Child and Adolescent Mental Health

Question 1

Define mental health?

Answer 1

Ability to function well from and emotional and social perspective within your culture/environment

Question 2

Why is mental health important?

Answer 2

To be able to function well emotionally and socially are vital human function that allow us to withstand stress and to survive and reproduce as a society

Question 3

Function of the physical brain?

Answer 3

Processes that control the social, emotional and behavioural aspects allowing survival as humans

Question 4

Describe epigenetics

Answer 4

Genes are expressed differently when exposed to different environmental triggers

Question 5

What is the Disability Adjusted Life Year (DALY)?

Answer 5

Measure of overall disease burden, expressed as the no. of YEARS lost due to ill health, disability or early death

Question 6

Factors that shape mental health in children and young people?

Answer 6

Genetic risk (non-modifiable)

Environmental risk (modifiable)

Repetitive experience during childhood is important

Question 7

Why are children and young people vulnerable to mental health issues?

Answer 7

Exist within systems they are dependent on and cannot change

Subject to significant stressors and transitions during their development

Question 8

Why are children and young people often targeted for mental health change?

Answer 8

Early developmental windows of change

Reduction of impact at developmental transitions

Reduce morbidity and co-morbidity

Prevent formation of established pattern of behaviour and vicious cycles

Spiraling self-esteem and maladaptive coping

Question 9

Define attachment?

Answer 9

Strong emotional tie that develops over time between an infant and its primary caregiver(s)

Describes the special, specific affective/emotional relationship normally observed between an infant and primary caregivers

Question 10

Mechanism of developing attachment?

Answer 10

Infant and primary caregiver trigger each other’s instinctual social behaviours and form an attachment

Initial goal is to protect the infant and promote survival of the species; development of attachment ensures that someone will protect the infant during this defenceless period of life

Question 11

Define a primary caregiver?

Answer 11

Anyone who satisfies infant’s attachment needs, i.e: predictable safety

Children develop different styles of attachment based on repetitive experiences and interactions with their caregivers

Question 12

Importance of attachment?

Answer 12

Early relational experience in the context of stress leads to an “internal working model” for day-to-day life

It is often seen as an ingredient in the context of FORMULATION

Framework of how environmental influence in childhood can affect child (and caregiver’s) mental health

Question 13

4 principles of attachment?

Answer 13

Part of the "Strange situation test":
• Proximity maintenance
• Safe haven
• Secure base
• Separation distress

Question 14

Categories of infant attachment?

Answer 14

1. Secure attachment - 70% of infants
2. Anxious attachment (avoidant) - 15% of infants
3. Anxious attachment (ambivalent) - 15% of infants
4. Disorganised attachment response

Question 15

Describe secure attachment

Answer 15

Confident child readily explores, using the carer as a secure base; cries infrequently and is easily put down after being held

Caregiver gives an appropriate response to upset child; encourages infant to explore and is tuned to their needs

Question 16

Describe anxious attachment (avoidant)

Answer 16

Child avoids/ignores parent when they return, showing little overt indications of an emotional response; often, the stranger will not be treated much differently from the parent

Caregiver is disinterested, uncomfortable with showing affection but overly encourages separation/independence

Question 17

Describe anxious attachment (ambivalent)

Answer 17

Child is unsure how to respond to the parent when they return, despite large emotional response;May seek comfort/be unsure with this attention

Caregiver is unpredictable, inconsistent, frightening

Question 18

Describe disorganised attachment response

Answer 18

Older children in the context of severe trauma; they have no cohesive response and have bizarre behaviour, e.g: soiling, destruction of possessions and odd noises

It OVERLAPS with dissociation

Question 19

Other ways of assessing attachment?

Answer 19

Observational strange situation (school, up to 18 months)

Semi-structures interviews

Story stems and picture responses

Attachment q sort

Question 20

What is an attachment disorder?

Answer 20

Rare and individual has difficulty forming lasting relationships; often show nearly a complete lack of ability to be genuinely affectionate with others and they typically fail to develop a conscience

Question 21

Define temperament?

Answer 21

Inherent, constitutionally based characteristics that constitute the core of personality and influence directions for development

Question 22

Methods of measuring temperament?

Answer 22

Observations in socially-structures situations

Questionnaires

Physiological measures, e.g: HR, ECG, etc

Question 23

9 dimensions of temperament?

Answer 23

1. Activity level
2. Approach/withdrawal
3. Adaptability
4. Mood
5. Threshold
6. Intensity
7. Distractibility
8. Rhythmicity
9. Attention spans/persistence

Question 24

3 broad catefories of temperament?

Answer 24

Acitivity - intensity and pace of behaviour

Emotionality - positivity/negativity of a person in general

Sociability - preferences for social interaction or solitude

Question 25

Describe the stability of temperament over time

Answer 25

Temperament is inherent but development of it can be influenced by the environment, i.e: different trajectories and outcomes may occur for children with similar temperamental traits; also, children differing in temperament may come to similar developmental outcomes via different pathways

Question 26

Differences in children in relation to resilience?

Answer 26

Some children manage well despite significant adverse experiences

Question 27

When does a child who experiences chronic adversity fare better or recover more successfully?

Answer 27

• If they have a positive relationship with a competent adult (attachment)
• If they are good learners and problem-solvers (temperament)
• If they are engaging to other people (temperament)
• If they have areas of competence and perceived efficacy valued by self/society (systems)

Question 28

Variations in neurobiology that can alter resilience?

Answer 28

Neuropeptide Y limits the stress response

5-DHEA protects brain from elevated cortisol

Question 29

Ingredients of resilience?

Answer 29

Attachment
Temperament
Systemic model (family, support, etc)