Child and adolescent mental health Flashcards
Relative frequency of types of abuse
Neglect > physical > sexual > emotional
At-risk groups for abuse
14-17 yo
Learning disability/ASD/other special needs
Foster children
Babies <1yo with bruising
Forms of physical abuse
Induced illness (only witnessed by parent)
Bruises/fractures/ano-genital signs
Clinical presentations that should raise safeguarding concerns
Unexplained poor school attendance
Fabricated illness
Pregnancy
Poisoning
Apprent life-threatening events (esp if repeatedly)
Risk factors for childhood mental illness
Maternal: Separation, mental illness
Home environment: Abuse, domestic abuse, financial/parental instability
Other: Parental loss (<11), poor social network, lack of hobbies/community
Brain changes during adolescence
Grey matter increases in size then pruning –> high plasticity + high risk of developing addictive behaviours
Increase in senses precedes increase in executive f(x) –> more risk-taking behaviour
Empathic responding not mature until adulthood
Differential for low mood in childhood
- Physical illness (e.g. post-viral depression)
- Medication (e.g. OCP)
- Adjustment disorder:
- School, friendship, relationship, family issues
- Bereavement
- Psychiatric illness
- Neurodevelopmental disorder (esp ASD)
Associations of early depressive episodes in future life
Future depressive episodes
Greater psych + medical comorbidity
Impaired social/occupational f(x)
Risk factors for delibarate self-harm in adolescence
Self-harm by friends/family
Low self-esteem
Drug use
Depression, anxiety, impulsivity (esp in females)
First-line treatment for depression/anxiety in young people
Specific psychological therapy
Family therapy
Interpersonal therapy
CBT
Medication use for depression in children
Limited evidence base, only fluoxetine licensed
Need frequent monitoring ?suicidal risk in first 4w
Considerations for anxiety presentations in YP
Acute or chronic?
Triggers?
Severity + impact on f(x)
Family response (Esp encouragement of safety behaviours)
Comorbidity - ED, depression, low mood
Clinical features of AN in YP
Weight loss >15% OR failure to gain weight (<5th centile)
Fear of weight gain + attempts to lose weight
Body image distortion
Low mood, poor concentration, withdrawal
Hormonal disturbance (esp amennorhoea)
Clinical features of conduct disorder
Persistent/repetitve violent, antisocial, and/or aggressive behaviour that violates age-appropriate societal norms
>=3 behaviours with one for >=6mo
Examples of behaviours seen in conduct disorder
Violence/cruelty to animals/others
Property damage
Fire-setting
Forced sexual activity
Truancy
Bullying, deceit
Risk factors for conduct disorder
Bio: Neurodevelopmental issues, epilepsy, brain damage, ?genetic component
Psycho: Substance misuse, learning difficulties, depression/anxiety/ASD, child maltreatment or attachment issues
Social: Parental criminality, parental psych disorder, domestic abuse, social disadvantage
Aetiology of anxiety in children
Bio: Hyperthyroidism, cardiomyopathy, arrhythmia, genetic predisposition
Psycho: Stressful/traumatic life experiences, insecure attachment, timidness/shyness (predisposed personality)
Social: High social adversity, critical parenting
Presentation of anxiety in children
Mainly somatic symptoms (somatization)
Separation difficulty
School refusal
Social withdrawal
Aggression
Sleep disturbance
Inattention, over-activity
Management of anxiety in children
Psychoeducation: Of parents and child
CBT: Esp family-based with younger children
Relaxation techniques
Comorbidity in social anxiety disorder
30-60% anxiety
20% depression
Substance abuse
Gender ratio for depression in children
No difference pre-pubertal
More F post-pubertal
Risk factors for childhood depression
Bio: Female, endocrine issues, post-pubertal
Psycho: personal/parental Hx of depression, high neuroticism trait, ruminative style of thinking
Social: Poverty, permanent change in interpersonal relationships, parental loss, bullying, isolation
Recovery from childhood depression
10% at 3mths
50% at 1yr
80% at 2yrs
Recurrence for childhood depression
30% recurrence within next 5 years
20% progress to diagnosis of bipolar
Presentation of childhood depression
Atypical features: Weight gain, hypersomnia, sleep disturbance but not EMW
Mood: Irritable, feeling everything is unfair, withdrawal from school
Somatization: Abdominal pain, headache, fatigue
Clinical features of ODD
Oppositional defiance disorder
Recurrent disobediant and defiant behaviour (hostility towards authority figures)
Generally boys <10
Arguments, provocation of others, noncompliance with rules
Not extreme aggression (c.f. CD)
Poor prognostic factors for ODD/CD
Male
Co-morbid ADHD
Low IQ
Parental criminality, alcoholism
Poor socioeconomic and educational status
Early onset
Management of ODD/CD
Psychoeducation: Child + family
Parent management training: Group-based treatments (e.g. Positive parenting programme)
Treat comorbidity: e.g. ADHD, learning difficulty
Child interventions: Anger management, social skills
Education: Liaise with school
Differential/comorbidity for ODD/CD
ADHD/ASD
Adjustment (should resolve by 6 mo)
Depression/anxiety
Substance misuse
LD
