Child and adolescent psych Flashcards
What’s the difference between mild, moderate, severe and profound intellectual disability
Mild: IQ 50-70: development of language and intellectual difficulty only emerges as schools start
Moderate: IQ 35-49- can communicate and get around
Severe: IQ 20-34- limited social activity
Profound: IQ <20, even simple speech unavailable, needs special schooling and medical services
What may cause an intellectual disability?
- chromosome abnormality: downs, fragile x
- antenatal causes: infections, alcohol, hypoxia, nutritional growth, retardation, hypothyroidism
- perinatal causes: cerebral palsy
- post natal causes: injury, infections, impoverished environment, hypoglycaemia
- neglect and abuse can contribute
What is important to consider in care of person with intellectual disability?
- prevention and early detection
- regular assessment of attainment and disabilities
- advice, support and help for families
- arrange and special needs education plans (EHCP)
- housing and social support to enable self care
- diagnostic overshadowing
- psychiatric and psychological services
What factors in a childs life affect their mental health?
- Bio: temperament, genetic, neurodevelopmental, biochemical
- developmental/ psychological: attachment, learning, cognitive, emotional
- Social/ environemental: parents, family structure, school, friendships, bullying, culture
How may depression present in a child?
- moody/ grumpy/ irritable rather than sad
- anger
- not wanting todo anything
- reduced energy
- sleep and appetite changes
- self harm
- loss of self esteem and confidence
- worse school performance
- lack of eye contact
- Can often laugh and joke for short periods
How should depression be managed in a child?
- if mild then try 4 weeks watchful waiting as may be transient
- moderate: fluoxetine (SSRI) and CBT
- avoid citalopram, paroxetine, sertraline and tricyclics
Which anxiety disorders are common in children?
- generalised anxiety
- separation anxiety disorders
- phobic disorders
- OCD
- PTSD
how does anxiety presentation differ in children
- somatic manifestations much more common: nausea, abdo pain, sickness, headaches, sweating, palpitations
- panic attacks more common
- nightmares with separation anxiety (often has theme)
- refusal to go to school
- fears of death and loss of parents
How should anxiety be managed in children?
- behaviour therapy- systemic sensitisation, flooding, response prevention
- psychotherapy: brief psychodynamic, family and cognitive therapy
- SSRI- fluoxteine
- refer to CAMHS
how may psychosis present in a child?
Nonspecific psychotic symptoms: odd beliefs, mistrust of others, magical thinking. These overvalued ideas lead to a decline in interpersonal and school functioning
Other than psychosis what may cause odd ideas?
- substance abuse
- anxiety, depression, hypomania
- head injury
- epileptic aura
- SLE
- Anti NMDA receptor antibody encephalitis
- alice in wonderland syndrome (disturbances in sensory perception)
give 4 RFs for behaviour difficulties
- rejection
- child abuse
- child temperament
- family conflict
- lack of clear boundaries
- inconsistent parenting
- comorbid learning
- developmental difficulties
What is attachment and what does poor attachment lead to?
- the powerful emotional bond between baby and caregiver
- without good attachment the child is at risk of forming emotional, social and behavioural problems lasting into childhood
- reactive attachment disorder: diagnosed before age 5. May be inhibited (withdrawn, detached, hypervigilant) or disinhibited (seeks comfort from anyone, extremely dependent and immature)
How are attachment disorders treated?
- psychological therapies
- parenting skills education
What is criteria for conduct disorder diagnosis?
- defiance of will or authority
- aggression
- antisocial behaviour
All 3 acts must have been exhibited in last 12 months, with at leats one present in last 6 months in multiple places.
What does conduct disorder increase the risk of?
- mental health problems
- substance misuse
- criminal activity
- early death by violent and sudden means
- antisocial personality disorder diagnosis in later life
What is oppositional defiance disorder?
- a subsection of conduct disorder with enduring patterns of negative, hostile or defiant behaviour without serious violation of societal norms or rights of others
- uncooperative, unwilling to comply with requests, temper tantrums
- aggressive and defiant
- tend to escalate if not managed
How is conduct disorder and oppositional defiance disorder managed?
- parent training programmes
- individual cognitive and behaviour therapy for older children
- family therapy
- anger management
- school based interventions
- community interventions
Describe the important clinical features of autism
- impaired reciprocal and social interaction: unaware of others feelings, abnormal response to being hurt, poor imitation, solitary repetitive play, poor social developement
- Impaired imagination: little babbling and expressions, no smiles, doesnt act adult roles, no interest in stories, odd speech, poor imaginative play
- poor range of activities and interests: stereotyped movements, head banging, marked distress over minor/ trivial change, insists on routines, narrow fixations eg lining up objects
What is important in management of ASD?
- early behavioural intervention, speech therapy and special schooling
- parent training and support
- social skills training
What are the core diagnostic criteria for ADHD?
- inattention: bad at listening, sustaining attention to play, follow instructions, finish homework, organise tasks, remembering todo things
- hyperactivity: fidgeting, on the go all the time, talks incessantly, climbs, restless, no quiet hobbies
Give 3 differentials for ADHD?
- age appropriate behaviour
- low IQ
- hearing impairment
- behaviour disorders
how should adhd be managed?
- advice on behaviour support
- parent training/ education
- CBT
- methylphenidate (ritalin) to help concentration while at school
- dextroamphetamine
- atomoxetine: noradrenaline reuptake inhibitor- can take up to 6 weeks for effect
what is major side effect of methylpenidate?
- surpresses appetitie so growth
- need to monitor height and weight
- dont take at weekends/ holidays
What physical health problems are common amongst those with learning disabilities?
- constipation
- dental problems
- epilepsy
- gastro reflux
- injuries: self inflicted, accidental or physical abuse
- infections: ear/uti/ rti
- mobility problems
- obesity
- sensory impairment
- swallowing problems
- downs syndrome: hypothyroid, sensory, cvs, resp
What is the difference between learning difficulty and disability?
Difficulty is a specific issue eg dyslexia, dyscalculus
Disability is profound global impairment with reduction in IQ
