First Aid Psych 9-3 Disorders In Children

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60. Childhood disintegrative disorder?

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a. There is normal development in the first 2 yrs of life, including communication, social relationships, play, and adaptive behaviour, but there is loss of previously acquired skills before age 10 yrs in at least 2 of these areas: language, social skills or adaptive behaviour, bowel or bladder control, play, motor skills, and in at least 2 of these areas: impaired social interaction, impaired communication, restricted, repetitive, stereotypes behaviours, and interests.

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61. Features of Childhood disintegrative disorder?

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a. Onset after age 2, usually between 3-4. Must be before 10.
b. 4-8x higher incidence in boys than girls.
c. Rare, maybe 1 in 100,000.

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62. EEG w/ Childhood disintegrative disorder?

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a. High rates of EEG abnormality and seizure disorder.

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63. With what other conditions has Childhood disintegrative disorder been associated?

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a. Landau-Kleffner syndrome
b. Neurolipidoses
c. Mitochondrial deficits
d. Metachromatic leukodystrophy
e. CNS infection, etc.

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64. Tx of Childhood disintegrative disorder??

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a. Supportive, w/a focus on helping child relearn basic skills.

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65. How is Childhood disintegrative disorder different from Rett disorder physically?

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a. In contrast to Rett disorder, head growth does not slow and the unusual hand movements are not present in Childhood disintegrative disorder.

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66. Tourette disorder?

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a. The most severe tic disorder.
b. Characterized by multiple daily motor and one or more vocal tics w/onset before age 18.
c. Vocal tics may first appear many yrs after the motor tics.
d. The most common motor tics involve the face and head, such as blinking of the eyes.
e. Examples of vocal tics include:
i. Coprolalia
ii. Echolalia

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67. Coprolalia?

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a. Repetitive speaking of obscene words (uncommon in children)

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68. Echolalia?

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a. Exact repetition of words.

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69. Diagnosis of Tourette?

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a. Multiple motor and 1 or more vocal tics (both must be present at some time during the illness, but not necessarily concurrently) that are not attributable to CNS disease (ie, Huntington or postviral encephalopathies).
b. Onset prior to 18.
c. Tics occur many times a day, almost every day for > 1 yr (no tic-free period > 3 months).
d. Change in anatomic location and character of tics over time.
e. Both motor and vocal tics must be present to diagnose Tourette disorder.

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70. Note: Tic disorders are one of the few psychiatric disorders in which a diagnosis can be given w/out symptoms causing significant distress.

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70. Note: Tic disorders are one of the few psychiatric disorders in which a diagnosis can be given w/out symptoms causing significant distress.

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71. Tx of choice for Tourette disorders?

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a. Psychopharmacology.

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72. When do Tourette sx peak in severity?

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a. Between ages 8-12, decreasing w/puberty.
b. ½ to 1/3 experience marked reduction of sx by their late teens, w/1/3 to ½ becoming virtually asymptomatic in adulthood.

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73. With what 2 conditions does Tourette have high comorbidity?

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a. OCD and ADHD.

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74. Neurochemical factors for Tourette?

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a. Impaired regulation of dopamine in the caudate nucleus (and possibly impaired regulation of endogenous opiates and the noradrenergic system).

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75. Tx of Tourette?

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a. Educational and supportive interventions: Create realistic expectations, supportive classroom environments.
b. Psychosocial: Supportive therapy, behavioural therapy.
c. Pharmacological.

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76. Pharmacological Tx of Tourette?

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a. Atypical neuroleptics (risperidone)
b. Alpha-2 agonists (clonidine, guanfacine)
c. Typical neuroleptics (haloperidol, pimozide) for severe cases.

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77. Use of stimulants in ADHD associated w/tic disorder?

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a. Controversial in ADHD associated w/tic disorder, due to concern for exacerbation of tics.

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78. Tx of OCD pts w/comorbid tics?

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a. Have good response to SSRI augmentation of antipsychotics.

