Child psychiatry: school + early development Flashcards
Mental health problems associated with being out of school (5)
- Anxiety
- Conduct disorder
- Autism
- Depression
- Obsessional compulsive disorder
What are 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 are the 3 A’s in terms of features of anxiety
- Anxious thoughts and feelings (e.g impending doom)
- Autonomic symptoms
- Avoidant behaviour
What things might make a child not to go to school?
- Learning difficulties
- Bullying
- Lack of friends and relationships
- Lack of parental attention or concern (e.g lack of interest in child’s education
- Encouraging one to stay at home (maternal depression - separation anxiety)
What is important in regards to assessment and management of school-aged children with anxiety symptoms?
Contain their anxiety and return to school as soon as possible
Look
Amygdala activity is supressed by right ventrolateral cortex when labelling emotions. The Ventrolateral prefrontal cortex is associated with response inhibition and goal-appropriate response selection.
There is reduced connectivity between right ventrolateral cortex and amygdala in generalised anxiety disorders in adolescents meaning that those with GAD cannot differentiate between perceived and real threat and cannot label their emotions.
Treatment of anxiety in kids?
Behavioural = first line
- Learning alternative patterns of behaviour
- Desensitisation
- Overcoming fear
- Managing feelings
Medication - only given if child is not responding to behavioural therapy.
- SSRIs such as fluoxetine
CBT with children & families
- Don’t expect children to have cognitive awareness - Mostly B & T
- Parents as collaborators in the team
- Step-wise approach/progression: the ladder to success
- Externalisation: disorder is not a matter of blame so take blame, guilt or anger out of the equation
- Overcoming barriers to change: problem solving
- Psychoeducation – explaining the problem in terms that make sense to everyone.
- Goal-setting – choosing reasonable objectives that can be achieved.
- Motivating: getting buy-in so the goals can be achieved.
What is a ‘narrative approach’?
Uses things like drawing, play, expressive arts etc to learn about how the child is feeling or to explain ideas/concepts to the child.
- For example, the child may start to draw more alarming etc drawings that give you an insight into what they are thinking / their fears etc
How is Autism defined?
A neurodevelopmental disorder, defined as a syndrome of persistent, pervasive and distinctive behavioural abnormalities.
- Pervasive: present across the life span (onset <3yrs) and across settings (a feature of brain development and function)
- It is highly heritable
- Often associated with a low IQ but not defined by a low IQ
What are some distinctive features of Autism?
Socially - they have difficulties in:
- Reciprocal conversation
- Expressing emotional concern
- Non-verbal comunication
- Declarative pointing
- Modulated eye-contact
- Other gestures
- Facial expression
Also show repetitive behaviour:
- Mannerisms and stereotypes
- Obsessions, preoccupations and interests
- Rigid and inflexible patterns of behaviour
- Routines
- Rituals
- Play
3 key features of autism
Problems with:
- Reciprocity
- Language
- Obsessions
Causes of Autism
- Genetics
- 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
- Alterations in Glutamate and GABA are linked to autism
- Epigenetics
What is the spectrum of autism dependent on? What is at each end of the spectrum?
The spectrum of autism is dependent on the severity of neurotransmitter dysfunction
- Lower end of spectrum = Autism with a normal IQ - Only effects on synaptic function and plasticity (e.g. turnover)
OR
- Severe end of spectrum = Autism with a LD - Effects on synaptic function, neural migration and brain development
Common Clinical problems in ASD
- Learning disability - mild to severe
- Disturbed sleep and eating habits
- Hyperactivity
- High levels of anxiety and depression - risk is higher, flattness of affect which comes with autism also comes with depression (difficult to detect) - if their parents say they have anhedonia then it looks more like depression
- Autism brain is more sensitive to medication
- OCD
- School avoidance
- Aggression
- Temper tantrums
- Self-injury, self-harm
- Suicidal behaviour (6x)
