Child

Piaget 4 stages

Stage	Age Range (approx.)	Key Features	Example Milestones
1. Sensorimotor	0–2 years	Learning through sensory experiences and motor actions. Development of object permanence (understanding that objects exist even when unseen).	Peek-a-boo: baby realizes toy still exists when hidden.
2. Preoperational	2–7 years	Symbolic thinking and language development, but thinking is egocentric and intuitive rather than logical.	Child believes the moon follows them; struggles with conservation tasks.
3. Concrete Operational	7–11 years	Logical thinking about concrete events; understanding of conservation, classification, and reversibility.	Realizes that pouring water into a taller glass doesn’t change the amount.
4. Formal Operational	12+ years	Abstract, hypothetical, and systematic thinking emerges. Can reason about possibilities, morality, and future plans.	Can think about algebraic concepts or debate ethical dilemmas.

Ages: remember 7-11
Think terrible twos: egocentric and intuitive
Concrete = conservation and reversibility (engineering)

Erikson’s Development

Stage (Age)	Psychosocial Crisis	Basic Virtue	Key Task/Challenge
1. Infancy (0–1 yr)	Trust vs. Mistrust	Hope	Developing trust in caregivers
2. Early Childhood (1–3 yrs)	Autonomy vs. Shame/Doubt	Will	Developing independence, toilet training, self-control
3. Preschool (3–6 yrs)	Initiative vs. Guilt	Purpose	Initiating activities, asserting control
4. School Age (6–12 yrs)	Industry vs. Inferiority	Competence	Mastery of knowledge & skills, peer comparison
5. Adolescence (12–18 yrs)	Identity vs. Role Confusion	Fidelity	Developing sense of self and personal identity
6. Young Adulthood (18–40 yrs)	Intimacy vs. Isolation	Love	Forming close relationships, commitment
7. Middle Adulthood (40–65 yrs)	Generativity vs. Stagnation	Care	Contributing to society, guiding next generation
8. Late Adulthood (65+ yrs)	Integrity vs. Despair	Wisdom	Reflecting on life, sense of fulfillment vs regret

trust - shame through self awareness - initiative pre school- industry in peers - identity - fucking in young adulthood - then next generation - then reflection

When to treat enuresis with bell and pad / enuresis alarm?

if over 5 years old or functionally impaired

First line OCD in kids

ERP, then SSRIs (Fluoxetine, sertraline, fluvoxamine)

How to manage youth with conduct issues?

Multisystemic approach - Targets home, school, peer, and community systems.

• More effective than individual therapy alone for serious, escalating behavior.

Early red flags for autism

• Red flags <12 months:

  • Doesn’t respond to name

  • Poor eye contact

  • Doesn’t point to objects

• Red flags 12–24 months:

  • Limited pretend play

  • Poor joint attention

How many symptoms of either ADHD category do you need for dx?

6

Age at which you should have symptoms for ADHD

12, if over 17 must have 5 sx

Most common comorbidity for ADHD?

ODD > anxiety > LD > mood > conduct > substance use > tics

Neuroimaging findings in ADHD?

Overall reduced gray matter and brain volume

Environmental risk factors for ADHD

low birth weight, maternal smoking or alcohol, adversity

4 factors that increase adulthood persistence of ADHD?

severity, conduct, MDD, parental MH issues

first line for <5 years or equal ADHD

behavioral

Combine or not for ADHD?

combo most effective

Amount of growth suppresion on average?

2-4 cm

When do you recommend cardiac exam, ECG, and consult Peds cardio with stims? (4)

personal cardiac history, family history, abnormal exam, sudden unexplained death in family

What are the 3 domains of symptoms you must have in autism?

social emotional reciprocity, noverbal comm skills, relationships. And then 2 of restricted patterns or interests, not explained by IDD or GDD

Environmental RF for autism

perinatal complications, advanced paternal age, extreme prematurity, exposure in utero to VPA or other toxins

Gold standard dx tool for autism

ADOS

Treatment of autism

intensive behavioral intervention (ABC), CBT for comorbid

Aggression in autism treatment

Risperidone, abilify (none approved by health canada)

Name differences between youth MDD and adult

Dx: can be irritable mood instead

Increased:

• irritabiltiy

• labile mood

• energy loss

• physical sx

• appetite

• sleep

Less anhedonia and low mood.

