Child/Youth Mental Health Flashcards
What is social and emotional wellbeing?
- a resource for living and learning
- enables resilience in the face of adversity
- essential for all children to flourish + meet potential
- Crucial for human development across domains, stages, relationships
What are the domains of Child Development
- Physical (genetic/biological)
- Cognitive (intellectual/language)
- Emotional (feelings/regulation)
- Social (Behaviour/Relationships)
- Spiritual (Ethics/Constructive engagement)
What are the stages of Child Development
Preconception -> birth
Infancy -> Birth though 12 months
Early childhood -> 1-6 years
Middle childhood -> 7-12 years
Adolescence -> 13-18 years
adulthood - 19 years and beyond
What are the levels of child development in relationships
child.. family… community… culture… environment
What are basic children’s needs
- safety, security, stability, healthy living conditions
- warm and authoritative parenting
- good nutrition and opportunities for physical activity
- developmentally appropriate learning experiences
- access to effective public health and health=social services
- ability to play and be creative
- culture, language, constructive resilient communities
What does good child emotional and social well being entail?
- capacity to manage feelings/behaviour
- ability to engage in positive relationships
ability to be creative - sense of purpose/hopefulness
- connection to culture, language, identity
- ability to make contributions to larger community
- strengths and resilience in face of adversity
what percentage of children with mental disorders received any service for these conditions
only 44.2%
What is the impact of childhood mental disorders
- profound adverse individual consequences (distress, social exclusion, costs, to adulthood -> under education, underemployment, poor physical health, increased mortality)
- Profound adverse collective consequences
What are some examples of childhood adversities that contribute to behaviour problems, anxiety, depression, and problematic substance use?
- racism + colonialism
- Family socioeconomic disadvantage
- Child maltreatment
How do things ‘get under the skin’
influences
- developing brain architecture
- physiological stress response systems
- emotional dysreguation
- epigenetic changes
What should we be doing for all children
- address determinants and avoidable childhood adversities
- Address service shortfalls
- add further services as needed
What should we be doing for children with mental health risks or symptoms?
- offer effective prevention programs
What should we be doing for all children with more severe symptoms or disorders?
Offer effective treatment services
What does adopting a life course perspective mean?
- identify key opportunities for minimizing risk factors
- enhance protective factors
- through evidence based interventions at key life stages
- from preconception - early years - adolescence - working age - older age
What are the measure outcomes?
All children - promote healthy development
All Children at Risk - prevent disorders
All Children with Disorders - provide treatment
How does Canada’s health spending look like?
- most towards older Canadians 65+
- 6% for public health including prevention
- preventing just one case of a severe childhood problem saves a lot
- prevention program can yield money
What is epidemiology?
*cornerstone of public health and healthcare
- shapes policy and practise by identifying risks, strengths
- targets for prevention and treatment
What do prevalence and incidence need and what do they do?
- need reliable and valid measures
- accurate estimates in general population of interest over time + across places
How does mis-diagnosis have severe consequences
- over diagnosis = unneeded treatment, labelling, stigma
- under-diagnosis = children do not get treatment they need
What are some examples of diagnostic controversies?
- altered autism definitions = fears of reduced service access
- transgender as a diagnosis now gender dysphoria
What are challenges in measuring children’s mental health?
- Dynamic - dynamic nature of human development, measures must change as development unfolds
- Relational - Children highly dependent, must consider family, school, community
- Definitions and measures - not agreed upon, information differs by informant source
What is risk
correlate
what is a risk factor
correlate that PRECEDES outcome of interest
what is a causal risk factor
when changed, changes outcome
What are mediators/moderators?
Intermediate/proxy influences
What is a big risk factor for multiple disorders found in prospective studies
Family adversity
What are the integrated models of child development
- consider both biological/genetic and social/environmental aspects
- life experiences
- genes and environment over time
- individual variation
How do children thrive despite adversity
- protective factors
- resilience now defined as a developmental process - ABILITY TO THRIVE DESPITE SIGNIFICANT ADVERSITIES
What are the implications for intervention
- ensure children’s basic needs are met
- Promoting mental wellness / give families and children skills to cope
What are children’s basic needs
- safety, stability, supports
- warm and authoritative parenting
- positive adult, peer, community relationshipts
- successful school - work - community experiences
- inclusion
- recreational opportunities
- opportunities for meaningful engagement
- ensuring availability of effective services
What is primary prevention
reducing incidence
What is secondary prevention
Reducing reocurrences or exacerbations of existing cases
What are tertiary prevention
reducing duration or degree of disability
What kind of prevention is the goal in children’s mental health?
primary prevention
What is the best way to evaluate interventions
Randomized control trials
- positive benefits according to two or more RCT’s evaluating outcomes in children
- for psychosocial - follow up of 3 months or more
- for meds, blinding + placebo controls
What is separation anxiety
fear of leaving primary caregivers (younger children)
What is involved with CBT for childhood anxiety?
