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Mental health > Conduct disorder, Autism Spectrum, and ADHD > Flashcards

Conduct disorder, Autism Spectrum, and ADHD Flashcards

1
Q

What changing areas can be used to assess childhood development?

A

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

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2
Q

List 3 child factors that promote resilience

A 
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
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3
Q

List 3 family factors that promote resilience

A

Warm and supportive parents
Good parent-child relationship
Parental harmony
Valued social role

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4
Q

List 3 environmental factors that promote resilience

A 
Supportive extended family
Successful school experience
Valued social role
Extracurricular activities
Member of faith/religious community
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5
Q

What is the importance of resilience in regards to child mental health?

A

Enhances formulation
Recognises resources the child/family can use
May prevent or inhibit development of mental disorders

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6
Q

How can child attachments be categorised?

A 
Secure
Insecure (avoidant)
Insecure (anxious)
Insecure (ambivalent)
Disorganised
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7
Q

Define secure attachment

A

Child values relationships and is confident of self-worth

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8
Q

Define insecure (avoidant) attachment

A

Child appears emotionally independent, does not value relationships

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9
Q

Define insecure (anxious) attachment

A

Self-worth depends on approval from others.
Values relationships, but see them as unreliable.
Develops attention seeking strategies.

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10
Q

Define insecure (ambivalent) attachment

A

Child values relationships, but is cautious about their safety

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11
Q

Define disorganised attachment

A

Not self-sufficient, and unable to use relationships

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12
Q

What is conduct disorder

A

Repetitive and persistent pattern of antisocial and aggressive behaviour that violates age-appropriate societal norms.

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13
Q

What is the prevalence of conduct disorder in the UK?

A

5-7%

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14
Q

What groups are more at risk of conduct disorder?

A

Boys

Urban populations

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15
Q

Outline the presentation of conduct disorder

A

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
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16
Q

What is the ICD-10 criteria for conduct disorder?

A

1+ features at a marked level for over 6 months

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17
Q

Describe the illness course and prognosis of conduct disorder

A

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

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18
Q

What are the principles for management of conduct disorder?

A

Case-by-case basis

Multiagency communication

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19
Q

What routine interventions exist for conduct disorder?

A

Group parent training programmes - for 3-11years
Functional family therapy
Multi systemic therapy - family-based, including school and community
Child-focused programmes

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20
Q

When are pharmacological interventions to be considered in conduct disorder?

A

Risperidone is considered for short-term management of severely aggressive behaviour in conduct disorder with explore anger and severe emotional dysregulation.

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21
Q

What are the side effects of Risperidone?

A

Metabolic: weight gain, diabetes
EPSE: akathisia, dyskinesia, dystonia
CV: QTc prolongation
Hormonal: increased PRL

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22
Q

What is Attention deficit hyperactivity disorder (ADHD)?

A

A behaviour syndrome characterised by the triad of:

  • Inattention
  • Hyperactivity
  • Impulsiveness
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23
Q

What duration of time must the symptoms be present for a diagnosis of ADHD?

A

Symptoms should be at developmentally inappropriate levels for 6+ months, and starting before age 7.

Symptoms must occur in at least two settings.

24
Q

What is the prevalence of ADHD in the UK?

A

2.4%

25
Q

What risk factors predispose to ADHD?

A 
Boys
First degree relatives
Maternal substance abuse
Learning disability
Low birth weight
26
Q

What short-term problems are associated with ADHD?

A 
Sleep problems
Low self esteem
Relationship issues
Reduced academic achievement
Increased risk of accidents
27
Q

What long-term problems are associated with ADHD?

A

Comorbidity: learning disorders, motor problems, autism spectrum disorder, conduct disorder, anxiety, depression
Reduced academic/employment achievement
Crime
Antisocial PD

28
Q

What percentage of ADHD develops at least one comorbidity?

A

50-80%

29
Q

What proportion of full ADHD symptoms persist to adulthood?

