4.4 Child and Adolescent psychiatry Dr. Graham Flashcards
What is the diagnostic triad for ADHD?
- Inattention
- Hyperactivity
- Impulsivity.
ADHD is a cluster of impairing symptoms relating to self-regulation = executive functioning.
What are some common comorbid difficulties in ADHD?
Social communication difficulties Learning disability Attachment difficulties Mood and anxiety problems Behavioural disorders- OCC, CD Substance use
What is the prevalence of ADHD?
What is the ratio of boys to girls?
About 5.29% globally
M2:F1
The working memory in those with ADHD resembles the elderly with what disease?
Alzheimer’s
What are the main psychological treatment options for ADHD?
1st line: Parent training- New Forest Parenting Programme, behavioural classroom management strategies
2nd linke: social skills training, sleep and diet modifications
What are the main pharmacological treatment options for ADHD?
1st line: (stimulants) Methylphenidate (‘Ritalin’)
Dexamfetamine
Lisdexamfetamine
2nd line: Atomoxetine
3rd line: Antidepressants, antihypertensives, antipsychotics
What effect does methylphenidate (‘Ritalin’) have on the brain?
As a stimulant, it increased dopaminergic neurotransmission in networks involved in executive functioning.
Functions in the pre-frontal cortex, and others.
Directly improves symptoms
Minor side effects: appetite and sleep reduction
dysphoria, anxiety, and tics also possible SE.
Is pharmacological treatment in ADHD effective?
YES! Unusually so.
NNT for methylphenidate, amfetamine, and atomoxetine are all 4. Compare to antidepressants and antipsychotics in depression and schizophrenia- which is 10.
What is autism?
Problems in the area of social communication and interaction
And
restricted/repetitive patterns of thinking.
How common is autism?
1 in 68
M>F
What are the triad of impairments in autism?
- Qualitative impairment in reciprocal social interactions.
- Language and impairment deficits
- Restricted thought and behaviour
What does it mean to have qualitative impairment in reciprocal relationships?
- Relationships difficult to establish
- Not motivated by need for social approval
- No interest in the needs of others
- Little awareness of the feelings of others.
What does it mean to have language impairment/deficits?
No speech Difficulty using pronouns Speech intonation may be odd Difficulty interpreting non-verbal communication Difficulty with similes and metaphors Peculiar or no eye contact Unresponsive to non-verbal feedback
What does it mean to have restricted thought and behaviours?
Restricted, repetitive and stereotyped patterns of behaviour, interests and activities
Resistance to change
Lack of social imagination/theory of mind
Concrete and inflexible thinking
Ritualistic behaviours/stereotypies
What assessment tools can help the diagnosis of autism?
Social responsiveness scale- screening
Semi-structured interview - 3DI
Standardized assessment tools- Autism Diagnostic Observation Schedule - ADOS
