STUDY GUIDE TO CHILD AND ADOLES- CENT PSYCHIATRY A Companion to Dulcan’s Textbook of Child and Adolescent Psychiatry

Contents Preface ..............................................................................................................................xv Questions C H A P T E R 1 Assessing Infants and Toddlers.......................................................................................... 1 C H A P T E R 2 Assessing the Preschool-Age Child.................................................................................... 2 C H A P T E R 3 Assessing the Elementary School–Age Child ..................................................................... 4 C H A P T E R 4 Assessing Adolescents ....................................................................................................... 5 C H A P T E R 5 Classification of Psychiatric Disorders ................................................................................ 7 C H A P T E R 6 The Process of Assessment and Diagnosis........................................................................ 9 C H A P T E R 7 Diagnostic Interviews........................................................................................................ 11 C H A P T E R 8 Rating Scales.................................................................................................................... 13 C H A P T E R 9 Pediatric Evaluation and Laboratory Testing .................................................................... 14 C H A P T E R 1 0 Neurological Examination, Electroencephalography, and Neuroimaging.......................... 16 C H A P T E R 1 1 Psychological and Neuropsychological Testing ................................................................ 18 C H A P T E R 1 2 Intellectual Disability (Mental Retardation)........................................................................ 20 C H A P T E R 1 3 4 | Autism Spectrum Disorders .............................................................................................. 22 C H A P T E R 1 4 Developmental Disorders of Learning, Communication, and Motor Skills......................... 23 C H A P T E R 1 5 Attention-Deficit/Hyperactivity Disorder............................................................................. 25 C H A P T E R 1 6 Oppositional Defiant Disorder and Conduct Disorder........................................................ 27 C H A P T E R 1 7 Substance Abuse and Addictions ..................................................................................... 28 C H A P T E R 1 8 Depression and Dysthymia ............................................................................................... 30 C H A P T E R 1 9 Bipolar Disorder................................................................................................................ 32 C H A P T E R 2 0 Generalized Anxiety Disorder, Specific Phobia, Panic Disorder, Social Phobia, and Selective Mutism ................................................................................ 34 C H A P T E R 2 1 Separation Anxiety Disorder and School Refusal ............................................................. 36 C H A P T E R 2 2 Posttraumatic Stress Disorder .......................................................................................... 38 C H A P T E R 2 3 Obsessive-Compulsive Disorder....................................................................................... 39 C H A P T E R 2 4 Early-Onset Schizophrenia ............................................................................................... 41 C H A P T E R 2 5 Obesity.............................................................................................................................. 43 C H A P T E R 2 6 Anorexia Nervosa and Bulimia Nervosa............................................................................ 45 C H A P T E R 2 7 Tic Disorders..................................................................................................................... 47 C H A P T E R 2 8 Elimination Disorders........................................................................................................ 48 C H A P T E R 2 9 4 | Sleep Disorders ................................................................................................................ 49 C H A P T E R 3 0 Evidence-Based Practices ................................................................................................ 51 C H A P T E R 3 1 Child Abuse and Neglect .................................................................................................. 52 C H A P T E R 3 2 HIV and AIDS ................................................................................................................... 53 C H A P T E R 3 3 Bereavement and Traumatic Grief.................................................................................... 54 C H A P T E R 3 4 Ethnic, Cultural, and Religious Issues............................................................................... 56 C H A P T E R 3 5 Youth Suicide.................................................................................................................... 58 C H A P T E R 3 6 Gender Identity and Sexual Orientation ............................................................................ 60 C H A P T E R 3 7 Aggression and Violence .................................................................................................. 62 C H A P T E R 3 8 Genetics: Fundamentals Relevant to Child and Adolescent Psychiatry ............................ 64 C H A P T E R 3 9 Psychiatric Emergencies................................................................................................... 66 C H A P T E R 4 0 Family Transitions: Challenges and Resilience................................................................. 68 C H A P T E R 4 1 Psychiatric Aspects of Chronic Physical Disorders ........................................................... 70 C H A P T E R 4 2 Children of Parents With Psychiatric and Substance Abuse Disorders............................. 72 6 | C H A P T E R 4 3 Legal and Ethical Issues................................................................................................... 