Behavioural & Emotional Issues Flashcards
What is autistic spectrum disorder?
Autistic spectrum disorder refers to the full range of people affected by a deficit in social interaction, communication and flexible behaviour.
The classification of autistic spectrum disorder was introduced in the diagnostic and statistical manual of mental disorders fifth edition (DSM-5), introduced in 2013. This took previous diagnoses such as Aspergers syndrome and autistic disorder and grouped them into one spectrum disorder, suggesting that the same disorder was responsible for the features of the condition and those affected fall somewhere along the spectrum.
The autistic spectrum has a significant range. On one end patients have normal intelligence and ability to function in everyday life but displaying difficulties with reading emotions and responding to others. This was previously known as Asperger syndrome. On the other end, patients can be severely affected and unable to function in normal environments.
What are the features of autistic spectrum disorder?
Features vary greatly between individuals along the autistic spectrum. They can be categorised as deficits in social interaction, communication and behaviour. Features are usually observable before the age of 3 years.
Social Interaction
Lack of eye contact Delay in smiling Avoids physical contact Unable to read non-verbal cues Difficulty establishing friendships Not displaying a desire to share attention (i.e. not playing with others) Communication
Delay, absence or regression in language development
Lack of appropriate non-verbal communication such as smiling, eye contact, responding to others and sharing interest
Difficulty with imaginative or imitative behaviour
Repetitive use of words or phrases
Behaviour
Greater interest in objects, numbers or patterns than people
Stereotypical repetitive movements. There may be self-stimulating movements that are used to comfort themselves, such as hand-flapping or rocking.
Intensive and deep interests that are persistent and rigid
Repetitive behaviour and fixed routines
Anxiety and distress with experiences outside their normal routine
Extremely restricted food preferences
How is a diagnosis of ASD achieved?
Diagnosis should be made by a specialist in autism. This may be a paediatric psychiatrist or paediatrician with an interest in development and behaviour. A diagnosis can be made before the age of 3 years. It involves a detailed history and assessment of the child’s behaviour and communication.
How is ASD managed?
Autism cannot be cured. Management depends on the severity of the child’s condition. Management involves a multidisciplinary team to provide the best environment and support for the child and parent:
Child psychology and child and adolescent psychiatry (CAMHS)
Speech and language specialists
Dietician
Paediatrician
Social workers
Specially trained educators and special school environments
Charities such as the national autistic society
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is at the extreme end of “hyperactivity” and inability to concentrate (“attention deficit“). It affects the person’s ability to carry out everyday tasks, develop normal skills and perform well in school.
Features should be consistent across various settings. When a child displays these features only at school but is calm and well behaved at home, this is suggestive of an environmental problem rather than an underlying diagnosis.
Which features might suggest ADHD?
All the features of ADHD can be part of a normal spectrum of childhood behaviour. When many of these features are present and it is adversely affecting the child, ADHD can be considered:
Very short attention span
Quickly moving from one activity to another
Quickly losing interest in a task and not being able to persist with challenging tasks
Constantly moving or fidgeting
Impulsive behaviour
Disruptive or rule breaking
How can ADHD be managed?
A detailed assessment should be carried out by a specialist in childhood behavioural problems before a diagnosis is made. Management should be coordinated by a specialist in ADHD. Parental and child education is essential. This includes education about parental strategies to manage the child.
Establishing a healthy diet and exercise can offer significant improvement in symptoms. Keeping a food diary may suggest a link between certain foods, such as food colourings, and behaviour. Elimination of these triggers should be done with the assistance of a dietician
Medication is an option after conservative management has failed or in severe cases. This should be coordinated by a specialist. Contrary to what you might think, they are central nervous system stimulants. Examples are:
Methylphenidate (“Ritalin“)
Dexamfetamine
Atomoxetine
What is anorexia nervosa?
In patients with anorexia nervosa, the person feel they are overweight despite evidence of normal or low body weight. It involves obsessively restricting calorie intake with the intention of losing weight. Often the person exercises excessively and may use diet pills or laxatives to restrict absorption of food.
What are the features suggestive of anorexia nervosa?
Excessive weight loss Amenorrhoea Lanugo hair is fine, soft hair across most of the body Hypokalaemia Hypotension Hypothermia Changes in mood, anxiety and depression Solitude Cardiac complications include arrhythmia, cardiac atrophy and sudden cardiac death.
What is bulimia nervosa?
Unlike with anorexia, people with bulimia often have a normal body weight. Their body weight tends to fluctuate. The condition involves binge eating, followed by “purging” by inducing vomiting or taking laxatives to prevent the calories being absorbed.
Which features are suggestive of bulimia nervosa?
Alkalosis, due to vomiting hydrochloric acid from the stomach
Hypokalaemia
Erosion of teeth
Swollen salivary glands
Mouth ulcers
Gastro-oesophageal reflux and irritation
Calluses on the knuckles where they have been scraped across the teeth. This is called Russell’s sign.
What is binge eating disorder?
Binge eating disorder is characterised by episodes where the person excessively overeats, often as an expression of underlying psychological distress. This is not a restrictive condition like anorexia or bulimia, and patients are likely to be overweight.
Which features may suggest a binge eating disorder?
A planned binge involving “binge foods” Eating very quickly Unrelated to whether they are hungry or not Becoming uncomfortably full Eating in a “dazed state”
How can eating disorders be managed?
Patient and carer education is key to the condition. Management is centred around changing behaviour and addressing environmental factors:
Self help resources
Counselling
Cognitive behavioural therapy (CBT)
Addressing other areas of life, such as relationships and past experiences
Severe cases may require admission for observed refeeding and monitoring for refeeding syndrome.
SSRI medication may be used by a specialist in child and adolescent mental health.
What is refeeding syndrome and who is most at risk?
Refeeding syndrome occurs in people that have been in a severe nutritional deficit for an extended period, when they start to eat again. Patients are at higher risk if they have a BMI below 20 and have had little to eat for the past 5 days. The lower the BMI and the longer the period of malnutrition, the higher the risk.
Metabolism in the cells and organs dramatically slows during prolonged periods of malnutrition. As the starved cells start to process glucose, protein and fats again they use up magnesium, potassium and phosphorus. This leads to:
Hypomagnesaemia
Hypokalaemia
Hypophosphataemia
These patients are also at risk of cardiac arrhythmias, heart failure and fluid overload.
