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Child & Adolescent. Most of the questions for general psychiatrists are related to identifying, not treating, these disorders, so that is the focus here. All answers come from DSM-IV-TR or First and Tasman unless otherwise indicated. As of 12Aug08. Written exam.

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child adolescent

Child & Adolescent

Most of the questions for general psychiatrists are related to identifying, not treating, these disorders, so that is the focus here. All answers come from DSM-IV-TR or First and Tasman unless otherwise indicated.

As of 12Aug08

written exam
Written exam

This PowerPoint is unlikely to be relevant for oral adult boards. It does have material that is likely to be on Part I or on the recertification exam.

mr subtypes
MR* subtypes

Q. IQ level and definition of MR subtypes?

* Beginning in 2006, it is becoming more and more “correct” to use “Intellectual Disorder,” “ID,” for this disorder.

mr subtypes1
MR subtypes

Ans. Mental retardation IQ subtypes:

Profound mental retardation: below 20-25

Severe mental retardation: 20-25 to 35-40

Moderate mental retardation: 35-40 to 50-55

Mild mental retardation: 50-55 to 70

[borderline intellectual functioning, a V code, 71-84.]

down s

Q. Characteristics of Down’s?

down s1


  • IQ averages 50.
  • Upward-slanted palpebral fissure
  • Low nasal bridge
  • Flat nasal bridge
  • Small mouth & ears
  • Single palmer cease
  • Short & wide palms
  • Muscle hypotonia
down s cause
Down’s cause

Q. Most are caused by?

down s cause1
Down’s cause

Ans. Trisomy 21.

angelman syndrome
Angelman syndrome

Q. Characteristics of Angelman’s syndrome?

angelman s syndrome
Angelman’s syndrome


1] severe mental retardation

2] can’t speak but periodic laughter

3] ataxia, motor clumsiness

4] have a large mouth

angelman syndrome genetics
Angelman syndrome - genetics

Q. What genetic abnormality is associated with Angelman syndrome?

angelman s syndrome genetics
Angelman’s syndrome - genetics

Ans. If you say “chromosome 15,” that should be sufficient. More specifically, deletion of the section 15q11-q13 of the maternal chromosome.

prader willi syndrome
Prader-Willi syndrome

Q. Features of Prader-Willi?

prader willi syndrome1
Prader-Willi syndrome


  • Mild to moderately retarded.
  • Small hands and feet
  • Muscles are hypotonic
  • Poor feeders as infants and later are vociferous eaters of about anything which leads to obesity.
prader willi syndrome genetics
Prader-Willi syndrome - genetics

Q. Genetics of Prader-Willi syndrome?

prader willi syndrome genetics1
Prader-Willi syndrome - genetics

Ans. Chromosome 15 abnormality, deletions, unlike Angelman syndrome, originate from the father.

fragile x
Fragile X

Q. Characteristics of fragile X?

fragile x1
Fragile X


1] usually moderate mental retardation

2] oblong face

3] prominent ears and jaw

4] macroorchidism

fetal alcohol syndrome
Fetal alcohol syndrome

Q. Features of fetal alcohol syndrome?

fetal alcohol syndrome1
Fetal alcohol syndrome

Ans. While variable, examiners are likely to expect:

  • Mild to moderate mental retardation
  • Growth retardation
  • Facial dysmorphic features

[“fetal alcohol effects” = 2 of these 3.]

reading disorder
Reading disorder

Q. Basic criteria of Reading Disorder?

reading disorder1
Reading disorder

Ans. Reading ability is substantially below what would be expected given pt’s age, schooling, intelligence, and need.*

*”Need” gets to the issue that it has to be problematic in some way.

mathematical disorder
Mathematical disorder

Q. Criteria for mathematical disorder?

mathematics disorder
Mathematics disorder

Ans. Mathematical ability is substantially below what would be expected given the pt’s age, schooling, intelligence, and need.

written expression
Written expression

Q. Criteria for Disorder of Written Expression?

written expression1
Written expression

Ans. Written expression is substantially below what is expected of the pt given the age, schooling, intelligence, and need.

motor skills disorder
Motor Skills Disorder

Q. ‘Criteria for motor skills disorder?

motor skills disorder1
Motor skills disorder

Ans. The pt’s motor skills are substantially below what would be expected of someone of that age, intelligence, training, physical health, and need.

expressive language
Expressive language

Q. Criteria for expressive language disorder?

expressive language1
Expressive language

Ans. Pt’s expressive language [vocabulary, grammar] are substantially below what would be expected given the age, intelligence, schooling, and need.

phonological disorder
Phonological disorder

Q. What is criteria for phonological disorder?

phonological disorder1
Phonological disorder

Ans. Pt’s ability to make correct speech sounds is substantially below what is expected given the person’s age, intelligence, schooling, and need [e.g., “t” sound for “k” sound].

