Child and Adolescent Psychiatry Flashcards
This deck does not have ASD and ADHD, these are in Pediatrics Neuro
How common are mental health disorders in children?
Up to 15% of children (younger than 12 years) and adolescents (12– 18 years) are affected by mental health problems at any time.
Define Intellectual disability (ID).
Intellectual disability (ID), or disorders of intellectual development (ICD- 11 terminology), are a group of conditions in which intellectual functioning and adaptive behaviour are significantly below average
What is the diagnosis of ID usually based on?
- Diagnosis may be based upon appropriate standardised tests such as the intelligence quotient (IQ) (mean of 100)
- Clinical assessment of day-to-day functioning and behaviour - valid if tests aren’t available
- Onset before adulthood (18 yrs) - while brain is till developing
Describe the epidemiology of IDs.
- Affects slightly more males than females (3:2)
- It’s thought that the number of people with severe and profound ID is rising due to the increased survival of very premature babies.
Describe the aetiology of IDs.
- 50% of people - no clear cause
- Probably from a combination of environmental and non-Mendelian polygenic factors
- Chromosomal abnormalities accounts for 40% of sever ID and up to 20% of mild ID
- Genetic causes - may rise as syndromes, associated with recognised physical abnormalities (dysmorphisms)
- Consanguinity and stratification increases risk of certain autosomal recessive disorders.
What are the antenatal, perinatal and postnatal causes of ID?
What syndrome are associated with IDs?
What is the prevention of IDs?
Describe the clinical presentation of ID.
Usually in childhood - may be missed if mild
Abilities can be delayed, reduced or absent in
o Language
o Schooling
o Motor ability
o Independent living
o Employment
o Social ability
Generally, the more severed the ID, the greater the likelihood of comorbid problems e.g. epilepsy, sensory impairment, ASD.
Behavioural difficulties may arise, secondary to a combination of communication problems, psychiatric or physical illness, epilepsy or suboptimal support for individual needs
Behavioural phenotypes = commonly recognised behaviours in particular syndromes
What are the differences between mild, moderate, severe, profound ID?
How are behavioural difficulties affected by IDs?
- Increases as severity of ID increases e.g. overactivity, withdrawal, aggression, disinhibition, stereotyped movements (hand-flapping, pirouetting), self-injury (e.g. self-biting, eye-poking).
- These may a way of communicating stress or coping with discomfort
- Some behaviour related to neurodevelopment disorders
- repetitive movement - ASD
- restlessness - ADHD
- Behavioural phenotypes with syndromes
- Compulsive eating - prader-willi
- self-injury - Lesch-Nyhan syndrome
- Behaviour may disappear if you solve the underlying problem
What is the association between mental health and ID?
- 50% of ID pts → comorbid neurodevelopment or psychiatric disorders
- Largely mediated via genetic susceptibility, obstetric complications and psychosocial stressors
- Schizophrenia and BPAD are 2 to 3x more commoner
- Dementia affects 4x as many older adults with ID
- ASD and ADHD more prevalent , increasing as IQ falls
- Mood and anxiety disorders are at least as prevalent
Substance misuse and anorexia nervosa - less common
How is physical health influenced by ID?
Higher rates of:
- Epilepsy (25%)
- Sensory impairment
- Mobility problems
- Respiratory disease
- Obesity
- Vascular RFs (except smoking)
Life expectancy reduced due to:
- difficulty accessing preventative measures
- Lack of assertive, coordinated services for people with ID
- Delayed diagnosis due to atypical ppts and communication barriers
- Stigma and value judgements by healthcare professionals → discrimination and inadequate tx
- Staff overlooking medical conditions due to diagnostic overshadowing
What is the differential diagnosis for ID?
- Autistic spectrum disorders (can be comorbid)
- Epilepsy
- Transient cognitive impairment
- Frequent uncontrolled seizures can mimic perceived cognitive impairment
- Adult traumatic brain injury or progressive neurological conditions
- Psychiatric disorder
- Severe and enduring mental illness → chronic cognitive impairment, reduced social functioning and associated speech disorder
- Educational disadvantage/neglect (reversible to some extent)
- Developmental learning/motor disorders:
- dyslexia, dyspraxia, dyscalculia - isolated learning impairments
What are the investigations for ID?
- IQ testing
- Functional assessment of skills
- Detailed developmental hx from parents
- Full physical examination and ix as appropriate
- Genetic testing if appropriate
- Ix of associated physical illness e.g. EEG for epilepsy
- MRI brain e.g. if neurological abnormality
What is the management for ID?
-
Treat physical comorbidity
- Hearing and visual impairments must be addressed
- Annual health checkups recommended
- Health promotion → increase uptake of vaccines, dental checks and screening programmes
- May carry Healthcare passports
-
Treat psychiatric comorbidity
- Mental health problems can be difficult to diagnose because of cognitive, language and communication difficulties
- Patients may be particularly sensitive to medications so slower dose titration and careful monitoring maybe required
-
Educational Support
- Statement of Special Educational Needs allow appropriate support
- This may be in mainstream or specialised schools
- The aim is to maximise the child’s potential
-
Psychological Therapy
- May include counselling, group therapy and modified CBT
- Behavioural therapy - helps improve unhelpful behaviour patterns
-
ABC approach
- Antecedents (triggers)
- Behaviour
- Consequences (of behaviour)
- Management involves:
- Avoiding antecedents
- Reinforcing positive behaviours
- Preventing reinforcement of negative behaviours (e.g. using distraction techniques)
- Helping people understand the consequences of their actions
-
Other support
- Augmentative and alternative communication (AAC) - support people with ID to speak (augmentative) or provides alternatives to verbal communication
- Support network is needed to provide specific help with daily living, housing, employment and finances
- Assess carers’ needs
- Support for ID pts and carers - Mencap, Scope, BILD (British Institute of Learning Disabilities), Down’s syndrome association
What is the prognosis of ID?
• Prognosis
o Lifelong condition however still able to learn new skills
o Life expectancy is reduced (16 yrs earlier) because of comorbid physical illness and unmet health needs
o Important: people with learning disabilities are very vulnerable to neglect, abuse and exploitation
o This may be compounded by communication difficulties
o Behavioural change may be their way of communicating distress
Define separation anxiety.
Children present with excessive fear of separation from specific attachment figures, usually parents or othercaregivers, for at least several months, causing significant distress or functional impairment
Describe the presentation of separation anxiety disorder.
Symptoms include:
- thoughts of harm coming to their parent
- reluctance to attend school or sleep apart
- marked distress at separation, and nightmares about separation.
- Tactful exploration of the family history may reveal a threatened or unmourned loss
What are the risk factors of mental health problems in children?
