Term
| How common are psychiatric disorders in children? |
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Definition
| 5-15% have a psychiatric disturbance requiring treatment/impair function |
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Term
| What factors go into determining the developmental level of a child? |
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Definition
| Level of emotional/intellectual maturity, strengths, weaknesses, stressors, and gender-specific challenges (like the death of a mother & how kids take over) |
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Term
| Why is there usually worse compliance or trust with pediatric patients than adult patients in psychiatry? |
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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 |
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Term
| What is the best way to get a history of a psychiatric illness when a child patient presents with the parents? |
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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 |
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Term
| How does interviewing a child differ from interviewing an adult? |
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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) |
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Term
| What is the importance of acknowledging pt age, IQ, and gender? |
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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 |
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Term
| What is the relationship between parental involvement and pt age? |
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Definition
| As the patient gets older, the parents are not typically as involved in the process |
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Term
| How does the treatment team in child psychiatry differ from adult psychiatry? |
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Definition
| There are more “non-psychiatrist” members of the health care team to offer a broader range of support to the family and patient |
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Term
| T/F A physical exam is an important part to a psychiatric exam |
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Definition
| True; this is usually done by the pediatrician, but a psychiatrist can do it |
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Term
| What are the criteria for diagnosing attention-deficit/hyperactivity disorder (ADHD)? |
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Definition
| 1- Some hyperactive/inattentive symptoms were present before age 7 yrs |
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Term
| What symptoms are seen in ADHD-primarily inattentive type? |
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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 |
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Term
| What symptoms are seen in ADHD-primarily hyperactive/impulsive type? |
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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 |
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Term
| How long must the ADHD subtype symptoms persist for diagnosis? |
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Definition
|
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Term
| What if the patient meets criteria for both ADHD subtypes? |
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Definition
| You diagnose them with “combined subtype” |
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Term
|
Definition
| 3-10% of children; M>F 3:1 |
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Term
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Definition
| ½ have a good outcome, but as many as 60-70% persist into adulthood |
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Term
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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 |
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Term
| What is thought to cause ADHD? |
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Definition
| Genes (especially those related to dopamine), maternal smoking/malnutrition, EtOH and drug abuse, complicated delivery, exposure to toxins, viral infections |
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Term
| What are common comorbidities with ADHD? |
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Definition
| Seizures, learning disorders, or oppositional defiant disorder/conduct disorder |
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Term
| What other disorders are commonly confused with ADHD? |
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Definition
| Mood disorder, conduct disorder, pathological home environment, thyroid… |
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Term
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Definition
| Rx (stimulants, α-agonists, antidepressant), classroom/workplace modification (sit them close to teacher), behavior modification (positive reinforcement) |
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Term
| T/F Treating ADHD with stimulantsà increased risk for substance abuse |
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Definition
| FALSE; decreased risk (they are the DOC for ADHD) |
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Term
| What are common side effects with ADHD medications? |
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Definition
| Stimulant- ↓ appetite (most common), irritable, insomnia, ↓ growth, tics, abuse |
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Term
| (stimulants, atomoxetine) |
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Definition
| Atomoxetine- Abdominal pain, induction of mania, suicidality |
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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? |
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Definition
| Oppositional defiant disorder |
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Term
| Epidemiology of oppositional defiant disorder? |
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Definition
| 5-10% of children; more common in boys |
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Term
| T/F Oppositional defiant disorder commonly co-occurs with conduct disorder |
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Definition
| FALSE; the two CANNOT co-exist; ODD is commonly comorbid with ADHD |
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Term
| How do ODD and conduct disorder differ? |
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Definition
| ODD is Dx mainly on the basis of annoying, difficult & disruptive behavior |
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Term
| What are long-term complications of ODD? |
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Definition
| Increased likelihood of substance abuse or antisocial personality disorder |
