Child and adolescent psychiatry 3 Flashcards
school refusal
fear of leaving home
fear of going to school
School truancy
unwilling to leave home
unwilling to go to school
Mental health problems associated with being out of school
anxiety conduct disorder autism depression OCD
Some effects on MI on school attendance/learning
poor attention - learning difficulties difficult controlling emotion lack of energy + motivation 2 learning problem eg dyslexia sensory problems preoccupation eg germs difficult joining in
Separation anxiety
fear of leaving parents and home
problems on doorstep
Social phobia
fear of joining group
problems at school gate
3 A’s of anxiety disorders
anxious thoughts and feelings
ANS
avoidant behaviour
motivation factors affecting willingness to go to school
learning difficulty
lack of friends + relationships
bullying
lack of parental attention or concern
Motivational factors encouraging one to stay home
maternal depression
Amygdala in GAD
very active when experiencing anxiety
Verbalisation of emotion in GAD
enables control
Treating anxiety
behavioural
medication
Behavioural treatment of anxiety
learning alternative pattern of behaviour
desensitisation
overcoming fear
managing feelings
medication of anxiety
SSRI eg fluoxetine
Assessment and management of anxiety (school)
contain anxiety
return to school ASAP
3 principles of CBT
thoughts
feelings
behaviour
Long terms effects of successful behavioural treatment
challenge
success
resilience
self confidence
Long term effects of no behavioural treatment
challenge
avoidance
low self confidence
vulnerability
CBT with children (&families)
More B&T
externalisation - not blame
overcome barriers
parents as collaborators
Narrative approaches
gremlin in head stopping you from attending school
go to battle and defeat
overactive amygdala
psychoeducation
explain problem in terms that makes sense
Externalising
taking blame
guilt and anger out of equation
How is autism defined?
syndrome of distinctive behavioural abnormalities
autism and IQ
often associated with low IQ but not defined by low IQ
Autism - pervasive
present across the life span and across settings
Epidemiology of autism
1%
male 3: female 1
highly heritable
onset under 3 years
Synaptic proteins in autism
glutaminergic
GABA
autism - normal IQ
only effects on synaptic function
Autism with LD
effects on synaptic function, neural migration and brain development
clinical features of autism
social: reciprocity and communication
repetitive behaviour
Social features of autism
reciprocal conversation
expressing emotional concern
pointing, gesture, facial expression
Repetitive behaviour of autism
mannerisms and stereotypes
obsessions, preoccupations and interests
rigid and inflexible
patterns eg routines, rituals
ASD features - decreased
self-other perspective talking
sharing/divided attention
flexible learning
social understanding
ASD features - increased
rigidity
sameness
fixed learning patterns
technical understanding
ASD - younger/lower IQ
joint attention/attention to others
emotional responses
movements/actions
ASD - older/higher IQ
conversation
empathy
interests
ASD clinical problems
learning disability disturbed sleep and eating hyperactivity anxiety, depression, OCD school avoidance aggression, temper self injury, self harm, suicide
ASD causes
strongly genetic
congenital/genetic eg rubella, downs, tuberous sclerosis
GWAS - modulators
broader phenotype in family
Broader phenotype in siblings and parents - ASD
depression, OCD, anxiety
career in engineering, maths, computers
Managing ASD
recognise, describe, acknowledge
reduce demands
psychopharmacology
Oppositional defiance - key features
refuse to obey adults argues with adults, lose temper deliberately annoys people easily annoyed spiteful or vindictive
What is ODD linked to?
impaired parenting
adversity
behaviour is learned
ADHD linked to..
poor cognitive control
often remorseful
stronger genetics
H2M children factors
child - temperament, ADHD
parent - poverty, depression
lack of positive experience
H2M effective management
parent training programmes
multi systemic therapy
Outcome risks of H2M children
antisocial behaviour
substance misuse
long term mental health
Parent training
group, individual/self taught 1-2hrs/week for 8-12 weeks social learning theory positive reinforcement develop positive relationships
