Child & Adolescent

Most of the questions for general psychiatrists are related to identifying, not treating, these disorders, so that is the focus here. All answers come from DSM-IV-

TR or First and Tasman unless otherwise indicated.As of 12Aug08

Written exam

This PowerPoint is unlikely to be relevant for oral adult boards. It does have material that is likely to be on Part I or on the recertification exam.

MR* subtypes

Q. IQ level and definition of MR subtypes?

* Beginning in 2006, it is becoming more and more “correct” to use “Intellectual Disorder,” “ID,” for this disorder.

MR subtypes

Ans. Mental retardation IQ subtypes:

Profound mental retardation: below 20-25

Severe mental retardation: 20-25 to 35-40

Moderate mental retardation: 35-40 to 50-55

Mild mental retardation: 50-55 to 70

[borderline intellectual functioning, a V code, 71-84.]

Down’s

Q. Characteristics of Down’s?

Down’s

Ans.1. IQ averages 50.2. Upward-slanted palpebral fissure3. Low nasal bridge4. Flat nasal bridge5. Small mouth & ears6. Single palmer cease7. Short & wide palms8. Muscle hypotonia

Down’s cause

Q. Most are caused by?

Down’s cause

Ans. Trisomy 21.

Angelman syndrome

Q. Characteristics of Angelman’s syndrome?

Angelman’s syndrome

Ans.

1] severe mental retardation

2] can’t speak but periodic laughter

3] ataxia, motor clumsiness

4] have a large mouth

Angelman syndrome - genetics

Q. What genetic abnormality is associated with Angelman syndrome?

Angelman’s syndrome - genetics

Ans. If you say “chromosome 15,” that should be sufficient. More specifically, deletion of the section 15q11-q13 of the maternal chromosome.

Prader-Willi syndrome

Q. Features of Prader-Willi?

Prader-Willi syndrome

Ans.

1. Mild to moderately retarded.

2. Small hands and feet

3. Muscles are hypotonic

4. Poor feeders as infants and later are vociferous eaters of about anything which leads to obesity.

Prader-Willi syndrome - genetics

Q. Genetics of Prader-Willi syndrome?

Prader-Willi syndrome - genetics

Ans. Chromosome 15 abnormality, deletions, unlike Angelman syndrome, originate from the father.

Fragile X

Q. Characteristics of fragile X?

Fragile X

Ans.

1] usually moderate mental retardation

2] oblong face

3] prominent ears and jaw

4] macroorchidism

Fetal alcohol syndrome

Q. Features of fetal alcohol syndrome?

Fetal alcohol syndrome

Ans. While variable, examiners are likely to expect:

1. Mild to moderate mental retardation

2. Growth retardation

3. Facial dysmorphic features

[“fetal alcohol effects” = 2 of these 3.]

Reading disorder

Q. Basic criteria of Reading Disorder?

Reading disorder

Ans. Reading ability is substantially below what would be expected given pt’s age, schooling, intelligence, and need.*

*”Need” gets to the issue that it has to be problematic in some way.

Mathematical disorder

Q. Criteria for mathematical disorder?

Mathematics disorder

Ans. Mathematical ability is substantially below what would be expected given the pt’s age, schooling, intelligence, and need.

Written expression

Q. Criteria for Disorder of Written Expression?

Written expression

Ans. Written expression is substantially below what is expected of the pt given the age, schooling, intelligence, and need.

Motor Skills Disorder

Q. ‘Criteria for motor skills disorder?

Motor skills disorder

Ans. The pt’s motor skills are substantially below what would be expected of someone of that age, intelligence, training, physical health, and need.

Expressive language

Q. Criteria for expressive language disorder?

Expressive language

Ans. Pt’s expressive language [vocabulary, grammar] are substantially below what would be expected given the age, intelligence, schooling, and need.

Phonological disorder

Q. What is criteria for phonological disorder?

Phonological disorder

Ans. Pt’s ability to make correct speech sounds is substantially below what is expected given the person’s age, intelligence, schooling, and need [e.g., “t” sound for “k” sound].

stuttering

• Q. Basic criteria for stuttering?

