Child Psychiatry Flashcards
What is autism?
Pervasive developmental disorder consisting of a triad of impairment of:
. Social interaction
. Communication
. Restricted, stereotyped interests and behaviours
What are the prenatal risks of autism?
Genetics- polygenic, number of chromosomes implicated ie: chromosome 7, genetic syndromes like fragile X and tuberous sclerosis.
Parental age- women who are 40 have 50% more chance of having a child with autism than those 20-29
Drugs- certain meds like sodium valproate
Infection- pre natal like rubella
What are the antenatal risks of autism?
Hypoxia during childbirth
Decreased gestational age at birth (born before 35 weeks)
low birth weight
What are the post natal risks of autism?
Toxins - lead and Mercury
Pesticide exposure
What is meant by asocial in people with autism?
People with autism have few social gestures: waving, nodding, pointing at objects
They are unable to make eye contact (gaze avoidance), social smile, response to name, interest in others, emotional expression, suistain relationships and awareness of social rules.
What is meant by restricted behaviour in autism?
Autism patients have a restricted, repetitive and stereotyped behaviour- rocking and twisting
They get upset at changes in their routine
May prefer the same foods, insist on the same clothes and play the same games
Obsessively pursued interests
They have a fascination with the sensory aspects of the environment
What is meant by communication impairment in children with autism?
Distorted and delayed speech (the first sign which is noticed)
Echolalia (repetition of words)
When is the onset of autism?
Parents normally have a cause for concern by 12-18 months
The onset of autism is normally before 3.
What is the ICD-10 criteria for the diagnosis of autism?
Presence of abnormal or impaired development before the age of three
Qualitative abnormalities in social interaction
Qualitative abnormalities in communication
Restrictive, repetitive and stereotyped patterns of behaviour, interests and activities.
The clinical picture shouldn’t be attributable to other varieties of Pervasive developmental disorders.
What screening tools can be used for autism?
CHAT
Checklist for Autism in Toddlers
What are the differentials for autism?
Asperger syndrome Rett’s syndrome Childhood disintegrative disorder Learning disability Deafness Childhood schizophrenia
What is Retts syndrome?
A rare non inherited genetic postnatal neurological disorder which occurs mainly in girls.
What is the hallmark of Retts syndrome?
A regression of cognitive and motor skills ie: a woman will say her child was walking and now they are
Only crawling.
What is Retts syndrome caused by?
A mutation in the MECP2 gene
It is X linked dominant and fatal in males.
What is childhood disintegrative disorder (hellers syndrome)?
This is characterised by two years of normal development, followed by loss of previously learned skills (language/social/motor) it is also associated with repetitive, stereotyped interests and behaviours, as well as cognitive deterioration.
What are the biological treatments of autism?
Treat co- existing disorders eg: methylphenidate for hyperkinetic disorder
Antipsychotics for challenging behaviours
Melatonin
What are the psychological interventions for autism?
Psycho education for families or carers
Full assesment of the functions of behaviour to fully understand the child
CBT
What are the social managements of autism?
Modification of environmental factors
Social communication intervention
Self help groups - national autistic society
Special schooling
What is hyperkinetic disorder/ attention deficit hyperactivity disorder?
A behavioural syndrome characterised by:
- hyperactivity
- impulsivity
- inattention
They will result in functional impairment for the child- psychological, social and educational
What are the risk factors for hyperkinetic disorder?
Genetic- DRD4 and DRD5 genes are thought to play a role
Neuro chemical- the Dopaminergic are thought to be affected
Neuro developmental- there is a theory that there is neuro developmental abnormalities of the pre frontal cortex.
Social- social deprivation and family conflict, as well as parental cannabis and alcohol exposure.
What are the 3 core features of hyperkinetic disorder?
Inattention
Hyperactivity
Impulsivity
What rating Scales can be used for ADHD?
Conners rating scale and the strengths and difficulties questionnaire.
It is also important to get collateral histories from teachers and parents
What are the differentials for ADHD?
Learning disability/ dyslexia Oppositional defiant disorder Conduct disorder Autism Sleep disorders
What is conduct disorder?
This is a disorder which co exists in 50% of hyperkinetic children, it is a repetitive and severe pattern of antisocial behaviour including aggression, destruction of property, deceit fullness, major violations of age appropriate social expectations.
What are risk factors of conductance disorder?
Male
Being abused as a child
Low socioeconomic class
Parental Psychiatric disorders
What is an oppositional defiant disorder?
Defiant and disruptive behaviour against authoritative figures, it is less severe than conductance, in that violation of the law and physical abuse of others are far less common.
What is the management of hyperkinetic disorder in pre school?
Depends on the severity and the age
Pre school: parent training and education programmes are first line
Parent training is behavioural with parents being helped to reinforce positive behaviour and to find alternative ways of managing disruptive behaviour.
Drug treatments not recommended
What is the management of ADHD in school goers?
Psycho education and CBT (and/or social skills training) should be provided
If severe then drug treatment is the first line of choice- methylphenidate
Atomexitine can also be used, this is a non stimulant drug (a selective norepinephrine reuptake inhibitor)
What are the side effects of the drugs used for ADHD?
Headache
Insomnia
Loss of appetite
Weight loss
What is a learning disability?
A learning disability is a reduced intellectual ability and difficulty with everyday activities. This disability affects someone for their whole life.
What is the triad that constitutes a learning disability?
Low intellectual performance (IQ<70)
Onset at birth or during early childhood
Wide range of functional impairement
What are the causes of learning disability?
Genetic causes- Down’s syndrome, fragile X syndrome, tuberous sclerosis etc
Antenatal- congenital infections (rubella, CMV, toxoplasmosis), pre eclampsia, intoxication, nutritional deficiencies, physical damage, antepartum haemorrhage, pre eclampsia
Perinatal- birth asphyxia, intraventricular haemorrhage, neonatal sepsis
Neonatal- hypoglycaemia, meningitis, neonatal infections, kerniceterus
Postnatal- infection, metabolic, cerebral palsy
Environmental- neglect, non accidental injury, malnutrition, socioeconomically deprived
psychiatric- autism, Retts
What is the most common risk factor for learning disabilities?
Positive family history.
What are the clinical features of a mild learning disability?
. Usually identified at a later age . Adequate social skills . Adequate language abilities . Adequate self care . Most live independently
What are the clinical features of a moderate learning disability?
Able to communicate but language is limited
May need supervision for self care but they are able to do simple work
What are the clinical features of a severe learning difficulty?
Marked degree of motor impairment
Little or no speech in early childhood but may eventually use simple communication. May be able to perform simple tasks under supervision. May have associated physical disorders.
What is meant by a profound learning difficulty?
Severe motor impairment and severe difficulties in communication
They have little or no self care
Frequently they have physical disorders and require residential care
What are the physical features of Down syndrome?
Palpebral fissure Round face Occipital and nasal flattening Brush field spots Brachycephaly Low set small ears Epicanthic folds Mouth open and protruding tongue Strabismus (squint) Single palmar crease
