Childhood and early-onset psychological disorders: Pathology review

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Childhood and early-onset psychological disorders: Pathology review

Psychological disorders

Psychological disorders

Psychological disorders


Childhood and early-onset psychological disorders: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 3-year-old boy is brought to the pediatrician by his parent in winter for a routine checkup. He has missed several previous appointments since the parent was overwhelmed with work and could not take time off. According to the parent, the patient does not interact with other children in the neighborhood and often avoids eye contact with other people. Vitals are within normal limits. Height and weight are below the 10th percentile. The child is not wearing a jacket despite the cold weather outside. He makes minimal eye contact with the physician. Physical examination reveals patches of hair loss on the patient’s head. Oral examination reveals multiple dental caries. The remainder of the physical examination is noncontributory. The physician decides to interview the child separately. Which of the following diagnoses is the physician most likely concerned for?  

Memory Anchors and Partner Content


A 16 year old female, named Tayla, comes to the clinic because she’s been feeling urges to repeatedly blink her eyes, shake her head from side to side, or clear her throat. Tayla notes that she is able to suppress the urge for a while, but she eventually loses control of her actions. This all started a little over a year ago, and Tayla is under distress because her classmates often tease her about it. During the conversation, she suddenly utters an inappropriate curse word, and immediately goes on to say that she doesn’t know how that came out of her mouth. Physical examination reveals no neurological deficits and she shows normal cognitive skills for her age.

Okay, based on the initial presentation, Tayla seems to have some form of childhood or early-onset psychological disorder. These include several psychological conditions that typically have their onset during childhood, although some of these disorders may last into adulthood. As a consequence, these disorders can interfere with how the affected person functions independently in society, and impair everyday activities like working, studying, eating, and sleeping, as well as have an impact on their families.

For your exams, the most common childhood or early-onset psychological disorders are separation anxiety disorder, selective mutism, oppositional defiant disorder, conduct disorder, disruptive mood dysregulation disorder, tourette syndrome, and child abuse.

Let’s begin with separation anxiety disorder. That happens when separation from someone that the child is very attached to, like a parent, causes overwhelming or excessive fear and anxiety. In some cases, this can reach the point where it may lead to factitious physical complaints so that individuals can stay home and miss school. To be diagnosed as separation anxiety disorder, this needs to last for at least four weeks or more. Bear in mind, though, that this can be considered normal behavior until the age of 3 or 4.

Now, treatment includes cognitive behavioral therapy, or cbt for short, which is a type of talk therapy that primarily focuses on teaching the individual strategies to better cope with stress and social pressures, as well as identify the anxious patterns of thinking that might be influencing their disorder. Other approaches include play therapy, which uses play to help individuals deal with their anxiety, and family therapy, where parents and siblings can learn new ways to interact with the individual and help them when anxiety spikes.


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  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "Diagnostic and Statistical Manual of Mental Disorders" A.P. Association and A.P.A.T.F.O.N.A. Statistics (1980)
  5. "Selective mutism: A review and integration of the last 15 years" Clinical Psychology Review (2009)
  6. "IN THIS ISSUE/ABSTRACT THINKING" Journal of the American Academy of Child & Adolescent Psychiatry (2010)
  7. "Tics and Tourette" Current Opinion in Pediatrics (2017)

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