Child Psychiatry Book Flashcards
What is autism?
Developmental disorder characterised by the triad-
Impairment of social interaction
Impairment of communication
Restricted and stereotyped behaviours/interests.
What is the pathophysiology of autism?
Prenatal, antenatal and post natal causes.
Prenatal- Genetics, closely associated with Fragile X syndrome and tuberous sclerosis. Maternal age I.e. >40yrs old. Drugs I.e. sodium valproate Infections i.e. rubella
Antenatal-
Hypoxia during childbirth
Small for gestational age
LMBW
Post natal-
Toxins i.e. lead and Mercury
Exposure to pesticides
What are the RF for developing autism?
Male Maternal age >40yrs FHx Maternal psychiatric disorder i.e. schizophrenia Prematurity <35wks Maternal use of sodium valproate
What are the clinical features of autism?
ABC
Asocial- Few social gestures. Lack of eye contact, responding to name, interest in others, social smile,emotional expression etc.
Behaviour- restricted, repetitive tasks, need for routine, upset at change of routine, fascination of sensory aspect of environment etc.
Communication impaired- repetition of words, distorted and delayed speech.
Usually impaired development before the age of three.
May also present with epileptic seizures (20%), visual impairment, hearing impairment, infections, pica (eating inedible objects), constipation, impulsivity, temper tantrums etc.
Psychiatric hyperkinetic disorder, depression, bipolar affective disorder, OCD, anxiety etc.
How is autism investigated?
Full developmental history including FHx, pregnancy, birth, medical history, developmental milestones, daily activities, social interactions etc.
Hearing test
Screening tools e.g. CHAT- CHecklist for Autism in Toddlers
What are the differentials for autism?
Asperger’s syndrome Rett’s syndrome Childhood disintegration disorder Learning disability Deafness Childhood schizophrenia
How is autism managed?
Specialist makes the diagnosis- reliable at age 3.
Have a key worker to manage and coordinate treatments
CBT if the child has the verbal and cognitive ability to engage
Life skills interventions I.e. daily living skills, coping strategies, access to education and community facilities I.e. sports
Family and carer support
Self help groups I.e. National Autistic Society
Special schooling
Melatonin if sleep disorders
Social communication interventions
Treat co-existing physical (epilepsy) or mental (anxiety) or behavioural (hyperkinetic) disorders
Modify environmental factors which can initiate or maintain challenging behaviour i.e. lighting, noise, social circumstances etc)
If severe or challenging behaviour may in extreme circumstances consider risperidone antipsychotic- significant side effects and needs metabolic monitoring.
What is Asperger’s syndrome?
More in boys Similar to autism, in terms of social interaction and restricted behaviours No language impairment Cognition/intelligence is normal High functioning jobs
What is Rett’s syndrome?
Severe progressive disorder Starts in early life Language impairment Restricted, repetitive behaviour Loss of fine motor skills Irregular breathing and seizures
What is childhood disintegrative disorder? (Heller’s syndrome)
2 years of normal development followed by loss of previously learned skills (language, social and motor)
Repetitive, stereotyped interests
Cognitive deterioration
What is hyperkinetic disorder?
ADHD attention deficit hyperactivity disorder.
Inattention, hyperactivity and impulsivity which occurs mor frequently and severely than others at that developmental stage.
Presents with problems at school and home
What is the pathophysiology of hyperkinetic disorder?
Genetics Abnormality in dopaminergic pathways Neurodevelopmental abnormalities of the pre frontal cortex Social deprivation Family conflict Parental cannabis and alcohol exposure
What are the RF of hyperkinetic disorder?
Male
3-7yrs old
FHx
Social deprivation
What are the clinical features of hyperkinetic disorder?
Inattention, hyperactivity and impulsivity.
Demonstrate at home, at school/nursery.
Does not meet the criteria for pervasive developmental disorder, mania, depressive or anxiety disorder.
Onset before 7 yrs old
Lasting 6 months
IQ above 50.
