Week 1 Flashcards
1
Q
What are the most common disorders in child and adolescent mental health?
A
- ADHD
- Anxiety disorders
- Conduct disorders
- Major depressive disorder
2
Q
Discuss the trajectory of mental health disorder across the lifespan of children
A
- longitudinal studies have demonstrated childhood behaviours are evidence of adult mental health disorders
- child motor, cognitive, behaviour and social characteristics predict adults schizophrenia (National Survey of Health and Development)
- long terms effects of sexual abuse and risk for suicide in adolescence
- observed behaviour in 3 year olds predicts adults psychopathology
3
Q
What are predisposing factors for mental health disorders in childhood?
A
- early life experiences (e.g. sexual abuse, physical abuse, separation, moving country)
- genetics
- family environment (parental conflict, siblings, parents employment, parental mental health)
- parenting factors (less warmth, overprotectiveness, less monitoring, less autonomy granting, critical, corporal punishment)
- temperament (behavioural inhibition, callous-unemotional traits)
- attachment (although evidence about later development is unclear)
4
Q
What are the general principles of assessing youngens?
A
- multi-methods: symptom rating scales (child, teacher, parent), clinician interview, behavioural observation
- multi-informant: self-report, parent report (mum and dad), teacher report, GP, paediatrician, carer/parent
5
Q
What is the purpose of a multi-informant approach?
A
- there can be a cross-informant disagreement
- agreement highest for observable behaviour
- children provide most accurate report of internal behavours (behavioural correlates e.g. what if questions)
- parents most accurate for socially undesirable behaviours
- internalising behaviours can be situation specific
- agreement on internalizing symptomatology is poorer with increasing age.
6
Q
How do we use multi-informant approaches in interview?
A
- include multiple informants (child and preferably both parents)
- establish the nature of the problem from the parents and child’s point of view
(situational context, duration, current management attempts) - mandatory reporting obligations for children and adolescents
- confidentiality
7
Q
How do we work with young children?
A
- rewards to manage behaviour in the therapy session
- playing games
- interactive - not just sitting and talking or going through activity sheets
- simplified language
- relaxed environment (e.g. sitting on the floor, kneeling at a coffee table)
- writing skills may be poor (or non-existent)
- short concentration span
- siblings may be present at sessions
8
Q
What information do we gather from the parents during the interview?
A
- history of the problem
- previous interventions (in detail)
- establish development history (developmental milestones, labour complications, feeding complications), medical history
- family psychiatric history
- child’s social functioning
- child’s school functioning
- child’s relationship with siblings
- financial and environmental stressors
- how do they manage the problems now (situational analysis)
- is the behaviour consistent across all settings and individuals?
- parent health and wellbeing
- parent social support
- marital relationship
- parents own childhood
- things parents like about their child - what they think their child is good at
9
Q
What is a typical structure of a child interview?
A
- start with all parties in the room, 5 minute intro of who you are and how the session will run (e.g. 5 mins together outline of the problem, 15-20 minutes with child, 30 minutes parents, 5 minutes together)
- always give the child some time on their own to get their perspective
- for young children tell them where mum/dad will be - its okay to leave the door open if that helps
- do an activity with them (assessment related) - use white board, pens and paper, toys to engage them
- elicit likes and dislikes - elicit some general info as well as info related to target problems
- ask what sorts of things they like to do with mum and dad
- ask what they like to do with their siblings
- ask about school - friends, teachers, subjects/activities
- share a little info about yourself for rapport building
10
Q
What is a typical structure of an adolescent interview?
A
- rapport building is critical
- TRUST and RESPECT is critical
- start with all parties in the room, 5 minute intro of who you are and how the session will run (5-30 minutes together outline of the problem, 15-20 minutes with adolescent, 15-30 minutes parents, 5 mins altogether)
- some parents and adolescents work well together and the adolescent might have told their parents some stuff in which case a lot of assessment can be done together. However, still have some time apart.
- discuss boundaries of confidentiality
- need to keep non-risk, non-essential things private (respect and trust)
- ask what info they don’t want discussed with parents (respect that) - if necessary, revisit in later sessions and get their agreement to discuss with parents (with them present or not - ideally present)
- ask the adolescent what they want fixed (often it is very different)
11
Q
What is the purpose and structure of a behavioural assessment?
A
- direct observation of behaviour in natural settings
- within assessment interview (on separation - behavioural inhibition test for <6 years; asking families to discuss something in the therapy context - family problem solving task; free play - parent and child; ask the parent to ask the child to clean up the toys)
- playground/classroom
- behavioural avoidance tests (anxiety)
- observing a contrived situation designed to elicit suspected fears potentially in absence of safety behaviours (such as parents)
12
Q
What do we want to find out about the parental cognitive attributions?
A
- parents attributions for child behaviour
- parents of children with externalising problems develop attributions that: behaviour is intentional, behaviour is designed to upset the parent, behaviour is indicative of a serious mental health problem
- parents of children with anxiety develop attributions that: it is not okay for my child to experience distress
- parent attribution of own thoughts: it is not okay to feel hatred or dislike towards my child
13
Q
What is the purpose of a situational analysis?
A
- to understand the exact details of events to look for problems in the process
- the trajectory of behaviours and responses is critical to understand as it will help you identify the places where things could have changed and gone in a different direction
14
Q
What do we want to illicit information about for a situational analysis?
A
- situation: what happened first? who said that? then what did you say? then what happened? and then?
