12.09.17 Child psychiatry notes

Conduct disorder

• • Psychological disorder diagnosed in childhood that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated

  • DSM IVCriteria:

    • A repetitive and persistent pattern of behavior in which the basic rules of others or major age-appropriate societal norms or rules are violated

    • Manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:

      • Aggression to people and animals

        • Often bullies, threatens, or intimidates others

        • Often initiates physical fights

        • Has used a weapon that can cause serious physical harm to others

        • Has been physically cruel to people

        • Has been physically cruel to animals

        • Has stolen while confronting a victim

        • Has forced someone into sexual activity

      • Destruction of property

        • Has deliberately engaged in fire setting with the intention of causing serious damage

        • Has deliberately destroyed others' property (other than by firesetting)

      • Deceitfulness or theft

        • Has broken into someone else's house, building, or car

        • Often lies to obtain goods of favors or to avoid obligations

        • Has stolen items of nontrivial value without confronting a victim

      • Serious violations of rules

        • Often stays out at night despite parental prohibitions, beginning before age 13 years

        • Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning home for a lengthy period of time)

        • Is often truant from school, beginning before the age 13 years

    • The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

    • If individual is age 18 years or older, criteria are not met for antisocial Personality Disorder

  • Precursor to antisocial personality disorder

  • May be:

    • Socialised

      • Apparent when in a group

      • cf Herd mentality

    • Unsocialised

      • Apparent when alone

      • Much more serious

ADHD Diagnosis

• • IA. Six or more of the following signs of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

    • Inattention:

      • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

      • Often has trouble keeping attention on tasks or play activities.

      • Often does not seem to listen when spoken to directly.

      • Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).

      • Often has trouble organizing activities.

      • Often avoids, dislikes, or does not want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).

      • Often loses things needed for tasks and activities (such as toys, school assignments, pencils, books, or tools).

      • Is often easily distracted.

      • Often forgetful in daily activities.

  • IB. Six or more of the following signs of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

    • Hyperactivity:

      • Often fidgets with hands or feet or squirms in seat.

      • Often gets up from seat when remaining in seat is expected.

      • Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).

      • Often has trouble playing or enjoying leisure activities quietly.

      • Is often "on the go" or often acts as if "driven by a motor".

      • Often talks excessively.

    • Impulsiveness:

      • Often blurts out answers before questions have been finished.

      • Often has trouble waiting one's turn.

      • Often interrupts or intrudes on others (example: butts into conversations or games).

  • II. Some signs that cause impairment were present before age 7 years.

  • III. Some impairment from the signs is present in two or more settings (such as at school/work and at home)

  • IV. There must be clear evidence of significant impairment in social, school, or work functioning.

  • V. Exclusions:

    • The signs do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder

    • The signs are not better accounted for by another mental disorder

      • Such as Mood Disorder, Anxiety Disorder, Dissociative Identity Disorder, or a Personality Disorder

Notes

• • Abuse types

    • Physical

    • Emotional

    • Sexual

    • Neglect

  • Dad has full parental responsibility if he is named on the birth certificate, even if separated

  • Connor's questionnaire for ADHD

  • ABCDE

    • Asymmetry

    • Border

    • Colour

    • Diameter

    • Elevation