Develop Psyc

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components of development:

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-slides

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stages of child development

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1. preg and delivery
2. neonatal period
3. infancy
4. early childhood
5. childhood
6. adolescence

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developmental milestones

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1. motor
2. cognitive
3. speech and language
4. social

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Traits

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-i.e. temperaments: enduring characteristics regarding worldview; mental constructs organizing one's place within and interaction with the world

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Temperament

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-Characteristic emotional responses (i.e., behavioral style) to stimuli -- Influenced by biological foundations (e.g., genetic predispositions/gender) & experience (sociocultural foundation)

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chess & thomas classification

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-Easy, difficult, or slow-to-warm-up child

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Kagan's behavioral inhibition

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-Shy, subdued, & timid vs. sociable, extraverted, & bold.

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Rothbart & Bates Classification

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-Positive Affect & Approach (uninhibited) vs. Negative Affectivity (inhibited)
Effortful control (self regulation

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construct development

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-inheritance and prenatal exposure-->traits-->response to stimuli-->learned responses (adaptations)--> construct development--> states -->response to stimuli

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Pediatric/Adolescent Psychiatric interview

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1. prenatal hx
2. perinatal and postnatal hx: birth hx, immediate caretakers, breast-fed vs. bottle ged
3. developmental milestones
4. PMH: significant or acute illnesses
5. FH
6. SH:Cultural Background, Living Arrangements, Parental Occupations, SES, Toxin Exposure, Transportation Issues

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peds/adolescent psyc interview-other informants

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1. Teachers: subject/learning preferences, grades, classroom/classmate interactions, disciplinary actions
2. Psychologists: psycho-educational testing -->acheivement, intelligence and behavioral assessments

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Axis I

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-clinical disorders
1. affective disorders
2. anxiety disorders
3. substance abuse disorders
STATES

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Axis II

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-personality disorders and mental retardation
1. personality disorders
2. mental retardation
TRAITS

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Axis IIi

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-non-psychoatric medical comorbidity affecting psychiatric illness

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Axis IV

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-psychosocial and enviornmental issues

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Axis V

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-global assessment of functioning or children's global assessment scale

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global assessment of functioning (GAF)

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-may useful in determining level of disability or assistance benefit level, direct intensity of intervention, predicting outcomes (i.e., prognoses)
-0-100
-below 50 cant do things
(childrens global assessment scale- talks more about home and school)

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developmental psychiatry

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-Growth, adaptations, and responses are dynamic and multifactorial (i.e., Traits and States are constantly interacting to form new or prolonged states)
-several axis I diagnoses first appear in childhood and dx is partly based on age at pres
-Many disorders presenting in childhood and adolescence predict a severe course

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disruptive behavioral disorders

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1. ADHD
2. Conduct disorder
3. Oppositional defiant disorder

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ADHD

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1. Inattention: difficulty listening, sustaining attention, difficulty with organization, distractibility etc.
2. Impulsivity: blurting out answers, having difficulty waiting for turn
3. Hyperactivity: fidgetiness, running around inappropriately, excessive talking

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ADHD - cont.

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-M>F
-ssx must present before age 7
-ssx must cross enviornments
-70-80% response to psychostimulants
-antihypertensives also beneficial (clonidine)
-tricyclics also beneficial
-non-pharm therapy also beneficial

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Conduct disorder

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-Behavioral Pattern in which rules, norms, & rights of individuals are violated and resulting in social educational & occupational impairment.
1. aggression towards ppl &/or animals
2. destruction of property
3. lying and stealing
4. serious rule violation
5. earlier onset = poorer prognosis
6. boys with earlier onset
7. behavioral therapy is mainstay of tx

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oppositional defiant disorder

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-Pattern of hostile & deviant behavior usually directed towards perceived authority figures resulting in significant social and academic distress.
1. gradual onset of suspicious behaviors prior to 8yrs old
2. cannot be dx if another axis I disorder present
3. M>F prior to puberty, equal gender distribution after puberty
4. 25% have resolution while others often progress to conduct disorder

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unipolar

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-prevalence inc with age
-Equal gender incidence prior to adolescence. In adolescence female:male ratio of 3:2
-Presents with neurovegetative symptoms similar to adults but age specific.
-tx: social support, psychotherapy, antidepressants (SSRIs, TCAs)

