Child psychiatry

Question 1

Definition of autism

Answer 1

Lifelong neurodevelopment condition characterised by a triad of impairments:
Social interaction
Communication
Restricted interests and behaviour

Question 2

Clinical features of autism split into triad of impairments

Answer 2

Social: few social gestures, lack of smile or eye contact, little interest in others
Communication: delayed speech, echolalia (repetition of words or noises)
Behaviour: repetitive behaviour; rigid in daily routine e.g same foods, same clothes; fascination with sensory aspects of environment

Question 3

Conditions associated with autism

Answer 3

Epilepsy (20%)
Visual or hearing impairment
Eating inedible objects
Sensory overload 
Other mental health disorders - anxiety, depression, OCD

Question 4

ICD10 criteria for autism

Answer 4

Triad of impairments

Impaired development <3 years old

Question 5

Difference between autism and Aspergers

Answer 5

Same triad of impairments

Asperger’s syndrome has no impairment in language, cognition or IQ

Question 6

Management of autism

Answer 6

BIOPSYCHOSOCIAL MODEL
Self communication intervention 
Psycho education 
Treat coexisting physical and mental health disorders 
Modify environment - plain and simple
Consider special schooling
Self help groups e.g national autistic society 
Melatonin for sleep disorders

Question 7

Core features of attention deficit hyperactivity disorder

Answer 7

Inattention
Hyperactivity
Impulsivity

Question 8

ICD10 criteria for ADHD

Answer 8

Abnormal attention, activity and impulsivity at home
Abnormal attention and activity at nursery/school
Directly observed abnormality of attention or activity
Onset <7 years old
>6 months duration
IQ >50

Question 9

Management of ADHD

Answer 9

BIOPSYCHOSOCIAL MODEL
Psycho education
Training for parents in discipline and reinforcing positive behaviour
CBT
Pharmacological management first line in severe school aged children

Question 10

Pharmacological management of ADHD

Answer 10

1st line: methylphenidate (Ritalin)

2nd line: atomoxetine

Question 11

Categories of LD defined by ICD10

Answer 11

Mild: 50-70
Moderate: 35-49
Severe: 20-34
Profound: <20

Question 12

Definition of learning disability

Answer 12

IQ <70
Onset <18 years old
At least 2 areas of limited adaptive functioning e.g self care, communication, organisation

Question 13

Conditions associated with LD

Answer 13

Incontinence
Motor disabilities
Epilepsy
Visual or hearing impairments 
Mental health disorders 
Related to specific cause of LD e.g early onset Alzheimer's disease

Question 14

Features of mild LD

Answer 14

Relatively independent but abstract concepts e.g time may be difficult

Question 15

Features of moderate LD

Answer 15

Can communicate but language is limited, need supervised self care and supported accommodation

Question 16

Features of severe LD

Answer 16

Marked degree of motor impairment, little or no speech, need 24 hour staffed accommodation

Question 17

Features of profound LD

Answer 17

Need 24 hour care, multiple medical problems

Question 18

Management of LD

Answer 18

Manage comorbid physical and mental health problems
Family education
Speech and language therapist
CBT
Positive behaviour reinforcement