Paediatric Behavioral and Psych Disorders

Question 1

What are some clinical features on history that parents often identify that may indicate that their child has autism?

Answer 1

Parents often identify that something is different about their child before the second birthday. Early features include lack of pretend play,pointing out object to another person, and social interest and social play

Question 2

What is the difference between aspergers syndrome and autism?

Answer 2

Asperger’s syndrome is used to describe individuals with normal intelligence no obvious delay in language development but impaired social and communication skills with an ego egocentric approach to others. They often exhibit a range of obsessional interests, and some social immaturity

Question 3

How might we manage functional constipation in a child?

Answer 3

• Behavioural modifications- positioning on toilet, toileting after meals
• Positive reinforcement of toileting behaviour
• Increasing dietary intake and ensure adequate hydration
• Oral osmotic laxatives are first line like Movicol. Use daily longterm if needed. In infants use coloxyl drops
• If inpatient, can use NGT with macrogol (glycoprep) which is the same thing as movicol; if severe disimpaction may be considered

Arrange follow up in continence/encopresis clinic or general medical clinic for difficult cases

Question 4

define the clinical features of ADHD? (DSM 5)

Answer 4

inattention, hyperactivity, impulsivity that has persisted > 6 months to a degree that is maladaptive and inconsistent with developmental level.

onset can be NO LATER than 7 yrs of age

disturbances cause significant distress and social/functional/occupational impairment

not better explained by other medical/mental illness

Question 5

how might we examine/ix a child with ADHD?

Answer 5

Neurodevelopment assessment: fine and gross motor coordination, visual‐motor integration, auditory and visual sequencing.

• School reports.
• Psychoeducational assessment: An educational psychologist performs a formal assessment to identify their learning strengths and weaknesses.
• Audiology including auditory processing assessment is often helpful.

Question 6

describe the stepwise management of ADHD?

Answer 6

1. behavioural modification with positive reinforcement
2. educational support strategies
3. medical management with dexamphetamine/clonidine/atomoxetine

Question 7

what are some management advice you can give to the parent of a ‘fussy eater’?

Answer 7

Showing independence is an important part of toddler development – choosing and refusing food is an expression of independence.

• Serve small portions – lower expectations.
• Change the way food is presented.
• Include limited healthy options and allow the child to choose among the options.
• Include some healthy food choices that they like. Offering cereal at lunch is okay! A lack of variety is not a major worry at this age.

• Avoid filling up on milk and juice. Large volumes of milk (> 600 mL a day) can make the child feel full. Juice is not necessary in the
child’s diet.

• Give the child time to enjoy the meal without comment. Remove the food after 30 minutes or if they dawdle or lose interest.

Question 8

define primary and secondary enuresis?

Answer 8

primary enuresis- continuously wet for at least 6 months

secondary enuresis- child was previously dry for at least 6 months and has now relapsed

Question 9

what are some ways we can manage nocturnal enuresis?

Answer 9

1. bedwetting alarms are first line treatment
2. temporary mats for bed sheet protection may be used during the treatment period
3. treat underlying cause e.g. constipation with aperiants or UTI etc
4. positive encouragement and reinforcement- star diary
5. no punishment for bedwetting
6. for significant refractive cases–> Medication Minirin DDAVP (desmopressin) may be used