CAMHS & Learning Disability

Question 1

What is CAMHS?

Answer 1

Child and Adolescent mental health services

Question 2

Who do CAMHS work with?

Answer 2

work with young people up to 18 (and 25 in some specialist services)

Question 3

What do CAMHS do? (7 things)

Answer 3

Identify mental disorder
Treat difficulties through bio-psycho-social-relational models
Identify neurodiversity (ADHD, Autism)
Take a developmental approach
Think within systems (families, schools)
Assess and manage risk to young people and those around them
Identify and escalate safeguarding concerns

Question 4

What do CAMHS do? (7 things)

Answer 4

Identify mental disorder
Treat difficulties through bio-psycho-social-relational models
Identify neurodiversity (ADHD, Autism)
Take a developmental approach
Think within systems (families, schools)
Assess and manage risk to young people and those around them
Identify and escalate safeguarding concerns

Question 5

Why do children need their own service? (2 main reasons…)

Answer 5

Brain is developing - cognitive ability, emotional maturity, moral development, decision making (and risk taking)
Children have unique needs - right to an education, they often live with parents and families (or carers/ foster carers), they are legally different to adults (united nations, human rights act, capacity and consent)

Question 6

How do children end up with mental health problems? (Antenatal risk factors, perinatal risk factors, t…, parent and … and a…)

Answer 6

Antenatal risk factors - maternal age, unplanned pregnancy, substance misuse, maternal illness, genetic vulnerability
Perinatal risk factors - oxygen deprivation, infant illness (including ITU/SCBU), Preterm
Temperament (baby behaviour style which determines how they react to situations, and expresses and regulates emotions) activity level, distractibility, sensitivity adaptability
Parent and environment (post natal depression, lack of support, housing problems, availability of carer)
Attachment - young children need to develop a relationship with at least one primary caregiver (first 1-2 years of life) - secure, insecure types, disinhibited
Neurodevelopmental difference, physical illness and disability, parenting capacity, environment
School - environment, friends, bullying

Question 7

How do children end up with mental health problems? (Antenatal risk factors, perinatal risk factors, t…, parent and … and a…, s…)

Answer 7

Antenatal risk factors - maternal age, unplanned pregnancy, substance misuse, maternal illness, genetic vulnerability
Perinatal risk factors - oxygen deprivation, infant illness (including ITU/SCBU), Preterm
Temperament (baby behaviour style which determines how they react to situations, and expresses and regulates emotions) activity level, distractibility, sensitivity adaptability
Parent and environment (post natal depression, lack of support, housing problems, availability of carer)
Attachment - young children need to develop a relationship with at least one primary caregiver (first 1-2 years of life) - secure, insecure types, disinhibited
Neurodevelopmental difference, physical illness and disability, parenting capacity, environment
School - environment, friends, bullying

Question 8

What is Temperament?

Answer 8

baby behaviour style which determines how they react to situations, and expresses and regulates emotions

Question 9

How do children end up with mental health problems? Adolescence

Answer 9

Onset of serious mental illness
Identity formation and challenges of adolescence
Substance exposure

Question 10

How do children end up with mental health problems? School

Answer 10

environment, friends, bullying

Question 11

How do children end up with mental health problems? Adverse childhood experiences

Answer 11

Physical/emotional/sexual abuse
Death of family member
Extreme poverty
Neglect
Violence
Incarcerated relative
Parental divorce (sometimes)
Parental substance misuse or severe mental illness

Question 12

So what does mental illness look like in young people?

Answer 12

Depression
Anxiety Disorders (Generalised anxiety, social anxiety, phobias)
OCD
Psychotic illnesses (including adolescent onset bipolar)
Anorexia and Bulimia
Oppositional Defiant Disorder and Conduct Disorder
Enuresis/Encopresis
Attachment Disorder
ADHD
Autistic Spectrum
Substance Misuse
Tic Disorders (including tourettes)

Question 13

How do we treat mental disorders?

