Child and Adolescent Psychiatry

Question 1

What are the four categories of infant attachment?

Answer 1

1. Secure attachment
2. Anxious attachment - avoidant
3. Anxious attachment - Ambivalent
4. Disorganised attachment response

Question 2

Describe secure attachment

Answer 2

Child:
Readily explores, using carer as a secure base. Cries infrequently. Easily put down after being held. Confident.
Caregiver:
Appropriate response to upset, appropriate encouragement to explore, tuned in to child’s needs

Question 3

Describe anxious attachment - avoidant

Answer 3

Child:
Avoids or ignore the parent when he or she returns - showing little overt indications of an emotional response. Often, the stranger will not be treated much differently from the parent
Caregiver:
Disinterested, uncomfortable with showing affection but overly encourages separation/independence

Question 4

Describe anxious attachment: Ambivalent

Answer 4

Child:
Unsure how to respond to the parent when he or she returns – despite large emotional response. May seek comfort be unsure about how to manage the attention
Caregiver:
Unpredictable, inconsistent, frightening.

Question 5

Describe disorganised attachment response

Answer 5

Older children in the context of severe trauma
No cohesive response, bizarre behaviour
Soiling, destruction of possessions, odd noises
Overlaps with dissociation

Question 6

Define temperament

Answer 6

Temperamental traits can be seen as inherent, constitutionally based characteristics that constitute the core of personality and influence directions for development.
Temperament is inherent, but development of temperament can be influenced by the environment.

Question 7

What are some factors that contribute to a young person recovering better from adversity

Answer 7

They have a positive relationship with a competent adult (attachment)
They are good learners and problem-solvers (temperament)
They are engaging to other people (temperament)
They have areas of competence and perceived efficacy valued by self or society (systems)

Question 8

What are the four components of the family system?

Answer 8

Structure
‘nuclear’ families, lone parent, gay and lesbian families, stepfamilies , extended family

Connection
the family system is connected through verbal and non verbal communication

Pattern
circular processes , maintaining ‘homeostasis’

Adaptability
adaptable to change both internal and external over time

Question 9

What is behavioural family therapy?

Answer 9

An evidence-based, psychoeducational approach. the main focus of delivery has been around working with families where a member experiences psychosis or bipolar disorder. However, family interventions may be helpful for families experiencing a range of mental health problems, including anxiety, depression, eating disorders, the dementias and learning disabilities

Question 10

What is the McMaster model?

Answer 10

Six main dimensions of family functioning:

1. Problem solving
2. Communication
3. Roles
4. Affective responses
5. Affective involvement
6. Behaviroual controls

Question 11

What is level 1 team around the child activation?

Answer 11

A ‘Level 1’ TATC activates when the Named Person assesses that the support available within their own resources is not sufficient to address the wellbeing concerns around for a child and determines that additional support is required from other resources within their own agency.
If a concern is noted it is the responsibility of the Named Person to initiate assessment, gather information, analyse that information and arrange the TATC meeting.

Level 1, involvement is single agency only.

Question 12

What is level 1 team around the child activation?

Answer 12

A ‘Level 2’ TATC activates when evaluation of the single agency response indicates that there are insufficient resources within the single agency to resolve the wellbeing concerns and that additional resources, from partner agencies, are required.
A Level 2 TATC will plan, implement and review these additional supports.
TATC at this level is multi-agency, a Lead Professional will be required to coordinate the Child’s Plan that will emerge.

Question 13

What is level 1 team around the child activation?

Answer 13

A ‘Level 3’ TATC is where the voluntary integrated approach implemented at Level 2 has not resolved the issues and the wellbeing concerns will have escalated or the child may be deemed to be at risk. At this stage referral to the Scottish Children’s Reporter or to Options is being seriously considered.
Given the possibility of statutory provision, consideration should be given to whether or not Social Work Department representation is appropriate at the TATC meeting.
If a child protection concern / incident is noted then referral should be made immediately. Do not wait until the Level 3 TATC meeting.

Question 14

What are the four stage of Piaget development and at what age are they?

Answer 14

Sonsorimotor 0-2 y
Preoperational 2-7 y
Concrete operational 7-11 y
Formal operations 11+ y

Question 15

What are the three main factors contributing to teenagers misbehaving

Answer 15

Brain cortex grey/white matter changes
Change in balance of dopamine circuits
Increasing importance of peer group standards and involvement

Question 16

What is conduct disorder?

Answer 16

A diagnostic term used to describe children and young people who present with persistent, repetitive , aggressive and antisocial behaviours. All current diagnostic criteria is antisocial behaviours which means that they can be objectively measured but does not give a true reflection of the difficulties a young person could be experiencing

Question 17

Name two prenatal and two perinatal factors contributing towards conduct disorder

Answer 17

Prenatal Factors
Maternal Smoking
Maternal alcohol

Perinatal Factors
Low Birth weight
Birth complications

Question 18

Give three treatments for conduct disorder

Answer 18

1. Collaborative Problem Solving (CPS)
2. Multi-systemic Therapy (MST)
3. Psychopharmacology

Question 19

Describe collaborative problem solving

Answer 19

Based on fit between child and environment
Emphasis on ‘lagging’ cognitive skills rather than the behaviour itself
‘When the demands of the environment exceed a child’s capacity to respond adaptively then behaviours occur’
- Mild: whining, sulking, pouting
- Moderate: screaming, swearing, hitting, property destruction
- Severe: resulting in injury of self or others

Question 20

What three plans does CPS outline?

Answer 20

Plan A - "you will do it"
Plan B:
- Empathy step
- Defining the problem
- Invitation step
- Mutually satisfactory plan
Plan C - removing the expectations

Question 21

What is multi-systemic therapy?

Answer 21

Family and Community based treatment for serious conduct problems at imminent risk of ‘out of home’ placements

Care givers are the key to achieving and sustaining positive long term outcomes