Child and Adolescent Flashcards
(14 cards)
ASD
Applied behavioural analysis (ABA)
- A behavioural programme for treating young children (age 2 to 3 years at the start of intervention) with ASD.
- ABA may be used if it is considered that the child would benefit from a heavily structured environment with the use of a reward system to
lessen the impact of either repetitive behaviours or overactivity.
Early Start Denver Model (ESDM)
- ESDM intervention is based on developmental and applied behavioural analytical principles and delivered by trained therapists and
parents.
- Aimed for children with autism between the ages of 12-48 months
More Than Words (Hanen programme)
- Designed to help parents of all children <6 years of age who are experiencing difficulties in social interaction and communication.
- Parents learn a number of strategies that help to improve their child’s communication and interaction.
Involving parents in the therapy plan and ensuring that they gain an understanding of the disorder and what works best for each child is vital
Discuss need for education, health and care (EHC) plan assessment with nursery/school/GP/community paediatrician
Asperger’s syndrome
Advice
Support (involve nursery/school/GP/community paediatrician) – discuss EHC
plan assessment
Routine
Social skills training
Depression in children
1st line: CBT or other psychological therapies
Antidepressants are only used in severe cases
- Fluoxetine is the safest option in children
Good prognosis
Anxiety disorders
Psychological therapies are the mainstay of treatment e.g. Counselling and CBT
Encopresis
Encopresis, sometimes known as fecal incontinence, is the repeated passing of stool (usually involuntarily) into clothing. Occurs in toilet-trained children and is usually due to leakage caused by constipation
- Laxatives (if constipated)
- Reassure, address stress and review toilet training
- Pelvic floor exercises
- Star charts
Conduct disorder
Family education
- Make the family understand CD and how they may accidentally reinforce the behaviours
Psychological therapy
- Talk about feelings and thoughts and how these affect behaviour and
wellbeing to a therapist
Parent management training
- Teaches parents to reward good behaviour and deal constructively with negative behaviours
Family therapy
- Family meets with a skilled therapist to discuss current problems
- They are helped to cooperate in problem solving
Educational support
Anger management for child
Treat comorbid problems (e.g. ADHD)
Tic disorders
Reassurance, education and stress management
Behavioural therapy – habit reversal therapy, exposure and response prevention
Clonidine (alpha-2 agonist)
Atypical antipsychotics
Personality disorders
They are treatable
Encourage the individual to take responsibility for their actions
Boundaries are essential
Personality disorders psychological management
CBT and psychoanalysis
Dialectical behaviour therapy (DBT)
- Type of CBT that has been adapted for people who experience emotions very
intensely
- Used to treat emotionally unstable (borderline) personality disorder
- Focuses on changing unhelpful behaviours AND accepting who you are at the
same time
Cognitive analytical therapy (CAT)
Personality disorders pharmacological management
Antipsychotics - may reduce impulsivity and aggression (e.g. risperidone)
Antidepressants - may reduce impulsivity and anxiety
Mood stabilisers - may be used for labile affect (effects aren’t evidence-based)
Personality disorders prognosis
Personality disorders disrupt relationships, education and employment
Although they are persistent, they may change in severity over time
ICD-11 no longer categorises PDs based on their subtype, but instead classes them by severity.
Emotionally unstable personality disorder psychological management
Dialectical Behavioural Therapy (DBT) aims to introduce two important concepts:
- Validation: accepting that your emotions are acceptable
- Dialectics: showing you that things in life are rarely black or white, and helping you be open to ideas and opinions that contradict your own
Mentalisation-Based Therapy
Emotially unstable personality disorder pharmacological management
SSRIs may be useful to reduce impulsive behaviour
Check for features of insomnia
Chronic insomnia
Defined as difficulty getting to sleep or maintaining sleep on 3 or more nights of the week for 3 months
May be investigated using a sleep diary and actigraphy
Identify potential causes (e.g. depression and anxiety)
Advice on sleep hygiene and not to drive when tired
CBT-I for insomnia
Consider hypnotics if major day time impairment
- Short-acting benzodiazepines (e.g. lorazepam) or Z-drugs can be used
- Use lowest possible dose for the shortest possible time
- Review in 2 weeks and consider CBT
