Child & Adolescent Most of the questions for general psychiatrists are related to identifying, not treating, these disorders, so that is the focus here.
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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.]
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 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 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 language 2.If can use spoken language, marked impairment in ability to sustain a conversation 3.Repetitive or idiosyncratic language 4.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?
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 – 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 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 temper 2] argues with adults 3] defies complying with adult requests 4] deliberately annoys people 5] blames others for own misdeeds 6] easily annoyed 7] angry 8] vindictive
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.
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 home 2.Worry about harm befalling significant attachment 3.Worry that an untoward event will lead to separation from significant attachment. 4.Reluctant to go to school 5.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]