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Child Psych and Autism
Neuro/Psych Assessment 14
117
Psychology
Graduate
02/27/2012

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Cards

Term
How common are psychiatric disorders in children?
Definition
5-15% have a psychiatric disturbance requiring treatment/impair function
Term
What factors go into determining the developmental level of a child?
Definition
Level of emotional/intellectual maturity, strengths, weaknesses, stressors, and gender-specific challenges (like the death of a mother & how kids take over)
Term
Why is there usually worse compliance or trust with pediatric patients than adult patients in psychiatry?
Definition
Because an adult usually brings him/herself to the office willingly, while the child is usually forced to go by a parent/legal guardian
Term
What is the best way to get a history of a psychiatric illness when a child patient presents with the parents?
Definition
Interview the parties together and both individually; the child can give more insight about their views, while the parents can usually offer a better history
Term
How does interviewing a child differ from interviewing an adult?
Definition
The questions should be more concrete and specific (“do you ever want to hit people” instead of “are you depressed”); you should build rapport early on to build trust (ask about hobbies instead of jumping right to the illness); direct observation is important (play with child, sit on floor with the child)
Term
What is the importance of acknowledging pt age, IQ, and gender?
Definition
Since children a dynamic, “normal” changes rapidly; a 2-year-old has greatly different mindset than a 6-year-old, and people of the same age but different gender (or maturity) and IQ have different “normal” behaviors
Term
What is the relationship between parental involvement and pt age?
Definition
As the patient gets older, the parents are not typically as involved in the process
Term
How does the treatment team in child psychiatry differ from adult psychiatry?
Definition
There are more “non-psychiatrist” members of the health care team to offer a broader range of support to the family and patient
Term
T/F A physical exam is an important part to a psychiatric exam
Definition
True; this is usually done by the pediatrician, but a psychiatrist can do it
Term
What are the criteria for diagnosing attention-deficit/hyperactivity disorder (ADHD)?
Definition
1- Some hyperactive/inattentive symptoms were present before age 7 yrs
Term
What symptoms are seen in ADHD-primarily inattentive type?
Definition
6+: Careless mistakes, short attention span, does not listen when spoken to directly, doesn’t follow instructions/finish work, hard time organizing tasks or activities, avoids sustained mental activity, loses things, distracted, forgetful
Term
What symptoms are seen in ADHD-primarily hyperactive/impulsive type?
Definition
6+: Fidgeting/squirming, inappropriately leaves seat, inappropriately runs or climbs, difficulty being quiet, always “on the go”, talks excessively, shouts answers out of turn, difficulty waiting for turn, interrupts or intrudes
Term
How long must the ADHD subtype symptoms persist for diagnosis?
Definition
At least 6 months
Term
What if the patient meets criteria for both ADHD subtypes?
Definition
You diagnose them with “combined subtype”
Term
How common is ADHD?
Definition
3-10% of children; M>F 3:1
Term
Prognosis of ADHD?
Definition
½ have a good outcome, but as many as 60-70% persist into adulthood
Term
Complications of ADHD?
Definition
Academic failure, relationship problems, legal difficulties, substance abuse, injuries, motor vehicle accidents, occupational/vocational problems, 25% subsequently meet criteria for antisocial personality disorder as adults
Term
What is thought to cause ADHD?
Definition
Genes (especially those related to dopamine), maternal smoking/malnutrition, EtOH and drug abuse, complicated delivery, exposure to toxins, viral infections
Term
What are common comorbidities with ADHD?
Definition
Seizures, learning disorders, or oppositional defiant disorder/conduct disorder
Term
What other disorders are commonly confused with ADHD?
Definition
Mood disorder, conduct disorder, pathological home environment, thyroid…
Term
Tx of ADHD?
Definition
Rx (stimulants, α-agonists, antidepressant), classroom/workplace modification (sit them close to teacher), behavior modification (positive reinforcement)
Term
T/F Treating ADHD with stimulantsà increased risk for substance abuse
Definition
FALSE; decreased risk (they are the DOC for ADHD)
Term
What are common side effects with ADHD medications?
Definition
Stimulant- ↓ appetite (most common), irritable, insomnia, ↓ growth, tics, abuse
Term
(stimulants, atomoxetine)
Definition
Atomoxetine- Abdominal pain, induction of mania, suicidality
Term
How do you diagnose a child that loses his temper, argues with adults, defies rules, deliberately annoys people, blames others, touchy, easily annoyed, and easily gets angry, resentful, spiteful, or vindictive?
