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Psychiatry > Learning Difficulties > Flashcards

Learning Difficulties Flashcards

Autism, ADD, Hyperkinetic, ADHD,

1
Q

Autism

A

Pervasive developmental disorder by a triad of impairment in social interaction, communication and restricted stereotypes interests and behaviours.

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2
Q

Prenatal causes autism

A
  • Genetics - chromosome 7. Increased risk of autism with fragile X syndrome and tuberous sclerosis.
  • Parental age - greater than 40
  • Drugs - Babies exposed to certain medications - sodium valproate
  • Infection - rubella
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3
Q

Antenatal causes autism

A

Obstetric complications - hypoxia during childbirth, dec gestational age, very low birth weight.

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4
Q

Post natal causes of autism

A
  • Toxins - mercury and lead
  • Pesticide exposure
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5
Q

RF autism

A
  • Male - 4x more likely
  • Genetics and family history
  • Advancing parental age
  • Parental psychiatric disorders - schizophrenia
  • Prematurity - born before 35 weeks
  • Maternal medication use
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6
Q

Symptoms autism

A

ABC

Asocial -

  • Few social gestures - waving, nodding, pointing at objects.
  • Lack of eye contact, social smile, response to name and interest in others, social expression and sustained relationships

Behaviour restricted -

  • Restricted, repetitive and stereotypes behaviour
  • Upset at change in daily routine
  • May prefer the same foods, insist on the same clothes and play the same games
  • Obsessively pursued interests
  • Fascination with sensory aspects of the environment

Communication impaired -

  • Distorted and delayed speech
  • Echolalia

Temper tantrums, impulsivity, cognitive impairment, intellectual disability.

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7
Q

Conditions associated with autism

A
  • Epileptic seizures
  • Visual impairment
  • Hearing impairment
  • Infections
  • Pica - eating inedible objects
  • Constipation
  • Sleep disorders
  • Underlying medical conditions - PKU, fragile X, tuberous sclerosis, congenital rubella, CMV, toxoplasmosis
  • Psychiatric - hyperkinetic, depression, bipolar, anxiety, psychosis, OCD and DSH
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8
Q

MSE Autism

A

Appearance - ritualised, stereotypes behaviour. - Clapping, rocking, poor eye contact, detached. Lack of facial expression and gestures.

Speech - delayed speech, difficulty initiating and maintaining conversation. Repetitive language, with unusual rate, rhythm and volume.

Mood - normal or have erratic mood changes - labile mood

Thought - obsessions and compulsions with intense preoccupation with special interests

Perception - sensitive to smell, touch or noise

Cognition - Impaired attention but may also be able to concentrated on special interests

Insight - poor and may be distressed if aware different / not fitting in

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9
Q

ICD-10 autism

A
  • Presence of abnormal or impaired development before the age of 3
  • Qualitative abnormalities in social interaction
  • Qualitative abnormalities in communication
  • Restrictive, repetitive and stereotypes patterns of behaviour, interests and activities.
  • The clinical picture is not attributable to other varieties of persuasive developmental disorder.
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10
Q

Ix autism

A
  • Full developmental assessment - Fhx, pregnancy, birth, medical history and developmental milestones. Assessment of communication, daily living skills, and social interaction and stereotyped behaviours

Hearing tests

  • Screening tools - CHAT - CHecklist for Autism in Toddlers
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11
Q

Treatment autism general

A
  • Specialist made at age 3 for diagnosis
  • Local autism teams
  • Have a key worker to manage and co-ordinate treatment
  • CBT
  • Daily living skills and coping strategies with enabling access to education and community facilities
  • Ensure physical health mental and behavioural issues are addressed
  • Family and carers offered support - NAS - national autistic society
  • Special schooling
  • Melatonin - sleep disorders.
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12
Q

Intervention for behaviour challenged in autism

A
  • Treat co-existing disorders
  • Modification of environmental factors
  • Antipsychotics - risperidone - challenging behaviour after all other psychosocial interventions have failed.
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13
Q

Biological, psych and social treatment autism

A

Biological -

  • Treat co-existing disorders
  • Antipsychotics for behaviour that challenges
  • melatonin

Psychological -

  • Psychoeducation for carers and family
  • Full assessment of functions and behaviour
  • CBT

Social -

  • Modification of environmental factors
  • Social-communication intervention
  • Self help groups
  • Special schooling.
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14
Q

DDX autism

A
  • Aspergers
  • Retts
  • Childhood disiintegrative disorder
  • Learning disability
  • Deafness
  • Childhood schizophrenia
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15
Q

Aspergers

A

Similar to autism with social interaction, restricted, stereotyped, repetitive interests and behaviours.