Stuttering

Ans. Pt has disturbance in fluency and time pattering of speech that is inappropriate for someone of his/her age and need – and beyond any neurological deficits.

Stuttering - treatment

Q. General treatment for stuttering?

Stuttering - treatment

Ans. Speech therapist, who often attempt to modify speech’s rhythm and speed, and as a temporary manner, encourage prolongation of the speech.

Autism

Q. The three major areas of psychopathology of autism are?

Autism

Ans.

1] Impaired social interaction

2] Impaired communication

3] Stereotyped patterns of behavior.

Autism – social function

Q. DSM expects at least 2 of 4 signs of impaired social functioning. List the 4.

Autism – social functioning

Ans.

1] impaired social behaviors such as eye-to-eye contact

2] failure to develop peer relationships appropriate to age level

3] lack of seeking social interactions

4] lack of social interaction reciprocity

Autism - communications

Q. DSM expects at least one of four communications deficits. Name the four.

Autism -- communications

Ans.1. Delay in development of spoken

language2. If can use spoken language, marked

impairment in ability to sustain a conversation

3. Repetitive or idiosyncratic language4. Lack of varied, make-believe play or

social imitative play.

Autism – stereotyped behaviors

Q. DSM expects at least one of four stereotyped behaviors. Name the four.

Autism – stereotyped behavior

Ans.

1] abnormal intensity or focus of interests.

2] inflexible adherence to rituals

3] repetitive motor mannerisms

4] overly persistent preoccupation with parts of objects.

Rett’s

Q. Rett’s has 8 requirements, 3 of which are “normal.” List the 8.

Rett’s – ans. - 1

Ans.

1. Normal prenatal and perinatal development.

2. Normal psychomotor for first 5 months.

3. Normal head circumference at birth.

4. Deceleration of head growth between 5 months and 48 months.

5. See next slide

Rett’s – ans. - 2

5] loss of previous hand skills, replaced with stereotyped hand movements between 5 and 30 months.

6] loss of social engagement

7] poorly coordinated gait

8] impaired expressive and receptive language.

Rett’s - gender

Q. Gender breakdown with Rett’s?

Rett’s - gender

Ans. Only females.

Childhood Disintegrative Disorder

Q. List the four general requirements of childhood disintegrative disorder.

Childhood Disintegrative Disorder

Ans.

1] OK for first two years.

2] Lost of language, social, bowel/bladder, play or motor skills between ages 2 and 10.

3] Abnormal social interactions, communications, behaviors evolve after 2 year’s old.

4] Not part of pervasive developmental disorders or early onset schizophrenia.

Asperger’s

Q. Criteria for Asperger’s? Lists 4 general findings [findings beyond the DSM’s usual requirements 1] that the Disorder cause significant problems and 2] that the Disorder not be part of another Disorder].

Asperger’s

Ans.

1] Qualitative impairment in social interactions.

2] Stereotyped patterns of behavior.

3] No delay in language skills

4] No delay in cognitive development

ADHD - types

Q. List the three main types of ADHD.

ADHD - types

Ans.

1] combined type

2] predominantly inattentive type

3] predominantly hyperactive type

ADHD - duration

Q. What is the minimum duration of the duration of time, weeks or months, of the psychopathology expected by DSM before you can DX ADHD?

ADHD - duration

Ans. 6 months or more.

ADHD – inattentive

Q. DSM criteria for inattentive type expects 6 of 9 findings. List some of the 9.

ADHD – inattentive ans. - 1

Ans.

1] Fails to pay attention to details

2] Difficulty sustaining a task

3] Does not seem to listen when being spoken to

4] poor on follow through as to a task

5] see next slide

ADHD – inattentive ans. - 2

5] disorganized

6] Avoids sustained mental effort [exceptions are topics of great interest]

7] loses things

8] easily distracted

9] forgetful

ADHD - hyperactive

Q. DSM expects 6 of 9 signs of hyperactivity/impulsivity. List the 9.

ADHD – hyperactive - 1

Ans.

1] fidgety

2] restless

3] runs or climbs excessively

4] noisy

5] see next slide

ADHD – hyperactive - 2

5. Often on the go

6. Excessively talkative

7. Blurts out answers before other party has finished the question

8. Difficulty in awaiting his/her turn

9. Interrupts others

ADHD -- settings

Q. Kid fully meets the signs and symptoms in school, but in no other setting. DX?

ADHS -- settings

Ans. ADHD NOS as it needs to be seen in two distinct settings for ADHD.