MDD in children what is more common

somatic, anxiety, agitation

ADeolescents: hypersomnia, mood reactivity (atypical)

younger onset = greater illness severity overall, increase SI, poor physical health outcomes

2 FDA approved medications for youth MDD

Fluoxetine > 8 yo, escitalopram > 12 yo
sertaline is used.

Combined for MDD?

yes

Most common psychiatric disorder in youth

anxiety disorders

Time course of anxiety disorders

separation - phobia - social - generalized

First line for anxiety in youth

CBT, use drugs for moderate to severe, limited CBT progress, or high impairment (smae 3 meds as depression). Combo again better.

Risk factors for early onset bipolar?

early onset depression, atypical sx, psychosis, rx induced mania, family hx

highest comorbidity with youth bipolar?

ADHD > ODD > anxiety

How to treat childhood mania?

risperidone > lithium / VPA.

Lihtium / Abilify approved for mania or mixed episode in Health canada

Which medication has negative trials in bipolar youth that is used in adults?

quetiapine.

First line depression in bipolar youth?

lursidone

how to treat ADHD and bipolar

Treat bipolar first, cautiously treat ADHD (still use stimulants).

For DMDD, how many episodes of temper outbursts must they have?

3, and mood in between persistently angry or irritable, 12 months total, 2 settings, age onset < 10, no mania.

What happens if youth meets criteria for ODD and DMDD and IED?

DMDD trumps all

What defines very early onset bipolar?

13, early onset is 13-18

How does child SZA differ ?

More visual, less negative symptoms, less catatonia

Only AP approved in health canada for EOS

abilify

Frequency of purges or binges in both binge eating d/o and bulimia

1 x / week for 3 months

How many features must you have for ODD?

4/8.
3 domains: angry, arguing, asshole (vindictive)

trumped by BD, DMDD
6 months duration

Risk factors for ODD

family hx, insecure attachment, harsh parenting, lack of supervision, inconsistent discipline, abuse, low SES

How many ODD develop CD?

1/3

How many symptoms needed for conduct?

3 in 12 months from any category;

(DAPR)

Deceitfullness

Aggresion

Property Damage

Rules violation

Risk factors for CD

Same as ODD plus parental criminality, peer rejection, autonomic slowing fear response

What % of CD develop ASPD?

40. Lack of prosocial emotions is worse prognosis

Treatment of ODD and CD

multisystemic therapy

Treating aggression in ADHD?

stimulants, can try risperidone later

Aggression without ADHD

risperidone

OCD approach in kids

CBT (ERP), if severe can use SSRIs alongside (combo most effective). Clomipramine second line.

Tourette’s criteria

multiple motor and 1 vocal tic, > 1 year symptoms, may wax and wane, peak is 10-12 years old.

Most common comorbidity in tic disorder?

ADHD, then OCD

Provisional tic disorder

< 1 year

Treatment of tics

habit reversal, alpha agonists, riusperidone

Reactive attachment disorder

must 5 or younger, both seeks minimal comfort, and mimnimally responds to comfort when distressed, 2 of emotional symptoms, and 1 pattern of insufficient care

DSED

How PTSD criteria changes less than 6 yo

no negative cognitions in criteria

22q11

Memory tool: George a 22 (deletion) M has a good heart (cardiac issues), but is a little psycho (SZA) because he never drank milk (low Ca).

Lesch Nyhan syndrome

hypoaxanthine guanine …. (HGPRT) get high uric acid

X linked receissive

ID, self mutalation

kidney failure

autism neuroimaging

overall increased brain volume, decreased cerebellar vermis,

atomoxetine weight dosage

0.5 mg / kg

Attachment

Attachment Style	Also Called	Key Features	Typical Childhood Presentation	Adult Relationship Pattern
1. Secure	—	- Child feels safe and supported.- Uses caregiver as a “secure base.”- Comforted by caregiver after distress.	- Cries when caregiver leaves but is easily comforted on return.- Explores environment confidently.	- Comfortable with intimacy and independence.- Trusting, emotionally available.
2. Insecure–Avoidant	Dismissive (in adults)	- Minimizes emotional expression.- Avoids closeness or reliance on others.- Caregiver often distant or rejecting.	- Little distress when caregiver leaves.- Avoids or ignores caregiver on return.	- Values independence, avoids emotional closeness.- May appear detached or self-reliant.
3. Insecure–Ambivalent / Resistant	Preoccupied (in adults)	- Anxiety about caregiver availability.- Seeks closeness but resists comfort.- Caregiver inconsistent or unpredictable.	- Intense distress when caregiver leaves.- Seeks but resists contact on return.	- Craves intimacy but fears rejection.- Emotionally volatile, “clingy.”
4. Disorganized	Fearful–Avoidant (in adults)	- Conflicted behaviors: approach and avoid.- Often linked to trauma, neglect, or fear of caregiver.- Caregiver is source of both comfort and fear.	- Freezing, dazed, contradictory behavior when caregiver returns.	- Desire closeness but fear intimacy.- Difficulty trusting others; may show erratic relationship patterns.

