CAMHS

Question 1

Can ADHD only be diagnosed in children?

Answer 1

No, it can be diagnosed at any age, but it primarily affects children.

Question 2

What are the differential diagnoses for ADHD?

Answer 2

Anxiety and depression.
Autism.
Childhood trauma/PTSD.

Question 3

What percentage of individuals with ADHD have their symptoms persistent into adulthood?

Answer 3

60%

Question 4

What are the complications of ADHD in adulthood?

Answer 4

Lower educational and employment attainment, poor self-esteem, criminal behaviour, relationship issues, sleep disturbance, substance abuse, road traffic accidents and self-harm.

Question 5

What is the first line medication for the management of ADHD?

Answer 5

Methylphenidate (Ritalin).

Question 6

Name some co-morbidities associated with ASD

Answer 6

ADHD, epilepsy, bowel disorders.

Question 7

What are the differential diagnoses for ASD?

Answer 7

Global developmental delay.
ADHD.

Question 8

Name some co-morbidities associated with ADHD

Answer 8

Oppositional defiant disorder (ODD), tic disorders, conduct disorder, mood disorders, anxiety.

Question 9

What are common side effects of methylphenidate?

Answer 9

Reduction in appetite, nausea, sleep disturbance, headache, raised BP.

Question 10

At what age must symptoms be present for ASD to be diagnosed?

Answer 10

Present before 72 months (3 years old).

Question 11

Describe the important milestones in the normal emotional and social development of childhood and adolescence

Answer 11

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.

Question 12

Define ADHD

Answer 12

Attention deficit hyperactivity disorder - neurodevelopmental condition characterised by an abnormally high activity level and an inability to concentrate.

Question 13

How is ADHD diagnosed?

Answer 13

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).

Question 14

What is the UK prevalence for ADHD?

Answer 14

3-4%

Question 15

Are boys or girls more likely to have ADHD?

Answer 15

Boys (3:1 ratio).

Question 16

What are the 3 core features of ADHD?

Answer 16

Hyperactivity, impulsivity and inattention.

Question 17

Describe some of the clinical features of ADHD

Answer 17

Very short attention span, quickly losing interest in tasks, constantly moving, impulsive behaviour, disruptive, poor organisation skills.

Question 18

Describe the management plan for a patient with ADHD

Answer 18

Behavioural management.
Self-help.
Group-based support programme for parents/carers.
Referral to CAMHS.
ADHD-focussed group parent training programme.
Methylphenidate/dexamfetamine/atomoxetine.
CBT.

Question 19

What class of drug is methylphenidate?

Answer 19

CNS stimulant.

Question 20

Define ASD

Answer 20

Autism spectrum disorder - neurodevelopmental disorder characterised by abnormal social interaction, communication and restricted, repetitive behaviours.

Question 21

Is ASD more common in boys or girls?

Answer 21

Boys (x4 more prevalent).

Question 22

What is the prevalence of ASD in the UK?

Answer 22

1 in 100 (1%)

Question 23

List some of the features of social interaction deficits in ASD

Answer 23

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.

Question 24

List some of the features of communication deficits in ASD

Answer 24

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.

Question 25

List some behavioural features of ASD

Answer 25

Stereotypical repetitive movements, intensive and deep interests, repetitive behaviours and fixed routines, anxiety outside normal routine, inability to adapt to new environments.

Question 26

Describe the management plan for ASD

Answer 26

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.

Question 27

What is attachment behaviour?

Answer 27

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.

Question 28

Describe secure attachment

Answer 28

Distressed when caregiver leaves, but able to compose themselves. Greets positively upon reunion.

Question 29

Describe insecure avoidant attachment

Answer 29

Less distressed upon separation and ignores caregiver on reunion. Explores with no anxiety. Unable to learn how to soothe themselves.

Question 30

Describe insecure ambivalent/resistant attachment

Answer 30

Inconsistent attachment behaviours. Distressed upon separation and difficult to soothe, not comforted by caregiver.

Question 31

What are insecure attachments associated with?

Answer 31

Poor parenting or abuse.

Question 32

What are the future complications of attachment difficulties?

Answer 32

Struggle trusting others/forming relationships. Rule breaking. Struggle to regulate emotions. Problems with empathy. Poor self-esteem.

Question 33

Insecure avoidant attachment is associated with what disorders?

Answer 33

Social withdrawal and anxiety.

Question 34

Disorganised attachment is associated with which disorders?

Answer 34

Conduct disorders and hyperactivity.

Question 35

What is oppositional defiant disorder?

Answer 35

Type of behavioural disorder seen in younger children, characterised by uncooperative, defiant, disobedient and hostile behaviours towards parents, teachers and authority figures.

Question 36

What is conduct disorder?

Answer 36

A more severe form of behavioural disorder seen in adolescents, characterised by antisocial behaviours and criminal acts.

Question 37

How are behavioural/conduct disorders managed?

Answer 37

Parenting skills and family therapy.

Question 38

How might an anxious child present?

Answer 38

Irritable, tearful, clingy, sleep difficulties, bed wetting, nightmares, lack of confidence, decreased concentration, angry outbursts, negative thinking, avoidance of school.

Question 39

Describe the management plan of a child with anxiety

Answer 39

Mild anxiety: self-help, diet, exercise. Moderate-severe anxiety: referral to CAMHS, counselling, CBT, SSRIs (e.g. sertraline).

Question 40

How might a depressed child present?

Answer 40

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.

Question 41

Describe the management plan for a child with depression

Answer 41

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.

Question 42

Clues of physical abuse in child

Answer 42

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’.

Question 43

Signs of sexual abuse in a child

Answer 43

Local trauma, early sexualised conduct, STIs, pregnancy, emotional effects, self-harm.

Question 44

Emotional sequelae of sexual abuse in children

Answer 44

Poor concentration, soiling or bed wetting, low mood, self harm, drugs or alcohol abuse, eating disorders.

Question 45

Sequelae of emotional abuse in children

Answer 45

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.