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Flashcards in Pediatric Psychiatry Deck (56)
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Impact on Primary Care: Advantage/Potential Roles of Primary Care Clinicians?

1. Prevention
2. Early identification / screening
3. Early intervention / engagement
4. Referral / collaborative care (with MH professionals)
5. Monitoring progress in care
6. Care coordination


Barriers to Enhancing MH Care in Primary Care Settings


1. Ambivalence / variability
2. Discomfort
3. Time constraints
4. Poor payment
5. Variable access to MH specialty resources
6. Administrative barriers to MH services
7. Limited information exchange with MH specialists
8. Stigma


Strategies: What Works for Families
-At the individual family level what can we educate on?

1. Trusting relationship
2. Understand emotional turmoil
3. Teach how to access MH services
4. Provide resources
5. Family advocacy organization


Parenting a Child with a Disability

1. Seek the assistance of other parents

2. Know that you are not alone

3. Rely on positive resources in your life (e.g., church, counselors)

4. Take it one day at a time

5. Seek information (e.g., internet, support groups, library)

6. Do not be intimidated

7. Maintain a positive outlook

8. Find programs for your child

9. Take care of yourself

10. Keep daily routines as normal as possible

11. Most importantly, keep your sense of humor


Approach to the Adolescent
Rules of confidentiality?

1. outline the rules first
2. not absolute
3. ask them to explain confidentiality
4. alone time with patient


HEADSSS assessment?
Describe each

1. HOME: How are things going at home? Who lives at home? Do you get along with the other people in your house?

2. EDUCATION: What school do you attend? How are your grades? What grades do you think you should be getting? How many days of school have you missed?

3. ACTIVITIES: What do you do after school? Do you have a job? Who are your best friends?

4. DRUGS: Do any of your friends smoke? Drink alcohol? Use drugs? Have you ever tried...? Does anyone in your family have trouble with alcohol? Drugs?

5. SEX: Do you have a boyfriend/girlfriend? How long have you been going out? Are you getting along? Have you ever had sex? When you have sex, is it with men, women or both? Do you know how to protect yourself from pregnancy, STIs, and AIDS?

6. SUICIDE/DEPRESSION: How have your moods been? Do you ever feel down or depressed? Have you ever felt like hurting yourself or suicide? Do you know anyone who has committed suicide?

7. SAFETY: Are things safe for you at home? At school? In your neighborhood? Has anyone ever hurt you? Physically? Sexually?


Definition of intellectual disability (ID)?

is a neurodevelopmental disorder with multiple etiologies that encompass a broad spectrum of functioning, disability, and strengths


Definition of Global developmental delay (GDD) ?

the term applied to children under 5 who fail to meet expected developmental milestones and have significant impairments in several areas of functioning.


1. What two components make up intellectual disability?

2. Clinical features of intellectual disability? 3

1. Two components include
-Adaptive behavior
-Intellectual functioning

2. Clinical features
-Parent concerns
-Younger sibling overtake an older child
-Fails to meet expected developmental milestones


Caues of Intellectual Disability? 5

1. Genetic in more than 50% (down syndrome MOST common)
2. Embryonic development
3. prenatal causes include congenital infections, congenital hypothyroidism, and teratogens including alcohol, lead, and valproate
4. Environmental deprivation
5. Hereditary abnormalities


Intellectual Disability
Screening tools?

1. Ages and Stages Questionnaires (ASQ)

2. Bayley Infant Neurodevelopmental Screener (BINS)

3. Brigance Screens-II

4. Infant-Toddler Checklist for Language and Communications

5. Parent’s Evaluation of Developmental Status (PEDS)


DSM V Criteria for intellectual disability:
3 main
11 areas

1. IQ ≈ 70 or below (deficits in intellectual fx)

2. Concurrent deficits or impairments in adaptive functioning in at least 2 of the following areas:
-home living
-social/interpersonal skills
-use of community resources
-functional academic skills

3. Onset before age 18 years


Treatment for intellectual disability? 3

Early intervention program

Multidisciplinary team support

Family support and counseling


Typical learning difficulties include (what are the top three)?

