adolescent childhood disorders

ASD

Neuro developmental delay with or without intellectual disability

Autism and asperger syndrome are no longer

Seperate disorders

Chracteristics of ASD

severe and sustained impairment in social interaction, so restricted, repetitive patterns of behaviors, interests and activities

Stereotypic behaviors

Highly restricted area of interest so intense, narrow, and repetitive focus on specific topics or objects that is not typical for developmental age

In severe ASD may have

Self-injurious behaviors such as rocking, biting, and head banging

Epidemiology of ASD

Children aged 8 y/o

Risk factors of ASD

Sibling with ASD, children born to older parents, X syndrome or tuberous sclerosis, use of valproic acid and thalidomide during pregnancy

Criteria to determine the level of strcture in ASD

IQ and adaptive functioning

Tx that supports child development with ASD

Academic, interpersonal, social experiences

In ASD, physical safety is

A priority

Comorbitidy with ASD

Depression and seizure disorders

Interventions for ASD

Consistent structured environment with predictable routines for activities, mealtimes, and bedtimes.

Intentionally create opportunities for social interaction s including non-verbal

Remove child briefly if aggressive or inappropriate then proompt rentry

Ignored behavior with negative affects

Protective headgear for headbanging

Keep toys, dishes, etc in same place, helps ease anxiety

If pt with ASD is constantly criticized then

Self-esteem will go down and more unlikely to cooperate and learn

In pts with ASD it is Important to redirect and positive reinforcement for

Positive behavior —> catch them doing good

Psychosocial interventions for ASD

Build on their strengths, positive reinforcement, teach self care skills but also keeping in mind their limitations

Family interventions for pt with ASD

Prevent caregiver stress syndrome, offer parents the opportunity to express their frustration and disappointments, parent support groups or respite care, counseling.

Caregiver stress syndrome

Physicl, mental, and emotional exhaustion frok neglecting their own health bc they are focused on caring for injured loved one

Med interventions for pt with ASD

Atypical antipsychotics, mood stablizers

Atypical antipsychotics meds for ASD

Risperidome, apriprazole

Atypical antipsychotics meds in general

Risperidone, olanzapine, quetiapine, ziprasidone, apriprazole, clozapine

Concern with atypical antipsychotics

Weight gain and metabolic syndrome (diabetes, htn, high cholesterol)

ADHD is

Persistent pattern of inattention, hyperactivity, and impulsiveness that interferes with functioning

Chracterisitcs of ADHD

Disruptive behavior, prone to impulsive risk taking behavior and fail to consider consequences of their actions, restless, always on the go, highly distractible, unable to wait their turn

What part of the brain is Dysfunctional in ADHD

Dorsolateral prefrontal cortex which is center of directed attention snd ability to manage their emotions, and frontal lobe

Pts with ADHD require

High degree of structure and supervision

Risk factors for ADHD

Family hx, substance use during pregnancy, exposure to environmental toxins (lead) during pregnancy and or at young age, low birth weight and brain injuries

Etiology of ADHD

High consumption of refinded sugars and saturated fat diet in childhood

Family response to ADHD

Parents need to work together with teachers to provide consistent directions to the child, child needs a structured environment that helps support focus and attention

Safety issues associated with ADHD

Greater risk of injury due to impulsiveness, risk for mood changes that can lead to self harm or SI

Sources of data for mental health interview for pt with ADHD

Direct interview, observation of child and parent, teacher ratings

Standardized instrument for ADHD

Conners parent questionnaire (48 item), child behavior check litt (118 items)

Psychosocial assessment for ADHD

School performance, behavior at home, comorbid psych disorders, review family situation

Outcomes for pts with ADHD should be

Individualized to the child

Inattentive symptoms for ADHD

Carless mistakes, attention difficultly, listening problems, loses things, fails to finish what they start, forgetful in routine activities, reluctant to do taks that require mental effort

Hyperactivity-inattentive symptoms for ADHD

Restless, run, unable to wait their turn, not able to play quietly, talks excessively, answers are blurted out, staying seated is difficult

Physical health intervention for ADHD

Few foods diet, restricted elimination diet (free of chemicals), polyunsaturated diet

