Child & Adolescent Psychiatry 1.3 Flashcards
What characterises disorder of written expression?
Writing skills significantly below expected level for childs age and intellectual capacity.
Common features of disorder of written expression
Spelling and grammatical errors
Punctuation error
Poor paragraph organisation
Poor handwriting
How many school-aged children have disorder of written expression?
2-8%
M:F ratio of disorder of written expression
3:1
Treatment of disorder of written expression
Direct practice in spelling and sentence writing
Review of grammatical rules
Intensive and continuous administration of individually tailored, 1:1 expressive and creative writing therapy
How many school-aged children have difficulty with maths
6%
Gender differences in difficulties with Maths
More common in females
What is mathematics disorder associated with?
Visuo-spatial deficits
Right parietal dysfunction
Common features of mathematics disorder
Difficulty learning number names, remembering signs for addition/substraction, learning multiplication tables, translating word problems into computations and doing calculations at expected pace
Treatment for mathematics disorder
Combine teaching mathematics with continuous practice in solving problems.
What characterises Learning disorder not otherwise specified?
Does not meet criteria for any specific disorder but causes impairment and reflects learning abilities below those expected for a persons intelligence, education and age.
How does ICD 10 classify specific disorders of scholastic skills learning disorders?
Specific reading disorder
Specific writing disorder
Specific disorder or arithmetic skills
Mixed disorder of scholastic skills
Other developmental disorders of scholastic skills
Developmental disorder of scholastic skills unspecified
When is expressive language disorder diagnosed?
When child demonstrates selective deficit in expressive language development relative to receptive language skills and nonverbal intelligence
What is a child with expressive language disorder likely to function low in?
Acquired vocab
Correct tense usage
Complex sentence construction
Word Recall
Prevalence of expressive language disorder in children
3-5%
M:F ratio of expressive language disorder
2-3:1
Which group of children is expressive language disorder most common?
Children whose relatives have a hx of phonological disorder or other communication disorders
Most common comorbid disorder with expressive language disorder
ADHD
Anxiety
ODD
Conduct disorder
Management of expressive language disorder
Special education
Speech Therapy
Essential clinical feature of mixed receptive-expressive language disorder
Significant impairment in both language comprehension and language expression
Features of mixed receptive-expressive language disorder
Delayed and below-normal ability to comprehend verbal or sign language but have age appropriate nonverbal intelligence
Prevalence of mixed receptive-expressive language disorder in school-aged children
3%
M:F ratio of mixed receptive-expressive language disorder
2:1
What happens in phonoogical disorder?
Delayed in producing speech sounds as expected for their age and intelligence. Not due to physical problems.
How do children with phonoogical disorder present?
Unable to articulate phonemes correctly
May distort or substitute or even omit affected phonemes
What is stuttering?
Normal flow of speech is disrupted by involuntary speech motor events
Which syllables do people who stutter usually struggle with?
Initial syllables
M:F ratio of stuttering?
3:1
Prevalence of stuttering in general popilation
1%
Typical age of onset of stuttering
2-7 years
How many children who stutter resolve spontaneously?
50-80%
How many adults are affected with stuttering?
1-2%
School-aged children have increased incidence of what?
Social anxiety
School refusal
Adolescents who stutter have increased incidence of what?
Social isolation
Aetiology of stuttering
Genetic
Incomplete cerebral dominance
Hyperdopaminergic state
Management of stuttering
Speech therapy
What characterises tourette syndrome?
Multiple motor and one or more vocal tics present for at least one year causing distress and impaired function
Duration of tics for tourettes
Many times a day, nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months
When do vocal tics begin in tourettes?
1-2 years after onset of motor sx
What type of tics are crucial for diagnosis of tourettes?
Vocal tics
How many people with tourettes have echolalia or echopraxia
10%
How many people with tourettes have coprolalia?
33%
What are periods of exacerbation of tics in tourettes associated with?
Physical and emotional stress
Anxiety
Fatigue
Prevalence of tourettes in children
1%
MZ and DZ rates of tourettes
50% vs 10%
Mean age of onset of tourettes
7 years
M:F ratio of tourettes
3-4:1
What disorder does tourettes overlap with?
OCD
What neurotransmitter abnormalities are associated with tourettes?
Functional excess of dopamine system - antipsychotics reduce sx
What do neuroimaging studies suggest re tourettes?
Role of circuits involved in basal ganglia, premotor and motor cortex
Post-infectious autoimmune mechanism underlying tourettes?
Group A beta haemolytic strep can trigger immune-mediated disease in genetically predisposed individuals.
Aetiology of tourettes
Genetics Neurotransmitters Neuroimaging Post-infectious Comorbidity
How many children with tourettes have OCD
33-66%
How many children with tourettes have ADHD?
