Child and adolescent psychiatry

Question 1

Psychiatric disorders of children and adolescents are divided into what 4 broad categories?

Answer 1

1) Mental retardation (learning disability)
2) Developmental disorders (specific and pervasive)
3) Acquired disorders with onset usually in childhood or adolescence
4) Acquired ‘adult’ disorders with onset in childhood or adolescence

Question 2

Define “learning disability”

Answer 2

This condition describes the failure to develop a normal level of cognition rather than the loss of it, such as in dementia

Question 3

What is cognition in relation to learning disabilities measured in?

Answer 3

Intelligence quotient (IQ)

Question 4

What level of cognition is said to be subaverage?

Answer 4

IQ

Question 5

As well as impaired cognition what should a patient have to be diagnosed with a learning diability?

Answer 5

Significant impairment in adaptive functioning (communication, self care, social skills, academia etc)

Question 6

What are the classifications of learning disability according to ICD-10?

Answer 6

1) Mild
2) Moderate
3) Severe
4) Profound

Question 7

What qualifies as a mild learning disability (LD)? (also state % of all LDs)

Answer 7

(85%) IQ 69-50
1) usually capable of unskilled or semi-skilled manual labour
and
2) may be able to live independently

Question 8

What qualifies as a moderate learning disability (LD)? (also state % of all LDs)

Answer 8

(10%) IQ 49-35

1) language, self care and comprehension are limited and usually needs supervision
2) may be able to do some practical work with supervision

Question 9

What qualifies as a severe learning disability (LD)? (also state % of all LDs)

Answer 9

(3-4%) IQ 34-20

1) needs substantial care, limited motor skills and speech.
2) capable of only very basic self care

Question 10

What qualifies as a profound learning disability (LD)? (also state % of all LDs)

Answer 10

(1-2%) IQ

Question 11

What is the prevalence of LDs in the general population? (and what is the M:F)

Answer 11

12% (M:F 1.5:1)

Question 12

What are the two main types of developmental disorder?

Answer 12

1) Specific

2) Pervasive

Question 13

What are the three traits of autism? (when do they manifest?)

Answer 13

(manifest in the first 3 years of life)

1) Impairment of social interaction – poor eye contact, facial expressions, failure to share and enjoy peer relationships
2) Impairment in communication – poor spoken language, extreme difficulty initiating and sustaining conversation, lack of imaginative play
3) Restricted, stereotyped interests and behaviours – intense preoccupation with interests such as dates, phone numbers, timetables etc, inflexible adherence to routines and rituals, repetitive motor movements such as clapping and an unusual interest in parts of hard or moving objects.

Question 14

What % of autistic pts have mental retardation?

Answer 14

75%

Question 15

What % of autistic pts develop epilepsy?

Answer 15

20-30%

Question 16

What is the prevalence of autism?

Answer 16

0.05%

Question 17

How does autism affect the sexes differently?

Answer 17

1) a male to female ratio of 3-5:1

2) but females are more seriously affected

Question 18

What is the prognosis of autism?

Answer 18

1) Poor
2) Only 1-2% achieve full independence
3) 20-30% of patients achieving partial independence

Question 19

What are the good prognostic factors for autistic children?

Answer 19

1) IQ above 70
2) Good language development by the age of 5-7
3) The home environment is supportive with good family education and support

Question 20

What is the difference between autism and Asperger’s syndrome?

Answer 20

there is no abnormalities in language acquisition and ability or in cognition development and intelligence in Asperger’s

Question 21

What broad term does Asperger’s fall under?

Answer 21

Autistic spectrum

Question 22

Describe the course of Rett’s syndrome.

Answer 22

Normal development at birth up to around 5 months. This is followed by a progressive and destructive encephalopathy from 6 months to 2 years of age.

Question 23

What is the gender ratio of Rett’s syndrome?

Answer 23

Almost only ever seen in girls.

Question 24

What are the symptoms of Rett’s syndrome?

Answer 24

1) loss or lack of language development
2) loss of fine motor skills
3) incontinence
4) profound muscle wasting plus rigidity

Question 25

Describe the course and symptoms of Child disintegrative disorder (Heller’s syndrome).

Answer 25

1) More common in boys
2) Characterised by around two years of normal development followed by a loss of previously acquired skills (language, social, adaptive, bowel and bladder control, and motor skills) before the age of 10
3) It is also associated with autism like impairment of social interaction and repetitive stereotyped interests and mannerisms.

Question 26

Which two categories can acquired LD’s be split into?

Answer 26

1) Those specifically developing in childhood

2) Those that are ‘adult’ psychiatric disorders that have a childhood onset

Question 27

What age does ADHD/ hyperkinetic disorder usually begin before?

Answer 27

6-7 years old

Question 28

What is are the important criteria required to make a diagnosis of ADHD?

Answer 28

1) symptoms are evident in more than one situation i.e. at school and at home
AND
2) symptoms are present for at least 6 months

Question 29

What is prevelance of ADHD in school aged children in the UK?

Answer 29

1%

Question 30

What is the M:F ratio of ADHD?

Answer 30

6:1

Question 31

What is the 1st line pharmacological treatment for children with ADHD? (how effective are they?

Answer 31

CNS stimulants such as:
1) methylphenidate (Ritalin)
2) dexamphetamine
(highly effective in ¾ of children)

Question 32

What % of children with ADHD have symptoms persisting into adulthood?

Answer 32

15%

Question 33

What ages does conduct disorder usually affect children?

Answer 33

Boys by the age of 10-12

Girls by 14-16

Question 34

What psychiatric issues may children with conduct disorder go on to develop?

Answer 34

1) antisocial personality disorder

2) substance related problems

Question 35

What is opposition defiant disorder?

Answer 35

a pattern of defiant and hostile behaviour that does not violate the law or basic rights of others

Question 36

What are emotional disorders? (what is the prognosis like?)

Answer 36

1) Disorders that revolve around anxiety and depression.

2) seldom persist into adult life 3) Tend to have a good prognosis.

Question 37

What treatment is used in emotional disorders?

Answer 37

The treatment of these disorders is focused on behavioural and family therapy

Question 38

Give 4 examples of emotional disorders and their usual age of onset.

Answer 38

1) Separation anxiety – normal in 6 months to 2 years
2) Phobic anxiety
3) Social anxiety – normal between 8 months and 1 year
4) Sibling rivalry – normal immediately after birth

These disorders are diagnosed when the response seems exaggerated.