Milestones
3 mo |
Social smile |
6 mo |
Sit up, babble & coo |
9 mo |
Stranger anxiety, pull-up & cruise, pincer grasp |
12 mo |
Walk, First Words |
18 mo |
15+ words |
2 yrs |
Parallel play/ 2 word phrases/ climb stairs (1 foot at a time) |
3 yrs |
3 word phrases, rides tricycle, draws triangle and |
4 yrs |
Draws and |
5 yrs |
Knows name & address/ hops & jumps/ counts to 10+ |
Neuropsych testing
IQ tests |
Verbal IQ= learned facts
Performance IQ=visuo/motor skills |
WAIS-III |
IQ test for adults |
WISC-V |
IQ for age 5-15 |
WPPSI-R |
IQ for pre-schoolers |
Achievement tests |
for school age |
Woodcock -Johnson Psychoed Battery |
reading, math, writing
IDs learning disability |
Wide Range Achievement
WRAT-3 |
screens for deficits in academic skills |
Vineland Adaptive
Behavioral Scales |
evals communication, living skills, social, & motor |
Personality Tests
Objective Tests |
MMPI |
10 scales/ can detect malingering |
Millon Clinical Multiaxial |
"most helpful to confirm personlality do" |
Sctructured Assessments |
Beck Depression |
brief screening in office |
Hamilton Rating scale for depression |
Yale-Brown for OCD |
Y-BOCs |
Projective Tests |
Rorschach |
ink blot |
Thematic Apperception Test |
shown pic & asked to describe scene |
Word- Association |
Jung, free association |
Draw a Person |
representation of self/ kids |
Cognitive Tests
Executive Fxning |
Wisconsin Card Sorting |
abstract reasoning & flexibility
cards sorted thru trial & error |
Trail Making |
concentration & executive fxning*
conect letters & #s in sequence |
Visuomotor |
Bender Gestalt |
Copy designs w/ & w/o visualizing design |
Receptive & Expressive Lang |
Token Test |
comprehension of instructions, grammar & attention |
Boston Naming |
verbal confrontation & naming
Alzheimer's vs depression |
Genetic
Fragile X |
FMR1 |
X-linked...3-5% of ASD pts |
Angelman |
15q11-q13 MATERNAL |
"cocktail personality", hand-flapping, ataxia, seizures |
Prader-Willi |
15q11-q13 PATERNAL |
overeating, OCD, hypothalamic insuff |
Velocardofacial |
22q11.2 |
genetic risk for SCZ |
Rett syndrome |
MECP |
girls, regression, microcephaly, stereotypic hand movements, seizures |
Huntington Dz |
Autosomal Dominant |
CAG repeats |
FKBP5 |
trauma |
glucocorticoid signaling |
SERT/ SLC6A4 |
Alzheimer, MDD, PTSD |
serotonin transport |
ApoE2 |
Alzheimer |
AKT1 |
MJ psychosis |
Risk/Devpt of Substance Use
Imbalance in devpt... |
sub-cortical= bottoms up |
reactive to stimuli/ curvilinear devpt |
pre-frontal= top down |
linear pattern of devpt |
Thus, kid brains |
vulnerable to reward properties of subs |
PRITE topics
Reactive Attachment |
Rapprochement |
Bonding vs. Attachmen |
Object Constancy |
avoidant attachmet |
parenting styles |
permissive |
devpt |
gender identity- age 3 |
parallel play |
object permanence |
peek-a-boo |
preference for human voice |
at birth |
social learning theory of pssychosexual devpt |
maternal modeling & behavior |
strange situtation |
= maternal attachment |
secrets, collecting, organized games |
elementary age |
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Attachment Theorists
Harry Harlow |
1950s |
Contact comfort research |
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infant monkeys preferred |
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cuddly surrogate to |
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wire w/ food |
John Bowlby |
1960s |
Attachment=connection betwn 2 indiv overtime |
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secure base-caregiver is "home base" to explore environment |
Mary Ainsworth |
1970s |
"strange situation" |
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involves introducing stranger |
