Child Psychiatry Flashcards
Define Autism
Pervasive developmental disorder characterised by triad of: impairment in social interaction, communication and restricted/stereotyped interests
Give three PRENATAL risk factors for Autism
Genetics
Parental Age >40
Sodium Valproate usage
Give three ANTENATAL risk factors for Autism
Hypoxia at birth
Prematurity
Low birth weight
Give a POSTNATAL risk factors for Autism
Toxins such as lead/mercury/pesticides
How might the ‘Asocial’ component of the Autism triad present?
Few social gestures, lack of eye contact, lack of emotional expression
How might the ‘Restricted Behaviour’ component of the Autism triad present?
Repetitive and stereotyped
Upset at any change in routine
Obsessively pursued interests
How might the ‘Impaired Communication’ component of the Autism triad present?
Distorted and delayed speech
Echolalia (repeated words)
Name three conditions associated with Autism
Epileptic seizures
Visual impairment
OCD
Describe the ICD10 criteria A-E for Autism
A - Presence of abnormal/impaired development before the age of three
B - Qualitative abnormalities in social interaction
C- Qualitative abnormalities in communication
D - Restrictive/Repetitive stereotyped behaviours
E - Clinical picture not attributable to anything else
Describe the Appearance, Speech and Thought of a patient with suspected Autism
Appearance - ritualised/stereotyped behaviours, clapping, rocking, poor eye contact
Speech - delayed, repetitive, unusual rate and rhythm
Thought - Obsessions and Compulsions, intense preoccupations
Describe the expected Perception, Cognition and Insight of a patient with suspected Autism
Perception - may be sensitive to noise/touch/ smell
Cognition - Impaired attention but can concentrate on special interests
Insight - may be poor
At what age should a child turn towards sound?
3 months
At what age should a child know and respond to own name?
12 months
What age should a child combine two words?
2 years
At what age should a child be smiling?
6 weeks to 10 weeks
At what age should a child play with other children?
4 years
Name two investigations you could do for a child with suspected Autism
Hearing tests
CHAT - Checklist for Autism in Toddlers
Aspergers Syndrome is a differential for Autism. Describe three clinical features
Abnormalities in social interaction
No impairment in language/cognition or intelligence
More prevalent in boys
Rett’s Syndrome is a differential for Autism. Describe three clinical features
Severe progressive disorder starting in early life
Language impairment, stereotyped hand movement
Irregular breathing
Hellers Syndrome is a differential for Autism. Describe the clinical features
AKA Childhood Disintegrative Behaviour
Two years of normal development followed by loss of previously learned skills
When can a diagnosis of Autism be reliably made?
At the age of 3 by a specialist
Describe the Psychological management of Autism
CBT (if able to engage and is motivated)
Describe the sociological management of Autism
All diagnosed should have a key worker
Specialist schooling if necessary
Families should be offered support
Describe the potential biological managements of Autism
Antipsychotics (Risperidone)
Melatonin (Sleeping difficulties)
Define Hyperkinetic Disorder/ADHD
Early onset persistent pattern of Inattention, hyperactivity and impulsivity
When is the typical onset of ADHD?
