Pediatricians may receive three credit hours in Category 1 for the American Medical Association's Physician's Recognition Award by reading the material in this issue and successfully answering the quiz below. Follow these simple rules:
1. Read the Educational Objective at the beginning of the issue and answer the Pre-Test before reading the articles. This will indicate the areas to be covered.
2. Read each of the articles carefully. Do not neglect the tables and other illustrative material, as they have been selected to enhance your knowledge and understanding.
3. Following are questions on patient management that have been designed to provide a useful link between the articles in this issue and your everyday practice. Read each question, choose the correct answer, and record your answer on the CME registration form printed at the end of the quiz.
4. Type or print your full name and address (including zip code) and your social-security number in the spaces provided.
5. Send check or money order ($10) made out to Pediatric Annals CME Quiz, with your answer form, to:
501 Madison Avenue
New York, N.Y. 10022
6. After your answers have been graded, you will be advised of your score and the answers to any incorrect or missed questions. Review those parts of the article dealing with any questions you answer incorrectly, and read the supplemental materials on this aspect of the subject that are listed in the references in this issue. Unanswered questions will be considered incorrect and so scored. A minimum score of 70 percent must be obtained in order for credits to be awarded.
7. Credits can be awarded only if your answers are received before the deadline indicated on the CME registration form, since after that date correct answers to the quiz will be printed in the magazine.
CME QUIZ: Behavioral Pediatrics in Office Practice
Record your answers on page 55.
Type A Questions. Choose one letter after each of the numbers listed below, and transfer to the coupon. Choose the one best answer.
1. Drs. Prazar and Chamey suggest that the pediatric nurse-practitioner may help you in handling behavioral problems of your patients by
A. Taking detailed case histories of children with behavioral problems.
B. Taking care of the well babies and patients in your practice, leaving you more time for counseling children with behavioral problems.
C. Teaching courses for parents on the management of difficult children.
D. Taking graduate courses in psychiatric nursing in order to counsel your more "difficult" children with serious mental illnesses.
2. Your aide has scheduled a conference appointment with the parents after a child has been referred to you for a behavioral problem. Drs. Prazar and Charney suggest you allot _____ for this initial interview.
A. Five minutes.
B. Ten minutes.
C. "A brief appointment."
D. One hour.
3. Follow-up visits with the parents often are scheduled when a child has behavioral problems.
A. Usually only one brief appointment will be necessary.
B. No follow-up by a pediatrician is indicated. When a follow-up seems desirable, the child should be referred to a psychiatrist.
C. They should be scheduled within the next few weeks after the child is initially seen and should last perhaps 45 minutes.
D. Bi-weekly follow-up sessions should be held with all parents for a 12-week period, regardless of the child's problem.
4. A sixth-grade boy who Is smoking at school and misbehaving in other ways has been referred to you. Your intervention will be most effective, according to the authors in this issue, if you
A. Tell the boy to "shape up or ship out."
B. Are successful in keeping the boy from finding out how concerned his parents are about him.
C. Give the boy a direct order to quit smoking because of the danger of cancer.
D. Attempt to establish rapport with him by using a nondirective, nonthreatening approach.
5. An internist has referred a 12-year-old girl to you because of behavioral problems. You would like to let the physician know how things are progressing.
A. Appropriate permission should be obtained from the girl and her parents before you do this.
B. Once the internist has referred the patient, it is best not to keep him informed of the child's behavioral problem.
C. Any subsequent communications should be only in writing.
D. You should not report back to the internist, since it would be a breach of medical ethics to keep him informed.
6. Authors of this issue believe that the best person to treat common behavioral problems in children and adolescents is A. The psychiatrist.
B. The psychiatric social worker.
C. The pediatric nurse-practitioner.
D. The pediatrician.
7. A referral to a psychiatrist is indicated if
A. Your patient is a 16-year-old girl who has been anorectic for three years.
B. Your patient is a seven-year-old boy with enuresis.
C. Your patient is a four-year-old child who has nightmares.
D. The parents have observed their preschool child masturbating.
8. An eight-year-old-boy who has been "causing trouble" for his teacher is referred to you as having a behavioral problem. After your second interview with the boy, you don't seem to be making any progress.
A. You should refer.
B. You should continue to treat the child if the parents believe they have seen some improvement.
C. Neuroleptic pharmacotherapy is now indicated.
D. You should tell the parents that your pediatric nurse-practitioner will handle all subsequent interviews with the child.
9. You are a pediatrician who is known for his ability to counsel children with behavioral problems. As such,
A. You should avoid meeting with school groups or parent-teacher organizations in order to provide some separation from parents and teachers.
B. You should seek out a resource for continuing supervision of yourself.
C. You will be most effective if you schedule your behavioral cases before regular office hours.
D. As a behavioral pediatrician, you should not accept school referrals.
10. "One does what one knows best." So your psychologic interventions in behavioral pediatrics should be based on
A. Your own experiences in rearing your children.
B. What you have learned in your study of the science of behavioral medicine.
C. The writings of Holt.
D. The Haran-Friedman Behavioral Pediatric Evaluation Score.
11 . A nine-year-old boy taps with his pencil repeatedly in school, gazes out the window, and works very slowly. He obviously is not dyslexic. Which "mistaken goal" is he likely to be pursuing?
D. Rhythmic self -stimulation.
12. In discussing sexuality issues with a teenager, Drs. Smith and Felice suggest, the best approach for the behavioral pediatrician is to
A. Broach the subject immediately and "get down to brass tacks."
B. Realize that virtually all teenagers have had sexual intercourse by the time they are seniors in high school.
C. Go into the subject gradually, since many adolescents feel uncomfortable discussing sexual matters.
D. Be willing to share your own teenage sexual experiences with your patients.
13. Office logistics are important when a pediatrician is working in behavioral problems. The authors of this issue recommended which of the following?
A. Using the same waiting room for adolescents with behavioral problems that you use for younger children.
B. Using a regular examining room so the teenager will "feel more at home" when he sees the examining table and medical equipment.
C. Using an office that is relatively soundproof.
D. Keeping a separate medical record for behavioral problems.
14. A 15-year-old-boy has been referred to you because of behavioral problems. During your initial interview he becomes verbose and boasts of his many sexual conquests. Your response should be to
A. Tell him to stop, since this is probably a defense mechanism.
B. Encourage him to tell more, since he obviously needs to ventilate.
C. Say nothing but allow him to continue as long as he wishes.
D. Tell him this appears to be an area of concern that he may wish to discuss further during a future visit.
15. When a youth in his middle teens is retened by school officials for a behavioral problem,
A. Father, mother, and siblings will usually be in agreement on the nature of his problem.
B. The pediatrician's main task may be to clarify what the real problem is.
C. He usually won't be able to discuss his problem with you, because adolescents cannot deal with abstract terms.
D. The pediatrician inevitably will be viewed by the youth as a representative of the parents' values.
Type B Questions. Match the names in column one with the answers in column two.
16. Erik H. Erikson
17. Jean Piaget
18. B. F. Skinner
19. Alfred Adler
20. Benjamin Spock
A. Individual psychology
B. Behavioral modification
C. Confidence in parents' common sense
D. Importance of biologic and social factors in behavioral problems
E. Origins of intelligence in children
QUIZ ANSWERS WILL APPEAR IN A SUBSEQUENT ISSUE
ANSWERS TO THE CME QUIZ IN THE MARCH ISSUE
The Pregnant Adolescent