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Learning Disability - psych > Behavioural + emotional disorders w/ onset associated w/ childhood > Flashcards

Behavioural + emotional disorders w/ onset associated w/ childhood Flashcards

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1
Q

ICD 10

A

F90-98
F90 Hyperkinetic disorders (including ADHD)
F91 Conduct disorders
F92 Mixed disorders of conduct + emotions (e.g. depressive conductive disorder)
F93 Emotional disorders with onset specific to childhood (e.g. separation anxiety disorder, sibling rivalry disorder)
F94 Disorders of social functioning with the onset specific to childhood and adolescence (e.g. selective mutism)
F95 Tic disorders
F98 Other behavioural and emotional disorders → e.g. enuresis, Pica (persistent eating of non-nutrientive substances), stuttering…etc)

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2
Q

Define ADHD

A

Hyperkinetic disorder: early onset, persistent pattern of inattention, hyperactivity + impulsivity that are more frequent + severe in individuals at a comparable stage of development, and are present in more than one situation

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3
Q

Aetiology ADHD

What gene

A

• 80% → genetic (DRD4 + DRD5 genes)

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4
Q

RFs ADHD

A

Risk factors:
• Low birth weight
• Babies born to mothers who used drugs, alcohol or to tobacco during pregnancy
• FHx
• Male
• Environment: social deprivation, family conflicts

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5
Q

3 core features ADHD

A

Inattention
Hyperactivity
Impulsiveness

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6
Q

Inattention ADHD

A

careless w/ detail, fails to sustain attention, appears not to listen, fails to finish tasks (highly distractible), poor self-organisation, lose things, forgetful, easily distracted, avoids tasks requiring sustained attention

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7
Q

Hyperactivity ADHD

A

restlessness + fidgeting (hands/feet), recklessness, running/jumping around inappropriate places, difficulty engaging in quiet activities, excessive talking/nooises

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8
Q

Impulsiveness ADHD

A

talks excessively, blurts out answers, cannot wait turn, interrupts others, intrudes on others

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9
Q

Problems with ADHD

Short and long term

A

Short term
- Sleep problems, low self-esteem, family/peer relationship problems, reduced academic achievement, ↑ risk of accidents

Long term
- Comorbidities (e.g. depression), ↓ academic/employment success, ↑ crime, ↑ risk antisocial personality disorder

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10
Q

DDx ADHD

A
  • Attachment disorder
  • Learning difficulty
  • Hearing problem
  • High IQ child unstimulated by school
  • Behavioural disorder
  • Anxiety disorder
  • Medication (e.g. antihistamines)
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11
Q

ICD 10 dx ADHD

A
  • Demonstrable abnormality of attention, activity + impulsivity at home
  • Demonstrable abnormality of attention + activity at school or nursery (if child)
  • Directly observed abnormality of attention or activity
  • Onset before age 7
  • Duration >6mths
  • IQ above 50
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12
Q

Prognosis ADHD

A

• Some ADHD Sx’s persist into adulthood

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13
Q

Ix ADHD

A
  • Interview family + child
  • Observe child (dif situations: clinic + school)
  • Collateral Hx (school…)
  • Rating scales (EXAM) → SDQ (strengths and difficulties questionnaire), connor’s rating scale
  • Screen comorbidity
  • Bloods: TFT
  • Hearing test (otoscope → pure tone audiogram)
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14
Q

Rx ADHD

A
  • Psychoeducation (family)
  • Behavioural interventions: encouraging realistic expectations, +ve reinforcement of desired behaviours (immediate rewards), break down tasks, reduce distraction…etc
  • School intervention/involvement
  • Treat co-morbidity
  • Possibly: Food diary → Dietary changes
  • Voluntary organisations (support) → ADDISS
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15
Q

What medical treatments available for ADHD

A

Medication (not recommended for pre-school)

