6 Child and adolescent psychiatry – 2
| T | F | |
|---|---|---|
| 1. Very low birthweight is a risk factor for ADHD. |  |
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| 2. ADHD is associated with alcohol dependence in later life. |  |
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| 3. In ADHD, combined drugs and behaviour treatment is better than drug treatment alone. |  |
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| 4. Autistic children have poor imaginative play. |  |
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| 5. In autism, IQ is usually less than 70. |  |
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| 6. Half of autistic children never develop language. |  |
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| 7. Heritability of conduct disorder is about 0.1–0.2. |  |
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| 8. Conduct disordered boys usually get approval from their non-deviant peers. |  |
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| 9. Conduct disorder is associated with mood disorders in adulthood. |  |
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| 10. In a 14-year-old boy caught shoplifting, depression is a likely diagnosis. |  |
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| 11. Perinatal insult increases chances of violence in later life. |  |
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| 12. After adolescence, girls get more depressive symptoms than boys. |  |
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| 13. Fluoxetine is more effective than cognitive behavioural therapy in the short-term treatment of depression in adolescents. |  |
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| 14. Encopresis is related to parenting style. |  |
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| 15. Several studies have linked the MMR vaccine to autism. |  |
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| 16. Primary enuresis in an 8-year-old boy is an indication for an intravenous urogram. |  |
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| 17. Genetic influences are as important as family factors in children’s adjustment. |  |
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| 18. More than 50% of mothers with Munchausen’s syndrome by proxy have psychiatric illness. |  |
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| 19. Specific reading disorder is more common in boys. |  |
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| 20. Specific reading disorder is associated with low IQ. |  |
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| 21. School refusal is more common in girls than in boys. |  |
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| 22. Antidepressants are likely to be useful in the treatment of school refusal if depressive symptoms are present. |  |
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| 23. If a 12-year-old girl is complaining of repeated sexual abuse by her father, this is an indication for immediately securing a Child Protection Order for her. |  |
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| 24. Night terrors are likely to be related to relationship difficulties. |  |
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| 25. Truancy is associated with somatization in children. |  |
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ANSWERS
True: Aetiological factors include fetal exposure to the mother’s use of alcohol, drugs, or cigarettes; perinatal obstetric complications and prematurity (Gelder et al 2000, p. 1739).
True: People with ADHD are at increased risk for substance use disorders, e.g. alcohol, tobacco, illicit drugs (Gelder et al 2000, p. 1739).
False: The Multimodal Treatment study of children with ADHD (MTA) in 1999 randomized children with ADHD to 4 groups – drug treatment, behavioural treatment, combined drug and behavioural treatments or treatment as usual. Both drug and combined treatments were better than treatment as usual, but there was no significant difference between drug and combined groups. The behavioural management was not significantly more effective than treatment as usual, except for improving social skills and self-esteem (Gelder et al 2000, p. 1743; Johnstone et al 2004, p. 595).
Poor imaginative play is also seen in non-autistic children with language delay because the capacity for abstract and imaginative play is linked with the ability to use words as representations of objects. Therefore, when trying to assess whether a child has autism, compare imaginative play with what would be normal for a child with that level of language (Sadock & Sadock 2005, p. 3169).
True: 50% of those with autism have IQ<50, 70% have IQ<70 and 95% have IQ<100. Verbal IQ is almost always lower than performance IQ (Goodman & Scott 1997, p. 43).
True: Around 50% of people with autism never develop useful speech. In those who develop language, the abnormalities include delayed and deviant language acquisition, echolalia, poor comprehension, poor use of gesture, pronominal reversal, non-reciprocal communication and abnormalities in intonation, rhythm and tone (Goodman & Scott 1997, p. 42).
True: Conduct disorder is associated with increased antisocial personality traits, substance abuse, anxiety, depression, somatic complaints, self-harm, suicide and time spent in psychiatric hospitals (Gelder et al 2000, p. 1758).
False: Most shoplifting has no association with any mental disorder. However, children with conduct disorder are more likely to develop depression than children without conduct disorder (Johnstone et al 2004, p. 715).
True: Perinatal insults including fetal exposure to alcohol and cocaine can impair brain development, resulting in minimal brain dysfunction, low IQ and impulsivity, increasing the risk of later violence. Obstetric complications also have been implicated (Gelder et al 2000, p. 1756; Stone et al 2000, p. 265).
True: Before puberty, boys are more vulnerable than girls to depression. Over the course of adolescence, the girls have a precipitous rise in depression rates compared to the boys. By age 15 years, girls are twice as likely as boys to have experienced an episode of major depression. This gender difference persists for the next 35–40 years (Sadock & Sadock 2005, p. 2295).
True: The TADS study showed fluoxetine to be more effective than CBT in the short-term treatment of depressed adolescents. CBT was no more effective than placebo. Fluoxetine plus CBT was better than fluoxetine alone (March et al 2004).
True: In Munchausen’s syndrome by proxy, also termed factitious illness by proxy, a parent/carer produces a state of ill health or falsely describes ill health in a child they are responsible for. The majority of children are under 5 years of age, with boys and girls equally represented. Most fabricators are female. 79% have a somatization disorder themselves and half have a personality disorder (Gelder et al 2000, p. 1832).
True: Specific reading disorder affects 3–10% of children. It is two to three times more common in boys than girls (Goodman & Scott 1997, p. 189; Rutter & Taylor 2002, p. 682).
True: If school refusal is associated with major depression and anxiety, treatment with CBT and imipramine is more effective than treatment with CBT and placebo, both in improving school attendance and reducing depressive symptoms (Bernstein et al 2000).
