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Flashcards in Behavioural Disorders Deck (18):
1

Definition of encopresis

Involuntary defecation, especially associated with emotional disturbance or psychiatric disorder

2

Prevalence of encopresis, which gender more common

2-8% of primary school children
More common among boys

3

Types of encopresis (5)

- Constipation with overflow
- failed toilet training
- Toilet phobia
- Stress induced loss of control
- Provocative soiling

4

Management of encopresis (in setting of constipation with overflow)

1. treat constipation if present (laxatives e.g. parachoc/movicol or microenemas)
2. ensure diet contains enough fibre to avoid future constipation
3. establish routine of regular toilet use (use laxatives until established, educate to child why regular toilet use reduces soiling, small rewards for regular toilet use to condition child)

5

Management of encopresis in children with toilet phobia

incentives/rewards for sitting on the toilet even for short time without voiding, later building up to rewards for when empty bowels into toilet

6

Inattention symptoms of ADHD

Poor attention to detail
Careless mistakes
Difficulty sustaining attention
Seems not to listen
Seems not to follow through
Difficulty with organisation
Avoids tasks requiring sustained attention
Loses things
Easily distracted
Forgetful

7

Criteria for diagnosis of ADHD

- Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before 7 years of age
- Some impairment from the symptoms is present in 2 or more settings (e.g. school, work, home)
- There must be clear evidence of clinically significant impairment in social, academic or occupational functioning
- Behaviour not better explained by another condition

8

Hyperactivity/Impulsivity symptoms of ADHD

Fidgets
Often leaves seat
Runs/climbs excessively
Difficulty playing quietly
Always "on the go"
Talks excessively
Blurts out answers
Difficulty waiting turn
Interrupts others

9

Comorbidities with ADHD

Learning difficulties
Language disorder
Oppositional defiant disorder
Conduct disorder
Anxiety, mood disorders
Developmental coordination disorder
Tics, Tourette syndrome

10

Management options for ADHD

Stimulant medications
Parental behaviour management
Classroom behaviour management
Congnitive behavioural therapy
Management of co-morbidities (e.g. learning support, treatment of anxiety/depression)
Structured parenting programmes, parent support groups

11

Medications available for ADHD

Stimulants: increase dopamine in brain
- Dexamphetamine
- methylphenidate (Ritalin)

If tolerant to stimulants:
Atomexatine (noradrenergic reuptake inhibitor)

12

Most common side effects of stimulant medications for ADHD

Insomnia
Appetite suppression
Headache

mostly resolve spontaneously by 2-3 weeks or can be managed by altering dosing/time etc.

13

Effectiveness of stimulant medications in ADHD

The most effective treatment of ADHD
Underprescribed due to fear of abuse
Improves target symptoms in 75%, leads to enhanced task completion, academic progress and social interaction sustained overtime

14

Options for introducing ritalin if concerned about abuse

introduce with weeks of ritalin v weeks of placebo
Have parent and teacher both fill out a diary of child's behaviour and at end, de-code placebo v ritalin and compare behaviours (don't re-prescribe if doesn't match up obviously)

15

Differentials for hyperactivity

Difficult temperament
poor parenting skills
family dysfunction
Developmental delay
Language disorders
Learning difficulties
Anxiety/mood disorders
ODD
Conduct disorder
Intellectually gifted
Sleep disorders
Medication conditions (VLBW or SGA, foetal alcohol syndrome, prenatal exposure to smoking or stress, lead poisoning, acquired brain syndrome e.g. head injury, chromosomal abnormalities e.g. fragile C, velocardiofacial syndrome)

16

What are the 3 cardinal features of autism spectrum disorder

Impaired social communication
Impaired relationships
Restricted, repetitive behaviours, interests and activities

17

How do you make a diagnosis of autism spectrum disorder co-occurring with intellectual disability (given that symptoms must not be better explained by an intellectual disability, but they frequently co-occur)

Intellectual disability and autism spectrum disorder frequently co-occur, to make comorbid diagnosis of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level

18

Erikson stages of psychosocial development

Infancy (birth-18m)
- Trust v mistrust
- based on attachment theory (predictablity and reliability of carers)
Early childhood (2-3y)
- Autonomy v shame and doubt
- fostering self-efficacy in a safe way (sense of achievement rather than failure and embarassment)
Kindergarten (3-5y)
- Initiative v guilt
- learning to lead and follow as appropriate
- balance personal sense of success with healthy social relationships (guilt is self-referenced, shame is society-referenced)
School age (6-11y)
- Industry v inferiority
- to do with success with skills (movement, language etc), lower rate of success with these skills can lead to feelings of inferiority and loneliness
Adolescence (12-18y)
- identity v role confusion
- adolescents seeking out where they fit
- success with relationships allows to see yourself through others eyes, allows clearer sense of identity than if isolated