Q
What are the features and categories of intellectual disability?
A
- 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
5
Q
What are the features of mild intellectual disability?
A
- 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
6
Q
What are the features of moderate intellectual disability?
A
- 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
7
Q
What are the features of profound/severe intellectual disability?
A
- Severe IQ: 25-40; Profound: under 25
- Unable to complete self-help
- Likely to require care in an institutionalized setting
8
Q
What is the epi of intellectual disability?
A
- 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
9
Q
Does intellectual disability usually have an identifiable cause?
A
- 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
10
Q
What are the most common etiologies of intellectual disability?
A
- 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
11
Q
What are the prenatal and perinatal/postnatal factors that can contribute to intellectual disability?
A
- 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
12
Q
What are some of the comorbidities associated with ID?
A
- 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
13
Q
What things do you need to make sure you consider before assigning a diagnosis of ID?
A
- 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
14
Q
What is the tx for ID?
A
- ID itself is NOT treated or cured
- Treat problematic behaviors
- Treat comorbid conditions
- Teach independent living skills
- Provide special education assistance
15
Q
What are learning disorders? Dx? Tx? Provide some examples.
A
- 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
16
Q
What is the prevalence of learning disorders?
A
- 2-8% of children
- M:F or 2-4:1
17
Q
What are some of the learning disorder comorbidities?
A
- ADHD
- Mood disorder
- Truancy, school refusal, substance abuse -> these may be associated with frustration due to school difficulty and failure
18
Q
What are some of the communication disorders children experience?
A
- Expressive language disorder
- Mixed-receptive expressive language disorder
- Phonological disorder
- Stuttering
- Communication disorder NOS
19
Q
What are the features of phonological disorder? 4 types?
A
- 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
20
Q
What are the features of language disorders?
A
- Impairment in comprehension and/or use of a spoken, written, or other verbal system
- RECEPTIVE: taking info in
- EXPRESSIVE: getting info out
21
Q
What is stuttering?
A
- 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
22
Q
What are some of the assessment issues in speech?
A
- Concomitant retardation or learning disability
- Dialect
- Regionalism
- Facial structure (cleft palate, etc.)
23
Q
What are the pervasive development disorders (5)?
A
- 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
24
Q
What are the DSM criteria for autistic disorder?
A
- 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
25
Q
How does autistic disorder typically present?
A
- 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
26
Q
What are the prevalence, prognosis, and etiology of autism? Screening?
A
- 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
27
Q
What comorbidities are associated with autism disorder?
A
- 70% show some evidence of mental retardation
- 25% have comorbid seizure disorder
28
Q
How is autism disorder treated?
A
- 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
29
Q
What are the features of Asperger’s disorder? Tx?
A
- 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)
30
Q
What are the ADHD (types) and disruptive behavior disorders?
A
- ADHD: combined, predominantly inattentive, and predominantly hyperactive types
- ADHD NOS
- Conduct disorder
- Oppositional defiant disorder
- Disruptive behavior disorder NOS
31
Q
What are the features of ADHD?
A
- Significant difficulty focusing and maintaining attention
- Significant hyperactivity and impulsivity
- Symptoms present for AT LEAST 6 MONTHS, and ONSET BEFORE AGE 12
- Impairment in at least 2 SETTINGS
- Inattention, hyperactivity, and impulsivity present to a greater degree than expected for child’s devo level
- NOTE: trauma symptoms can look a lot like ADHD -> these kids can get stuck in “fight or flight” all the time, making them appear hyperactive
32
Q
What are the features of ADHD - primarily inattentive?
A
- Frequent mistakes/failure to pay close attention
- Difficulty sustaining attention
- Does not listen when spoken to directly
- Fails to finish work/does not follow instructions
- Lacks organizational skills
- Avoids sustained mental effort
- Misplaces items
- Easily distracted and forgetful
33
Q
What are the features of ADHD - primarily hyperactive/impulsive?
A
- Often fidgets or squirms
- Leaves seat
- Difficulty being quiet in leisure activities
- On the go, as if driven by a motor
- Talks excessively
- Shouts answers out of turn
- Runs instead of walks
- Difficulty waiting for turn
- Interrupts or intrudes
34
Q
What are the executive function deficits in ADHD?
