Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
From Concerns to Conditions by Dr. Jaruwan Kittisopit and Dr. Joom Chomchuay
1. From Concern to Condition
A research-based approach to
Medical Diagnosis
Jaruwan Kittisopit,M.D.
Developmental and Behavioral Pediatrician
Jom Choomchauy, M.D.
Child and Adolescent Psychiatrist
20 September 2013, Bangkok
2. Disclosure
The speakers have no financial relationships
with or commercial interests in any products
discussed in this presentation.
5. Significant Concerns?
Consideration
Norm : Age
Ethnicity
Individual profile / baseline of
development/temperament
Cultural variations
Onset, Severity, Duration, Progression ?
Functional impairment?
Different settings ?
Red Flags : Early signs
6. Significant Concerns?
Functional Impairment:
Symptoms & Signs cause clinically
significant impairment, negatively
impact, interfere with or reduce
social, academic, occupational or other
important areas of current functioning.
(DSM V May 2013)
7. Medical Approach
• History taking
• Physical examination
• Developmental & Mental status examination
• Further Investigations:
Laboratories
Formal Assessments
Signs & Symptoms(S/S) Work up Dx PlanRx
8. Pediatric Approach
• A child as a whole
person : p/db/m
• A child as a part of
Family system
• Source of information:
primary & secondary
client
caregivers
3rd party:
school, agency, communi
ty
9. Research & Clinical Application
Evidence-based practice
Study designs?
Degu G, Tessema F. ,January 2005.
10. Research & Clinical Application
Evidence-based practice
Classification of Research /study
Retrospective , Cross-sectional, Prospective study
Exploratory, Descriptive study , Analytical study
Observational , Interventive study
Case report, Case series, Case-control
RCT : randomized, double blind,(cross over), trial
Clinical trials
Epidemiologic study
Genetic study
Psychometric validity study
Degu G, Tessema F. ,January 2005.
13. Social and Communication Red flags
• No big smiles or other warm, joyful expressions by 6 months
• No back-and-forth sharing of sounds, smiles, or other facial
expressions by 9 months
• No babbling by 12 months
• No back-and-forth gestures, such as
pointing, showing, reaching, or waving by 12 months
• No words by 16 months
• No two-word meaningful phrases (without imitating or
repeating) by 24 months
• Any loss of speech or babbling or social skills at any age
Greenspan, S.I. (1999) , Filipek, P.A. et al.( 2000 )
24. Case Vignette:NC
A 13 years old South American girl with history of depressed
mood for 2 months
Symptoms
• Depressed mood, lonely
• Negative thoughts
about herself
• Difficulty concentrating
• Lethargy, Loss of Energy
• Guilty feeling
• Irritability and agitation
Symptoms
• Sense of Inferiority
• Suicidal ideation
• Emotionally sensitive
• Social anxiety
• Paranoid ideation
• Auditory hallucination
25. Major Depressive Disorder:
Diagnostic Criteria DSM-5
5 of following symptoms, must include one of first
two, occurred almost every day for two weeks
• Depressed mood
• Pleasure or interest/ Loss
• Appetite
• Sleep disturbance, too much or too little
• Agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Difficulty concentrating or deciding
• Recurrent thoughts of death
American Psychiatric Association. 2013, DSM-5
26. Clinical Approach
• Clinical Evaluation and Psychological tests
• Diagnosis: Major Depressive Disorder, Severe
with Psychotic Features
• Plan
– Ongoing monitoring and Follow up sessions
- Medication
- Psychotherapy
- Music Therapy
- Family Intervention
- School Consultation and Clinical Liaison
27. depressed mood
loss of happiness (joy)
loss of interest/pleasure
loss of energy/enthusiasm
decreased alertness
decreased self-confidence
reduced
positive affect
+
+
+
+ +
normal
mood
depressed mood
guilt/disgust
fear/anxiety
hostility
irritability
loneliness
increased
negative affect
-
- - -
-
Nutt D etal, J Psychopharmacol July 2007 21: 461-471
28. Match Each DSM IV Diagnostic Symptom for a Major Depressive
Episode to Hypothetically Malfunctioning Brain Circuits
S
NA
PFC
BF
A
H
Hy
T
NT
SC
C
psychomotor
fatigue (physical)
pleasure
interests
fatigue/
energyconcentration
interest/pleasure
psychomotor
fatigue (mental)
guilt
suicidality
worthlessness
mood
guilt
suicidality
worthlessness
mood
sleep
appetite
fatigue (physical)
psychomotor
Stahl SM, Zhang L &Damatarca C & Grady M. J Clin Psychiatry 2003;64[suppl 14]:6–17)
29. Categorical & Dimensional Model
• Categorical model: Symptoms
Categories, DSM IV
• Dimensional model: Functioning
level, Severity, Continuum
• DSM-5— Incorporate Dimensional Model and
Categorical model!