50%
Management of tourettes
Psychoeducation
Medications
What psychotherapy can improve tourettes?
CBT if successful exposure-response can be achieved
Techniques involved in CBT for tourettes
Relaxation
Exposure-response prevention
Massed practice (forced repetition of tic)
Habit reversal (movements incompatible with tic)
When should medications be considered for tourettes?
If tics are disabling and non-responsive to other therapies
Medications used to treat Tourettes?
Haloperidol Pimozide Sulpride Risperidone Clonidine
What type of drug is Clonidine?
Adrenergic alpha 2 agonist
Which drug should be first line for Tourettes?
Clonidine
Benefits of Clonidine for Tourettes?
Reduces severity and frequency of tics
SEs of Clonidine?
Sedation
Postural hypotension
What other alpha 2 agonist can help with tourettes?
Guanfacine
What characterises transient tic disorder?
Single or multiple motor or vocal tics affecting face, nose or throat
Duration criteria for transient tic criteria
Occur many times a day, nearly every day for at least 4 weeks but no longer than 12 consecutive months
Onset of transient tic disorder
<18 years of age
Exclusion criteria of transient tic disorder
Due to physiological effects of a substance )stimulants) or medical condition
Criteria met for Tourettes, Chronic Motor or Vocal Tic Disorder
How many children have transient tics?
5-20%
How many children with transient tics outgrow them by adulthood?
80%
What is chronic tic disorder?
Persists for more than one year and shows relapses throughout childhood.
Vocal or motor tics but not both.
Which substance is most commonly abused by adolescents?
Alcohol
How many 13 year olds admit to the use of alcohol at least once a week?
30%
What alcohol drinking pattern is more common in adolescents?
Binge drinking
How many 11-16 year olds in the UK have used cannabis?
5%
How many heroin users will switch to IV use within 1 year?
15%
How many 12-17 year olds have used cocaine
2.4%
How many 11-15 year olds have used cocaine?
0.5%
Which recreational drug misuse is declining?
Tobacco
Methamphetamine (speed)
LSD
Name some rating scales used in CAMHS
Connors Autism diagnostic interview (ADI-R) WISC Strength and difficulties questionnaire - SDQ Child behaviour checklist Child & adolescent functional assessment scale Childrens depression inventory Becks depression inventory CY-BOCS
What is Conners used for?
Obtain information from parents and teachers on ADHD sx.
What is ADI-R used for?
Structured interview used in research to obtain assessment of individuals suspected of having autism.
What is ADI-R useful for?
Formal diagnosis and treatment and educational planning
Composition of ADI-R
93 items focusing on language & communication, reciprocal social interactions, restricted & stereotyped intersts and behaviours
Who is WISC used for
<16 years of age
Structure of WISC
Verbal and performance subscales that yield a verbal, performance and fullscale IQ
What is SDQ?
Used to obtain information on variety of psychiatric sx.
Who is SDQ used in?
Children aged 4-16
What does the Child Behaviour checklist assess?
Range of sx related to social and academic competence in children 4-16 years of age.
Which diagnostic category is child behaviour checklist mainly used in?
Children with ODD or CD
Who is child behaviour checklist completed by?
Parents or others who know the child well.
Structure of child behaviour checklist
113 items in Likert fashion
What is the child & adolescent functional assessment scale?
Scale to assess degree of impairment in functioning due to psychiatric problems.
What does Child & Adolescent functional assessment measure?
Aggression and conduct problems in ages 7-17
Who completes the Child & Adolescent functional assessment measure?
Clinical staff
Takes 10 minutes
Who is Childrens Depression Inventory used on?
Children aged 7-17 years
Who is Beck Depression Inventory used on?
> 14 years
What type of tool is Beck Depression Inventory?
Screening
What is CY-BOCs
Paediatric version of Y-BOCs used to measure symptoms of childhood OCD
Who cited factors against childhood hospitalistino
Dalton et al 1989
Factors against childhood hospitalisation
Disruption of childs family and community relationships
Expenses incurred by family and services
Reinforcement of parent denial/guilt
Siblings confused and distorted perception of issues treated
Removal of child from continuum education
Predictable noxious stigma and labelling
Potential for unresolved transference and institutionalistion
Who proposed a set of admission criteria for children and need to remove children from home?
Hersov 1994
Admission criteria for hospitalisation of children?
Diagnostic work that cannot be obtained as OP
Severe psychiatric disorder with need for treatment by multiprofessional team in safe setting
Impaired physical status of child that requires skilled medical and nursing care
What are the criteria needed to remove a child from their home?
Adverse environmental circumstances that preclude childs improvement within home or severely distorted family interaction that leads to progressive interference with childs progress
Gross overprotection by parents after trauma/injury that precludes recovery
