Child and Adolescent Psychiatry Flashcards
What is separation anxiety disorder?
Child presents with excessive fear of separation from specific attachment figures e.g. parent/caregiver causing significant distress/functional impairment
What are examples of separation anxiety disorder?
Thoughts of harm happening to parent
Reluctant to attend school
Reluctant to sleep apart from patent
Nightmares about separation
How does school refusal present?
Tummy ache before school
What is enuresis?
Voiding of urine into clothing/bed past the age of expected urinary continence (5 years)
What is secondary enuresis caused by?
STRESS
What is encopresis?
Repeated defecation in inappropirate places above the age of expected faecal incontinence (4yo)
What is encopresis usually due to ?
Consitpation (overflow diarrhoea)
What is the clinical presentation of autism?
TRIAD
- social communication (delayed speech and comprehension, takes ideas literally, monologue, echolalia)
- social interaction (not interested in people, struggle too reciprocate social interaction, cannot develop relationships, no appreciation for social cues, poor NON VERBAL e.g. eye contact, smiling, facial expression range)
- repetitive interest, behaviours (play games repetitively rather than creatively, stereotyped motor mannerisms eg swaying back and forth)
Other (sensitivity to touch, taste, sound, smell> cause anxiety and discomfort)
What age is autism usually identified at?
3 years old
What are differentials for autism?
- Untreated deafness
- Language development disorder
- Intellectual development disorder
- Neglect
What is management for ASD?
- Carer support and Advice (National Autistic Society)
- Behavioural therapy (+ve reinforcement)
- Speech and language therapy
- School support
What is ADHD?
TRIAD:
Inattention - hyperactivity - impulsivity for min 6 months
Starting in early childhood
Outside the limits of normal variation
Interfering with child’s functioning significantly
Who is ADHD more common in?
Boys x3 more common than girls
What does inattention mean?
Distractability, disorganised, difficulty concentrating on tasks that aren’t exceptionally stimulating
What does hyperactivity mean?
Difficulty keeping still
What are differentials for ADHD?
Organic (hearing impairment, epilepsy)
CDD
Agitation
Mania
How do you treat ADHD?
Parent training programme
Group CBT, social skills training
Social support and self help for family
Medications (increase monoamine pathway) e.fg. methylphenidate, dexamfetamine
What is conduct / dissocial disorder (CDD)
behavioural disorder
Occurs in adolescence
Behaviour violating basic rights of others or age-appropriate societal norms, rules or norms for >1 year
Truancy
What is management for CDD?
Family therapy
Educational support
Anger management for child
What are non-verbal cues for autism?
NON VERBAL e.g. eye contact, smiling, facial expression range
What is the learning capability of someone with autism?
POOR - 75% have learning disability
Have UNUSUAL PREOCCUPATION /INTEREST e.g. know everything about trains
What is the difference between ADS and Aspergers?
Asperger’s have high IQ and normal language
ASD have poor speech and low IQ
What are differentials for Autism?
Deafness Asperger's Language disorder (delayed speech, normal IQ and social ability) Learning disability Neglect
What are Ix for Autism?
hearing test
Speech and language assessment
Sally and Anne test
Neurophysiological assessment
What are presentations of depression in children that differ from adults?
Somatic symptoms (tummy ache)
Social withdrawal/school refusal/Decreased academic performance
Irritability
How do you manage depression in children?
Mild-moderate: 3m of CBT, interpersonal therapy, family therapy, psychoeducation, manage environment stressors
Severe: same as above + antidepressants (less commonly given than in adults)
What are common anxiety disorders in children?
Separation anxiety disorder
School refusal
How do you treat anxiety disorders in children?
- Psycho-education, CBT, behavioural therapy (systematic desensitisation, relaxation)
- Medication - SSRI
- Deal with problem!! e.g. bully in school
What are medications for ADHD?
methylphenidate,
dexamfetamine
What questionnaire can you do for ADHD?
Conner’s Rating Scale (to child, parents, school)
How do you investigate ADHD?
Questionnaire
Stroop Test
Classroom observation
Educational Psychologist assessment
What kinds of behaviour occur in conduct disorder?
Truanting
Stealing
Initiating fights
Destruction of property
What is oppositional defiant disorder?
Repetitive and persistent pattern of defiant behaviour in YOUNGER children (<10)
Includes: severe tantrum, frequent anger, refusal to comply
How do you manage conduct disorder/ODD?
Family education
Parent management training
Behavioural management (+ reinforcement for desired behaviour, ignore undesired behaviour)
How do you manage tics
reassurance, education, stress management
clonidine (alpha2 agonist)
atypical antipsychotic
