Module 12 - Child and adolesence Mental Health Issues Flashcards
Most children with anxiety disorders have a history of anxious temperament in infancy or early childhood, this temperament is described as…
Behavioural inhibition - characterized by a profound avoidance of others in preschool and atypical autonomic nervous system responses (display withdrawal or fear behaviour) to novelty.
Childhood anxiety has a heritable component
38% of children with parents with anxiety disorders also had an anxiety disorder.
It is important to bear in mind that this type of familial clustering can also be explained by shared environment
How are autism spectrum disorders diagnosed?
-Assessments should be carried out in a multidisciplinary team; psychologist, occupational therapist, teacher, psychiatrist, speech and language specialist.
-Audiological and neurological assessments
-ADOS-2 - standardized observational measure
-ADI-R: structured interview 90 minutes
DSM-5-TR Criteria:
A. Persistent deficits in social communication and social interaction across multiple contexts
- Deficits in social-emotional reciprocity
- Deficits in non-verbal communicative behaviours
- Deficits in developing, maintaining and understanding relationships
B. Restrictive, repetitive patterns of behaviour, interests or activities as manifested by at least 2 of the following:
- stereotyped or repetitive motor movements, use of objects or speech
- Deficits in nonverbal communicative behaviours used for social interaction (abnormalities in eye contact, body language or deficits in understanding or use of gestures, lack of facial expressions
- Highly restrictive, fixated interests that are abnormal in intensity or focus
- Hyper or hypoactive to sensory input
C. Symptoms must be present in the early developmental period
ASD Prevelance
Canadian estimates is 1-3 per 1000 live births
U.S estimated 1 in 68 children (similar rates around the world)
Higher estimates of 1 in 150 births may reflect changes in the diagnostic criteria that include a broader ranges of disorders in the spectrum and use different measures, and increasing awareness in the general public.
3-4x more often in males than females.
Sex difference appears to occur among people with higher IQ’s
1/3 of individuals with Autism do not speak
up to 1/2 exhibit significant psychiatric and/or behavioural problems including depression, anxiety and aggression
Epilepsy and sensory impairments are also common
Strongest predictors of functional outcome has been found to be the development of functional speech by age 5
What etiological factors for ASD are supported by research?
Research has shifted from psychogenic to biological
Genetic factors are now thought to play a dominant role in development:
- high frequency of autism among family members
- frequent occurance of Autism features in ppl with fragile X syndrome, PKU, tuberous sclerosis
- evidence that the phenotype extends beyond autism
What treatment factors for ASD are supported by research?
Medication:
-No medications have been developed specifically
-Risperidol (age 5+) and Ablify (age 6+) are the only FDA approved medications to treat irritability in Autism
-Emerging evidence that oxytocin may address social symptoms of autism
-Dopamine receptor antagonists are effective in reducing challenging behaviours
-Stimulants such as ritalin and clonadine may reduce distractibility and hyperactivity
-Naltrexone has shown some benefit in reducing hyperactivity
Behavioural Intervention:
-highlight tantrums, aggression, stereotypy and self-injurious behaviours
-focus on stimulus and instruction based
-evidence is strong for effectiveness of positive and proactive interventions with reduction in challenging behaviours in 80-90% cases
-strong evidence of EIBI (early intensive behavoural intervention); 75-95% of children developed useful speech by age 5,
-shift to naturalistic developmental behavioural interventions (NDBI) - can lead to significant gains in functional communication, language, shared smiling and social orienting
-Other group social interventions
-PECS (picture exchange communication systems) - individuals with liitle or no speech can learn to use
What are the major disorders of childhood and adolescence?
-ADHD
- Oppositional Defiant Disorder/Conduct Disorder
-Separation Anxiety Disorder
What is known about the etiology of ADHD?
-Strong biological basis for ADHD in that many of the symptoms are related to delays or abnormalities of the development of the connections between emotional and motor areas of the brain
Heritable and non-heritable factors contribute to development and these are interdependent
Commonly co-occurs with other psychiatric disorders and involves the most complicated brain functions: sustained attention.