- learn about fear
- learn to relax
- Learn to fight your fear
- fight your fear
How are we preventing suicide
- make sure children’s needs met
- prevent and treat depression (CBT)
- prevent and treat problematic substance use
- prevent suicide
What is oppositional defiant disorder
- pattern of angry or argumentative behaviour involving 4+ symptoms over 6+months
- loses temper a lot
- easily annoyed, angry, resentful
- actively defies or refuses requests or breaks rules
- deliberately annoys others
- blames others
What is conduct disorder
- repetitive and persistent pattern of severe antisocial behaviour involving 3+ symptoms over 12+ months
- being aggressive to people or animals
- destroying property, setting fires
- deceiving people or stealing
- violating serious rules
How to prevent behaviour disorders
- make sure children’s needs are met
- give families and children skills to cope
- Parent Training
- multicomponent programs including behaviour therapy, enriched school curricula…
- meds - serious side effects
How to prevent childhood substance misuse
- make sure children’s needs are met
- control availability and ensure positive role models
- give families and children skills to cope
- multicomponent programs..
What is preventure
- prevention program for high risk adolescents
- target 4 personality risk factors
1. hopelessness
2. anxiety sensitivity
3. impulsivity
4. sensation seeking
What is Childhood ADHD
- problems with attention or hyperactivity can be common but problematic if severe and persistent
- 6+ symptoms across 2+ settings
- inconsistent with developmental level, several symptoms before 12
How to prevent childhood ADHD
- make sure children’s basic needs are met
- give families and children skills to cope
-psychosocial treatment (parent training, multicomponent interventions) - medication
What is childhood autism
- many children have difficulties with social communication and interactions, but autism involves severe and persistent problems across multiple contexts
- not simply due to intellectual disability
How to treat childhood autism
- better prognosis if identified and treated early
- psychosocial treatment
- treatment helps/mitigates, but usually a chronic condition
- intensive family supports are crucial
What is childhood OCD
- any child can have temporary recurrent thoughts or rituals, but OCD involves severe + persistent problems
- obsessions… repeated attempts to ignore or suppress (ex:
- compulsions
- consume over 1 hour a day
How to treat childhood OCD
- psychosocial treatment
- medications
-family supports + education = crucial
What are childhood eating disorders?
- many children have phases of fussy eating, but disorders involve severe and persistent problems
- anorexia
- bulimia
- binge eating
- avoidant/restrictive food intake disorder
How to address childhood eating disorders?
- prevention (multicomponent interventions)
- psychosocial treatment (family therapy, hospitalization to stabilize those who are very ill)
What is psychosis?
delusions or hallucinations interfering with ability to connect with reality + care for oneself
What is Childhood BP
- manic episodes often preceded by or interspersed with hypomanic and or major depressive episodes
- psychosis may develop = hospitalization
- diagnosis highly controversial in younger children
What is childhood schizophrenia?
- 2+ psychotic and/or negative symptoms over 4+ weeks
- continuously impaired functioning over 6+ months
- often ‘prodromal’ symptoms in young people (transient perceptual disturbances, social withdrawal, reduced school performance)
How to address childhood BP
- psychosocial treatment
- medications (serious side effects)
- intensive child + family supports are crucial
How to address childhood schizophrenia
- medications (serious side effects)
- intensive child + family supports are crucial
What are examples of diverse developmental abilities and causes
- intellectual disability (genetic and environment?)
- fetal alcohol spectrum disorder (prenatal alcohol exposure)
Why has overall prevalence of neurodevelopment disorders increased 15% in 10 years
“counting”
- greatest increases in wealthier groups (but still 1.5 times in disadvantaged)
- diagnostic changes, reduced stigma, demand services
Neurodiversity can be defined as
- a range of difference between how people’s brains may function and how they might behave as a result
what causes autism
no single cause
what can cure autism
nothing, no cure
What are the 3 most common mental disorders in childhood
Anxiety, ADHD, Oppositional defiant disorder
What conditions typically start before age 6
autism, ADHD, Oppositional defiant disorder
What was the global impact of COVID on children
- extreme poverty
- at risk of vaccine preventable illnesses
- more child deaths
- more child marriages
- school closure
- isolation and quarantine
How was COVID transmission like
adult -> child -> in homes + community
children not a primary driver
How did covid change children’s mental health
- certain mental disorders increased (anxiety, PTSD, depression, behaviour problems)
- worse outcomes associated with injury, bereavement, witnessing injury or death, prior adverse experiences, fewer supports
How did COVID change children’s physical wellbeing
- less active = less sports
- eating less healthy foods + eating more
- spending more time on screens
What did COVID fuel
- social disparities
- racism
What were the cumulative adversities during covid
- socioeconomic disadvantage
- pre-existing conditions
- racism
- being a child
how to help kids cope with covid
- adults as role models
- adults talk things through + remain calm
How does keeping schools open help?
