L"évaluation en pédopsychiatrie

Je vous ferait qu'un bref résumé et mettre ce que le péso-psychiatre a ecrit dans son rapport:
EN gros tout c'est bien passé meghan a intergie eun peut mais moins qua la clinique des trouble envahissant du developpement.
De la facon que le pédo-psy ma expliquer ca c'est que ma fille souffrirait d'un trouble d'adaptation et un trouble du developpement du a la situation famillial.Vue l'instabiliter de sont pere et que j'ai 3 pere différent pour mes 3 enfants(so what,voir si je suis la seule).
Il ma expliquer que ma fille c'était developper comme un enfant autiste,mais sans être de l'autisme.Ok ca exsite ca!!!Voici en anglais ce que le rapport disait:Je n'ai pas la traduction et je suis pas bilingue!!Alors désoler!!!


The family's paediatrician, Dr. Marin, referred Meghan to the Montreal Children's
Hospital at the age of 5 months for assessment of plagiocephaly. Indeed, she
was diagnosed with flattening of the right parietal-occipital areas and torticollis
For this physiotherapy was recommended for 3 months. At four years old it was
noted that there was asymmetry in the patient's lower extremities and a
diagnosis of right lower extremity hemihypertrophy was made.
Past Psychiatric History
Mother has had multiple concerns throughout Meghan's development of specific
behaviours. In particular, mother had suspicions that Meghan was autistic.
Meghan was assessed at the programme des troubles envahissants de
dfweloppement at the Montreal Children's Hospital but their observations did not
lend themselves to the diagnosis of a pervasive developmental delay. However,
given the healthcare seeking behaviour of Meghan's mother, the possibility of
Munchausen's by proxy was raised by the psychologist.

Mother states that about a year and a half ago it was first noticed by a family
friend that Meghan had some bizarre, stereotyped behaviours. These included
spinning around the kitchen table, touching various objects, shaking her hands
and repeating certain words. Since this initial observation mother has taken it
upon herself to take note of every odd behaviour her daughter does and has
compiled extensive lists of her findings. Mother also states that Meghan avoids
people she is unfamiliar with, maintains poor eye contact, often shows
inappropriate facial expressions and has difficulty initiating and maintaining social
interactions. On the basis of these observations, the family's pediatrician, Dr.
Marin, referred to the Autism Spectrum Disorder Clinic where she was assessed
on July 4, 2008. Based on her findings the psychologist at this clinic and Dli.
Fombonne did not have sufficient reason to give a diagnosis of PDD. A referral
for psychiatric assessment at the MCH was then made based on the mother's
stories of stereotyped behaviour and difficulties relating to others. Mother also
complains that Meghan has "Ies crises" where she screams and cries for 20-30
minutes. These fits occur only on weekdays at the end of the day when she is
discussing her day. They have decreased in frequency and intensity since
moving out of the apartment where she lived with her current family, uncle and
grandmother.

Psychiatric Examination:
Meghan was assessed in the presence of her two sisters, her mother and
mother's boyfriend. She was well behaved throughout the interview and
maintained an appropriate temperament. Her coordination was good and no
neurological dysfunction was grossly evident. She is shorter than expected for
age and her head is slightly large and out of proportion with her body. The right
hemihypertrophy was not noticeable.
Throughout the interview, which lasted over an hour, Meghan played well with
her older sister, and, at times, even with her younger sister. At some points she
communicated with her mother or her mother's boyfriend, asking them questions
or showing them drawings. She was also able to explain to the interview panel
what she was doing when she played "Je cherche un autre comme t;:a".In fact,
she was not initially shy and adapted well to her surroundings. She was ratheli
indifferent to the large number of individuals in the room but responded
appropriately when called on. While Meghan did maintain some eye contact, it
was decreased overall. There were no stereotyped movements or bizarre
behaviours observed during the interview. Meghan displayed an appropriate
affect that was of normal ranae and intensitv_


Dynamic Formulation:
Meghan was brought for assessment based on the "autistic traits" reported by
her mother. She has already been diagnosed with global developmental delay
and assessment at the autism spectrum disorders clinic ruled out the diagnosis
of a Pervasive Developmental Disorder. Her environment has never been stable
considering her mother's relationships, her father's inconsistent presence and
her fluctuating living conditions. Concerning the latter, it is interesting that
Meghan's fits were worst when she lived in an apartment with 6 other individuals
and that they have decreased since moving out in July, 2008. It must also be
taken into consideration that no bizarre behaviours, language issues or
communication impairments were observed during the assessment. Parenting
appears to be an issue. Parents are receptive to help in this regard.

Différential diagnosis:

Axis I 309.3 Adjustment disorder with disturbance of Conduct

Axis II Nil

Axis IV Psychosocial stressors:
Unstable home environment
Parent Child Relational Problem

Axis V GAF 61


PLan

• Meghan and her family were referred for family counselling at their local
elSe. An educator could work in the home if necessary. It was also
recommended that mother and her boyfriend attend parental counselling
as well.