Child psychiatry

Question 1

What is the epidemiology of ASD?

Answer 1

M:F = 3:1

1 in 1000 children

Question 2

What are the causes of ASD?

Answer 2

Genetic: heritability of 56-96% (de novo, inherited, syndrome)
Prenatal
Perinatal
Immunological

Question 3

What are the features of ASD?

Answer 3

Deficits in social & communication skills: poor verbal (speech delay, pronoun reversal) & non-verbal communication (expression, eye contact), weak social awareness, weak empathy, egocentric, see parts but not whole
Rigid & repetitive stereotyped behaviors: insistent on sameness, stereotyped behaviors & interest (know a lot about an interest), unusual preoccupation, x imaginative play, sensory problems (hyper/hypo)

Question 4

How to manage ASD?

Answer 4

Psychoeducation & ongoing support
Training (involve parents): social skills & stories, behavioral modification
Emotional regulatory skills
Education support: SCCC, ICCC, early education & training centre
Parenting skills & stress
Med for mood & ADHD

Question 5

What is the red flag sx for ASD?

Answer 5

Rapid deterioration of social +/- language skills before 2yo

Question 6

What is the prognosis of ASD?

Answer 6

Lifelong
Poor prognosis: only 1-2% achieve full independence
Higher IQ -> higher ability to adapt, but most do worse than normal ppl w/ similar IQ

Question 7

What is ADHD?

Answer 7

Co-existence of inattention, chaotic overactivity, impulsivity
Inappropriate to age + impaired functioning

Question 8

How to diagnose ADHD?

Answer 8

Inattention (6 for 6m): make mistakes, x listen, x organize, x follow instructions, distractible, forgetful, loses things, x sustain attention, avoids/dislikes activities requiring sustained mental effort
Hyperactivity & impulsivity (6 for 6m): fidget/squirm, x stay seated, on the go, talk excessively, run/climb inappropriately, x play quietly, blurt out answer before question is finished, interrupt, x wait

Before 12yo + in 2 or more settings
Impaired functioning

Question 9

What are the causes of ADHD?

Answer 9

Genetic: 80% heritability
Acquired: pre/perinatal (fetal alcohol syndrome, maternal smoking, birth complications, hypoxia, brain injury)

Question 10

What is the epidemiology of ADHD?

Answer 10

M:F = 3:1

Question 11

How to manage ADHD?

Answer 11

Psychoeducation, CBT, social skills training
Behavioural strategies for impulsivity
Pharm: methylphenidate (stimulant), atomoxetine (SSRI)
Educational needs e.g. take breaks during exam