Child and adolescent psychiatry – 1

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5 Child and adolescent psychiatry – 1

	T	F
1. Using ICD-10 results in diagnosing more cases of hyperkinetic disorder than using DSM-IV.
2. A child with ADHD is likely to experience peer rejection.
3. Clonidine and methylphenidate combination is more effective than either alone in treatment of ADHD with associated tics.
4. Autistic children do not show attachment to mother.
5. Autism is associated with epilepsy in adolescence.
6. One in six people with autism manage to live independently as adults.
7. Children who are aggressive are likely to develop antisocial traits in adulthood.
8. Conduct disorder children have normal executive function if there is no ADHD.
9. Maternal smoking in pregnancy is associated with conduct disorders.
10. Shoplifting is a feature of social anxiety in children.
11. Being the first child in the family increases the risk of violence.
12. Adolescent girls have more depressive cognitions than boys.
13. Mutation of the methyltetrahydrofolate reductase (MTHFR) allele is associated with adolescent onset depression.
14. Dyslexic children have decreased temporal lobe activity during attempts to read.
15. Encopresis is associated with school refusal.
16. In children with both faecal and urinary soiling the urinary problem needs to be treated first.
17. In divorce, adjustment difficulties are seen in children before the event even if there is a lack of parental conflict.
18. Gender identity disorder in childhood is associated with decreased contact with the father.
19. The prevalence of specific reading disorder is higher in China compared to the US.
20. Severe specific reading disorder is associated with impaired non-verbal task performance in an IQ test.
21. In children with specific reading disorders there is an increased risk of schizophrenia in adulthood.
22. In a 14-year-old boy with school refusal, depression is a likely diagnosis if there is no history of missing school.
23. If a 12-year-old girl discloses repeated sexual abuse by her father, an interview using ‘anatomically correct’ dolls is indicated.
24. Night terrors are associated with depression.
25. Death of a parent is associated with truancy.

ANSWERS

1. Using ICD-10 results in diagnosing more cases of hyperkinetic disorder than using DSM-IV.

False: DSM-IV criteria for ADHD are looser, and there can be the predominantly inattentive subtype or the predominantly hyperactive–impulsive subtype. The combined type better matches the stricter ICD-10 criteria for hyperkinetic disorder. Hence, using DSM-IV results in more cases being diagnosed than using ICD-10. This must be considered when interpreting research findings in ADHD.

2. A child with ADHD is likely to experience peer rejection.

False: Children with ADHD are at increased risk of peer relationship problems, as they are often overactive, intrusive and have difficulty following rules of games. However, the majority do not suffer from these problems so much that they ‘experience peer rejection’.

3. Clonidine and methylphenidate combination is more effective than either alone in treatment of ADHD with associated tics.

False: A recent RCT compared clonidine, methylphenidate, clonidine and methylphenidate combination and placebo in patients with ADHD and tic disorder. All three active groups led to significant clinical improvement compared to placebo. While the greatest difference was between combined treatment and placebo, the study was not adequately powered to demonstrate significant differences between combined and single treatments. Tics reduced in all active treatments compared with placebo (Tourette’s Syndrome Study Group 2002).

4. Autistic children do not show attachment to mother.

False: Attachment is the infant’s predisposition to seek proximity to certain people and to be more secure in their presence. Attachment is variable in autistic children: often attachment is very poor. They have little interest in the human face. They rarely seek others for comfort or attention. They are aloof and indifferent to people. However, sometimes an autistic child is very affectionate and shows strong attachment behaviours. While attachment is possible, autistic children still normally show poor social reciprocity with their attachment figures, for example, giving hugs only on their terms, whether or not their mother is able to give a hug in that situation (Johnstone et al 2004, p. 583).

5. Autism is associated with epilepsy in adolescence.

True: About 20–25% of those with autism develop epilepsy, particularly in adolescence (Gelder et al 2000, p. 1726; Johnstone et al 2004, p. 590).

6. One in six people with autism manage to live independently as adults.

False: One in 10 lives independently (Gelder et al 2000, p. 1726).

7. Children who are aggressive are likely to develop antisocial traits in adulthood.

False: Aggressive children are more likely to be antisocial in adulthood, but as a group, they are still more likely to be non-antisocial. 40% of children with conduct disorder go on to be delinquent as young adults (Goodman & Scott 1997, p. 66).

