Externalising CAMH Disorders (ADHD, ODD, Conduct D/O) Flashcards
What are the classic symptoms of ADHD?
- Hyperactivity
- Impulsivity
- Inattention
What are the subtypes of ADHD?
- Hyperactive / impulsive
- Inattentive (may be harder to pick)
- Combined: both aspects simultaneously
MSE features of ADHD?
- Disinhibited
- Fidgeting
What is the role of medications in adolescent patients with MH disorders?
Aid and facilitate learning by increasing resilience factors
what are the principles of managing an adolescent with a MH disorder?
- Major focus on small wins
- Build competencies
- Don’t make sweeping changes quickly
- Emphasise decreasing stress in family unit
Drugs Mx ADHD?
- Stimulant medication
- Atomexetine
- Clonidine / Imipramine / Risperidone
What are the major principles which must be considered in ADHD pharmacotherapy?
- Clear goals for medication treatment
- AEx monitoring plan
- Crisis plan
- Clear review plan
- Plan for duration of Rx before trial withdrawal
Psychosocial strategies for management of ADHD?
- Time management strategies
- Behavioural strategies
- Environmental manipulation (sit close to teacher, away from distractions)
- Limit group work
What are the behavioural strategies in ADHD management?
- Clear rules and immediate consequences
- Academic targets and behavioural goals
- Reward pro social behaviours immediately
Strategies to improve working memory in ADHD?
Teach:
- ability to ask for help
- chunking
- rehearsal
- rote learning
- generate mental images of information
- frequent breaks
- realistic targets for work period
Environmental changes in ADHD Mx?
- Look for warning signs of memory overload
- Quiet working area / minimise distractions
- Gain attention before giving instructions
- Use short sentences / simple grammatical forms
- One task at a time
- Guide through tasks using prompts
- Visual aids where psosible
What are the child interventions for ODD?
- Cycle of change / motivational interviewing
- CBT
- Social skills
- Managing anger (recognising / self control)
- Changing self narrative
- Perspective taking / victim empathy
CBT strategies for ODD Mx?
- Self talk
- Relaxation techniques
- Problem solving
Social skills to develop for ODD Mx?
- making friends,
- assertiveness,
- communication skills
- accepting no
What characterises the hyperactive / impulsive subtype of ADHD?
Inability to sit still or inhibit behaviour
Symptoms of hyperactivity / impulsivity?
- Excessive fidgitiness
- Difficulty remaining seated
- Feelings of restlessness/ inappropriate running or climbing
Pattern of hyperactive symptoms throughout the lifespan?
Hyperactive:
- Observed by 4y
- peak 7-8y
- Decline by adolescence (may seem normal)
Pattern of impulsive symptoms throughout the lifespan?
Impulsive: persist throughout life
What determines the focus of impulsivity?
Environments e.g. ADHD teens in environment with EtOH/drugs available more likely to engage
What characterises the inattentive subtype of ADHD?
Reduced ability to focus attention and reduced speed of cognitive processing and responding: sluggish / day dreaming / off task
When do symptoms of inattention typically become apparent?
8-9yo. Usually lifelong
What must occur for core symptoms to meet ADHD criteria?
Must impair academic, social or occupational function
What should be discussed in ADHD consultations?
Safety: greater risk of intentional and unintentional injury
What are the clinical features of conduct disorder?
- Aggression to people and animals
- Destruction of property
- Deceitfulness or theft
- Serious violations of rules