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bipolar

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-prevalece inc with age
-Extreme irritability with poor psychosocial functioning.
-Neurovegetative sx as with adults
-Must differentiate from other disease processes that may have similar presentation
-tx: social support, psychotherapy, mood stabilizers (lithium, anticonvulsants, antipsychotics)

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alternative treatments for depression and bipolar disorder

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1. exercise
2. yoga
3. relaxation therapy
4. mindfulness based practices
5. full spectrum light therapy
6. dietary therapy

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Suicidality

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-up to 2/3 of all individuals who attempt suicide visit a medical practitioner in the preceding month
-3rd leading cause of death among 15-24yr olds
-highest among caucasians and N.Americans
-M>F at successful suicide attempts

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what are kids and adolescent so susceptible to suicide?

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-commonly experience stress, confusion, self-doubt, pressure to succeed and multiple fears in regard to uncertainty of life events and future
-warning signs of mood lability, irritability, impulsivity, obstinacy, and withdrawal may go unnoticed

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Separation anxiety disorders

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-reactive anxiety occuring with forced separation from home or significant attachment figure
-nml around 2yo, pathologic when occuring late in childhood
-anxiety may take form of excessive worry regarding parental loss/injury
-must last >4wks with onset prior to age 18
-M=F
-tx: CBT, antidepressants/anxiolytics

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OCD

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-obsessions and compulsions
-obsessions may involve fears of contamination, fears surrounding self-efficacy and corresponding guilt
-frequently 1st presents in childhood & adolescence
-M=F
-tx: CBT; antidepressants; alternative therapies

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PANDAS- pediatric Autoimmune neuropsychiatric disorders
associated with streptococcal infections

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-OCD and Tic presentations may have episodic course or become exacerbated during acute illness. S&S disappear between episodes
-Standard OCD treatments and group A Streptococcus (GAS) prophylaxis are mainstays of treatment; Proven benefit with CBT

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social phobia (social anxiety disorder)

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-typically manifests in easrly adolecence by can occur at almost any age
-can lead to extreme social isolation and impairment
-freq accompanied by comobidity
-anxiety manifest as crying, temper tantrums, freezing, or withdrawal
-tx: psychotherapy, antidepressants,

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Generalized anxiety disorder

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-excessive worrying/anxiety lasting >6months and resulting in sig impairment
-Frequently, children are seen as being perfectionists, participating in repetitive task completion, and needing frequent reinforcement and reassurance.

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PTSD

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-post-traumatic reactive anxiety
-flashbacks
-autonomic arousal with subsequent reminders
-hypervigilance & avoidance of trauma reminders
-tx: psychotherapy, antidepressants, alternative therapies

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traumatic stress in ill or injured children

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-considers DEF's
-D = distress (asses & manage pin, ask about fears & worries, consider grief & loss)
-E = emotional support (who & what does the pt need now? barriers to mobilizing existing supports?)
-F = family (asses parents' or siblings & others distress, gauge family stressor, address other needs)

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Reactive attachment disorder

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-Deficient ability to relate socially due to pathologic child care in the absence of developmental delay (onset before age 5)
-inhibited type (marked decrease in social interaction initiation & response)
-disinhibited type (Indiscriminate initiation & response in social interaction (diffuse attachments)
-tx: established of appropriate social structure and intensive caregiver/child dyad therapy

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Childhood onset schizophrenia (COD)

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-begins, usually insidiously, before age 13
-characterized by pre-morbid impairments, insidious onset and high tx resistance
-positive (hallucinations, delusions, disorganized behavior and speech) and negative sx (reduction in expression, enjoyment)
-misdiagnosis is common
-Up to 99% of individuals with COS have an associated disorder(s) such as ADHD, ODD, depression, separation anxiety disorder.

