Community & Psych

Question 1

what are the main developmental domains?

Answer 1

1. Social, emotional + behavioural
2. Gross motor
3. Fine motor + vision
4. Language, hearing + speech

Question 2

what is ADHD? (include diagnostic criteria)

Answer 2

triad of:
inattention
impulsivity
hyperactivity
demonstrated across 2 or more settings (+ persistent), that result in significant psychological, social and/or educational or occupational impairment.
within this, some kids have features of inattention only/ hyperactivity + impulsivity, but some have all 3.
For hyperactive/ impulsive criteria: fidgeting of hands/feet / squirming, leaving seat when expected to remain seated, described as “on the go”, diff engaging in play/ activities quietly, talks excessively, blurts out answers before question finished, interrupts/ intrudes on others, difficulty waiting their turn, no insight to danger
For inattention: makes careless errors/ fails to give close attn to detail, poor organisation, does not seem to listen when spoken to directly, diff sustaining attn, avoids tasks involving sustained mental effort, forgetful, loses things imp for activities, easily distractible by external stimuli.

Question 3

How is ADHD managed non-pharma?

Answer 3

First line for pre-school and school aged children with mild- moderate ADHD is a Parent-training/education programmes to educate parents on the disorder, and provide strategies for managing the child’s behaviour, to build concentration skills, encourage quiet self-occupation, build self-esteem. These are done initially in a group setting but can be done on an individual basis carried out by a family support worker if there are more complex needs. individual involve both the carers + child and may span support in housing/ employment as well as ADHD strategies.
CBT + / social skills training for the child in a group setting is also recommended for school-aged kids. problem solving, self-control, listening + social skills, dealing with and expressing emotion.

Question 4

Who is involved in ADHD management?

Answer 4

paediatrician
CAMHS (sometimes) - psychiatrist
Specialist nurse (if on meds)
GP 
SENCO (special educational needs coordinator) teacher background who identifies and supports an individual through school ensuring they have the right support 
teachers
Educational psychologist 
OT 
Social worker
Family support worker (if necessary)

Question 5

How is ADHD managed pharma?

Answer 5

for severe ADHD with severe impairment first line: stimulant medication either methylphenidate or atomoxetine. increase brain levels of NE + DA by blocking presynaptic neuronal reuptake and triggering their release.
SE: Abdominal pain; aggression; anorexia; arrhythmias; changes in blood pressure; depression; headache; insomnia; irritability; movement disorders; nausea; nervousness; palpitation; tachycardia; tics.

Question 6

what is the diagnostic criteria of dyspraxia?

Answer 6

developmental coordination disorder. disorder of motor planning and/ or execution with normal neuro examination. it is a disorder of higher cortical processing and may be associated with perceptive difficulties/ language problems.
Features: problems with handwriting + drawing- messy/awkward/irregular/ slow, dressing- buttons/laces, cutting up food, eating- messy + diff coordinating biting chewing and swallowing.

Question 7

what are the diagnostic criteria for anorexia nervosa?

Answer 7

1. self-induced weight loss resulting in a low BMI in children this must be plotted on BMI centile, in adolescents up it is a BMI <17.5kg/m2
2. distorted perception of the body which increases as weight is lost.
3. determined attempt to lose weight by: excessive exercise, self-induced vomitting, excessive laxatives restrictive eating or a combo of these.
4. Intense fear of gaining weight or persistent behaviour that interferes with weight gain

Question 8

what is the diagnostic criteria for autism?

Answer 8

triad of:

1. impaired social interaction
2. speech + language disorder
3. imposition of routines with ritualistic + repetitive behaviour

1/ gaze avoidance, doesn’t seek comfort, prefers own company + no interest/ ab to interact w others, social + emotionally inappropriate behaviour, no appreciation of social cues/ thoughts/ feelings of others
2/ delayed development, limited use of facial exp/ gestures, formal pedantic language + monotone voice, over-literal interpretation, echoes Q
3/ unusal sterotyped movements - tiptoe gait/ hand flap, concrete play, poor imaginative play, extreme distress at small changes, peculiar + rigid interests, repetitive adherence, restricted behaviour repertoire, rigid thinking, diff transitions, hypo/hyper reactivity to sensory input