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Paediatrics > Externalising CAMH Disorders (ADHD, ODD, Conduct D/O) > Flashcards

Externalising CAMH Disorders (ADHD, ODD, Conduct D/O) Flashcards

1
Q

What are the classic symptoms of ADHD?

A
  • Hyperactivity
  • Impulsivity
  • Inattention
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2
Q

What are the subtypes of ADHD?

A
    1. Hyperactive / impulsive
  • Inattentive (may be harder to pick)
  • Combined: both aspects simultaneously
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3
Q

MSE features of ADHD?

A
  • Disinhibited

- Fidgeting

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4
Q

What is the role of medications in adolescent patients with MH disorders?

A

Aid and facilitate learning by increasing resilience factors

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5
Q

what are the principles of managing an adolescent with a MH disorder?

A
  • Major focus on small wins
  • Build competencies
  • Don’t make sweeping changes quickly
  • Emphasise decreasing stress in family unit
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6
Q

Drugs Mx ADHD?

A
  1. Stimulant medication
  2. Atomexetine
  3. Clonidine / Imipramine / Risperidone
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7
Q

What are the major principles which must be considered in ADHD pharmacotherapy?

A
  • Clear goals for medication treatment
  • AEx monitoring plan
  • Crisis plan
  • Clear review plan
  • Plan for duration of Rx before trial withdrawal
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8
Q

Psychosocial strategies for management of ADHD?

A
  • Time management strategies
  • Behavioural strategies
  • Environmental manipulation (sit close to teacher, away from distractions)
  • Limit group work
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9
Q

What are the behavioural strategies in ADHD management?

A
  • Clear rules and immediate consequences
  • Academic targets and behavioural goals
  • Reward pro social behaviours immediately
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10
Q

Strategies to improve working memory in ADHD?

A

Teach:

  • ability to ask for help
  • chunking
  • rehearsal
  • rote learning
  • generate mental images of information
  • frequent breaks
  • realistic targets for work period
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11
Q

Environmental changes in ADHD Mx?

A
  • Look for warning signs of memory overload
  • Quiet working area / minimise distractions
  • Gain attention before giving instructions
  • Use short sentences / simple grammatical forms
  • One task at a time
  • Guide through tasks using prompts
  • Visual aids where psosible
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12
Q

What are the child interventions for ODD?

A
  • Cycle of change / motivational interviewing
  • CBT
  • Social skills
  • Managing anger (recognising / self control)
  • Changing self narrative
  • Perspective taking / victim empathy
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13
Q

CBT strategies for ODD Mx?

A
  • Self talk
  • Relaxation techniques
  • Problem solving
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14
Q

Social skills to develop for ODD Mx?

A
  • making friends,
  • assertiveness,
  • communication skills
  • accepting no
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15
Q

What characterises the hyperactive / impulsive subtype of ADHD?

A

Inability to sit still or inhibit behaviour

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16
Q

Symptoms of hyperactivity / impulsivity?

A
  • Excessive fidgitiness
  • Difficulty remaining seated
  • Feelings of restlessness/ inappropriate running or climbing
17
Q

Pattern of hyperactive symptoms throughout the lifespan?

A

Hyperactive:

  • Observed by 4y
  • peak 7-8y
  • Decline by adolescence (may seem normal)
18
Q

Pattern of impulsive symptoms throughout the lifespan?

A

Impulsive: persist throughout life

19
Q

What determines the focus of impulsivity?

A

Environments e.g. ADHD teens in environment with EtOH/drugs available more likely to engage

20
Q

What characterises the inattentive subtype of ADHD?

A

Reduced ability to focus attention and reduced speed of cognitive processing and responding: sluggish / day dreaming / off task

21
Q

When do symptoms of inattention typically become apparent?

A

8-9yo. Usually lifelong

22
Q

What must occur for core symptoms to meet ADHD criteria?

A

Must impair academic, social or occupational function

23
Q

What should be discussed in ADHD consultations?

A

Safety: greater risk of intentional and unintentional injury

24
Q

What are the clinical features of conduct disorder?

A
  • Aggression to people and animals
  • Destruction of property
  • Deceitfulness or theft
  • Serious violations of rules
25
Q

What is conduct disorder?

A

Repetitive and persistent violation of age-appropriate social norms, rules, or basic rights of other

26
Q

What are the CFx of anxiety disorder?

A

Persistent, excessive, difficult to control worry about events or activities; associated with:

  • Restlessness
  • Easy fatigability
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance
27
Q

What is learning disability inc CFx?

A

Intrinsic cognitive difficulty that results in lower academic achievement than expected for intellectual potential; examples include:

  • Reading disorder
  • Disorder of written language
  • Mathematics disorder
  • Learning disorder, not otherwise specified
28
Q

What is ODD?

A

Recurrent, negative, defiant, disobedient and hostile behaviour toward authority figures

29
Q

What are the CFx of ODD?

A
  • Losing temper
  • Arguing with adults
  • Actively defying or refusing to comply with adult’s requests or rules
  • Deliberately annoying people
  • Blaming others for mistakes or misbehaviour
  • Touchy or easily annoyed
  • Angry or resentful
  • Spiteful or vindictive
30
Q

ADHD evaluation should screen for which comorbid conditions?

A
  • Anxiety / depression
  • ODD
  • Conduct disorder
  • learning disabilities
  • substance use
31
Q

DSM V criteria ADHD?

A

Under 17 = 6+
Over 17 = 5+
Symptoms of hyperactivity or inattention.
Must:
- occur often
- present in more than one setting
- persist for at least six months
- present before 12y
- impair function
- excessive for develop,mental level of child
- not explained by other physical / situtaional / MH explanation

32
Q

Neuro / developmental Ddx for ADHD?

A
  • Learning disability
  • Language / communication disorders
  • ASD
  • Neurodev syndromes (FRAX, FAS, Klinefelter)
  • Seizure do
  • CNS infxn/trauma sequelae
33
Q

Stimulant medication MoA?

A

Increases post synaptic concentrations of catecholamines (esp DA, NA, 5HT3). Stimulates post synaptic release, inhibits repute weak MAO inhibitor

34
Q

Stimulants used for ADHD Mx?

A
  • Dexamphetamine

- Methylphenidate (Ritalin)

35
Q

Common AEx stimulant medication?

A
  • LoA, LoW
  • Insomnia
  • HA
  • Abdo pain
36
Q

What should be documented pre commencement of stimulant medication?

A
  • Growth parameters
  • BP
  • PR
    Consider behaviour rating scale pre and during treatment
37
Q

CIx to stimulants?

A
  • Psychosis
  • Previous sensitivity
  • Symptomatic CVD
  • Hyperthyroidism
  • HTN
  • Glaucoma

Paediatrics (31 decks)

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