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L20 Psychological Medicine Childhood disorders 2

Childhood disorders 2

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

tasks:

Content:

Objectives:

  • Demonstrate an understanding of how the disorder affects everyday function and behaviour
  • Understand the presentation and diagnostic criteria for common developmental disorders
  • 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

ADHD

Broadly ADHD can be divided into 3 types

  • Inattentive (more common in females)
  • Hyperactive-impulsive
  • Combined hyperactivity and inattentiveness

Diagnostic criteria:

  • Persistent pattern of inattention and or hyperactivity/impulsivity that interferes with functioning or development
  • Number of symptoms required vary across lifespan
    • 6 or more in each catagory up to age 16
    • 5 or more in each catagory from age 17
  • Present for at least 6 months
  • Inappropriate for age (eg its okay for a kid to be scatterbrained but a 40 yr old adult doesnt tend to be)
Inattentive criteria
  • Fails to pay attention to details or makes careless mistakes
  • Difficulty sustaining attention in tasks or play
  • Often doesn’t seem to be listening when spoken to
  • Doesn’t follow through with instructions and fails to finish school work or duties
  • Has difficulty organising tasks or activities
  • Avoids or dislikes sustained mental effort
  • Often loses things
  • Easily distracted by irrelevant stimuli
  • Often forgetful
Hyperactivity and impulsivity
  • Often fidgets, squirms in seat
  • Leaves seat in classroom
  • Runs about, climbs excessively
  • On the go, acts as if driven by motor
  • Unable to play… quietly
  • Often talks excessively
  • Blurts out answers, difficulty waiting turn
  • Interrupts Longitudinal criteria
  • need to be causing impariment before 12 Cross situational criteria
  • Impairment is present in 2 or more settings  Pervasiveness and severity criterion
  • Clear evidence of significant impairment in social, academic, or occupational functioning Exclusion Cannot be attributed to anything else

Common presentations of the types of ADHD In children

In adults

Prevalence

• Worldwide prevalence = 5% • Adults = 2-3% • New Zealand = 1 in 20 (1 child in every classroom) • Sex differences • Males: Females = 2:1 in childhood • 1:1 in adulthood • Cultural differences • Diagnosis depends or difference from culturally accepted standards

Risk factors

  • Genetic
    • If a parent has ADHD = 60% risk the child will also have it
    • 3x as likely to have ADHD if a biological parent has it versus an adoptive parent
  • Dopamine regulation genes
  • Pregnancy, birth and early development
  • Birth complications, maternal stress and exposure to toxins can create a general risk for the child developing later problems
  • Family influences
    • Family interactions may exacerbate symptoms
    • Family problems may result from the difficulty of dealing with ADHD symptoms
  • Family conflict is related to the presence of oppositional problems

Brain function in people with ADHD(aetiology)

centre for executive function is normed differently executive functions have a hard time

Comorbidities

• ADHD only (20%) • Anxiety (25%) • Mood (20-30%) • Oppositional problems (50%) • ASD (50% with ASD have ADHD) • Developmental coordination (30-50%)

Associated problems

  • Tourette’s disorder. ADHD precedes TS
  • Autism spectrum disorder
  • Trauma/maltreatment
  • Nonsuicidal self injury
  • Suicide attempts
  • Substance misuse
  • Challanging behaviour (Conduct Disorder, Oppositional Defiant Disorder, Intermittent Explosive Disorder)
  • Cognitive problems
    • Academic underachievement, school failure, unemployment
    • substantially poorer language skill across expressive, receptive, and pragmatic language
    • application of intellegance
    • executive functions
  • Emotional and social problems
    • Problems reading others emotional cues, modulating responses
    • reduced emotional regulation
    • peer rejection
    • Family stress and discord
    • More likely to become hyperaroused in presence of reward and may become frustrated in absence of reward

Sleep

  • Up to 70% of children with ADHD/Aroreretini experience sleep/Moe problems (cf 20-30% in the general population)
  • Associated with worse ADHD symptoms, poorer quality of life and other mental health problems.
  • Up to 20% of adolescents with ADHD report sleep problems (< 7 hours/night), daytime sleepiness, falling asleep in class (cf 10% without ADHD)
  • Unclear whether treating sleep improves symptoms.

Physical problems

  • Motor coordination and development
    • risk of accidental injury is increase as well as heightened presence of risk taking behaviour
  • Other health problems
    • smoking
    • obesity
    • hypertension

Females and adhd

  • More males than females with ADHD but ratio becomes more equal by adulthood
  • most research with boys and men but research with girls shows high levels of real world problems across time 1

Assessment for ADHD

  • Specialist assessment
  • Consider strengths and difficulties, fit with environment and expectations
  • CBDS approach
  • Consider common comorbidities and assess/screen for those
  • May be involved with significant cost
  • Specific problem descriptions, we need the parent to give specific descriptions
  • functional analysis what precipitate difficulties
  • family styles understand dynamics to see where can we help
  • Cognitive Behavioural developmental approach to child characteristics CBDS
  • Cognitive Behavioural developmental approach to caregivers characteristics
  • environemntal contextual factors
  • comorbidities

Treatment

  • Medication + behavioural intervention is best.
  • Medication can be difficult to figure out the correct dose and drug
  • compliance can be poor
  • Behavioural intervention - building skills to manage with ADHD and some strategies to cope. this can be elevated well with medication

Effects of medication

Compliance with stimulant medication quite poor, especially in adolescence

  • Fewer than 10% of children persist with long term medication
  • Parents tend to prefer non-medication approaches Side effects
  • irritability, loss of appetite, insomnia
  • longer term: social withdrawal, blunting, reduced weight and height gain, increased blood pressure and heart rate
  • longer term reduced height with medication

Foci of parent training interventions

medication is like glasses for the brain

Common foci of effective parent training interventions (look at these to guide parent advice and setting up sustainable systems)

Reinforcement processes reinforce positive processes and shit i dunno Family structure - look where you can repair attachment as often there is frustration in the family. Attributions ensuring the cognitions that the parents and children have about themselves and each other are helpful

Summary

five key messages genuine medical conditions only comprehensice assessment can distinguish ADHD from other mental health condition, chaotis home environments, or after effects of maltreatment. rarely done. psychologists have an important role medications are effective in reducing core symptoms in short term; ost genuine gains achieved by combining medications with skill building approached rates of ADHD and medication vary dramatically, related to family and cultural values, demand s dor achievement, and other core factors misdiagnosis common falso +ve and -ve

Footnotes

  1. Review ↩

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