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Y4 Paeds CCs > 15. Behavioural problems > Flashcards

15. Behavioural problems Flashcards

1
Q

What are possible reasons why a baby would be crying?

A

Normal:
-Wet / dirty nappy
-Too hot / too cold
-Hungry
-Wind
-Colic
-Environmental stress
-Reflux
-Teething
Sudden / severe onset:
-OM
-Intussusception
-Inguinal hernia strangulation

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2
Q

What different types of anxiety can manifest in children?

A

-Generalised anxiety disorder
-Separation anxiety disorder
-Social anxiety disorder (CBT + SSRIs can treat)
-Panic disorder
-Simple and social phobias
-PTSD

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3
Q

What behaviours can be a sign of anxiety in children?

A

-Poor concentration
-Not sleeping, nightmares
-Not eating properly
-Out of control outbursts
-Constant worrying / negative thoughts
-Tense, fidgety, frequent toilet use
-Clingy
-Complaining of tummy aches / feeling unwell

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4
Q

How can anxiety be managed in children?

A

-CBT = first line
-Clarity of diagnosis is needed
-Psychoeducation of child and family
–Use parents as motivators
-Help child to face fears - desensitisation
-Early relapse identification
-Meds only used if no response or incomplete response to psychological therapies

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5
Q

What is attachment and why is it important for children to develop it?

A

-Seeking proximity to an identified attachment figure in situations of perceived distress or alarm for the purpose of survival
-Used as a survival enhancing motivational system - attachment figure acts as a secure base from which to explore the environment from
-Permanent separation –> impaired capacity to feel secure

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6
Q

When do children start to develop attachment?

A

-Around 6 months - 1 year
-Associated with locomotor development and physical separation from caregiver / proximity to dangerous stimuli
-Stranger anxiety

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7
Q

What are the 4 types of attachment styles?

A

Type A = insecure avoidant
Type B = secure attachment
Type C = insecure ambivalent
Type D = disorganised

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8
Q

What features does insecure avoidant attachment have?

A

-Occurs when caregivers FAIL to respond to a child’s needs
-Child explores environment with LITTLE reference to the caregiver
-Learns to SUPPRESS emotional distress
-May show little behaviour reaction to separations from or reunions with caregiver (although likely to display physiological signs of stress eg raised cortisol)

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9
Q

What features does secure attachment have?

A

-Occurs when caregivers respond SENSIBLY to child’s needs
-Infant uses caregiver as a SECURE BASE from which to explore
-Becomes distressed at caregiver’s absence
-Greets POSITIVELY on return
-Associated with better behavioural and academic outcomes in childhood

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10
Q

What features does insecure ambivalent attachment have?

A

-Caregiver responds INCONSISTENTLY
-Infant stressed on separation and ANGRY on reunion
-Cannot learn contingencies about situations
-Copes by splitting off conflicting emotions

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11
Q

What features does disorganised attachment have?

A

-Mixture of type A+C
-Occurs when caregiver is mentally ill / abusive / alcohol dependent
-Child AFRAID of / for caregiver
-May predict AGGRESSION in school / behavioural problems

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12
Q

What features does disinhibited attachment disorder have?

A

-Associated with an institutional style of care in early life / being cared for by a number of people
-PresentationL
–Unduly friendly with a stranger
–Does not seem to mind who looks after them
–Forms superficial relationships easily
–May also be overactive, aggressive, show emotional lability, poor tolerance of frustration

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13
Q

What features does reactive attachment disorder have?

A

-Often caused by parental abuse / neglect / severe maltreatment
-Presentation:
–Failure to respond appropriately to social interactions
–Displays a fearfulness and hyper vigilance which is not responsive to reassurance
–May present similarly to autism spectrum disorder, PTSD, ADHD, anxiety

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14
Q

What 3 key features are present in ADHD?