  • Q. Basic criteria for stuttering?

Ans. Pt has disturbance in fluency and time pattering of speech that is inappropriate for someone of his/her age and need – and beyond any neurological deficits.

stuttering treatment
Stuttering - treatment

Q. General treatment for stuttering?

stuttering treatment1
Stuttering - treatment

Ans. Speech therapist, who often attempt to modify speech’s rhythm and speed, and as a temporary manner, encourage prolongation of the speech.


Q. The three major areas of psychopathology of autism are?



1] Impaired social interaction

2] Impaired communication

3] Stereotyped patterns of behavior.

autism social function
Autism – social function

Q. DSM expects at least 2 of 4 signs of impaired social functioning. List the 4.

autism social functioning
Autism – social functioning


1] impaired social behaviors such as eye-to-eye contact

2] failure to develop peer relationships appropriate to age level

3] lack of seeking social interactions

4] lack of social interaction reciprocity

autism communications
Autism - communications

Q. DSM expects at least one of four communications deficits. Name the four.

autism communications1
Autism -- communications


  • Delay in development of spoken language
  • If can use spoken language, marked impairment in ability to sustain a conversation
  • Repetitive or idiosyncratic language
  • Lack of varied, make-believe play or social imitative play.
autism stereotyped behaviors
Autism – stereotyped behaviors

Q. DSM expects at least one of four stereotyped behaviors. Name the four.

autism stereotyped behavior
Autism – stereotyped behavior


1] abnormal intensity or focus of interests.

2] inflexible adherence to rituals

3] repetitive motor mannerisms

4] overly persistent preoccupation with parts of objects.

rett s

Q. Rett’s has 8 requirements, 3 of which are “normal.” List the 8.

rett s ans 1
Rett’s – ans. - 1


  • Normal prenatal and perinatal development.
  • Normal psychomotor for first 5 months.
  • Normal head circumference at birth.
  • Deceleration of head growth between 5 months and 48 months.
  • See next slide
rett s ans 2
Rett’s – ans. - 2

5] loss of previous hand skills, replaced with stereotyped hand movements between 5 and 30 months.

6] loss of social engagement

7] poorly coordinated gait

8] impaired expressive and receptive language.

rett s gender
Rett’s - gender

Q. Gender breakdown with Rett’s?

rett s gender1
Rett’s - gender

Ans. Only females.

childhood disintegrative disorder
Childhood Disintegrative Disorder

Q. List the four general requirements of childhood disintegrative disorder.

childhood disintegrative disorder1
Childhood Disintegrative Disorder


1] OK for first two years.

2] Lost of language, social, bowel/bladder, play or motor skills between ages 2 and 10.

3] Abnormal social interactions, communications, behaviors evolve after 2 year’s old.

4] Not part of pervasive developmental disorders or early onset schizophrenia.

asperger s

Q. Criteria for Asperger’s? Lists 4 general findings [findings beyond the DSM’s usual requirements 1] that the Disorder cause significant problems and 2] that the Disorder not be part of another Disorder].

asperger s1


1] Qualitative impairment in social interactions.

2] Stereotyped patterns of behavior.

3] No delay in language skills

4] No delay in cognitive development

adhd types
ADHD - types

Q. List the three main types of ADHD.

adhd types1
ADHD - types


1] combined type

2] predominantly inattentive type

3] predominantly hyperactive type

adhd duration
ADHD - duration

Q. What is the minimum duration of the duration of time, weeks or months, of the psychopathology expected by DSM before you can DX ADHD?

adhd duration1
ADHD - duration

Ans. 6 months or more.

adhd inattentive
ADHD – inattentive

Q. DSM criteria for inattentive type expects 6 of 9 findings. List some of the 9.

adhd inattentive ans 1
ADHD – inattentive ans. - 1


1] Fails to pay attention to details

2] Difficulty sustaining a task

3] Does not seem to listen when being spoken to

4] poor on follow through as to a task

5] see next slide

adhd inattentive ans 2
ADHD – inattentive ans. - 2

5] disorganized

6] Avoids sustained mental effort [exceptions are topics of great interest]

