4- Childhood Disorders Flashcards
How many children have a diagnosable mental health disorder
1 in 8
How many young people aged 16-24 has symptoms of a common mental disorder such as depression or an anxiety disorder.
1 in 6
Half of all mental health problems manifest by the age of
14
75% by age 24.
When is anxiety a Disorder?
- There is a worry about a particular event or multiple areas of life
- The worry is excessive compared to that experienced by peers or is age-inappropriate
- The worry leads to avoidance of events
- The worry causes significant distress and/or significant interference in daily activities
Anxiety disorders are one of the most common mental health problems affecting
Children
Anxiety disordered school children are
- Less likely to have satisfying social relationships
- Have higher ongoing usage of health facilities
- Take longer to move out of home
- Live a life (in their own words) of “missed opportunity”
For a diagnosis of separation anxiety in children they must have
- Must last at least 4 weeks
- Must cause clinically significant distress or interference.
Common traits in children with separation anxiety are
- Developmentally inappropriate, recurrent, excessive anxiety concerning separation either from home or attachment figures
- Excessive worry about possible separation, including losing caregivers or harm coming to caregivers.
- Experience physical symptoms on separation or anticipation of separation
- Be reluctant to attend school
- Fear being alone
- Have nightmares about separation
For a diagnosis of generalised anxiety in children they must have
Must exist for at least 6 months Worry accompanied by at least 3 somatic symptoms: -stomach or head aches -problems sleeping -irritability -poor concentration -fatigue
Common traits in children with generalised anxiety are
- Excessive anxiety and worry occurring more days than not
- Worry is difficult to control
- Causes significant distress and impairs functioning
- Seek out reassurance constantly
- Overly compliant/perfectionist
For a diagnosis of social anxiety in children they must have
- Must last at least 6 months
- Must cause clinically significant distress or interference.
- Evidence child has capacity for age-appropriate social relationships
- Anxiety must occur with peers not just adults
Common traits in children with social anxiety are
- Pronounced and persistent fear of one or more social situations in which embarrassment and negative social evaluation may occur or in which the individual encounters unfamiliar people.
- Intense anxiety is experienced in feared situation
- Often leads to avoidance of feared situation.
For a diagnosis of a specific phobia in children they must have
- Must last at least 6 months
- Must cause clinically significant distress or interference.
Common traits in children with a specific phobia are
- Intense and persistent fear of specific object or situation
- Avoidance and distress caused when confronted
- Children may cry, freeze or cling to express fear
- Common fears are animals/insects, storms, dark, heights, blood/injection/injury, vomiting & small spaces
Common traits in children with panic disorders are
- Recurrent, unexpected panic attacks for no apparent reason
- Attacks involve intense fear, accompanied by somatic symptoms (heart pounding, sweating etc.) and catastrophic cognitions
- Associated with agoraphobia
At least one panic attack must have been followed with
- Persistent concern or worry that about panic attacks or their consequences (e.g.I’m going crazy)
- Maladaptive change in behaviour related to the attack(s)
Common traits in children with agoraphobia are
-Persistent fear of certain environments, typically crowded places of open spaces.
Must exist in at least two environments.
-Fear must be out of proportion to realistic threat posed.
-Presence or anticipated presence of feared environment results in significant distress.
-Feared environment is avoided or endured with extreme distress.
Types of Unipolar
- Major depressive disorder (MDD)
- Persistent Depressive Disorder (milder but more chronic)
Types of Bipolar
- Periods of mania and depression
- Bipolar I (mania)/Bipolar II (hypomania)
- Cyclothymic disorder (milder but more chronic)
Major Depression Diagnosis
- Persistent depressed mood (or irritability in YP) AND/OR Marked loss of interest
- At least 5 symptoms in total
- Lasts at least 2 weeks
- Clinically significant impairment
Additional symptoms of Major Depression in DSM-5 include
- Significant weight loss/weight gain or changes in appetite
- Insomnia or hypersomnia
- Unable to sit still or lethargy
- Loss of energy or fatigue
- Feelings of worthlessness or excessive, inappropriate guilt
- Impaired concentration/slowed down thinking/indecisiveness
- Recurring thoughts of death/suicide
Comorbidity refers to
The presence of more than one disorders occurring together.
