CAMHS

Question 1

Describe the professionals and roles of the different tiers of CAMHS services (1-4)

Answer 1

1. any professional who sees children every day; supported by primary mental health workers to refer a child into CAMHS
2. individual CAMHS therapists
3. CAMHS therapists working in specialists teams
4. Regional or national services (includes inpatient services)

Question 2

1. why can assessment of a child be difficult?
2. In what context should a child be assessed?
3. Name things that it is important to ask about when assessing a child for a mental health problem

Answer 2

1. may not necessarily acknowledge the need for help/agree to referral
   may be a reluctant attendee to referral, experiencing emotions that make it difficult to develop rapport
   children may not be able to express themselves as eloquently as adults
2. context of their developmental age
3. family composition and family hx
   school, hobbies, interests, friends
   developmental hx
   substance use and forensic hx (adolescents)

Question 3

Describe 4 common presentations of mental health problems in children

Answer 3

1. somatic - headaches; tummy pains
2. behavioural - tantrums, arguments etc
3. problems with peer and adult interactions
4. decreased school performance/school refusal

Question 4

Name other parties who may provide a useful collateral hx about a child

Answer 4

• other family members
• GP
• teachers
• social workers

Question 5

GROSS MOTOR DEVELOPMENT
describe the main milestones at the following ages:
1. 6 weeks
2. 6 months
3. 9 months
4. 12 months
5. 2 years
6. 3 years

Answer 5

1. raises head
2. sits without support
3. crawling; standing unsupported
4. walking
5. climbs stairs
6. runs and jumps

Question 6

FINE MOTOR & VISUAL DEVELOPMENR
describe the main milestones at the following ages:
1. 6 weeks
2. 6 months
3. 9 months
4. 18 months
5. 2 years
6. 3 years

Answer 6

1. follows moving object with head
2. palmar grasp
3. transfers objects from hand to hand
4. makes marks with crayon; eats with spoon
5. draws line; builds tower of 6
6. draws circle and a cross

Question 7

SPEECH DEVELOPMENT
describe the main milestones at the following ages
1. 6 weeks
2. 6-9 months
3. 12 months
4. 18 months
5. 2 years
6. 3 years

Answer 7

1. begins to vocalise
2. babbles
3. 2-3 word vocab
4. 6-10 word vocab
5. simple phrases
6. 3-4 word sentences

Question 8

SOCIAL AND EMOTIONAL DEVELOPMENT

1. 6 weeks
2. 6 months
3. 12 monts
4. 18 months
5. 2 years
6. 3 years

Answer 8

1. smiles
2. develops stranger and separation anxiety
3. understands name
4. prone to temper tantrums
5. symbolic play
6. achieves continence; parallel play; turn taking

Question 9

1. What is attachment?
2. Why is positive attachment important?
3. Name 3 features of attachment behaviour that is demonstrated at 6-36 months

Answer 9

1. deep and enduring emotional bond that connects people across space and time
2. crucial to an infant’s neurodevelopment, and helps them get a sense of who they are, explore the world around them and develop a positive internal working model of a relationship
3. proximity seeking to attachment figure, particularly when threatened
   use of attachment figure as a secure base from which to explore environment
   separation from attachment figure leads to separation protest by the infant

Question 10

What is attachment disorder?

Answer 10

an umbrella term used to describe disorders of mood, behaviour, and social relationships, arising from a failure to form normal attachments to primary caregivers in early childhood

Question 11

Describe the 4 attachment styles:

1. secure
2. insecure-avoidant
3. insecure-ambivalent
4. disorganised

Answer 11

1. distressed by separation, but quickly soothed on reunion
2. seems unconcerned about separation or reunion. independent of caregiver. Associated with unresponsive parenting
3. distress at separation and resistance to comfort on caregiver return. Clingy and dependent behaviour towards caregiver but rejects caregiver during interaction. Associated with inconsistent parenting
4. confused and at times contradictory behaviour; may seek out comfort but fears close proximity with cate giver; associated with maltreatment or parental trauma

Question 12

How may children with the following attachment styles act?

