W13_06 common issues in the older child Flashcards
define primary enuresis
never been dry since birth for more than 6 months in a row
define secondary enuresis
has been dry at some point for more than 6 months in a row
define diurnal enuresis
wetting themselves when they’re awake
define nocturnal enuresis
wetting themselves when asleep
when to worry about enuresis?
diurnal enuresis in school agers;
secondary enuresis
note: diurnal enuresis is almost never a result of a severe disease when it’s in isolation
it’s usually other things, like constipation or other more motivating things like playing games
note that it’s more difficult to wake up those with nocturnal diuresis
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what’s the workup for primary nocturnal enuresis?
do nothing. Watchful waiting
should you give imipramine to bedwetting children?
not recommended unless exceptional;
can cause torsades de pointes
should you give desmopressin (DDAVP) to bedwetting children?
decent efficacy;
take an hour before bed and don’t drink water
should you give sleep-alarms to bedwetting children?
no mostly - don’t give them the wrong message. Convince it’s not a problem.
In older, more motivated kids, can use these
which gender is more affected by ADHD?
boys
which ages are more affected by ADHD
under 12 years
what are factors associated with ADHD?
single parent fam;
low parent education;
low family income;
low birth weight;
developmental problems
what are factors identified in infancy that can predict ADHD?
prenatal smoking;
maternal depression;
poor parenting practices;
living in a disadvantaged neighborhood
is ADHD genetic?
yes, it’s inherited. Dopamine identified
what are some gene-environment interactions that can contribute to ADHD?
epigenetics;
intergenerational effects (e.g. young mother with ADHD has substance use during pregs, and gives her child more ADHD);
poor behaviour can cause ill parenting, then ill parenting causes more worse behaviours
what are some higher-order controls of cognition?
preparing
stopping
switching
working mem
error detection
response inhibition
what are the primary treatments of ADHD to improve cognition?
d-amphetamine;
methylphenidate
what are some structural changes of the brain in children with ADHD?
reduced size of many brain parts, including total cerebral volume, right cerebral volume, right caudate, cerebellum, splenium of corpus callosum, frontal regions
note: psychostimulants seem to make rate of change of cortex to be closer to the normal brains
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what are the DSM-V criteria for ADHD?
INATTENTION;
hyperactivity/impulsivity;
symptoms < 12 yrs;
two or more settings (school likely one of them);
functionally impairing;
not due to another mental health disorder
what factors to consider when trying to make the diagnosis?
history, school input, psychoeducational assessment
note: long term improvement in ADHD treatment is unproven and meds have side effects
but untreated ADHD has a poor outcome.
note: the big clinical study found that medication is a more effective treatment for ADHD
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note: kids performed better when their PARENTS were treated for ADHD also
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when is behaviour modification recommended as monotherapy for ADHD?
ADHD in pre-schoolers
what are side effects of ADHD stimulants?
appetite suppression;
insomnia (rare);
emotional after school;
anxiety in pre-disposed
what’s the effect of ADHD stimulant medication in those with tourette’s?
nothing - no extra tics
what’s the effect of ADHD stimulants on cardiac dysrrhythmias?
suspected, but evidence seems to show no effect;
good to monitor blood pressure in those taking the meds
note: ritalin (methylphenidate) has a wide range of dosing
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