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