Psych: Childhood Disorders

earlier intervention for a child with a mental disorder results in

better outcomes

familial risk factors:

severe parental discord, low socioeconomic status, overcrowded home, parental criminality, maternal psych disorders, foster care

what pediatric symptoms need immediate assessment?

sudden drastic personality/behavior change, SI, genuine aggression in tantrums, ED-related behavior, sudden severe anxiety increase, severe distress/sadness, impaired concentration, repeat substance use

motor disorders:

developmental coordination disorder, stereotypic movement disorder, tic disorders

major tic disorder:

Tourette's disorder

when must a tic disorder appear?

before 18 (usually 4-6 for Tourette's)

what must be present to dx Tourette's?

multiple motor tics, one or more vocal tics

what are examples of motor tics?

blinking, tongue protrusion, touching, squatting, skipping

what are examples of vocal tics?

grunts, yelps, clicks, snorts, sniffs, coughs

what meds can be given for Tourette's?

haloperidol, aripiprazole, risperidone, clonidine, pimozide, guanfacine

what non-med treatments can be done for Tourette's?

botox, DBS, CBT

autism spectrum definition:

severely impaired social interaction, repetitive behavior and interests

what type of intervention is best in children with autism?

early intervention

what three factors determine autism prognosis?

early intervention, overall intellectual level, development of social/language skills

stereotyped behaviors

repeated motor behaviors that do not serve a logical purpose (echolalia, drumming, etc)

interventions for autism disorder:

school programs, special education, behavioral management plans, parental involvement

medications for autism disorder:

risperidone, aripiprazole, SSRIs, naltrexone

adhd main symptoms/diagnostic indicators

inattention, hyperactivity/impulsivity

ADHD hyperactivity

fidgeting, restlessness, running about inappropriately, struggles to play quietly, excessive talking

ADHD inattention

wandering of task, lacking persistence, difficulty with focus, disorganized (not due to defiance)

other qualifiers for ADHD

low frustration tolerance, sx present before 12 & in 2+ types of situations, significant impairment in social/academic life

meds for ADHD - stimulants:

Ritalin (methyphenidate), Adderall (amphetamines)

AE of ADHD stimulants:

insomnia, appetite suppression, HA, lethargy, abdominal pain

meds for ADHD - nonstimulants

atomexitine (Strattera - NRI)

AE of atomexitine (for ADHD)

GI issues, reduced appetite, weight loss, urinary retention, dizziness, fatigue, insomnia, liver injury, BP/HR increase, SI

how long can it take for atomexitine to work?

6 weeks

what is separation anxiety disorder?

severe anxiety from a child when away from a caregiver

what type of sx may present in a child with separation anxiety disorder?

physical

how long can separation anxiety last in kids?

>4 weeks

preschool sx of PTSD

temper tantrums, reliving trauma in play/drawings, night terrors, regression of skills, somatic sx

school age sx of PTSD

nightmares, irritability, difficulty concentrating, hypervigilance, omen formation

what is reactive attachment disorder?

emotionally withdrawn behavior toward adult caregivers

how does reactive attachment disorder manifest?

child doesn't seek or respond to comfort from adults, child exhibits fear or irritation with safe caregivers

what types of past experiences can cause reactive attachment disorder?

neglect or social deprivation as a child (lack of emotional needs met by caregivers), foster care & caregiver change, reared in unusual settings

pica -

eating non-food sources (no aversion to eating food, often accompanies intellectual disability)

rumination disorder -

repeated regurgitation and rechewing food (no nausea, etc: can accompany developmental delay)

which disorders are impulse control disorders?

oppositional defiant, intermittent explosive, conduct

what is oppositional defiant disorder?

a pattern of angry defiant behavior or vindictiveness (for 6+ months with non-siblings)

how does oppositional defiant disorder present?

temper tantrums, actively defying requests/rules, deliberately provokes others, actively vindictive with others

what is intermittent explosive disorder?

recurring outbursts, inability to control aggressive impulses (verbal/physical aggression, property damage or physical assault)

additional factors of intermittent explosive disorder:

aggression wildly out of proportion, unmeditated, marked distress, 6+ years old

what is conduct disorder?

aggression toward people/animals, property destruction, deceit/theft, serious rule violations

those with conduct disorder are often:

physically cruel, rob others, force others into sexual acts, bullies, burglars, manipulators, shoplifters, deliberate violators of rules, truants

signs of adolescent conduct disorder (all):

misconduct with peer group, school discipline issues, deliberately disruptive behavior, severe anxiety/aggression/anger, inability to empathize

signs of adolescent conduct disorder (boys):

fight, vandalize, steal

signs of adolescent conduct disorder (girls):

truancy, running away, substance abuse, prostitution

what is pyromania?

pleasure or relief when setting, witnessing, participating in a fire

pyromania comorbs:

AUD, conduct disorder, ADHD

what is kleptomania?

stealing objects unnecessary for material gain

kleptomania comorbs:

MDD, anxiety/eating/personality disorders

types of therapy for children/adolescents:

family, group, milieu, behavioral

play therapy is for

children

what is the equivalent of play therapy for adolescents?

discussion groups

behavioral therapy in kids

operant conditioning, point & level system

what type of treatment is last resort for kids?

restraints

seclusion is ___ in nature

controversial (child feels it's punishment)

quiet room:

removes child from situation to come back to place of self-control

time out:

removes child from activity temporarily

play therapy:

builds relationship with child, recognizes feelings and reflects them back

dramatic play therapy has many forms:

psychodrama, dramatic play, mutual storytelling, therapeutic games, bibliotherapy, therapeutic drawing

psychodrama:

uses drama techniques to workshop problems and try solutions

dramatic play:

mediums to act out problems/solutions (hand puppets, etc)

mutual storytelling:

child makes up story, tells moral: nurse and child retell story to find a better moral

what does therapeutic drawing help children with?

expressing thoughts, feelings, emotions that the child may not be able to verbally express