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In criteria for autism, patients must exhibit delay or deficit in social interaction and communication with accompanying stereotyped or repetitive behaviors. Onset must occur prior to ____ years of age.
three
Autism diagnosis requires 6 criteria from three domains: 1)Impairment in social interaction, 2)Impairment in communication and play, 3)Restrictive, repetitive, & sterotyped behavior. 2 criteria MUST be from ______ domain.
Impairment in social interaction: Nonverbal behavior, peer relationships, eye contact, sharing / reciprocity
Approximately 60% of those with autism fall into the mental retardation range. ___ are four times more likely to suffer from autism.
Males
_____ Disorder involves symptoms similar to autism but there is no clinically significant delay in language
Asbergers
____ has FDA appproval for the treatment of irritability associated with autistic disorders in children and adolescents, including symptoms of aggression toward others, deliberate self-injuriousness, temper tantrums and quickly changing moods.
risperidone
____ is significant for a normal course of development for at least first two years. By age ten, patient's regress in at least two of the following domains: play, coordination or motor skills, control of bladder, Repetitive behaviors, social interaction, communication
childhood disintegrative disorder (CDD)
____ Disorder is characterized by changes in head circum. (normal until five to six mos), head growth, loss of previously acquired motor skills, social engagement and language expression. Almost always female.
Rett's
Children with Rett's often appear uncoordinated, stereotyped hand wringing, language delay, and can develop _____.
seizures
____ is given when someone does not meet the diagnostic criteria for one of the other pervasive developmental disorders but exhibit significant symptoms.
Pervasive Developmental Disorder NOS
Diagnostic instruments for pervasive developmental disorders include:
ADOS-G (Autism Diagnostic Observational Schedule - Generic), ADI (Autism Diagnostic Interview)
As part of diagnostic workup for a developmental disorder, genetic testing for ____ syndrome should be done, and Wood's Lamp test for _____.
Fragile X, Tuberous sclerosis
The ___ Adaptive Behavior scale assesses overall functioning, if a clinician suspects a PDD.
Vineland
Mental retardation is characterized by IQ below __, impairment in adaptive functioning (ADLs, social skills, communication), nset before age ___.
70, 18 years
Mild mental retardation: 50 to 70, Moderate mental retardation: _____, Severe mental retardation: 20 to 40 Profound MR: IQ of below 20.
35 to 55
Childhood psychosis is less common than adults, linked to greater rate of traumatic birth, and can be assessed by the ___ scale.
Schedule for Affective Disorders and Schizophrenia for School-Age Children
Auditory and visual hallucinations are commonly reported in young children but are actually quite rare, and clinicians must take the child's ______ into account.
developmental stage
5 y/o boy talking to himself in class. Whenasked about his behavior, he states that he is talking to the ghost who has been following him around all day.  Is this an auditory hallucination?
Probably not. It is more likely that this child is talking to an imaginary friend as opposed to having an AH. Some types of magical thinking are dev. appropriate and not pathological in this age group.
Unique features that arecommonly seen in children with psychotic symptoms include poor motor functioning, visual-spatial impairments and ______.
attentional difficulties
Criteria for the diagnosis of ADHD, including thecore symptoms of inattention, hyperactivity, and impulsivity present for at least ___  months that are disruptive andinappropriate for developmental level.
6
Symptoms of ADHD are more frequent and are more ____ than those of a child at the same developmental stage without ADHD.
severe
3 Core Elements of ADHD1) Hyperactivity in excess of expected for dev. stage2) Inattention usually predominates in the ____ setting3) Impulsivity
classroom
Co-morbid conditions are common in two-thirds of children with ADHD. The most common mental disorders diagnosed in children with behavioral disinhibition are:
ODD/Conduct D/O (50%)Anxiety (33%)Depression (6%)
To diagnose ADHD, the mental age (not ___ age) of the child should be taken into consideration.
Chronological.  Important with MR children.
50% of children with ___ have co-morbid ADHD. However, a majority ofchildren with ADHD do not have co-morbid ____.
Tourette's Disorder
To diagnose ADHD, symptoms must be present in __  or more different settings.
two
_____ is the primary tool to diagnose ADHD, as self-reports are less reliable in children age 6-11 and directobservation is often inadequate in the office setting
Parent interview
Diagnosis of adult ADHD must meet full ADHD criteria including symptom presentation prior to age ____.
seven
_____ is easy to use, easy to score, sensitive (>90%) and specific (77-98%).  This is the most helpful instrument used in the assessment of children suspected of having ADHD.
