Child Psychiatry



 
Autistic Disorder ADHD Tourette's Disorder
Characteristic:
• Impairments - interaction, communicaiton
• Stereotypical behavioral patterns
• Usually diagnosed < age 3
• Inversely related to IQ
• Boys > Girls
• Associated with Congenital rubella

Clinical:

• Oblivious to external world
• Abnormal or delayed language development
• No separation anxiety, shrink from touch
• Preference for sameness, inanimate objects
• Hyperkinesis, self-injurious behavior

Management:
• Education & behavioral techniques preferred
• No drug is proven to be highly effective
• If behavioral symptoms - Consider haloperidol
Characteristic:
• Short attention span, impulsivity, hyperactivity.
• > 6 Mo, < 7 yr
• Increased incidence among school age
• Boys > Girls



Clinical:

• Symptoms must be present in at least 2 situations (home, school, or work)
• Symptoms may persist into adult life
• Increased incidence of conduct disorder
• Antisocial personality & substance-related disorders

Management:
• Stimulants
• Methylphenidate SE: Suppresses HGH
• Consider drug holiday
Characteristic:
• Multiple motor & vocal tics present for > 1yr, must occur < age 18 yr.
• 3x common in boys
• Association between OCD & ADHD
• Abnormalities in the dopaminergic & adrenergic systems



Clinical:

• Initial tics are in the face & neck, progress down.
Coprolalia - begins in early adolesence
• Chronic, with remission & exacerbations


Management:
• Antipsychotics - Haloperidol, Risperdol, Pimozide.
• Noradrenergic antagonist such as clonidine
• Clonazepam