Psych - CAMHS ASD And ADHD Flashcards
What is ASD? Name the three important features of this condition
-Spectrum where children can range from normal intelligence and ability to function to severely affected and unable to function.
Features
- Social difficulties: poor eye contact and physical contact, delay in smiling, cannot read non-verbal cues, difficulty making friends and playing with others
- Speech and language delay: delay/absence/regression in communication (speech and language), lack of non-verbal/imaginative behaviour, repetitive use of words/phrases
- Rigid and repetitive behaviours: interested in things/numbers/patterns over people, stereotyped repetitive movements (rocking/balls of feet), rigid routines, rigid routine and restricted food preferences
- These features must be present before 3 yo.
ASD: name some risk factors and other important diagnostic factors
Risk factors:
- FHx
- M>F
- Genetic variants (eg fragile X syndrome)
Other diagnostic factors:
- Placid or v irritable baby
- Feeding difficulties
- Unusual posture
- Sensory interests
- Macrocephaly
- Evidence of other neurodevelopmental disorder
How do you diagnose autism?
- ASD screening using GARS2 test (home and school)
- Detailed Hx and assessment by community paeds/psych
- SLT/OT, audiology and optometrist assessment
- Karyotypic: fragile X
- Skin examination: signs of neurocutaneous conditions (ash leaf macules, cafe au lait) to exclude tuberous sclerosis/neurofibromatosis
How do you manage autism?
- No cute
- CAMHS assessment and diagnosis
- Dietician input
- Paediatrician
- Social worker
- SENCO: special education needs school coordinator
What is ADHD? Name the three important features of this condition
-Attention deficit: quickly moves from one activity to another, loses interest and cannot persist with difficult tasks.
-Impulsivity: disruptive and/or rule breaking
-Hyperactivity: constant moving/fidgeting
These must be present over 2 or more domains of life (eg at home and at school) and affect ability to carry out every day tasks, develop normal skills and perform well in school.
*Some impairment must be present by 12 yo.
How do you diagnose ADHD?
- CONNERS questionnaire: input from home and school
- Visit to community paeds: detailed Hx and child and FHx (next cards)
- Audiometry and optometry appointment
How do you manage ADHD? What investigations do you need before starting medication?
- Parent and child education + school care plan (should have a SENCO)
- Monitor general health of child and explore effect of inattention on life of child.
- Methylphenidate: do baseline LFT, FBC, ferritin, BP, height and wt (should be done every 6/12)
- SEs: appetite suppression, growth suppression (medication breaks every 6/12 for a weekend to see if still needed and for growth), wt loss, anxiety, insomnia
Paeds ADHD/ASD Hx taking: what should you ask about when taking the birth and medical history of the child?
- Pregnancy: medication, maternal problems, scan issues/pregnancy issues, smoking/alcohol/drugs during pregnancy
- Birth: birthweight, resus required?, NIPE issues, hearing tests
- Family: tree, FHx (of ASD/ADHD), work, housing, social, safeguarding concerns
- Post birth: vaccinations, allergies, medical conditions, general health
Paeds ADHD/ASD Hx taking: how do you assess speech skills?
Speech
- Any worries, delays or non-verbal communication issues?
- Hx of speech in child: babbling, 1st words, 2 words together
- SLT: any problem making speech sounds
- Current problems with understanding instructions?
Paeds ADHD/ASD Hx taking: how do you assess social skills?
- Do they make eye contact?
- Do they understand emotions?
- Do they make spontaneous conversation?
- Do they have friendships or talk with other children? What happens if someone talks to child? Are they interested in other children?
- Do they play imaginatively or copy/put toys in lines? What do they play with?
- What happens if there are changes in routines?
- Do they get invited to play dates/parties?
- Any problems reported with school?
Paeds ADHD/ASD Hx taking: how do you assess a child’s sensory aspects?
- Do they like specific food textures?
- Repetitive behaviours: rocking, spinning, heel walking, hand flatting
- Are they able to wash easily?
- How do they deal with loud noises (eg ear defenders required?)
- Clothes: labels, scratchy fabrics?
Paeds ADHD/ASD Hx taking: how do you assess motor skills?
- When did they roll on side, sit upright, walk, ride bike, run, hop, take stairs?
- Can they kick or catch a ball?
- Handedness: did it develop before 1 yo?
- Use of scissors/writing/letter formation
- Help with buttons/dressing?
- Use knife and fork? (Cut and stab?)
- Brush on teeth?
- Do own toiletting?
Paeds ADHD/ASD Hx taking: what general assessment/Ix should do? (Not including examination)
- SLT/OT, audiometry and optometry assessment
- Involve educational psychology
- Bloods: FBC, LFT, ferritin, TFT, U+E, bone profile, serum amino acids
- Karyotype: look for fragile X
Paeds ADHD/ASD Hx taking: what should you for in your examination of a child?
- 3 x head circumference measurements (use biggest)
- Auscultate chest and heart
- Birthmarks/neurocutaneous marks
- Reflexes
- Tone and finger squeeze
- Assess ability to get dressed and undressed
- Ticks
