Lecture 17 Infant, Child and adolescent mental health

Question 1

Infant health in relation to the model of development being dynamic and interactive?

Answer 1

social emotional and environmental:
children need to have 1 Primary relationship with their PARENTS, as from this INTERACTION they begin to understand that they’re an INDIVIDUAL WHO MATTERS and learn to REGULATE THEIR BEHAVIOURS
w/o they don’t think of themselves as useful beings and DONT feel as if their behaviour matters

Question 2

What is Mental Health/Wellbeing?

Answer 2

POSITIVE
positive concept that is more about the ABSENCE of mental illness:
refers to RESILIENCE and good functioning, but also incorporates FLOURISHING, HAPPINESS and getting the MOST OUT OF LIFE
-resilience (how well you face adversity)
(good mental health = ability to form good relationships- allowing to explore environ and learn)

Question 3

What is Mental Illness?

Answer 3

more CRITERIA based
a DIAGNOSED clinical condition:
common disorders include depression, anxiety, psychosis, substance abuse, eating disorders
-Criteria= have to fulfil a group of symptoms which make to give a diagnosis
-people can have a mental illness and still live a productive life

Question 4

What is infant mental health?

Answer 4

DEVELOPING CAPACITY of child in first 3 years of age to experience, regulate and express emotions; form close and secure INTERPERSONAL RELATIONSHIPS and EXPLORE THE ENVIRONMENT and LEARN- all in the CONTEXT OF FAMILY, community and CULTURAL expectations for your children

• CONTEXT OF FAMILY is the Most Important interaction
• day to day
• relationships and where you sit in those

Question 5

What are some infant mental health problems?

Answer 5

some IMH:
1. Genetic or via Perinatal trauma (LBW, chromosomal disorder, prenatal exposure to stress/alcohol/drugs)
2. Environmental (toxic) (domestic violence, poverty, drug abuse, parent mental illness)
-POVERTY is the biggest indicator of IMH, due to Not having the Resources to get help (unsatisfactory environments)
-often it is a combination of Perinatal AND Environmental risk factors
-Co-morbid experience
-Large problem worldwide
the YOUNGER the child, the MORE AT RISK they are to DEATH BY MALTREATMENT
(under 1 year –3x–> 1-4 years —2x–> 5-14 years)
-minority populations higher (Higher Poverty and Other Social Problems)

Question 6

What is the equation which results in “Poor outcomes for children”?

Answer 6

Substance abuse
+
Psychopathology(mental health)
-co-morbid experience

Question 7

What does Co-mobrid mean?

Answer 7

combination of 2x diagnosis

1st. Mental Health (psycopathology)
2nd. Substance abuse (self medicate. substance abuse often related to diagnostic category(meth parent, greater chance of having mental psychosis))

Question 8

What is Autistic Spectrum disorder?

Answer 8

common GENETIC IMH problem
1/150 –> 1/60
poor social and emotional development
delayed or lack of language development (delay in social and emotional development)
global delay
No Theory of mind (can’t see from someone else’s perspective)(girl at window, thinking about doll’s thoughts (in someone else’s mind), No TOM wouldn’t know what she is thinking)) also problems READING FACIAL EXPRESSION
REPETITIVE stereotypical behaviours - spinning, lining up toys (categorising obsession), INFLEXIBILITY (one task to another -cant go to zoo because is raining)

Question 9

What are common IMH behavioural problems?

Answer 9

1. Disorganised attachment (no secure attachment with caregiver)
2. Disinhibition (executive functions in frontal cortex, to plant and attend to things and inhibit bad behaviour)
3. Early regulatory problems (change eating, sleeping, toileting (bed wetting or constipation)

Question 10

How do you test an adult for inhibition?

Answer 10

Stoop effect
meant to say the COLOUR of the word, not the word itself
Prepotent response

Question 11

How would you test a child for inhibition?

Answer 11

Snack delay video
-cant eat until bell rings
younger the child = shorter time they can go without

Question 12

What is ADHD?

Answer 12

common IMH and ECH problem
Attention deficit-Hyperactive disorder
girls increased
problems for over 6 months prior to age 7
sometimes OVER diagnosed and OVER prescribed
often associated with Oppositional disorder + Learning difficulties
50-70% of children ADHD will have problems as adult

Question 13

What is the ACE study?

Answer 13

linear relationship between the number of adult health outcomes and ACE
-4 or more ACE vs people with No ACE

Question 14

What mental health longitudinal study was conducted in NZ?

Answer 14

Tech and dunedin multidisciplinary health and development study

• problems associated with EARLY adverse environments associated with later:
• crime, arrest and imprisonment
• mental health problems
• suicidal thoughts
• teen pregnancy
• impaired parenting
• poor physical health and dental health

Question 15

What are common childhood MH problems?

