Child Psychiatry

Question 1

Define Autism

Answer 1

Pervasive developmental disorder characterised by triad of: impairment in social interaction, communication and restricted/stereotyped interests

Question 2

Give three PRENATAL risk factors for Autism

Answer 2

Genetics
Parental Age >40
Sodium Valproate usage

Question 3

Give three ANTENATAL risk factors for Autism

Answer 3

Hypoxia at birth
Prematurity
Low birth weight

Question 4

Give a POSTNATAL risk factors for Autism

Answer 4

Toxins such as lead/mercury/pesticides

Question 5

How might the ‘Asocial’ component of the Autism triad present?

Answer 5

Few social gestures, lack of eye contact, lack of emotional expression

Question 6

How might the ‘Restricted Behaviour’ component of the Autism triad present?

Answer 6

Repetitive and stereotyped
Upset at any change in routine
Obsessively pursued interests

Question 7

How might the ‘Impaired Communication’ component of the Autism triad present?

Answer 7

Distorted and delayed speech

Echolalia (repeated words)

Question 8

Name three conditions associated with Autism

Answer 8

Epileptic seizures
Visual impairment
OCD

Question 9

Describe the ICD10 criteria A-E for Autism

Answer 9

A - Presence of abnormal/impaired development before the age of three
B - Qualitative abnormalities in social interaction
C- Qualitative abnormalities in communication
D - Restrictive/Repetitive stereotyped behaviours
E - Clinical picture not attributable to anything else

Question 10

Describe the Appearance, Speech and Thought of a patient with suspected Autism

Answer 10

Appearance - ritualised/stereotyped behaviours, clapping, rocking, poor eye contact

Speech - delayed, repetitive, unusual rate and rhythm

Thought - Obsessions and Compulsions, intense preoccupations

Question 11

Describe the expected Perception, Cognition and Insight of a patient with suspected Autism

Answer 11

Perception - may be sensitive to noise/touch/ smell
Cognition - Impaired attention but can concentrate on special interests
Insight - may be poor

Question 12

At what age should a child turn towards sound?

Answer 12

3 months

Question 13

At what age should a child know and respond to own name?

Answer 13

12 months

Question 14

What age should a child combine two words?

Answer 14

2 years

Question 15

At what age should a child be smiling?

Answer 15

6 weeks to 10 weeks

Question 16

At what age should a child play with other children?

Answer 16

4 years

Question 17

Name two investigations you could do for a child with suspected Autism

Answer 17

Hearing tests

CHAT - Checklist for Autism in Toddlers

Question 18

Aspergers Syndrome is a differential for Autism. Describe three clinical features

Answer 18

Abnormalities in social interaction
No impairment in language/cognition or intelligence
More prevalent in boys

Question 19

Rett’s Syndrome is a differential for Autism. Describe three clinical features

Answer 19

Severe progressive disorder starting in early life
Language impairment, stereotyped hand movement
Irregular breathing

Question 20

Hellers Syndrome is a differential for Autism. Describe the clinical features

Answer 20

AKA Childhood Disintegrative Behaviour

Two years of normal development followed by loss of previously learned skills

Question 21

When can a diagnosis of Autism be reliably made?

Answer 21

At the age of 3 by a specialist

Question 22

Describe the Psychological management of Autism

Answer 22

CBT (if able to engage and is motivated)

Question 23

Describe the sociological management of Autism

Answer 23

All diagnosed should have a key worker
Specialist schooling if necessary
Families should be offered support

Question 24

Describe the potential biological managements of Autism

Answer 24

Antipsychotics (Risperidone)

Melatonin (Sleeping difficulties)

Question 25

Define Hyperkinetic Disorder/ADHD

Answer 25

Early onset persistent pattern of Inattention, hyperactivity and impulsivity

Question 26

When is the typical onset of ADHD?

Answer 26

Between ages of 3-7

Question 27

Describe the four potential aetiologies of ADHD

Answer 27

Genetic (DRD4 and DRD5 genes) Neurochemical (Abnormalities in Dopaminergic pathway) Neurodevelopmental (Abnormalities of Pre-Frontal Cortex) Social (eg Social Deprivation)

Question 28

Describe the ‘Inattention’ component of the three core symptoms of ADHD

Answer 28

Not listening Highly distractable Regularly forgetting

Question 29

Describe the ‘Hyperactivity’ component of the three core symptoms of ADHD

Answer 29

Restless Reckless Running and Jumping in inappropriate places

Question 30

Describe the ‘Impulsivity’ component of the three core symptoms of ADHD

Answer 30

Difficulty waiting their turn Interrupting Temper Tantrums

Question 31

Describe the ICD10 criteria A-G of ADHD

Answer 31

A- Abnormality of attention/activity/impulsivity for age at home B - The above at school C - Directly observed A D- Doesn’t meet criteria for autism, mania, depression or anxiety E - Onset before 7y F - Duration >6m G - IQ>50

