Conduct disorder, Autism Spectrum, and ADHD Flashcards
What changing areas can be used to assess childhood development?
Theory of mind - attribute beliefs, knowledge and desire to self, whilst understanding other people may hold different beliefs, knowledge and desires. Develops at 10 years.
Emotional development - differentiation, acceptable expression, containment
Social development - play, friendships, social skills
Cognitive development
Physical development - motor and language skills
Moral development
List 3 child factors that promote resilience
Easy temperament and good nature Female (prior to adolescence) Male (during adolescence) Higher IQ Good social skills Empathetic Humour Self-aware of strengths and limitations
List 3 family factors that promote resilience
Warm and supportive parents
Good parent-child relationship
Parental harmony
Valued social role
List 3 environmental factors that promote resilience
Supportive extended family Successful school experience Valued social role Extracurricular activities Member of faith/religious community
What is the importance of resilience in regards to child mental health?
Enhances formulation
Recognises resources the child/family can use
May prevent or inhibit development of mental disorders
How can child attachments be categorised?
Secure Insecure (avoidant) Insecure (anxious) Insecure (ambivalent) Disorganised
Define secure attachment
Child values relationships and is confident of self-worth
Define insecure (avoidant) attachment
Child appears emotionally independent, does not value relationships
Define insecure (anxious) attachment
Self-worth depends on approval from others.
Values relationships, but see them as unreliable.
Develops attention seeking strategies.
Define insecure (ambivalent) attachment
Child values relationships, but is cautious about their safety
Define disorganised attachment
Not self-sufficient, and unable to use relationships
What is conduct disorder
Repetitive and persistent pattern of antisocial and aggressive behaviour that violates age-appropriate societal norms.
What is the prevalence of conduct disorder in the UK?
5-7%
What groups are more at risk of conduct disorder?
Boys
Urban populations
Outline the presentation of conduct disorder
Behaviour causing significant impact on family, peers, and schooling:
- Aggression/cruelty to people and/or animals
- Destruction of property
- Deceitfulness and theft
- Truancy (abstaining from school) and running from home
- Severe provocative or disobedient behavioural
What is the ICD-10 criteria for conduct disorder?
1+ features at a marked level for over 6 months
Describe the illness course and prognosis of conduct disorder
Persistent disorder, esp with younger onset
50% will be diagnosed with antisocial personality disorder as adults
Increases risk of social exclusion, poor school achievement, unemployment, crime, and poor relationships
What are the principles for management of conduct disorder?
Case-by-case basis
Multiagency communication
What routine interventions exist for conduct disorder?
Group parent training programmes - for 3-11years
Functional family therapy
Multi systemic therapy - family-based, including school and community
Child-focused programmes
When are pharmacological interventions to be considered in conduct disorder?
Risperidone is considered for short-term management of severely aggressive behaviour in conduct disorder with explore anger and severe emotional dysregulation.
What are the side effects of Risperidone?
Metabolic: weight gain, diabetes
EPSE: akathisia, dyskinesia, dystonia
CV: QTc prolongation
Hormonal: increased PRL
What is Attention deficit hyperactivity disorder (ADHD)?
A behaviour syndrome characterised by the triad of:
- Inattention
- Hyperactivity
- Impulsiveness
What duration of time must the symptoms be present for a diagnosis of ADHD?
Symptoms should be at developmentally inappropriate levels for 6+ months, and starting before age 7.
Symptoms must occur in at least two settings.
What is the prevalence of ADHD in the UK?
2.4%
What risk factors predispose to ADHD?
Boys First degree relatives Maternal substance abuse Learning disability Low birth weight
What short-term problems are associated with ADHD?
Sleep problems Low self esteem Relationship issues Reduced academic achievement Increased risk of accidents
What long-term problems are associated with ADHD?
Comorbidity: learning disorders, motor problems, autism spectrum disorder, conduct disorder, anxiety, depression
Reduced academic/employment achievement
Crime
Antisocial PD
What percentage of ADHD develops at least one comorbidity?
50-80%
What proportion of full ADHD symptoms persist to adulthood?
