child psych part 2 Flashcards
What should you think about when taking a MH history from a teen?
fear of leaving home
fear of going to school
unwilling to go to school
unwilling to leave home
MH probs associated with being out of school
Anxiety Conduct disorder Autism Depression Obsessional compulsive disorder
Some effects of mental health problems on school attendance and learning
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
what is separation anxiety?
– fear of leaving parents and home. Problems on the doorstep
what is social phobia?
– fear of joining group. Problems at the school gate.
what are the features of anxiety disorders? 3As
- Anxious thoughts and feelings (e.g. impending doom)
- Autonomic symptoms
- Avoidant behaviour
what factors affect willingness to go to school?
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
what brain activity is seen in teen with GAD
Amygdala activity
what suppresses amygdala activity?
right ventrolateral cortex when labelling emotions.
what anatomical problem is seen in teens with GAD?
Reduced connectivity between right ventrolateral cortex and amygdala
treatment in children for anxiety>
Behavioural Learning alternative patterns of behaviour Desensitization Overcoming fear Managing feelings
Medication
Serotonin reuptake inhibitors e.g. fluoxetine
autism and intelligence?
Often associated with Low IQ but not defined by low IQ.
social distinctive features of autism?
Reciprocal conversation Expressing emotional concern Non-verbal communication Declarative pointing Modulated eye-contact Other gesture Facial expression
repetitive behaviour examples in autism?
Mannerisms and stereotypies
Obsessions, preoccupations and interests
Rigid and inflexible patterns of behaviour
Routines
Rituals
Play
what are the 3 parts of autism
reciprocity
obsessions
language
Autism spectrum disporder (ASD) clinical feutres- which are decreased
decreased: Self-other perspective taking Sharing/ divided attention Flexible learning Social understanding
Autism spectrum disporder (ASD) clinical feutres- which are increased
Rigidity
Sameness
Fixed learning patterns
Technical understanding
Autism spectrum disporder (ASD) clinical feutres- seen in younger/lower IQ
Joint attention/ attention to others
Emotional responses
Movements/ Actions
Autism spectrum disporder (ASD)clinical features- seen in older/higher IQ
Conversation
Empathy
Interests
causes of ASD
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
what proteins are affected in ASD?
Many synaptic proteins are implicated mainly glutaminergic but also GABA.
autism with normal IQ? pathophysiology. on synapses
Only effects on synaptic function and plasticity (e.g. turnover)
autism with LD? pathophysiology. on synapses
Effects on synaptic function, neural migration and brain development
what are the common clinical problems in ASD?
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)
principles of management?
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
ODD and tantrums
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
ADHD and tantrums
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.
what can be cause behind H2M kids (hard 2 manage)
, 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.
treatment for H2M kids?
Parent Training programmes are effective (NICE guidance, 2006)
Multi-Systemic Therapy (MST) attempts to correct all causes.
outcome risks of H2M kids
ntisocial behaviour, substance misuse, long-term mental health problems
