Tuesday 24 April 2018

What I did today... Prof Michael Fitzgerald Child Psychiatrist

Ailin Quinlan

'Today I supervised a psychotherapist who was treating a child with behavioural difficulties.

"The psychotherapist came to me by appointment for supervision of the work she had carried out with the child.

"I reviewed the report, discussed its contents with her and provided some pointers for the future treatment of the child. This is a routine part of continuous professional development and I regularly provide such supervision to qualified practising mental health professionals.

"Later I saw a mother with her daughter*. This child had developed normally until the age of 18 months, at which stage she lost the language she previously had. The child had withdrawn from the mother and had poor eye-contact and was not relating to the mother or father or to other close relatives.

"The child was happy to sit on her own all day long without relating to anyone.

"She had become obsessed with spinning the wheels of a toy car, suddenly refused to tolerate any change in routine and developed a sudden hatred of loud noises.

"The mother was wondering what the problem was. I diagnosed autism. I did a genetic test to identify any genetic abnormalities and referred the child to a speech and language therapist.

"I gave the parents guidance on how to work on the child's social skills and referred the child to a specialist multi-disciplinary autism service run by the HSE.

"Today I also saw a teenager who had been suspended by his school. He had been disrupting the class and shouting and fighting with other students. When I saw him, it turned out that he had poor attention, poor concentration, could not do his homework and was hyperactive and impulsive.

"He was also confrontational and defiant. I diagnosed Attention Deficit Hyperactivity Disorder which is 60pc--90pc genetic, and also Oppositional Defiant Disorder.

"In terms of treatment I provided his parents with behavioural interventions and recommended that the school provide a part-time special needs assistant and five hours of resource teaching a week.

"I also asked the school to seat him in front of the class beside a child with good concentration and away from distractions, and prescribed medication for his ADHD.

"I was in London recently to contribute to a documentary on LS Lowry, the painter, known for his matchstick-like figures (pictured left).

"The programme was about how his autism affected his painting. His paintings are autistic particularly because there is no communication or eye contact between the figures in them and a lot of them are also rather robotic in style.

"Lowry was a great observer -- people with autism are massively visual and incredibly observant and that is why the paintings are so powerful. They are also hugely detailed.

"We call this savant skills or special skills. About five per cent to 10pc of the patients with autism that I deal with would have very special talents such as music or calculation. For example if you give them a date on which you were born, a person with such talents could tell you what day of the week you would retire on.

"People like de Valera, Samuel Beckett and James Joyce had high-functioning autism and that had a very special influence on their work."

*Some details changed

Prof Michael Fitzgerald, the first professor of child and adolescent psychiatry in Ireland, is former professor of child and adolescent psychiatry in Trinity College and currently director of psychotherapy courses in Trinity College, Dublin.

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