Answer 15

10% of population
profoundly affecting LATER problem behaviour
characteristic conduct problems:
1. aggressive behaviour
2. dishonest, delinquent, decienta, disruptive
causes distress to child, family and peers
impacts criminal justice system and general society

Question 16

What is depression of adolescence like?

Answer 16

Serios, common, often unrecognised and untreated
-Most expensive illnesses next to heat disease stroke etc
-2nd biggest global non-communicable disease burden
-leading risk factor for suicide
-NZ has 2nd highest suicide rate in OECD
-linked to Teen pregnancy, failing school, substance abuse
girls 2x more likely
15-18 yrs start (where we need to intervene)
1/2 experiences by 18
High risk groups are Maori and LGBTI (lesbian gan bisexual transgender intersex)
-LARGELY UNTREATED (75%) - poorly recognised, stigma associated, reluctance/not knowing where/how to get help, expensive to train clincians)
-effective treatments SSRIS antidepressants / psychological therapy - but has limited access

Question 17

What are the 4x characteristics of adolescent depression?

Answer 17

1. FEELINGS: sadness/IRRITABILITY, miserable, worried, mood swings
2. PHYSICAL: constantly tired, disturbed sleep, aches and upset stomach
3. BEHAVIOUR: little interest of previous things, school grades change, social withdrawal and frequent crying
4. THOUGHTS OF DEATH OR SUICIDE common

Question 18

What is the difference between “the views” and depression?

Answer 18

short period vs long term case
more than two weeks
interferes with daily activities
significant impact on functioning
-needs to still be DIAGNOSED by a health professional

Question 19

What is CBT?

Answer 19

Cognitive Behavioural treatment
evidence based psychological therapy for depression and anxiety
PRACTICAL “here and now” approach which is “skill based”
1. Activity scheduling (do things to improve mood)
2. Problem solving (active trouble shooting rather than passively experiencing distress)
3. Relaxation (can’t be anxious at same time)
4. Cognitive restructuring (change thoughts to a more helpful and balanced way of thinking)
5. Exposure (facing fears while remaining calm and relaxed)
6. Accessing help (recognise symptoms AND when you need it)

Question 20

What is the relationship between anxiety and childhood and adolescent?

Answer 20

ANXIETY
one of the most common psychological disorders in childhood (1/8)
chronic and fluctuating often
impacts social, academic, and family functioning
-Majority have little or no contact with mental health services

Question 21

What are the key characteristics of anxiety?

Answer 21

generally marked by PSYCHOLOGICAL AROUSAL, feeling of TENSION, and INTENSE APPREHENSION …. WITHOUT AND APPARENT REASON
(ongoing and w/o reason)
1. Feelings: excessive fear and worries, inner restless, unable to relax and concentrate
2. Physical: muscle tension, cramps, stomach/headaches, sweat, hyperventilation, fatigue, startled easily
3. Behavioural: excessively WARY and VIGILANT, uneasy or dependant (OVERLY RESTRAINED OR EMOTIONAL)

Question 22

What two things are commonly co-mrobid?

Answer 22

DEPRESSION and ANXIETY
comorbidity- presence of one or more additional disorders (diseases) occurring with a PRIMARY disease or disorder
-depression and anxiety can often be treated same way, the same time
-around 1/2 of depressed people are also diagnosed with an anxiety disorder

Question 23

What ar the common risk factors for depression and anxiety?

Answer 23

multiple factors
all interacts
dependant on individual circumstances
(nature vs nurture)
1. genetics (family history)
2. parenting style (parents own mental health problems)
3. 2x more common in females
4. Life events and environmental adversity (e.g. POVERTY, isolation, discrimination, family violence)
5. SCHOOL difficulties - bullying, peer rejection
6. the CHILDS NEGATIVE thinking style

Question 24

What is the best treatment for depression and anxiety?

Answer 24

PREVENTION is best
EARLY INTERVENTION
-being aware, accept mental illness and indifferent to other chronic physical illnesses
adress INEQUALITIES
GOOD TREATMENTS which are available need to be IDENTIFIED
FUNDING for infant, child and adolescent is REPRESENTATIVE/proportionate
-teaches, friends health professionals, help lines, good websites

Question 25

What are 4x examples of Online Mental health resources?

Answer 25

1. SPARX -UoA and funded by MOH - CBT for 12-18, youth friendly “gameified”
2. BRAVE - anxiety, aussie, parent and child component
3. LOWDOWN = Sir John Kirwan - adults and children
4. COMMON GROUND - family and whanau