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COD diagnosis

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-best made via structured interview of child and parent coupled with observational evaluation
-watch for prodromal ssx. hints of less severe and less consistent ssx
-early tx is key

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Autistic spectrum disorders

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-Biologically based neurodevelopmental disorder of impairment with social interaction, communication, & behavior
-onset before age 3
-1/150 8 yo kids
-M>F 4:1
-ALARM: autism is prevalent, listen to parents, act early, refer, monitor

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Autistic spectrum disorders- associated medical conditions

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-microcephaly
-tuberous scleorosis
-fraile x syndrome
-angelman syndrome
-metabolic syndrome
-all kids should have screening lead level

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Autistic spectrum disorders- DSM-IV TR criteria

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1. qualitative impairment in social interaction
2. qualitative impairments in communication
3. restricted repetitive and stereotyped patterns of behavior, interests and activities
-onset must be prior to age 3

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Aspergers disorder

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-no delay in language or cognitive development
-no delay in age-appropriate self-care, adaptive behavior, or curiosity about enviornement
-M>F

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Rett's disorder

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-normal functioning through first 5 months of life
-Between 5-48 months of age develop multiple deficits (head growth, fine & gross motor skills, language skills, social skills
-only reported in females
-almost always associ with severe mental retardation

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childhood disintegrative disorder

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-marked regression in multiple areas after nmlp development in first 2 yrs of life
-losses occur b/t 2-10 yo
-loses involves language, behavior, bowel, bladder control, play and or motor skills
-Impaired social interactions & communication

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mental retardation

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Mild (FSIQ 50-55 to 70)
Moderate (FSIQ 35-40 to 50-55)
Severe (FSIQ 20-25 to 35-40)
Profound (FSIQ <20-25)
Onset must occur prior to age 18

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learning disorders

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-reading, math, disorder of written expression
-intelligence and achievement tests
-full scale IQ, composite IQ scores, index scores

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Expressive language disorder

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Expressive < non-verbal & < receptive
Presentation varies by age: limited speech, vocabulary, errors in tense, immature verbal sentence construction
Developmental (3-5% prevalence) vs. acquired (as result of insult – less common)

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mixed receptive-expressive language disorder

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Difficulty understanding words & sentences

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phonologial disorder

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Abnormalities in speech production

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stuttering

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-Disturbance in speech fluency (often absent in singing)
Familial pattern (children with 1˚ relative with stuttering have 3x risk compared to general population)
Prevalence: 1% pre-pubertal but often resolved by adolescence; M:F ratio 3:1
Peak age of onset 5 years (2-7 years)

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selective mutism

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-failure to speak in specific situations/enviornments despite fluency with lang and speaking freely in other situations
-must persist for >4wks
-often, child will use non-verbal communication
-assoc with social anxiety

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developmental coordination disorder

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-not related to underlying medical condition
-Variable presentation depending on age (e.g., slow to crawl, clumsy with fine and gross motor skills
-often seen in premees
-correlation with obesity

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functional encopresis

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-inappropriate passage of feces 1 time per month x 3+months
-must be at least 4
-many children deny problem
-Secondary Complications: Physical/Emotional (more so than enuresis)
Treatment: Behavioral therapy is mainstay of treatment
Some need pharmacotherapy for constipation and/or diarrhea

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enuresis

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-nml micturaiton wetting at socially unacceptable places and times
-Correlation between behavioral problems & enuresis has been well studied
- Up to a 30% incidence of co-occurring ADHD and Enuresis

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pica

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-persistent consumption of non-nutritional substance for >4wks

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rumination

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-repeated regurgitation and chewing of food for >4wks developing b/t 3-12 months of age
-often assoc with developmental delay and or neglect

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feeding disorder of infancy and early childhood

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-failure to gain weight or weight loss secondary to failure to eat over 4wk period
-onset prior to age 6

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childhood and adolescent eating disorder

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1. anorexia nervosa
2. bulimia
3. binge eating disorder
4. eating disorder not otherwised specified
-medical tx*

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tic disorders

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-Sudden, rapid, involuntary, non-rhythmic, stereotyped movements (although may be voluntarily suppressed) that may be exacerbated with anxiety/stress and reduced with sleep and ‘absorbing activities’ (e.g., video games)
1. motor
2. vocal
3. simple
4. complex

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tourette's disorder

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-multiple motor tics and one or more vocal tics resulting in social and/or academic impairment
-tics occur throughout the day for most days of the yr
-freq assoc with OCD, ADHD, anxiety disorders
-avg onset at age 7

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chronic motor or vocal tic disorder

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-Unlike Tourette’s, children have only motor or only vocal tics

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transient tic disorder

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-Single or multiple motor or vocal tics occurring for > 4 weeks but <12 months

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multi-domain social support

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1. popular sector- home, family, neighborhood
2. folk sector- traditional dealers and helpers
3. professional sector- medical professionals

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meds

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-slides?