Definition
Oppositional defiant disorder
Term
Epidemiology of oppositional defiant disorder?
Definition
5-10% of children; more common in boys
Term
T/F Oppositional defiant disorder commonly co-occurs with conduct disorder
Definition
FALSE; the two CANNOT co-exist; ODD is commonly comorbid with ADHD
Term
How do ODD and conduct disorder differ?
Definition
ODD is Dx mainly on the basis of annoying, difficult & disruptive behavior
Term
What are long-term complications of ODD?
Definition
Increased likelihood of substance abuse or antisocial personality disorder
Term
Tx of ODD?
Definition
Individual and family counseling, behavior modification, and parental training
Term
What are the diagnostic criteria for conduct disorder?
Definition
3+ for 12 mo with 1+ in the last 6 mo; Aggression to people and animals (threatens other, initiates fights, uses weapons, physically cruel to people or animals, stolen while confronting a person, forced sexual behavior), destruction of property/rule violation (setting fires, destroying property, breaking and entering, “cons” others, stolen without confrontation, sneaks out at night, run away from home >2x, truant from school)
Term
What are the different types of conduct disorder? How does prognosis change?
Definition
Whether it started before or after 10 y/o; better prognosis if after 10 y/o
Term
Epidemiology for conduct disorder?
Definition
8% of boys and 3% of girls <18 y/o
Term
What percent of conduct disorder pts progress to antisocial disorder?
Definition
40% of boys and 25% of girls
Term
What is thought to cause conduct disorder?
Definition
Families with antisocial/mood/learning disorders or substance abuse, parental divorce, poor parenting, hanging with the wrong crowd
Term
What are common comorbidities with conduct disorder?
Definition
Learning disorders (10%+), ADHD (20-30% overlap), mood disorder
Term
Tx of conduct disorder?
Definition
Individual/family therapy, removal from homeà juvenile, multisystem therapy
Term
How common is MDD in kids?
Definition
Up to 5% of children and 7% of adolescents meet criteria
Term
Tx of MDD in kids?
Definition
TCAs NOT effective; SSRIs (BBW for suicidality)
Term
How does the Dx of bipolar disorder differ for kids than adults?
Definition
The DSM-IV makes no special provision for kids yet
Term
Tx of bipolar disorder in kids?
Definition
Similar to adults (lithium, divalproex sodium, antipsychotics)
Term
What complicates the diagnosis of schizophrenia in children?
Definition
“Imaginary friends” are normal, “seeing and hearing things” may be associated with PTSD flashbacks, their wild imaginations may sound delusional
Term
Tx of schizophrenia in kids?
Definition
The same antipsychotics as in kids
Term
Dx and Tx of substance abuse disorders in kids?
Definition
Same as adults (except kids may be “forced” into treatment by parents)
Term
So, in what disorder is the treatment really different b/w kids and adults?
Definition
MDD; adults can be treated with TCAs, but kids cannot (not effective)
Term
What are the 6 main areas in psychological testing of kids?
Definition
Cognitive, achievement, adaptive, visual-motor, behavior, personality
Term
What is meant by “cognitive function”?
Definition
Innate knowledge; not dependant on the level of education (a person with a high IQ should be able to excel at all levels)
Term
How do you test a child’s cognitive function, and how do scores work?
Definition
Take some IQ test; 100 is the mean, and 15 is the standard deviation
Term
What is meant by “achievement” testing in kids?
Definition
Testing acquired knowledge to see if a student qualifies for learning disabilities or should be enrolled in accelerated programs
Term
How do you assess a child’s level of achievement?
Definition
More tests, like the TCAP for groups or Woodcock-Johnson for individual Most measure reading, writing, spelling, and math
Term
What is meant by “adaptive behavior”?
Definition
Skill in daily living such as socialization, communication, and self-help
Term
What is the purpose of testing the child’s visual-motor skills?
Definition
To assess the kid’s neural pathways (i.e. ask him to draw a shape you show)
Term
How do you assess a child’s behavior?
Definition
Have the parents and teachers fill out forms assessing the child’s behavior
Term
What are the different types of tests used to assess personality?
Definition
Standardized self-reports- Usually better for older kids who can read/write
Term
What is mental retardation?
Definition
A significantly low IQ AND limitation of adaptive functioning (communication, self-care, life skills, and health/safety skills)
Term
What are the different categories of mental retardation?
Definition
Borderline intellectual function (not mental retardation)- IQ 70-85
Term
SS of mild mental retardation?