- reduce social inequities
- practice prevention in schools to reduce risk
- control community transmission
What was childhood previously not recognized as?
- quantitatively different from adulthood
- a developmentally “vulnerable” period
What was the basic protections for children in the early 1900s in Europe and North America?
- restrictions on child labour
- mandatory public schooling for all children
- child protection laws governing responses to maltreatment
- criminal codes directing different treatment of young people
What are 3 competing ideas about childhood
- Children as “chattel”
- Children as “equals”
- Children as “vulnerable”
What is the idea of children as chattel and it’s critiques
- children’s role to contribute to family + community survival
- children ‘belong’ to parents/families
- parents have rights on treatment… = socioeconomic duress may be used as a justification (for child labour)
What is the idea of children as equals and its critiques?
- children are responsible (for their behaviour)
- can be difficult to recognize children’s differing developmental capacities
- children are dependent, lack real power = PSEUDO-EQUALITY
What is the idea of children as vulnerable and critiques?
- adult role = provide, protect, nurture
- children have limited responsibilities according to developmental stages
- protection can be patronizing
- some concerned there is a risk of children failing to have consequences
What is the UN convention on the rights of the child and when made
1989
- all children have rights
- to safety and nurturing
- to opportunities to thrice
- protect from discrimination
- protections from forced labour, child marriage, deprivation of legal identity
- grants right to health care, education, freedom of expression
- parental leave
What was added on general comment no. 26 to children’s rights
addresses climate emergency, collapse of biodiversity and pervasive pollution
What is child maltreatment
any oct of commission or omission by a parent or caregiver that results in harm, potential for harm or threat of harm to a child
- harm may not be intended
- caregivers can include temporary custodial roles
What is the estimate of children that have experienced psychical, sexual, or emotional violence or neglect in past year
up to 1 billion
- experiencing violence in childhood impacts lifelong health and well being
- evidence shows that violence against children can be prevented
What is the primary category of child maltreatment
- Exposure to intimate partner violence
What are the associations of child maltreatment
- depression
- anxiety
- PTSD
- behaviour problems
- substance misuse
Which international agreement protects children’s rights
United Nations convention on the rights of the child
Children’s rights apply to everyone who is aged
under 18 years old
What are the 4 I’s influencing policymaking?
individuals
institutions
ideas
interests (implicit or explicit)
What are the levels of institution
- legislative (decisions for populations)
- administrative (decisions for populations)
- Clinical / practise (service/care for individuals)
What do federal government roles do
- provide transfer payments to provinces for health and social programs
- oversee
- administer
- lead special initiatives
What do provincial/territorial roles do?
- deliver health + social programs
- oversee child protection + education legislation
- lead special initiatives
- provide transfer payments to municipalities
What do regional health authority roles do
deliver primary, secondary, and tertiary healthcare programs
What do school district roles do
deliver primary and secondary education programs
What do municipal roles do
deliver selected programs
What do indigenous government roles do
- deliver wide range of health and social programs
- ensure cultural continuity and integrity
What do practitioners do
work within organizational frameworks
What do news media do?
- play vital role as public ‘watchdogs’ in democracies
- raise public awareness = influence public policy agenda setting
- determine what policy makers + public think about , but not necessarily what to think
What do courts and human rights tribunals do
- provide checks + balances on policy
- rule on fairness, legality/constitutionality
- provide a vehicle for challenges by citizens
What are aspects of interest?
- politicians = represent diverse interests…respond to emerging problems
- civil servants = diver best advice to politicians while considering public opinion
- both = represent own interests…
What do practitioners advocate
patients interests
what do families advocate
child’s interest
What do coalitions and think tanks advocate
specific issues
What do businesses advocate
advocate for shareholders..
What are conflicts about ideas
conflicts persist about what we OUGHT to do
What do individuals do
exert powerful influence
- create, inhabit, transform, maintain institutions
- develop and align various interests
- create and market ideas
What is policy
what is -> what OUGHT to be?
What are policy windows of opportunity
- policy making proceeds iteratively
What are policy options for progress
doing forward on the path
- constructive change, opposing destructive change
- finding stability, while doing important work
- choosing hope
- taking leadership
