child psych part 2

Question 1

What should you think about when taking a MH history from a teen?

Answer 1

fear of leaving home
fear of going to school
unwilling to go to school
unwilling to leave home

Question 2

MH probs associated with being out of school

Answer 2

Anxiety
Conduct disorder
Autism
Depression
Obsessional compulsive disorder

Question 3

Some effects of mental health problems on school attendance and learning

Answer 3

Learning difficulties due to poor attention
Co-morbid specific (or general) learning problems
Difficulty controlling emotion e.g. frustration, escalation of anger, frequent conflict.
Anxiety (see below)
Lack of energy, motivation
Difficulties joining in – wanting to be alone or unable to make friends (feeling different).
Sensory problems – too noisy
Preoccupation e.g. fear of germs and contamination
Associations between mental health and learning difficulties e.g. dyslexia

Question 4

what is separation anxiety?

Answer 4

– fear of leaving parents and home. Problems on the doorstep

Question 5

what is social phobia?

Answer 5

– fear of joining group. Problems at the school gate.

Question 6

what are the features of anxiety disorders? 3As

Answer 6

• Anxious thoughts and feelings (e.g. impending doom)
• Autonomic symptoms
• Avoidant behaviour

Question 7

what factors affect willingness to go to school?

Answer 7

Learning difficulties
Lack of friends and relationships
Bullying
Lack of parental attention or concern (e.g. lack of interest in child’s education)
Encouraging one to stay at home
Maternal depression (enc. Separation anxiety)

Maternal depression or psychiatric disorder.
School bullying
Lack of parental attention or control

Question 8

what brain activity is seen in teen with GAD

Answer 8

Amygdala activity

Question 9

what suppresses amygdala activity?

Answer 9

right ventrolateral cortex when labelling emotions.

Question 10

what anatomical problem is seen in teens with GAD?

Answer 10

Reduced connectivity between right ventrolateral cortex and amygdala

Question 11

treatment in children for anxiety>

Answer 11

Behavioural
Learning alternative patterns of behaviour
Desensitization
Overcoming fear
Managing feelings

Medication
Serotonin reuptake inhibitors e.g. fluoxetine

Question 12

autism and intelligence?

Answer 12

Often associated with Low IQ but not defined by low IQ.

Question 13

social distinctive features of autism?

Answer 13

Reciprocal conversation
Expressing emotional concern
Non-verbal communication
Declarative pointing
Modulated eye-contact
Other gesture
Facial expression

Question 14

repetitive behaviour examples in autism?

Answer 14

Mannerisms and stereotypies

Obsessions, preoccupations and interests

Rigid and inflexible patterns of behaviour
Routines
Rituals
Play

Question 15

what are the 3 parts of autism

Answer 15

reciprocity
obsessions
language

Question 16

Autism spectrum disporder (ASD) clinical feutres- which are decreased

Answer 16

decreased:
Self-other perspective taking
Sharing/ divided attention
Flexible learning
Social understanding

Question 17

Autism spectrum disporder (ASD) clinical feutres- which are increased

Answer 17

Rigidity
Sameness
Fixed learning patterns
Technical understanding

Question 18

Autism spectrum disporder (ASD) clinical feutres- seen in younger/lower IQ

Answer 18

Joint attention/ attention to others
Emotional responses
Movements/ Actions

Question 19

Autism spectrum disporder (ASD)clinical features- seen in older/higher IQ

Answer 19

Conversation
Empathy
Interests

Question 20

causes of ASD

Answer 20

strongly genetic

Co-morbid with congenital or genetic disorders:
e.g Rubella, Callosal agenesis, Down’s syndrome, Fragile X, Tuberous sclerosis.

GWAS identifying modulators of genetic expression e.g rbfox1

Also epigenetics

Broader phenotype in siblings and parents:
increased rates of depression, OCD, anxiety disorders, language impairment
Poor set-shifting ability, increased visuospatial ability, careers in engineering, computing or mathematics

Question 21

what proteins are affected in ASD?

Answer 21

Many synaptic proteins are implicated mainly glutaminergic but also GABA.

Question 22

autism with normal IQ? pathophysiology. on synapses

Answer 22

Only effects on synaptic function and plasticity (e.g. turnover)

Question 23

autism with LD? pathophysiology. on synapses

Answer 23

Effects on synaptic function, neural migration and brain development

Question 24

what are the common clinical problems in ASD?

Answer 24

Learning disability – mild to severe
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 (6 x)

Question 25

principles of management?

Answer 25

Recognition, description and acknowledgement of disability
Establishing needs
Appreciating the can’t and the won’t.
The broken leg metaphor
Decrease the demands -> reduce stress ->improve coping
Psychopharmacology

Question 26

ODD and tantrums

Answer 26

Relates to temperament – irritable and ‘headstrong’
Behaviour is learned
Enacted to obtain a desired result
More likely to result from impaired parenting
Associated with adversity

Question 27

ADHD and tantrums

Answer 27

Aggression is impulsive, (and aggression may not be a feature).
Poor cognitive control and ability to sustain a goal
Often remorseful
Resistant to pure behavioural management
Stronger genetic component.

Question 28

what can be cause behind H2M kids (hard 2 manage)

Answer 28

, caused by many factors: in child (e.g. temperament, ADHD, neurodevelopment) and parent (e.g. overcrowding, poverty, depression)
Especially lack of positive experience of being parented.

Question 29

treatment for H2M kids?

Answer 29

Parent Training programmes are effective (NICE guidance, 2006)
Multi-Systemic Therapy (MST) attempts to correct all causes.

Question 30

outcome risks of H2M kids

Answer 30

ntisocial behaviour, substance misuse, long-term mental health problems