Childhood and Adolescent Pyschiatric Disorders Flashcards
Common Disorders
Autism Spectrum disorder
ADHD
Intellectual disability
Tic disorders
Anxiety disorders
Elimination disorders
Autism spectrum disorder is also known as
childhood autism, infantile autism, or early infantile autism
ASD is marked and sustained
impairment in social interaction and communication with restricted or stereotyped patterns of behavior and interest.
Asd abnormalities must be present by
age 3
Most common comorbidity with asd
intellectual disability
Presentation and Clinical features of asd
Parental -
School -
Routine -
Specialists -
Parental - Early Parental concerns
School - Concern from school
Routine - Routine well child clinics.
Specialists - Paediatricians and GPs
Common parental concerns with asd
Child’s lack of language,
inconsistencies in responsiveness
concern that the child might be deaf
In children with autism, social and communication skills increase by school age
Loss of earlier acquired words or language
Problems dealing with change and transitions and various self-stimulatory behaviors (sometimes including self-injury) also may become more prominent during this time.
Asd dsm 5 core symptom domain
A. Persistent deficits in social communication and social interaction across multiple contexts (SCI)
B. Restricted, repetitive patterns of behavior, interests, or activities. (RRBI)
asd dsm 5 lesser core symptoms
C. must be present in the early developmental period (manifest until social demands exceed limited capacities, or masked by learned strategies in later life).
D. cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. not better explained by id or global developmental delay. ID &ASD frequently co-o
Persistent deficits in social communication and interaction in asd include
- Deficits in social-emotional reciprocity
- Deficits in non verbal communicative behaviours
- Deficits in developing, maintaining and understanding relationships
Differential diagnosis of asd
Sensory impairment (hearing loss, visual impairment)
Intellectual disability
Severe Psychosocial deprivation
Selective mutism & separation anxiety disorder
Specific language disorder
Childhood schizophrenia
OCD, ADHD
The goal of treatment of asd are
to reduce disruptive behaviors and to promote learning,
particularly language acquisition and communication and self-help skills.
Children with ADHD display___
the early onset symptoms consisting of developmentally inappropriate activity, inattention, academic underachievement and impulse behaviour
Making diagnosis of hyperkinetic disorder requires
definite presence of abnormal levels of inattention, hyperactivity, and restlessness that are pervasive across situations and persistent over time and that are not caused by other disorders such as autism or affective disorders for at least six months
Risk factors of ADHD
Genetics, Obstetric complications and Psychosocial adversity
Aetiology of ADHD
Evidence from animal and human studies implicates the dysregulation of frontal-subcorticalcerebellar catecholaminergic circuits in the pathophysiology of ADHD, and molecular imaging studies suggest that abnormalities of the dopamine transporter lead to impaired neurotransmission.
ADHD Epidemiology
Prevalence:
Sex Ratio:
Social class:
Ethnic origin:
Age:
6-12% globally
Commoner in men
Commoner in lower economic strata
Under identified and Under treated in minority groups
Prevalence falls with age
ADHD treatment
Studies during the past decade have shown the safety and effectiveness of new non-stimulant drugs (Atomoxetine) and long-acting formulations of methylphenidate and amphetamine.
Parental training and behavioural management techniques will be useful for children below
6 years
Definition of intellectual disability
A disability characterized by significant limitations both in intellectual functioning and in adaptive behaviour.
IQ test score below _ indicate a limitation in intellectual functioning
70 (2SD)
Degrees of severity
Mild mental retardation-
Moderate retardation-
Severe mental retardation-
Profound mental retardation-
50/55 - 70
35/40 - 50/55
20/25 - 35/40
below 20/25
Signs of ID in children
Delayed sitting, crawling, walking
Speech delays
Delayed potty training
Problems in memory & concentration
Behaviour problems: temper tantrums, aggression, self harm, poor social skills
Appears clumsy or uncoordinated
Fine motor skills slow to develop
Most wildly recognised and most severe form of tic disorder is
Gilles de la Tourette syndrome, or Tourette’s disorder.
The tic disorders are increasingly recognized as __
highly familial conditions involving disruptions of frontal, striatal, and subcortical brain circuitry and commonly accompanied by other forms of psychopathology.
What is a tic
Sudden, rapid, recurrent, nonrhythmic motor movement or vocalization.
Tics may be classified according to
degree of complexity (simple, complex)
their quality (motor, vocal)
Duration (Transient, Chronic)
Copropraxia
a complex motor tic presenting as an obscene gesture
Echopraxia
complex motor tic where a person is compelled to repeat or imitate a movement observed in another person
Coprolalia
complex vocal tic with utterance of obscene or aggressive words or sentences
Management of tic disorders
- Psychoeducation
- Psychotherapy
- Medication
Useful psychotherapy include
habit reversal training, Exposure and response prevention, Relaxation training, Contingency management, family therapy
Characteristics of attachment
- Proximity maintenance
- Safe haven
- Secure base
- Separation distress
RAD?