7] loses things

8] easily distracted

9] forgetful

adhd hyperactive
ADHD - hyperactive

Q. DSM expects 6 of 9 signs of hyperactivity/impulsivity. List the 9.

adhd hyperactive 1
ADHD – hyperactive - 1


1] fidgety

2] restless

3] runs or climbs excessively

4] noisy

5] see next slide

adhd hyperactive 2
ADHD – hyperactive - 2

5. Often on the go

6. Excessively talkative

7. Blurts out answers before other party has finished the question

8. Difficulty in awaiting his/her turn

9. Interrupts others

adhd settings
ADHD -- settings

Q. Kid fully meets the signs and symptoms in school, but in no other setting. DX?

adhs settings
ADHS -- settings

Ans. ADHD NOS as it needs to be seen in two distinct settings for ADHD.

adhd fda

Q. FDA approved for ADHD?

adhd fda1


1] amphetamines

2] atomoxetine

3] chlorpromazine [for hyperactivity]

4] haloperidol [for hyperactivity]

5] methylphenidate

6] pemoline [since withdrawn from market]

conduct disorder
Conduct disorder

Q. There are 15 signs of this Disorder. List the four headings of these 15.

conduct disorder1
Conduct disorder


1] Aggression to people and animals

2] Destruction of property

3] Deceitful or theft

4] Serious violation of rules.

oppositional defiant disorder
Oppositional defiant disorder

Q. DSM list 8 defiant signs expected for 6 months or more. List:

oppositional defiant disorder1
Oppositional defiant disorder

Ans. OFTEN as to each of these:

1] loses temper

2] argues with adults

3] defies complying with adult requests

4] deliberately annoys people

5] blames others for own misdeeds

6] easily annoyed

7] angry

8] vindictive


Q. Criteria for Pica?


Ans. For at least one month, eating nonnutritive substance that is inappropriate to age level and to the person’s culture.

rumination disorder
Rumination disorder

Q. Criteria of rumination disorder?

rumination disorder1
Rumination disorder

Ans. Repeated regurgitation and rechewing for at least one month and not part of 1] a general medical condition, 2] anorexia nervosa o 3] bulimia.

feeding disorder
Feeding disorder

Q. Criteria of feeding disorder of infancy or early childhood?

feeding disorder1
Feeding disorder

Ans. Before age 6 and lasting at least one month: Persistent failure to eat to where there is significant failure to gain or even to lose weight – and not part of general medical condition.

tourette s

Q. Criteria for Tourette’s?

tourette s1


1] onset < 18 years old

2] For at least 9 months of a 12 month period, every day the pt has motor or vocal tics.


Q. What is a tic?


Ans. Tic = sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.

tourette s first signs
Tourette’s first signs

Q. What is most frequent first tic?

tourette s fda
Tourette’s - FDA

Q. FDA approved for Tourette’s?

tourette s fda1
Tourette’s - FDA


1] Haloperidol

2] Pimozide


Q. Criteria of encopresis?



  • > 4 years old
  • At least once a month for at least 3 months: defecating into inappropriate places.
  • Not part of another disorder or result of taking a substance.

Q. Criteria for enuresis?



  • > 5 years old
  • Frequent urinating into clothes or bed
  • Not part of another condition.
separation anxiety disorder
Separation anxiety disorder

Q. Three or more of what 8 signs?

What age?

separation anxiety disorder 1
Separation anxiety disorder - 1

Q. < 18 years old. “Excessive” applies all 8 of:

  • Distress when away from home
  • Worry about harm befalling significant attachment
  • Worry that an untoward event will lead to separation from significant attachment.
  • Reluctant to go to school
  • See next slide
separation anxiety disorder 2
Separation anxiety disorder - 2

5] Fearful to be alone.

6] Fearful to go to sleep without a significant attachment nearby.

7] Nightmares involving theme of separation

8] Somatic complaints in the face of separation.

selective mutism
Selective mutism

Q. Criteria for selective mutism?

selective mutism1
Selective mutism

Ans. Despite being able to speak, in specific social situations or places [e.g., school], fails to speak.

reactive attachment disorder
Reactive attachment disorder

Q. Criteria of reactive attachment disorder of infancy or early childhood?

reactive attachment disorder1
Reactive attachment disorder

Ans. Onset before the age of 5: Failure to develop socially in the face of pathogenic care of the child.

[Thus joins PTSD, Acute stress disorder and adjustment disorders in being a reaction to untoward events.]

williams syndrome
Williams syndrome

Q. What is Williams syndrome?

williams syndrome1
Williams Syndrome

Ans. Intellectual limitations, impaired visuospatial construction, language perserveration, and very social.

[Michael Egan presentation, 16Nov07]


Q. What is velocardial facial syndrome?



1] cleft palate

2] cardiac defects

3] learning disabilities and other psychiatric problems [30% psychosis]

4] short statue

[source: Michael Egan presentation, 16Nov07]