American Psychiatric Association. 2013, DSM-5
Busko M. Why Dimensional as Well as Categorical Diagnoses Are Needed
in DSM-V.Medscape Medical News; 2007, Jun 15,
30.
31. Case Vignette : JK
• JK: 5-year Thai boy, 1st language is Thai, English is 2ndlanguage for 3
years since entered an International school :
• School concerned of his aloofness, preferred to talk and play with
particular peers and toys and often had conflicts.
• Sometimes he appeared to show no sympathy to peers looking on
when peers cried after their fights. He rarely spoke in English but
appeared to understand however would often ask the same
questions again and again to TA in Thai.
• Parents disagreed with school but were aware of his shyness
especially in new situations: he is easily worried about whether he
did things wrong and would often drift away during homework. He
is a very talkative boy, curious and creative at home.
• He enjoys playing with other kids but has few chances to join them
due to his schedule. Mostly after school he would be dropped off at
his mother’s office and spend time playing with an ipad.
32. Case Vignette : JK
• JK: 5-year Thai boy, 1st language is Thai, English is 2ndlanguage for 3 years since entered an
International school :ESL : English as Second Language
• School concerned of his aloofness, preferred to talk and play with particular peers and toys
and often had conflicts.
• Sometimes he appeared to show no sympathy to peers looking on when peers cried after
their fights. He rarely spoke in English but appeared to understand however would often ask
the same questions again and again to TA in Thai. Social and Communication and
Play skills concerns from school
• Parents disagreed with school but were aware of his shyness especially in new situations: he
is easily worried about whether he did things wrong and would often drift away during
homework. He is a very talkative boy, curious and creative at home. Parents had
different perspective. Slow to warm up temperament, Creative
, curious, but anxious and distractible
• He enjoys playing with other kids but has few chances to join them due to his schedule.
Mostly after school he would be dropped off at his mother’s office and spend time playing
with an iPad. Able to socialize with same age peers in familiar
situations, under-exposure to child-plays
33. Case Vignette : JK 5-yr boy
• ESL
• Social and Communication and Play skills
concerns from school
• Parents had different perspective : Slow to
warm up temperament, Creative
, curious, but anxious and distractible
• Able to socialize with same age peers in
familiar situations
• Under-exposure to child-plays
34.
35. What’s next?
• Gather more information from different perspectives
: client, parents, school and other professionals in
order to get to know a child’s profile :
ability, strengths and needs , in order to provide
suitable and appropriate interventions
• Evaluation :Clinical & Formal
• Assessment: Diagnostic & Follow up
– Developmental & Behavioral
– Psychoeducational
– Neurodevelopmental / Neuropsychological
– Speech& Language
– Physio/Occupational
36. Case Vignette: JK 5-yr boy
• Clinical assessment: parent clinical
interview, play-based developmental
evaluation /MSE
• Diagnostic evaluation:
ADI-R, ADOS,
Mullen Scales, NEPSY-II (AT/EF, SP:ToM,AR)
School vdo, school visit
Questionnaires: SDQ, SNAP-IV,PDDSQ
37. Case Vignette: JK 5-yr boy
• Assessment results
• Clinical Diagnosis based on
DSM-IV TR (2000) &
DSM-5 (2013)
• Recommendations : Ix, Rx, F/U
• Feedback / Collaborations
39. So, Does Diagnosis Matter?
Why?
