Post on 08-Apr-2018
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Types of PDD (ICD-10)
Childhood autism
autistic ds, infantile autism, infantile psychoseKanners syndrome
Atypical autismRetts syndrome
Childhood disintegrative ds
Overactive ds associated with MR
Aspergers syndrome
PDD- not otherwise specified
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Diagnosis: 3 main areas of
impairment in PDD or ASDDelay and abnormal quality in:
reciprocal social interaction
language and communication
imaginative thinking - restricted,repetitive activities and interests
&early onset: before age 3
***Prediagnosis
Infant-good baby
6-8/12 no regards mother
2/3 trait f/u diagnosis change
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Social impairmentQualitative impairment in reciprocalsocial relationships
non-verbal cues: poor eye contact, facial
expressions, body postures, gesturesfailure to develop peer relationship
fail to share enjoyment or seek comfortwhen hurt (lack of pointing, requesting)
difficulties with understanding socialcues
lack of social empathy (difficulty to
recognise others emotions)
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Language &
communicationDelay in receptive and expressivelanguage
stereotyped or repetitive use of languageidiosyncratic use of words
unable to initiate or sustain aconversation (those with speech)
echolalia, pronoun reversal, inventedreduced gestures or poorly co-ordinated
(abnormal pointing)
lack of social imitative or pretend play
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Repetitive stereotyped
activities and interestsRigid and inflexible thought processes
resistance to change, insist on same
routines, ritualistic behaviours (lengthymealtime ritual)
repetitive activities and interests(complex or simple)- hand flapping,
twirling objects, fascinated with unusualparts of objects, same segment TV show)
persistent preoccupation with parts ofobjects
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Other features: not
required for diagnosisUnusual responses to sensory stimuli egcertain sounds, fascination by certainvisual stimuli, dislike gentle touch, butenjoys firm pressure
poor motor co-ordination
over or underactivity
food fadserratic sleeping patterns
abnormalities of mood- excitement/misery
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Age of OnsetDelay or abnormal functioning in at
least one area must be before age 3
years
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PrevalenceChildhood autism:
3-4 per 10,000 population
20 per 10,000 (broader definition)
Asperger Syndrome
36 per 10,000
Male preponderance
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Dif ferent ia l d iagnoses of
c h i ldhood aut ismDeafness
Developmental language disorder
Mental retardation with autistic featuresMental retardation without autisticfeatures
Intense early deprivation
Pervasive developmental disorders:Asperger Syndrome, Retts syndrome,Degenerative disorder, atypical
autism, PDD-not otherwise specified
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Treatment plan Establish goals for educational purposes
Establish target symptoms for
intervention
Co-morbid conditions
Monitoring
Multiple domains of functioning
Medication
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? Die t m odi f ic a t ion
No gandum
Milk
Vanilla
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The l i t t le Rasc a ls @
Attention Deficit Hyperactive Disorder
(ADHD)
Dr. Fauzi IsmailDepartment of Psychiatry
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Hyperk ine t i c c h i ldren
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Hyperactive parents
all manner of behaviour e.g. frequent night awakenings, talking loudly,
naughtiness, exuberance
depends on attitudes and tolerance ofparents
MUST always pay attention to the stage ofdevelopment when deciding normality and abnormality
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Hyperactive Children
Hyperactive psychiatrists
more restrictive definition restlessness
inattentiveness
impulsiveness
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Hyperactive Children
Overactive : increase in amount and tempo of purposeful
activity increase in number of purposeless minor
movements irrelevant to tasks
e.g. wriggle and squirm in seatfidget with objectsrestless
unable to suppress activity when stillness isrequired e.g. in classroom or at meal table
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Core
symp tomsHyperactivity More active than children their age
Inattentive Short attention span
Impulsive
Poor impulse controlPervasive Symptoms occur across all situations
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Hyperac t i v i t y
Fidgets with hands or feet
Squirms in seat
Runs about or climbs excessivelyDifficulty playing or engaging in leisureactivities quietly
Talks excessivelyAlways on the go
Described as if driven by a motor
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Ina t ten t i vene
ss
Fails to give attention to details
Makes careless mistake
Do not follow through instructionsFails to complete schoolwork, chores orduties
Reluctance to engage in tasks requiring
sustain mental effortsDifficulty organizing tasks & activities
Easily distracted
Often forgetful for their age
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Impuls ive
Blurts out answers before questioncompleted
Difficulty awaiting their turn
Interrupts or intrudes on others
Makes poor judgement
Accident prone
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Do you fit these criteria
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Epidemio logy
Prevalent in 1-3% of children
Male : Female
3:1Hyperactivity dates back to pre-schoolyears
Referral delayed until primary school Present with inattentiveness, learning
difficulties & disruptiveness
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Et io logy
Unknown
Unlikely to be a single etiological factor
Most likely an interplay
psychosocial & biological factors
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Dif ferent ia l
d iagnos is
Normality Consider parents expectations & level of
tolerance
Situational hyperactivity Symptoms occur only in certain situations
Mental retardation Poor attention and activity control
Specific learning disability
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Management
Requires a multi-disciplinary approach
Pharmacological treatment - etarline
Psychological intervention
Educational support
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PrognosisHyperactivity wanes in adolescence
30% have residual symptoms in adulthood
Restless & inattentive30% have no symptoms with good
functioning
Choose job which allow freedom of movement30% continuous display of symptom
Develop other psychopathologies
E.g. substance abuse & anti-social personality
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