Child and adolescent psychiatry

Question 1

when are the features of autism usually observable in a child?

Answer 1

< 3 years old

Question 2

what is the prevalence of autism in males vs females?

Answer 2

M:F
3:1

Question 3

What are the distinctive features of autism?

Answer 3

social reciprocity and communication;

reduced/ inability for reciprocal conversation and showing emotional concern 
non-verbal communication 
- declarative pointing
- modulating eye-contact 
- unable to recognise facial expressions

repetitive behaviours;

• obsessions, preoccupation and interests
• may be out of enjoyement or a way to cope with anxiety
• routines, rituals

Question 4

what two factors affect the variation in the features of autism in each individual?

Answer 4

age

IQ

Question 5

what clinical problems are associated wit autism?

Answer 5

learning disability 
sutured sleep and eating habits 
hyperactivity
high levels of anxiety and depression
OCD
school avoidance
aggression
temper tamtrums
self-injury
suicide

Question 6

what congenital & genetic disorders are associated with autism?

Answer 6

rubella
callosal agenesis
down syndrome
fragile X 
tuberous sclerosis

Question 7

how is autism managed?

Answer 7

recognition, description and acknowledgement of the disability
establishing needs
appreciating their cant’s and wonts
decrease the demand / expectations
psychopharmacology (for irritability, hyperactivity, aggression)

Question 8

what are the differences between oppositional defiant disorder and ADHD?

Answer 8

ODD relates to temperament where ADHD relates to hyperactivity and inattention
behaviour is learned in ODD where ADHD has a strong genetic component
ODD behaviours are enacted to sustain a desired goal where ADHD they have poor cognition and inability to sustain a goal
ODD more likely to result from poor parenting
ODD often shows vindictive acts where ADHD show remorse

Question 9

what are the management options for hard to manage children?

Answer 9

parent training programme

multi-systemic therapy

Question 10

what are hard to manage children i.e. ODD at risk of in adult life?

Answer 10

ADHD
antisocial behaviour
long-term mental health problems

Question 11

what is the role of the amygdala and generalised anxiety disorder in children and adolescents?

Answer 11

we manage to control our emotions through connections with the amygdala and the ventrolateral cortex
these connections are lost in GAD so they become anxious when they can’t control emotions

Question 12

what are the management options for GAD in adolescents/children?

Answer 12

behavioural therapy
CBT
medication - SSRI
psychoeducation

Question 13

what are the 2 main types of anxiety disorders in children/adolescents?

Answer 13

separation anxiety

social phobia

Question 14

what mental health problems are associated with being out of school?

Answer 14

depression
anxiety
OCD
conduct disorder
autism

Question 15

what are the features of ADHD?

Answer 15

abnormal inattention
hyperactivity
impulsivity
present across time and situations

Question 16

what are the management options for ADHD?

Answer 16

psychopharmacology i.e. methylphenidate

parenting training
psychoeducation
school interventions

Question 17

what co-morbid problems are found along side ADHD?

Answer 17

depression and anxiety
motor coordination problems
substance misuse

Question 18

what is the 1st line and 2nd line medication treatments for ADHD?

Answer 18

methylphenidate

atomoxetine

Question 19

what is methylphenidate used to treat and what are the side effects?

Answer 19

ADHD

weight loss
appetite suppression
insomnia

Question 20

what are the features of conduct disorder?

Answer 20

repetitive, persistant patterns of antisocial, aggressive or defiant behaviours which violate age-appropriate norms

Question 21

what are the management options for conduct disorder?

Answer 21

parenting training programme
modification of school environment
family therapy 
anger management 
multi-systemic therapy

Question 22

if a child/ adolescent tried to commit suicide, what would be the management steps?

Answer 22

admit to the ward for medical treatment and psychosocial assessment
mental health and risk assessment
referral to agencies i.e. CAMHS, child protection

Question 23

what factors increase the risk of suicide?

Answer 23

depression
persistant suicidal thoughts 
high lethality of method used 
high suicidal intent and motivation 
ongoing precipitating illness
poor physical health 
mental disorder 
impulsivity, narcissism, low self esteem
parental psychopathology and suicidal behaviour 
physical and sexual abuse 
disconnection from support  systems

Question 24

which regards to white matter connectivity, how does this influence the development of ADHD?

Answer 24

in ADHD, the white matter connectivity between the hippocampus and anterior cingulate is reduced
this results in more noise in the system resulting in poor concentration and distractibility

Question 25

what is delay-aversion?

Answer 25

inability to wait and maintain attention in the absence of immediate reward
associated with ADHD