However unlike autism and there is no impairment in language, cognition or intelligence (normal IQ)

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16
Q

Retts syndrome

A

Severe progressive disorder - result in language impairment, repetitive stereotyped hand movements, loss of fine motor skills, irregular breathing and motor skills. MECP2 gene.

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17
Q

Childhood disintegrative disorder - hellers syndrome

A

Characterised by two years normal development followed by loss of previously had skills. Repetitive and stereotyped interests and behaviours as well as cognitive deterioration

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18
Q

Complications autism

A
  • Social isolation
  • Bullying and victimisation
  • Problems in education
  • Problems with employment
  • Inability to live independently
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19
Q

Hyperkinetic disorder

A

ADHD - an early onset, persistent pattern of inattention, hyperactivity and impulsivity that are more frequent and severe than in individuals at a comparable stage of development.

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20
Q

Pathophysiology ADHD

A

Genetic - DRD4 and DRD5 geners

Neurochemical - dopaminergic pathway abnormality

Neurodevelopmental - pre-frontal cortex abnormalities

Social - social deprovation, family conflict and parental cannabis and alcohol exposure.

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21
Q

RF ADHD

A
  • Male
  • FHx -
  • Environmental risk factors - social deprivation
  • Prematurity
  • Low birth weight
  • Low paternal education
  • Prenatal smoking
  • Maternal depression
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22
Q

Symptoms ADHD

A

Inattention

  • Not listening
  • Highly distractible
  • Reluctant to engage
  • Forgetting or regular losing belongings.

Hyperactivity

  • Restless and fidgeting
  • Recklessness
  • Running and jumping inappropriate
  • Difficulty engaging in quiet activities
  • Excessive talking or noisiness.

Impulsivity

  • Difficulty waiting turn
  • Interupting
  • Blurting
  • Temper tantums and aggression
  • Disobedient
  • Running into street
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23
Q

MSE ADHD

A

Attention - fidgety, unable to sit still, running around. Child interrupts

Speech - Talks loudly, even at inappropriate times and makes excessive noise

Mood - Normal

Thought - No disorder

Perception - No hallucinations

Cognition - Poor attention levels

Insight - Poor

24
Q

ICD 10 ADHD

A

A.Abnormality of attention, activity and impulsivity at home

B. Abnormality of attention and activity at school or nursery

C. Directly observed abnormality of attention or activity

D. Does not meet criteria for other disorder

E. Onset before 7

F. Duration at least 6 months

G. IQ above 50

25
Q

Ix ADHD

A
  • Blood tests
  • Hearing tests
  • Rating scales - conners rating scale and the strength and difficulties questionnaire. Diagnostic interview for ADHD in Adults (DIVA) questionnaire
26
Q

General treatment ADHD

A
  • support for parents and carers - add up and ADDISS
  • If there is a link between food and drink and behaviour parents should be advised to keep a food diary

1-2-3-reward visuals are used to break down tasks intothree simple stepsand help the child understand how they are progressing through a task. Completed stages should be ticked off by the child as they go. For example, “Get ready for bed.” can be broken down into:

  • One: change into your pyjamas
  • Two: brush your teeth
  • Three: get into bed
  • Reward: reading a story
27
Q

Preschool treatment ADHD

A
  • parent training and education programmes
28
Q

School goer treatment ADHD

A
  • Psychoeducation and CBT
  • Drug treatment first line only in SEVERE - Ritalin - CNS stimulant methylphenidate
29
Q

Alternative to CNS stimulant Ritalin in ADHD

A

Atomoxetine or dexamfetamine is alternative when methylphenidate has been ineffective.

