Psychiatry
Child and Adolescent Psychiatry
Child and adolescent psychiatry for MBBS and NEET-PG: ADHD, autism spectrum disorder, conduct disorder, enuresis and tics, with treatment, mapped to NMC codes PS14.
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Child and Adolescent Psychiatry
Child and adolescent psychiatry for MBBS and NEET-PG: ADHD, autism spectrum disorder, conduct disorder, enuresis and tics, with treatment, mapped to NMC codes PS14.
This chapter covers the psychiatric disorders of childhood and adolescence. It sets out attention deficit hyperactivity disorder and its treatment, autism spectrum disorder, the disruptive behaviour disorders, the elimination disorders enuresis and encopresis, tics and learning disorders, with an emphasis on early identification and family and school involvement.
High-yield: Child and Adolescent Psychiatry
- Attention deficit hyperactivity disorder is characterised by inattention, hyperactivity and impulsivity that are excessive for the child's developmental age and present in more than one setting.
- Symptoms of attention deficit hyperactivity disorder must be present before the age of twelve and cause impairment at home and at school.
- Methylphenidate, a stimulant, is a first-line pharmacological treatment for attention deficit hyperactivity disorder.
- Autism spectrum disorder features persistent deficits in social communication together with restricted, repetitive behaviours and interests, with onset in early childhood.
- Behavioural and educational interventions are the mainstay for autism spectrum disorder; there is no medication for the core deficits.
- Conduct disorder is a repetitive pattern of behaviour that violates the rights of others or major age-appropriate norms.
- Oppositional defiant disorder is a pattern of angry, defiant and vindictive behaviour, milder than and often preceding conduct disorder.
- Enuresis is involuntary passage of urine, usually at night, in a child aged five years or older, and is treated with behavioural methods, an enuresis alarm and desmopressin.
- Encopresis is the repeated passage of faeces in inappropriate places in a child aged four years or older.
- Tic disorders include Tourette syndrome, which combines multiple motor tics with one or more vocal tics lasting over a year.
- Specific learning disorders such as dyslexia affect reading, writing or arithmetic despite adequate intelligence and schooling.
- Separation anxiety disorder is developmentally excessive anxiety on separation from attachment figures.
- Early identification and family and school involvement improve outcomes across childhood disorders.
- Many childhood disorders, if untreated, continue to cause difficulty into adolescence and adult life.
Common childhood disorders
- **ADHD:** Inattention, hyperactivity, impulsivity before age twelve. Methylphenidate first-line.
- **Autism spectrum disorder:** Social communication deficits with repetitive behaviour. Behavioural and educational therapy.
- **Conduct disorder:** Repetitive violation of others' rights and social norms.
- **Enuresis:** Involuntary urination at age five or older. Alarm and desmopressin.
NMC competencies in this chapter
- **PS14.1:** Magnitude and aetiology of child and adolescent disorders
- **PS14.2:** Clinical features of child and adolescent psychiatric disorders
- **PS14.3:** Indications and interpretation of investigations
- **PS14.4:** Treatment including behavioural methods
- **PS14.5:** Family education and specialist referral
- **PS14.6:** Pharmacological basis and side effects of therapies
Frequently Asked Questions
What is attention deficit hyperactivity disorder?
It is a disorder of inattention, hyperactivity and impulsivity that is excessive for the child's age, begins before the age of twelve and causes impairment in more than one setting, such as home and school.
How is autism spectrum disorder treated?
The mainstay is behavioural and educational intervention, as there is no medication for the core social communication and repetitive behaviour deficits. Medication may help associated symptoms.
What is the difference between conduct and oppositional defiant disorder?
Conduct disorder involves serious violation of the rights of others and social norms, while oppositional defiant disorder is a milder pattern of angry, defiant behaviour that often precedes it.
How is nocturnal enuresis managed?
In a child of five or older it is managed with behavioural measures, an enuresis alarm as the mainstay, and desmopressin for short-term needs, after excluding a physical cause.
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