Child And Adolescent Mental Health Part 3 Flashcards
What are the two groups of people who are unwilling to go to school?
School refusal- simply won’t even leave house
Truancy- leaves house, doesn’t make school
What problems arise from having a mental health problem in school
Learning difficulties due to poor attention Co- morbid specific Difficulty controlling emotion Anxiety Lack of energy/motivation Difficulties joining in Sensory problems Preoccupation Associations between mental health and learning difficulties e.g. dyslexia
What anxiety disorders affect those in school?
Separation anxiety- fear of leaving parents and home, problems on doorstep
Social phobia- fear of joining group, problems at school gate
An opus thoughts and feelings
Autonomic symptoms
Avoidant behaviour
What factors drive school attendance
Learning difficulties Lack of friends/relationships Bullying Lack of parental attention or concern Encouraging one to stay home Maternal psychiatric disorder, lack of parental attention or control
How does brain physiology contribute to anxiety
Reduced connectivity between the amygdala and the ventrolateral cortex . The ventrolateral cortex suppresses the activity of the amygdala, reducing anxiety
How do you avoid feeding fears and increasing child anxiety
By testing and acknowledging conditions that may not be pathological this reinforces the anxiety experience in the parent and the child
How do you treat the cycle of anxiety
Behavioural
Learning. Alternative pathways
Desensitisation
Overcome fear
Manage feelings
Behaviour (fluoxetine)
What is the underlying principle of CBT
Our behaviour, thoughts and feelings are all interlinked. By changing one we break the cycle
What is the positive cycle of behavioural treatment
Challenge –> Success –> Self confidence –> Resilience
What is the negative cycle of behavioural therapy
Challenge –> Avoidance –> Low self confidence –> Vulnerability
How do we use CBT to overcome difficulties
Children don’t have cognitive behaviour so we usually use behavioural therapy
Parents are the collaborators in the team
Step-wise approach on the ladder to success
Externalisation- disorder is not a matter of blame
Overcoming barriers to change- problem solving
What are good practice when using psychological therapy to treat an eating disorder?
Get everyone on board to achieve a limited goal, use metaphors like climbing mountains.
Sand dune metaphor- taking every step up leads to a small step backwards
What are the key concepts of psychological therapy upon mental health disorders in children?
Psychoeducation - explain the problem in terms that make sense to everyone
Goal- setting choosing reasonable objectives that can be achieved
Step-wise progression
Motivating
Externalising, taking blame, anger and guilt out of the equation
What is autism
A neurodevelopmental disorder
A problem with the growing brain defined as persistent, pervasive and distinctive behavioural abnormalities
What is the difference between autism and Aspergers?
Aspergers- normal IQ
Autism - low IQ
old terms so it’s all defined as an autism spectrum as of now
What are some distinctive features of autism?
Reciprocal conversation
Expressing emotional concern
Non verbal communication- pointing, changed eye contact facial expressions
Mannerisms and stereotypes
Obsessions preoccupations and interests
Rigid and inflexible patterns of behaviour (routines, rituals, plays)
What aspects are decreased in autism?
Self-other perspective taking
Sharing/ divided attntion
Flexible learning
Social understanding
What aspects are increased in autism?
Rigidity
Sameness
Fixed learning patterns
Technical understanding
What is shown in younger people with a low IQ
Joint attention to others
Emotional response
Movements/ Actions
What is shown in older people with a high IQ
Struggle to conversate
Struggle with empathy
Struggle to have a wide range of interests
What causes autism?
Strong genetic link
Rubella, Collsal agenesis Down’s syndrome, fragile X, tuberous sclerosis
GWAS identifies modulators of genetic expression e.g. rbfox 1
Epigenetics
Broad phenotypes in siblings and parents
What are the majority of proteins associated with autism linked with
Glutaminergic Pathways and GABA
How does people with autism and a normal IQ caused
Only effects on synaptic function and plasticity (turnover)
How does people with autism and a low IQ caused
Effects on synaptic function, neural migration adn brain development
What are some common clinical problems in those with autism?
Not done
Learning disability Disturbed sleeps and eating habits Hyperactivity High levels of anxiety and depression Obsessional compulsive disorder School avoidance Aggression Temper tantrums Self injury/self harm Suicidal behaviour (6 times more common)
How do we manage autism?
Recognise, describe and acknowledge the condition
Establish the needs of the young person
There is a can’t and a won’t
If you decrease the demands, the stress is reduced and coping improves. Psychopharmacology is also key
What is the broken leg metaphor?
You wouldn’t run on a broke leg
Yiu wouldn’t get them to climb a a tree
Alternately cannot just immobilise them
Need to get them going, give them tasks and increase this as time goes on
What is ODD?
Irritable and headstrong Learned behaviour Enacted to obtain a desired result More likely to obtain a desired result Associated with adversity
What is ADHD?
Aggression is impulsive (although may not be a feature)
Poor cognition control and ability to sustain a goal
Often remorseful
Resistant to pure behavioural management
Stronger genetic component
How do we manage hard to manage children?
It can be caused by many things
Look to correct negative factors that have caused this
Parent training programs may be effective
Multi-systemic therapy acts to correct all of these
What is parent training?
A long structured program whereby teach parents to encourage good behaviours by reward rather than punishment
1-2 hours for 8-12 weeks
Structured
Informed by social-learning theory e.g. modelling behaviour
Focus on positive behaviour and developing positive parent-child relationships
