Child and Adolescent Psychiatry

Question 1

What is separation anxiety disorder?

Answer 1

Child presents with excessive fear of separation from specific attachment figures e.g. parent/caregiver causing significant distress/functional impairment

Question 2

What are examples of separation anxiety disorder?

Answer 2

Thoughts of harm happening to parent
Reluctant to attend school
Reluctant to sleep apart from patent
Nightmares about separation

Question 3

How does school refusal present?

Answer 3

Tummy ache before school

Question 4

What is enuresis?

Answer 4

Voiding of urine into clothing/bed past the age of expected urinary continence (5 years)

Question 5

What is secondary enuresis caused by?

Answer 5

STRESS

Question 6

What is encopresis?

Answer 6

Repeated defecation in inappropirate places above the age of expected faecal incontinence (4yo)

Question 7

What is encopresis usually due to ?

Answer 7

Consitpation (overflow diarrhoea)

Question 8

What is the clinical presentation of autism?

Answer 8

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)

Question 9

What age is autism usually identified at?

Answer 9

3 years old

Question 10

What are differentials for autism?

Answer 10

• Untreated deafness
• Language development disorder
• Intellectual development disorder
• Neglect

Question 11

What is management for ASD?

Answer 11

• Carer support and Advice (National Autistic Society)
• Behavioural therapy (+ve reinforcement)
• Speech and language therapy
• School support

Question 12

What is ADHD?

Answer 12

TRIAD:
Inattention - hyperactivity - impulsivity for min 6 months
Starting in early childhood
Outside the limits of normal variation
Interfering with child’s functioning significantly

Question 13

Who is ADHD more common in?

Answer 13

Boys x3 more common than girls

Question 14

What does inattention mean?

Answer 14

Distractability, disorganised, difficulty concentrating on tasks that aren’t exceptionally stimulating

Question 15

What does hyperactivity mean?

Answer 15

Difficulty keeping still

Question 16

What are differentials for ADHD?

Answer 16

Organic (hearing impairment, epilepsy)
CDD
Agitation
Mania

Question 17

How do you treat ADHD?

Answer 17

Parent training programme
Group CBT, social skills training
Social support and self help for family

Medications (increase monoamine pathway) e.fg. methylphenidate, dexamfetamine

Question 18

What is conduct / dissocial disorder (CDD)

Answer 18

behavioural disorder
Occurs in adolescence
Behaviour violating basic rights of others or age-appropriate societal norms, rules or norms for >1 year
Truancy

Question 19

What is management for CDD?

Answer 19

Family therapy
Educational support
Anger management for child

Question 20

What are non-verbal cues for autism?

Answer 20

NON VERBAL e.g. eye contact, smiling, facial expression range

Question 21

What is the learning capability of someone with autism?

Answer 21

POOR - 75% have learning disability

Have UNUSUAL PREOCCUPATION /INTEREST e.g. know everything about trains

Question 22

What is the difference between ADS and Aspergers?

Answer 22

Asperger’s have high IQ and normal language

ASD have poor speech and low IQ

Question 23

What are differentials for Autism?

Answer 23

Deafness 
Asperger's 
Language disorder (delayed speech, normal IQ and social ability)
Learning disability 
Neglect

Question 24

What are Ix for Autism?

Answer 24

hearing test
Speech and language assessment
Sally and Anne test
Neurophysiological assessment

Question 25

What are presentations of depression in children that differ from adults?

Answer 25

Somatic symptoms (tummy ache)
Social withdrawal/school refusal/Decreased academic performance
Irritability

Question 26

How do you manage depression in children?

Answer 26

Mild-moderate: 3m of CBT, interpersonal therapy, family therapy, psychoeducation, manage environment stressors

Severe: same as above + antidepressants (less commonly given than in adults)

Question 27

What are common anxiety disorders in children?

Answer 27

Separation anxiety disorder

School refusal

Question 28

How do you treat anxiety disorders in children?

Answer 28

1. Psycho-education, CBT, behavioural therapy (systematic desensitisation, relaxation)
2. Medication - SSRI
3. Deal with problem!! e.g. bully in school

Question 29

What are medications for ADHD?

Answer 29

methylphenidate,

dexamfetamine

Question 30

What questionnaire can you do for ADHD?

Answer 30

Conner’s Rating Scale (to child, parents, school)

Question 31

How do you investigate ADHD?

Answer 31

Questionnaire
Stroop Test
Classroom observation
Educational Psychologist assessment

Question 32

What kinds of behaviour occur in conduct disorder?

Answer 32

Truanting
Stealing
Initiating fights
Destruction of property

Question 33

What is oppositional defiant disorder?

Answer 33

Repetitive and persistent pattern of defiant behaviour in YOUNGER children (<10)
Includes: severe tantrum, frequent anger, refusal to comply

Question 34

How do you manage conduct disorder/ODD?

Answer 34

Family education
Parent management training
Behavioural management (+ reinforcement for desired behaviour, ignore undesired behaviour)

Question 35

How do you manage tics

Answer 35

reassurance, education, stress management
clonidine (alpha2 agonist)
atypical antipsychotic