Disorders associated with childhood onset

Question 1

What does ASD stand for?

Answer 1

Autistic spectrum disorder

Question 2

What are the core symptoms of ASDs?

Answer 2

1. Persistent deficits in social communication and social interaction across multiple contexts
2. Restricted, repetitive patterns of behaviour, interests or activities

Question 3

A diagnosis of ASD can only be given if the problems were present in childhood. True or false?

Answer 3

True

Question 4

There are 3 categories that features of ASD fall into: what are they? Give some features of each category.

Answer 4

SIA

S - social interaction

• unaware of feelings of others
• doesn’t come for comfort when hurt
• repetitive play
• bad at making friends

I - impaired imagination

• little babbling, facial expression as an infant
• avoids mutual gaze, no smiles, stiffens when held
• no interest in stories, fantasy

A - activities and interests, restricted and repetitive

• stereotyped movements
• preoccupation with parts of objects
• marked distress over trivial changes
• insists on following routines

Question 5

Causes of ASD?

Answer 5

Unknown

There are some genes known to play a part

Question 6

What neurological disorder is associated with ASD?

Answer 6

Epilepsy is seen in 30% of ASD patients

Question 7

Management of ASD?

Answer 7

Early intensive behavioural intervention (speech therapy, special schooling)

Parent training

Social skills training

Drugs

Question 8

What drugs can be used to help manage ASD?

Answer 8

Risperidone for aggression
Melatonin for sleep
SSRIs for reducing repetitive behaviour

Question 9

What does ADHD stand for?

Answer 9

Attention deficit hyperactivity disorder

Question 10

Causes of ADHD?

Answer 10

Inherited (80% of cases)

Question 11

There are 3 categories that features of ADHD fall into: what are they? Give some features of each category.

Answer 11

1. Inattention
   - unable to listen closely to detail
   - short attention span
   - loses, forgets things
2. Hyperactivity
   - fidgeting
   - talks incessantly
3. Impulsivity
   - Blurts out answers
   - Interrupts
   - Cannot take turns

Question 12

Differential diagnosis of ADHD?

Answer 12

Low or high IQ
Hearing impairment
Conduct disorders

Question 13

Treatment of ADHD?

Answer 13

Parent education
In older children CBT
Drugs

Question 14

What drugs are used to treat ADHD? Describe how they work?

Answer 14

Methylphenidate (Ritalin) either as immediate (lasting 4 hours) or modified release (lasting 12 hours)

Atomoxetine takes up to 6 weeks to reach full efficacy

Question 15

Why should patients on methylphenidate not take it during weekends and school holidays?

Answer 15

It reduces appetite so can reduce growth

Question 16

List some types of eating disorder?

Answer 16

Anorexia nervosa
Bullimia
Binge-eating

Question 17

What’s the diagnostic criteria of anorexia nervosa?

Answer 17

1. weight <85% of predicted
2. intense fear of gaining weight with persistent behaviour to prevent weight gain
3. feeling fat when thin

Question 18

Causes of anorexia nervosa?

Answer 18

Genetics
Other psychological problems: depression, anxiety etc.
Low self-esteem
Media, image-aware activities (ballet), bullying

Question 19

What is the impact of anorexia nervosa on physical health?

Answer 19

Fatigue
Unable to concentrate
GI problems: constipation
Amenorrhoea
De-ranged bloods
Osteoporosis
Cardiovascular: long QT
Lanugo hair (downy hair all over body)

Question 20

Treatment of anorexia nervosa?

Answer 20

Restore nutritional balance
Treat complications
Therapy for patient, involving family