Children and Adolescent Mental Health Flashcards
What is autism characterised by?
Impairment in social interaction
Impairment in communication
Restrictive stereotyped behaviours and interests
What are the main risk factors for autism?
Male - 4x more likely Prenatal: - Mother >40 - Genetic - chromosome 7 - Sodium valproate use by mother - Viral infections - rubella
Ante-natal:
- Difficult birth - hypoxia
- Low birth weight
- Premature
Postnatal:
- Exposure to toxins - lead, mercury
- Pesticide exposure
What behaviours may be seen in a child with autism?
Rocking and twisting
Upset at routine change
Prefer same foods, toys etc.
Obsessively pursued interests
What communication abnormalities may be seen in a child with autism?
Delayed speech
Echolalia - repeat words
What social aspects may be observed in a child with autism?
Unaware of social rules
No emotional expression
Lack of eye contact
Few gestures - waving/nodding
What conditions are associated with autism?
Epilepsy - 20% chance of developing it Visual impairment Hearing impairment Infections Pica - eating inedible objects Constipation Sleep disorders ADHD, depression, bipolar, anxiety
How common is autism? What is the typical age of onset?
1.1% of the population
Before 3yo
How is autism diagnosed?
Ask parents what things they play with, who they play with, food habits, abnormal movements, development concerns
Do full developmental assessment
Hearing tests
Screening tools - M-CHAT (Modified Checklist for Autism in Toddlers)
How is autism managed?
Bio:
- Treat co-existing disorders
- Antipsychotics if challenging behaviours that isnt othewise solved
- Melatonin - sleep
Psycho:
- Psychoeducation for family
- CBT if child is able and motivated
Social:
- Modify home - light and sound
- Social communication intervention - play based strategies
- Self-help groups
- Special schooling
- Support in life skills
- Support for carers and family
What is asperger’s syndrome?
Abnormalities in social interaction
Restricted stereotyped behaviours
BUT
No impairment to language - may still struggle with tone of voice, sarcasm and facial expressions
Average or above average cognition and IQ
What is ADHD characterised by?
Inattention, Hyperactivity and Impulsivity
+
Early onset, persistent, present in >1 situation
+
More frequent and severe than comparable individuals
How common is ADHD?
2.4% prevalence
What can cause ADHD?
Genetic - DRD4/5 gene
Neurochemical - dopaminergic pathway changes
Neurodevelopmental - pre-frontal cortex abnormalities
Social - Drug/alcohol in parents, social deprivation
How is ADHD diagnosed?
Assessment by CAMHS to observe child, talk to parents and teachers and looking at school reports
DIVA test is used to judge symptoms
To be diagnosed, symptoms must interfere with performance
What inattentive signs are typical of ADHD?
Distracted so doesnt finish tasks Avoid tasks that req. concentration for a long time Doesnt listen Lose and forget belongings Trouble organising tasks
What hyperactivity/impulsive signs are typical of ADHD?
Fidget and restless Doesn't engage in quiet activities Temper tantrums and aggression Doesnt wait their turn Talk lots, interrupt others, blurt out answers at school
How does ADHD present?
Can be a mixture of inattentive and hyperactivity signs
May be predominantly one of the other too
How is ADHD managed pre-school?
Train parents to reinforce good behaviours and manage disruptive behaviours
How is ADHD managed at a school age?
Psychoeducation, CBT and behaviour modification
Drug treatment:
- Methylphenidate (Ritalin)
- Atomoxetine if Ritalin fails
What are the general management principals for ADHD?
Stress importance of balanced diet and exercise
Educate and support parents
Consider family therapy
Address underlying learning difficulties
How are learning disabilities defined?
State of arrested or incomplete development of the mind leading to impairment of skills that are learnt over the developmental period and that contribute to overall intelligence
How can learning disabilities be categorised?
Mild - IQ 50-70
Moderate - IQ 35-49
Severe - IQ 20-34
Profound - IQ <20
How would an individual with a mild learning disability appear?
Adequate language and social skills but academic difficulties, can live independently but may need support
How would a moderate learning disability appear?
Can communicate with limited language
May need supervision with self-care
How would a severe learning disability appear?
Marked motor impairment
Very simple communication
May be associated physical disorders
How would profound learning disabilities appear?
Severe motor impairment and communication difficulties
Struggle with self-care
Most have physical disorders and require residential care
What physical disorders are associated with learning disabilties?
Epilepsy
Hearing and visual impairment
Motor disability
Incontinence
How common are learning disabilities?
2% prevalence
What can cause learning disabilities?
Brain haemorrhage Hypoxia Meningitis/Infection Pre-eclampsia Genetic - Down's, fragile X, Prader-Willi Cerebral Palsy Autism Tuberous Sclerosis Alcohol/caffeine Neglect Nutritional deficiency/galactossaemia
What is important to consider when managing patients with learning disabilites?
40% have co-existing mental health problem
Genetic issues - children/parents
More life stressors - inc. way viewed by society
Poor access to services
How are patients with learning disabilities managed?
CBT Psychodynamic therapy Family therapy Special schooling Anti-psychotics may be needed if challenging behaviour
What is a conduct disorder?
Severe pattern of antisocial behaviour:
- Aggression towards people and animals
- Property destruction
- Stealing
- Rule violation - skipping school, running away
What may place a child at increased risk of conduct disorder?
Male
Abuse
Poor socio-economic status
Parental psychiatric disorders
What are emotional disorders?
Mental disorder in which a persons personality is taken over by their emotional thinking
Purely psychological (no biological cause)
What can cause emotional disorders?
Abuse
Exposure to pre-natal drugs
Poverty
What may children with emotional disorders have?
Conduct disorder
Affective disorders - depression and bipolar common
Personality disorders
Anxiety disorders - most common emotional disorder
ADHD
Oppositional defiant disorder - lose temper and argue a lot