  • Methylphenidate (Ritalin) → CNS stimulant
    • SEs: abdo pain, N+V, dry mouth, anxiety, insomnia, dysphoria, headaches, anorexia, reduced weight gain (GROWTH MONITORING)
  • Atomoxetine
  • Dexamfetamine
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16
Q

Define conduct disorders

A

Repetitive + persistent pattern of antisocial, aggrieve or defiant behaviours that violate age-appropriate societal norms
Divided into:
o Conduct disorders
o Oppositional defiant disorder (not covered)

17
Q

CFs conduct disorders

A
  • Aggression/cruelty to people ± animals
  • Destruction of property
  • Deceitfulness
  • Theft
  • Fire-setting
  • Truancy
  • Running away from home
  • Severe provocative + disobedient behaviours
  • Sig. impact of family + peer relationships, school

(ICD-10 requires 1 for >6mths)

18
Q

Aetiology conduct disorders

A
  • Social disadvantage → poverty, low-socioeconomic class, overcrowding, homelessness…etc
  • Parenting → parental crime, parental psych disorder or substance misuse, poor parenting style, parental conflict, teenage pregnancy…etc
  • Child → low IQ, neurodevelopmental problems, brain damage
19
Q

DDx conduct disorders

A

ADHD, dyslexia, substance abuse, anxiety, ASD

20
Q

Prognosis conduct disorders

A
  • ½ receive antisocial personality disorder as adults

* Risk of early death (violence…etc), unemployment, crime…etc

21
Q

Ix conduct disorders

A
  • See family + child
  • Hx (school, social worker, legal system)
  • Identify causal, risk and protective factors
  • Assess comorbidity
22
Q

Rx conduct disorders

A
  • Parenting management training
  • Functional family therapy
  • Multi-systemic therapy (inc. school)
  • Child interventions: anger management, confidence building…etc
  • Rx co-morbidity
  • Address child protection concerns
23
Q

Define separation anxiety disorder

A

• Increased + inappropriate anxiety around separation from attachment figures or home, which is developmentally abnormal + results in impaired functioning

NB separation anxiety is normal during development (E.g. 2yr old)

24
Q

Aetiology separation anxiety disorder

A
  • Genetic vulnerability

* Parenting: anxious, inconsistent or over-involved

25
Q

CFs separation anxiety disorder

A
  • Anxiety about actual or anticipated separation from or danger to attachment figure
  • Sleep disturbance + nightmare
  • Somatisation
26
Q

What is a tic

A

repeated, sudden, involuntary, irregular movements involving a group of muscles

27
Q

Define Tourette’s syndrome

A

A developmental neuropsychiatry disorder characterised by multiple motor + one or more vocal tics, present for at least 1yr, causing distress + impaired function

28
Q

Aetiology Tourette’s

A
  • Genetic + environmental factors

* Association w/ psychological stress, heightened HPA axis + NE system reactivity

29
Q

Rx Tourette’s

A
  • Psychoeducation (child + family) → what tics are, realistic expectations, stress reduction, caffeine reduction
  • Liaison w/ school + educational interventions
  • Treat co-morbidities
  • Behavioural interventions (e.g. awareness training)
  • If tics severe → consider: anti-psychotics, A-adrenergics…etc
  • Tourette Syndrome Association
30
Q

Define enuresis

A
  • Involuntary voiding of urine, by day + night
  • Abnormal for pt’s mental age
  • Not a consequence of a lack of bladder control due to neurological disorder, epileptic attacks or structural abnormality of the urinary tract
31
Q

Aetiology enuresis

A

Nocturnal enuresis → strong genetic component

32
Q

Rx enuresis

A

• Nocturnal enuresis
o Night lifting, reward systems (star charts), medication (oxybutynin [antimuscarinic] or desmopressin [analogue of ADH/vasopressin])
• Diurnal enuresis
o Body alarms, watch alarms (remind child to use toilet)…etc

Learning Disability - psych (3 decks)

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