20-30%
What proportion of partial ADHD symptoms persist to adulthood?
60%
Which of the triad of ADHD is most likely to persist in adulthood?
Inattention
What factors are associated with a poorer prognosis for ADHD?
Social deprivation
High expressed emotion
Parental mental illness
Predominantly hyperactive-impulsive symptoms
Conduct disorder, learning difficulties, language disorders
Outline the management of ADHD in children
Group parent training programmes (1st line)
Group CBT (younger children)
Individual psychological treatment (older children)
Drugs (severe symptoms and impairment)
How does management of severe childhood ADHD and adult ADHD differ from mild-moderate ADHD in children?
Drug treatment is offered 1st line.
Methylphenidate (Ritalin): CNS stimulant
Atomoxetine: NA reuptake inhibitor
Dexamfetamine: CNS stimulant used for Tx resistant ADHD
Define Pervasive developmental disorders (PDDs)
A group of lifelong developmental disorders characterised by triad of:
- Abnormal reciprocal social interaction
- Communication and language impairment
- Restricted, stereotypes, repetitive repertoire of interests and activities
How can pervasive development disorders be categorised?
Autism and atypical autism Rett's syndrome Childhood disintegrative disorder Asperger's syndrome PDD not otherwise specified
Outline the epidemiology of pervasive developmental disorders
Prevalence: 1-2 per 1000 Male predominance (except Rett's syndrome)
What percentage of patients with autism have mild-moderate learning difficulties?
80%
How can patients of normal IQ with autism be categorised?
High-functioning autism (with language difficulties)
Asperger’s syndrome (normal language, may have superior IQ)
What is the typical age of onset for autism?
3 years old
Outline the epidemiology of autism
Male (4:1)
Prevalence: 1%, 5-10 per 1000
What percentage of individuals with ASD develop at least one psychiatric/neurodevelopmental comorbidity?
70%
What comorbidites are commonly seen with autism?
Anxiety ADHD Intellectual disability Challenging behaviour Oppositional defiant disorder
Besides the triad of autism, what other clinical features may be seen?
Neurological: seizures, motor tics
Physiological: Unusually intense sensory responsiveness, absence of typical response to pain, abnormal temperature regulation (high), increased paediatric illness
Behavioural: irritable, tantrums, self-injury, aggression
Savants: enhanced single abilities
Outline treatment strategies for autism
STRUCTURE, ROUTINE, PREDICTABILITY
- Communication aids: symbols, pictures, stories
- Education and vocation intervention
- CBT and family interventions
- Speech and language therapy, OT, PT, dietician
- Symptom management: Antipsychotics (Risperidone), SSRIs
- Treat comorbidites
What are the indications for Methylphenidate (Ritalin)?
ADHD
Narcolepsy
Name 3 side effects of Methylphenidate
Anxiety Insomnia Abdominal pain NaV Anorexia and moderately reduced weight gain
Thrombocytopenia and leucopenia
List 3 signs and symptoms of Methylphenidate toxicity
Similar to acute amphetamine toxicity
Paranoia
Behavioural disturbances - euphoria, aggression
Psychosis
Delirium
Sudden cardiac death in pre-exisiting cardiac abnormalities
What monitoring is advised if taking Methylphenidate?
Growth monitoring - longterm use may result in growth suppression
Blood and platelet count - can cause thrombocytopenia and leukopenia
What is the indication for Atomoxetine?
ADHD
Name 3 side effects of Atomoxetine
Anorexia Dry mouth NaV Headache Fatigue
List 2 signs and symptoms of Atomoxetine toxicity
Tachycardia
NaV
Agitation
What are the indications for Dexamfetamine?
Treatment resistant ADHD
Narcolepsy
Name 2 side effects of Dexamfetamine
*Similar to side effect profile of methylphenidate
Anxiety
Insomnia
Abdominal pain
NaV
Anorexia and moderately reduced weight gain
List 2 signs and symptoms of Dexamfetamine toxicity
Wakefulness Excessive activity Paranoia Hallucination Hypertension Hyperthermia
What monitoring is advised if taking Dexamfetamine?
Growth monitoring - longterm use may result in growth suppression
