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Child psychiatry: autism, tics and behaviour disorders
Autism is diagnosed by difficulty with social communication together with repetitive behaviours and restricted interests from an early age; Tourette means several motor tics plus one or more vocal tics lasting over a year; and among the behaviour disorders the difference is between defiance of authority and violation of others' rights.
Why it matters in the exam
Autism questions test the two domains of the criteria, the need to check hearing in every child with speech delay, and the work-up: the M-CHAT screening questionnaire at 18 and 24 months, genetic testing (chromosomal microarray and fragile X). The main treatment is early, intensive behavioural and developmental intervention; risperidone or aripiprazole are for severe irritability and tantrums, not for the core of autism. Regression in language or social skills at any age requires investigation.
Tics: rapid, repeated movements or sounds, sometimes preceded by an urge and briefly suppressible. In Tourette syndrome there are several motor tics plus one or more vocal tics, lasting over a year, beginning before age 18; coprolalia is rare. The comorbidities — ADHD and OCD — are often more disabling than the tics. The first treatment is behavioural (CBIT), followed by guanfacine or clonidine, and in severe cases aripiprazole. Oppositional defiant disorder (ODD): anger, arguing and defiance towards adults for at least 6 months. Conduct disorder: harm to people and animals, destruction, theft and serious rule-breaking — and it may develop into antisocial personality disorder in adulthood. In nocturnal enuresis from age 5, the first treatment is an enuresis alarm, with desmopressin as an alternative.
Key points
- Autism: social communication and repetitive behaviours; hearing and genetic testing.
- Early behavioural intervention; risperidone for severe irritability.
- Tourette: motor and vocal tics, more than a year, before 18; CBIT and α2 agonists.
- ODD: defiance of authority; conduct disorder: violation of others' rights.
- Nocturnal enuresis from age 5: alarm, desmopressin.
Summary table
| Disorder | Core criterion | Treatment | Exam notes |
|---|---|---|---|
| Autism (ASD) | Difficulty with social communication and repetitive, restricted interests, from an early age | Early behavioural intervention; risperidone or aripiprazole for severe irritability | Hearing test; microarray and fragile X |
| Tourette | Multiple motor tics and a vocal tic, more than a year, before age 18 | CBIT; guanfacine or clonidine; aripiprazole in severe cases | Comorbid: ADHD and OCD |
| Oppositional defiant disorder (ODD) | Anger, arguing and defiance towards authority, 6 months | Parent training | No serious violation of others' rights |
| Conduct disorder | Harm to people and animals, destruction, theft, rule-breaking | Family and multisystemic therapy | May become antisocial personality after age 18 |
| Nocturnal enuresis | Wetting from age 5 | Enuresis alarm; desmopressin | Exclude infection and diabetes |
A free exam question
בן 3 שנים, מאובחן עם autism spectrum disorder ופוקד מעון שיקומי. במצבו הבסיסי משחק בד"כ בדובי קבוע, ובעזרת תיווך מצליח להשתתף בשיחה לא מילולית באופן חלקי. עדיין לא נגמל מחיתול. אמו מספרת שבשבועיים האחרונים חלה נסיגה במצבו: הוא לא משתף פעולה במשחק, לא אומר את המילים שכבר למד ונראה לעתים לא מרוכז. אין חום, עצירות, נזלת, שיעול, הקאה או שלשול. אוכל ושותה כרגיל. מהו הצעד הבא? (the question as examined, in Hebrew)
- א. תרבית שתן
- ב. בדיקת אלקטרוליטים בסרום
- ג. תחילת טיפול ב- Risperidone
- ד. בדיקת EEG
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Sources
- DSM-5-TR, American Psychiatric Association, 2022 — Neurodevelopmental Disorders; Disruptive, Impulse-Control, and Conduct Disorders
- AAP Clinical Report, 2020 — Identification, Evaluation, and Management of Children With Autism Spectrum Disorder
- AAN Practice Guideline, 2019 — Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders
- Kaplan and Sadock's Synopsis of Psychiatry, 12th edition (2021) — Child Psychiatry
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.