Definition
85% of mental retardation; can read, write, do simple math, & eventually hold a job a live independently, but they have concrete thoughts (hard to change)
Term
SS of moderate mental retardation?
Definition
10% of mental retardation; can talk, recognize name, basic hygiene, laundry & small tasks, rarely go past 4th grade, can’t usually live alone, work special jobs
Term
SS of profound/severe mental retardation?
Definition
Can’t complete any self-help or personal hygiene; usually are institutionalized
Term
How common is mental retardation overall?
Definition
1-2% prevalence (M>F 2:1)
Term
How does socioeconomic status play into mental retardation rates?
Definition
Mild mental retardation is more common in low SES (usually have less mental stimulation), while the more severe forms are equal across the board
Term
T/F All forms of mental retardation usually have an identifiable cause
Definition
False; mild forms usually do NOT have an identifiable cause (other forms do)
Term
What are the most common identifiable causes of mental retardation?
Definition
Fetal alcohol (most common), Down syndrome (most common chromosomal), Fragile X (most common heritable form), teratogens, infections…
Term
What are common comorbidities with mental retardation?
Definition
ADHD, disruptive behavior disorders, mood disorders, anxiety disorders, habit disorders and stereotypes (arm flapping), seizure disorder
Term
T/F Pts with mental retardation lack the higher mental function to be depressed
Definition
0
Term
Tx of mental retardation?
Definition
The retardation cannot be treated, but comorbidities are addressed (ADHD…)
Term
How does a child with learning disorder differ from a mentally retarded child?
Definition
Retardation= Low cognitive function; Learning disorder= Low achievement
Term
SS of learning disorders?
Definition
Inability to achieve at a level predicted by the individual’s IQ (borderline +)
Term
Tx of learning disorders?
Definition
Special education services
Term
What different types of learning disorders?
Definition
Reading, mathematics, and disorder of written expression
Term
How common are learning disorders?
Definition
2-8% of children; M>F (2-4:1)
Term
What are common comorbidities with learning disorders?
Definition
ADHD, Mood disorder, truancy, school refusal, substance abuse
Term
What are language disorders?
Definition
Impairment in the comprehension and/or use of a spoken, written, or other verbal symbol system
Term
What is phonological disorder?
Definition
Good language reception, with faulty word production; substitution (toat =coat), distortion(crote=coat), omission (oat=coat), addition (cowatat=coat)
Term
What is stuttering?
Definition
Good language reception, but with repetitions/prolongation of sound, syllables or words, that interrupt the FLOW of speech (tics may also be seen)
Term
What are the two most common feeding and eating disorders in kids?
Definition
Pica and rumination disorder
Term
What is pica?
Definition
Persistent intake of non-nutritive substances (dirt/hair…) for >1 month
Term
What in rumination disorder?
Definition
Repeated regurgitation and re-chewing of food for >1 month after normal fxn
Term
How do all the tic disorders differ from each other?
Definition
Tourette’s has BOTH motor and vocal tic
Term
What are diagnostic criteria for Tourette’s syndrome?
Definition
Multiple motor AND vocal tics (not necessarily concurrently); occur almost daily or intermittently throughout a yr, onset <18 y/o; < 3 straight mo w/o tics
Term
What should you do if a pt with ADHD comes in with tics?
Definition
Ensure they’re not just a side effect of medications before Dx Tourette’s
Term
How common is Tourette’s syndrome?
Definition
1-10/10,000 school kids 6-17 y/o (0/01-0.1%); M>F (3:1); 20% remit in 20’s
Term
Tx of Tourette’s Disorder?
Definition
α-agonists and neuroleptics
Term
What is a “tic”?
Definition
Sudden, rapid, recurrent, non-rhythmic, stereotyped motor mvnt/vocalization
Term
What is enuresis, and how do you treat it?
Definition
Pt >5 y/o urinating in places other than the toilet; enuresis alarms (pad in the underpants detects moisture & wakes the child) are the most effective treatment
Term
What is encopresis, and how do you treat it?
Definition
Pt >4 y/o defecating in places other than the toilet (rare); Tx is more complex
Term
T/F Separation anxiety is normal in kids
Definition
True; it usually starts after the kid turns 9 months old
Term
What is separation anxiety disorder, and what are the diagnostic criteria?
Definition
Excessive separation anxiety that lasts > 4 weeks and causes impairment
Term
How common is separation anxiety disorder?
Definition
4% of school children; usually onset at preschool
Term
T/F School phobia is the same as separation anxiety disorder
Definition
False; While SAD may be a cause of school phobia, school phobia may also be caused by anxiety about being around other kids
Term
What is selective mutism? How common is it?
