Session 10 - Childhood Conditions

Question 1

What are the characteristic symptoms of ADHD?

Answer 1

1. Inattention:

Easily distracted, forgets daily activities, loses possessions, does not listen, etc.

2. Hyperactivity:

Unable to play quietly, restless.

3. Impulsive:

Cannot wait their turn, interruptive in class.

Question 2

In order to be diagnosed with ADHD, the symptoms must be:

Answer 2

1. Persistent:

If behaviour does fluctuate, this could be an acute reaction to a change in the environment as a child.

2. Pervasive:

If the behaviour is simply concentrated at home, the child may not be engaging with their parents. If it solely exists at school, is could suggest an alternate cause such as bullying.

3. Developmental delay

Question 3

Diagnosis of ADHD.

Answer 3

Age <16 - ≥6 symptoms

Age >17 - ≥5 symptoms

School observation (prove behaviour is pervasive).

QB test - measures impulsivity, attention and concentration.

Question 4

Management of ADHD.

Answer 4

1. 10-week watch and wait period to see if symptoms resolve.
2. Refer to paediatrician or child and adolescent psychiatrist.
3. Parent education and training programme.
4. Methylphenidate for 6 week trial.
5. Lisdexamphetamine.
6. Dexamphetamine.
7. Amoxetine.

Question 5

Medical management of ADHD.

Answer 5

1) Methylphenidate for 6-week trial. Monitor height and weight every 6 months.

2) Lisdexamphetamine.

3) Dexamphetamine.

4) Atomoxetine.

All drugs are cardiotoxic so must perform a baseline ECG prior to starting treatment.

Question 6

What is encopresis?

Answer 6

The voluntary or involuntary soiling of undergarments in children older than 4, without an organic cause.

It can occur with or without constipation.

Question 7

Causes of encopresis.

Answer 7

Majority of cases are behavioural.

For example, it could be due to anger (self-soiling to spite parents); regression in childhood; not learning how to use the toilet properly.

Question 8

Diagnosis of encopresis.

Answer 8

Age >4 years AND:

• repeated passage of faeces in an inappropriate place
• at least one event a month for 3 months
• behaviour not due to drugs or other medical condition (except constipation)

Question 9

Management of encopresis.

Answer 9

• exclude biological causes
• put in place regular toilet times

If constipated, give stool softeners and osmotic laxatives to help make egestion easier.

Question 10

Which serious biological cause of encopresis must be excluded?

Answer 10

Hirschsrung’s disease:

The nerves that control the motility of the bowel are absent from birth, causing severe constipation.

Question 11

Prognosis of encoperesis.

Answer 11

90% of cases resolve in a year.

Question 12

What is Autism Spectrum Disorder (ASD)?

Answer 12

A developmental disorder which causes children to exhibit high levels of systemising rather than empathising.

It represents a spectrum ranging from mild impairment to severe dependency.

Question 13

Diagnosis of ASD.

Answer 13

i) Global impairment of language and communication
ii) impairment of social relationships
iii) ritualistic and compulsive features

Question 14

Co-morbid conditions with ASD.

Answer 14

• ADHD
• epilepsy
• low IQ <95

Some may have isolated skills (e.g. memory, computation) but this is the minority.

Question 15

Management of ASD.

Answer 15

Multidisciplinary approach to aide education, give independence and improve social skills.

Uses a mixture of behaviour treatments, special education, family counselling.

Medication may be used to treat comorbid conditions, but has no primary role.

Question 16

What is Asperger’s syndrome?

Answer 16

A less severe form of autism, characterised by more minor impairment.

It is typically diagnosed after the age of 3, whereas autism is diagnosed before the age of 3, marked by the developmental delay especially in social communication.

Question 17

Symptoms of Asperger’s syndrome.

Answer 17

• indifferent to praise or criticism
• prefer solitary activities
• lack desire for companionships and sexual interactions
• pedantic speech
• pre-occupation with obscure facts
• normal intelligence and language development

Question 18

What are breath holding attacks?

Answer 18

Short periods of episodic apnoea in children which can lead to a temporary loss of consciousness.

They often occur after a child has got upset or startled, occurring as part of toddler tantrums.

Question 19

Difference between breath holding attacks and seizures.

Answer 19

There is no post-ictal phase, no incontinence, and the EEG will be normal in breath holding attacks.

Question 20

Blue spells features.

Answer 20

Type of breath holding attack precipitated by anger or frustration:
- child cries and expires forcefully, leading to cyanosis, loss of muscle tone and consciousness
- leads to hypocapnia and hypoxia (cyanosis)
- rapid recovery (1-2 minutes)

Question 21

Pale spells features.

Answer 21

Type of breath holding attack precipiated by a painful event:
- little to no crying
- child turns pale and loses consciousness
- rarer than blue spells

Question 22

Management of breath holding attacks.

Answer 22

No definitive treatment as the child will eventually outgrow the spells.