PSY603 — Subspecialty Psychiatry: Lecture Note

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This is the complete lecture note for PSY603 Subspecialty Psychiatry. You can read it online below, open it in the full viewer, or download the PDF for offline study. It pairs with the course's video lectures, so you can read and watch together.

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la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: PSY 603 Course title: Subspecialty Psychiatry Course credit load: 2 Units Series 1: Child and Adolescent Psychiatry: Assessment, Neurodevelopmental, and Disruptive Behaviour Disorders • Part 1.1: Foundations of Child and Adolescent Psychiatric Assessment o Sub Part 1.1.1: Principles of psychiatric evaluation in children and adolescents o Sub Part 1.1.2: Developmental history and informant-based assessment o Sub Part 1.1.3: Elimination disorders: enuresis and encopresis • Part 1.2: Neurodevelopmental Disorders I: Intellectual Disability and Communication o Sub Part 1.2.1: Intellectual disability: diagnosis and severity levels o Sub Part 1.2.2: Communication disorders in children o Sub Part 1.2.3: Autism spectrum disorder: core features and diagnosis • Part 1.3: Neurodevelopmental Disorders II: ADHD, Learning, and Motor Disorders o Sub Part 1.3.1: Attention-deficit/hyperactivity disorder o Sub Part 1.3.2: Specific learning disorders o Sub Part 1.3.3: Motor disorders: developmental coordination and tic disorders • Part 1.4: Disruptive Behaviour Disorders and Differential Diagnosis o Sub Part 1.4.1: Oppositional defiant disorder o Sub Part 1.4.2: Conduct disorder o Sub Part 1.4.3: Differential diagnosis of disruptive behaviour in children and adolescents Introduction Few areas of clinical practice demand as much patience and observational skill as working out what is actually going on inside a child's mind, and this opening Series of Subspecialty Psychiatry sets out to build exactly that skill. Children and adolescents rarely announce their distress in the tidy sentences adults use; instead it surfaces in tantrums, withdrawn silence, a stubborn refusal to sit still, or a pattern of wetting the bed long after peers have stopped. Making

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS sense of these presentations calls for a structured, developmentally informed approach, and that is the task this Series takes on. The aim of this Series is to equip you with a sound, practical grasp of how psychiatric evaluation of children and adolescents is properly conducted, how elimination disorders and the major neurodevelopmental disorders such as intellectual disability, communication disorders, autism spectrum disorder, attention-deficit/hyperactivity disorder, specific learning disorders, and motor disorders present and are diagnosed, and how disruptive behaviour disorders are assessed and differentiated in this age group. This Series begins with the foundations of child and adolescent psychiatric assessment, before working through neurodevelopmental disorders across two Parts covering intellectual disability, communication difficulties, autism, ADHD, learning disorders, and motor disorders, and closes with disruptive behaviour disorders and their differential diagnosis. Series Learning Outcomes At the end of this Series, you should be able to: • SLO 1.1: describe how to perform a psychiatric evaluation of children and adolescents • SLO 1.2: explain the clinical presentation, assessment, and management of elimination disorders • SLO 1.3: describe the diagnostic features and severity levels of intellectual disability and communication disorders • SLO 1.4: describe the core diagnostic features of autism spectrum disorder • SLO 1.5: describe the clinical presentation and assessment of attention-deficit/hyperactivity disorder • SLO 1.6: distinguish specific learning disorders from motor disorders in children and adolescents • SLO 1.7: assess and explain proposed differential diagnosis for children and adolescents presenting with disruptive behaviour • SLO 1.8: compare and contrast oppositional defiant disorder and conduct disorder

