Developmental Psychiatry

Question 1

What does ADHD stand for?

Answer 1

Attention deficit hyperactivity disorder

Question 2

What is the diagnostic triad of ADHD?

Answer 2

Inattention
Hyperactivity
Impulsivity

Question 3

How would you describe a person with ADHD’s actions?

Answer 3

Essentially act before they think - impulsive and often later regret

Question 4

What further attributes does “combined-type ADHD” have?

Answer 4

Triad of ADHD
which are developmentally inappropriate,
impair functioning,
pervasive across setting,
longstanding from age 5

Question 5

What impacts can ADHD have at home?

Answer 5

Parents can’t cope
Raised family stress
Increased anger and upset
Increased risk of harm

Question 6

What impacts can ADHD have at school?

Answer 6

Barrier to learning
Frequently in trouble
Disorganised
Forgetful
Lose things

Question 7

List some comorbid difficulties that can occur with ADHD

Answer 7

Social difficulty
Learning disability
Mood and anxiety problems
Behavioural disorder
Substance use + crime

Question 8

Is ADHD more common in males or females?

Answer 8

Males

Question 9

List methods of diagnosing ADHD

Answer 9

Parent + school report
Screening and structured questionnaires (Conners Rating, SDQ…)
Family and developmental history (genes)
Cognitive assessment

Question 10

List essential criteria needed to diagnose ADHD

Answer 10

6 (5 for adults) or more symptoms of inattentiveness
6 (5 for adults) or more symptoms of hyperactivity and impulsiveness
Historical concerns since early age
Current symptoms consistent with ADHD
Impact on daily functioning

Question 11

Children can grow out of ADHD. True/False?

Answer 11

True

Some will as part of brain’s natural process of cortical maturation, which compensates for cognitive deficiency

Question 12

List some psychological therapies for ADHD

Answer 12

Parent training
Behavioural management
Social skills training
Sleep + diet review
Specific educational interventions

Question 13

List 1st line drugs for ADHD

Answer 13

“stimulants”
Methylphenidate
Dexamfetamine
Lisdexamfetamine

Question 14

List 2nd line drug for ADHD

Answer 14

SSRI - Atomoxetine

Question 15

List 3rd line drug classes for ADHD

Answer 15

Alpha agonist
Clonidine
Guanfacine

Question 16

What is the aim/purpose of using stimulant drugs in ADHD?

Answer 16

Improve dopaminergic neurotransmission in networks involved in higher executive functioning

Question 17

What does ASD stand for?

Answer 17

Autism spectrum disorder

Question 18

List the triad of impairments in autism

Answer 18

Social communication
Social interaction
Social imagination
Repetitive behaviours

Question 19

Is autism more common in boys or girls? Why?

Answer 19

Boys (5:1)
Sex harmones role in organisation of brain circuits during early development
Poor specifity in diagnostic tests for females

Question 20

List some social interaction difficulties in autism

Answer 20

Difficulty establishing relationships
Lack of motivation for social approval
No interest in others' needs
Little awareness of feelings of others (lack of empathy)
Difficulty picking up non-verbal cues

Question 21

List some social communication difficulties in autism

Answer 21

Hard to grasp meaning of conversations e.g. sarcasm
Monotonous voice
Pedantic language
Narrow interests
Difficulting sharing thoughts and feeling

Question 22

List some social imagination difficulties in autism

Answer 22

Lack of imagination
Inflexible thoughts
Understanding other people's views
Using knowledge and skills across setting
Thinking about the future

Question 23

List some comorbid conditions that may be found with autism

Answer 23

Learning disability
Mood and anxiety disorder
OCD
ADHD
Dyspraxia
Tourette's syndrome

Question 24

List methods of diagnosing autism

Answer 24

Developmental and collateral history
Screening scales 
Interviews (3di, DISCO)
ADOS assessment
SALT, OT, psychology

Question 25

What is the DSM criteria for diagnosing autism?

Answer 25

6 symptoms in total 2 symptoms of social interaction 1 symptoms of communication 1 symptom of behaviour Early onset Longstanding and cause significant in functioning Disturbances not better explained by a MH problem, intellectual disability or global developmental delay

Question 26

List non-pharmacological management of autism

Answer 26

``` Self and family psychoeducation Family and school support Behaviour analysis SALT Social skills training ```

Question 27

List pharmacological management of autism

Answer 27

``` None for core symptoms of autism Risperidone for ST Mx of severe aggression/ self-injury Methylphenidate (ADHD) Melatonin (chronic insomnia) Mood stabilisers (learning disability) ```

Question 28

Outline aetiology of ADHD which contributes to the neuroanatomical brain changes seen in this condition

Answer 28

``` Genetic predisposition (dopamine/serotonin receptors) Perinatal precipitants (smoking, alcohol, prematurity, hypoxia, complication of delivery) Psychosocial adversity (parenting style, criminality, maltreatment) ```

Question 29

Which part of the brain is affected in ADHD?

Answer 29

Frontal lobe

Question 30

Outline the neurochemical changes in ADHD

Answer 30

Higher concentration of dopamine reuptake inhibitors Reduced norephirine Reduced serotonin

Question 31

List 4th line drug classes for ADHD

Answer 31

Antidepressants (imipramine) | Antipsychotics (risperidone)

Question 32

List some repetitive behaviour difficulties in autism

Answer 32

Stereotyped movements, speech, use of objects Insist on sameness/ rituals Fixated interests Hyper/ hypoactivity to SENSORY STIMULUS

Question 33

Outline aetiology of autism

Answer 33

Genetics (strong heritability) Environmental (rubella in pregnancy) Biological (birth complications/injury, foetal distress, low birth weight, meconium aspiration)

Question 34

Which parts of the brain are affected in autism?

Answer 34

Frontal lobes Amygdala Cerebellum

Question 35

Outline the neurochemical changes that occur in autism

Answer 35

Reduction in glutamate receptors Reduced GABA Reduced serotonin