Symp 4 - Child and Adolescent Psychiatry Flashcards
what are mental health problems associated with being out of school?
- Anxiety
- Conduct disorder
- Autism
- Depression
- Obsessional compulsive disorder
what are some effects of mental health problems on school attendance and learning?
- Learning difficulties due to poor attention
- Co-morbid specific (or general) learning problems
- Difficulty controlling emotion e.g. frustration, escalation of anger, frequent conflict
- Anxiety
- Lack of energy, motivation
- Difficulties joining in – wanting to be alone or unable to make friends (feeling different)
- Sensory problems – too noisy
- Preoccupation e.g. fear of germs and contamination
- Associations between mental health and learning difficulties e.g. dyslexia
2 types of anxiey - seperation anxiety and social phobia
what are they?
- Separation anxiety – fear of leaving parents and home. Problems on the doorstep
- Social phobia – fear of joining group. Problems at the school gate
what are the features of anxiety disorders (3A’s)?
Anxious thoughts and feelings (e.g. impending doom)
Autonomic symptoms
Avoidant behaviour
Motivational factors affecting school attendance:
What things affect willingness to go to school?
- Learning difficulties
- Lack of friends and relationships
- Bullying
- Lack of parental attention or concern (e.g. lack of interest in child’s education)
Encouraging one to stay at home
•Maternal depression (enc. Separation anxiety)
what are some causes of childrne not going to school?
- Maternal depression or psychiatric disorder.
- School bullying
- Lack of parental attention or control
Amygdala activity in adolescents with general anxiety disorder - what is it?
Amygdala is part of limbic system
Amygdala is linked to chronic anxiety
It is the sensor of threats
This is where emotions are given meaning, remembered, and attached to associations and responses to them (emotional memories)
drives the so-called “fight or flight” response
Anxiety disorders:
what is the relationship between Amygdala activity and the right ventrolateral cortex in anxiety disorders?
Amygdala activity is supressed by right ventrolateral cortex when labelling emotions
Reduced connectivity between right ventrolateral cortex and amygdala in generalised anxiety disorders in adolescents
how can you treat childhood anxiety?
•Behavioural:
- Learning alternative patterns of behaviour
- Desensitization
- Overcoming fear
- Managing feelings
(Picture - Resilience then leads to them being more prepared for future challenge)
•Medication - Serotonin reuptake inhibitors e.g. fluoxetine
how should CBT be done with children & families?
- Don’t expect children to have cognitive awareness
- Parents as collaborators in the team
- Step-wise approach: the ladder to success
- Externalisation: disorder is not a matter of blame
- Overcoming barriers to change: problem solving
Narrative approaches:
- Psychoeducation – explaining the problem in terms that make _____ to everyone
- Goal-setting – choosing ________ objectives that can be achieved
- ____-wise progression
- Motivating: getting buy-in so the goals can be _______
- Externalising: taking _____, guilt and anger out of the equation
sense
reasonable
Step
achieved
blame
what is autism?
Autism is a developmental disorder characterized by difficulties with social interaction and communication, and by restricted and repetitive behavior
- A neurodevelopmental disorder
- Defined as a syndrome of persistent, pervasive and distinctive behavioural abnormalities.
- Often associated with Low IQ but not defined by low IQ.
- Pervasive: present across the life span (onset <3yrs) and across settings (a feature of brain development and function)
what is Aspergers syndrome?
Asperger syndrome (AS), also known as Asperger’s, is a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests
what the epidemiology of autism?
- Highly heritable.
- Now thought to affect 1%
- Male:female ratio 3:1
Some distinctive features - Autism
Social: reciprocity and communication - what is seen?
- Reciprocal conversation
- Expressing emotional concern
- Non-verbal communication - Declarative pointing. Modulated eye-contact, Other gesture, Facial expression
Some distinctive features - Autism
Repetitive behaviour - what is seen?
- Mannerisms and stereotypies
- Obsessions, preoccupations and interests
- Rigid and inflexible patterns of behaviour - Routines, Rituals, Play
hwo does the clinical pictire of autism vary?
The variable clinical picture of autism: each domain is variable and in addition variation is affected by age and IQ
Dimensions of clinical features of ASD
what causes autism?
Strongly genetic:
- Co-morbid with congenital or genetic disorders: e.g Rubella, Callosal agenesis, Down’s syndrome, Fragile X, Tuberous sclerosis.
- GWAS identifying modulators of genetic expression e.g rbfox1
- Also epigenetics
- Broader phenotype in siblings and parents:
- increased rates of depression, OCD, anxiety disorders, language impairment
- Poor set-shifting ability, increased visuospatial ability, careers in engineering, computing or mathematics
Autism:
Many synaptic proteins are implicated mainly what?
glutaminergic but also GABA
MECP2 comes up in exams
what is the autism spectrum?
what are Common Clinical problems in ASD?
- Learning disability - mild to severe
- Disturbed sleep and eating habits
- Hyperactivity
- High levels of anxiety and depression
- Obsessional compulsive disorder
- School avoidance
- Aggression
- Temper tantrums
- Self-injury, self-harm
- Suicidal behaviour (6 x)
what are the principles of manageemnt in autism?
- Recognition, description and acknowledgement of disability
- Establishing needs
- Appreciating the can’t and the won’t
- Decrease the demands -> reduce stress ->improve coping
- Psychopharmacology
Hard to Manage (H2M) Children:
Oppositional Defiant Disorder – What are the Key features?
ODD vs ADHD - what are the differences?
Impulsive nature to ADHD and remorse
what causes Hard to Manage (H2M) Children?
- As previously discussed, caused by many factors: in child (e.g. temperament, ADHD, neurodevelopment) and parent (e.g. overcrowding, poverty, depression)
- Especially lack of positive experience of being parented
- Remember lecture 1 – effects of psychosocial adversity and experience of hostility
how do you manage Hard to Manage (H2M) Children and what may the outcomes of H2M childrne be?
- Parent Training programmes are effective (NICE guidance, 2006) -Parent training is one of the key interventions
- Multi-Systemic Therapy (MST) attempts to correct all causes
Multi source of history taking – child, adult, school
•Outcome risks: antisocial behaviour, substance misuse, long-term mental health problems
what is parent training?
- Groups, individuals or self-taught (e.g. DVD packages)
- Structured 1-2hrs/wk for 8-12 weeks
- Informed by social-learning theory e.g modelling behaviour
- Focus on positive reinforcement of desired behaviour and developing positive parent-child relationships
Help parents understand their child behaviour
Summary:
- Child and adolescent mental disorder is _______
- Aetiology is multi-factorial and dependent upon ____________ interaction
- Important predictor of _____ mental health
- Successful treatment minimises ________ and can develop _________ for longer term mental health
- Very dependent upon a ____________ approach and good interagency co-operation
common
bio-psycho-social
adult
disability
resilience
multidimensional