Between ages of 3-7
Describe the four potential aetiologies of ADHD
Genetic (DRD4 and DRD5 genes)
Neurochemical (Abnormalities in Dopaminergic pathway)
Neurodevelopmental (Abnormalities of Pre-Frontal Cortex)
Social (eg Social Deprivation)
Describe the ‘Inattention’ component of the three core symptoms of ADHD
Not listening
Highly distractable
Regularly forgetting
Describe the ‘Hyperactivity’ component of the three core symptoms of ADHD
Restless
Reckless
Running and Jumping in inappropriate places
Describe the ‘Impulsivity’ component of the three core symptoms of ADHD
Difficulty waiting their turn
Interrupting
Temper Tantrums
Describe the ICD10 criteria A-G of ADHD
A- Abnormality of attention/activity/impulsivity for age at home
B - The above at school
C - Directly observed A
D- Doesn’t meet criteria for autism, mania, depression or anxiety
E - Onset before 7y
F - Duration >6m
G - IQ>50
Describe the expected Appearance and Behaviour, Speech and Mood for a patient with suspected ADHD
Appearance and Behaviour- Fidgety, unable to sit still, replies over parents
Speech - Talks loudly, makes excessive noise
Mood - Normal
Describe the expected Thought, Perception, Cognition and Insight for a patient with suspected ADHD
Thought - normal
Perception - No hallucinations
Cognition - poor attention, lack of concentration
Insight - poor
Name two investigations for suspected ADHD
Bloods - TFTs to rule out Thyroid disorder
Hearing tests
Name three differentials for a diagnosis of ADHD
Learning disability
Oppositional Defiant Disorder (Defiant and Disruptive against authoritative figures)
Conduct Disorder (repetitive Antisocial Behaviour)
Name two organisations which can support Parents and Teachers of Children with ADHD
Add Up
ADDISS
How could you manage a preschool child with ADHD?
Psychoeducation and parent training
How could you manage a school age child with ADHD?
Psychoeducation
CBT
How could you manage ADHD Pharmacologically?
Methyphenidate (Ritalin)
Atomoxetine
Define Learning Disability
State of arrested or incomplete development of the mind
Characterised by impairment of skills manifested over the developmental period
What is the clinical triad of Learning Disabilities?
Low intellectual performance (IQ<70)
Onset at Birth/Early Childhood
Wide range of functional impairments
Describe the ICD10 criteria of Learning Disability
Mild - IQ 50-70/ mental age 9-12
Mod - IQ 35-49/mental age 6-9
Severe - IQ 20-34/ mental age 3-6
Profound - IQ<20 / mental age <3
Name two genetic causes of Learning Disabilities
Downs Syndrome
Fragile X Syndrome
Describe the physical features of Downs Syndrome using the mnemonic PROBLEMS
Palpebral Fissure Round Face Occipital and Nasal Flattening Brachycephaly Low set small ears Epicanthic Folds Mouth open and protruding tongue Single Palmar Crease
Describe the physical features of Fragile X Syndrome
Large protruding ears
Long face
High arched palate
Flat feet
Name four Antenatal causes of Learning Difficulties
Rubella
Nutritional deficiency
Hypothyroidism
Alcoholism
Name four causes in the Neonatal period of Learning Difficulties
Neonatal Sepsis
Hypoglycaemia
Hypothyroidism
Birth Asphyxia
How would a patient with MILD learning difficulties present?
Usually at a later age
Adequate abilities but may struggle with academic work
Most live independently
How would a patient with MODERATE learning difficulties present?
Able to communicate but language is limited
May need supervision with self care but able to carry out simple work
How would a patient with SEVERE learning difficulties present?
Marked degree of motor impairment
Little or no speech in early childhood
How would a patient with PROFOUND learning difficulties present?
Severe motor impairment
Severe difficulties in communication
Little to no self care
How would you test for Downs Syndrome during pregnancy?
Serum Screening (bHCG or PAPP- A)
Quad Test (bHCG, AFP, Inhibin A, Estriol)
How would you investigate Learning Difficulties
Full range of bloods
CT head
IQ test
Name four occupations involved in the MDT for learning difficulties
Psychiatrist
Specialist Nurses
Psychiatrist
Social Worker
Name three behaviour techniques used for patients with Learning Difficulties
CBT
Applied Behavioural Analysis
Positive Behaviour Support
There are four main Primitive Defences. Define Projection
Perceiving and reacting to unacceptable impulses as someone else’s fault
There are four main Primitive Defences. Define Dissociation
Disconnecting self from areas of identity/memory/consciousness to retain illusion of control
There are four main Primitive Defences. Define Idealisation
Attributing perfect/near perfect qualities to others as a way of avoiding anxiety or negative feelings
There are four main Primitive Defences. Define Regression
Returning to an earlier phase of development or functioning to avoid conflicts/tension