Definition
A consistent failure to speak in specific social situations, but they speak in other places (maybe they talk at home but nowhere else); <1% prevalence
Term
What is reactive attachment disorder (RAD)?
Definition
Disturbed & developmentally inappropriate social relatedness; begins < 5 y/o; usually the result of grossly pathological care (neglect, abuse…)
Term
What types of behaviors are seen in children with RAD?
Definition
Inhibited- Child fails to initiate & respond to social interactions appropriately
Term
What is stereotypic movement disorder?
Definition
Motor behavior that is repetitive, seemingly driven and nonfunctional (hitting own head/flapping hands) and interferes with normal activities or results in self-inflicted bodily injury that requires medical treatment
Term
What disorder is stereotypic movement disorder most commonly associated?
Definition
Mental retardation
Term
What are the DMS IV criteria for the Dx of autism?
Definition
6+ of the following (2+ from A, and 1+ from each B and C)
Term
So in a nutshell, what characterizes autism?
Definition
Poor progress of language, poor social skill, & obsessive-compulsive behavior
Term
If autism is characterized by delayed language; what is normal development?
Definition
First words at less than 2 years and fluent language between 2-3 years
Term
T/F Autism is characterized by delayed motor milestones
Definition
False; they are typically normal
Term
SS of autism?
Definition
Anxiety, fear, ADHD-like SS, aggression, rigidity, repetitive behaviors
Term
Dx criteria for Asperger’s Syndrome?
Definition
Qualitative impairment in social interaction w/ 2+: a)Marked impairment in nonverbal behaviors (eye contact, affect, posture), b) Failure to develop peer relationships, c) Lack of interest in sharing joy in others, d)Lack of social or emotional reciprocity
Term
So in a nutshell, what characterizes Asperger’s Syndrome?
Definition
Social awkward kids of above-normal intelligence with NO delay in language or cognitive development (UNLIKE AUTISM); often experts in one area
Term
How common is autism?
Definition
Roughly 1 in 150 kids; M>F (4.3:1)ß these numbers include the subtypes
Term
What causes autism?
Definition
Unknown, but there are many theories… (chromosomal, trauma, virus)
Term
What evidence strongly disputes the thimerosol and autism link?
Definition
Thimerosol has been removed since 2001, but autism rates are on the rise
Term
Dx of autism?
Definition
History and PE, MRI, EEG, chromosomal testing, metabolic study, hearing test
Term
What is seen histologically in a patient with autism?
Definition
↓ Purkinje cells in cerebellum, abnormal maturation of forebrain limbic system, abnormal frontal/temporal lobe cortical minicolumns, developmental changes in cell size/number in nucleus of the diagonal band of Broca, deep cerebellar nuclei, and inferior olive, and abnormalities in the brainstem
Term
What percent of children with autism spectrum disorder have subclinical epileptiform activity?
Definition
One slide says 13-83%, but he says 20-30% is more typical
Term
What is Landau Kleffner Syndrome (LKS)?
Definition
Patients with normal development in the first 2-3 yrs followed by progressive loss of language skill/auditory agnosia (nearly continuous epileptiform activity, but clinical seizures are pretty rare); should be considered in regressive autism
Term
How can you distinguish between LKS and non-LKS epileptic activity?
Definition
LKS epileptiform activity is noted in the language dominant region of the brain
Term
Is there any significance to this subclinical epileptiform activity?
Definition
In some cases, it increases the risk of actual clinical seizures
Term
What is the importance of a neuropsychological evaluation in autism?
Definition
By testing IQ and assessing motor functions and sociability, it allows the physician to see if there are any focal neurologic deficits and to assess treatment plans better by having a strong baseline
Term
What are the goals in Tx autistic patients?
Definition
↑ language development, ↑ socialization, ↓ fear, anxiety, and aggression
Term
What medical therapy is used to Tx autism?
Definition
Geared towards facilitating improved behavioral therapy; Risperdal (atypical antipsychotic) is the only FDA approved drug for the symptoms of autism
Term
Why shouldn’t Risperdal be given to every autistic patient?
Definition
It causes sedation, aggression, weight gain (little social function gain)
Term
What behavioral therapy is used to Tx autism?
Definition
Main treatment; doing repetitive exercises to promote increased socialization and language function; individually catered to each patient
Term
What are some alternative treatments for autism?
Definition
Casein-free/diet-free diets, heavy metal chelation, hyperbaric O2, vitamins
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