CAMHS - 1 Flashcards
prevalence of mental health problems in children and adolescents
10% age 5-16 have clinically diagnosable mental health problem
70% with MH problems have not had appropriate interventions at a sufficiently early age
prevalence around 10%, lower in girls, some studies report incidence as high as 20%
issues diagnosing psych problems in a child
- lack of ability to communicate and articulate feelings and thoughts
- may report somatic symptoms - e.g. say they have a stomach ache which could be caused by anxiety but they don’t know this
- change with age - normal at one age is not at another - developmental trajectories (regression etc.)
- cultural norms
externalising disorder
disorders based on outward-directed behaviour problems such as aggressiveness, hyperactivity, non-compliance or impulsiveness
internalising disorder
disorders represented by more inward-looking and withdrawn behaviours, and may represent the experience of depression, anxiety and active attempts to socially withdraw
childhood anxiety - separation anxiety
specific to children
excessive anxiety from those attached to - at least 3 of:
disproportionate distress when anticipating or experiencing separation from home or attachment figures
ongoing and unnecessary concern about:
- losing attachment figure or harm to them
- unexpected event which causes separation from attachment figure
- aversion to going out or away from home
- being left alone or without attachment figure
- sleeping alone or away from home
repeated nightmares around separation
physical symptoms - headaches, nausea - when separated or anticipating separation
last at least 4 weeks in kids, 6 months in adults
not better explained by another mental disorder
childhood anxiety - OCD
similar to adults - children can get compulsions without obsessions (e.g. intrusive thoughts)
OCD cycle in adults
obsession –> anxiety –> compulsion –> relief –>
Obsessions = intrusive and recurring thoughts that the individual finds disturbing and uncontrollable.
- often associated with causing harm to oneself or a loved one
- can take the form of pathological doubting and indecision, and this may lead to sufferers developing repetitive behaviour patterns such as compulsive checking or washing
compulsions = represent repetitive or ritualised behaviour patterns that the individual feels driven to perform in order to prevent some negative outcome from happening
- e.g. ritualised and persistent checking of door/light switches
- ritualised compulsions act to reduce stress and anxiety caused by the sufferer’s obsessive fears
- in most cases compulsions are clearly excessive and are recognised as so by the sufferer
4 types of OCD
checking
contamination
symmetry and ordering
ruminations/intrusive thoughts
OCD diagnostic criteria
- obsessions
- compulsions
- belief that behaviour will prevent a catastrophic event
- obsessions and compulsions cause difficulty in performing other functions
- symptoms not explained by other disorders
childhood anxiety - GAD
+specififc focus of worries in childhood
generalised anxiety disorder
(similar to adult)
in children:
- chronic worrying about potential problems and threats
- pathological worrying
specific focuses of worries in childhood:
- 4-7 years = separation from parents and fear of imaginary creatures
- 8 years = have double the worries of 5 year olds
- 11-13 years = social threats
1% prevalence in UK - some US studies show 11%
specific phobias
normal:
- appear and disappear quickly
- e.g. heights, spiders
social phobia:
- begins as a fear of strangers
anxiety prevalence and causes in childhood (3)
moderate anxiety = 54%
causes:
- trauma
- modelling and exposure to info (e.g. showing a child an animal they haven’t seen before, tell them they are scary, they will be scared of it)
- parenting style
childhood and adolescent depression - how it presents
difficult to recognise in young children, can be seen as:
- ‘clingy’ behaviour school refusal, exaggerated fears
- somatic complaints: stomach aches and headaches
however, same as adult with minor amendments (DSM-5)
childhood and adolescent depression - heritability and risk factors
heritability - varies, some studies find low in childhood which increases into adolescence
younger children - abuse and neglect as risk factors
increased risk of depression in children of those with depression:
- genes associated with depression
- psychological factors: home environment, modelling of parental behaviours, parenting styles, transmit low mood and attributions, may not be able to respond well to their emotions
adolescent depression risk factor (7 domains)
cognitive
- depressive negative cognitions
- depressive attributional style
dispositional (and other psychopathologies)
- self-consciousness
- low self-esteem
- emotional reliance
- current depression
- internalising and externalising problem behaviours
- past suicide attempts
- past depression
- past anxiety
stress
- daily hassles
- major life events
social and coping skills
- low self-rated social competence
- poor coping skills
- interpersonal conflict with parents
social support
- low from family
- low from friends
physical
- physical illness
- poor self-rated health
- reduced activity levels
- lifetime number of physical symptoms
- current rate of tobacco use
academic
- school absenteeism
- dissatisfaction with grades
ambiguous scenarios test (AST-D)
measure of pessimistic or optimistic responses to scenarios - for depressive traits
given different scenarios which are neutral - could go either way
emotional value rating of each scenario made by participants on a 9-point scale - from extremely unpleasant to extremely pleasant
ADHD
3 types of presentation:
- predominantly inattentive
- predominantly hyperactive/impulsive
- combined
inattention:
- not detail focused
- difficulty maintaining attention
- doesn’t listen when spoken to directly
- ignores instruction
- difficulty organising
- loses things
- distractible
- forgetful
hyperactive and impulsive:
- fidgeting
- not sitting still
- running and climbing when inappropriate
- unable to do activities quietly
- excessive talking
- blurt out answer
- difficulty taking turns
- interrupts others
symptoms present before age 12, in at least 2 settings, reduce ability (educational, social, occupational)
drug treatment of childhood and adolescent psychological problems + mice prozac study
similar to adults
ADHD - stimulant drugs
issues:
- developing dependencies / addiction
- brain still developing
- danger of over-diagnosing and then overtreating - although current issue of underdiagnosis - difficult balance
study in mice - mice walk more when anxious, mice given prozac when young walk around less than control
non-drug treatment of childhood and adolescent psychological problems
family intervention:
- systemic family therapy = communication, structure, organisation
- parent management training = not rewarding antisocial behaviours
- functional family therapy = strengthens relationships
CBT
play therapy
shared decision making on treatment and support of children’s mental health
involving child in choices
helps reduce miscommunication - mutual understanding of what is needed e.g. talking therapy or drugs
better outcomes
UCL study - kids spoke positively of being involved in their own treatment
disruptive behaviour disorders (2)
oppositional defiant disorder (ODD)
conduct disorder (CD)
(with CD, <10 years = childhood, >10 years = adolescence)
- bullying/threatening others
- starting fights
- using weapon to do serious physical harm
- physical cruelty to others/animals
- mugging
- forced sexual activity
- fire setting to destroy
- deliberate destruction
- lies to get goods/favours
- stay out at night before age of 13
- run away from home at least 2 times
- misses school before age 13
previously known as internalising disorders
callous and unemotional (CU) traits
similar to adult psychopathy
persistent pattern of behaviour that reflects a disregard for others, and also a lack of empathy and generally deficient affect
children with CU traits have distinct problems in emotional and behavioural regulation that distinguish them from other antisocial youth and show more similarity to characteristics found in adult psychopathy
antisocial youth with CU traits tend to have a range of distinctive cognitive characteristics
often less sensitive to punishment cues, particularly when they are already keen for a reward
CU traits are positively related to intellectual skills in the verbal realm