74 C H A P T E R 4 4 Telepsychiatry................................................................................................................... 75 C H A P T E R 4 5 Principles of Psychopharmacology ................................................................................... 76 C H A P T E R 4 6 Medications Used for Attention-Deficit/Hyperactivity Disorder .......................................... 78 C H A P T E R 4 7 Antidepressants ................................................................................................................ 79 C H A P T E R 4 8 Mood Stabilizers ............................................................................................................... 81 C H A P T E R 4 9 Antipsychotic Medications................................................................................................. 83 C H A P T E R 5 0 Alpha-Adrenergics, Beta-Blockers, Benzodiazepines, Buspirone, and Desmopressin ..... 85 C H A P T E R 5 1 Medications Used for Sleep .............................................................................................. 87 C H A P T E R 5 2 Electroconvulsive Therapy, Transcranial Magnetic Stimulation, and Deep Brain Stimulation .............................................................................................. 88 C H A P T E R 5 3 Individual Psychotherapy .................................................................................................. 90 C H A P T E R 5 4 Parent Counseling, Psychoeducation, and Parent Support Groups ................................. 91 C H A P T E R 5 5 Behavioral Parent Training ............................................................................................... 93 C H A P T E R 5 6 Family Therapy ................................................................................................................. 94 C H A P T E R 5 7 Interpersonal Psychotherapy for Depressed Adolescents ................................................ 95 C H A P T E R 5 8 Cognitive-Behavioral Treatment for Anxiety Disorders...................................................... 97 C H A P T E R 5 9 Cognitive-Behavioral Therapy for Depression................................................................... 99 C H A P T E R 6 0 Motivational Interviewing................................................................................................. 101 C H A P T E R 6 1 Systems of Care, Wraparound Services, and Home-Based Services............................. 102 C H A P T E R 6 2 Milieu Treatment: Inpatient, Partial Hospitalization, and Residential Programs .............. 104 C H A P T E R 6 3 School-Based Interventions ............................................................................................ 106 C H A P T E R 6 4 Collaborating With Primary Care..................................................................................... 108 C H A P T E R 6 5 Juvenile Justice .............................................................................................................. 110 Answer Guide C H A P T E R 1 Assessing Infants and Toddlers...................................................................................... 111 C H A P T E R 2 Assessing the Preschool-Age Child................................................................................ 114 C H A P T E R 3 Assessing the Elementary School–Age Child ................................................................. 118 C H A P T E R 4 Assessing Adolescents ................................................................................................... 121 C H A P T E R 5 Classification of Psychiatric Disorders ............................................................................ 125 C H A P T E R 6 The Process of Assessment and Diagnosis.................................................................... 128 8 | C H A P T E R 7 Diagnostic Interviews...................................................................................................... 131 C H A P T E R 8 Rating Scales.................................................................................................................. 134 C H A P T E R 9 Pediatric Evaluation and Laboratory Testing .................................................................. 138 C H A P T E R 1 0 Neurological Examination, Electroencephalography, and Neuroimaging........................ 143 C H A P T E R 1 1 Psychological and Neuropsychological Testing .............................................................. 146 C H A P T E R 1 2 Intellectual Disability (Mental Retardation)...................................................................... 149 C H A P T E R 1 3 Autism Spectrum Disorders ............................................................................................ 153 C H A P T E R 1 4 Developmental Disorders of Learning, Communication, and Motor Skills....................... 157 C H A P T E R 1 5 Attention-Deficit/Hyperactivity Disorder........................................................................... 160 C H A P T E R 1 6 Oppositional Defiant Disorder and Conduct Disorder ..................................................... 165 C H A P T E R 1 7 Substance Abuse and Addictions ................................................................................... 168 C H A P T E R 1 8 Depression and Dysthymia............................................................................................. 171 C H A P T E R 1 9 Bipolar Disorder.............................................................................................................. 175 C H A P T E R 2 0 Generalized Anxiety Disorder, Specific Phobia, Panic Disorder, Social Phobia, and Selective Mutism.............................................................................. 178 C H A P T E R 2 1 Separation Anxiety Disorder and School Refusal ........................................................... 183 C H A P T E R 2 2 Posttraumatic Stress Disorder ........................................................................................ 