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Child and Adolescent Psych (Assessment (kids are in context of parents,…
Child and Adolescent Psych
Development
prefrontal cortex continues to develop until 25
serotonin consistent
NE increase throughout childhood/adolescence
DA receptors decrease after age 3
body fat increases during adolescence - shorter 1/2 life for lipid soluble meds in kids - also faster metabolism (need more frequent/higher doses)
Assessment
kids are in context of parents, family, friends, school
need to interview caregivers, teachers, etc.
maturity, strengths, weaknesses, stressors
use concrete questions, rely on collateral info from parents (less as they get older)
teaming w/ therapists, teachers, counselors, speech/occupational/physical tx
kids less confidentiality than adolescents - exception: safety (suicidality/homicidality, substance use, illegal activities)
always ask about abuse/neglect
- signs - bruises, burns, acting out, clinging, detachment, stealing, etc. - responsibility to report to CPS
Adverse childhood experiences lead to later problems
PTSD
different presentations depending on age/level of cognition
over 6: intrusive s/s, avoidance of stimuli associated w/ event, negative mood/cognition, increased arousal/reactivity
younger than 6: intrusive symptoms (play reenactment), avoidance of stimuli OR negative changes in mood and cognition, increased arousal and reactivity; reexperienced in different ways - can occur when relaxed (adults: during stress), repetitive play or behaviors
changed attitudes about life/people; sense of limited future
Tx: psychotherapy, pharmacotherapy (SSRIs, alpha-adrenergic agonists for hyperarousal, atypical antipsychotics)
Long delays b/w s/s onset and when tx is sought
suicide 3rd leading cause of death 15-24
less than 30% of youth with emotional difficulties ID'd by PCP
Intellectual Disability
confirmed with testing
borderline - IQ 70-85; mild 50-70 (often function in community and have jobs); moderate 35-50 (group homes); severe/profound - require round the clock care
Learning disability: specific deficits in reading, writing, math
Psychotic disorders
distinguishing normal fantasies and developmental delays from psychosis
if depressed and has hallucinations, likely the beginnings of bipolar
pre-adolescence: mild neuro impairment, low intelligence, 1st degree relative w/ schizophrenia
adolescence: more insidious onset
presenting s/s: aud/vis hallucinations, illogical thinking, poverty of content of speech, delusions not common until adolescence (higher level of cognitive development needed)
only make dx when multiple s/s and profound effect on fct
tx: antipsychotics, psychotherapy, school interventions, hospitalization if suicidal or family can't support
Bipolar
mania: rarely euphoric in kids - hyperactivity, aggression, irritability, poor concentration
high energy, some grandiosity, excessive involvement and easily distracted, speak rapidly
risk factors: early onset MDD, family hx, pharm induced (antidepressant) mania
tx: lithium, valproate, lamo, carbamazepine, antipsychotic, antidepressants, therapy