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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.
_____ 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 ____.
_____ 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
Prevelance of ADHD is ___ % in school age children. Hyperactive subtype more common in preschool. 2:1 male - female ratio.
____ 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.
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.
ODD is defined by a recurrent pattern of defiant, disobedient, and hostile behavior toward authority figureslasting at least __ months
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.
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
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.
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.
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
Somatic complaints are common w/ anxiety disorders and exacerbate physical illness._____ is not in the DSM-IV but is a syndrome of growing concern in pediatrics. Threeepisodes of abdominal pain occur over a period of at least 3 months. Episodes are severe enough to limit dailyactivities.
Recurrent Abdominal Pain (RAP)
In children, the challenge is to differentiate phobias from age-appropriate fears.  Common phobias inc: animals, costumed characters, storms & vomiting.  1st line Tx is behavioral intervention____ is the most well-known and studied intervention for children with phobias
Exposure and response prevention (E/RP)
Panic attacks often look different in children aas expressed by crying, temper tantrums, “freezing up,” or clinging behaviors. Children are more likely to present as ___ when faced with feared stimuli
Criteria for children w/ PTSD are currently the same as adults. Children’s response to trauma may be disorganized or agitated behavior, recurrent and intrusive recollections by  repetitive play in trauma themes, nonspecific distressing nightmares, may not “feel as if trauma is recurring” but involved in _______.
traumatic specific reenactments
The best behavioral intervention in children with PTSD is _____.
Trauma-Focused CBT
Some studies in children with PTSD found usefulness with SSRIs,propanolol and ____  (in acutely burned patients)
DSM-IV does not require children to have ___ into their obsessions & compulsions.  It is normal for toddlers and youngchildren to use magical thinking. Rituals are an expected part of the early latency years (5-8years)
____ is the most common evaluation tool in children with OCD. In mild OCD, first line treatment is CBT (with E/RP); in moderate-severe OCD, first line treatment is CBT with SSRI.
Children's Yale-Brown OC Scale (CYBOCS)
Criteria for MDD in children is same as in adults.  But for dysthymia, duration of illness is ___, instead of ___ years.
one, two
In children w/ MDD, predominant sx inc. anxiety, irritability, somatic complaints, temper tantrums,______, school refusal, and behavioral problems
auditory hallucinations
Adolescents w/ MDD will report symptoms of appetite and sleep changes, irritability, ____, suicidal ideationand attempts, and impairment of functioning
Prevalence of MDD is: Preschool age 0.3%, School-age 1–2%, Adolescents __%
Children w/ MDD may present with ____ instead of depressed or sad mood
Criteria for Bipolar d/o same in children. But,  predominant symptoms include irritable or explosive mood and poor psychosocial functioning.  Distinguishing from ADHD include grandiosity,_____, decreased need for sleep, flight of ideas and elated mood
____ is the only SSRI that is FDA approved for the treatment of depression in children and adolescents.
fluoxetine ?
Benzodiazepines in children and adolescents may result in paradoxical ______, so are often avoided
Children metabolize most medications ____ than adults and may require ___ weight-corrected doses
faster, higher
___ is used a s a first line agent in children/adolescents with Bipolar.  A commom side effect in teens is ____.
Lithium, acne
After a therapeutic level is achieved, lithium level, thyroid function tests and _____ should be monitoredevery three to six months
It is recommended that weight, BMI, fasting _____ and fasting lipids be drawn at baseline threemonths and six months after initiating treatment with antipsychotics.
blood glucose
Children may have higher ___ plasma concentrations and lower ___ plasma concentrations with medications.
peak, trough
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