Child And Adolescent Mental Health Part 3

Question 1

What are the two groups of people who are unwilling to go to school?

Answer 1

School refusal- simply won’t even leave house

Truancy- leaves house, doesn’t make school

Question 2

What problems arise from having a mental health problem in school

Answer 2

Learning difficulties due to poor attention
Co- morbid specific
Difficulty controlling emotion
Anxiety
Lack of energy/motivation 
Difficulties joining in
Sensory problems
Preoccupation
Associations between mental health and learning difficulties e.g. dyslexia

Question 3

What anxiety disorders affect those in school?

Answer 3

Separation anxiety- fear of leaving parents and home, problems on doorstep

Social phobia- fear of joining group, problems at school gate

An opus thoughts and feelings
Autonomic symptoms
Avoidant behaviour

Question 4

What factors drive school attendance

Answer 4

Learning difficulties
Lack of friends/relationships
Bullying
Lack of parental attention or concern
Encouraging one to stay home
Maternal psychiatric disorder, lack of parental attention or control

Question 5

How does brain physiology contribute to anxiety

Answer 5

Reduced connectivity between the amygdala and the ventrolateral cortex . The ventrolateral cortex suppresses the activity of the amygdala, reducing anxiety

Question 6

How do you avoid feeding fears and increasing child anxiety

Answer 6

By testing and acknowledging conditions that may not be pathological this reinforces the anxiety experience in the parent and the child

Question 7

How do you treat the cycle of anxiety

Answer 7

Behavioural

Learning. Alternative pathways
Desensitisation
Overcome fear
Manage feelings

Behaviour (fluoxetine)

Question 8

What is the underlying principle of CBT

Answer 8

Our behaviour, thoughts and feelings are all interlinked. By changing one we break the cycle

Question 9

What is the positive cycle of behavioural treatment

Answer 9

Challenge –> Success –> Self confidence –> Resilience

Question 10

What is the negative cycle of behavioural therapy

Answer 10

Challenge –> Avoidance –> Low self confidence –> Vulnerability

Question 11

How do we use CBT to overcome difficulties

Answer 11

Children don’t have cognitive behaviour so we usually use behavioural therapy
Parents are the collaborators in the team
Step-wise approach on the ladder to success
Externalisation- disorder is not a matter of blame
Overcoming barriers to change- problem solving

Question 12

What are good practice when using psychological therapy to treat an eating disorder?

Answer 12

Get everyone on board to achieve a limited goal, use metaphors like climbing mountains.

Sand dune metaphor- taking every step up leads to a small step backwards

Question 13

What are the key concepts of psychological therapy upon mental health disorders in children?

Answer 13

Psychoeducation - explain the problem in terms that make sense to everyone
Goal- setting choosing reasonable objectives that can be achieved
Step-wise progression
Motivating
Externalising, taking blame, anger and guilt out of the equation

Question 14

What is autism

Answer 14

A neurodevelopmental disorder

A problem with the growing brain defined as persistent, pervasive and distinctive behavioural abnormalities

Question 15

What is the difference between autism and Aspergers?

Answer 15

Aspergers- normal IQ
Autism - low IQ

old terms so it’s all defined as an autism spectrum as of now

Question 16

What are some distinctive features of autism?

Answer 16

Reciprocal conversation
Expressing emotional concern
Non verbal communication- pointing, changed eye contact facial expressions

Mannerisms and stereotypes
Obsessions preoccupations and interests
Rigid and inflexible patterns of behaviour (routines, rituals, plays)

Question 17

What aspects are decreased in autism?

Answer 17

Self-other perspective taking
Sharing/ divided attntion
Flexible learning
Social understanding

Question 18

What aspects are increased in autism?

Answer 18

Rigidity
Sameness
Fixed learning patterns
Technical understanding

Question 19

What is shown in younger people with a low IQ

Answer 19

Joint attention to others
Emotional response
Movements/ Actions

Question 20

What is shown in older people with a high IQ

Answer 20

Struggle to conversate
Struggle with empathy
Struggle to have a wide range of interests

Question 21

What causes autism?

Answer 21

Strong genetic link

Rubella, Collsal agenesis Down’s syndrome, fragile X, tuberous sclerosis

GWAS identifies modulators of genetic expression e.g. rbfox 1

Epigenetics

Broad phenotypes in siblings and parents

Question 22

What are the majority of proteins associated with autism linked with

Answer 22

Glutaminergic Pathways and GABA

Question 23

How does people with autism and a normal IQ caused

Answer 23

Only effects on synaptic function and plasticity (turnover)

Question 24

How does people with autism and a low IQ caused

Answer 24

Effects on synaptic function, neural migration adn brain development

Question 25

What are some common clinical problems in those with autism? Not done

Answer 25

``` Learning disability Disturbed sleeps 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 times more common) ```

Question 26

How do we manage autism?

Answer 26

Recognise, describe and acknowledge the condition Establish the needs of the young person There is a can’t and a won’t If you decrease the demands, the stress is reduced and coping improves. Psychopharmacology is also key

Question 27

What is the broken leg metaphor?

Answer 27

You wouldn’t run on a broke leg Yiu wouldn’t get them to climb a a tree Alternately cannot just immobilise them Need to get them going, give them tasks and increase this as time goes on

Question 28

What is ODD?

Answer 28

``` Irritable and headstrong Learned behaviour Enacted to obtain a desired result More likely to obtain a desired result Associated with adversity ```

Question 29

What is ADHD?

Answer 29

Aggression is impulsive (although may not be a feature) Poor cognition control and ability to sustain a goal Often remorseful Resistant to pure behavioural management Stronger genetic component

Question 30

How do we manage hard to manage children?

Answer 30

It can be caused by many things Look to correct negative factors that have caused this Parent training programs may be effective Multi-systemic therapy acts to correct all of these

Question 31

What is parent training?

Answer 31

A long structured program whereby teach parents to encourage good behaviours by reward rather than punishment 1-2 hours for 8-12 weeks Structured Informed by social-learning theory e.g. modelling behaviour Focus on positive behaviour and developing positive parent-child relationships