A
- Planning
- Organizing
- Starting and stopping activity
- Managing behavior
- Persisting on tasks
- Problem solving
- Working memory
- NOTE: ADHD goes beyond hyperactivity and impulsivity, and deficits in executive functioning can result in academic difficulties like not completing work/forgetting to turn it in, problems with peers due to impulsive actions, and problems at home like not following directions, difficulty completing chores, and losing or misplacing items
35
Q
Is ADHD due to laziness?
A
- NO
- Nor is it due to lack of will power, inadequate parenting, lack of motivation, or lack of intelligence
36
Q
What is the epi of ADHD?
A
- 3-10% of kids
- M:F ratio 3:1
- Occurs in all cultures
37
Q
What is the prognosis for ADHD?
A
- At least 50% of all kids with ADHD have a good outcome, completing school
- Persistence into adolescence and adulthood:
- 1/3 continue to meet full criteria
- 1/3 have some symptoms
- 1/3 full remission
38
Q
What are some of the life “complications” that go along with ADHD?
A
- Academic failure
- Relationship problems
- Legal difficulties
- Smoking and substance abuse
- Injuries
- MVA’s
- Occupational/vocational problems
- NOTE: with tx, these risks DEC significantly
39
Q
What is the etiology of ADHD?
A
- Runs in families: girls have a stronger family hx than boys
- Associated with familial mood disorders, learning disorders, substance abuse, and antisocial personality disorder
- Genes related to DOPAMINE have been implicated
- Non-genetic factors: maternal smoking, alcohol, and drug abuse, complications during delivery, exposure to toxins, viral infections, and maternal malnutrition
- Neuroimaging: not currently being used to dx ADHD or guide tx selection
40
Q
What are some of the ADHD comorbidities?
A
- Oppositional defiant disorder: 60%
- Anxiety disorder
- Depressive disorder
- Learning disorder
- Conduct disorder
- Substance use disorder
41
Q
What are the tx options for ADHD?
A
- Behavior modification with child and parents
- Classroom/workplace accommodations
- Medications: stimulants, alpha-2 agonists
42
Q
What are some of the classroom accommodations for ADHD?
A
- Preferential seating and shorter assignments
- Closer supervision and clearer instructions
- Help in getting started on assignments
- Daily report card program
- Allow TIME FOR MVMT
- Extra set of books
- Environment with FEWER DISTRACTIONS during tests
43
Q
What meds are used to tx ADHD?
A
- STIMULANTS (psychostimulants): generally accepted as most effective
- Methylphenidate, Amphetamine/Dextroamphetamine, Atomoxetine
- Alpha-adrenergic agonists: Clonidine, Guanfacine
- Anti-depressants: Bupropion, TCA’s (Imipramine)
- NOTE: tx with stimulant medications has been associated with a decreased risk for substance abuse
44
Q
What are some of the potential side effects of the stimulants?
A
- Most common AE = DEC appetite (anorexia)
- Growth retardation
- Tics
- BBW for high abuse potential and serious CV AE’s and sudden death
- May do an EKG before writing a prescription for a stimulant, but this is not “required”
- Monitor HR and BP throughout tx
45
Q
What are some of the potential side effects of Atomoxetine?
A
- Abdominal pain
- Induction of mania
- BBW for INC risk of suicidality (0.4% vs. placebo)
46
Q
What are the 2 disruptive behavior disorder?
A
- Oppositional defiant disorder
- Conduct disorder
47
Q
What are the features of oppositional defiant disorder?
A
- Tends to be in younger kids, and more about authority
- Pattern of negative, hostile, and defiant behavior lasting AT LEAST 6 MONTHS, during which 4 (or more) of the following are present:
- Often loses temper
- Often argues with adults
- Often actively defies or refuses to comply with adults’ requests or rules
- Often deliberately annoys people
- Often blames others for his/her mistakes/behavior
- Is often touchy or easily annoyed by others
- Is often angry or resentful
- If often spiteful or vindictive
- Most children are oppositional at times, but to warrant this dx, a child must show a clear pattern of negativistic and defiant behavior over a significant period of time, to a degree MUCH GREATER THAN MOST KIDS THEIR AGE
48
Q
What is the epi of ODD?
A
- 3-15% of kids
- M:F ratio 3:1
- Commonly comorbid with ADHD
- Usually diagnosed BEFORE AGE 8, and always BEFORE ADOLESCENCE
49
Q
What is the relationship between ODD and conduct disorder?
A
- Considered by some to be a milder, easier variant of conduct disorder
- Similar risk factors and characteristics
- > 90% of youth with conduct disorder have previously met, and still retain, criteria for ODD
- BUT, majority of youth with ODD do NOT progress to conduct disorder
50
Q
What are the diagnostic criteria for conduct disorder?
