Child and Adolescent Psychiatry

Question 1

what is developmental psychopathology?

Answer 1

Developmental psychopathology is an approach or field of study designed to better understand the complexities of human development.

Question 2

adverse childhood experiences are more common among:

Answer 2

• girls or children assigned female at birth
• racial or ethnic groups classified as a minority
• children who experience socioeconomic challenges
• children of parents or caregivers who experience stress
• children who have family members or friends diagnosed with substance use disorder or a mental health condition

Question 3

what investigations are used to diagnose ADHD in children?

Answer 3

• history - developmental, sleep, school, family and social
• from child and parents
• examination
• assessment tools: Vanderbilt’s, Conners Q to P&T
• reports from teachers and other involved adults
• consider the impact of difficulties on child and family
• consider formulation

Question 4

what is the treatment for children with ADHD?

Answer 4

• ADHD focused parenting program - parents in control PINC
• school adjustements
• assess comorbidities, autism, tics
• medications - need to monitor height, weight, pulse, BP, rule out FH of sudden cardiac death or any fatigue/SOB/syncope on exercise
• Methylphenidate 1st line
• Lisdexamfetamine 2nd line
• Atomoxetine/Guanfacine 3rd line

Question 5

what are motor/phonic tics?

Answer 5

Brief, repetitive, patterned and non-rhythmic movements or vocalisations sometimes performed in response to premonitory urges.
- simple - blinking, grunting
- complex - gestures, words and phrases

Question 6

how is tourettes syndrome classified?

Answer 6

presence of motor and phonic tics for at least one year

Question 7

Tourette’s syndrome epidemiology

Answer 7

• 1% of population
• more common in boys 5:1
• onset in the developmental period 4-6 years with peak at 8-12 years

Question 8

how are Tics assessed?

Answer 8

• diagnosis based on history and normal examination
• tools include Yale Global Tic Severity scale
• investigations not required

Question 9

non-pharmacological treatment on tics

Answer 9

• comprehensive behavioural intervention for tics (CBIT).
• exposure and response prevention (ERP), habit reversal training (as a stand-alone therapy) and CBT.

Question 10

pharmacological treatment for tics

Answer 10

• alpha-2 adrenergic agonist > Clonidine and Guanfacine (Intuniv)
• atypical antipsychotics
• Physicians in the United Kingdom can prescribe medications off-label. According toGeneral Medical Councilguidance, the physician must be satisfied that there is sufficient evidence or experience of using the medicine to demonstrate safety and efficacy.
• Typical antipsychotics
• Botulinum toxin
• Deep Brain stimulation

Question 11

what is used for diagnosis of a child with suspected autism?

Answer 11

• history and exam
• Vanderbilt and SRS2 questionnaire
• school report +/- observations
• ADOS 2
• speech and language assessment