• Universal Language among professionals
• Practice Guidelines/Road map: for
Intervention , Counseling, Prognosis
• Strengths & Needs
• Future Research : etiology ,
specific treatment, course,
prognosis
40. Mens Sana Monogr. 2006 Jan-Dec; 4(1): 127–138.
doi: 10.4103/0973-1229.27610
Good morning everybody. Thank you for the lovely introduction.It is our pleasure to be here and have a chance to get to know all of you.We would like to thanks the ATOC to make this happen. We wish this will be a good start of networking.We would like this presentation to be an interactive one, so feel free to ask at any point we wont prescribe you any medication for interruptions
This is our disclosure. We bothwork atMerak clinic as clinicians.
Today we would like to introduce you and show you simply : how the “doctor in our field approach the client’s issues , using a research-based information in decision making .
So, what are the concerns?Usually, it never come in one single concern, mostly in combinations , Listen to this story for example: “my 2-year old son does not talk yet , and he also doesn’t like to play with others, he did not response when I called his name , he seemed to understand what we asked however would do only when he want to, he preferred to play with funny stuff ,like shaking the string and pouring water, also he likes to run around , he never stay still at meal time , he always on the move , he is easily upset, if he could not get what he want he would hit his head or bite others. I and my husband disagree with each other, he think he just a boy, stubborn and he will out grown it. But I think something not quite right about him. We have very different parenting style. He is easy and laid back, give-in to kids easily but I am very discipline. This also effect our 9-year old daughter. She dislike to be with me, she preferred her father. She dislike to read or write , I try hard to teach her but she often bargains and tries to avoid this. The school told us that she needs to practice more. I think she is a smart girl , she has very good memory and lot of brilliant ideas far advance that her peers but she is a bit lazy. She doesn’t want to go to school , every morning we have a fight. I am so exhausted , I feel like I am a bad mom. !! So, most of the concerns are interrelated and evolved around the delays, deviation, advance, regression, or imbalance in Developmental milestonesBehaviorsMental & Emotional stateLearning & Academic achievementsFamily issues
all concerns should be addressed however which ones are significant to investigate further?We look atNormative data of : Age, Ethnicity for example if I say my 4 month old baby likes to play alone , this may not as significant as 18 month toddler who prefers to play alone. Or the 2-year toddler who move around and cant wait for turn might be different from 7-year old one.Individual profile ,their baseline development and temperament. For instance: a 10-year boy, who is cheerful and easy going but recently was observed to be reluctant to participate in school trip and party.Cultural variations: This is very important , especially nowadays we are more and more dealing with cross-cultural kids.We look at Onset, Severity, Duration and Progression of each concernDoes a client has Any Functional impairment?Does it occur across different settings ?And the most importantly anyRed Flags orEarly signs of particular conditions
Talking about Functional impairment:We look at whether Symptoms & Signs cause clinically significant impairment, or negatively impact, orinterfere with or reducesocial, academic, occupational or other important areas of current functioning. Especially , self –value.Dr. Jom … A 7-year old boy who is easily distract, forgetful to the point that miss his assignment but not drop his grade however he felt bad about himself..effect to self is the most important..
