CAMHS Lecture Flashcards
What services come under CAMHS?
Child & Family Team Neuro-developmental Team Learning Disability Adolescent Team CRISIS Team
What are the different disorders associated with ADHD?
ADHD (Attention deficit/ hyperactivity)
ADD (attention deficit- not hyperactive)
Hyperkinetic disorder (Hyperactive)
What is the ICD 10 classification for HKD?
2 pervasive symptoms necessary for diagnosis:
Impaired attention: a lack of persistent task involvement and tendency to move from one activity to another without completion
Over-activity: restlessness, talkativeness, noisiness and fidgeting, particularly in situations requiring calm
Who do you weigh children up against?
Considered in the context of children of the same age and similar IQ; other mental health disorder excluded
What can HKD present with?
Can present with disinhibition in social relationships, Recklessness in dangerous situations, Non-adherence to social norms
What is the epidemiology of ADHD?
UK Prevalence: ~2.4% of children (diagnosis rising in recent years) Most commonly in children aged 3-7 years M>F Significant genetic contribution Link with obstetric complications
Which co-morbidities may ADHD present with?
Generalised or specific learning difficulties Tourette's syndrome or tic disorder. Oppositional defiant disorder Conduct disorder Affective disorder Deliberate and accidental self harm Substance misuse Academic underachievement
How many cases of ADHD have a psych co morbidity?
70%
What is the DSM-V criteria to diagnose inattention in ADHD?
> 5 for up to 16 yo, >4 for up to 17yo
Inattention to details/Careless mistakes
Trouble holding attention on tasks or play activities
Does not seem to listen when spoken to directly
Not follow through on instructions and fails to finish tasks
Disorganised
Avoids, dislikes, or reluctant on tasks that require mental effort over a long period of time
Loses things often
Easily distracted
Forgetful in daily activities
What is the DSM-V criteria to diagnose Hyperactivity/ impulsivity in ADHD?
Often fidgets
Often leaves seat in situations when remaining seated is expected
runs about or climbs in situations where it is not appropriate/Restlessness in Adult
Unable to play or take part in leisure activities quietly
‘On the go’ acting as if ‘driven by a motor’
Excessive talking
Blurts out answers
Trouble waiting his/her turn
Interrupts or intrudes on others
What are the key features of ADHD?
Symptoms of Inattention and/or Hyperactive-impulsive present before 12YO
Interferes with functioning
Pervasive and present in 2 or more settings
Rule out co-morbidity (eg. Mood disorder, Anxiety disorder, Dissociative disorder, Personality disorder).
What is the management of ADHD?
Refer to CAMHS/Specialist Paediatrician for assessment and diagnostic process
Include assessment tools such as “Conners Scale for ADHD Assessment”
Primary Care is nor responsible for diagnosing or starting medication
Psycho-social support
Reassurance and Psychoeducation for children and parents/carer
Family therapy, CBT if appropriate
Other specialist input (Eg. School’s Special Education Need department/SEN)
Biochemical treatment (only consider if symptoms are moderate to severe):
Stimulant: methylphenidate and dexamfetamine
Beware of cardio-vascular profile, dietary intake, sleep and growth
Non-stimulant: guanfacine and atomoxetine
What are the ASD disorders?
ASD
Aspergers
What is the epidemiology of ASD?
Prevalence of 1% in general population Male to Female ratio: 4:1 50% affected will have normal IQ Began before 3YO and lifelong Varying degrees of impairment and affect functioning in all situations
Which co-morbidities may exist with ASD?
65% have Affective disorders, OCD, ADHD, Tourette’s, Delusions and hallucinations (more common when under stress)
30% has Epilepsy
What are the groups of symptoms needed for an ASD diagnosis?
Reciprocal social interaction
Communication difficulty
Restricted/stereotyped/repetitive repertoire of interests
What are the disorders of Reciprocal social interaction?
Eye contact Indifference Reduced seeking comfort Reduced enjoyment from shared activities Lack of joint attention Poor peer relationships Incomplete theory of mind Impaired empathy Emotional instability
What are the disorders of Communication difficulty?
Delayed language
Stereotyped, repetitive use of language/ echolalia
Concrete understanding
Precocious language
Impairment in non verbal communication
Monologue on favourite subject, difficult reciprocal conversation
What are the disorders of Restricted/stereotyped/repetitive repertoire of interests?
Movements e.g. rocking Self injury Lining up toys Inflexible routines Preoccupation with certain topics Change is difficult
What may ASD also present with?
Also presents with: Poor motor co-ordination, sleeping and eating disturbances, Aggression & temper tantrums, Sensory problems, Phobia etc.
What is the management of ASD?
Refer to CAMHS/Specialist Paediatrician for specialised interviews and observation screens:
Clinical and Developmental history
Speech and language assessment
Cognitive profile and IQ
Physical examination (include for hearing, vision, motor etc.)
Assessment tools such as “Sally-Anne task”, “Children’s Communication Checklist/CCC-2”
Psychological therapy
Reassurance and Psychoeducation for children and parents/carer
CBT can be helpful for associated mental health concerns (Eg. Anxiety, Depression)
Social support:
OT for sensory issues
SALT for speech and language issues
School’s Special Education Need department/SEN and Educational Psychologist; Specialist Schools
Summarise tourette’s
Complex neuropsychiatric disorder of juvenile onset (2-21YO, usually around 7YO; typically diminish as the young person grow into adulthood)
Aetiology suggestions both genetic factors and environmental influences
Global prevalence of 1%; whilst tics present in ~10% of children
Male to F emale ratio: 3-4>1
Comorbid psychiatric conditions include: ADHD (60%), OCD (~30%), ASD (~10%), Self-harm (30%)
Also depression, anxiety, Personality disorder, tantrum, sleep disturbance which affect quality of life in the young person as well as caregiver burden and stress
What are the two types of tics?
Motor
Phonic
What are the motor tics?
Usually began from head and face Eye blinking eye rolling) Scrunching up faces Head and neck movement Hands/Arm movment (e.g. touching Legs movement (Eg. hopping) Echopraxia (copying what others do) Palipraxia (repeating one’s action)
What are the simple phonic tics?
Sniffing Throat clearing Gulping Snorting Coughing
What are the complex vocal tics?
Barking
Animal noises
Srings of words/Swearing
Echolalia (copying what others say) Palilalia (repeating the last word or part of one’s sentences)
How do symptoms vary over time?
Wax and wane features (but less than 1 week of symptom-free period)
Usually preceded by premonitory sensations, diminish during goal-directed behaviour and increase with emotional excitement and fatigue
What is the management of tourettes?
Referral to CAMHS/Specialist Paediatrician is necessary when causing significant discomfort and functional impairment
Psycho-social support:
Reassurance and psychoeducation for children and parents/carers
CBT and Family therapies if indicated
Supportive network meeting with school, Special Education Need department (SEN)
Medication is indicated with severe presentation (eg. Botox injection to periorbital tissues and vocal cord) and for associated co-morbidities