A
- Repetitive and persistent pattern of behavior in which basic rights of others or major age-appropriate societal norms or rules are violated, including:
- Aggression to people and animals
- Destruction of property, deceitfulness or theft, and serious violation of rules
- 3 (or more) criteria in the past 12 months, with at least 1 criterion present in the past 6 months
- Childhood-onset type begins PRIOR TO AGE 10
51
Q
What kinds of aggression towards people and animals do conduct disorder pts express?
A
- Often bullies, threatens, or intimidates others, or initiates physical fights
- Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
- Has been physically cruel to people or animals
- Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
- Has forced someone into sexual activity
52
Q
What kinds of destruction of property, deceitfulness, theft, and serious violation of rules do conduct disorder pts engage in?
A
- Deliberate fire setting or destroying others’ property
- Broken into someone else’s house, building, or car
- Often lies to obtain goods or favors, or to avoid obligations (i.e., “cons” others)
- Has stolen without confronting a victim
- Often stays out at night, beginning before age 13 years
- Run away from home overnight at least twice
- Is often truant from school, beginning before age 13 years
53
Q
What are the subtypes of conduct disorder?
A
- Overt vs. covert behaviors:
- OVERT: confrontational behavior like fighting, physical cruelty, stealing while confronting victim
- COVERT: manipulating others, destroying property, running away, stealing without confrontation
- Aggressive vs. nonaggressive (these subtypes are not included in the DSM-IV-TR)
- Socialized vs. under-socialized:
- SOCIALIZED: act out in context of peer relationships
- UNDER-SOCIALIZED: act out in a solitary manner, and tend to be more aggressive and have poorer outcome
54
Q
What is the epidemiology of conduct disorder? How does biological sex play a role?
A
- 6-16% in boys, 2-9% in girls -> ratio of 3-12:1
a. 1.2:1 status offenses
b. 2.5:1 minor theft
c. 4.5:1 robbery - Ratio of M to F INC as offenses become more serious
55
Q
What is the prognosis for kids with conduct disorder?
A
- Can be a precursor to antisocial personality disorder in adulthood -> almost 50% of kids with CD develop significant APD symptoms
- # of CD symptoms and EARLY AGE OF ONSET predict devo of APD
- CD may be associated with early death, unemployment, marital conflict, financial instability, and poor interpersonal relationships in adulthood
56
Q
What are the comorbidities associated with conduct disorder?
A
- Learning Disorders
- ADHD
- Mood Disorder
- Substance Abuse
57
Q
What are the risk factors for the disruptive behavior disorders?
A
- Inconsistent discipline
- Poor supervision
- Low IQ
- High family conflict
- Low family warmth and supportiveness
- Low parental acceptance and affection
- Parental criminality, alcoholism, and drug abuse
- Parental psychopathology
58
Q
What is the tx for disruptive behavior disorders?
A
- Behavior mgmt training for parents and child
- Social skills training
- Problem solving skills
- Conflict mgmt
- Multi-systemic therapy (MST)
59
Q
What is pica?
A
- Persistent eating of non-nutritive substances for a period of at least 1 MONTH
- NOTE: feeding disorder of infancy or early childhood also exists
60
Q
What is rumination disorder?
A
- Repeated regurgitation and re-chewing of food for a period of at least 1 MONTH following a period of normal functioning
- NOTE: feeding and eating disorders can be difficult to treat, and often require involvement of multiple disciplines
61
Q
What are the 3 tic disorders?
A
- Tourette’s disorder: BOTH motor AND vocal tic
- Chronic motor or vocal tic disorder: doesn’t meet criteria for Tourette’s bc either motor or vocal tics present, not both
- Transient tic disorder: doesn’t meet criteria for Tourette’s because it hasn’t lasted long enough
62
Q
What are the features of Tourette’s disorder?
A
- BOTH multiple MOTOR and 1 or more VOCAL tics occur during the illness, but not necessarily concurrently
- Tic is sudden, rapid, recurrent, non-rhythmic, stereotyped motor movement or vocalization
- Tics occur many times a day NEARLY EVERY DAY, or intermittently throughout a period of MORE THAN 1 YEAR, and during this period there was never a tic-free period of more than 3 consecutive months
- Onset is BEFORE 18 YEARS
- Not due to the direct physiological effects of a substance (e.g., stimulants), or a general medical conditions (e.g., Huntington’s disease or post-viral encephalitis)
63
Q
What are the prevalence and prognosis for Tourette’s?