You may familiar with bringing your kid to a doctor visit, when they have physical illnessIn our field, The approach is the not different but They are soft signs, like a software instead of hardware concerns.Therefore, We have to be objectives as much as possible, however not many tools available to make it tangibles or measurable , it is not like you see the complete blood count or Chest x-ray.Many new technology are coming out to assist in assessment, however it is not yet accessible in Thai and still needs to use in combination of clinical judgment . For example , many psychometrics tests are not yet have normative data in Thai population. or we do not have formal speech and language assessment in Thai language. This is one of our frustrations. We have clinical data but not normative data. The recent exciting news in the field is the tool called NEBA ,, The NEBA systemcalculates ratios of theta and beta brain waves given off each second. Past research has shown that this ratio is significantly higher in individuals with ADHD. FDA just approved to use in assisting ADHD DxThere are lots of debate going on about this. As doctors, we love science and would love to find a definitive test to tell exactly what condition someone has. But we haven't yet find one. we have to combine data from HX, Clinical examination , IX in order to make dx in order to plan for comprehensice treatment or interventions,, to predict long term outcome, …on the other hand, We live in a very cost-sensitive environment when it comes to healthcare....therefore we have to use technology with wisdom and monetary wise…."Sometimes parents need the confirming laboratory test when the diagnosis of condition is not too clear," However in many other cases, the diagnosis is clear by clinical informaiton and additional testing is not needed.”
On the other hand,Our clients are kids which is not the small size adult.We approach them as a whole person, look at their profile in the areas of physical, developmental, behavioral and mental state.They also are part of family system, therefore it is crucial to get to know their family in details as well.Some of our kids can tell what is going on with them however mostly we have to get information from secondary sources such as their caregivers, teachers or significat others.
I will touch briefly on Research Model , to give you an idea of how we use the information from research study.Do you familiar with these terms?Evidence-based practice (EBP) is an interdisciplinary approach to clinical practice that has been gaining ground following its formal introduction in 1992. It started in medicine as evidence-based medicine (EBM) and spread to other fields . Its basic principles are that all practical decisions made should 1) be based on research studies and 2) that these research studies are selected and interpreted according to some specific norms characteristic for EBP. Typically such norms disregard theoretical and qualitative studies and consider quantitative studies according to a narrow set of criteria of what counts as evidence. If such a narrow set of methodological criteria are not applied, it is better instead just to speak of research based practice.[1]In Areas of professional practice, such as medicine, psychology, psychiatry, rehabilitation and so forth, have had periods in their pasts where practice was based on loose bodies of knowledge. Some of the knowledge was lore that drew upon the experiences of generations of practitioners, and much of it had no valid scientific evidence on which to justify various practices.In the past, this has often left the door open to quackery perpetrated by individuals who had no training at all in the domain, but who wished to convey the impression that they did, for profit or other motives. As the scientific method became increasingly recognized as the means to provide sound validation for such methods, the need for a way to exclude quack practitioners became clear, not only as a way of preserving the integrity of the field (particularly medicine), but also of protecting the public from the dangers of their "cures." Furthermore, even where overt quackery was not present, it was recognized that there was a value in identifying what actually does work so it could be improved and promoted.Evidence-based practice of psychology requires practitioners to follow psychological approaches and techniques that are based on the best available research evidence (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Evidence suggests that some therapy approaches work better than others. Criteria for empirically supported therapies have been defined by Chambless and Hollon (1998). Accordingly, a therapy is considered efficacious and specific if there is evidence from at least two settings that it is superior to a pill or psychological placebo or another bona fide treatment. If there is evidence from two or more settings that the therapy is superior to no treatment it is considered efficacious. If there is support from one or more studies from just a single setting, the therapy is considered possibly efficacious pending replication. Following these guidelines, cognitive behavior therapy (CBT) stands out as having the most empirical support for a wide range of symptoms in adults, adolescents, and children. Unfortunately, the term "evidence-based practice" is not always used in such a rigorous fashion, and many psychologists claim to follow "evidence-based approaches" even when the methods they use do not meet established criteria for efficacy (Berke, Rozell, Hogan, Norcross, and Karpiak, 2011). In reality, not all mental health practitioners receive training in evidence-based approaches, and members of the public are often unaware that evidence-based practices exist. Consequently, patients do not always receive the most effective, safe, and cost effective treatments available. To improve dissemination of evidence-based practices, the Association for Behavioral and Cognitive Therapies (ABCT) and the Society of Clinical Child and Adolescent Psychology (SCCPA, Division 53 of the American Psychological Association) maintain updated information on their websites on evidence-based practices in psychology for practitioners and the general public.
