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.
