Child/adolescent psychiatry Flashcards
Factors that can contribute to psychopathology?
- Genes
- Biological processes
- Normal Brain development vs abnormal brain development
- Life experiences
- Adverse Childhood Experiences and ‘toxic stress’
- Intrauterine exposures and environment before birth
Between what ages does the L hemisphere of the brain have a growth spurt for development of language skills?
Between 3 and 6
What happens as a result of growth of the corpus callosum between 3-6 yrs?
Integration of both L+R hemispheres and development of fine and gross motor skills through play
What are 6 key executive functioning skills that we use every day to learn, work, and manage daily life?
Action - monitoring and self-regulating actions
Memory - a working memory and accessing recall
Emotion - control, regulation, managing frustrations
Focus - focusing, sustaining and shifting attention to tasks
Effort - regulating alertness, sustained effort and speed
Activation - organising, planning, prioritising and activating to work
As we grow up what sorts of things do we develop in relation to psychology?
- Motor skills
- Executive functions
- Moral understanding
- Language acquisition
- Social change
- Personality
- Emotional development
- Self concept and identify formation
Look
- ADHD and autism are highly genetic
- Depression and anxiety are also substancially genetic
- Product of one gene-environmental interaction becomes precursor to further gene-environment interaction e.g. gene-drug> ADHD+ adversity > conduct disorder
What type of study is being used to identify genetic risk factors for psychiatric disorder?
Genome Wide Association Studies (GWAS)
What is epigenetic modulation/mechanisms?
Epigenetic mechanisms control gene expression during normal development.
Abnormalities/issues in this regulatory process may lead to human diseases.
Look
There is a link between adverse childhood experiences with MAOA activity (neurotransmitter in the brain).
Your environment can change the biology inside of you which, as a result, can modify your behaviour and mental health
Intra-uterine and perinatal factors that can impact on development and therefore increase risk of MH disorders for the child later in life ?
- Maternal health – Maternal antibodies, obesity, diabetes
- Substance misuse – alcohol, marijuana
- Toxins – lead, mercury and PCB’s
- Drugs - esp psychotropics/antiepileptics (lipid soluble)
- Epigenetics – folate controlled methylation
- Endocrine environment – esp androgens
- Immune environment
- Premature birth/ Perinatal complications
- Twinning
These can all change the biology inside the child or it can change the mother’s response to stress etc. For example, say there was a traumatic labour/delivery where the mother almost lost the child. She may become a very anxious parent who smothers her child / doesn’t let them leave her side and this will have a profound effect on the child’s development/behaviour.
How does foetal alcohol syndrome affect a child’s development?
It can cause:
- Growth retardation
- Body - sexual development, stature etc
- Head
- Brain (including cerebellum)
- Eyes
- Multiple neuro-developmental effects:
- Sensorimotor problems
- Cognitive development problems
- Executive function problems
- Language issues
Commonly causes ADHD, Developmental coordination disorder or Learning disabilities.
Why is white matter connectivity so improtant in early years?
WM connectivity is important for functions that require interplay between brain areas e.g. working memory between hippocampus (learning and memory) and anterior cingulate (empathy, emotion control).
- In our early life we do things like playing, developing skills etc to improve the connectivity between structures in our brain.
- Low connectivity is associated with more neural ‘noise’ in the system, intra-individual variability and ‘cognitive instability’. In developing brains this is typically associated with ADHD – poor concentration, distractibility.
Abnormal development in terms of Grey matter gyrification can cause which problems?
Decreased ridges can be associated with learning disabilities
Increased – autism and schizophrenia
Environmental factors during childhood that have an impact on development / MH
- Carer - child relationship (attachment)
- Parenting skill and parental mental disorder e.g. post-natal depression, substance misuse
- Marital harmony, family function
- Nutrition, poverty, deprivation
- Abuse, neglect
- Discipline - different attitudes in discipline between parents/care givers etc
- Day-care and schooling
- Peer relationships
- Life events
- Physical disability
What is meant by the term ‘toxic stress’?
A little bit of stress is good for children to learn resilience.
But toxic stress is long-term and undermines a child’s sense of safety and support. Prolonged stress leads to the production of hormones such as cortisol which normally help the body to either fight/flight.
If a child has prolonged exposure to cortisol/stress this can really impact them as during childhood their brains are building wiring systems in response to our environments:
- Reduces our immunity to disease and leads to problems with digestion, blood pressure, and muscle tensions.
- Low threshold to stress within the brain circuitry. Such a child may be nervous or hyper-vigilant. Having a caring, supportive parent or other caregiver can reduce the impact of toxic stress.
Example of how aggressive patterns of behaviour can develop