Story of Secretin using in Autism is a very good example.GFCF diet : most of them are case reports or case seriesThis does not mean that the alternative treatments are not effective, one may say it is not yet studied does not meant that it is not effective, however we have to exercise our analytical and critical thinking when there is not yet evidence-based support of their benefit. Especially if one that may do you harm…ADHD RxSo, these leads to Clinical Practice Guideline which based on the evidence-based recommendation:
This is example of clinical practice guideline for ASD, from the AAP in 2010 including the identification and evaluation process as well as management strategies
When concerns will turn into condition?
First of all , let’s take a quick look at our brain , as we are working with the brain-based conditionsThis is a cool picture of the very new exciting technology , call Connectome.Have you heard about it?A connectome is a comprehensive map of neural connections in the brain.Mapping the human brain is one of the great scientific challenges of the 21st century. The Human Connectome Project (HCP) is tackling a key aspect of this challenge by elucidating the neural pathways that underlie brain function and behavior. Deciphering this amazingly complex wiring diagram will reveal much about what makes us uniquely human and what makes every person different from all others. And hopefully will transform our understanding of the human brain in health and disease.The consortium led by Washington University, University of Minnesota, and Oxford University (the WU-Minn HCP consortium) is comprehensively mapping human brain circuitry in a target number of 1200 healthy adults using cutting-edge methods of noninvasive neuroimaging , combinations of various fmri,meg,eeg. It will yield invaluable information about brain connectivity, its relationship to behavior, and the contributions of genetic and environmental factors to individual differences in brain circuitry and behavior. Resting-state functional MRI (rfMRI) and diffusion imaging (dMRI) provide information about brain connectivity. Task-evoked fMRI reveals much about brain function. Structural MRI captures the shape of the highly convoluted cerebral cortex. Behavioral data provides the basis for relating brain circuits to individual differences in cognition, perception, and personality. In addition, 100 participants will be studied using magnetoencephalography and electroencephalography (MEG/EEG).Successful charting of the human connectome in healthy adults will pave the way for future studies of brain circuitry during development and aging and in numerous brain disorders. In short, it will transform our understanding of the human brain in health and disease.The production and study of connectomes, known as connectomics, may range in scale from a detailed map of the full set of neurons and synapses within part or all of the nervous system of an organism to a macro scale description of the functional and structural connectivity between all cortical areas and subcortical structures. The term "connectome" is used primarily in scientific efforts to capture, map, and understand the organization of neural interactions within the brain. One such effort is the Human Connectome Project, sponsored by the National Institutes of Health, whose focus is to build a network map of the human brain in healthy, living adults. Another was the successful reconstruction of all neural and synaptic connections in C. elegans (White et al., 1986,[1]Varshney et al., 2011[2]). Partial connectomes of a mouse retina [3] and mouse primary visual cortex [4] have also been successfully reconstructed. Bock et al.'s complete 12TB data set is publicly available at Open Connectome Project.
As developmental/behavioral or Mental health involved mainly with brain function, not the structural aspect of brainTherefore there is no role of conventional brain imaging , such as CT scan in clinical practice unless there is clinical information that leads to investigate structures of brain For instance a baby who presents with progressive lost of acquired global developmental milestone, or who displayed focal neurological deficit or signs Such as a child who present with ASD s/s but had skin lesions that lead to rule out neurofibromatosis. This case of ASD profile will qualify to work up further with neuroimaging. But not all ASD case will have to.
