Child and Adolescent Psych Flashcards
Cornelia de Lange Syndrome
Chromosome 9q33, lack of pregnancy assoc plasma protein A (PAPPA)
- continuous eyebrow, thin downturning upper lip, microcephaly, short, small hands/feet, small upturned nose, malformed upper limbs, FTT
- severe-profound ID, self injury, stereotypic movements, twirling, language delay, avoids being held
Fragile X
- mutation of FMR1 (CGG repeats > 200)
- most common inherited cause of ID (DS most common genetic)
- prominent forehead, long face, prominent jaw, large ears, short
- male- mod to severe ID, female mild ID/LD
- comorbid ADHD, anxiety, OCD-like sx, ASD, irritability/lability
FASD
-most common preventable cause of ID
-sentinel facial features: short palpebral fissures, smooth/flat philtre, thin upper lip
-neurodevelopmental domains: motor skills, cognition, language, academic achievement, memory, attention, executive function incl hyperactivity and impulse control, affect regulation, adaptive behaviour/social skills/communication
Diagnosis:
FASD with sentinenel facial features- 3 sentinel facial features AND confirmed/unknown prenatal EtOH exposure And evidence of impairment in 3 domains or microcephaly
FASD w/o sentinel facial features: impairment in 3+ neurodevelopment domains AND confirmation of prenatal EtOH at levels known to be associated with neurodevelopment effects
Down Syndrome
- Trisomy 21
- Most common genetic disorder
- short, hypotonia, single transverse palmar crease, epicanthal folds, flat nasal bridge, upward slanting palpebral fissures, small mouth and ears, hearing loss
- frequent otitis media, eye disease , OSA, thyroid disease, neurological disroders
- psychiatric- ASD (<10%), ADHD (>25%), mild-mod ID, stubbornness/oppositional, but severe psychiatric/behavioural problems are rare
- high risk of dementia
Prader-Willi
15q11-13
- most common genetic cause of obesity
- hyperplasia, central obesity, small hands/feet, microorchidism, fair hair, almond shaped eyes
- ID: 5% normal, 60% mild 30% moderate ID
- sensitive to medications
- comorbid: ASD, skin picking ++, OCD like sx, high rates of behavioural problems == aggression, tantrum, emotional lability, mood disorders
Angelman syndrome
-fair hair, blue eyes, wide smile, thin upper lip, ataxic gait, happy, paroxysmal laugh, sleep problems, love music/water
-90% epilepsy
42% ASD
Williams Syndrome
homozygous AD deletion on 7q11.23
- short stature, broad forehead, depressed nasal bridge, wide spaced teeth, elfin like face, sociable
- mild-moderate ID; verbal > visual/spatial,
- medical- renal, CV, thyroid, hypercalcemia, poor vision
- comorbid- anxiety, hyperactivity
Turner Syndrome
- XO- X monosomy
- short stature, low set ears, webbed neck, shield chest, cubits values, gonadal dysgenesis
- NOT an important cause of ID, but may have LDs in math or visual spatial skills
- 25% have ADHD
Velocardiofacial syndrome (DiGeorge)
22q11
- cardiac anomalies, T cell deficits, cleft palate, hypoCa, pharyngeal hypotonia, slender hands/digits
- schizophrenia (25%), LD, ADHD (35-45%) anxiety, BPAD, depression
Lesch-Nyan Syndrome
defect in hypoxanthine quinine phospohribosyl transferase
- ataxia, chorea, kidney failure, gout
- severe self biting, aggression, anxiety
- mild-moderate ID
Cri du Chat SYndrome
AD hemizygous deletion 5p15.2
-congential heart disease, GI anomalies, infantile cat like cry, epicentral folds, slanting palpebral fissures, broad flat nose, migcrognathia
Severe ID
hyperactivity, stereotypies, self-injury
Smith Magenis syndrome
17p11.2 deletion
facial features- broad square face, prominent forehead, deep set up slanting eyes, unibrow, short broad hands, deep hoarse voice, laryngeal abnormabilites
-Moderate ID
comorbid- hyperactive, severe self injury (hand biting, head banging, pulling out nails)
ADHD Comorbidities
40% ADHD and ODD 38% ADHD and mood/anxiety disorders 32% ADHD only 14% ADHD and Conduct disorder 10% ADHD and tics (exam-- ASD no prominent comorbidity)
Oppositional Defiant Disorder
A. Pattern of angry/irritable mood, argumentative/defiant behaviour or vindictiveness lasting at least 6 months with evidence of 4 symptoms and exhibited in interactions with at least one person who is not a sibling:
angry irritable mood: often loses temper, is grouchy or easily annoyed, is often angry or resentful
Argumentative/defiant behaviour: often argues with authority figures/adults, actively defies rules or refuses to comply with requests/rules from authority, deliberately annoys others, blames others for mistakes/misbehaviours
Vindictiveness: spiteful or vindictive at least twice in past 6 months
*under 5 yo: sx should be most days for 6 months
*over 5 yo: weekly sx for 6 months
B. behavioural disturbances causes distress to individual OR to others in immediate social context, or impacts negatively on social, educational, occupational, or other important areas of function
C. behaviours are not due to psychosis, substance use, depression or bipolar disorder. Does not meet criteria for DMDD.
specifiers:
Mild- sx are confined to one setting
moderate- sx in at least 2 settings
severe- sx in 3 or more settings
Conduct disorder
A. Repetitive and persistent pattern of violating the basic rights of others or age appropriate societal norms/rules with 3/15 for the past 12 months, with 1 in the last 6 months:
-Aggression to people and animals: bullies, threatens or intimidates others, initiates physical fights, has a weapon, physically cruel to people, physically cruel to animals, stolen while confronting a victim, forced sexual activity
-Destruction of property: setting fires, destroying other’s property
-Deceitfulness or theft: broken into house/building/car, lies to obtain goods/favors or to avoid obligations, has stolen items of non-trivial value w/o confronting victim
-Serious Violations or Rules: stays out at night < 13yo, run away from home overnight at least 2x while at parents, or once without returning for a lengthy period, truant from school beginning < 13yo
B. Behaviour causes significant impairment in social, academic or occupational function
C. if age 18 or older, antisocial PD criteria not met
specify:
childhood onset- 1 symptom before age 10 yo
adolescent option- no symptoms prior to age 10 yo
unspecified onset– unknown age of onset
with limited prosocial emotions- persistently displays 2 of the following in multiple settings over 12 months: lack of remorse/guilt, callous (lack of empathy), unconcerned re performance, shallow or deficient affect
mild, moderate or severe (based on symptom severity)
