First Aid Psych 9-2 Disorders In Children

Front 1

31. ADHD?

Back 1

a. Consists of inattention and/or hyperactivity and impulsivity greater than expected for stage of development.
b. There are 3 subcategories of ADHD.

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32. 3 subcategories of ADHD?

Back 2

a. Predominantly inattentive type
b. Predominantly hyperactive-impulsive type
c. Combined type.

Front 3

33. DSM diagnosis of ADHD?

Back 3

a. At least 6 sx of either inattentiveness, hyperactivity, or both, that:
1. Have persisted for at least 6 months.
2. Are presented at a degree that is maladaptive.
3. Have an onset prior to age 7.

Front 4

34. Inattentive sx:

Back 4

a. Careless mistakes
b. Difficulty sustaining attention
c. Difficulty listening
d. Does not follow instructions
e. Lack of organizational skills
f. Reluctant to do tasks that require a sustained effort
g. Losing things easily
h. Forgetful
i. Easily distracted.

Front 5

35. Hyperactivity-impulsivity sx?

Back 5

a. Restlessness (leaves the classroom, runs or climbs excessively)
b. Difficulty engaging in quiet activities
c. Appears as though “driven by a motor”
d. Excessive talking
e. Blurts out answers
f. Difficulty waiting their turn
g. Often interrupts.

Front 6

36. Comorbidities w/ADHD?

Back 6

a. High incidence of comorbid mood disorders, anxiety disorders, personality disorders, conduct disorder (30-50%), and ODD (30-40%)
b. More than 50% of children w/ADHD have a comorbid psychiatric diagnosis.

Front 7

37. Encopresis?

Back 7

a. Requires that the person be greater than 5 yrs old and already been toilet trained.

Front 8

38. Tx of ADHD?

Back 8

a. Medication is considered the most effective tx for decreasing core sx, but should be only one component of the tx plan, which has to be individualized.
b. CNS stimulants are first line.
c. Atomoxetine (Strattera): is atomoxetine is non-stimulant that has also been given FDA approval for ADHD.
d. Alpha-2 agonists (clonidine, guanfacine)
e. If there is an underlying mood or anxiety disorder, that should be tx’d first.

Front 9

39. CNS stimulants used for ADHD?

Back 9

1. methylphenidates (Ritalin, Concerta, Metadate, Focalin)
2. Dextroamphetamine (Dexedrine, Dextrostat)
3. Amphetamine (Adderall)

Front 10

40. Alpha-2 agonists for ADHD?

Back 10

a. Clonidine and Guanfacine.
b. Used if first-line tx cannot be used (due to intolerable side effects or ineffectiveness) or as adjunctive therapy to stimulants.

Front 11

41. Pervasive Developmental Disorders (PDDs)

Back 11

a. Pervasive Developmental are a group of conditions that involve problems w/social skills, language, and behaviours.
b. Impairment is noticeable at an early age of life and involves multiple areas of development (social, communicative, and cognitive).

Front 12

42. Included in the Pervasive Developmental class in the DSM-IV?

Back 12

1. Autistic disorder
2. Asperger disorder
3. Rett Disorder
4. Childhood disintegrative disorder
5. PDD NOS

Front 13

43. DSM-IV Diagnosis of Autistic Disorder?

Back 13

a. At least 6 sx must be present by age 3, w/at least 2 from (1) and at least 1 from (2) and (3).
1. Problems w/social interaction: Impairment in nonverbal behaviours, lack of peer relationships, lack of interest in sharing enjoyment w/others, lack of social/emotional reciprocity.
2. Impairments in communication: Delayed speech, inability to hold conversations, repetitive or stereotyped use of language, lack of make-believe and imitative play.
3. Repetitive and stereotyped patterns of behaviours and activities: Narrowed interests, inflexible adherence to rituals, repetitive motor mannerisms (hand flapping), preoccupation w/parts of objects.

Front 14

44. DSM-IV Diagnosis of Autistic Disorder (cont)?

Back 14

a. Abnormalities in functioning must be present by age 3.
b. The condition cannot be better accounted for by Rett disorder or childhood disintegrative disorder.

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45. Epidemiology of Autistic Disorder?

Back 15

a. There has been a recent ↑ in reported prevalence, but this could be related to changes in definition, as well as ↑ awareness and recognition of the condition.
b. Estimates of incidence range from 1/1000 children to 1/100.
c. Boys are affected 3-4x more than girls.
d. 70% of autistics meet criteria for mental retardation (IQ < 70).
e. Association w/fragile X syndrome, tuberous sclerosis, and seizures.

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46. Etiology of Autism?

Back 16

a. Multifactorial, including:
1. Prenatal neurological insults (infections, drugs, etc)
2. genetic factors (siblings affected are at a > 22-fold risk)
3. Immunological and biochemical factors (may have higher peripheral 5-HT levels), ↑ head size, persistent primitive reflexed, EEG abnormalities.

Front 17

47. Prognosis and tx of Autism?

Back 17

a. Prognosis is variable, but the 2 most important predictors of adult outcome are level of intellectual functioning and communicative competence.
b. Tx: No cure but various treatments used to help manage symptoms and improve functioning:
i. Remedial education
ii. Behavioural therapy
iii. Antipsychotic meds (to help control aggression, hyperactivity, and mood lability)
iv. Considered antidepressants or stimulants if other sx warrant them.

Front 18

48. Asperger DSM?

Back 18

a. This condition is characterized by the same impairments seen in autism involving social interaction and restricted or stereotypes interests and behaviours, but it differs from autism in that there is no clinically significant delay in spoken or receptive language, cognitive development, self-help skills, or curiosity about the environment.

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49. Is Asperger’s more common in boys or girls?

Back 19

a. Boys

Front 20

50. Social interaction w/Asperger?

Back 20

a. Social interaction is often characterized by a “professorial” or “pedantic” (overly concerned with trivial rules and formality) style.
b. Social difficulties often -> social frustration and ↑ risk for depression in adolescence.

Front 21

51. Tx of Asperger?

Back 21

a. Supportive tx as used w/autism.
b. Preservation of verbal abilities will allow for more benefit from social skills training and behavioural modification techniques.

Front 22

52. By what is Rett Disorder characterized?

Back 22

a. By normal physical and psychomotor development during the first 5 months after birth, followed by a decreasing rate of head growth and loss of previously learned purposeful hand skills between ages 5 and 30 months.
b. These children will then develop stereotyped hand movements (hand wringing, hand washing), impaired language and psychomotor retardation, and problems w/gait or trunk movements.

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53. Features of Rett Disorder?

Back 23

a. Onset between 48 months and age 5.
b. Seen in girls predominantly; boys have variable phenotype, and iti s most likely lethal in utero for males.
c. Pts may become nonambulatory due to motor problems and scoliosis.
d. ↑ risk of sudden death.

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54. Prevalence of Rett Disorder?

Back 24

a. Rare- Between 1/15000 and 1/22,000 females.

Front 25

55. Is genetic testing available for Rett disorder?

Back 25

a. Yes

Front 26

56. What genetic mutation is Rett disorder associated with?

Back 26

a. MECP2 gene mutation on X chromosome.

Front 27

57. Other diagnostic features of Rett Disorder?

Back 27

a. EEG is frequently abnormal and seizures are common.

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58. Tx of Rett disorder?

Back 28

a. Supportive.

Front 29

59. When does cognitive development end for Rett disorder?

Back 29

a. It never progresses beyond that of the first yr of life.