These pictures simply illustrate cortical mapping of brain functions, which we know that they are interrelated and overlapped
If we look further at cellular level, we will see Nerve cells (i.e., neurons) communicate to each other via a combination of electrical and chemical signals. Within the neuron, electrical signals driven by charged particles allow rapid conduction from one end of the cell to the other. Communication between neurons occurs at tiny gaps called synapses, where specialized parts of the two cells (i.e., the presynaptic and postsynaptic neurons) come within nanometers of one another to allow for chemical transmission. The presynaptic neuron releases a chemical (i.e., a neurotransmitter) that is received by the postsynaptic neuron’s specialized proteins called neurotransmitter receptors. The neurotransmitter molecules bind to the receptor proteins and alter postsynaptic neuronal function. Two types of neurotransmitter receptors exist—ligand-gated ion channels, which permit rapid ion flow directly across the outer cell membrane, and G-protein–coupled receptors, which set into motion chemical signaling events within the cell. Hundreds of molecules are known to act as neurotransmitters in the brain. Neuronal development ( also called neurogenesis)and neuronalfunction also are affected by peptides known as neurotrophins and by steroid hormonesThis is where the medical treatment start!! Dr. Jom will give you more details laterOn the other hand, Do you with “ Use it or Lose it concepts of brain development”??At birth , a baby was born with trillions neurons, however, after years of development, there is a process called neuronal prunning, to get rid of un-used neurons or networks ,, as well as to elaborate the active one : Use it or Lose it!!, in order to shape the functional brain connectivity.This is where the “intervention” start !!
This is a bit messy slide that I made I want to show you how the interaction between the nature and nurture , which can occur at every step of brain development and functionsNature and Nuture interactionEpigenetic: It refers to functionally relevant modifications to the genome that do not involve a change in the nucleotide sequence. Examples of such modifications are DNA methylation and histone modification, both of which serve to regulate gene expression without altering the underlying DNA sequence. Gene expression can be controlled through the action of repressor proteins that attach to silencer regions of the DNA. These changes may remain through cell divisions for the remainder of the cell's life and may also last for multiple generations. However, there is no change in the underlying DNA sequence of the organism;[2] instead, non-genetic factors cause the organism's genes to behave (or "express themselves") differently
Bishop DVM &Snowling MJ
She wants to get better, not hopeless. NC realizes that she has family who care for her. She was able to see her strength even though a bit unsure feeling!
After getting initial concerns:The next process is to……
The Autism Diagnostic Interview-Revised (ADI-R) is a structured interview conducted with the parents or caregivers of individuals who have been referred for the evaluation of possible autism or autism spectrum disorders. The interview, used by researchers and clinicians for decades, can be used for diagnostic purposes for anyone with a mental age of at least 24 months and measures behavior in the 3 areas of reciprocal social interaction, communication and language, and patterns of behavior. Following highly standardized procedures, the interviewer records and codes the informant's responses. Interview questions cover 8 content areas:The subject's background, including family, education, previous diagnoses, and medications Overview of the subject's behavior Early development and developmental milestones Language acquisition and loss of language or other skills Current functioning in regard to language and communication Social development and play Interests and behaviors Clinically relevant behaviors, such as aggression, self-injury, and possible epileptic featuresAfter the interview is completed, the interviewer determines a rating score for each question based on their evaluation of the caregiver’s response.The ADOS is a semi-structured, standardized assessment based on child-friendly activities that sample the child’s social interaction, social communication, play or imaginative use of materials, interests and behaviors. ADOS is research based and internationally recognized as a gold standard test for diagnosis of autism spectrum disorder in complement to the Autism Diagnostic Interview, Revised edition, ADI-R. ADOS _II , new version has 5 diffferent module start