Child And Adolescent Mental Health Flashcards
What is Tier 1 of CAHMS?
Those who come into contact with young people and whose training is not within mental health. These include GPs, school nurses, social workers, teachers and youth workers.
What is Tier 2 of CAHMS?
Specialist mental health clinicians trained in child development that work in community clinics like Limetrees that deal with mild to moderate mental health difficulties.
What is Tier 3 of CAHMs?
Specialist team of clinicians working as part of an MDT for young people with complex mental health problems.
E.g Eating Disoder teams, family therapy, crisis team and ADHD
What is Tier 4 of CAHMS?
Advanced services like tertiary care, inpatient and deaf services for specialist teams that work with young people that require a combination of interventions of a higher complexity than Tier 3.
What are important considerations for assessment of a young person?
Assessment is typically in presence of a parent or carer and is important to obtain this both alone and with their carer. It is important to do a systematic review for depression, anxiety and psychosis as well as exploring their early development Factors that may alter assessment include:
Developmental stage of child
Presence of mental or physical disorder
Communication difficulties such as interpreter
It
What is the ICD-10 definition of ADHD?
Neurodevelopmental disorder with a high co-morbidity, characterised by 3 core symptoms occurring before the age of 7 for at least 6 months with:
—> Hyperactivity
—> Impulsivity
—> Inattention
These must be present within a range of settings and be developmentally inappropriate for the child. The symptoms must present with significant social or academic impairment
What are the common co-morbidities with ADHD?
Autism Spectrum disorder
Oppositional defiance disorder
Tic disorder
Motor co-ordination issues
Anxiety
Depression
Bipolar disorder
What are the clinical features of inattention?
Must fulfil at least 6 of the following criteria:
->Careless with detail
->Fails to finish tasks
->Forgetful
->Easily distracted
->Avoids tasks requiring sustained attention
->Appears to ignore when spoken to
->Loses things easily
What are the clinical features of impulsivity?
Must fulfil one criteria of:
-> Talking excessively
-> Blurting out answers
-> Interrupts or intrudes on others
What are the clinical features of hyperactivity?
Must fulfil 3 criteria of:
-> Often fidgeting
-> Cannot remain seated for long
-> Restlesness, often running or climbing
-> Difficulty quietly playing
->
What are important aspects of an ADHD assessment?
-> Taking a history from the parent and child
-> Observing the child in multiple settings such as clinics and school
-> Taking information from school and other teams involved with the child
-> Screen for common co-morbidities such as autism spectrum disorder
-> Physical examination, especially neurological
What are the common impacts of ADHD?
Inattention persists while impulsivity-hyperactivity remits
->Issues with sleep
->Low self esteem
->Poor family and peer relationships
->Reduced academic and employment
->Increased risk of criminal activity and antisocial personality disorder
->Development of comorbidities such as anxiety and depression
-> Self-medication with nicotine and alcohol
What is the aetiology of ADHD?
High level of heritability
Greater rate in low birthweight babies
Pregnancies with drugs, alcohol and tobacco use
Head injuries
What is the differential diagnosis for ADHD?
Active child displatying age-appropriate behaviour
Hearing impairment
Learning difficult
Behavioural disorder
High IQ child insufficiently stimulated
What is the management for ADHD?
Behavioural interventions
-> For the young person, this is focused on organisation, school support, anger management and sleep
Psychoeducation to set realistic expectations
School intervention
Treating co-morbidities
What is autism spectrum disorder?
Neurodevelopmental disorder with an onset before 72 months (3 years old) characterised by 4 main clusters:
->Difficulties with social relationships
->Communication
->Restrictive and repetitive behaviours
->Sensory sensitivity
This can lead to difficulties sustaining employment, education and social relationships.
How does ASD present with social relationships?
Typical presentation is few or no sustained relationships, with a persistent aloofness or awkward interaction with peers.
There is difficulties in interpreting emotions and gestures, with a literal interpretation and poor listening skills.
There is an egocentric projection, with limited perceived empathy or sensitivity and lack for awareness of social rules.
How does ASD present with communication?
Only 50% of patients will develop functional speech
Echolalia
Monotonous voice with little awareness to response from others
Language is formal and stilted
Atypical posture and body language
Limited eye contact and limited non verbal communicative behaviour
Reduced verbal response as infants with babbles
Opposed to physical contact
How does ASD present with speech development?
Develops normally and declines rapidly around age 2
Echolalia and monotonous voice
Peculiar use of words
How does ASD present with behaviour?
->Intense special interests
-> Repetitive movements called “stimming”
->Set approach to everyday life routines and rituals
->Focus on rules
How does ASD present with sensory sensitivity?
Under/oversensitiyibity to light, sound,, pressure, smells and propioception
What are the common co-morbidities with ASD?
ADHD
OCD
Tic disorders
Visual/auditory impairment
Depression and anxiety
Bipolar disorder
Pychosis
What is the assessment of or autism spectrum disorder?
->Take history for level of distress, specific concerns and impairment in cognitive ability, co-morbidities and impact on parent/carer
->Observation of child
->Link in aetiology for the gene variant for autism and multiple sclerosis; important to screen for tuberous sclerosis
->Multidisciplinary approach is important for assessment by psychiatrist, paediatrician, speech and language therapist and psychologist
->Referral for specialist assessment
How is ASD managed?
-> Parenting programmes for education, counselling and methods
-> Liason with education services for support within school
-> Adaptation of the child’s environment and routines
-> Interventions to address communication I and sensory sensitivities
-> Treat any existing co-morbidities
-> Potential for respite care and social work assistance for wider family support
In young people who exhibit significant aggression in ASD, risperidone antipsychotic is a potential use.
What is a secure attachment?
Most common type of attachment where the child is distressed by the parent’s separation and is quickly soothed on reunion. This demonstrates attuned and consistent parenting.
What is an insecure-avoidant attachment?
Following separation, the child is unconcerned at reunion which is associated with unresponsive parenting. There is more focus directed to the environment due to suppressing behaviours to alert their parent.
What is an insecure-anxious attachment?
Extreme distress when parent leaves and on return, both rejects comfort and seeks out comfort. This demonstrates inconsistent parenting which is unresponsive and insensitive to child’s needs and demands.
What is a disorganised attachment?
Child demonstrates contradictory behaviours with pursuing strong proximity to caregiver and then extreme avoidance. They show distress and freezing reactions, indicating abuse from mother or witness to mother’s abuse.
