Struggling at School Flashcards
What questions do you want to ask about a child with behavioural issues?
- Specific aspects of behaviour - what are the parents main concerns
- Learning/schooling - attendance at school, what have the school reported regarding progress, is the child receiving any support
- Activities of daily living
- Attention and relationship with others
- Previous development
- If disabled - what disabilities at present, what additional support is in place?
What questions would you want to directly ask a child who is struggling at school?
- Any concerns about school/home? Likes/dislikes
- Ask about relationships with friends
- Anything they find easy or difficult
What is a red flag regarding development?
Any definite loss of skills may represent developmental regression - red flag for serious degenerative or destructive condition needing urgent investigation.
What are differentials for motor difficulties?
- Cerebral palsy - spastic diplegia
- Disorders of muscle have to be considered
What is Autism Spectrum Disorder?
ASDs are a range of developmental disorders that describe the abnormal social interactions, communication behaviours and patterns of thought and physical behaviour of some people. It includes severe autism of infancy through to the milder Asperger’s syndrome (autism spectrum).
Autism is a lifelong, developmental disability that affects how a person communicates with and relates to other people and how they experience the world around them. 4:1 boys : girls.
What medical disorders are associated with ASD?
- Fragile X syndrome more common
- Tuberous sclerosis - very common
- Williams syndrome
- Rubella and other congenital infections
- Co-existing conditions like intellectual disability, ADHD and OCD are common
What are key features of ASD?
- Difficulties in communication, social interaction and inflexible thinking
- At a younger age, children with autism have difficulties to communicate, leading to tantrums, frustration and being labelled as a difficult child. They are often very active and difficult to engage with.
- There may be difficulties with parent child bonding due to both parties being unable to understand each other
- As a child gets older, they may have difficulty making and maintaining friendships. They may isolate themselves, as they have difficulty understanding social cues. They may find it hard to take turns and may be on the edge of a group - look like he/she wants to join in but doesn’t know how to.
- Huge impact on families and education. Families often struggle to cope with the child failing to understand what is wrong and why a child behaves as he does. School may be unable to meet a child’s needs without extra support as the child is unable to engage to access the curriculum.
What are the clinical features of ASD?
- Impaired social skills: usually play alone, can’t understand social cues like eye gaze, facial expressions and gestures, struggle to maintain relationships
- Repetitive behaviours, interests and social activities: repetitive behaviour (stimming) e.g. tapping fingers on table, must have a routine or gets distressed
- Meltdowns - complete loss of emotional control
- ADHD in 35% and epilepsy in 18%
- History of speech delay: warning signs for true social communication disorder - lack of e.g. turn taking, following instructions
What is CAMHS role in managing ASD?
CAMHS are vital in helping families understand their child and put strategies in place to cope with their behaviour. The following can help:
- Create a profile of the child with the family
- Help the family identify the child’s strengths and difficulties
- Develop strategies in meeting the child’s needs in liasion with child psychologist/psychiatrist
What can paediatricians do to help manage ASD?
- Community paediatrician will look at other possible explanations/differentials for the child’s difficulties e.g. other LDs, specific language disability, and the health of the child in general (e.g. nutritional deficiencies due to restricted diet)
- Also they look at antenatal history, birth history, developmental and family history
What is the management of ASD?
- Goal is to increase ability to function independently and improve quality of life: learning and development, social skills, decreased disability and comorbidity
- Non-pharmacological therapy: early educational and behavioural interventions
- Pharmacological interventions: SSRIs can help relieve stress, anxiety, aggressions etc, antipsychotic drugs can reduce symptoms like aggression and self-injury, methylphenidate manages ADHD
- Family support and counselling
What are the effects on speech and language in ASD?
Speech delay is common in the general population, particularly in boys warning signs for a true social communication disorder are lack of the other building blocks of language such as turn taking (natural pause after a parent talks to an infant/child), showing understanding of language (following verbal instructions) and attempting to indicate need verbally or by pointing.
What repetitive behaviours are used in ASD children?
Repetitive play is typical with common reports of lining up the toys, repetitive noises or hand flapping. Echolalia is a specific kind of repetitive speech, words and phrases repeated often with specific intonation and without meaning.
What are the key features of ADHD?
- Usually affects children between age 3-7 years
- Inattention: short attention span with difficulty concentrating in class
- Hyperactivity: unable to sit still for short periods and constantly fidgeting
- Impulsiveness: unable to wait turn and little sense of danger
- Symptoms must be present for >6 months across at least 2 environments
How do you diagnose ADHD?
- Symptoms tend to be pervasive across all settings associated with difficulties in concentration and distractibility in order for diagnosis to be made
- Diagnosis is time consuming and requires information gathering from home and school usually via standardised questionnaires and procedures
- The inattention and distractibility cause difficulty in organisation and completion of tasks, leading to deterioration in academic performance unrelated to intellectual potential.
- To the combination of hyperactivity and inattention is added impulsivity. There is an association with risk taking particularly in adolescence e.g. crossing roads (green cross code is a methodical approach to gauge speed of oncoming vehicles and impulsive children often just set off).
