Rpdwk7- 4-27 Henson Common Disorders In Children

Front 1

Age of adolescence

Back 1

13+

Front 2

Piagets stages of cognitive development...
1st?
2nd?

Back 2

1. Sensorimotor: birth to 2y/o
– Object permanence- know you dont disappear in "peak a boo"
– Symbolization
2nd. • Preoperational thought: 2-7y/o (preschool to late kindergarten)
– Unable to think logically or deductively: egocentrism, animistic thinking

Front 3

animistic thinking?

Back 3

Believing that inanimate objects have thoughts and feelings (TOY STORY)

Front 4

Piagets stages of cognitive development...
3rd stage?
4th stage?

Back 4

3rd. Concrete operations: 7-11y/o
– More logical thinking: conservation (understanding water in different containers has same amount), reversibility
4th- Formal operations- – Can think abstractly, reason deductively, and define abstract concepts

Front 5

Mood disorders covered in this lecture?

Back 5

• Major depressive d/o
• Dysthymic d/o
• Bipolar d/o
• Cyclothymic d/o
• Schizoaffective d/o
• Bereavement

Front 6

Normal sadness vs. true depression how do you tell in kids?

Back 6

• Failure to meet excepted weight gain (not so much weight loss but lack of gain)
• Somatic complaints- other parts of their body hurt
• Irritability vs. depressed mood- anger
• Psychomotor agitation- restless
• Mood-congruent hallucinations-

Front 7

What is dysthymic disorder in children?
Differs from adult

Back 7

Adult- most of the time of the day for 2 yrs... but in children only 1 yr
Early = <21 y/o

Front 8

Bipolar I diagnosiing in kids?

Back 8

Dont display classic manic symptoms- often have severe ADHD making diagnosis is more complicated
- usually intermittent aggressive behavior and are less responsive to mood stabilizers

Front 9

Bereavement vs. MDD (kids)?

Back 9

Sometimes kids dont process things until 6 month
- preoccupation with death and will lose energy level more than normal in "griefing period"
- hallucinations (hearing loved one's voice= normal but hearing instructions= not normal)

Front 10

Mood disorders in kids tx?

Back 10

• Hospitalization
• Psychotherapy
• Pharmacology (SSRIs, Bupropion, Venlafaxine, Mirtazapine, TCAs)
• ECT

Front 11

Bipolar I pharm tx?

Back 11

1. Lithium- 12 and up
2. Anticonvulsants
3. Antipsychotics- haloperidol (12-17)

Front 12

ECT and children?

Back 12

Rarely used in adolescents (not in kids)
- must have approval from 2 separate psychiatrists

Front 13

OCD diagnosis in kids vs. adults
What is best tx of OCD in kids?

Back 13

OCD: obsessions and compulsions only have to be present for 1 hour per day, not 2 hours
Therapy is huge

Front 14

Other kids anxiety disorders not in notes

Back 14

spearation anxiety
selective mutism
Reactive attachment disorder

Front 15

Phobia diagnosis highest incidence at what age?
MC phobias in kids...?

Back 15

>6 months fear peaks age 5-9 y/o
MC- natural disasters, blood-injection, animal type, fear of vomiting/ choking

Front 16

Treatment of specific phobias?

Back 16

-Therapy involving exposure therapy
- SSRIs if anxiety is extreme and chronic
- Beta blockers or sedating meds (Benadryl)
- Benzos may be of use

Front 17

Usually separation anxiety age?
MC in what situation

Back 17

10-18 months usually preceded by stranger anxiety (6-12 months age)
- Abnormal in 3-4 y/o... mc of school refusal

Front 18

Tx of separation anxiety?

Back 18

- CBT
- Family education
- Family Psychosocial interventions
-Pharm- SSRIs, Benzos, Benadryl

Front 19

What is selective mutism? MC age?

Back 19

Children who are completely silent or have minimal language in certain environments- has to lasts for weeks to months
– Usually at school or outside the home (beginning stages of social phobia)
MC- 4-8 y/o

Front 20

What is reactive attachment disorder? Cause?
How does it present?
Types?

