Child & Adolescent Psychiatry Flashcards
In the following domains, give some factors that can predispose mental health problems in children: child, family, environment
Child: • Male • Sensory impairment • Physical illness • Developmental delay • Genetics
Family: • Family breakdown/conflict • Separation/death and loss • Abuse/neglect, Inconsistent discipline • Large families >4 children • Parental psychiatric illness
Environment: • Inner city • Overcrowding • Poor social support • Criminality
Give the developmental milestones for the following: eye contact/follows face, smiles responsively, reaches for objects, good head control when sitting, turns to a voice
Eye contact/follows face
- 1-4 weeks (limit age: 3 months)
Smiles responsively
- 4-6 weeks (limit age: 8 weeks)
Reaches for object
- 4 months (limit age: 6 months)
Good head control when sitting
- 4 months (limit age: 6 months)
Turns to a voice
- 7 months (limit age: 9 months)
Give the developmental milestones for the following: tuneful babble, sits unsupported, pincer grip, walks independently, builds two cubes, first word
Tuneful babble
- 5-6 months (limit age: 10 months)
Sits unsupported
- 7-8 months (limit age: 10 months)
Pincer grip
- 9-10 months (limit age: 15 months)
Walks independently
- 11-13 months (limit age: 18 months)
Builds two cubes
- 13-15 months (limit age: 19 months)
First word
- 8-18 months (limit age: 2 years)
Which conditions come under the autism spectrum disorder?
It is a developmental disorder which includes: childhood autism, atypical autism, Asperger’s syndrome
Define autism spectrum disorder
Developmental disorder with abnormalities in quantitative ( number of responses) and qualitative impairment (how they say things) in:
- Reciprocal social interactions
- Verbal and nonverbal communication
- Restricted and repetitive behaviours or interests
Explain the aetiology of autism spectrum disorder using a bio-psycho-social model
Biological:
o Obstetric complications
o Perinatal infection e.g. maternal rubella
o Genetic disorders (e.g tuberous sclerosis, down syndrome, fragile X)
Psychological:
o NOT parenting styles
o Severe psychological deprivation and neglect
Social:
o Parents are both engineers
o Diet and pollutants
Detail the 3 key features of clinical presentation of autism spectrum disorders
Reciprocal Social Interaction
• Not interested in people, tend to play alone
• Lack the ability to read the emotional states of others
• Eye contact avoidant
Communication Abnormalities
• Expressive speech and comprehension are delayed or minimal
• Ideas are taken literally (concrete thinking)
• Gestures are usually absent (e.g. pointing, waving goodbye)
• Speech may consist of monologue, interminable questions and echolalia (repeating what has been said)
Restricted Behaviours and Routine
• Characterised by repetitive, stereotypes behaviours and restricted interests (rather than imaginative play)
• Small changes in routine (e.g. using the wrong spoon) can result in intense tantrums
Additionally: children often have learning disabilities, seizures, and overactive behaviour
How does Asperger’s syndrome differ from autism in terms of clinical presentation?
- Poor social skills and restricted interests
- But NORMAL language and IQ
- Tendency to literal interpretation of language and difficulty in reading social cues
Give some differentials for autism
o Deafness (causing poor language acquisition)
o Asperger’s syndrome
o Specific language disorder (delayed speech with normal IQ and social ability)
o Learning disability (IQ problems but relatively intact social skills)
o Rare disorders (e.g. childhood schizophrenia, Rett’s syndrome)
o Neglect (can lead to language delay and poor socialisation)
Give some investigations for autism spectrum disorders
- Hearing tests
- Speech and language assessment
- Neuropsychological testing- assess IQ and confirm diagnosis
- ADOS: Autism diagnostic observation schedule: Observation of child, set tasks (play based)
- ADI-R: autistic diagnostic interview revised (questionnaire)
Outline a management plan for autism using a bio-psycho-social model
Social
- Support and advice for families (e.g National Autistic Society)
Psychological
- Behavioural therapies (e.g ABC approach: reinforce positive behaviours)
- Special education
Biological
- Treat comorbid problems (e.g epliepsy)
- Speech and language therapy
- Antipsychotics or mood stabilisers OCCASIONALLY used for extreme aggression or hyperactivity
Involving parents in the therapy plan and ensuring that they gain an understanding of the disorder and what works best for each child is VITAL
Outline a management plan for asperger’s syndrome
- Advice and support
- Routine
- Social skills training
What do you need to particularly look out for when considering depression in children/adolescents?
Presentation is similar to adults, although children mainly present with:
- Somatic problems (e.g headaches, tummy aches)
- Deteriorating school performance
- Changes in social functioning
What is the treatment for depression in children/adolescents?
• 1st line: CBT
• Antidepressants are only used in severe cases
o Fluoxetine is the safest option in children
How does anxiety usually present in children/adolescents?
- Separation anxiety disorder
- School refusal
What is the main treatment for anxiety in children/adolescents?
Psychological therapies (counselling, CBT)
What is enuresis?
Involuntary urination, especially at night
Can be primary (toilet training was never mastered) or secondary (dryness achieved for at least 1 year but has been lost)
Outline the management for enuresis
- Refer organic causes to paediatricians (e.g. epilepsy, UTI, diabetes)
- Reassure the family and the child that the problem is common and no one’s fault
- Address stressors and review toilet training received so far
- Restrict fluids before bed
- Star charts to celebrate each dry night (positive reinforcement)
- Bell and pad (clips onto the pyjamas and wakes the child if the moisture is detected)
- Medication (e.g. imipramine (TCA) or desmopressin (ADH))
What is encopresis?
Inappropriate defecation after the age of 4
Most cases relate to constipation (overflow incontinence)
Give some causes of constipation causing encopresis
o Dehydration
o Painful defecation (e.g. anal fissure)
o Fear of punishment
o Toilet fears (e.g. monsters)
o Hirschsprung’s disease (rare - bowel obstruction due to an aganglionic section of colon)
Outline the management for encopresis
- Laxatives (if constipated)
- Reassure, address stress and review toilet training
- Star charts
Give 2 examples of behavioural disorders
- ADHD (attention deficit hyperactivity disorder)
- Conduct disorder
Define ADHD
A hyperkinetic disorder, in which problems must be present by the age of SIX, for at least SIX months, being persistent and pervasive across DIFFERENT social situations
Outline the clinical triad of ADHD
- Hyperactivity (3+ of): o Fidgets or squirms o Leaves seat o Excess running about o Unduly noisy o Excess motor activity (in adults: restlessness)
- Inattention (6+ of): o Fails to: o Sustain attention o Follow-through on instruction/work o Listen o Careless errors o Avoids tasks requiring mental effort o Lose things o Easily distracted o Forgetting, poor planning (esp. adolescents/adults)
- Impulsivity (1+ of) o Blurts out answers o Fails to wait in lines/their turn o Interrupts or intrudes others o Excess talking o In adults: poor self-control, risk-taking