Conner’s Parent and Teacher rating scale
_____ Checklist (i.e., Achenbach) is a broadband scale, and is easy to use and score.  Barkley Home and School Situations Questionnaire can also be useful.
Child Behavior
Rule or 3s in ADHD. 1/3 remit, 1/3 persist fully, 1/3 _________.
persist but to a lesser degree
In ADHD, ____ symptoms tend to persist, whereas ______ often remits.
Inattention, Hyperactivity
In ADHD, ____% show delinquent behavior or antisocial personality on adult follow up, especially males with comorbid conduct disorder
25-40%
Prevelance of ADHD is ___ % in school age children. Hyperactive subtype more common in preschool. 2:1 male - female ratio.
3-7%
____ is the most intensive study to date to evaluate treatment of children with ADHD.
NIMH Multimodal Treatment Study of Children with ADHD (NIMH MTA Study)
NIMH MTA Study,  the expected outcome was that combined treatment would have the most efficacy. However, the____ alone was superior in the case of ADHD with no co-morbidities. Combined treatment had better effect when the child had a co-morbid diagnosis, especially anxiety or depression.
medication
First line tx for ADHD includes stimulants, either _____, _____ or both.
methylphenidate, dextroamphetamine
Adverse effects of stimulants inc. insomnia, anorexia, weight loss, GI upset; effects on growth minimal; dysphoria /  sadness associated with withdrawal; hepatotoxicity (esp. w/ ____); Do not use in children w/ psychosis, sub. abuse, and caution w/ tics.
pemoline
ODD is defined by a recurrent pattern of defiant, disobedient, and hostile behavior toward authority figureslasting at least __ months
six
Criteria for ODD must occur more frequently than would be typically observed in other children at the same age/dev. level. The disturbance in behavior causes significant impairment in functioning and does not occur exclusivelyduring the course of a psychotic or mood disorder. Cannot meet criteria for CD or ____ .
Antisocial Personality Disorder
CD is a repetitive and persistent pattern of behavior in which the basic rights of others or age appropriate societalnorms are violated. Childhood-onset type starts before age ___ and meets full criteria before puberty.
10
Prevalence rates of CD range from 1-10%, M > F.Four main groupings:1) Aggressive conduct that causes/threatens physical harm to people/animals2) Destruction of property (+/- fire setting)3) Deceitfulness or theft4) _____________
Serious violations of rules
Important to distinguish normal age appropriate oppositional behavior from ODD. The behavior should be excessive and persistent. The key distinction between CD and ODD is the violationof _____ and ____ in conduct disorder.
social norms, laws
Anxiety disorders affect up to ___ of children under the age of 18 years
20%
Separation anxiety is a normal part of development that appears at ____ months and usually decreasesafter ___  months.
6 to 7, 30
Criteria for Separation Anxiety Disorder inc. dev. inappropriate and excessive anxiety evidenced by 3 (or more) of : Recurrent excessive distress when separation from home or major figures, Persistent worry about losing, or harm befalling, major figures, Persistent worry that an untoward event will lead to separation, reluctance or refusal to go to school or elsewhere because of fear or separation,....
fearful or reluctant to be alone or without significant adults in other settings, reluctance to go to sleep without being near to figur, Repeated nightmares involving separation, Repeated complaints of physical symptoms when separation from attachment figure, duration of disturbance is at least four weeks, onset is before 18 years.
Early onset SAD is defined when onset occurs before age ___ years.
six
Separation anxiety disorder may be related to the development of ____ in adults
panic disorder
Treatment of SAD  includes cognitive behavior therapy and family management. If medications are used, SSRIs, ___ or benzodiazepines may be considered.
buspirone
Separation anxiety should be distinguished from ____ anxiety, which is a normal part of development. ____ anxiety occurs at four to six months when infants become cautious of ____.  Outright fear of _____ can be observed at 8-12 months.
stranger (s)
Diagnosis of GAD in children inc. fewer somatic complaints criteria, mean age of onset of 8, kids worry and feel paralyzed by their fear, children require excessive reassurance, ___ is the first line of treatment, no medication is FDA approved for GAD in children and adolescents.
behavioral intervention
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