Child Psychiatry

Question 1

When does reactive attachment disorder (RAD) start?

Answer 1

Before the age of 5

Question 2

Describe the 2 subtypes of reactive attachment disorder.

Answer 2

Inhibited - fail to initiate and respond to social interaction, avoidant and resistant to comforting, hypervigilant or highly ambivalent.
Disinhibited - opposite to inhibited, more enduring over time, indisciminate sociability or lack of selectivity in their choices of attachment figure.

Question 3

Describe the management for RAD.

Answer 3

Individual therapy
Family therapy
Special educational interventions
Meds for co-morbid disorder.

Question 4

What are potential causes for RAD?

Answer 4

Basically had a tough childhood

Neurodevelopmental difficulties e.g. autism spectrum disorder (ASD).

Question 5

What are the criteria for diagnosing conduct disorder (CD)?

Answer 5

3 in last 12 months with 1 in last 6 months:

1. Aggression to people or animals
2. Destruction of property
3. Deceitfulness or theft
4. Serious violation of the rules

Question 6

Describe mild-moderate conduct disorder.

Answer 6

Restricted to family environment.

Question 7

Describe the 2 types of severe conduct disorder.

Answer 7

Unsocialised - predominantly violent behaviour, more likely to be dealt with in the criminal justice system.
Socialised - more covert antisocial acts, less likely to be picked up by criminal justice system, usually higher cognitive ability.

Question 8

What are common co-morbidities of conduct disorder?

Answer 8

Attachment difficulties
ADHD
Reading/learning difficulties
Depression
Substance misuse
Deviant sexual behaviour

Question 9

What is the management of conduct disorder for people of different ages?

Answer 9

<11 years - parent/foster training
9-14 - child focused programmes e.g. social and cognitive problem solving programmes
11-17 - multimodal interventions
Medications (not main line)

Question 10

Describe the use of medication in conduct disorder.

Answer 10

To treat co-morbid condition
Can help with impulsivity and aggressive behaviour
Would give risperidone (atypical antipsychotic)

Question 11

What is the ADHD triad?

Answer 11

Inattention
Hyperactivity
Impulsivity

Question 12

What is the criteria for ADHD symptoms?

Answer 12

Are:
Developmentally inappropriate
Impairing functioning
Pervasive across settings e.g. home, school
Longstanding from the age of 5

Question 13

What is the aetiology of ADHD?

Answer 13

Multifactorial (genetics and environment)

More of a genetic link than conduct disorder.

Question 14

What is the association with ADHD and CD?

Answer 14

Present similarly and are highly co-morbid.

Question 15

What is a key difference between just ADHD and ADHD+CD?

Answer 15

ADHD+CD have higher rates of antisocial personality in adults.