187 C H A P T E R 2 3 Obsessive-Compulsive Disorder..................................................................................... 190 C H A P T E R 2 4 Early-Onset Schizophrenia ............................................................................................. 194 C H A P T E R 2 5 Obesity............................................................................................................................ 199 C H A P T E R 2 6 Anorexia Nervosa and Bulimia Nervosa.......................................................................... 202 C H A P T E R 2 7 Tic Disorders................................................................................................................... 205 C H A P T E R 2 8 Elimination Disorders...................................................................................................... 209 C H A P T E R 2 9 Sleep Disorders .............................................................................................................. 212 C H A P T E R 3 0 Evidence-Based Practices .............................................................................................. 216 C H A P T E R 3 1 Child Abuse and Neglect ................................................................................................ 219 C H A P T E R 3 2 HIV and AIDS ................................................................................................................. 222 C H A P T E R 3 3 Bereavement and Traumatic Grief.................................................................................. 225 C H A P T E R 3 4 Ethnic, Cultural, and Religious Issues............................................................................. 229 C H A P T E R 3 5 Youth Suicide.................................................................................................................. 232 C H A P T E R 3 6 Gender Identity and Sexual Orientation .......................................................................... 236 10 | C H A P T E R 3 7 Aggression and Violence ................................................................................................ 239 C H A P T E R 3 8 Genetics: Fundamentals Relevant to Child and Adolescent Psychiatry.......................... 242 C H A P T E R 3 9 Psychiatric Emergencies................................................................................................. 245 C H A P T E R 4 0 Family Transitions: Challenges and Resilience .............................................................. 248 C H A P T E R 4 1 Psychiatric Aspects of Chronic Physical Disorders......................................................... 251 C H A P T E R 4 2 Children of Parents With Psychiatric and Substance Abuse Disorders........................... 255 C H A P T E R 4 3 Legal and Ethical Issues................................................................................................. 258 C H A P T E R 4 4 Telepsychiatry................................................................................................................. 261 C H A P T E R 4 5 Principles of Psychopharmacology ................................................................................. 264 C H A P T E R 4 6 Medications Used for Attention-Deficit/Hyperactivity Disorder ........................................ 267 C H A P T E R 4 7 Antidepressants .............................................................................................................. 271 C H A P T E R 4 8 Mood Stabilizers ............................................................................................................. 274 C H A P T E R 4 9 Antipsychotic Medications............................................................................................... 278 C H A P T E R 5 0 Alpha-Adrenergics, Beta-Blockers, Benzodiazepines, Buspirone, and Desmopressin ... 281 C H A P T E R 5 1 Medications Used for Sleep ............................................................................................ 284 12 | C H A P T E R 5 2 Electroconvulsive Therapy, Transcranial Magnetic Stimulation, and Deep Brain Stimulation ............................................................................................ 287 C H A P T E R 5 3 Individual Psychotherapy ................................................................................................ 291 C H A P T E R 5 4 Parent Counseling, Psychoeducation, and Parent Support Groups................................ 294 C H A P T E R 5 5 Behavioral Parent Training ............................................................................................. 297 C H A P T E R 5 6 Family Therapy ............................................................................................................... 300 C H A P T E R 5 7 Interpersonal Psychotherapy for Depressed Adolescents............................................... 304 C H A P T E R 5 8 Cognitive-Behavioral Treatment for Anxiety Disorders.................................................... 307 C H A P T E R 5 9 Cognitive-Behavioral Therapy for Depression................................................................. 312 C H A P T E R 6 0 Motivational Interviewing................................................................................................. 315 C H A P T E R 6 1 Systems of Care, Wraparound Services, and Home-Based Services............................. 318 C H A P T E R 6 2 Milieu Treatment: Inpatient, Partial Hospitalization, and Residential Programs .............. 322 C H A P T E R 6 3 School-Based Interventions ............................................................................................ 326 C H A P T E R 6 4 Collaborating With Primary Care..................................................................................... 329 C H A P T E R 6 5 Juvenile Justice .............................................................................................................. 