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Term
|
Definition
| Individual and family counseling, behavior modification, and parental training |
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Term
| What are the diagnostic criteria for conduct disorder? |
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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) |
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Term
| What are the different types of conduct disorder? How does prognosis change? |
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Definition
| Whether it started before or after 10 y/o; better prognosis if after 10 y/o |
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Term
| Epidemiology for conduct disorder? |
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Definition
| 8% of boys and 3% of girls <18 y/o |
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Term
| What percent of conduct disorder pts progress to antisocial disorder? |
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Definition
| 40% of boys and 25% of girls |
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Term
| What is thought to cause conduct disorder? |
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Definition
| Families with antisocial/mood/learning disorders or substance abuse, parental divorce, poor parenting, hanging with the wrong crowd |
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Term
| What are common comorbidities with conduct disorder? |
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Definition
| Learning disorders (10%+), ADHD (20-30% overlap), mood disorder |
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Term
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Definition
| Individual/family therapy, removal from homeà juvenile, multisystem therapy |
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Term
| How common is MDD in kids? |
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Definition
| Up to 5% of children and 7% of adolescents meet criteria |
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Term
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Definition
| TCAs NOT effective; SSRIs (BBW for suicidality) |
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Term
| How does the Dx of bipolar disorder differ for kids than adults? |
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Definition
| The DSM-IV makes no special provision for kids yet |
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Term
| Tx of bipolar disorder in kids? |
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Definition
| Similar to adults (lithium, divalproex sodium, antipsychotics) |
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Term
| What complicates the diagnosis of schizophrenia in children? |
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Definition
| “Imaginary friends” are normal, “seeing and hearing things” may be associated with PTSD flashbacks, their wild imaginations may sound delusional |
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Term
| Tx of schizophrenia in kids? |
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Definition
| The same antipsychotics as in kids |
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Term
| Dx and Tx of substance abuse disorders in kids? |
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Definition
| Same as adults (except kids may be “forced” into treatment by parents) |
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Term
| So, in what disorder is the treatment really different b/w kids and adults? |
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Definition
| MDD; adults can be treated with TCAs, but kids cannot (not effective) |
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Term
| What are the 6 main areas in psychological testing of kids? |
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Definition
| Cognitive, achievement, adaptive, visual-motor, behavior, personality |
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Term
| What is meant by “cognitive function”? |
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Definition
| Innate knowledge; not dependant on the level of education (a person with a high IQ should be able to excel at all levels) |
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Term
| How do you test a child’s cognitive function, and how do scores work? |
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Definition
| Take some IQ test; 100 is the mean, and 15 is the standard deviation |
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Term
| What is meant by “achievement” testing in kids? |
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Definition
| Testing acquired knowledge to see if a student qualifies for learning disabilities or should be enrolled in accelerated programs |
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Term
| How do you assess a child’s level of achievement? |
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Definition
| More tests, like the TCAP for groups or Woodcock-Johnson for individual Most measure reading, writing, spelling, and math |
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Term
| What is meant by “adaptive behavior”? |
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Definition
| Skill in daily living such as socialization, communication, and self-help |
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Term
| What is the purpose of testing the child’s visual-motor skills? |
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Definition
| To assess the kid’s neural pathways (i.e. ask him to draw a shape you show) |
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Term
| How do you assess a child’s behavior? |
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Definition
| Have the parents and teachers fill out forms assessing the child’s behavior |
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Term
| What are the different types of tests used to assess personality? |
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Definition
| Standardized self-reports- Usually better for older kids who can read/write |
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Term
| What is mental retardation? |
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Definition
| A significantly low IQ AND limitation of adaptive functioning (communication, self-care, life skills, and health/safety skills) |
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Term
| What are the different categories of mental retardation? |
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Definition
| Borderline intellectual function (not mental retardation)- IQ 70-85 |
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Term
| SS of mild mental retardation? |
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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) |
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Term
| SS of moderate mental retardation? |
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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 |
