Paeds: Mental Health (2) Flashcards
Overview of ADHD management
Epidemiology of autism
- 75% of children are male
- usually develops before 3 years of age
Diagnostic features for autism
All 3 of the following features must be present for a diagnosis to be made:
- global impairment of language and communication
- impairment of social relationships
- ritualistic and compulsive phenomena
Other features
- most children have a decreased IQ - the ‘savant’ is rare
Other conditions associated with autism
- Fragile X
- Rett’s syndrome
- Tuberous sclerosis
- Angelmann Syndrome
What’s ASD?
Autism spectrum disorder (ASD)
- neurodevelopmental disorder that affects a person’s social interaction, communication and behaviour
- usually diagnosed in childhood, with some of the key symptoms being present from before the age of three (although diagnosis may be much later than this)
Neuropathology of ASD
The neuropathology of autism:
- poorly defined → no particular region of the brain or neuropathological mechanism identified
- studies have detected structural changes of the brain
- not well understood how these differences can explain the resulting symptoms.
Clinical features of autism
Abnormality of Social Interaction
poor eye contact, failure to use facial expression or body language during social interactions, problems making friends with peers, and difficulty in reading social situations
Impaired Social Communication
failure to develop either spoken language or sign language to communicate with others, failure to initiate or continue conversations, abnormal use of language, abnormal intonation, pitch, rate or rhythm of speech
Restrictive or Repetitive activities
preoccupations with subjects beyond the limits of normality/preoccupation with something unusual, or just an all-encompassing obsession , need for routine/certain rituals to be performed by themselves or others in a specific way as part of this routine, “motor mannerisms” with the classical hand-flapping or other such repetitive and compulsive movements, which can occur more when the child is excited or upset
Other Features
sensory issues, may only eat certain foods (due to not liking the texture or needing it all to be a certain colour), may not tolerate loud noises or seem to have a very high pain threshold, may self-harm (head banging or hitting themselves) as a part of their motor mannerisms or when frustrated. They may not tolerate their hair being cut or their teeth being brushed
Examination of a child with suspected autism
The examination is usually unremarkable, but its purpose is to exclude any underlying medical or genetic conditions
- Skin stigmata of neurofibromatosis or tuberous sclerosis using a Wood’s light
- Signs of injury, for example self-harm or child maltreatment.
- Congenital anomalies and dysmorphic features including macrocephaly or microcephaly
Management of autism
There are no medications to specifically treat autism → but may be required to treat other co-morbid conditions such as ADHD
- older children with marked aggression →antipsychotic medications have been used (but very rarely)
Management techniques include behavioural management and educational measures:
- Behavioural management strategies – visual timetables, preparation and explanation for changes in routine.
- Educational measures – special educational measures
Adequate treatment of co-morbid conditions is also helpful e.g.:
- use of melatonin for sleep can aid the child’s behaviour and education
The most common co-morbid conditions with autism
The most common co-morbid conditions include:
- ADHD
- sleep disorders
- learning disability
- mental health problems such as anxiety and depression
Investigations and diagnosis of autism
- a clinical diagnosis, with no specific blood or imaging tests available
- gather information to support or dismiss a diagnosis
The symptoms should be consistently present in different environments (i.e. both at home and at school) – thus at the very least a report of how the child functions at school is usually sought and a school observation may be performed.
- diagnosis made through MDT at a meeting with parents and teachers
*MDT should ideally consist of an educational psychologist and speech therapist, as well as either a Community Paediatrician or Child Psychiatrist.
Prognosis of autism
The features of autism exist on a spectrum:
- at one end there will be children who are able to learn ways to manage their difficulties and live independent lives in successful careers with children of their own
- at the other end are children who are so severely affected that they will never be able to live independently, most remaining with the family throughout their lives
What disorders are classified as ASD?
- childhood autism
- Asperger’s syndrome
- atypical autism
Brain abnormalities in ASD
Warning signs (that need further assessment) of ASD in early childhood
- communication and language delay
- no imitation of others actions
- no pretend play
- limited/unusual eye contact
- no orientation to name
- no joint attention/pointing
- motor mannerisms
- repetitive use of particular objects
- unusual sensory interests
- unusual sensory responses
Abnormalities in verbal vs non-verbal communication in ASD
- echolalia - repeating words/phrases that others have just said
- idiosyncratic language - use of words in very formal and precise way
Pharmacological treatment of childhood anxiety disorders
SSRIs may be used if symptoms moderate-severe, however psychological therapies should be always tried first
Prognosis in childhood depression
Criteria for conduct disorder
Presence of 3 (or more) of the criteria in the past 12 months, of which at least one criterion present in the last 6 months
Two possible courses of conduct disorder
