Emotional and Behavioural Flashcards
what is the clinical features of a temper tantrums
frustration, anger and tantrums
hitting and other harmful behaviour
babies/toddler may breath-hold
Mx of a temper tantrums
parental response to tantrums is very important - teach control by example. reward good behaviour
firm handling, no anger, and aggression
avoiding high-risk situations like hunger and tiredness
distraction
once tantrum in full cry, best to ignore until calmed down
time-outs after event
what can aggressive behaviour be called if extreme in psychiatric term
conduct disorder
clinical features of aggressive behaviour
boys > girls, large, active children, and children from larger families
marital discord and aggression in-home, exposure to aggression on TV
emotional disturbance, school failure, brain damage, and overactivity
management of aggressive behavior
parents needs to be consistent, resist from counteracting with aggression
time-out + star charts
dec tension at home
address academic/social problems
if aggression + bullying, the institution of school-based intervention
clinical features of hyperactivity
may not demonstrate hyperactivity in the clinic, so Hx more important than observation - need to involve school here
restless, impulsive + excitable, fails to focus on activity for long
little sense of danger, requires great vigilance
management of hyperactivity
routine + regularity in everday life, firm boundaries, consistency in discipline
teacher support to help with adjustment when starting school
medical management of ADHD
what are some universal management which you can use in almost all behavioural problems?
reinforcement
o Positive reinforcers act as rewards.
o Negative reinforcers act by removal of something unpleasant (e.g. avoidance)
reinforce the reinforcement with CICC –> Clear, Immediate, consistent, contingent
extinction
- withholding reward after inappropriate behaviour
ABC format
- antecedent - what happened before the behavior
- Behaviour - what happened during the behaviour?
- Consequence - what happened afterwards
- choose single behaviour to target (that is most likely to meet wit hsuccess)
- make gaol specific and achievable
Star charts
- positive reinforcers
- useful in bedwetting or tantrums from 4-5 yrs old
only reward behaviour that are controlled by the child
what is the children specific subtype of anxiety?
separation anxiety disorder - SAD
what are some anxiety disorder which can happen in children
GAD panic disorder +/- phobia simple and social phobia PTSD separation anxiety disorder
when is separation anxiety disorder most common?
in very young children, children who is starting school years
what anxiety disorder does middle childhood children experience
phobia
anxiety related abdo pain
what are some differentials for anxiety disorder in children
child abuse
acting out behaviour maybe due to anxiety
• Prominent physical Sx esp without typical anxiety-related onset (e.g. Monday-morning abdo pain), should be investigated.
what is the management of anxiety in children
CBT
SSRI - only short term benefit in children and adolescents
what is attachment?
- Attachment behaviour results in individual attaining/retaining proximity to other differentiated + preferred individual
- Leads to development of affectional bonds initially btw parent and child, and later btw adults.
features of attachment
proximity-seeking to attachemetn figure, esp when threatened
use attachment figure as secure base from which to explore environment
separation form attachment fiague –> separation protest.
Permanent separation –> impaired capacity to feel secure + explore the environment
this beavour seen between 6 and 36 m
what are the different types of attachment
Type A - insecure avoidant
B - secure
C - insecure ambivalent
D - disorganised or unclassifiable
features of Type an insecure-avoidant attachment
• Caregivers fail to respond to distress. Infant explores with little reference to caregiver. Infant learns to suppress emotional distress, little reaction to separations + reunions with caregiver, but physiologically aroused + stressed.
features of Type B secure attachment
• Caregivers respond predictably + sensitively to needs. Infant uses caregiver as secure base from which to explore, distressed when absent, greets positively on return, then continues to explore.
features of Type C secure attachment
• Caregivers respond inconsistently. Infant distressed on separation, difficult to settle + angry on reunion. Infant cannot learn contingencies about situations (e.g. when punished, when comforted), copes by splitting off conflicting emotions.
features of Type D disorgansied attachment
• Often mixture of types A + C. Caregiver often depressed, alcohol-dependent or abusive. The child is afraid of or for the caregiver. A strong predictor of aggression in school and general behavior problems.
why is attachment important
- Securely attached children: more sociable and co-operative at school entry
- Avoidant children: clingy and relatively passive.
- Ambivalent children: isolate themselves + unprovoked outbursts of aggression.
what are the 3 main areas of problem in ADHD?
overactivity
impulsivity
inattention
what are some symptoms of inattentions in ADHD
- Often fails to give close attention to details or makes careless errors in school work, work, or other activities
- Often fails to sustain attention in tasks or play activities
- Often appears not to listen to what is being said to him or her
- Often fails to follow through on instructions or to finish school work, chores, or duties in the workplace (not because of oppositional behaviour or failure to understand instructions)
- Is often impaired in organising tasks and activities
- Often avoids or strongly dislikes tasks, such as homework, that require sustained mental effort
- Often loses things necessary for certain tasks and activities, such as school assignments, pencils, books, toys, or tools
- Is often easily distracted by external stimuli
- Is often forgetful in the course of daily activities.
what are some symptoms of overactivity in ADHD
- Often fidgets with hands or feet or squirms on seat
- Leaves seat in classroom or in other situations in which remaining seated is expected
- Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, only feelings of restlessness may be present)
- Is often unduly noisy in playing or has difficulty in engaging quietly in leisure activities
- Exhibits a persistent pattern of excessive motor activity that is not substantially modified by social context or demands.
what are some symptoms of impulsivity in ADHD
- Often blurts out answers before questions have been completed
- Often fails to wait in lines or await turns in games or group situations
- Often interrupts or intrudes on others (e.g., butts into others’ conversations or games)
- Often talks excessively without appropriate response to social constraints
- Onset of the disorder is no later than the age of 12 years.
management of ADHD
structured tasks + good behavioral strategy.
o Time-out regimes for unacceptable behaviour. School intervention programmes.
meds
• 1st line = methylphenidate (best known brand name is ritalin): CNS stimulant
• 2nd line = amefetamine
• if risk of stimulant abuse +/- prominent anxiety symptoms atomoxetine or guanfacine or clonidine
side effects of methylphenidate
o appetite or nausea.
o Occasionally slowed growth.
o Difficulty sleeping.
o Abdo pains & headaches, often transient.
o Potential for abuse as a recreational drug or overmedication.
what are some predisposing characteristic to completed suicide
psychiatric disorders social isolation physical illness low self-esteem Fhx of abuse/neglect, psychiatric illness and suicide, family dysfunction
management of deliebrate self-harm
• Treat physical effects + arrange mental health assessment.
• Social services
• Treat any co-morbid psych disorders.
• Management options for DSH:
o Address self-esteem issues
o Improve interpersonal skills and address relationship difficulties. Improve communiation skills
o Family work: support and counselling
what is a conduct disorder?
disruptive behavioral disorder - defiance, disobedience, violation of social rules and rights of others
which gender is most affected by conduct disorder
M
RF for conduct disorder
M, lower SE status, peer relationship difficulties, parental mental illness, child maltreatment, neglect, abuse
features of conduct disorder
- Serious aggressive behaviour and rule violation, property damage, theft, arson, truancy, running away.
- Symptoms for at least 6m
management of conduct disorder
- Parental and child education and social therapy groups.
* Impulsive aggression may respond to: 5-HT antagonist or an atypical antipsychotic (e.g. risperidone)
