Child and adolescent psychiatry – 5

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9 Child and adolescent psychiatry – 5

	T	F
1. ADHD is associated with hypofrontality.
2. Clonidine can be used to treat ADHD.
3. Autistic children are unable to make eye contact.
4. Autistic patients have greater difficulty than non-autistic controls in identifying someone’s gender from their eyes.
5. Siblings of patients with autism have an 8% risk of developing autism.
6. Aggression is more common in urban teenagers than rural teenagers.
7. More than 50% of children with conduct disorder have EEG abnormalities.
8. Irrespective of the child’s aggression, peer rejection on its own increases later antisocial behaviour.
9. Delinquency is associated with low IQ.
10. Truancy is commonly associated with antisocial behaviour.
11. 20% of adolescent males have a criminal record.
12. The effect of cortisol is more than that of DHEA in adolescent depression.
13. In dyslexia, automatic lexical recognition is normal.
14. Encopresis is associated with nocturnal enuresis.
15. Primary enuresis has genetic heterogeneity.
16. In high parental discord, child psychiatric illness is high.
17. Siblings of child and adolescent patients are more reliable historians than parents.
18. The prevalence of specific reading disorder in schoolchildren in England is 20%.
19. Severe specific reading disorder is associated with normal digit span.
20. Reading difficulties are associated with otitis media.
21. School refusal is associated with reading difficulties.
22. Girls are more likely than boys to tell someone about childhood sexual abuse.
23. Nightmares are frequently associated with nocturnal enuresis.
24. Body rocking is seen in 40% of normal children at 18 months.
25. Non-accidental injury to the child is very rare if the mother has obsessive compulsive disorder.

ANSWERS

1. ADHD is associated with hypofrontality.

True: Neuroimaging studies show smaller and asymmetrical prefrontal and basal ganglia structures, particularly on the right side (Gelder et al 2000, p. 1739).

2. Clonidine can be used to treat ADHD.

True: Clonidine can be particularly useful if there is a co-morbid tic disorder, as clonidine may also improve tics. It was believed that stimulants worsened tics, although recent evidence does not support this (Tourette’s Syndrome Study Group 2002).

3. Autistic children are unable to make eye contact.

False: Autistic children can make eye contact but it is usually markedly impaired. Children with autism fail to use eye-to-eye gaze and facial expression for social interaction. They usually focus exclusively on the mouth of the person speaking, avoiding the upper part of the face and not noticing the emotional responses of the listener (DSM-IV 1994; Johnstone et al 2004, p. 589; Sadock & Sadock 2005, p. 3171).

4. Autistic patients have greater difficulty than non-autistic controls in identifying someone’s gender from their eyes.

False: Adults with high-functioning autism/Asperger syndrome have been shown to be impaired in inferring the mental state of a person just from the photographs of their eyes. However, they were not impaired on the control tasks of recognizing gender from the eye region or recognizing emotions from the whole face (Baron-Cohen et al 1997).

5. Siblings of patients with autism have an 8% risk of developing autism.

False: The rate of narrowly-defined autism in siblings is 3%. For milder variants of the autistic spectrum the sibling rate is 10–20% (Goodman & Scott 1997, p. 46).

6. Aggression is more common in urban teenagers than rural teenagers.

False: Early studies of conduct disorder in a rural area (the Isle of Wight) and an urban area (London) suggested a higher rate of conduct disorder in the urban area. More recent studies (Ontario and North Carolina) showed minimal urban–rural differences. The Ontario study suggested higher conduct disorder in urban compared with rural children, but also higher rates in rural adolescents than urban adolescents. Poverty was an important confounding factor, and it diminished the effect of geography. Aggression itself has not been compared between rural and urban areas (Rutter & Taylor 2002, p. 421).

7. More than 50% of children with conduct disorder have EEG abnormalities.

False: There is no evidence of EEG abnormalities. Consistent biological findings include lower levels of electrodermal conductivity, lower mean resting heart rate, lower heart rate reactivity and variability and reduced serotonergic activity.

8. Irrespective of the child’s aggression, peer rejection on its own increases later antisocial behaviour.

False: Several studies have shown peer rejection to be predictive for later antisocial behaviour. However, Dodge et al (2003) also measured aggression at baseline and showed that peer rejection increases the risk for later antisocial development only in children initially disposed towards aggression.

9. Delinquency is associated with low IQ.

True: Low intelligence and attention problems, rather than educational performance, are associated with delinquency (Gelder et al 2000, p. 1862).