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to child/mom then observing |
Mary Ainsworth- attachment styles
Secure |
Child distressed composes self |
Anxious-
ambivalent |
Distressed unable to compose |
Anxious- avoidant |
Avoids parentno distress when they leave |
Disorganized |
Lack of attachment behavior |
Reactive Attachment Disorder
-1st presents under 5 yr
-child doesn't seek/respond to comfort
-unexplained irritability/sadness/fear
-limited positive affect
CAUSES
-Social neglect/deprivation
-Freq changes in caregivers (e.g. foster care)
-Care doesn't allow for primary attachment (e.g. institutions w/ low caregiver:child ratio |
Anxiety
Separation, Generalized,
Selective Mutism |
1) Psychotx x 12 wks |
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2) then FLUOXETINE |
Exposure-Based CBT |
OCD in kids/adol |
PCIT=Parent-Child Interactive Tx |
-empirical support for kids w/ anxiety & disruptive bx
-parent wears earpiece while tx observes/directs interactions w/ the child |
SCARED |
Screening tool for Child & Anxiety Related DO |
Tx'ing anxious parents= kids less anxious |
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EEG
Spike & slow wave |
Epileptogenic |
High-amplitude slowing |
Normal in kids |
Global suppression |
Encephalopathy |
Neuro
Upper motor lesion |
BABINSKI,HYPERtonia, spastic |
Lower motor lesions |
Fasciculation/fibrillation, HYPOtonia, |
ADHD
Highly genetic |
71-90% in mono/di-zygotic twin sudies |
Maternal smoking=risk factor |
Response inhibition |
tempero-parietal & inf frontal |
Pre-school |
behav tx= 1st line |
School-age |
Stimulant=1st line |
consider EKG if family hx of cardiac |
Hyperactive/impulsive |
Alpha Agonist |
Inattention |
Atomoxetine |
Depression |
Buproprion |
Autism Spectrum Disorder
Def in Social & Comm |
+ Restricted, repetitive interests |
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-hearing test |
| |
-screen for Fragile-X |
Tools to dx & screen: |
Autism Diagnostic Observation Scale |
ADOS-2= gold standard for dx |
CHAT- Checklist for Autism in Toddler |
peds use for screeening |
Tx= ABA |
Applied Behavioral Analysis |
| |
considered gold standard |
Social-Pragmatic
Communication Disorder |
= social & comm deficits
w/o restricted interest |
Bipolar DO in kids
Same criteria as adults |
1-2% prevalence |
ADHD |
50% co-morbidity |
ASD |
20% co-morbidity |
Twin Studies |
60-90% variance |
Mania in high-risk off-spring |
2-7% |
FDA tx for BPAD |
Olanzapine |
13+ |
Lithium |
12+ |
Risperidone |
10+ |
Aripiprazole |
10+ |
Quetiapine |
10+ |
TEAM (Tx of Early Age Mania Study) |
Atypical AP |
68.5% |
Divalproex |
40%...but not FDA approved for mania in kids |
Li response |
35.6% |
Disruptive Mood Dysregulation Disorder- DMDD
Criteria: |
severe temper outbursts |
| |
3x/ wk .... 2/3 settings |
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irritable/angry mood in between |
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onset before 10 yo |
Can't co-exist w/ ODD, Int Explosive or Bipolar |
Tx targets symptoms of aggression/irritability |
MDD in kids
Same criteria as adults |
May see more irritability, anger & somatic sx |
Rating Scales: |
PHQ-9, CES-DC, CDI |
TADS (Tx of Adol Depression Study) |
CBT+SSRI>CBT>SSRI |
SSRI |
Black box warning= re increased risk of SI |
TORDIA(Tx of Res Dep in Adol) |
failed 1st SSRI
switched to 2nd SSRI
vs Venlafaxine (VFL)
vs CBT+SSRI
vs CBT+VFL |
TORDIA outcome |
CBT+med= Best outcome
2nd SSRI=VFL
VFL= increased SE |
CBT+Interpersonal TX (IPT) |
Best evidence from RCTs in adol |
FDA black box SSRI/SNRIs |
increased risk of SI in adol & young adults |
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