Emotional disorders, e. Disorders of social functioning, e. Tic disorders, e.
Other symptomatic disorders with onset during childhood, e. A1 z Preferred diagnosis: Separation anxiety.
If they occur on a Sunday night, but not on a Friday night, this would point towards them being expressions of anxiety about school. This makes it unlikely to be a school-based problem. Are they aware of any problems e. She describes enjoying school. This makes a diagnosis of depression unlikely. A3 z Predisposing factors: z Poor parental discipline. A4 z Location: Treatment is usually as an outpatient.
It may also help to reduce emotional over involvement. If the absence is more long term, a gradual desensitization approach may be more effective. Answers 87 Q5: What is the prognosis in this case? A5 z The majority of children successfully return to school and have no further problems. There is an increased risk of school refusal in the future.
The fact that he can concentrate on his computer is not contradictory, as many children with hyperkinetic disorder can concentrate on the television and on computer games where little active attention is required.
In addition, he presents as overactive and his mother described impulsivity. Ratings scales are commonly used to obtain information from parents and teachers e. Connors scales. This will help to establish that his symptoms occur both at school and at home.
A school visit to observe him in class may be helpful. This may be as a result of his hyperactivity, poor concentration and impulsivity, but it may also be due to a conduct disorder. Both disorders involve impulsivity, and children with hyperkinetic disorder may also have a conduct disorder.
Children who do not understand or are bored may be inattentive and hyperactive. A3 z Predisposing factors: There is a genetic contribution to hyperkinetic disorder, which is more common in boys than girls, and is more common in association with: z Epilepsy. A4 z Location: Treatment should be as an outpatient. The child may also become unhappy and tearful or develop tics or stereotypical movements.
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Whilst on the drug the child must be followed up by a specialist. Exclusion diet. There is no way of predicting which foodstuffs are responsible in any particular child. Answers 89 z Psychological z Explaining the condition to the child, family and school is enormously helpful. When it is understood that the child is not behaving in this way on purpose, the pattern of the child being blamed all the time can be broken.
The child needs rapid rewards when they manage to stay on task. Rules about unacceptable behaviour must be clear and sanctions consistent. Parent training classes and teacher training can create consistency for the child. A2 z Chris does not have any friends, and at interview he does not make eye contact and does not check to see whether you are interested in what he is saying. He is displaying features of impaired reciprocal social interaction. He has a preoccupation with pebbles and lining them up. This is suggestive of an autistic spectrum disorder.
This makes it likely that his language development has not been seriously delayed as occurs in autism. His speech is, however, qualitatively different. He does not grasp the normal give and take of conversation, and his speech is stilted with abnormal intonation prosody. Chris may have tantrums as a result of changes in his routines that are so small that his parents do not notice them. In obsessive compulsive disorder the compulsive behaviour is associated with anxiety; however, in autistic spectrum disorders the repetitive behaviour is reassuring and can be seen as a way in which the individual tries to structure a world which otherwise seems very confusing.
Children with learning disabilities may have features of autistic disorder, and many children with autism are also learning disabled. This should also include hearing and visual acuity assessment.
A3 z Predisposing factors z Genetic. Twin studies indicate a heritability of over 90 per cent, probably due to an adverse combination of a number of genes. The majority opinion at present is that there is no good evidence of a link. Answers 91 Q4: What treatment options are available? A5 z The best predictors of outcome are non-verbal IQ and linguistic ability. A2 z Encopresis is a term that is used to describe any sort of inappropriate deposition of faeces including in the pants after 4 years of age. This results in further retention and a stretching of the rectum and an associated loss of sensation.
Semi-liquid faeces may be leaking around the blockage. Enquiries should be made about delays in any other areas e. In addition, an assessment of his diet would be useful. The parents should be asked if Charlie has ever been provocative with his soiling e. A3 z Predisposing factors: Only family studies have been done, but these do suggest a genetic contribution.
Answers 93 z Stresses both within the family and outside it may lead to constipation and soiling as a result of anxiety or anger. A4 z Location: Treatment will almost always be as an outpatient. A liaison approach with paediatricians is most appropriate. A regular bowel habit is then encouraged. A5 It is very rare for soiling to persist into adulthood. A1 z Preferred diagnosis: Schizophrenia. He now appears to be responding to hallucinations. This may suggest that he is suffering from schizophrenia.
Alternatively, depression may cause social withdrawal and psychotic symptoms. People with learning disabilities have increased rates of epilepsy and other neurological disabilities.
They are also more likely to have physical disability and associated physical illness including delirium. Side effects from medication may not follow normal patterns, and should be considered carefully. This may have distressed him enormously. Other possible stressors must also be considered. People with learning disabilities are vulnerable to abuse, and they also experience more stigma and social isolation than people who are not learning-disabled.
A3 z Predisposing factors: These may include poor communication skills, increased experience of failure leading to low expectations of success and global negative self-evaluation, impaired social understanding, increased vulnerability to abuse, social stigma or neurodevelopmental lesions of the medial temporal lobe.