Mahler’s Psychosocial development

Stage	Age Range (approx.)	Description / Key Features
1. Normal Autistic Phase	Birth – 1 month	Infant is focused inward, primarily on internal states and basic needs (sleeping, feeding). Minimal awareness of the external world. Mahler later viewed this as less distinct than originally thought.
2. Normal Symbiotic Phase	1 – 5 months	Infant begins to perceive the caregiver and environment but experiences them as part of a “symbiotic unit” — no clear distinction between self and mother. Sense of oneness and mutual dependency.
3. Separation–Individuation Phase	5 – 36 months	The central phase — the child gradually differentiates from the mother and forms an individual identity. It has four substages:
→ a. Differentiation	5 – 10 months	The infant starts to distinguish self from mother — increased alertness to differences, “hatching” from symbiotic shell. Stranger anxiety may appear.
→ b. Practicing	10 – 16 months	Increased mobility (e.g., crawling, walking) allows exploration away from mother. The child experiences elation at newfound autonomy but still checks back frequently for reassurance (“emotional refueling”).
→ c. Rapprochement	16 – 24 months	Awareness of separateness deepens; child wants independence but also reassurance and closeness — leads to ambivalence and possible temper tantrums. This is a key stage for autonomy and relationship balance.
→ d. Consolidation / Object Constancy	24 – 36 months and beyond	Stable sense of self and others develops. The child internalizes an image of the caregiver as stable and reliable, allowing comfort even in their absence. This supports later emotional regulation and stable relationships.

Fragile X

X chromosome-linked dominant disorder caused by the amplification of a CGG repeat in the 5′ untranslated region of the fragile X mental retardation gene 1 (FMR1). It is the most common inherited cause of intellectual disability, after Down syndrome.

The mnemonic “e**X**tra large testes, jaws, and ears” can be used to remember the features of Fragile X Syndrome. Individuals have very high rates of anxiety disorders (over 80%), attention-deficit/hyperactivity disorder (over 50%), autism (30 to 35%), and mood instability and aggression

Prader willi vs Angelmann

PWS is closely linked to a very similar genetic disorder, Angelman syndrome. In both disorders, region 15q11-13 of chromosome 15 is involved. The loss of the UBE3A gene in this region on the maternal chromosome causes Angelman syndrome, while a loss of a different cluster of genes within the same region on the paternal chromosome causes PWS.

Prader Willi

At birth, individuals will have muscle weakness, failure to feed, and slowed development. Characteristic hyperphagia begins in childhood, and children become at high risk for obesity and type 2 diabetes. Individuals have marked mild to moderate intellectual impairment and behavioural difficulties throughout the lifespan.

Bowlby’s attachment theory

secuire base (“bowl”)

PKU inheritance

autosomal recessive

Freud’s psychosocial

Sigmund Freud

Psychosexual Development

1⃣ Oral (0–1 yr) 2⃣ Anal (1–3 yr) 3⃣ Phallic (3–6 yr) 4⃣ Latency (6–12 yr) 5⃣ Genital (12+ yr)

Infancy → Adolescence

Resolution of unconscious conflicts and regulation of instinctual drives (Id vs. Superego).

Fixation at a stage → adult personality traits (e.g., oral = dependency, anal = control).

Winnicot

good enough mother, holding environment, true vs false self, transitional object

Criteria for separation anxiety disorder

3/8 for 4 weeks

higher risk of panic disorder later

Tuberous sclerosis

genetic disorder that causes noncancerous tumors to grow in various organs like the brain, kidneys, heart, lungs, and skin. It is caused by mutations in the TSC1 or TSC2 genes (autsomal dominant) and leads to symptoms such as seizures, developmental delays, intellectual disabilities, and various skin abnormalities like ash leaf spots and facial angiofibromas

Most common learning disorder

dyslexia - ADHD common