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Term
| SS of profound/severe mental retardation? |
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Definition
| Can’t complete any self-help or personal hygiene; usually are institutionalized |
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Term
| How common is mental retardation overall? |
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Definition
| 1-2% prevalence (M>F 2:1) |
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Term
| How does socioeconomic status play into mental retardation rates? |
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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 |
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Term
| T/F All forms of mental retardation usually have an identifiable cause |
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Definition
| False; mild forms usually do NOT have an identifiable cause (other forms do) |
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Term
| What are the most common identifiable causes of mental retardation? |
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Definition
| Fetal alcohol (most common), Down syndrome (most common chromosomal), Fragile X (most common heritable form), teratogens, infections… |
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Term
| What are common comorbidities with mental retardation? |
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Definition
| ADHD, disruptive behavior disorders, mood disorders, anxiety disorders, habit disorders and stereotypes (arm flapping), seizure disorder |
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Term
| T/F Pts with mental retardation lack the higher mental function to be depressed |
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Definition
|
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Term
| Tx of mental retardation? |
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Definition
| The retardation cannot be treated, but comorbidities are addressed (ADHD…) |
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Term
| How does a child with learning disorder differ from a mentally retarded child? |
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Definition
| Retardation= Low cognitive function; Learning disorder= Low achievement |
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Term
| SS of learning disorders? |
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Definition
| Inability to achieve at a level predicted by the individual’s IQ (borderline +) |
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Term
| Tx of learning disorders? |
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Definition
| Special education services |
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Term
| What different types of learning disorders? |
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Definition
| Reading, mathematics, and disorder of written expression |
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Term
| How common are learning disorders? |
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Definition
| 2-8% of children; M>F (2-4:1) |
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Term
| What are common comorbidities with learning disorders? |
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Definition
| ADHD, Mood disorder, truancy, school refusal, substance abuse |
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Term
| What are language disorders? |
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Definition
| Impairment in the comprehension and/or use of a spoken, written, or other verbal symbol system |
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Term
| What is phonological disorder? |
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Definition
| Good language reception, with faulty word production; substitution (toat =coat), distortion(crote=coat), omission (oat=coat), addition (cowatat=coat) |
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Term
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Definition
| Good language reception, but with repetitions/prolongation of sound, syllables or words, that interrupt the FLOW of speech (tics may also be seen) |
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Term
| What are the two most common feeding and eating disorders in kids? |
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Definition
| Pica and rumination disorder |
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Term
|
Definition
| Persistent intake of non-nutritive substances (dirt/hair…) for >1 month |
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Term
| What in rumination disorder? |
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Definition
| Repeated regurgitation and re-chewing of food for >1 month after normal fxn |
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Term
| How do all the tic disorders differ from each other? |
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Definition
| Tourette’s has BOTH motor and vocal tic |
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Term
| What are diagnostic criteria for Tourette’s syndrome? |
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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 |
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Term
| What should you do if a pt with ADHD comes in with tics? |
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Definition
| Ensure they’re not just a side effect of medications before Dx Tourette’s |
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Term
| How common is Tourette’s syndrome? |
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Definition
| 1-10/10,000 school kids 6-17 y/o (0/01-0.1%); M>F (3:1); 20% remit in 20’s |
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Term
| Tx of Tourette’s Disorder? |
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Definition
| α-agonists and neuroleptics |
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Term
|
Definition
| Sudden, rapid, recurrent, non-rhythmic, stereotyped motor mvnt/vocalization |
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Term
| What is enuresis, and how do you treat it? |
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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 |
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Term
| What is encopresis, and how do you treat it? |
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Definition
| Pt >4 y/o defecating in places other than the toilet (rare); Tx is more complex |
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Term
| T/F Separation anxiety is normal in kids |
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Definition
| True; it usually starts after the kid turns 9 months old |
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Term
| What is separation anxiety disorder, and what are the diagnostic criteria? |
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Definition
| Excessive separation anxiety that lasts > 4 weeks and causes impairment |
