CAMHs Flashcards
1
Q
ADHD - History Background
A
- Age?
- Current education?
- Onset of problems? How long for? (ADHD >6 months and onset before age of 7)
- Birth/developmental issues?
2
Q
Tics - Assessment
A
- Age?
- Known to CAMHs?
For both motor and vocal
- Description
- Motor where? simple or complex?
- Vocal what? simple (sounds) or complex (words/phrases)
- Onset? Any indentifiable event linked?
- Frequency and severity
- Duration? Periods free and for how long for?
- Triggers/exacerbators?
- Obscene gestures of words (copropraxia/lalia)
- Any funny feelings before tics?
- Able to consciously suppress?
3
Q
ADHD - Explanation
A
- Children diagnosed with ADHD tend to have symptoms in three domains:
- Hyperactivity
- Inattention
- Impulsivity
- Affects up to 1.7% of school-aged children in the UK, more common in males
- Causes:
- There is often a genetic component:
- If a sibling has it then 2x risk in the next child
- Other causes may include infections or other problems during pregnancy
- There is often a genetic component:
- We still don’t know a lot about what the underlying process is in the brain but we have reason to suspect that there is some kind of deficient action of the stimulating brain chemicals dopamine/noradrenaline, particularly in the front of the brain which regulates activity in the rest.
4
Q
ADHD - Assessment Process
A
- No specific test or scan
- Assessment in person with child, see and observe them
- Take a history of development from family
- With permission speak with school
- Perform Connor’s rating scale, gold standard
- Consider IQ/academic assessment to rule out LD
5
Q
ADHD - Psychosocial Management
A
- Parent skill course if behavioural issues
- Parent education course around ADHD including management and coping strategies
- School adaptations such as extra time, 1:1 learning, movement breaks, prompts, sitting at the front
- Behavioural treatment - positive reinforcement of good behaviours (and vice versa)
6
Q
ADHD Management - Pharmacological (Stimulants)
A
- 1st line is stimulant treatment - in children Methylphenidate first choice (90% show some response)
- Works best for attention and hyperactivity
- Start at low dose IR Ritalin 5mg up to three times a day
- Titrate up and switch to modified release when dose stable
- Common side effects: decreased appetite, abdominal pain, insomnia, headache, dry mouth, irritability, insomnia
- Risk of hypertension - therefore BP/HR ehecked beforehand, after dose changes and therafter at least 3 monthly.
- Risk of triggering cardiac problems therefore do an ECG beforehand.
- Risk of growth suppression - therefore height and weight checked before starting and every 6 months
- Consider taking drug holidays at weekends and school holidays
- Take with food if it affects appetite
- Caution in: thyroid problems, glaucoma, epilepsy, cardiac problems, tics
7
Q
ADHD - Pharmacological (Non-Stimulants)
A
- Atomoxetine - second line if unable to tolerate or unresponsive to stimlants (both types), stimulants contraindicated.
- Side effects - nausea, abdominal pain, dry mouth, difficulty passing urine.
- Rare risk of liver damage (1:50,000) therefore need to monitor LFTs
- Consider Melatonin for persistent sleep problems unresponsive to sleep hygeine
- Clonidine also second line option - sedating.
8
Q
ADHD - Prognosis
A
- 25% of chilren with ADHD will have symptoms age 30
- Usually hyperactivity improves with age but other symptoms may persist and be an issue
- Whilst most children with ADHD do not need medication as adults some do and this is appropriate.
9
Q
Conduct Disorder - Assessment Backgroun
A
- Age? (onset before 10 = early)
- Concerns? Onset?
- If <1 month after major stressor and <6 months duration may be adjustement)
- Known to services?
10
Q
Autism Assessment - Background
A
- Background:
- Age?
- Concerns? What makes them think Autism?
- Age of onset of these symptoms? (<3 to be childhood autism)
- Progression?
- Current schooling situation? Mainstream?
11
Q
Childhood Sexual Abuse - Immediate Management (A+E)
A
- Establish need with child to break confidentiality and share information
- Clarify need for admission to either a paediatric medical ward or CAMHs bed
- Clarify ongoing risk to self from suicide/self-harm
- Inform:
- Speak to nurse in charge
- Social worker - safeguarding referral
- Local child protection officer
- On call consultant
- Social worker and CP officer will liase with Police
- Consider informing mother or other NOK with parental responsibility if appropriate and explain the immediate plan, need to restrict access to offender, find out if any others at risk at home
- Special child protection interview will take place
- If intercourse suspected then paediatric examination may take place after
- Short term Social Worker or Police can offer emergency protection order or police protection order to ensure child is kept in a place of safety.
12
Q
Childhood Abuse - Further Management
A
- If allegations are proved true Social Services/Police can help finding alternative accomodation, via child care order if parents do not agree
- Needs full psychiatric assessment:
- Context and consistency of account
- Impact on childs physical and emotional condition
- Evidence of emotional and behavioural disturbances
- Recognising child’s therapeutic needs
- Childs view on safe and protective environment
- Family dynamics, family members and parental psychopathology
- Individual psychotherapy may help the child overcome emotional issues arising from abuse:
- Short term – Social isolation, depression, anxiety, sexualised behaviour
Long term – Low self-esteem, self-harm, impact on relationships, link with eating disorders and PD.
- Short term – Social isolation, depression, anxiety, sexualised behaviour
- Family therapy may be indicated to restore roles and boundaries within the family
13
Q
ADHD History - Attention With Examples
A
Attention
- Able to pay attention? Conversation/tasks/classes
- Do they make careless mistakes?
- Are they very forgetful?
- Do they abandon tasks easily?
- Do they struggle to follow instructions?
- Are they very disorganised?
14
Q
ADHD History - Hyperactivity/Impulsivity with Examples
A
Hyperactivity/impulsivity
- Do they struggle to sit still?
- Are they very fidgety?
- Are they visibly restless?
- Do they struggle to wait for their turn?
- Are they prone to interrupting?
- Do they engage in dangerous/risky behaviours?
15
Q
ADHD History - Impact
A
- Drugs and alcohol
- Risk to self/others - agression, risky behaviours, inattention
- Bullying
