child and adolescent psychiatry Flashcards
what is developmental psychopathology
the science underpinning the psychiatry
what are the processes that go wrong during development that result in problems with thinking and behaviour
genes/environment/biological processes
psychopathology components (mixing pot)
genes
biological processes
normal/abnormal brain development
life expriences: ACE, toxic stress, intrauterine exposures
normally developing brain: as cortex matures
changes in childs ability to override emotional outbursts and to coordinate movements
developmental psychology
changes across the physical development, cognitive development and social emotional development
motor skills executive functioning moral understanding language acquisition social change personality emotional development self concept + identify formation
intra-uterine and perinatal factors
maternal health - obesity, diabetes substance misuse - alcohol toxins - lead, mercury drugs - antiepileptics epigenetics endocrine environment immune environment premature birth/perinatal complications twinning impressive levels resilience
low white matter connectivity
assoc with neural ‘noise’ in system, intra-individual variability and ‘cognitive instability’
in developing brains assoc with ADHD - poor conc, distractibility
environmental factors during childhood
carer-child relationship parenting skill parental mental disorder marital harmony/family function nutrition, poverty, deprivation abuse, neglect discipline day-care, schooling peer relationships life events physical disability
normal stress in childhood
includes everyday frustrations, disappointments, minor illness
can be good life lessons for kids and do not cause harm
toxic stress in childhood
long-term and undermines child’s sense of safety + support
prolonged stress leads to production of stress hormones like cortisol
prolonged exposure to stress hormones e.g. cortisol
reduces immunity to disease, leads to problems with digestion, blood pressure + muscle tensions
child undergoing chronic stress when brains are wiring themselves can develop low threshold to stress within brain circuitry = nervous and hyper-vigilant
proximity-seeking behaviour
infant seeking contact with parent when frightened, injured or ill
foundation of attachment
attachment theory
strong emotional and physical bond to one primary caregiver in our 1st years of life is critical to our development
securely attached
greater trust, can connect to others, more successful in life
feel safe to explore world, always have a safe base to return to
insecurely attatched
mistrust others, lack social skills, problems forming relationships
afraid to leave/explore scary world as not sure can return to base
3 types of insecure attachment
anxious/ambivalent
anxious/avoidant
anxious/disorganised
what does early life stress influence
the function of the limbic circuit incl amygdala
determines subsequent patterns of stress response
influences mood and patterns of response to threat inlc withdrawal and/or aggressive response
traumatised brain - amygdala
thalamus constantly feeds inaccurate info to overactive amydala which keeps firing and so get sympathetic hyperarousal
anger, irritability, startled, fear, withdrawal, retreat
reward based learning - operant conditioning
dopamine neurons fire when you assoc an action with a subsequent awar
adversity and reward deficiency model of addiction
early adversity decreases DA response –> decreased reward sensitivity –> inc behaviour required to elicit reward –> intolerance –> inc behaviour –> dec reward sensitivity
mental health problems assoc with being out of school
anxiety conduct disorder autism depression OCD
effects of mental health problems on school attendance and learning
learning difficulties due to poor attention co-morbid learning problems difficulty controlling emotions anxiety lack energy, motivation difficulties joining in sensort probs - noisy preoccupation e.g. fear germs assoc between mental health and learning difficulties e.g. dyslexia
anxiety disorders
separation anxiety - leaving parents and home
social phobia - fear joining groups
features of anxiety disorders (3A’s)
anxious thoughts and feelings (impending doom)
autonomic symptoms
avoidant behaviour
what factors may affect willingness to go to school
learning difficulties
lack of friends/relationships
bullying
lack parental concern/attention (no interest in kids education)
managing childhood anxiety: behavioural
learning alternative patterns of behaviour
desensitisation
overcoming fear
managing feelings
managing childhood anxiety: medication
SSRI e.g. fluoxetine
CBT with children and families
dont expect kids to have cognitive awareness
parents are collaborators in team
step-wise approach: ladder to success
autism spectrum disorder
neurodevelopmental disorder
syndrome of persistent, pervasive and distinctive behavioural abnormalities
distinctive features of autism spectrum disorder: social - reciprocity + communication
reciprocal conversion
expressing emotional concern
non-verbal communication
- declarative pointing
- modulated eye contact
- facial expression
distinctive features of autism spectrum disorder: repetitive behaviour
mannerisms and stereotypes obsessions, pre-occupations + interests rigid and inflexible patterns of behaviour -routines -rituals -play
common clinical problems in autism spectrum disorder
learning disability disturbed sleep + eating habits hyperactivity anxiety, depression ocd aggression temper tantrums SH suicidal behaviour
principles of managing autism spectrum disorder
recognition, description + acknowledging disability
establishing needs
decrease demands - reduce stress - improve coping
psychopharmacology
key features of oppositional defiant disorder
refuse to obey adult request often argues with adults often loose temper delib annoys people touchy/easily annoyed spiteful/vindictive
factors relating to hard to manage children
temperament ADHD neurodevelopment parental depression poverty
effects of psychosocoial adversity and experience of hostility