1. avoidant
2. ambivalent

Answer 12

1. isolate themselves; show unprovoked outbursts of aggression
2. clingy and passive

Question 13

1. What is conduct disorder?
2. In what groups are conduct disorders more common?
3. name some associations/risk factors for conduct disorder

Answer 13

1. repetitive and persistent pattern of antisocial, aggressive or defiant behaviours that violate age appropriate social norms
2. males and urban populations

3. social disadvantage
    parenting - parental criminality, psychiatric disorder, substance use; domestic violence; neglect and maltreatment
    perinatal complications
    low IQ
    neurodevelopmental problems
    attachment problems

Question 14

1. Name some clinical features of conduct disorder

2. what other psych disorders are often co-morbid with conduct disorders?

Answer 14

1. aggression
   cruelty to others
   destruction of property
   bullying
   decietfulness/lying/blaming others
   theft
   arson
   truancy/running away from home

2. ADHD; learning difficulties; depression; anxiety disorder

Question 15

What is the prognosis/course of conduct disorder?

Answer 15

• can be a persistent disorder (particularly with you ger onset)
• antisocial personality disorder in adulthood
• increased risk of substance abuse and other psychiatric disorder in adulthood
• increased risk of social exclusion

Question 16

How is conduct disorder managed?

Answer 16

• parent management training
• functional family therapy
• multisystem therapy
• child interventions

Question 17

What is oppositional defiant disorder

Answer 17

an enduring pattern of negative, hostile and defiant behaviour, without serious violations of societal norms or the rights of others

Question 18

Describe ABC of behaviour monitoring

Answer 18

A- antecedent
B- behaviour
C- consequence

Question 19

What are the 3 core deficits of ADHD?

How might these deficits manifest?

Answer 19

INATTENTION

• fails to sustain attention
• appears not to listen
• fails to finish tasks
• poor self-organisation
• forgetful

HYPERACTIVITY

• fidgets with hands and feet
• leaves seat in class
• always on the go
• can’t play quietly

IMPULSIVENESS

• talks excessively
• blurts out answers
• can’t wait turn
• interrupts others

Question 20

1. Which neurotransmitter and brain areas are thought to be implicated in ADHD?
2. Name 4 groups in which rates of ADHD are higher

Answer 20

1. DA in frontal and pretemporal brain regions
2. low birthweight babies
   babies born to mothers who used drugs, alcohol and tobacco during pregnancy
   following head injury
   some genetic and metabolic disorders

Question 21

Name 5 problems that are commonly comorbid with ADHD

Answer 21

1. specific LD
2. motor co-ordination problems
3. ASD
4. tic disorders
5. conduct disorder

Question 22

What happens to symptoms of ADHD as the patient continues into adulthood?

Answer 22

• over activity lessens; impulsivity, poor concentration and risk taking can worsen
• co-morbid depression, anxiety and drug misuse are common

Question 23

1. What medication is used to treat ADHD? What is its MOA?

2. What behavioural interventions can be used in the management of ADHD?

Answer 23

1. methylphenidate (ritalin) - CNS stimulant
2. positive reinforcement for desired behaviours using small, immediate rewards
   consistent approach across school and home
   break down tasks
   reduce distraction

Question 24

What is the triad of impairment in ASD?

Answer 24

1. impairment in social interaction
2. abnormalities in patterns of communication
3. restricted, stereotyped and repetitive repertoire of interests and activities
4. sensory impairment

Question 25

Name common comorbid problems associated with ASD

Answer 25

- learning disability - epilepsy - depression - anxiety - bipolar disorder - psychosis - OCD - ADHD - tic disorders

Question 26

What rating scale can be useful in the assessment of ADHD?

Answer 26

Connor's Rating Scale

Question 27

Which diagnostic tool can be useful in the assessment of ADHD?

Answer 27

Autism Diagnostic Interview (ADI-R)

Question 28

1. Which 2 anxiety disorders tend to have an onset in early childhood? 2. Which anxiety disorders tend to occur in later childhood and asolescence?