30
Q

Ddx ADHD

A
  • Learning disability
  • Oppositional defiant disorder
  • Conduct disorder
  • Autism
  • Sleep disorders
  • Mood disorders
  • Anxiety disorder
  • Hearing impairment
31
Q

Conduct disorder

A

repetitive and severe pattern of antisocial behaviour - aggression, destruction of property and deceitfulness. Major violations of age-appropriate social expectations.

32
Q

Oppositional defiant disorder

A

defiant and disruptive behaviour against authoritative figures. Less severe than conduct disorder.

33
Q

Complications ADHD

A
  • Lower educational and employment attainment
  • Poor self-esteem
  • Criminal behaviour
  • Relationship issues
  • Sleep disturbance
  • Substance abuse
  • Road traffic accidents
  • Self-harm
34
Q

Learning Difficulty defintiion

A
  • State of arrested or incomplete development of the mind
  • Impairment of skills manifested during the developmental period and skills that contribute to the overall level of intelligence.
35
Q

Triad for LD

A
  1. low intellectual performance
  2. Onset at birth or during early childhood
  3. Wide functional impairment - daily living.
36
Q

genetic causes LD

A

Down syndrome, fragile X, tuberous sclerosis, angel man syndrome, hydrocephaly

37
Q

Antenatal causes LD

A

Congenital infection, nutritional deficiency, intoxication, endocrine disorders, physical damage,

38
Q

Perinatal causes LD

A

Birth asphyxia, intraventricular haemorrhage, neonatal sepsis

39
Q

Neonatal Causes LD

A

hypoglycaemia, meningitis, neonatal infections, kemicterus

40
Q

Postnatal causes LD

A

Infection, anoxia, metabolic, cerebral palsy

41
Q

Environmental causes LD

A

Neglect / non accidental injury. Malnutrition, socioeconomically deprived

42
Q

Psychiatric causes LD

A

Autism, Retts syndrome.

43
Q

Symptoms Mild LD

A
  • Identified at later stage.
  • Adequate language abilities and social skills and self care
  • Difficulties in academic work
  • Live independently but may need help employment and housing
44
Q

Moderate LD symtposm

A

Able to communicate but language is limited. May need supervision but can do simple work

45
Q

Severe LD symptoms

A

Marked degree of motor impairment with little or no speech. May be able to perform simple tasks under supervision. May have physical disorders

46
Q

Profound symptoms LD

A

Severe motor impairment, severe difficulties in communication and little to no self care. Frequently have physical disorders - residential care.

47
Q

Examination LD

A
  • Pregnancy related factors
  • Family related factors
  • Clinical features

MSE

Appearance will vary

Extent of behaviour will vary depending on level of LD

Cardio / resp / neuro / weight, head circumference and height / developmental assessment

48
Q

Mild LD IQ

A

IQ 50-70 - age 9-12s

49
Q

Moderate IQ

A

IQ 35-49 - age 6-9

50
Q

Severe IQ

A

IQ 20-34 - age 3-6

51
Q

Profund LD

A

IQ <20 - age <3

52
Q

IX before birth for LD

A

Aminocentesis, chorionic villus sampling, genetic testing and karyotyping.

53
Q

Down syndrome Testing pre birth

A
  1. serum screening (b-hCG and pregnancy associated plasma protein A) and nuchal translucency OR 2. Quad test (B-hCG, a-feroprotein, inhibin A, estriol)
54
Q

Treatment LD

A
  • MDT - psychiatrist, speech and language, specialist nurses, psychologist, occupational therapist, social worker and even teachers
  • GP - physical health problems
  • Antipsychotics - challenging behaviour
  • Behavioural techniques - applied behavioural analysis, positive behaviour support as well as CBT
  • Fam education is essential, educational programmes and voluntary organisations
  • Prevention can be attempted through genetic counselling and antenatal diagnosis.
55
Q

Common Co-morbidities with LD

A
  • Alzheimers
  • Schizophrenia
  • Anxiety and depressive disorders
  • Eating disorder
  • Personality disorders
56
Q

Learning disability vs difficulty

A

Difficulty learning in a specific area - dyslexia, dyspraxia - full scale IQ but trouble in one area

Disability -
1. low intellectual performance
2. Onset at birth or during early childhood
3. Wide functional impairment - daily living.
widespread IQ

Psychiatry (17 decks)

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