Children with anxiety disorders are how much more likely to be diagnosed with depression
8 –29 times
Anxiety is strongly associated with
Subsequent depression
Low positive affect is associated with
Depression
High physiological arousal associated with
Anxiety
What type of measurement is typically used to measure depression and anxiety
- Questionnaire measures of symptomatology
- Diagnostic interviews
‘Gold-standard’ for diagnosing anxiety
Anxiety Disorder Interview Schedule (ADIS)
‘Gold-standard’ for diagnosing depression
Schedule for Affective Disorders and Schizophrenia in School Age Children (Kiddie-SADS)
Problems with the diagnostic approach
Categorical (all or nothing) approach to diagnosis (What about people who are just below the threshold? Would a dimensional approach be more suitable)
- High comorbidity between diagnoses
- Results in labeling
- Tells us nothing about cause
ADHD, ADD, hyperkinetic disorder
- Terms used for a syndrome based on (maladaptively) high levels of impulsivity, hyperactivity, and inattention
- Highly comorbid with conduct disorder (~25% of cases) and ODD
- Associated with a number of ‘secondary’ problems (e.g., academic, relationships)
Requirements for diagnosis of ADHD
- 5 (adults) or 6 (children) symptoms of inattention out of possible 9 and/or hyperactivity/impulsivity out of possible 9
- Symptoms present in more than one setting
- Onset <12 years of age
What percentage of children will continue to have (ADHD, ADD, hyperkinetic disorder) in adulthood
25 –50%
Biological theories of ADHD, ADD, hyperkinetic disorder
Genetic
-Highly heritable (but not 100%)
-Dopamine receptor gene (D4) shows most robust evidence
Neurotransmitter dysregulation
-Dopamine and noradrenaline systems
Hypoarousalhypothesis
-Stimuli not sufficiently arousing, so behaviour is stimulus-seeking
-Not unique to ADHD (e.g., LD, conduct disorders)
Psychosocial theories of ADHD, ADD, hyperkinetic disorder
Executive function
-Impaired behavioural inhibition
Family / systemic factors
-High stress and low support
-Less “effective” parenting, conflict, comorbidity
-Cause or effect?
Environmental risk factors (e.g., alcohol, smoking in pregnancy) but difficult to establish causality
Biological treatment for ADHD, ADD, hyperkinetic disorder
- Methylphenidate (Ritalin®, Concerta®)
- Atomoxetine
- Lisdexamfetamine
- Dexamfetamine
Evaluation of biological treatment for ADHD, ADD, hyperkinetic disorder
Generally produce moderate effect sizes for symptom reduction
Cochrane review of methylphenidate (2015)
-Review including over 12,000 children
-Many small studies, few with long-term follow-up
-40% funded by industry
Some risks (e.g., sleeping problems, reduced appetite, compliance)
May improve teacher-reported symptoms, teacher-reported general behaviour, and parent-reported quality of life
Psychological treatment for ADHD, ADD, hyperkinetic disorder
- Social skills training
- CBT (including behaviour modification)
- Neurofeedback (teaching impulse control)
- Complementary / alternative (e.g., dietary, homeopathic)
Evaluation of psychological treatment for ADHD, ADD, hyperkinetic disorder
Some support for psychological interventions, particularly BT
-Little evidence for cognitive training, neurofeedback, dietary (e.g., PUFAs), homeopathic and therefore not currently recommended per se (although healthy diet likely to help!)
Diagnosis of conduct disorder (CD) due to what behaviours
- Aggression towards people and animals
- Destruction of property
- Deceitfulness or theft
- Serious violation of accepted rules
What is Oppositional defiant disorder (ODD)
- ODD is reserved for children who do not meet full criteria for conduct disorder but have regular temper tantrums, refuse to comply with instructions, or may appear to indulge in behaviours that annoy others
- ODD is common in preschool children and may predict later conduct disorder
Presentation of ODD in girls
- Petty theft
- Lying
- Running away from home
- Avoiding school
- Prostitution
Presentation of ODD in boys
- Aggressive and violent behaviours
- Fighting
- Stealing
- Damage to property
- School problems
Facts about CD
- 4-16% in boys
- 1-9% in girls
- Median age of onset 11.6 years
What is autism
- A (neuro)developmental ‘disorder’
- On a spectrum of difficulties
- It is not an illness or disease, it means the brain works differently
- Is not necessarily associated with above or below average intelligence
- Different for everyone
Characteristics of Autism
- Difficulty ‘reading’ other people
- Difficulties interpreting both verbal and non-verbal language, ranging from no speech to not understanding some jokes
- Prefer routine / predictability
- Sensory sensitivity
Possible Genetic ‘Causes’ of Autism
- Autism has a prenatal origin related to risk but precise cause has not been determined e.g., risk associated with greater maternal age, use of medication / alcohol, obstetric complications
- Highly heritable (but not 100%)
- “Stronger environmental component than previously believed”
- Several genes involved in synaptic plasticity, i.e., multifactorial
Cognitive factors of Autism
- Weak central coherence (Remembering the gist of a story, not elements)
- Theory-of-mind (ToM) deficit (Impairments in attributing thoughts and feelings to others)
- Executive dysfunction (unctions such as planning, working memory, impulse control, set shifting)
ABA (applied behavioural analysis)
Approach to modifying behaviour based on learning theory