A

20-30%

30
Q

What proportion of partial ADHD symptoms persist to adulthood?

A

60%

31
Q

Which of the triad of ADHD is most likely to persist in adulthood?

A

Inattention

32
Q

What factors are associated with a poorer prognosis for ADHD?

A

Social deprivation
High expressed emotion
Parental mental illness
Predominantly hyperactive-impulsive symptoms
Conduct disorder, learning difficulties, language disorders

33
Q

Outline the management of ADHD in children

A

Group parent training programmes (1st line)
Group CBT (younger children)
Individual psychological treatment (older children)
Drugs (severe symptoms and impairment)

34
Q

How does management of severe childhood ADHD and adult ADHD differ from mild-moderate ADHD in children?

A

Drug treatment is offered 1st line.
Methylphenidate (Ritalin): CNS stimulant
Atomoxetine: NA reuptake inhibitor
Dexamfetamine: CNS stimulant used for Tx resistant ADHD

35
Q

Define Pervasive developmental disorders (PDDs)

A

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
36
Q

How can pervasive development disorders be categorised?

A 
Autism and atypical autism
Rett's syndrome
Childhood disintegrative disorder
Asperger's syndrome
PDD not otherwise specified
37
Q

Outline the epidemiology of pervasive developmental disorders

A 
Prevalence: 1-2 per 1000
Male predominance (except Rett's syndrome)
38
Q

What percentage of patients with autism have mild-moderate learning difficulties?

A

80%

39
Q

How can patients of normal IQ with autism be categorised?

A

High-functioning autism (with language difficulties)

Asperger’s syndrome (normal language, may have superior IQ)

40
Q

What is the typical age of onset for autism?

A

3 years old

41
Q

Outline the epidemiology of autism

A

Male (4:1)

Prevalence: 1%, 5-10 per 1000

42
Q

What percentage of individuals with ASD develop at least one psychiatric/neurodevelopmental comorbidity?

A

70%

43
Q

What comorbidites are commonly seen with autism?

A 
Anxiety
ADHD
Intellectual disability
Challenging behaviour
Oppositional defiant disorder
44
Q

Besides the triad of autism, what other clinical features may be seen?

A

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

45
Q

Outline treatment strategies for autism

A

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
46
Q

What are the indications for Methylphenidate (Ritalin)?

A

ADHD

Narcolepsy

47
Q

Name 3 side effects of Methylphenidate

A 
Anxiety
Insomnia
Abdominal pain
NaV
Anorexia and moderately reduced weight gain

Thrombocytopenia and leucopenia

48
Q

List 3 signs and symptoms of Methylphenidate toxicity

A

Similar to acute amphetamine toxicity
Paranoia
Behavioural disturbances - euphoria, aggression
Psychosis
Delirium
Sudden cardiac death in pre-exisiting cardiac abnormalities

49
Q

What monitoring is advised if taking Methylphenidate?

A

Growth monitoring - longterm use may result in growth suppression

Blood and platelet count - can cause thrombocytopenia and leukopenia

50
Q

What is the indication for Atomoxetine?

A

ADHD

51
Q

Name 3 side effects of Atomoxetine

A 
Anorexia
Dry mouth
NaV
Headache
Fatigue
52
Q

List 2 signs and symptoms of Atomoxetine toxicity

A

Tachycardia
NaV
Agitation

53
Q

What are the indications for Dexamfetamine?

A

Treatment resistant ADHD

Narcolepsy

54
Q

Name 2 side effects of Dexamfetamine

A

*Similar to side effect profile of methylphenidate
Anxiety
Insomnia
Abdominal pain
NaV
Anorexia and moderately reduced weight gain

55
Q

List 2 signs and symptoms of Dexamfetamine toxicity

A 
Wakefulness
Excessive activity
Paranoia
Hallucination
Hypertension
Hyperthermia
56
Q

What monitoring is advised if taking Dexamfetamine?

A

Growth monitoring - longterm use may result in growth suppression

Mental health (27 decks)

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