Back 20

< 5 y/o usually
- Usually the result of maltreatment or frequent change in caregivers
• May present with malnourishment or failure to thrive
• 2 subtypes:
– Inhibited type- fails to initiate and respond to most social interactions in appropriate wa
– Disinhibited type- bonds too much with everyone

Front 21

Foster child that may present with malnourishment and failure to thrive... once you r/o abuse thinking?

Back 21

Reactive attachment disorder

Front 22

What are the disruptive behavior disorders...

Back 22

• Oppositional Defiant Disorder-
• Conduct Disorder, childhood-onset type
• Conduct Disorder, adolescent-onset type
• Conduct Disorder, unspecified onset
• Disruptive Behavioral Disorder, NOS

Front 23

ODD means oppositional defiant disorder...
criteria for dx?

Back 23

• Pattern of negative and defiant behavior
• Loses temper, argues with adults- Defies, refuses to comply
• Deliberately annoys people
• Blames others- Angry, spiteful, vindictive, and resentful
• Criteria not met for Conduct Disorder...Duration >6 months

Front 24

ODD treatment

Back 24

Multimodal treatment
- Family intervention w/ direct training of the parents
- individual psychotherapy... stimulants

Front 25

Conduct disorder defined?

Back 25

• Breaking rules of society, stealing, assaults, truancy
• May be antecedent to Antisocial Personality Disorder
• Duration >6 months
prequel to anti-social personality disorder usually have Triad

Front 26

Pharm army for conduct disorder

Back 26

• Antipsychotics
• Lithium
• Depakote
• Carbamazepine
• Clonidine
• SSRIs
• Always treat coexisting disorders

Front 27

Psychotic disorders

Back 27

The same disorders and criteria as in adult psychotic disorders
– except they may fail to achieve expected levels of social and academic functioning instead of having deteriorating functioning

Front 28

Pharm for psychotic disorders

Back 28

• Risperidone
• Olanzapine
• Clozapine
• Aripripazole
• Invega

Front 29

Tourettes diagnosis

Back 29

Tourette’s Disorder
– Multiple motor and at least one vocal tic
– For at least a year
– Onset prior to the age of 18

Front 30

Diagnosis of transient tic disorder...
MC age?

Back 30

Transient Tic Disorder
– Occurs for at least 4 weeks, but no longer than 12 months, most common in males around the age of 8
- on stimulant for awhile

Front 31

Tx of tic disorders

Back 31

Education for families
- behavioral therapy
- pharm (
typical antipsych, - haloperidol and pimozide
atypical antipsychs, - risperidone and olazapine
alpha-2 adrenergic agonists- clonidine and guanfacine

Front 32

Tourettes usually have what comorbid disorders?

Back 32

ADHD and OCD

Front 33

1. Encopresis

2. • Enuresis MC cause?
I

Back 33

1. – Always rule out medical problem– Most commonly comorbid with: anxiety disorders, disruptive behavior disorders, or developmental delay

2. – Always rule out medical: most common constipation or UTI

Front 34

Testing for psychiatric disorders

Back 34

1. Questionnaires and rating scales (– Child Behavior Checklist
– Revised Behavior Problem Checklist
– Connors Rating Scale for ADHD)
2. neuropsychiatric assessment- developmental, psychological, educational

Front 35

Sleep disorders in children go to treatment?

Pharm tx?

Back 35

Address sleep hygiene first!
- commonly seen in most primary psychiatric disorders
Pharm- melatonin also clonidine, especially if ADHDis contributing
Adolescents may consider trazodone (old anti-depressant causes sedation)

Front 36

Learning disorders....
4 main categories...

Back 36

Must be discrepancy between IQ and achievement
4 main categories:
– Reading Disorder
– Mathematics Disorder
– Disorder of Written Expression
– Learning Disorder, NOS

Front 37

Communication disorders... 5 main categories?

Back 37

– Expressive Language Disorder
– Mixed Receptive-Expressive Language Disorder
– Phonological Disorder- lisps
– Stuttering
– Communication Disorder, NOS