Ryst: Child Psych Diagnosis and Treatment Flashcards
What are some things to gather when collecting physical development and medical history
height weight gross motor development fine motor development coordination hyperactivity eating toiletry sleeping allergies meds etc
During the family interview, what are some things you should look for?
parents attitude toward the child (do they use positive words to describe their child) discipline practices parental attachment goodness of fit communication styles
After the child assessment is complete, what do you do?
come up with a diagnostic formulation, and communicate findings and recommendations
What type of treatment is usu the best for children?
multi-modal treatment (comprehensive treatment plan, never medications alone)
What are some concerns with medication use in children?
meds used despite lack of FDA regulation (“off label use”)
kids are not little adults - therapeutic and adverse effects vary by developmental stage
also, kids metabolize drugs differently
“A recurrent pattern of negativistic, hostile and defiant behavior.”
Must have at least four of the following for at least six months:
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 mistakes or misbehavior.
Often touch and easily annoyed.
Often angry and resentful
Often spiteful and vindictive
Oppositional Defiant Disorder
Violation of the rights of others and age-appropriate social norms. Must have at least three symptoms in the last 12 months, with at least one symptom in the last 6 months. Bullying or threatening others. Fighting Using a weapon that can cause serious physical harm. Physically cruel to animals. Physically cruel to people. Stealing while confronting a victim. Forcing someone into sexual activity. Fire setting. Destroying property. Breaking into a house, building or car. Frequent lying or “conning.” Stealing without confronting a victim. Staying out late despite parental prohibitions. Running away from home. Being truant from school.
Conduct disorder
Data have identified a subgroup of children with CD that display a lack of guilt and empathy, lack of concern over performance in important activities, and shallow affect. Compared to other children with CD, this subgroup appears to have more severe symptoms, a more stable course, and greater levels of aggression.
So, in addition to “conduct disorder,” you would add…
“with limited prosocial emotions”
Are ODD and conduct disorder more prevalent in males or females?
males
Males with early onset conduct disorder are much more likely to show (blank) symptoms
aggressive
Conduct disorder boys with this comorbidity have a worse outcome than conduct disorder boys without it
ADHD
Do all children with ODD go on to develop conduct disorder?
no, but a large number of them do
T/F: The more severe the symptoms are in ODD and CD, the more likely the patient is to engage in criminal activity
True
What behaviors in younger kids are predictive of conduct disorder? What behaviors in girls are most predictive of conduct disorder?
syx of cruelty, running away, breaking into a building; fighting and cruel behavior
**age and gender atypical behaviors are predictive of a worse outcome (ex: a girl getting in a fight)
Frequent comorbidities with conduct disorder
ADHD anxiety mood disorders substance abuse learning disabilities
T/F: Conduct disordered youth are more likely to be disruptive in adulthood (ex: higher rates of school drop-out, divorce, less contact with relatives, higher mortality rate)
True
How do you treat disruptive behavior disorders? Will an isolated, individual treatment be successful?
address multiple needs from multiple domains, and involve the parents; no!
**Ex: parent-directed component, social-cognitive skills training, academic skills training, teacher training, etc
Are medications helpful in disruptive behavior disorders?
no, there are no FDA approved medications and even in the best of cases, meds are only partially helpful
What are some psychosocial treatments for disruptive behavior disorders?
parent management training - teaches the parents to interact with a child in a way that promotes pro-social behavior
parent-child interaction training
Addresses risks at the individual, family, peer, school and neighborhood level. Treatment is intensive and addresses therapeutic barriers such as parental substance abuse, parental psychopathology, marital conflict, associations with delinquent peers, poor school performance and deficient problem-solving or perspective-taking skills.
multisystemic therapy
In the past, how were mood disorders in children regarded?
as the child’s inability to express emotions verbally
tendency of parents and teachers only to notice obvious, external symptoms
etc
Diagnosis of depression is the same for children and adults. What are some subtle differences?
children and adolescents can have “irritable” mood instead of depressed mood;
failure to make expected weight gains is equivalent to weight loss
What are some ways you can notice depression in children?
somatic complaints: stomach aches, etc, psychomotor agitation, mood-congruent hallucinations
can manifest as separation anxiety, phobias, and behavioral problems
look for deviations from developmental trajectory
What are some ways you can notice depression in adolescents?
antisocial behavior substance use restlessness grouchiness aggression withdrawal school or family problems
How is juvenile bipolar disorder different than adult bipolar disorder?
in juveniles, mania is different;
kids seem to be more “mixed” having mania and depression going on at the same time;
they tend to rapidly cycle;
seems to be more chronic and more continuous;
seldom associated with euphoria, but just prominent irritability with affective storms
T/F: In older children with bipolar disorder, elation, euphoria, grandiosity are more common
True
Symptoms of mania in childhood bipolar disorder
decreased need for sleep rapid speech, talkativeness distractibility, racing thoughts hypersexuality increased goal-directed activity impulsivity