332 Preface The purpose of this study guide is to provide individuals who have purchased Dulcan’s Textbook of Child and Adolescent Psychiatry an opportunity to evaluate their understanding of the material contained in the textbook. Whenever possible, the selected questions emphasize the major points of each chapter. In addition, every effort is made to select those questions of most relevance to psychiatrists who see patients in a variety of clinical practice settings. We encourage the readers of the textbook to answer the questions after reading each chapter. The format for the questions is similar to what candidates would expect to encounter when taking Part I of the American Board of Psychiatry and Neurology initial certification examination or the maintenance-of-certification examination in psychiatry that is required every 10 years. At the end of the study guide, the questions are repeated along with detailed answers. The answer section includes an explanation of the correct response for each question, as well as an explanation, in most cases, for why the other responses were incorrect. An online version is available in addition to the printed study guide. Psychiatrists who wish to earn continuing medical education credits may purchase the online version and obtain CME credit by completing it. We hope you will find the study guide a useful addition to Dulcan’s Textbook of Child and Adolescent Psychiatry. Our goal is to have an assessment instrument that is helpful for your understanding of the material and for clarification of important concepts. Although the questions are reviewed numerous times, both by the authors and by editors at American Psychiatric Publishing, Inc., occasionally an incorrect response may be included. If this is the case, we would appreciate your notifying the publisher of the error so it can be corrected in the online version of the self-assessment examination. If you have other suggestions concerning this study guide, please email Dr. Hales at . Best of luck with your self-examination. Hong Shen, M.D. Robert E. Hales, M.D., M.B.A. Narriman C. Shahrokh 14 | C h a p t e r 1 Assessing Infants and Toddlers Select the single best response for each question. 1.1 Infant psychiatry focuses on which of the following age groups? A. From birth to first birthday. B. From birth through age 3 years. C. From birth to preschool years. D. From conception to age 3 years. E. From conception to preschool years. 1.2 Which of the following is the strongest outcome predictor of early childhood development? A. Presence or absence of pregnancy complications. B. Birth weight. C. Child’s temperament. D. Parental relationship. E. Primary caregiving relationship. 1.3 Which of the following assessment or diagnostic tools uses the DSM-IV multiaxial system? A. Diagnostic Criteria: Zero to Three, Revised (DC:0–3R). B. Child Behavior Checklist 1½–5. C. Infant-Toddler Social and Emotional Assessment (ITSEA). D. Ages and Stages Questionnaires: Social-Emotional. E. None of the above. 1.4 Which of the following is not considered a key element of the infant/toddler assessment? A. History of presenting problem. B. Medical history. C. Developmental history. D. IQ. E. Family history. 1.5 Which of the following is the only diagnostic interview with published data to support its reliability for assessing infants and toddlers? A. Preschool Age Psychiatric Assessment (PAPA). B. Diagnostic Infant Preschool Structured Interview. C. Crowell procedure. D. Beck Depression Inventory. E. Parenting Stress Index. 16 | C h a p t e r 2 Assessing the Preschool-Age Child Select the single best response for each question. 2.1 The significant developmental differences between preschool- and school-age children require a tailored approach to obtaining a history and mental status exam. Which of the following principles should be kept in mind when evaluating a preschool-age child? A. The most meaningful evaluation occurs when the child is evaluated without the primary caregiver. B. The mental status examination should be conducted in the context of play. C. The preschooler should be evaluated in one session to avoid conflicting results. D. It is desirable to include only the primary caregiver when evaluating the child. E. All of the above. 2.2 The Washington University School of Medicine Infant/Preschool Mental Health (WUSM IPMH) clinic uses a standardized format for evaluating preschool-age children. Which of the following statements correctly describes this evaluation? A. The assessment is conducted in one 3-hour session. B. Free play is observed with the primary caregiver. C. A semistructured observation with secondary caregivers is included. D. Emotional, psychological, family, and developmental history is obtained only from the mother. E. None of the above. 2.3 Which of the following actions should be taken by parents to prepare their preschooler for the play evaluation? A. Parents should provide honest information to the child about the purpose of the evaluation. B. Parents should not disclose to their child that they have already met with the examiner. C. Parents should avoid discussing with the child that the examination will involve play. D. It is best to inform the child about the examination over several days to a week so he/she may ask questions. E. Parents should not prepare their child for the examination. 2.4 Which of the following statements regarding conduct of the free-play assessment with the preschooler is true? A. A brief separation between the parent and child midway through the free-play session is useful. B. The clinician should avoid disclosing to the child what was learned about his or her problems from the meeting with the parents. C. When the parent asks questions of the therapist during the play session, the therapist should freely answer the questions in order to reduce the parents’ anxiety. D. The examiner should not respond to the child’s bids to engage in play. E. All of the above. 2.5 Several standardized semistructured interviews may be useful in the dyadic assessment of parent and child. Which of the following are characteristics of the Parent-Child Early Relational Assessment (PCERA)? A. The parent blows bubbles to elicit affect from the child. B. Tasks of escalating difficulty are performed by the child and parent and videotaped for further review. C. The parent and child perform a structured task in which block designs are made from sample cards. D. None of the above. E. All of