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79. Elimination Disorders?

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a. Urinary continence is normally established before age 4.
b. Bowel control is normally achieved by the age of 4.
c. Incontinence can result in rejection by peers and impairment of social development.

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80. Enuresis?

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a. Involuntary voiding of urine (bed-wetting) after age 5 (at least 2x a week for at least 3 consecutive months or w/marked impairment).
b. Rule out infections, DM, seizures.

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81. Encopresis?

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a. Involuntary or intentional passage of feces in inappropriate places by age 4 (at least once a month for at least 3 months).
b. Rule out metabolic abnormalities (hypothyroidism), lower GI problems (anal fissure, IBD), and dietary factors
c. Distinguish between primary (never established continence) versus secondary (continence achieved and then lost).

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82. Prevalence of Elimination disorders?

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a. Enuresis: 5% of 5 yr olds
b. Encopresis: 1% of 5 yr olds

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83. Etiology of Enuresis?

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a. Genetic predisposition
b. Psychosocial stressors (Especially w/secondary incontinence)
c. Enuresis: Small bladder or low nocturnal levels of ADH.

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84. Etiology of encopresis?

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a. Lack of sphincter control, constipation w/overflow incontinence (responsible for 75% of cases).

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85. Tx of Elimination disorders?

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a. Take into account the high spontaneous remission rates.
b. Psychoeducation, psychotherapy, family therapy, and behavioural therapy.
c. Enuresis: Behaviour modification (ie, bell and pad method- buzzer that wakes child up when sensor detects wetness), antidiuretics (DDAVP), or TCAs such as imipramine.
d. Encopresis:
e. Initial bowel catharsis followed by stool softeners (if etiology is constipation).

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86. Selective Mutism?

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A rare condition that occurs more commonly in girls than in boys.
b. Characterized by refusal to speak in certain situations (such as in school) for at least 1 month, despite the ability to comprehend and use language.
c. Onset is usually around 2-5 yrs, although it is often not noticed until time of entry into school.

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87. Tx of selective mutism?

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a. Psychotherapy, behaviour therapy, and management of anxiety.

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88. At what ages is separation anxiety appropriate?

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a. From 7 months to 6 yrs, so it is usually not diagnosed until after age 6.

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89. When does stranger anxiety peak?

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a. 8-12 months old.

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90. Separation anxiety disorder?

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a. Involves excessive fear for ≥ 4 wks of leaving one’s parents or other major attachment figures.
b. Children w/this disorder may refuse (or complain of physical sx to avoid) going to school or sleeping alone, and they may report physical symptoms.
c. When forced to separate, they become extremely distressed and may worry excessively about losing their parents forever.
d. Separation anxiety affects up to 4% of school-age children, M:F, and may be preceded by a stressful life event.
e. Parents are often afflicted w/anxiety disorders and may express excessive concern about their children.

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91. Tx of separation anxiety disorder?

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a. Family therapy, CBT, and low-dose antidepressants.

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92. What may childhood separation anxiety disorder be a risk factor for?

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a. Development of panic disorder or agoraphobia as an adolescent or adult.

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93. Most common drug of abuse by adolescents?

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a. Alcohol, followed by cannabis.

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94. Most common perpetrator in substantiated child abuse cases?

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a. Child’s parent.

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95. Of what type are most child abuse cases?

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a. Cases of neglect.

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96. What do adults who were abused as children have an ↑ risk of developing?

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a. Anxiety disorders, substance abuse disorders, depressive disorders, dissociative disorders, self-destructive disorders, and posttraumatic stress disorder.
b. They also have an ↑ risk of subsequently abusing their own children.

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97. Evidence of sexual abuse in a child?!?

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1. STD
2. Anal or genital trauma
3. Knowledge about specific sexual acts (inappropriate for age)
4. Initiation of sexual activity with others
5. Sexual play with dolls (inappropriate for age)

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98. Complete

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98. Complete