Child and adolescent psychiatry Flashcards
What is the development of attachment?
Newborn: lack of selective attachments and stranger anxiety
9 month: stranger anxiety, selective attachment begins
18 month: peak pf proximity seeking with distressed and anxious behaviour
3-4 years: separate more easily from parents
5 year: more stable “internal representations” of parents/relationships
Adolescent: culturally dependent; western culture- minimal dependency needs
What is autistic spectrum disorder?
A pervasive developmental disorder that impairs all areas of patients’ functioning and are usually evident in the first few years of life
Autism is 4x more common in boys Prevalence = 5/10,000
Can present to services at any age
How does autistic spectrum disorder present?
Marked by disturbed acquisition of specific cognitive or motor function during
childhood development
Other areas of cognitive functioning are average or above average
Thought to arise from specific biological abnormality in cognitive processing
Compared with mental retardation, patients have LESS difficulty with overall social and
personal functioning
But the consequences of the delay might lead to emotional or behavioural problems
Patients may also show behavioural problems - aggressiveness, self harm 75% of autistic children have mental retardation
25-30% develop epilepsy
What are the persistent triad of deficits in autistic spectrum disorder?
Impairment in social interaction:
Poor use of non-verbal communication - eye contact, facial expression, gestures
Failure to develop/share enjoyment with peer relationships
Impairment in communication:
Poor development of spoken language
Difficulty initiating or sustaining conversation
Repetitive use of idiosyncratic language
Lack of imitative or imaginary play
Restricted, repetitive interests and behaviours:
Intense preoccupations with interests
Inflexible adherence to routines and rituals
Repetitive motor movements
Unusual interest in parts of hard or moving objects
What is the aetiology of autistic spectrum disorder?
Genetic
Biological- NT, brain injury, prenatal, perinatal, immunological
What is the prognosis for autistic spectrum disorder?
only 1-2% develop full independence 20-30% achieve partial
Best prognosis for children with IQ>70 with good language development by the age 5-7 Improved prognosis if the home environment is supportive
What is the prevalence of ADHD?
Prevalence = 1-5% depending on diagnostic criteria ADHD is 3x more common in boys than girls Onset before age of 7 years old
What re the core symptoms in ADHD?
Inattention
Hyperactivity
Impulsivity
PERSISTENT symptoms in more than 1 setting and >6 months
These are maladaptive and inconsistent with the child’s developmental level
What is the aetiology of ADHD?
Genetic
Biological - NT, brain injury
psychological/social factors
What is the management for ADHD?
Pharmacological:
CNS stimulants, RITALIN and DEXAMFETAMINE improve attention and academic effiicency Non-stimulants - ATOMOXETINE
Psychotherapy:
Behaviour modification in a structured environment Family education and support
Social:
Liaison with education
What is the prognosis for ADHD?
Improvements usually occurs with development Remission of symptoms usually occurs between 12-20 15% of patients have symptoms persisting into adulthood worse prognosis if there are unstable family dynamics
What is the prevalence of dyslexia?
Prevalence = 4% with most severe, 10% widest definition Dyslexia is 4x more common in boys
May present to services at any age
May present to CAMHS with secondary behaviour problems
What decisions can children make if they have capacity?
Can give consent to accept treatment, encouraging the patient to involve their parents in the decision making process, or other staff members for advice if needed
If refusing treatment, they may beed to have professional and legal involvement to ensure that these decisions act in their best interests
If they are refusing treatment, parents could override that decision, but their rights must be considered
If they meet the criteria, treatment could be given using the mental health act
What occurs with decision making if the child lacks capacity?
Parents can give consent- usually 1 is enough, if disputes happen legal advice may be required
Treatment can be given in the patient’s best interests without parental consent
Could give treatment using the mental health act if they meet the criteria
What is the criteria for Gillick competency/Fraser guidance?
Patient understands the advice
They cannot be persuaded to inform their parents or allow the doctor to inform their parents
They are likely to have sex with or without contraception
Their physical or mental health is likely to suffer without the advice or treatment
Their best interests require the doctor to give the advice or treatment without parental consent
