Child And Adolescent Psychiatry 2

Question 1

Some effects of mental health problems on school attendance and learning

Answer 1

Learning difficulties due to poor attention,
Co-morbid specific learning problems,
Difficulty controlling emotion,
Anxiety,
Lack of energy, motivation,
Difficulty joining in,
Sensory problems- too noisy,
Preoccupation eg fear of germs and contamination,
Mental health and learning difficulties association

Question 2

3As of anxiety disorder

Answer 2

Anxious thoughts and feelings
Autonomic symptoms
Avoidant behaviour

Question 3

Main anxiety disorders affecting children/ adolescents

Answer 3

Separation anxiety- fear of leaving parents and home (problem at doorstep)
Social phobia- (problems at school gate)

Question 4

Motivational factors affecting school attendance

Answer 4

Affecting willingness to go to school:

• learning difficulties
• lack of friends and relationships
• bullying
• lack of parental attention or concern

Encouraging one to stay at home:

• maternal depression
• parental psychiatric disorder

Question 5

Where is there reduced connectivity in generalised anxiety disorders in adolescents

Answer 5

Between right ventrolateral cortex and amygdala

Question 6

Anxiety in children/adolescent treatment

Answer 6

Behavioural:

• CBT with children and family
• learning alternative patterns of behaviour
• Desensitisation
• overcoming fear
• managing feelings

Medication:
Serotonitin reuptake inhibitors eg fluoxetine

Question 7

What is an autism spectrum disorder

Answer 7

A neurodevelopmental disorder,
A syndrome of persistent, pervasive and distinctive behavioural abnormalities,
Highly inheritable

Question 8

Autism social distinctive features

Answer 8

Reciprocal conversation,
Expressing emotional concern,
Non-verbal communication: declarative pointing, modulated eye-contact, other gesture, facial expression

Question 9

Autism repetitive behaviour symptoms

Answer 9

Mannerisms and stereotypies,
Obsessions, preoccupations and interest,
Rigid and inflexible patterns of behaviour: routines, rituals, play

Question 10

3 key areas of Austin’s

Answer 10

Language,
Obsessions,
Reciprocity

Variation of symptoms

Question 11

Clinical features of ASD

Answer 11

Decreased:
Self-other perspective taking,
Sharing/ divided attention,
Flexible understanding

Increased:
Rigidity,
Sameness,
Fixed learning patterns, 
Technical understanding

Question 12

Difference in clinical features of ASD with low and high IQ?

Answer 12

Low IQ:
Decreased
-Joint attention,
-Emotional responses 
-movements/ actions 

High IQ:
Increased:
-conversation 
-empathy 
-interests

Question 13

Causes of autism

Answer 13

Genetics
Co-morbid with congenital or genetic disorders eg rubella, Callosal agenesis, Down’s syndrome, Fragile X, tuberous sclerosis
Epigenetics,

Synaptic proteins are implicated mainly glutaminergic but also GABA

Question 14

What is the Autism spectrum

Answer 14

Severity of neurotransmitter dysfunction

Low end- only effects on synaptic function and plasticity
High end- effects on synaptic function, neural migration and brain development

Question 15

Common clinical problems in ASD

Answer 15

Learning disability, 
Disturbed sleep and eating habits,
Hyperactivity, 
High levels of anxiety and depression, 
Obsessional compulsive disorder, 
School avoidance, 
Aggression,
Temper tantrums, 
Self injury,
Self harm,
Suicidal behaviour

Question 16

Autism management

Answer 16

Recognition, description and acknowledgment of disability, 
Establishing needs, 
Appreciating the cant and the wont,
Decrease the demands, 
Psychopharmacology

Question 17

Key features of oppositional defiant disorder

Answer 17

Refusal to obey adults request,
Often argues with adults,
Often loses temper, 
Deliberately annoys people, 
Touchy or easily annoyed by others,
Spiteful or vindictive

Question 18

Key features of ADHD

Answer 18

Aggression is impulsive,
Poor cognitive control and ability to sustain a goal,
Often remorseful,
Resistant to pure behavioural management,
Stronger genetic component compared to ODD

Question 19

Key features of ODD that make it different from ADHD

Answer 19

Relates to temperament- irritable and “headstrong”,
Behaviour is learned,
Enacted to obtain a desired result,
More likely to result Rom impaired parenting,
Associated with adversity

Question 20

Hard to Manage Children

Answer 20

Caused by many factors: child (temperament, ADHD, neurodevelopment) and parent (e.g overcrowding, poverty, depression)

Question 21

What is parent training

Answer 21

Can be group, individual or self-taught,
1-2hrs/week for 8-12 weeks,
Structured,
Informed by social-learning theory,
Focus on positive reinforcement of desired behaviour and developing positive parent- child relationships