Answer 28

1. Separation anxiety disorder and specific phobias | 2. OCD, social phobia and panic disorder

Question 29

How might children with anxiety disorders present?

Answer 29

Behavioural changes - inattention - sleep disturbance - regression - withdrawal - school refusial - ritualistic behaviours - somatisation

Question 30

What is the sex difference in prevalence of depression in: 1. pre-pubertal patients 2. post-pubertal patients

Answer 30

1. no sex difference | 2. more common in famles

Question 31

How may a child with depression present?

Answer 31

- mood changes - sadness, irritable, anhedonia - thought changes - reduced self esteem, confidence, concentration and self efficacy - physical and behavioural changes - reduced energy, motivation, self care, withdrawal, appetite and sleep changes - reduced school performance

Question 32

1. How is mild depression in children managed? 2. How is moderate to severe depression in children managed? 3. Which medication is indicated for depression in children? 4. Why must medication be prescribed with care in children?

Answer 32

1. Tier 1/2 CAMHS; up to 4 weeks waitful watching; 2-3 months of psychologocal therapy 2. tiers 2-4 CAMHS; individual psychotherapy; consider alternative psychotherapy or medication if unresponsive 3. fluoxetine 4. SSRIs can cause/increase suicidal ideation in young people

Question 33

1. What is the onset of psychosis in children? | 2. Describe clinical features of psychosis in children

Answer 33

1. insidious; up to 12 months prodromal phase 2. associated with poor premorbid function with developmental delay negative symptoms often precede positive symptoms and are prominent strong family hx

Question 34

1. Name some causes of psychosis in children | 2. How is psychosis in children managed?

Answer 34

``` 1. normal experience organic conditions mood disorder pervasive developmental disorder/autism OCD schizophrenia Bipolar dissociative disorder ``` 2. risperidone

Question 35

1. What is enuresis? 2. What is primary eneuresis? 3. What is secondary eneuresis?

Answer 35

1. repeated involuntary voiding of urine in the absence of organic cause after the chronological and mental age of 5 2. if continence has never been achieved 3. if continence has been achieved preceding the period of incontinence

Question 36

1. Name common organic causes of eneuresis that must be excluded as a cause 2. What reassurance is important to give parents?

Answer 36

1. UTI, constipaiton, structural urinary tract abnormalities, diabetes 2. that the condition is common, rarely intentional and that no-one is to blame; children are likely to suffer hostile attitudes and behaviours and as a result may come to feel undesired

Question 37

1. What is encoporesis? 2. What is retentive encoporesis? 3. What is primary non-retentive encoporesis? 4. What is secondary non-retentive encoporesis?

Answer 37

1. repeated involuntary passage of faeces into places not appropriate for that purpose in children over the chronological and mental age of 4 2. results from both physical and psychological causes 3. encoporesis in children who have never previously achieved faecal continence; results from poor social training 4. encoporesis in children who have previously achieved faecal continence; typically results from emotional stress or defiance

Question 38

How is encoporesis managed?

Answer 38

- exclusion of organic causes (anal fissure, diarrhoea, constipation, hirschprung's disease) - explanation and reassurance - removal of stressors and re-training - manage with caution - children are likely to suffer hostile attitudes and behaviours and as a result may come to feel undesired

Question 39

Describe presentations/indications of physical abuse

Answer 39

1. delay in seeking help 2. inconsistent hx 3. parent unconcerned, hostile, paranoid, pre-occupied 4. suspicious injuries

Question 40

Describe presentations/indications of sexual abuse

Answer 40

1. disclosure 2. local trauma 3. early sexualised contaxt 4. STI 5. pregnancy 6. self harm 7. emotional effects - poor concentration; soiling and wetting; low mood; eating disorder; drug and alcohol abuse

Question 41

Describe presentations/indications of neglect

Answer 41

1. malnourished or dirty 2. inadequate supervision 3. substandard medical care 4. presentations of insecure attach,enr 5. irregular school attendance 6. developmental delay 7. eating problems (may steal or hoard food) 8. poor attention and emotional immaturity 9. frequent A&E attendance