A
- 1-10 school kids per 10,000 between 6 and 17
- Up to 20% of kids experience transient simple tics
- Male-to-female ratio of 3:1
- MOTOR TICS APPEAR FIRST, typically between ages of 3 and 8, several years before the appearance of vocal tics
- Symptoms PEAK IN ADOLESCENCE
- 20% of people have a remission of symptoms in their 20’s
64
Q
What are the tx’s for Tourette’s disorder?
A
- Alpha-adrenergic agents: Clonidine, Guanfacine
- Neuroleptics: Haloperidol, Pimozide
65
Q
What are the 2 elimination disorders? Describe them
A
- ENURESIS: involuntary urination
- Chronological age of AT LEAST 5-y/o
- Behavioral treatments: enuresis alarms are THE MOST EFFECTIVE TREATMENT
- Medications: deamino-8-D-arginine vasopressin (DDAVP) or desmopressin, Imipramine (TCA) -> clinicians often do not begin tx until age 6 or 7, esp. in boys
- ENCOPRESIS: involuntary defecation, esp. associated with emotional disturbance or psychiatric disorder
- Chronological age of AT LEAST 4-y/o
- Treatment is more complex
66
Q
What is separation anxiety disorder?
A
- Separation anxiety is a normal maturational experience that develops at 9 MONTHS
- Separation anxiety disorder is a level of anxiety beyond that expected for child’s developmental level
- Causes impairment
- Lasts AT LEAST 4 WEEKS
67
Q
What are the criteria for separation anxiety disorder?
A
- 3 or more of the following:
- Excessive distress when separation from home or major attachment figures occurs or is anticipated
- Worry about losing, or about possible harm befalling, major attachment figures
- Worry that an untoward event will lead to separation from a major attachment figure (such as kidnapping)
- Reluctance or refusal to go to school or elsewhere because of fear of separation
- Fearful of being alone or without major attachment figures
- Reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
- Repeated nightmares involving the theme of separation
- Physical symptoms when separation is anticipated or occurs
68
Q
What is the prevalence and onset of separation anxiety disorder?
A
- Prevalence: 4% of school children
- Onset may be as early as preschool
- Adolescent onset uncommon
- May develop after some life stress
- NOTE: school phobia is not a specific DSM diagnosis, and may be related to separation anxiety or be a social phobia
69
Q
What are the features of selective mutism?
A
- Consistent failure to speak in specific social situations where there is an expectation for speaking, despite speaking in other situations
- These kids often will speak at home but nowhere else
- Prevalence:
70
Q
What are the features of reactive attachment disorder of infancy or early childhood? 2 types?
A
- Disturbed and developmentally inappropriate social relatedness that begins BEFORE AGE 5
- Associated with grossly pathological care
- INHIBITED: child fails to initiate and respond to social interactions in a developmentally appropriate way
- DISINHIBITED: child exhibits indiscriminate sociability or a lack of selectivity in the choice of attachment figures
71
Q
What are the features of stereotypic movement disorder?
A
- Motor behavior that is repetitive, seemingly driven, and nonfunctional
- INTERFERES WITH NORMAL ACTIVITIES or results in self-inflicted bodily injury that requires medical treatment
- Most commonly associated with intellectual disability
72
Q
What do you always want to rule out when kids are displaying externalizing behavior in the classroom?
A
- Learning disability
73
Q
What is social (pragmatic) communication disorder?
A
- Persistent difficulties in the social use of verbal and nonverbal communication as manifested by:
1) Deficits in using communication for social purposes,
2) Impairment of ability to change communication to match context,
3) Difficulty following rules for conversation and storytelling, and
4) Difficulties understanding what is not explicitly stated - NOTE: now that Asperger’s is no longer a clinical diagnosis, these pts tend to fall into this category, ASD, or the spectrum of normal
74
Q
What is the prevalence of reactive attachment disorder?
A
- VERY RARE
- These kids generally have EXTREME neglect or abuse
75
Q
What is avoidant/restrictive food intake disorder?
A
- Eating or feeding disturbance
- Avoidance based on sensory characteristics of food
76
Q
How is the severity of AN determined?
A
- Based on BMI
77
Q
What are the “time” qualifiers for BN?
A
- At least 1 week over a period of 3 months (same time qualifications for binge eating disorder)