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Term
| How common is separation anxiety disorder? |
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Definition
| 4% of school children; usually onset at preschool |
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Term
| T/F School phobia is the same as separation anxiety disorder |
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Definition
| False; While SAD may be a cause of school phobia, school phobia may also be caused by anxiety about being around other kids |
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Term
| What is selective mutism? How common is it? |
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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 |
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Term
| What is reactive attachment disorder (RAD)? |
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Definition
| Disturbed & developmentally inappropriate social relatedness; begins < 5 y/o; usually the result of grossly pathological care (neglect, abuse…) |
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Term
| What types of behaviors are seen in children with RAD? |
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Definition
| Inhibited- Child fails to initiate & respond to social interactions appropriately |
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Term
| What is stereotypic movement disorder? |
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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 |
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Term
| What disorder is stereotypic movement disorder most commonly associated? |
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Definition
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Term
| What are the DMS IV criteria for the Dx of autism? |
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Definition
| 6+ of the following (2+ from A, and 1+ from each B and C) |
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Term
| So in a nutshell, what characterizes autism? |
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Definition
| Poor progress of language, poor social skill, & obsessive-compulsive behavior |
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Term
| If autism is characterized by delayed language; what is normal development? |
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Definition
| First words at less than 2 years and fluent language between 2-3 years |
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Term
| T/F Autism is characterized by delayed motor milestones |
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Definition
| False; they are typically normal |
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Term
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Definition
| Anxiety, fear, ADHD-like SS, aggression, rigidity, repetitive behaviors |
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Term
| Dx criteria for Asperger’s Syndrome? |
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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 |
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Term
| So in a nutshell, what characterizes Asperger’s Syndrome? |
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Definition
| Social awkward kids of above-normal intelligence with NO delay in language or cognitive development (UNLIKE AUTISM); often experts in one area |
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Term
|
Definition
| Roughly 1 in 150 kids; M>F (4.3:1)ß these numbers include the subtypes |
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Term
|
Definition
| Unknown, but there are many theories… (chromosomal, trauma, virus) |
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Term
| What evidence strongly disputes the thimerosol and autism link? |
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Definition
| Thimerosol has been removed since 2001, but autism rates are on the rise |
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Term
|
Definition
| History and PE, MRI, EEG, chromosomal testing, metabolic study, hearing test |
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Term
| What is seen histologically in a patient with autism? |
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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 |
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Term
| What percent of children with autism spectrum disorder have subclinical epileptiform activity? |
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Definition
| One slide says 13-83%, but he says 20-30% is more typical |
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Term
| What is Landau Kleffner Syndrome (LKS)? |
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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 |
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Term
| How can you distinguish between LKS and non-LKS epileptic activity? |
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Definition
| LKS epileptiform activity is noted in the language dominant region of the brain |
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Term
| Is there any significance to this subclinical epileptiform activity? |
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Definition
| In some cases, it increases the risk of actual clinical seizures |
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Term
| What is the importance of a neuropsychological evaluation in autism? |
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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 |
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Term
| What are the goals in Tx autistic patients? |
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Definition
| ↑ language development, ↑ socialization, ↓ fear, anxiety, and aggression |
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Term
| What medical therapy is used to Tx autism? |
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Definition
| Geared towards facilitating improved behavioral therapy; Risperdal (atypical antipsychotic) is the only FDA approved drug for the symptoms of autism |
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Term
| Why shouldn’t Risperdal be given to every autistic patient? |
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Definition
| It causes sedation, aggression, weight gain (little social function gain) |
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|
Term
| What behavioral therapy is used to Tx autism? |
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Definition
| Main treatment; doing repetitive exercises to promote increased socialization and language function; individually catered to each patient |
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|
Term
| What are some alternative treatments for autism? |
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Definition
| Casein-free/diet-free diets, heavy metal chelation, hyperbaric O2, vitamins |
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