Psychological development disorders Flashcards
Psychological development disorders in ICD-10
ICD F80-89
F80
F80 Specific developmental disorders of speech + language
F81
F81 Specific developmental disorders of scholastic skills • Dyslexia (reading) • Spelling disorder (agraphia) • Maths (acalculia) • …etc
F82
F82 Specific developmental disorders of motor function (e.g. dyspraxia)
F83
F83 Mixed specific developmental disorders
F84
F84 Pervasive developmental disorders • Childhood autism • Atypical autism • Asperger syndrome • Rett syndrome (don’t confuse w/ Rett’s) • …etc
F88
F88 Other disorders of psychological development (e.g. developmental agnosia)
F89
F89 Unspecified disorder of psychological development
Autistic spectrum disorder (ASD) - define
- Group of disorders characterised by effect on social + communication skills
- Spectrum ranges from autism → asperger’s syndrome
CFs ASDs
Difficulties w social relationships
Problems w communication
Absorbing & narrow interests
CFs ASDs Difficulties w/ social relationships
• Few/no sustained relationships, lack of awareness of social rules
CFs ASDs Problems w/ communication
- Monotomous voice
- Talking at you
- Literal meaning
- Few gestures
- Abnormal gaze
- Awkward posture + body-language
CFs ASDs Absorbing + narrow interests
- Unusual routines or rituals
* Change is upsetting
Comorbidities ASDs
depression, anxiety, BPAD, psychosis, learning disability, OCD, ADHD, tic disorders…etc
Ix ASD
- Hx
- Level of impairment in life
- Comorbidity
- Cognitive ability (learning disability)
- Impact on parents/carers + support
- MDT: SALT assessment, educational psychology, OT, PT as indicated
- Observation of child
- Diagnostic tools → e.g. Autism Diagnostic Interview – revised (ADI-R), DISCO, 3di
Rx ASD
- Information + support → inc. National autistic society
- Liason – education services
- Parenting programmes
- Adaptation of child’s environment, activities + routines (E.g. visual timetable)
- Communication interventions
- Rx comorbidity
- Risperidone (atypical) → aggression (short-term)
- Melatonin (sleep disturbance)
Define Autism
A pervasive developmental disorder characterised by a triad of:
- Impairment in social interaction
- Impairment in communication
- Restricted, stereotyped interests + behaviours
Aetiology autism
Pre-natal
• Genetics: chromosome 7; ↑ incidence in fragile X syndrome & tuberous sclerosis
• Older parental age
Ante-natal
• Drugs (exposure to baby in womb) → sodium valproate
• Infection (rubella)
• Obstetric complications → hypoxia during childbirth, ↓ gestational age at birth, low birthweight
Post-natal
• Toxins: lead + mercury
• Pesticide exposure
CFs autism
ABC
- Asocial →
a. Few social gestures (waving, nodding, pointing at objects)
b. Lack of (eye contact [gaze avoidance], social smile, response to name, interests in others, emotional expression, sustained relationships + awareness of social rules) - Behaviour restricted →
a. Restricted, repetitive and stereotyped behaviour (rocking + twisting)
b. Upset at change in daily routine
c. May prefer same foods, insist on same clothes, play same games
d. Obsessively pursued interests
e. Fascination with sensory of environment (heightened sensory responsiveness: e.g. better smelling) - Communication impaired →
a. Distorted + delayed speech (often first sign noticed)
b. Echolalia (repetition of words)
Associated conditions autism
epileptic seizures (20%), visual impairment, hearing impairment, infections, Pica, constipation, sleep disorders, PKU, Fragile X, tuberous sclerosis, hyperkinetic disorder, depression, BPAD, anxiety, OCD
Dx autism icd 10
a. Presence of abnormal or impaired development before the age 3 (onset is before age 3)
b. Qualitative abnormalities in social interaction
c. Qualitative abnormalities in communication
d. Restrictive, repitive + stereotyped patterns of behaviour, interests + activities
e. Clinical picture is not attributed to other varieties of pervasive developmental disorder
Ix autism
- Full developmental assessment
- Hearing test
- Screening tools: e.g. CHAT (checklist for autism in toddler’s)
General treatment for autism
- Local autism teams (MDT: paediatrician, psych, educ. Psychologist, SALT, OT) → KEY WORKER (manage + co-ordinate treatment)
- CBT
- Life sills interventions (including coping strategies)
- Address physical + mental health problems
- Support for families + carers (National Autistic Society)
- Special schooling
- Melatonin (for sleep disorders)
Intervention for core features of autism
Social communication intervention (play-based strategies)
Interventions for behaviour that challenges
- Treat co-existing physical disorders (epilepsy), mental health, behaviour (hyperkinetic)
- 1st line: Modification of environment (e.g. lighting, noise…etc) that initiate challenging behaviours → antipsychotics (risperidone) are second line
Define Asperger’s
• Similar to autism w/ abnormalities in social interaction + restricted, stereotyped, repetitive interest + behaviours → however, no impairment in language, cognition or intelligence (IQ normal)
CFs Asperger’s
mild motor clumsiness
Depression is common