It is important to promote sleep in

ASD and ADHD

Obtain sleep hx, prior meds, sleep diary, sleep hygiene, and behavior therapy techniques for

Pts with ADHD

Non-stimulants

Amoxwtine, bupropion, elavil, pamelor, clonidine, guanfacine, precedex

Amoxetine targets

ADHD and anxiety

Bupropion should be given in

The morning bc it causes hyperactivity, dont give at night

Tricyclic antidepressants

Elavil, pamelor

Alpha 2A antagonists

Clonidine, guanfacine, precedex

Psychostimulants

Methylphenidate, dextroamphetamine, mixed amphetamine salt

Methylphenidate SE

nervousness, insomnia, dizziness, headaches, dyskinesia

Methylphenidate total duration of action is

4 hrs, dose more during daytime

Longer acting methylphenidate don’t require

Frequent dosing

Lomger acting methylphenidate SE

Appetite supression, insomnia, dry mouth, nausea

Longer acting preperation of methylphenidate meds

Concerta, ritalin LA, metadate ER, amphetamine-dextroamphetamine

Drug holidays

Implemented to manage side effects of meds for ADHD

First line meds for ADHD

Psychostimulants

Second line meds of ADHD

Non-stimulants

Psychosocial intervention for ADHD

Behavioral programs rewarding for positive behavior, behavioral parent training, classroom management and peer interventions

CBT techniques for ADHD

Set clear limits with clear consequences

Establish and maintain a predictable environment with clear rules and regular routines for eating, sleeping, and playing.

Promote attention, maintain a calm environment with few stimuli

Established eye contact before giving directions ask child to repeat what was heard

Encourage the child to do homework and a quiet place.

Help the child work on one assignment at a time (reward with a break after each completion)

Educational outcomes for patients with ADHD

Increase in school performance, decrease and likelihood of early dropouts and suspension/expulsions

Social outcomes of treatment for ADHD

Decrease in social isolation, substance abuse

Biologic outcome of treatment for ADHD

Decrease in distractibility, increase in attention, decrease in impulsiveness. If this is me, then it affects education, educational, and social outcomes.

TICS

Sudden, rapid, repetitive, stereotypes, movements, or vocalizations

Motor sx in tic

Blinking, grimacing, hopping, skipping, tapping

Phonic aka vocal sx of tic

Repetitive throat clearing, barks, grunting, echolalia, palilalia (repeat own sound), obscenties

Tourettes disorder

Presence of multiple motor tics and one or more phonic tics

Comorbidites with tourettes

ADHD, OCD, DEPRESSION, ANXIETY

Med tx for tourettes

Clonidine, antipsychotics

Disruptive behavior disorders

ODD, CD

ODD (oppositional defiant disorder)

Persistent pattern of disobedience, argumentativeness, angry putburts, low tolerance for frustration and tendency to blame others for misfortnes

CD (conduct disorder)

More serious violations of social norms (agressive behavior, curelty to animals, destruction of property), diagnosed in adolescents

CD s/sx

bullying, setting fires, fighting, running away from home, everyday lying or conning, using a weapon, breaking into someone’s house building or car, actively forcing sex

ODD s/sx

Resentful, easily annoyed, argues with adult, loses temper, blames others for his or her misbehavior, annoys people deliberately, defies rules or requests, spiteful

Elimination disorders

Enuresis and encopersis

Enuresis

Diurnal and nocturnal incontinence

Tx for enuresis

Limit fluid intake before bed, treat constipation, bell undergarments, pads, r/o GI conditions

Med tx for enuresis

Desmopressin, imipramine, oxybutynin

Encorpersis

Fecal soiling of clothing or defecation in inappropriate places. Common in boys

Tx for encopersis

High fiber diet, behavioral, parenting interventions

Seperation anxiety disorder

Fear and anxiety developmentally inappropriate. Worry about harm or permanent loss of major attachment figure, school phobia is common to manifest anxiety

Risk factors for seperation anxiety disorder

Parents with anxiety, parental depression

Sleep disorder interventions

Sleep hygeine, bedtime schedule, reduce stimulation, limit setting, cherry juice, chamomile tea

Med tx for sleep disorder

Melatonin, benadryl, clonidine, trazadone