Emotional and Behavioural

Question 1

what is the clinical features of a temper tantrums

Answer 1

frustration, anger and tantrums
hitting and other harmful behaviour
babies/toddler may breath-hold

Question 2

Mx of a temper tantrums

Answer 2

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

Question 3

what can aggressive behaviour be called if extreme in psychiatric term

Answer 3

conduct disorder

Question 4

clinical features of aggressive behaviour

Answer 4

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

Question 5

management of aggressive behavior

Answer 5

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

Question 6

clinical features of hyperactivity

Answer 6

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

Question 7

management of hyperactivity

Answer 7

routine + regularity in everday life, firm boundaries, consistency in discipline

teacher support to help with adjustment when starting school

medical management of ADHD

Question 8

what are some universal management which you can use in almost all behavioural problems?

Answer 8

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

Question 9

what is the children specific subtype of anxiety?

Answer 9

separation anxiety disorder - SAD

Question 10

what are some anxiety disorder which can happen in children

Answer 10

GAD
panic disorder +/- phobia 
simple and social phobia 
PTSD 
separation anxiety disorder

Question 11

when is separation anxiety disorder most common?

Answer 11

in very young children, children who is starting school years

Question 12

what anxiety disorder does middle childhood children experience

Answer 12

phobia

anxiety related abdo pain

Question 13

what are some differentials for anxiety disorder in children

Answer 13

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.

Question 14

what is the management of anxiety in children

Answer 14

CBT

SSRI - only short term benefit in children and adolescents

Question 15

what is attachment?

Answer 15

• 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.

Question 16

features of attachment

Answer 16

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

Question 17

what are the different types of attachment

Answer 17

Type A - insecure avoidant
B - secure
C - insecure ambivalent
D - disorganised or unclassifiable

Question 18

features of Type an insecure-avoidant attachment

Answer 18

• 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.

Question 19

features of Type B secure attachment

Answer 19

• 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.

Question 20

features of Type C secure attachment

Answer 20

• 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.

Question 21

features of Type D disorgansied attachment

Answer 21

• 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.

Question 22

why is attachment important

Answer 22

• 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.

Question 23

what are the 3 main areas of problem in ADHD?

Answer 23

overactivity
impulsivity
inattention

Question 24

what are some symptoms of inattentions in ADHD

Answer 24

1. Often fails to give close attention to details or makes careless errors in school work, work, or other activities
2. Often fails to sustain attention in tasks or play activities
3. Often appears not to listen to what is being said to him or her
4. 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)
5. Is often impaired in organising tasks and activities
6. Often avoids or strongly dislikes tasks, such as homework, that require sustained mental effort
7. Often loses things necessary for certain tasks and activities, such as school assignments, pencils, books, toys, or tools
8. Is often easily distracted by external stimuli
9. Is often forgetful in the course of daily activities.

Question 25

what are some symptoms of overactivity in ADHD

Answer 25

• 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.

Question 26

what are some symptoms of impulsivity in ADHD

Answer 26

• 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.

Question 27

management of ADHD

Answer 27

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

Question 28

side effects of methylphenidate

Answer 28

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.

Question 29

what are some predisposing characteristic to completed suicide

Answer 29

psychiatric disorders 
social isolation 
physical illness
 low self-esteem 
Fhx of abuse/neglect, psychiatric illness and suicide, family dysfunction

Question 30

management of deliebrate self-harm

Answer 30

• 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

Question 31

what is a conduct disorder?

Answer 31

disruptive behavioral disorder - defiance, disobedience, violation of social rules and rights of others

Question 32

which gender is most affected by conduct disorder

Answer 32

M

Question 33

RF for conduct disorder

Answer 33

M, lower SE status, peer relationship difficulties, parental mental illness, child maltreatment, neglect, abuse

Question 34

features of conduct disorder

Answer 34

• Serious aggressive behaviour and rule violation, property damage, theft, arson, truancy, running away.
• Symptoms for at least 6m

Question 35

management of conduct disorder

Answer 35

• Parental and child education and social therapy groups.

* Impulsive aggression may respond to: 5-HT antagonist or an atypical antipsychotic (e.g. risperidone)