CAMHS Flashcards
Can ADHD only be diagnosed in children?
No, it can be diagnosed at any age, but it primarily affects children.
What are the differential diagnoses for ADHD?
Anxiety and depression.
Autism.
Childhood trauma/PTSD.
What percentage of individuals with ADHD have their symptoms persistent into adulthood?
60%
What are the complications of ADHD in adulthood?
Lower educational and employment attainment, poor self-esteem, criminal behaviour, relationship issues, sleep disturbance, substance abuse, road traffic accidents and self-harm.
What is the first line medication for the management of ADHD?
Methylphenidate (Ritalin).
Name some co-morbidities associated with ASD
ADHD, epilepsy, bowel disorders.
What are the differential diagnoses for ASD?
Global developmental delay.
ADHD.
Name some co-morbidities associated with ADHD
Oppositional defiant disorder (ODD), tic disorders, conduct disorder, mood disorders, anxiety.
What are common side effects of methylphenidate?
Reduction in appetite, nausea, sleep disturbance, headache, raised BP.
At what age must symptoms be present for ASD to be diagnosed?
Present before 72 months (3 years old).
Describe the important milestones in the normal emotional and social development of childhood and adolescence
Development of attachment to preferred adults.
Develop friendships.
Understand range of emotions.
Learn how to express emotions verbally.
Develop greater need for privacy in teenage years.
Individuation/separation.
Define ADHD
Attention deficit hyperactivity disorder - neurodevelopmental condition characterised by an abnormally high activity level and an inability to concentrate.
How is ADHD diagnosed?
Features must be present before the age of 7, for at least 6 months and be consistent across at least 2 settings (e.g. home and school).
What is the UK prevalence for ADHD?
3-4%
Are boys or girls more likely to have ADHD?
Boys (3:1 ratio).
What are the 3 core features of ADHD?
Hyperactivity, impulsivity and inattention.
Describe some of the clinical features of ADHD
Very short attention span, quickly losing interest in tasks, constantly moving, impulsive behaviour, disruptive, poor organisation skills.
Describe the management plan for a patient with ADHD
Behavioural management.
Self-help.
Group-based support programme for parents/carers.
Referral to CAMHS.
ADHD-focussed group parent training programme.
Methylphenidate/dexamfetamine/atomoxetine.
CBT.
What class of drug is methylphenidate?
CNS stimulant.
Define ASD
Autism spectrum disorder - neurodevelopmental disorder characterised by abnormal social interaction, communication and restricted, repetitive behaviours.
Is ASD more common in boys or girls?
Boys (x4 more prevalent).
What is the prevalence of ASD in the UK?
1 in 100 (1%)
List some of the features of social interaction deficits in ASD
Lack of eye contact, delay in smiling, avoids physical contact, unable to read non-verbal cues, difficultly making friends, not playing with others, lack of response to others emotions.
List some of the features of communication deficits in ASD
Delay/absence/regression in language development, lack of appropriate non-verbal communication (e.g. eye contact, smiling), difficulty with imaginative play, repetitive use of words/phrases, one-way conversation skills, monotone speech.
List some behavioural features of ASD
Stereotypical repetitive movements, intensive and deep interests, repetitive behaviours and fixed routines, anxiety outside normal routine, inability to adapt to new environments.
Describe the management plan for ASD
Early intervention in pre-school years to learn social, communications and behavioural skills.
Specialist education, OT, speech therapy, family support, behavioural methods, clinical psychology.
No specific drugs for ASD.
What is attachment behaviour?
Behaviour resulting in an individual attaining proximity to a preferred other, in order to keep them safe. Features include:
- proximity-seeking to attachment figure, especially when threatened.
- use of attachment figure as a secure base from which to explore environment.
- separation from attachment figure leads to separation protest by the infant.
- this behaviour is seen between 6-36 months.
Describe secure attachment
Distressed when caregiver leaves, but able to compose themselves. Greets positively upon reunion.
Describe insecure avoidant attachment
Less distressed upon separation and ignores caregiver on reunion. Explores with no anxiety. Unable to learn how to soothe themselves.
Describe insecure ambivalent/resistant attachment
Inconsistent attachment behaviours. Distressed upon separation and difficult to soothe, not comforted by caregiver.
What are insecure attachments associated with?
Poor parenting or abuse.
What are the future complications of attachment difficulties?
Struggle trusting others/forming relationships.
Rule breaking.
Struggle to regulate emotions.
Problems with empathy.
Poor self-esteem.
Insecure avoidant attachment is associated with what disorders?
Social withdrawal and anxiety.
Disorganised attachment is associated with which disorders?
Conduct disorders and hyperactivity.
What is oppositional defiant disorder?
Type of behavioural disorder seen in younger children, characterised by uncooperative, defiant, disobedient and hostile behaviours towards parents, teachers and authority figures.
What is conduct disorder?
A more severe form of behavioural disorder seen in adolescents, characterised by antisocial behaviours and criminal acts.
How are behavioural/conduct disorders managed?
Parenting skills and family therapy.
How might an anxious child present?
Irritable, tearful, clingy, sleep difficulties, bed wetting, nightmares, lack of confidence, decreased concentration, angry outbursts, negative thinking, avoidance of school.
Describe the management plan of a child with anxiety
Mild anxiety: self-help, diet, exercise.
Moderate-severe anxiety: referral to CAMHS, counselling, CBT, SSRIs (e.g. sertraline).
How might a depressed child present?
Low mood, anhedonia, lack of energy, clinginess, anxiety, irritable, avoiding school, bored, hopeless, poor sleep, early morning wakening, poor appetite/overeating, poor concentration, physical symptoms e.g. abdominal pain.
Describe the management plan for a child with depression
Mild depression: self-help, sleep hygiene, diet and exercise, watchful waiting (follow up in 2 weeks), group therapy.
Moderate-severe depression: referral to CAMHS, CBT, family therapy, fluoxetine (first line), intensive psychological therapy may be required, hospital admission if there’s a high risk of self harm, suicide or safeguarding issue.
Clues of physical abuse in child
Unexplained bruising, broken bones or burns. Unusual behaviour e.g. not feeding.
Delay in seeking medical help.
Inconsistent history/story.
Parent shows lack of concern, is preoccupied, hostile, paranoid or fails to wait.
Child is sad, withdrawn, ‘frozen watchfulness’.
Signs of sexual abuse in a child
Local trauma, early sexualised conduct, STIs, pregnancy, emotional effects, self-harm.
Emotional sequelae of sexual abuse in children
Poor concentration, soiling or bed wetting, low mood, self harm, drugs or alcohol abuse, eating disorders.
Sequelae of emotional abuse in children
Sleep or feeding problems, irritability, disordered or insecure attachment, withdrawal, developmental delay, soiling or bed wetting, poor concentration, overactivity, stealing or bullying, running away, low self-esteem, depression and anxiety, self harm, somatisation, drug and alcohol abuse.