Question 32

Describe the expected Appearance and Behaviour, Speech and Mood for a patient with suspected ADHD

Answer 32

Appearance and Behaviour- Fidgety, unable to sit still, replies over parents Speech - Talks loudly, makes excessive noise Mood - Normal

Question 33

Describe the expected Thought, Perception, Cognition and Insight for a patient with suspected ADHD

Answer 33

Thought - normal Perception - No hallucinations Cognition - poor attention, lack of concentration Insight - poor

Question 34

Name two investigations for suspected ADHD

Answer 34

Bloods - TFTs to rule out Thyroid disorder | Hearing tests

Question 35

Name three differentials for a diagnosis of ADHD

Answer 35

Learning disability Oppositional Defiant Disorder (Defiant and Disruptive against authoritative figures) Conduct Disorder (repetitive Antisocial Behaviour)

Question 36

Name two organisations which can support Parents and Teachers of Children with ADHD

Answer 36

Add Up | ADDISS

Question 37

How could you manage a preschool child with ADHD?

Answer 37

Psychoeducation and parent training

Question 38

How could you manage a school age child with ADHD?

Answer 38

Psychoeducation | CBT

Question 39

How could you manage ADHD Pharmacologically?

Answer 39

Methyphenidate (Ritalin) | Atomoxetine

Question 40

Define Learning Disability

Answer 40

State of arrested or incomplete development of the mind | Characterised by impairment of skills manifested over the developmental period

Question 41

What is the clinical triad of Learning Disabilities?

Answer 41

Low intellectual performance (IQ<70) Onset at Birth/Early Childhood Wide range of functional impairments

Question 42

Describe the ICD10 criteria of Learning Disability

Answer 42

Mild - IQ 50-70/ mental age 9-12 Mod - IQ 35-49/mental age 6-9 Severe - IQ 20-34/ mental age 3-6 Profound - IQ<20 / mental age <3

Question 43

Name two genetic causes of Learning Disabilities

Answer 43

Downs Syndrome | Fragile X Syndrome

Question 44

Describe the physical features of Downs Syndrome using the mnemonic PROBLEMS

Answer 44

``` Palpebral Fissure Round Face Occipital and Nasal Flattening Brachycephaly Low set small ears Epicanthic Folds Mouth open and protruding tongue Single Palmar Crease ```

Question 45

Describe the physical features of Fragile X Syndrome

Answer 45

Large protruding ears Long face High arched palate Flat feet

Question 46

Name four Antenatal causes of Learning Difficulties

Answer 46

Rubella Nutritional deficiency Hypothyroidism Alcoholism

Question 47

Name four causes in the Neonatal period of Learning Difficulties

Answer 47

Neonatal Sepsis Hypoglycaemia Hypothyroidism Birth Asphyxia

Question 48

How would a patient with MILD learning difficulties present?

Answer 48

Usually at a later age Adequate abilities but may struggle with academic work Most live independently

Question 49

How would a patient with MODERATE learning difficulties present?

Answer 49

Able to communicate but language is limited | May need supervision with self care but able to carry out simple work

Question 50

How would a patient with SEVERE learning difficulties present?

Answer 50

Marked degree of motor impairment | Little or no speech in early childhood

Question 51

How would a patient with PROFOUND learning difficulties present?

Answer 51

Severe motor impairment Severe difficulties in communication Little to no self care

Question 52

How would you test for Downs Syndrome during pregnancy?

Answer 52

Serum Screening (bHCG or PAPP- A) Quad Test (bHCG, AFP, Inhibin A, Estriol)

Question 53

How would you investigate Learning Difficulties

Answer 53

Full range of bloods CT head IQ test

Question 54

Name four occupations involved in the MDT for learning difficulties

Answer 54

Psychiatrist Specialist Nurses Psychiatrist Social Worker

Question 55

Name three behaviour techniques used for patients with Learning Difficulties

Answer 55

CBT Applied Behavioural Analysis Positive Behaviour Support

Question 56

There are four main Primitive Defences. Define Projection

Answer 56

Perceiving and reacting to unacceptable impulses as someone else’s fault

Question 57

There are four main Primitive Defences. Define Dissociation

Answer 57

Disconnecting self from areas of identity/memory/consciousness to retain illusion of control

Question 58

There are four main Primitive Defences. Define Idealisation

Answer 58

Attributing perfect/near perfect qualities to others as a way of avoiding anxiety or negative feelings

Question 59

There are four main Primitive Defences. Define Regression

Answer 59

Returning to an earlier phase of development or functioning to avoid conflicts/tension