ADHD - FDA

Q. FDA approved for ADHD?

ADHD - FDA

Ans.

1] amphetamines

2] atomoxetine

3] chlorpromazine [for hyperactivity]

4] haloperidol [for hyperactivity]

5] methylphenidate

6] pemoline [since withdrawn from market]

Conduct disorder

Q. There are 15 signs of this Disorder. List the four headings of these 15.

Conduct disorder

Ans.

1] Aggression to people and animals

2] Destruction of property

3] Deceitful or theft

4] Serious violation of rules.

Oppositional defiant disorder

Q. DSM list 8 defiant signs expected for 6 months or more. List:

Oppositional defiant disorder

Ans. OFTEN as to each of these:1] loses temper2] argues with adults3] defies complying with adult requests4] deliberately annoys people5] blames others for own misdeeds6] easily annoyed7] angry8] vindictive

Pica

Q. Criteria for Pica?

Pica

Ans. For at least one month, eating nonnutritive substance that is inappropriate to age level and to the person’s culture.

Rumination disorder

Q. Criteria of rumination disorder?

Rumination disorder

Ans. Repeated regurgitation and rechewing for at least one month and not part of 1] a general medical condition, 2] anorexia nervosa o 3] bulimia.

Feeding disorder

Q. Criteria of feeding disorder of infancy or early childhood?

Feeding disorder

Ans. Before age 6 and lasting at least one month: Persistent failure to eat to where there is significant failure to gain or even to lose weight – and not part of general medical condition.

Tourette’s

Q. Criteria for Tourette’s?

Tourette’s

Ans.

1] onset < 18 years old

2] For at least 9 months of a 12 month period, every day the pt has motor or vocal tics.

Tic

Q. What is a tic?

Tic

Ans. Tic = sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.

Tourette’s first signs

Q. What is most frequent first tic?

Tourette’s first sign

Ans. Blinking

Tourette’s - FDA

Q. FDA approved for Tourette’s?

Tourette’s - FDA

Ans.

1] Haloperidol

2] Pimozide

Encopresis

Q. Criteria of encopresis?

Encopresis

Ans.

1. > 4 years old

2. At least once a month for at least 3 months: defecating into inappropriate places.

3. Not part of another disorder or result of taking a substance.

Enuresis

Q. Criteria for enuresis?

Enuresis

Ans.

1. > 5 years old

2. Frequent urinating into clothes or bed

3. Not part of another condition.

Separation anxiety disorder

Q. Three or more of what 8 signs?

What age?

Separation anxiety disorder - 1

Q. < 18 years old. “Excessive” applies all 8 of:

1. Distress when away from home2. Worry about harm befalling significant

attachment3. Worry that an untoward event will lead to

separation from significant attachment.4. Reluctant to go to school5. See next slide

Separation anxiety disorder - 2

5] Fearful to be alone.

6] Fearful to go to sleep without a significant attachment nearby.

7] Nightmares involving theme of separation

8] Somatic complaints in the face of separation.

Selective mutism

Q. Criteria for selective mutism?

Selective mutism

Ans. Despite being able to speak, in specific social situations or places [e.g., school], fails to speak.

Reactive attachment disorder

Q. Criteria of reactive attachment disorder of infancy or early childhood?

Reactive attachment disorder

Ans. Onset before the age of 5: Failure to develop socially in the face of pathogenic care of the child.

[Thus joins PTSD, Acute stress disorder and adjustment disorders in being a reaction to untoward events.]

Williams syndrome

Q. What is Williams syndrome?

Williams Syndrome

Ans. Intellectual limitations, impaired visuospatial construction, language perserveration, and very social.

[Michael Egan presentation, 16Nov07]

VCFS

Q. What is velocardial facial syndrome?

VCFS

Ans.

1] cleft palate

2] cardiac defects

3] learning disabilities and other psychiatric problems [30% psychosis]

4] short statue

[source: Michael Egan presentation, 16Nov07]