10. Truancy is commonly associated with antisocial behaviour.

True: Truancy is associated with antisocial behaviour rather than emotional symptoms (Gelder et al 2000, p. 1764).

11. 20% of adolescent males have a criminal record.

True: 20% of males are convicted at least once during adolescence (Gelder et al 2006, p. 680).

12. The effect of cortisol is more than that of DHEA in adolescent depression.

True: Some, though not all, studies have shown increased cortisol in adolescent depression. Raised cortisol:DHEA ratio in depressed adolescents vs. controls has not been found. However, raised cortisol:DHEA ratio has been shown to predict persistent as opposed to remitting depression in currently depressed adolescents and children. Goodyer et al showed that just the evening cortisol and not the cortisol:DHEA ratio differentiates depressed adolescents who will remain depressed over a longer time period (72 weeks) from those who will recover. It is thought that DHEA may be produced by the body to counteract the harmful effects of cortisol, possibly on neurogenesis in the hippocampus (Goodyer et al 1998, 2003).

13. In dyslexia, automatic lexical recognition is normal.

True: The majority of cases of specific reading disorder are ‘phonological dyslexia’, where people have difficulty decoding words by their letters. Automatic lexical recognition is recognizing whole words, and is usually normal in cases of phonological dyslexia.

14. Encopresis is associated with nocturnal enuresis.

True: Specific developmental delays in bladder and bowel control are due to delays in maturation of similar mechanisms and so are associated. In addition, constipation can cause overflow encopresis and also makes bladder control harder, due to pressure from the overloaded bowel.

15. Primary enuresis has genetic heterogeneity.

True: There is thought to be autosomal dominant inheritance, with high (>90%) penetrance. However, linkage with several different gene areas has been demonstrated, indicating genetic heterogeneity (Gelder et al 2006, p. 690).

16. In high parental discord, child psychiatric illness is high.

False: Parental discord is one significant risk factor for child psychiatric illness. However, without other risk factors, the majority of children with high parental discord will not have a psychiatric illness.

17. Siblings of child and adolescent patients are more reliable historians than parents.

False: History from patients and their parents is very important. History from siblings can be helpful, but normally the parents know a lot more relevant information.

18. The prevalence of specific reading disorder in schoolchildren in England is 20%.

False: The prevalence in England is 3–10% (Goodman & Scott 1997, p. 193).

19. Severe specific reading disorder is associated with normal digit span.

True: The severity of specific reading disorder refers to the disparity between reading ability and IQ. There is no evidence that working memory difficulties are associated with specific reading disorder.

20. Reading difficulties are associated with otitis media.

False: Reading difficulties are usually due to a specific developmental disorder of reading, globally impaired intelligence or an environment not conducive to learning. They are not associated with otitis media, which is associated with impaired hearing and resultant language problems.

21. School refusal is associated with reading difficulties.

False: Children with school refusal are of average intelligence and academic performance.

22. Girls are more likely than boys to tell someone about childhood sexual abuse.

True: 12–17% of girls and 5–8% of boys are sexually abused. More than half of the children who are abused do not disclose it, especially boys (Gelder et al 2000, p. 1827; Johnstone et al 2004, p. 589).

23. Nightmares are frequently associated with nocturnal enuresis.

False: Nightmares are frightening dreams that usually awaken the sleeper from REM sleep, with clear consciousness and detailed dream recall. Children experience nightmares with a peak frequency around ages 5–6 years. Approxi- mately half of adults report occasional nightmares. Nightmares may be caused by frightening experiences during the day. Frequent nightmares occur during periods of anxiety. Other causes include PTSD, fever, psychotropic drugs and alcohol detoxification. While emotional disorders may increase the risk for both nightmares and nocturnal enuresis there is no direct association between the two (Gelder et al 2006, p. 689; Johnstone et al 2004, p. 786).

24. Body rocking is seen in 40% of normal children at 18 months.

False: Body rocking is uncommon at 18 months and is a symptom of disturbance. It can be for self-stimulation if the child is not given enough stimulation. It can be a motor stereotypy as in fragile X or Rubenstein–Taybi syndrome. It can be a sign of emotional disturbance in a (usually older) child unable to express themselves verbally.

25. Non-accidental injury to the child is very rare if the mother has obsessive compulsive disorder.

False: Mothers rarely act on obsessive thoughts to harm their children. However, non-accidental injury for other reasons is still possible.

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