Reactive Attachment disorder: linked to early childhood maltreatment, is characterized by inhibition of the normal developmental tendency to seek comfort from caregivers.
DSED?
Disinhibited social engagement disorder (DSM 5) : linked to institutionalization or exposure to multiple caregivers before age 5, is characterized by a relative hyperactivation of the attachment system, resulting in “diffuse” and unselective attachments, and patterned behavior labeled “indiscriminate sociability.“
Encopresis four related criteria
(1) the repeated inappropriate passage of feaces, usually involuntary;
(2) occurrence at least once a month for at least 3 months;
(3) a chronological or mental age of 4 years and
(4) exclusion of a substance or medical
condition as a cause.
Enuresis criteria
- Diagnosis is made after five years of age
- Severity is determined by frequency
- Wetting just occur at least twice a week for 3 consecutive months or produce significant distress
- Physical causes must be excluded
ODD
Oppositional Defiant Disorder
DSM-4 ODD symptoms
Is often angry and resentful
• Often argues with adults
• Is often touchy or easily
annoyed by others
• Often loses temper
• Often deliberately annoys or irritates
others
• Often blames others for his or her
mistakes or misbehaviour
• Often actively defies or refuses
to comply with adult requests or rules
• Is often spiteful and vindictive
In ICD-10 symptoms of ODD
Milder form of conduct disorder
Comorbidities of ODD
Anxiety
Depression
Conduct disorder
Substance abuse
ADHD
Treatment of ODD
Parent training
Anger management
Medication
Examples of behaviours the diagnosis of conduct disorders are based
excessive levels of fighting or bullying;
cruelty to animals or other people; severe destructiveness to
property;
firesetting; stealing; repeated lying; truancy from school
and running away from home; unusually frequent and severe
temper tantrums; defiant provocative behaviour; and persistent
severe disobedience. Any one of these categories, if marked, is
sufficient for the diagnosis, but isolated dissocial acts are not.”
Symptoms of conduct disorder
Aggression to people and animals
Destruction of property
Deceitfulness or theft
Serious violatons of rules
Subtypes of conduct disorder
- Confined to family context
- Unsocialised
- Socialised
To be diagnosed with MDD, a child or adolescent must have___
at least 2 weeks of persistent change in mood manifested by either depressed or irritable mood and/or loss of interest and pleasure plus a group of other symptoms including wishing to be dead, suicidal ideation or attempts; increased or decreased appetite, weight, or sleep; and decreased activity, concentration, energy, or self-worth or exaggerated guilt
Development response
Infants -
Toddlers –
School age –
Older children /adolescents –
Infants - fear of loud noises
Toddlers – fear of strangers, imaginary creatures.
School age – injury , natural events like storms
Older children /adolescents – worries and fears relating to school performance.
Developmental response
• Animal phobias –
• Separation anxiety disorder –
• Generalised anxiety disorder –
• Social anxiety disorder –
• Obsessive compulsive disorder –
• Panic disorder –
Animal phobias – early childhood (around 6-7 years)
• Separation anxiety disorder – early to mid-childhood (around 7-8
years)
• Generalised anxiety disorder – late childhood (around 10-12 years)
• Social anxiety disorder – early adolescence (around 11-13 years)
• Obsessive compulsive disorder – mid adolescence (around 13-15
years)
• Panic disorder – early adulthood (around 22-24 years)
Common behavioral features seen in human adolescents and their counterparts in other species ; include
elevations in peer-directed social interactions along with occasional increases in fighting with parents, increases in novelty-seeking, sensation-seeking and risk-taking , and greater per occasion alcohol use.
Adolescent Psychiatric Disorders
ADHD
ANXIETY DISORDERS
MOOD DISORDERS (Depression and Bipolar disorders)
DELIBERATE SELF HARM
SUBSTANCE ABUSE
PUI
EATING DISORDERS
PTSD
most common OCD comorbidities
tic disorders, attention deficit hyperactivity disorder (ADHD), other anxiety disorders, mood and eating disorders.
Components of OCD
Obsession – thought component – intrusive, ego dystonic.
Compulsion – to relieve the obsession
OCD is characterized by
the presence of obsessions or compulsions that are time consuming (at least one hour per day), cause subjective distress or interfere with the patient’s or the family’s life.
Obsessions are
intrusive, unwanted ideas, images, fears, thoughts or worries that are experienced as uncomfortable, unpleasant, distressing or anxiety provoking.
Compulsions are
repetitive behaviours or mental acts performed to ignore, reduce or eliminate the anxiety or distress caused by the obsessive thoughts.
Types of substance abuse disorders
Intoxication
SIPD
SUD ( Use /Abuse/dependence)
treatment of substance abuse disorders
Aim to achieve motivation to stop usage.
Detoxification
Rehabilitation and Treatment of comorbid psychiatric conditions.
PTSD is characterised by
triad of intrusive thoughts (flash backs), hyperarousal, and avoidance