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1 Foundations of Child and Adolescent Psychiatric Assessment 1.1.1 principles of psychiatric evaluation in children and adolescents Building a developmentally attuned assessment A psychiatric evaluation of a child or adolescent differs fundamentally from an adult assessment because the clinician must interpret behaviour against a shifting backdrop of normal development, gather information from multiple informants such as parents, teachers, and the young person, and adapt communication style to the child's cognitive and emotional maturity. The evaluation typically opens with a clear statement of the presenting complaint in the words of the referring adult, followed by a careful developmental history covering pregnancy, birth, milestones, temperament, and early attachment. Observation of the child's behaviour, affect, and interaction style during the interview itself often yields as much diagnostic information as the history, since younger children in particular struggle to verbalise internal states directly. A thorough evaluation also requires a mental state examination adapted for age, incorporating play-based or drawing techniques for younger children, and structured or semi-structured interviews for adolescents capable of more abstract self-report. Collateral information from school reports and standardised rating scales, such as behaviour checklists completed by parents and teachers, strengthens diagnostic confidence by triangulating observations across settings. The clinician must also remain alert to family functioning, psychosocial stressors, and possible safeguarding concerns throughout the process, since disruptive or regressive behaviour in a child can sometimes signal maltreatment rather than a primary psychiatric disorder. Fill in the blank: A thorough child psychiatric assessment routinely gathers information from multiple ________, including parents, teachers, and the child. 1.1.2 developmental history and informant-based assessment Triangulating the clinical picture across settings The developmental history anchors the entire assessment, tracing the child's progress through motor, language, social, and cognitive milestones and flagging any delay or regression that might point towards a neurodevelopmental or acquired condition. Clinicians typically ask about pregnancy complications, birth weight, early feeding and sleep patterns, and the age at which the child first sat, walked, spoke in single words, and combined words into short phrases. A history of regression, where previously acquired skills are lost, carries particular diagnostic weight and warrants prompt further evaluation, since it can indicate conditions ranging from autism spectrum disorder to rarer neurometabolic disease.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Because children are rarely reliable narrators of their own difficulties, informant-based assessment using parents, teachers, and, where appropriate, the child themselves is central to good practice. Discrepancies between informants are not simply noise to be resolved but often meaningful data, since a child who is disruptive at school yet calm at home may be signalling a specific difficulty with the school environment rather than a pervasive disorder. Structured tools such as the Strengths and Difficulties Questionnaire allow this cross-setting information to be gathered systematically and compared over time. Fill in the blank: The loss of previously acquired developmental skills is referred to as ________ and warrants prompt further evaluation. 1.1.3 elimination disorders: enuresis and encopresis Recognising and managing bladder and bowel control difficulties Elimination disorders comprise enuresis, the repeated voiding of urine into inappropriate places such as clothing or bed beyond the developmentally expected age of bladder control, and encopresis, the repeated passage of faeces into inappropriate places beyond the expected age of bowel control. Enuresis is further classified as nocturnal, diurnal, or a combination of both, and as primary, where continence was never achieved, or secondary, where it follows a period of established continence. A diagnosis generally requires the behaviour to occur at least twice weekly for three consecutive months, or to cause clinically significant distress or impairment, in a child of at least five years of age, the age below which involuntary elimination is considered developmentally normal. Assessment must first exclude organic causes such as urinary tract infection, diabetes, or structural bowel abnormality before a primary psychiatric diagnosis is made, and encopresis in particular is frequently associated with underlying chronic constipation and overflow soiling. Management is typically behavioural and family-centred, involving scheduled toileting, positive reinforcement, bladder training alarms for nocturnal enuresis, and, for encopresis, disimpaction followed by maintenance laxative therapy alongside behavioural retraining. Family psychoeducation is essential throughout, since punitive parental responses to elimination disorders are common, counterproductive, and can worsen the child's distress and shame. Fill in the blank: Encopresis is frequently associated with underlying chronic ________ and overflow soiling.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Figure 1.1: A clinician conducting a play-based psychiatric assessment with a young child. Pilot questions 1.1 1. Describe the key components of a psychiatric evaluation of a child or adolescent. (Linked to SLO 1.1) 2. Explain why informant-based assessment across multiple settings strengthens diagnostic confidence in child psychiatry. (Linked to SLO 1.1) 3. Distinguish primary from secondary enuresis. (Linked to SLO 1.2) 4. Discuss the organic causes that must be excluded before diagnosing an elimination disorder. (Linked to SLO 1.2) 5. Outline the behavioural management approach to nocturnal enuresis. (Linked to SLO 1.2) 1.2 Neurodevelopmental Disorders I: Intellectual Disability and Communication 1.2.1 intellectual disability: diagnosis and severity levels Assessing intellectual and adaptive functioning together Intellectual disability is diagnosed on the basis of deficits in both intellectual functioning, encompassing reasoning, problem-solving, planning, and abstract thinking, and adaptive

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS functioning, covering conceptual, social, and practical skills needed for everyday independent living, with onset during the developmental period. Standardised cognitive testing traditionally generates an intelligence quotient, but current diagnostic frameworks emphasise adaptive functioning as the primary determinant of severity level, since two individuals with similar test scores can differ markedly in their day-to-day independence and support needs. Severity is classified as mild, moderate, severe, or profound, with

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