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L19 Psychological Medicine Childhood disorders 1

Childhood disorders 1

Status: S1LectNotes Time: 2025-03-25 Tags: lecturenotes Links:

tasks:

Content:

Objectives:

  • Understand the presentation and diagnostic criteria for common developmental disorders
  • Demonstrate an understanding of how the disorder affects everyday function and behaviour
  • If given a case example be able to identify and describe the likely childhood disorder that may fit the child’s presentation and the reasons why you would consider it, what additional information you would need, and anything inconsistent with that diagnosis.

Childhood disorders

Intellectual developmental disorder / Intellectual disability

IDD is characterised by global difficulties in information processing (may still see variation in profile though) Distinct from special learning disability and illness or injury (neurocognitive disorder)

IDD diagnostic criteria

Intellectual and adaptive functioning deficits in conceptual, social, and practical domains with the following 3 criteria being met:

  • A. Deficits in intellectual functioning
    • Reasoning
    • Problem solving
    • Planning
    • Learning
    • Judgement
  • B. deficits in adaptive functioning that result in failure to meet developmental and social standards for personal independence and social responsibility
    • communication
    • social participation
    • independant living
    • across multiple environments (home, school, community)
  • Onset of intellectual and adaptive deficits during the developmental period

What does this look like

May not be obvious: Early recognition more likely if

  • severe impairment
  • Impairment across multiple domains of function
    • Delayed milestones
  • presence of multiple risk factors

Risk factors

  • Adverse postnatal development
    • Deprivation of nurturance and other stimulation
  • Pregnancy and perinatal problems
    • fetal malnutrition, prematurity, hypoxia, viral and other infections. trauma
  • general medical conditions
    • seizure disorders, infections, etc

Prevalence and etiology

• Prevalence • Estimates range from 1 – 3% • Males > females • Etiology often undetermined • 30 – 40% • Strong genetic/heredity component • >500 genetic disorders associated with ID • Down Syndrome • Fragile-X syndrome • Tuberous sclerosis • Adverse prenatal environment • Fetal alcohol syndrome • Lead poisoning • Maternal infection • Pervasive Developmental Disorders

Comorbidity

• Very common (range 10 – 70%) • Type may vary according to severity of IQ impairment • Depression, anxiety, antisocial more common in those with higher levels • Psychotic, autism spectrum disorder more likely in lower levels • Challenging behaviour common • ?reflects emotional problems • Maltreatment common (cause or outcome?) • Beware diagnostic overshadowing

Respect dignity and equity

Treat person with respect 25 yr old with information processing facilities of a 15yr old should not be treated as a 15 yr old

Autism spectrum disorder

Neurodevelopmental condition that leads to cognitive, social and sensory processing differences that influence a person’s understanding of, and interaction with, the world.

It is not an illness, it is a neurological difference and it is present from childhood throughout lifespan

Three domains of ASD

  • Social
  • Communication
  • Repetitive and restrictive behaviour

Diagnostic criteria

  • A. Persistent deficits in social communication and social interaction across multiple contexts
    • Social emotional reciprocity
    • nonverbal communicative behaviours
    • relationships
  • B. Restricted repetitive behaviours, interest or activities (at least 2)
  • C. Symptoms must be present in early childhood (however may not fully manifest until social demands exceed limited capacities)
  • D. Clinically significant impairment

Social communication disorder is pragmatic difficulties with communication just without restricted and repetitive behaviour

Incidence

• Varied rates reported across time and sources • Seems to be increasing • Ministry of Health • 1.2% in 2014 → 2.2% in 2017 • Rise = increased incidence vs detection? • More common in males – 4:1 • But ratios vary when no ID from 5 – 16:1 • When severe ID, 1:2 (more females) • Females often dx’d later

Risk Factors

• Family history • Rate of autism in siblings aprox 50 times than of general population • High concordance in monozygotic twins • Recurs in families at rate of 3 – 6% • Maternal age • Paternal age • Perinatal complications (e.g., hypoxia)

Common comorbidities

• IDD (50 – 80%) • Specific Learning Disorder • Speech Language Disorders • Anxiety • ADHD • Mood • Tic Disorder • Seizure Disorders

Other difficulties with ASD

  • Sleep disturbances
  • Eating
  • Emotional regulation

Positive outcomes with ASD

  • Higher IQ
  • Language skills - meaningful speech before 5
  • Early identification and intervention

IDD and ASD: assessment

Specialist assessment for Dx - refer Diagnostic overshadowing

Clinical considerations

  • Routine and sensory issues - need to work with patient
  • Consider how to prepare for unfamiliar places and experiences
    • Social stories
  • Use special interests as a way to develop rapport
  • may need more structure in questions and check in on shared understanding
    • Theory of mind difficulties
    • Literal metaphor and other language difficulties - may need more pragmatic pain scale

Graph View