1. Dyslexia
2. Dysgraphia
3. Dyscalculia
4. Ageometria (ageometresia)
5. Anarithmia
6. Anomic aphasia (dysnomia)


1. More often found in what gender?
2. Genetic?
3. Often occurs in people with what?

1. More often found in boys than girls

2. Tend to run in families

3. Often occurs in people with ADHD


Dyslexia signs and symptoms?

1. Delayed language production
2. Speech articulation difficulties
3. Difficulties remembering the names of letters, numbers, and colors
4. Reversals or visual confusion can occur
-d becomes b, m becomes w, h becomes n, was becomes saw, on becomes no


Individuals with dyslexia commonly have problems:

1. Processing and understanding what they hear
2. They may have difficulty comprehending rapid instructions
3. Following more than one command at a time
4. Remembering the sequence of things
5. Reversals of letters (b for d)
6. Reversal of words (saw for was) are typical among individuals who have dyslexia
7. Individuals with dyslexia may also try to read from right to left
8. May fail to see (and occasionally to hear) similarities and differences in letters and words
9. May not recognize the spacing that organizes letters into separate words
10. May be unable to sound out the pronunciation of an unfamiliar word


Dyslexia: Screening and diagnosis?

There's no single test for dyslexia.
Diagnosis involves an evaluation of:
1. medical
2. cognitive
3. sensory processing
4. educational
5. psychological factors

6. Vision, hearing, and neurologic examinations
Other evaluations include:
7. Psychological assessment


Treatment for dyslexia?

There's no known way to correct the underlying brain malfunction that causes dyslexia.

Treatment is by remedial education.

Psychological testing will help identify the areas pts. need to work on.

May use techniques involving hearing, vision and touch to improve reading skills. Helping an individual to use several senses to learn — for example, by listening to a taped lesson and tracing with a finger the shape of the words spoken — can help them process the information.

The most important teaching approach may be frequent instruction by a reading specialist who uses these multisensory methods of teaching!!!!!


Dyslexia Prognosis?

Tutoring may involve several individual or small-group sessions each week
Progress may be slow

1. Milder forms of dyslexia often eventually learn to read well enough to succeed in school.

2. Severe dyslexia may never be able to read well and may need training for vocations that don't require strong reading skills.


Dyscalculia is what?

(Math disability)
The word "dyscalculia" means difficulty performing math calculations.


signs and symtpoms?

Signs and Symptoms
Difficulty understanding
1. Number lines
2. Carrying and borrowing numbers
3. Word problems



1. Allow use of fingers and scratch paper
2. Use diagrams and draw math concepts
3. Provide peer assistance
4. Suggest use of graph paper


Dysgraphia is what?

(writing disability)-a learning disability resulting from the difficulty in expressing thoughts in writing


Difficulties with what tasks?

1. Handwriting (fine motor or graphomotor)

2. Grammar and syntax

3. Formulating, expressing, and organizing ideas in writing

4. Spelling "encoding," (which is the ability to use sound-letter relationships effectively)


Dysgraphia results in what types of problems?

1. resultss in irregular letter sizes and shapes, a mixture of upper and lower case letters or print and cursive letters.

2. Contributes to difficulties in using writing as a communication tool

3. Causes writing fatigue

4. Interferes with communication iof ideas in writing

5. results in unfinished letters and letter inconsistencies


Dysgraphia Dx?

Treatment? 3

1. Diagnosed
by licensed psychologist who specialize in learning disabilities

2. Treatment


Elimination Disorders? 2
Describe them

Repeated voiding of urine during the day or night into bed or clothes

Repeated passage of feces into inappropriate places


1. Normally controlled by what age?

2. common causes? 3

1. Usual control ages 4-5
-Primary or Secondary

2. Common causes
-Failure to arouse
-Increase production of urine while asleep
-Overactive bladder


1. Psychiatry/Psychology symtpoms? 2

2. Daytime occurance? 2

1. Stressors
2. Become withdrawn and anxious

Daytime incontinence
1. Bladder overactive
2. Constipation