Causes are largely unknown
Risk factors:
1) Brain structure and function - generally reduced brain size (3-8% reduction), abnormalities in prefrontal cortex and basal ganglia, delay in structural brain maturation, poor executive functioning skills, poor emotional self-regulation
2) Genetics - more than half of the risk. Some studies show 70-80% risk. G X E
3) Neurotransmitters - dopamine in the synaptic cleft, serotonin receptor 1B
4) Environmental factors-
-prenatal toxin exposure such as poor diet, antidepressants, antihypertensives, illicit drugs, tobacco, alcohol, caffeine, mercury, lead, delivery complications/
-Low SES, large family size, apternal criminality, poor maternal mental health, child maltreatment, foster care placement, family dysfunction
What is known about the treatment of ADHD?
Medication and psychosocial treatments are quite effective - focus on functional and biological deficits of the brain.
Medication -
Stimulants, 80% effective.
Pyschosocial -
-Psychoeducational interventions; caregiver education on symptoms, course, deficits, and how to facilitate the child’s strengths to their advantage. Importance of routines, exercise, planned activities to occupy child
-Academic skill Facilitation and remediation; scheduled breaks, reward systems, appropraite positioning of child’s desk, auditory vs written instruction, use of agendas
-Behavioural parenting training; develop skills to manage their child’s ADHD problem behaviour
What is known about the etiology of Oppositional Defiant disorder (ODD)?
Real cause remains elusive
Depression strongly correlated with ODD irritability symptoms
Insecure attachment
What is known about the treatment of Oppositional Defiant disorder and Conduct disorder (4)?
1) Problem solving skills - effective at reducing problematic behaviour, although children never really reach normal level of functioning
2) pharmacological interventions -
- psychostimulants (if they have ADHD first line is treatments for ADHD
- risperidone (antipsychotic) - moderate effect on disruptive and aggressive behaviour
3) parent management training
- based on social learning causal model
- general increase in positive parenting, decrease in harsh discipline, reductions in conflict problems
4) school and community based treatments
- community parent education program (COPE) - reduce symptoms of ADHD and CD
- Peer mediation - 50% reduction of physical aggression at school
- Stop now and plan program (SNAP, a community referral, risk/need, gender specific program) - decrease in aggression, CD, rule-breaking and improvements in problem solving, emotion regulation
What is known about the etiology of SAD?
Internalizing disorder and much less is known about these and the etiology of anxiety in children.
Most children with this disorder has a history of an anxious temperament in infancy and early childhood (anxious temperament described as behavioural inhibition)
abnormal functioning in medial temporal lobe (amygdala), higher resting heart rates and blood pressure, abnormal stress hormone regulation
38% of children with parents that have anxiety
If mother experiences considerable stress while pregnancy
“fear conditioning”
Close knit family with over-involved parents
What is known about the treatment of SAD?
Primary aim of treatment is physical symptoms and their pattern of avoidance in situations or things that provoke their fear symptoms and thought
First line is psychoeducation
Behavioural assessment of how parents and teachers handle anxiety
Life history of the child
CBT - coping cat program
Pharmacological Treatment -SSRI’s
Behavioural intervention Technology
What is known about the etiology of Conduct Disorder (CD)?
Real cause remains elusive
Tend to run in families
Children with Parents who have a history of antisocial disorder
Raised in non nurturing environments
Aggression is associated with decreased glucose metabolism in the frontal lobe and damage to the orbital ventrolateral prefrontal cortex and related to underarousal of autonomic nervous system
Low norepinephrine is associated with conduct disorder, as well as low salivary cortisol and low cortisol
Poor executive functioning
maternal smoking, substance use, pregnancy/birth problems
poor parenting; low monitoring, harsh and inconsistent discipline, child abuse = linked to externalizing difficulties
Insecure attachment
Poverty
Low monoamine oxidase A (MAOA)
What is known about the treatment of Conduct Disorder (CD) - 4?
Problem solving skills
pharmacological interventions
parent management training
school and community based treatments
Differential susceptibility theory
The view that while sources of vulnerability can increase the risk of poorer outcomes, they can also be associated with more positive outcomes in the context of more supportive.
*This is under the gene-enivornment etiology section of conduct disorder about plasticity
Biological sensitivity to context theory
Postulates that children have different susceptibilities to how their environments influence them that is dependent on their biological reactivity to stress in a manner that is described as “for better or for worse”
*This is under the gene-enivornment etiology section of conduct disorder about plasticity
Behavioural inhibition
A temperament displayed in early childhood that may be related to anxiety disorders later in life, characterized by profound avoidance of others in preschool, and atypical autonomic nervous system responses to novelty
