Child Psych + Intell Disability Flashcards
What is the definition of an intellectual disability?
- significantly sub-average intellectual function- IQ below 70
- Impaired adaptive behaviour for person’s age
- Onset of intellectual impairment before 18yo
- IQ is used for defining (ICD/ DSM) severity of impairment from mild to profound. IQ is coupled with adaptive functions e.g. ability to communicate, perform ADLs. Mild learning disability is most common of all types.
What is the epidemiology and aetiology of intellectual Disabilities?
M>F
Higher rate in low SES
Associated with overcrowding, poverty, irreg unskilled employment (i.e. social and economic deprivation)
Some genetic/chromosomal causes- Downs, Fragile X Syndrome (abnormal chr X), Phenylketonuria, Tuberous Sclerosis (deletion tumour suppressor gene chr9)
Mild Learning Disabilities account for the majority of Learning Disabilities
pre-natal causes- pre-eclampsia, FAS, infections e.g. CMV
peri-natal causes- birth trauma + hypoxia, hyperbilirubinaemia, intraventricular haemorrhage
post-natal causes- malnutrition, abuse, brain infection, head injury, chronic lead poisoning
Rates of mental illness 3x higher
High rate of comorbid epilepsy
Give examples of some of the professionals involved in the management of people with Moderate- Severe intellectual disabilities.
psychiatrists, OTs, PTs, music therapist, speech + language therapist, social worker, community nurse, support staff
What are the major risks to be covered in people with Intellectual Disability?
- Self- Suicide, Self-Harm, Exploitation/ Harm from others
- Others- Harm to others
- Damage to property
What are the 3 classical impairments seen in Autism?
- Social Interaction
- Communication
- Imagination/ Repetition/ Routines
Often child is aloof, poor eye contact, poor engagement with parents or other children, no imaginative play, rigid routines, many are non-verbal, poor non-verbal communication, difficulty with abstraction, have restricted interests and repetitive behaviours.
What are the features of Aspergers?
Physically clumsy, lack of common sense in social interactions, many above average IQ/ highly intelligent, monotonous, long monologues even w/o response, poor identification of emotions
How is Autism managed?
Refer children with any regression in language or motor skills and any with symptoms that have a significant impact on their functioning.
- provide visual supports for their communication
- personal quiet space to perform rituals which considers sensitivity to stimulation e.g. lighting
- each day to be organized and explained
- organized physical activities
- treatment of epilepsy or other physical problems
- appropriate content of activities- not beyond their capability
- approach to obsessions: aim is to reduce freq gradually with consistent immediate positive reinforcement
- setting limitations on disruptive behaviour: gain attention of individual, short easy to understand commands, warn before interruption, let tantrum run to end.
- counsel parents, aggressive outbursts usually to do with environment, usually not suited to meds.
- psychosocial therapies for challenging behaviour. If this fails, consider antipsychotics stopping if no response in 6w. Not to be used in management of core features only.
- Family and carer support.
What is the prognosis of autism?
life-long condition that does not limit lifespan which improves with age. Better outcome if higher intelligence and early speech. Does not develop into schizophrenia. 50% have intellectual Disability. Many have comorbid psych conditions that often remain unrecognized.
what is the epidemiology and aetiology of dyslexia?
Prevalence debated. Widest definition 10%, most severe form 4%
M:F 4:1
may present with secondary behavioural problems
characterized by problems processing and prod written materials out of keeping with person’s skills in other areas
aetiology: genetic, Neurotransmitters, brain injury, social/psychological factors
what is the epidemiology and aetiology of autism?
Broadest definition 1 in 100; Kanner’s definition 1 in 1000
M:F 4:1
Aetiology:
Brain injury, neurotransmitters
genetics
psychological/ social factors- affect how it presents and how patient copes with condition.
What is the prevalence and aetiology of ADHD?
1-5%
M:F 3:1
onset <7 yo
Aetiology: genetic, brain injury, Neurotransmitters, certain foods?, psychological/social
How do adolescent presentations differ from adult presentations of mental illness?
- social context: more fixed in adolescents- they are at the mercy of what the adults around them provide
- self- harm extremely common
- helpful to get parents perspective provided person consents.
- REMEMBER ABUSE may underlie the symptoms they are presenting with.
How does the management of mental illness in children/ adolescents differ from that in adults?
meds less well evidenced that they are effective in this agegroup therefore less commonly used (also recommended that specialists only make prescribing decision bc risk suicide on antidepressants partic SSRIs. Recommended Fluoxetine only)
psychological therapy mainstay of tx partic CBT, family therapy
social - v imp with links to education and social services
What is the management for ADHD?
Initially watchful waiting for 10w (if not severe at presentation) and referral to parenting course. If moderate impairment persists refer to 2ndary care e.g. CAMHS.
1. Biological- reserved primarily for those with severe symptoms and for those who are in school. Not recommended for mild symptoms or in pre-school children. (only secondary care should prescribe for ADHD)
Methylphenidate is first line (stimulant)
Atomoxetine is second line (non-stimulant)
Close monitoring req particularly for Atomoxetine for irritability, agitation, self-harm, suicidal thoughts
2. Psychological- parenting course
3. Social- Liaison with school for special needs
How old does a child have to be legally allowed to make decisions for themselves (provided they have capacity)?
16 but according to GMC you should encourage them to involve their parents in their decision making. Also, if they refuse treatment that you deem to be beneficial e.g. life saving then you should seek professional and legal advice ( this applies if their parents consent/ refuse the tx)
Could also detain them under MHA but only if they lack insight to mental health condition.
