A 7 yrs old child has conservative behavior, not playing quitely with peers, and difficulty in organization. He also interrupts others in school and easily gets distracted. Which of the foiling is likely diagnosis?
Correct Answer: Attention deficit hyperactivity disorder
Description: Ans. C. ADHD. (Ref: Kaplan & Sadock's Synopsis of Psychiatry, Xth/Ch.43, Page no, 1208.)A 7-year-old child has conservative behavior, not playing quietly with peers, and difficulty in organization. He also interrupts others in school and easily gets distracted. The most likely diagnosis is ADHD (Attention deficit hyperactivity disorder).Kaplan, pg. 576............"Excessive motor activity, usually with intrusive and annoying qualities, poor sustained attention, difficulties inhibiting impulsive behaviors in social situations and on cognitive tasks, and difficulties with peers are the main characteristics of ADHD, combined type. Symptoms must be present in two or more settings (in this case, home and school) and must cause significant impairment. The Rx of choice for ADHD is CNS stimulants, primarily detroamphetamine, methylphenidate, and pemoline.**.Discussion:Conduct disorder# Children with conduct disorder display a persistent disregard for rules and other people's rights that lasts at least one year.# Aggression toward people and animals, destruction of property, deceit and illegal activities, and frequent truancy from school are the main characteristics of the disorder.# Patients with antisocial personality disorder display a pervasive pattern of disregard for and violation of the rights of others since the age of 15 years, with evidence of a conduct disorder before age 15. Substance abuse is just one facet of conduct disorder.# Children with oppositional defiant disorder are problematic and rebellious but do not routinely engage in aggressive, destructive, or illegal activities.Autistic disorder# Autistic disorder is characterized by lack of interest in social interactions, severely impaired verbal and nonverbal communication, stereotyped behaviors, and a very restricted range of interests.# Children with autism do not involve themselves in imaginative and imitative play and can spend hours lining and spinning things or dismantling toys and putting them together.# Patients with obsessive-compulsive disorder may spend hours on repetitive tasks (such as lining up toys) but do not show the difficulties with language and social interaction that this patient displays.# Patients with Asperger's syndrome show no clinically significant delay in spoken or receptive language development, making this diagnosis unlikely.# Patients with Rett's disorder by the age of 5 would be expected to have microcephaly and a disordered gait (unsteady and stiff).Attention-deficit hyperactivity disorderOnset before age 12. Limited attention span and poor impulse control. Characterized by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc.). Normal intelligence, but commonly coexists with difficulties in school. Continues into adulthood in as many as 50% of individuals. Associated with*frontal lobe volume/ metabolism. Treatment: methylphenidate, amphetamines, atomoxetine, behavioral interventions (reinforcement, reward).Conduct disorderRepetitive and pervasive behavior violating the basic rights of others (e.g,, physical aggression, destruction of property, theft). After age 18, many of these patients will meet criteria for diagnosis of antisocial personality disorder.Oppositional defiant disorderEnduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms.Tourette syndromeOnset before age 18. Characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for > 1 year. Lifetime prevalence of 0.1-1.0% in the general population. Coprolalia (involuntary obscene speech) found in only 10-20% of patients. Associated with OCD and ADHD. Treatment: antipsychotics and behavioral therapy.Separation anxiety disorderCommon onset at 7-9 years. Overwhelming fear of separation from home or loss of attachment figure. May lead to factitious physical complaints to avoid going to or staying at school. Treatment: SSRIs and relaxation techniques/behavioral interventions.
Category:
Psychiatry
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