Child Psych

Question 1

ASD Criteria

Answer 1

A. Deficits in social communication and interaction
- impaired social-emotional reciprocity
- deficits in non-verbal communication
- deficits in developing, maintaining or understanding relationships
B. Restricted, repetitive patterns of behaviour, interests or activities manifested by 2 or more of
- stereotyped/repetitive motor movements, use of objects or speech
- insistence on sameness, inflexible adherence to routine, ritualized patterns
- highly restricted, fixated interests with abnormal intensity or focus
- hyper/hyporeactivity to sensory input or unusual interest in sensory aspects
C. Symptoms must be present in early developmental period
D. impaired functioning
E. Not better explained by intellectual disability or global developmental delay

Question 2

Screening and management of ASD

Answer 2

M-CHAT at 18 and 24 months, screen for comorbids and audiological evaluation

Management 
Biological (only if needed) 
- antipsychotics 
- SSRI (compulsion, stereotypy) 
- methylphenidate
- melatonin 
Psychological 
- psychoeducation 
- ABA 
- speech-language therapy 
- occupational therapy 
- behaviour therapy 
- social skills training
- early interventions

Question 3

Intellectual Disability Criteria

Answer 3

A. Deficits in intellectual function
- confirmed by clinical assessment + standardized intelligence testing
B. Deficits in adaptive functioning
- causes failure to meet developmental and sociocultural standards for personal independence and social responsibility
- without support, limits functioning in st least one area of life
C. onset during developmental period

Question 4

Management of intellectual disability

Answer 4

Psych: Speech and language therapy, occupational therapy, functional living skills, behavioral interventions, physical therapy
Social: psychoeducation, social support

Question 5

ADHD criteria

Answer 5

At least 6 symptoms of inattention and/or hyperactivity-impulsivity for at least 6 months, onset prior to age 12, present in 2 or more settings

Question 6

Management of ADHD

Answer 6

Biological: stimulants, atomoxetine, alpha-2 agonists
Psychological: Psychoeducation, CBT, family therapy, behaviour modification
Social: liaise with school, exercise, balanced diet

Question 7

Anorexia nervosa criteria

Answer 7

A. restriction of energy intake relative to requirement leading to a significantly low body weight in the context of age, sex, development and physical health
B. intense fear of gaining weight/becoming fat OR persistent behaviour interfering with weight gain despite being at a significantly low weight
C. disturbance in the way they experience their body weight/shape, undue influence of it on self-evaluation or persistent lack of recognition of seriousness of LBW

Question 8

Assessment of eating disorders (history, physical, tests)

Answer 8

History: eating habits, binges, purges, past experiences with food, physical symptoms of malnutrition, cognitive changes, psych co-morbid
SCOFF screening
Physical
- general: cold intolerance, emaciation, lanugo hair, Russel’s sign, alopecia, dehydration
- vitals: postural BP
- fluid status
- thyroid, CVS, salivary/parotid glands, dentition, pedal oedema, muscle bulk, reproductive

Tests
- FBC, UEC, FBG, LFT, Creat, ECG, TFT, ABG, iron, vit D, hcg, DEXA (if underweight more than 6 months)

Question 9

Treatment of eating disorders

Answer 9

Medical stabilization:

• hospital admission indicated if less than 75% of expected body weight, bradycardic, BP <80/50, postural tachycardia, postural hypotension, QTC prolonged, temp <35.5, hyperkalemia, neutropenia, low blood sugar, suicidal ideation
• nutrition: caution with rate of refeeding, thiamine, phosphate
• psychoeducation
• family-based therapy
• interpersonal psychotherapy
• CBT

Question 10

Bulimia Nervosa criteria

Answer 10

A. Recurrent episodes of binge eating
- eating in a discrete period of time an amount of food definitely more than what most people would eat in a similar period under similar conditions
- a sense of lack of control over eating during it
B. Recurrent inappropriate compensatory behaviour sin order to prevent weight gain such as self-induced vomiting, misusing laxatives, diuretics, fasting, excessive exercise
C. Both A&B occur on average at least once a week for 3 months
D. Self-evaluation unduly influenced by body shape and weight
E. Disturbance does not only occur during episodes of anorexia nervosa

Question 11

Complications of bulimia

Answer 11

Electrolyte abnormalities, Dental erosion, mallory-weiss tears, esophageal rupture