A
  1. INATTENTION
    -Poor attention to detail
    -Not listening
    -Poor organisation
    -Easily distracted
    -Cannot complete tasks, avoids tasks requiring sustained mental effort
    -Appears forgetful but memory fine upon testing
  2. HYPERACTIVITY
    -Fidgeting, leaving seat in class
    -Runs / climbs instead of walking
    -Noisy / cannot play or work quietly
    -Persistent over-activity not moderated by social demands
  3. IMPULSIVITY
    -Blurts out answers
    -Fails to wait in queues
    -Interrupts social situations / intrudes on others’ activities
    -Talks excessively without response to social constraints
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15
Q

How can ADHD be diagnosed?

A
  1. MUST distinguish between ADHD and just disinterest
    -Compare behaviour in different lessons / school vs home - ADHD is pervasive
  2. Presents from an early age
  3. Features are excessive when compared to the norm for a child of that developmental stage
  4. Must have problems in all 3 areas
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16
Q

How can ADHD be managed?

A

-Strict routines - structured tasks with simple instructions
-Praise for concentrating on / completing tasks
-Parental support
-Mindfulness and CBT for emotional regulation
-Ritalin
–Stimulant that has a calming effect
–Improves some behaviours but does not cure
NB under activity of dopamine in forebrain seen in ADHD –> stimulants help improve stimulation of forebrain

17
Q

How common is self-harm in adolescents?

A

-10% in their lifetime have engaged in self-harm
-More common in females, suicide more common in males

18
Q

How can self-harm be managed?

A

IMMEDIATE
1. 24h cooling off period - overnight admission and review by CAMHS
2. Appropriate medical treatment
3. Detailed history of event (before, during, after)
4. MSE
5. Collateral history from parents
LONG-TERM
1. Treat any comorbid psychiatric condition
2. Address self-esteem issues
3. Help to improve interpersonal / social issues and communication skills
–Especially how to communicate emotions
4. Family support + counselling

19
Q

What are the 3 key features of anorexia nervosa?

A
  1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health
  2. Intense fear of gaining weight or become fat
  3. Disturbance in experience of one’s own body weight / shape, undue influence of body weight on self-evaluation, or denial of the seriousness of the current low body weight
20
Q

What physiological abnormalities are found in anorexia nervosa?

A

-Hypokalaemia
-Low sex hormones
-Impaired glucose tolerance
-Hypercholesterolaemia
-Hypercarotinaemia
-Low T3

21
Q

What factors can cause bulimia nervosa?

A

-ACEs
-FHx of obesity, FHx of affective disorders
-Parental substance misuse
-Poor social network
-Critical parents
-Associated with high expression of emotions, impulsivity, chaotic lifestyle

22
Q

What are the 5 DSM diagnostic criteria for bulimia nervosa?

A
  1. Recurrent episodes of binge eating
  2. A sense of lack of control over eating during the episode
  3. Recurrent inappropriate compensatory behaviour to prevent weight gain eg induced vomiting
  4. Both 2+3 occurring at least once a week for 3 months
  5. Self-evaluation is unduly influenced by body weight / shape
    NB - disturbance does not exclusively occur during episodes of anorexia nervosa
23
Q

How can bulimia nervosa be managed?

A

-Focused family therapy = first line
–MDT must include family
-CBT
-Motivational interviewing
-Fluoxetine (lack of long-term data)

24
Q

What physiological complications can occur from bulimia nervosa?

A

-Electrolyte disturbance
-Seizures
-Tetany
-Haematemesis
-Stomach rupture

25
Q

What is conduct disorder?

A

-Range of antisocial types of behaviour eg:
–Serious aggressive behaviour
–Destructive behaviour
–Deceitful behaviour
–Rule violations
–Running away
–Irritability, frequent tantrums
–Little guilt / remorse
-Labelled conduct disorder when it interferes with ability to lead a normal life
-Must be present for at least 6 months before diagnosis

26
Q

How can attachment styles change over time?

A

-Tend to be fairly constant and predictive of later attachment styles
-But style can change if the caregiving environment changes (especially in early attachment)

27
Q

What does the Yerkes-Dodson curve show?

A

-Optimal productivity requires moderate stress levels
-Minimal and maximal stress lead to behaviours that are unproductive

Y4 Paeds CCs (25 decks)

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