form todller to adutl to assess an individual according to his age and language level. The session lasted about 45-60 minutes during which the examiner presented numerous opportunities for a child to exhibit behaviours of interest in the diagnosis of autism spectrum disorders through the standard “planned social occasions” referred to as “presses” for the social interaction, social communication and plays. The ADOS, unlike other standardized test, is always administered in a flexible manner in order to maximize the child’s ability to cooperate and interact with the examiner.Mullen Scales of Early Learning, AGS editionThe Mullen Scales of Early Learning, AGS Edition is an individually administered comprehensive measure of cognitive functioning for infants and preschool children, from birth through 68 months. The Mullen Scales assess a child's abilities in visual, linguistic, and motor domains, and distinguish between receptive and expressive processing. The Mullen scales consist of Gross Motor scale together with four cognitive scales-- Visual Reception, Fine Motor, Receptive Language, and Expressive Language. Gross motor is administered from birth to 33 months; each cognitive scales cover age range of birth through 68 months. A composite score, called the Early Learning Composite, is derived from the T scores of the four cognitive scales.NEPSY-Second edition (NEPSY-II)The NEPSY–II is a comprehensive instrument designed to assess neuropsychological development in children age 3-16. It helps assess academic, social, and behavioral difficulties in preschool and school-age children. It consists of 6 domains including Attention and Executive Functioning, Language, Memory and Learning, Sensorimotor, Social Perception and Visuospatial Processing. It is designed to assess both basic and complex aspects of cognition critical to children’s ability to learn and be productive in and outside of, school settings. It assesses cognitive functions not typically covered by general ability or achievement batteries. Results obtained from a NEPSY–II assessment can be used to diagnose and aid in intervention planning for a variety of childhood disorders. In particular, a comprehensive understanding of a child’s cognitive limitations can facilitate the development of appropriate Individual Education Plans (IEPs) and guide placement and intervention decisions.SDQ:The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire about 3-16 year olds. It exists in several versions to meet the needs of researchers, clinicians and educationalists. Each version includes between one and three of the following components: A) 25 items on psychological attributes.All versions of the SDQ ask about 25 attributes, some positive and others negative. These 25 items are divided between 5 scales: emotional symptoms (5 items) } 1) to 4) added together to generate a total difficulties score (based on 20 items)2) conduct problems (5 items) 3) hyperactivity/inattention (5 items) 4) peer relationship problems (5 items) 5) prosocialbehaviour (5 items)SNAP-IV:The SNAP-IV Rating Scale is a revision of the Swanson, Nolan and Pelham (SNAP) Questionnaire (Swanson et al, 1983). The items from the DSM-IV (1994) criteria for Attention-Deficit/Hyperactivity Disorder (ADHD) are included for the two subsets of symptoms: inattention (items #1-#9) and hyperactivity/ impulsivity (items #11-#19). Also, items are included from the DSM-IV criteria for Oppositional Defiant Disorder (items #21-#28) since it often is present in children with ADHD.PDDSQ ( Thai )
ADI-R, ADOS – normal rangeMullen : Above averageNEPSY: weakness in EF, Average in ToM and ARSDQ- inattention, anxietyPDDSQ-negative
So, DoesDx matter?Yes, but it is not to “label” a child, It is to understand a child’s developmental, behavioral, mental and ability profile in order plan for appropriate treatment and interventionIt is also a universal language among professionalsThat would benefit future research in the field.For instace:Dyspnea example: asthmatic attack, CHF, Pneumia, Metabolic DKAAcademic underachievement: low iq mood-Anxiety,MDD, or just bored, genius but bored
the art and science of medicine are complementary. For successful practice, a doctor has to be an artist armed with basic scientific knowledge in medicine, however our field is more than that.Medicine is both an art and a science. Both are interdependent and inseparable, just like two sides of a coin. The importance of the art of medicine is because we have to deal with a human being, his or her body, mind and soul. To be a good medical practitioner, one has to become a good artist with sufficient scientific knowledge. Technology covered with the layer of art alone can bring relief to the sick.
