CAMHS

Question 1

What things are really important to cover as part of your social history in a paediatric patient?

Answer 1

HEADSS
Home (who do they live with, how is everything at home, have they ever run away, moved house)

Education and Employment (How is school what’s their favourite subject, what do they want to be when they grow up, do they have a job as well as school)

Activities (on own, with peers, what do they do for fun, do they have a car, do they ever drink alcohol, smoke or take drugs, how much TV do they watch)

Drugs (Have they ever used drugs, have they ever felt pressured into using drugs, smoking or taking alcohol, where are they getting it from - how paid for)

Sexuality (Do they have a boyfriend/girlfriend, do they feel safe in that relationship, have they ever had sex, how many partners, contraception, abortion/pregnancies, knowledge of STDs)

Suicide/Depression/Self-image (How is their mood? Do they feel comfortable in their own body? Have they ever wanted to hurt themselves or thought that life isn’t worth living?)

Question 2

How does anxiety usually present in children?

Answer 2

Commonly as physical symptoms such as:

• Nausea
• Headaches
• Pain
• School truancies
• MONDAY MORNING STOMACH PAINS

All children get scared an anxious but if it is to the extent that they can’t be reassured by parents are are starting to exhibit avoidant behaviours this is considered pathological

Question 3

What other conditions should you consider alongside anxiety in children?

Answer 3

DEPRESSION - again it is not common but should always be considered

Question 4

How should children with anxiety be managed?

Answer 4

CBT often has a really positive effect
Psycho-education to parents and children
Hierarchal desensitisation - getting children to face their fears

Question 5

What is one of the most common stressors for a child to deal with?

Answer 5

BEREAVEMENT

Question 6

What are some warning signs that the child is not coping with death?

Answer 6

Extended periods of depression
Inability to sleep, loss of appetite, prolonged fear of being alone
Acting like a much younger child for a long time
Denying that family member has died
Imitating the dead person
Talking repeatedly about wanting to join the dead person
Withdrawing from friends
Sharp drop in school performance

Question 7

How is attachment behaviour classified in children?

Answer 7

A - Insecure avoidant (caregivers fail to respond to distress and infant suppresses emotional distress)
B - Secure (caregivers respond predictably to distress, uses caregiver as secure base)
C - Insecure ambivalent (Caregiver responds inconsistently, distressed on separation and difficult to console upon return)
D - Disorganised or unclassifiable

***Ainsworth’s strangulations situation procedure helps us classify this

Question 8

What are the four stages of Piaget’s cognitive development?

Answer 8

1. Sensori-motor (birth - 24months)
2. Pre-operational (2-7years)
3. Concrete operational (7-11years)
4. Formal operational (11 years - adulthood)

Question 9

What 5 things are needed for child rearing and therefore when might one raise child protection issues?

Answer 9

1. Nurturance (physical, emotional, intellectual)
2. Security (protection from harm, monitoring)
3. Socialisation (Age-appropriate, social skills training, opportunities to mix with children and adults)
4. Role-modelling (parents, spouse, gender)
5. Individuation (knowledge of life hx, encouragement to acquire autonomy)

Question 10

What are some examples of categories of safeguarding issues?

Answer 10

1. Physical abuse
2. Factitious illness by proxy
3. Sexual abuse
4. Emotional abuse
5. Neglect

Question 11

What are some indications for non-accidental injury?

Answer 11

• delay seeking medical help
• inconsistent history
• parent has lack of concern, preoccupied, hostile, paranoid, fail to wait
• Child is sad, withdrawn, ‘frozen watchfulness’
• Disclosure by child

Question 12

What might be some indicators for possible sexual abuse?

Answer 12

• Wetting or soling
• Low mood of child
• Self harm of child
• Drug or alcohol disorders
• Eating disorders

Question 13

What are the key features of attention deficit hyperactivity disorder?

Answer 13

Inattention (poor attention to tasks and detail, seems like they’re not listening, easily distracted, doesn’t finish tasks, loses homework)
Over-activity (Fidgety and squirms, leaves seat in class, noisy, cannot play or work quietly, runs rather than walks)
Impulsivity (Blurts out answers, fails to wait turn, interrupts and intrudes)

Question 14

What do we need in order to make a diagnosis of ADHD?

Answer 14

Must have disorder in all of these domains (impulsivity, inattention and over-activity) that are pervasive, present from an early age, and are pervasive

Question 15

What differentials should you have for ADHD?

Answer 15

Conduct disorder, drug reaction, autism, age or developmentally appropriate boisterousness

Question 16

What psychological treatments are there for ADHD?

Answer 16

Information giving and family support

Question 17

What behavioural management treatments can you suggest in ADHD?

Answer 17

Structured tasks
Simple instructions
Time-out regimens for unacceptable behaviour
Praise for concentrating and completing tasks
DIET - works for a few children but hard to follow

Question 18

What medications are available in the treatment of ADHD?

Answer 18

METHYLPHENIDATE (RITALIN) - weight gain is common side effect as well as nausea, difficulty sleeping, slowed growth, stomach pains

Question 19

What are the three areas of deficits in Autistic Spectrum Disorders?

Answer 19

Communications
Reciprocal social interaction
Restricted, repetitive behaviours and interests

Question 20

What problems with communication might be seen in people with ASD?

Answer 20

Delay in acquisition of speech 
Failure in reciprocal conversation 
Stereotypies or idiosyncrasies (e.g. repeating phrases from TV)
Speech abnormalities in pitch, rate, rhythm 
Lack of imaginative play 
Pronoun reversal
Echolalia
Neologism

Question 21

What problems might be seen with reciprocal social interaction in people with ASDs?

Answer 21

Failure or delay in use of gaze or gesture
Failure in peer relationships
Rarely seeking other or offering affection at times of stress
Lack of shared enjoyment of own or others happiness
Deviant response or lack of modulation of behaviour to fit social context

Question 22

What problems might be seen with restricted and repetitive interests and behaviours in people with ASDs?

Answer 22

Preoccupation with restricted interests (e.g. maps, shoe-sizes, washing machines, trains)
Attachments to unusual objects
Apparently compulsive, non-functional rituals
Stereotyped, repetitive, motor mannerisms
Preoccupation with small parts of larger objects (e.g. wheels on toy car)
Distress over small environmental changes
Also may become distressed if daily routines disrupted

Question 23

How can we manage ASDs?

Answer 23

Treat any co-morbid medical conditions
Correct hearing/visual defects
Dental care
Genetic counselling
Medications (for symptoms of e.g. anti-convulsant for epilepsy)
PSYCHOSOCIAL (education, speech therapy, family support, information, behavioural methods, counselling, practical help, respite)

Question 24

Who are conduct disorders more common in?

Answer 24

Males
Increases with age (*oppositional defiant disorder is something different and this is more common in younger children <10)

Question 25

What are some risk factors thought to be for ODD and CDD?

Answer 25

Coercive parenting 
Involvement with deviant peer group 
Low SES
Peer relationship difficulties 
Parental mental health problems 
Child maltreatment 
Neglect and abuse

Question 26

What are some features of children with ODD and CDD?

Answer 26

Hostile
Negative and defiant especially to parents
Behaviour pattern must last at least 6 months
Violations, property damage, theft, arson and truancy