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Peads > CAMHS > Flashcards

CAMHS Flashcards

1
Q

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

A 
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?)

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2
Q

How does anxiety usually present in children?

A

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

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3
Q

What other conditions should you consider alongside anxiety in children?

A

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

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4
Q

How should children with anxiety be managed?

A

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

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5
Q

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

A

BEREAVEMENT

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6
Q

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

A

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

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7
Q

How is attachment behaviour classified in children?

A

A - Insecure avoidant UNCONCERNED ABOUT SEPARATION
B - Secure (high stranger anxiety, happy to see return)
C - Insecure ambivalent (distressed on separation and difficult to console upon return)
D - Disorganised or unclassifiable

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

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8
Q

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

A
  1. Sensori-motor (birth - 24months)
  2. Pre-operational (2-7years)
  3. Concrete operational (7-11years)
  4. Formal operational (11 years - adulthood)
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9
Q

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

A
  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)
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10
Q

What are some examples of categories of safeguarding issues?

A
  1. Physical abuse
  2. Factitious illness by proxy
  3. Sexual abuse
  4. Emotional abuse
  5. Neglect
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11
Q

What are some indications for non-accidental injury?

A
  • 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
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12
Q

What might be some indicators for possible sexual abuse?

A
  • Wetting or soling
  • Low mood of child
  • Self harm of child
  • Drug or alcohol disorders
  • Eating disorders
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13
Q

What are the key features of attention deficit hyperactivity disorder?

A
  • 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)

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14
Q

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

A

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

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15
Q

What differentials should you have for ADHD?

A

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

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16
Q

What psychological treatments are there for ADHD?

A

Information giving and family support

17
Q

What behavioural management treatments can you suggest in ADHD?

A

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

18
Q

What medications are available in the treatment of ADHD? What are side effects?

When do you give?

A

METHYLPHENIDATE (RITALIN)

  • weight loss is common side effect (reduces appetite)
  • stunted growth (measure BMI monthly)
  • INcreased HR and BP- measure

Only give on school days (need some drug free days)

19
Q

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

A
  • Poor social functioning
  • Reciprocal social communication
  • Restricted, repetitive behaviours and interests
20
Q

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

A
  • 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
21
Q

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

A
  • 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
22
Q

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

A

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

23
Q

How can we manage ASDs?

A

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)

24
Q

Who are conduct disorders more common in?

A

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

25
Q

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

A 
Coercive parenting 
Involvement with deviant peer group 
Low SES
Peer relationship difficulties 
Parental mental health problems 
Child maltreatment 
Neglect and abuse
26
Q

What are some features of children with ODD and CDD?

A

-Hostile
-Negative and defiant especially to parents
-Behaviour pattern must last at least 6 months
-CDD has more serious, aggressive behaviour
Violations, property damage, theft, arson and truancy

27
Q

Managment of ODD and CDD?

A
  • Prevention is best approach
  • Parenting programs and support groups can be really helpful.
  • Often there is a ADHD comorbidity that must be treated
  • Help at school

Peads (29 decks)

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