Behavioural Disorders Flashcards
Definition of encopresis
Involuntary defecation, especially associated with emotional disturbance or psychiatric disorder
Prevalence of encopresis, which gender more common
2-8% of primary school children
More common among boys
Types of encopresis (5)
- Constipation with overflow
- failed toilet training
- Toilet phobia
- Stress induced loss of control
- Provocative soiling
Management of encopresis (in setting of constipation with overflow)
- treat constipation if present (laxatives e.g. parachoc/movicol or microenemas)
- ensure diet contains enough fibre to avoid future constipation
- establish routine of regular toilet use (use laxatives until established, educate to child why regular toilet use reduces soiling, small rewards for regular toilet use to condition child)
Management of encopresis in children with toilet phobia
incentives/rewards for sitting on the toilet even for short time without voiding, later building up to rewards for when empty bowels into toilet
Inattention symptoms of ADHD
Poor attention to detail Careless mistakes Difficulty sustaining attention Seems not to listen Seems not to follow through Difficulty with organisation Avoids tasks requiring sustained attention Loses things Easily distracted Forgetful
Criteria for diagnosis of ADHD
- Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before 7 years of age
- Some impairment from the symptoms is present in 2 or more settings (e.g. school, work, home)
- There must be clear evidence of clinically significant impairment in social, academic or occupational functioning
- Behaviour not better explained by another condition
Hyperactivity/Impulsivity symptoms of ADHD
Fidgets Often leaves seat Runs/climbs excessively Difficulty playing quietly Always "on the go" Talks excessively Blurts out answers Difficulty waiting turn Interrupts others
Comorbidities with ADHD
Learning difficulties Language disorder Oppositional defiant disorder Conduct disorder Anxiety, mood disorders Developmental coordination disorder Tics, Tourette syndrome
Management options for ADHD
Stimulant medications
Parental behaviour management
Classroom behaviour management
Congnitive behavioural therapy
Management of co-morbidities (e.g. learning support, treatment of anxiety/depression)
Structured parenting programmes, parent support groups
Medications available for ADHD
Stimulants: increase dopamine in brain
- Dexamphetamine
- methylphenidate (Ritalin)
If tolerant to stimulants:
Atomexatine (noradrenergic reuptake inhibitor)
Most common side effects of stimulant medications for ADHD
Insomnia
Appetite suppression
Headache
mostly resolve spontaneously by 2-3 weeks or can be managed by altering dosing/time etc.
Effectiveness of stimulant medications in ADHD
The most effective treatment of ADHD
Underprescribed due to fear of abuse
Improves target symptoms in 75%, leads to enhanced task completion, academic progress and social interaction sustained overtime
Options for introducing ritalin if concerned about abuse
introduce with weeks of ritalin v weeks of placebo
Have parent and teacher both fill out a diary of child’s behaviour and at end, de-code placebo v ritalin and compare behaviours (don’t re-prescribe if doesn’t match up obviously)
Differentials for hyperactivity
Difficult temperament poor parenting skills family dysfunction Developmental delay Language disorders Learning difficulties Anxiety/mood disorders ODD Conduct disorder Intellectually gifted Sleep disorders Medication conditions (VLBW or SGA, foetal alcohol syndrome, prenatal exposure to smoking or stress, lead poisoning, acquired brain syndrome e.g. head injury, chromosomal abnormalities e.g. fragile C, velocardiofacial syndrome)