8. Conduct disorder children have normal executive function if there is no ADHD.

False: Conduct disordered children have impairments of executive control functions such as planning, initiation of actions, inhibition of responses and self-monitoring behaviour. These are present even if there is no ADHD (Rutter & Taylor 2002, p. 424).

9. Maternal smoking in pregnancy is associated with conduct disorders.

True: This association is stronger for males, stronger for persistent conduct disorders and stronger for violent than non-violent criminality.

10. Shoplifting is a feature of social anxiety in children.

False: Shoplifting is not a common feature of childhood emotional disorders.

11. Being the first child in the family increases the risk of violence.

False: There is no evidence of this. However, behavioural problems are associated with large family size.

12. Adolescent girls have more depressive cognitions than boys.

True: Community studies of adolescent girls show higher levels of depressive symptoms and cognitions than boys.

13. Mutation of the methyltetrahydrofolate reductase (MTHFR) allele is associated with adolescent onset depression.

False: MTHFR is a regulatory enzyme in homocysteine metabolism. A mutation in the gene results in decreased enzyme activity, contributing to increased homocysteine levels and decreased folate levels. This is implicated in coronary artery disease and possibly Alzheimer’s disease, but there is no evidence linking it with depression.

14. Dyslexic children have decreased temporal lobe activity during attempts to read.

True: PET and fMRI studies have shown that when attempting phonologic tasks, e.g. rhythm detection, dyslexic children show reduced activation in parts of the left hemisphere, including the superior temporal, parieto-temporal, middle temporal, middle occipital and inferior frontal gyri; parts of the right hemisphere, including the inferior frontal gyrus; and two posterior sites – the parieto-temporal region and the occipito-temporal region. There is also an unusual degree of symmetry of planum temporale (Lishman 1997, p. 49).

15. Encopresis is associated with school refusal.

False: There is no evidence that children with encopresis are more likely to refuse to go to school.

16. In children with both faecal and urinary soiling the urinary problem needs to be treated first.

False: Faecal soiling is often as a result of overflow from constipation. Constipation can make enuresis worse due to pressure on the bladder. Therefore, constipation needs to be addressed first.

17. In divorce, adjustment difficulties are seen in children before the event even if there is a lack of parental conflict.

False: Conflict before divorce and the actual divorce are the major risk factors for adjustment problems. If there is no pre-divorce conflict, there is no increased risk for adjustment difficulties before the divorce (Gelder et al 2000, p. 1693).

18. Gender identity disorder in childhood is associated with decreased contact with the father.

True: Cross-gender behaving boys have been shown to spend less time with their fathers in their early years than conventionally masculine boys. There was no difference between times spent with mothers in the two groups. It is possible that, rather than the reduced contact with fathers causing feminine behaviour, boys with feminine identification were less interesting to their fathers (Gelder et al 2000, p. 1821).

19. The prevalence of specific reading disorder is higher in China compared to the US.

False: Despite great differences in the nature of printed words, there is no difference in the prevalence of specific reading disorder in USA, China and Japan.

20. Severe specific reading disorder is associated with impaired non-verbal task performance in an IQ test.

False: By definition, specific reading disorder tells us nothing about IQ other than that the level of reading is less than that expected from IQ. Specific reading disorder is associated with some neuropsychological and neurodevelopmental difficulties, e.g. left–right confusion, difficulty in construction and coordination, motor persistence and abnormalities of language. However, these would be unlikely to affect performance IQ tests significantly (Goodman & Scott 1997, p. 193).

21. In children with specific reading disorders there is an increased risk of schizophrenia in adulthood.

False: There is no association between specific reading disorder and schizophrenia (Goodman & Scott 1997, p. 197).

22. In a 14-year-old boy with school refusal, depression is a likely diagnosis if there is no history of missing school.

False: Depression is possible, but much less likely than anxiety or no formal psychiatric disorder (Goodman & Scott 1997, p. 76).

23. If a 12-year-old girl discloses repeated sexual abuse by her father, an interview using ‘anatomically correct’ dolls is indicated.

False: The use of anatomically correct dolls is controversial. Some practitioners find them useful but others feel that they should not be used, due to concerns that they may lead answers or bring up traumatic memories (Gelder et al 2006, p. 701).

24. Night terrors are associated with depression.

False: Night terror is a parasomnia occurring in non-REM deep sleep. The asleep child screams, appearing terrified with autonomic arousal. There is no relationship between night terrors and social or psychological problems.

25. Death of a parent is associated with truancy.

False: However, death of a parent is associated with the onset of school refusal.

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