Answer 13

Biological - Exclude organic causes (e.g. hypothyroidism), consider medication (risks vs benefits, evidence base, licensing)
Psychological - CBT, CAT, DBT, IPT, Art therapy, drama therapy
Social (psychoeducation, education, home environment, addressing bullying, lifestyle changes - exercise, sleep, diet)
Relational - support family, psychoeducation to parents, treat the parents, behavioural management techniques, family based therapies
Developmental - recognise and support ASC, ADHD, dyslexia, global developmental delay, learning disability

Question 14

Case 1 - Lucy (12yo, very intelligent, no problems in primary school)
Top sets - secondary school
Stops going to school - 3 months on
Struggles meeting new people, always been shy and prefers time with adults, loves music, self taught korean, often repeats phrases, one best friend who looks after her
What is going on?
1) anxiety disorder, OCD, or mood disorder
2) trauma at school or home (e.g. bullying, CSA)
3) autism spectrum (ASC)
4) family function (parents arguing, new domestic violence, is someone sick?)

Answer 14

Autism likely

Question 15

Autism spectrum conditions - 2 main criteria…

Answer 15

persistent deficits in social communication and social interaction across multiple contexts
restricted, repetitive patterns of behaviour
Around 3% of population
much harder to identify in girls
significant life changes (Starting school, moving to secondary, going to college) are key moments when things can “decompensate”
Girls can mask it

Question 16

Treatment of autism spectrum

Answer 16

no treatment as there isn’t anything wrong - comorbidity e.g. anxiety needs to be identified and treated, using 3rd sector to support young people with ASC
If extreme behavioural that challenges placing self or others at risk, positive behavioural support plans can be used, risperidone is a short term unlicensed option with a small evidence base

Question 17

What % of population have autism spectrum disorder?

Answer 17

around 3%

Question 18

Autism is harder to identify in…

Answer 18

much harder to identify in girls
significant life changes (Starting school, moving to secondary, going to college) are key moments when things can “decompensate”
Girls can mask it

Question 19

There are 5 types of medicine licensed for the treatment of ADHD:

Answer 19

methylphenidate
lisdexamfetamine
dexamfetamine
atomoxetine
guanfacine

Question 20

What is intellectual/ learning disability?

Answer 20

a learning disability is a significantly reduced ability to understand new or complex information or to learn new skills (impaired intelligence) and a reduced ability to cope independently (impaired social function) - valuing people, DoH 2001
The degree of disability is very variable and individual

Question 21

Common difficulties encountered (learning disabilities) are:

Answer 21

understanding and using information
making choices and decisions
communication difficulties
being independent at home and getting around in the community
dealing with social situations

Question 22

People with a diagnosis of learning disability die … years early in males and … years earlier in females than the general population

Answer 22

People with a diagnosis of learning disability die 23 years early in males and 27 years earlier in females than the general population

Question 23

What can help? (learning disability) as a specialist and non-specialist:

Answer 23

think about body language
have an “in” to talk about
be aware of surroundings
use pictures if able/appropriate

Question 24

Case 1 (Trevor) 57yo with down syndrome who has never had contact with MH services. Become more confused at times and struggles with self care for the last year. He interacts less with his peers and struggles to sleep at night. His carer who has worked with him for 2 weeks states he used to be “happy go lucky”. diet is reduced as is oral fluid intake. what might you like to know more?

Answer 24

Physical health +/- investigations
relationships with others
personal life stresses
what ADLs is he less able to do
better collateral from someone long term in his life
does he enjoy pastimes, can he focus
formal assessment of memory (DSQIID)
how does he feel

Question 25

Case 1 (Trevor) 57yo with down syndrome who has never had contact with MH services. Become more confused at times and struggles with self care for the last year. He interacts less with his peers and struggles to sleep at night. His carer who has worked with him for 2 weeks states he used to be “happy go lucky”. diet is reduced as is oral fluid intake. What could be going on?

Answer 25

Dementia? - risk of dementia much higher in those with down's 
forgetfulness
can lead to anger and irritability
can effect sleep
depression? - sometimes called pseudodementia
avolition
lack of focus
poor sleep
forgetfulness
poor oral intake