Child and adolescent psychiatry 3

Question 1

school refusal

Answer 1

fear of leaving home

fear of going to school

Question 2

School truancy

Answer 2

unwilling to leave home

unwilling to go to school

Question 3

Mental health problems associated with being out of school

Answer 3

anxiety 
conduct disorder 
autism 
depression 
OCD

Question 4

Some effects on MI on school attendance/learning

Answer 4

poor attention - learning difficulties
difficult controlling emotion
lack of energy + motivation
2 learning problem eg dyslexia
sensory problems 
preoccupation eg germs
difficult joining in

Question 5

Separation anxiety

Answer 5

fear of leaving parents and home

problems on doorstep

Question 6

Social phobia

Answer 6

fear of joining group

problems at school gate

Question 7

3 A’s of anxiety disorders

Answer 7

anxious thoughts and feelings
ANS
avoidant behaviour

Question 8

motivation factors affecting willingness to go to school

Answer 8

learning difficulty
lack of friends + relationships
bullying
lack of parental attention or concern

Question 9

Motivational factors encouraging one to stay home

Answer 9

maternal depression

Question 10

Amygdala in GAD

Answer 10

very active when experiencing anxiety

Question 11

Verbalisation of emotion in GAD

Answer 11

enables control

Question 12

Treating anxiety

Answer 12

behavioural

medication

Question 13

Behavioural treatment of anxiety

Answer 13

learning alternative pattern of behaviour
desensitisation
overcoming fear
managing feelings

Question 14

medication of anxiety

Answer 14

SSRI eg fluoxetine

Question 15

Assessment and management of anxiety (school)

Answer 15

contain anxiety

return to school ASAP

Question 16

3 principles of CBT

Answer 16

thoughts
feelings
behaviour

Question 17

Long terms effects of successful behavioural treatment

Answer 17

challenge
success
resilience
self confidence

Question 18

Long term effects of no behavioural treatment

Answer 18

challenge
avoidance
low self confidence
vulnerability

Question 19

CBT with children (&families)

Answer 19

More B&T
externalisation - not blame
overcome barriers
parents as collaborators

Question 20

Narrative approaches

Answer 20

gremlin in head stopping you from attending school
go to battle and defeat
overactive amygdala

Question 21

psychoeducation

Answer 21

explain problem in terms that makes sense

Question 22

Externalising

Answer 22

taking blame

guilt and anger out of equation

Question 23

How is autism defined?

Answer 23

syndrome of distinctive behavioural abnormalities

Question 24

autism and IQ

Answer 24

often associated with low IQ but not defined by low IQ

Question 25

Autism - pervasive

Answer 25

present across the life span and across settings

Question 26

Epidemiology of autism

Answer 26

1% male 3: female 1 highly heritable onset under 3 years

Question 27

Synaptic proteins in autism

Answer 27

glutaminergic | GABA

Question 28

autism - normal IQ

Answer 28

only effects on synaptic function

Question 29

Autism with LD

Answer 29

effects on synaptic function, neural migration and brain development

Question 30

clinical features of autism

Answer 30

social: reciprocity and communication | repetitive behaviour

Question 31

Social features of autism

Answer 31

reciprocal conversation expressing emotional concern pointing, gesture, facial expression

Question 32

Repetitive behaviour of autism

Answer 32

mannerisms and stereotypes obsessions, preoccupations and interests rigid and inflexible patterns eg routines, rituals

Question 33

ASD features - decreased

Answer 33

self-other perspective talking sharing/divided attention flexible learning social understanding

Question 34

ASD features - increased

Answer 34

rigidity sameness fixed learning patterns technical understanding

Question 35

ASD - younger/lower IQ

Answer 35

joint attention/attention to others emotional responses movements/actions

Question 36

ASD - older/higher IQ

Answer 36

conversation empathy interests

Question 37

ASD clinical problems

Answer 37

``` learning disability disturbed sleep and eating hyperactivity anxiety, depression, OCD school avoidance aggression, temper self injury, self harm, suicide ```

Question 38

ASD causes

Answer 38

strongly genetic congenital/genetic eg rubella, downs, tuberous sclerosis GWAS - modulators broader phenotype in family

Question 39

Broader phenotype in siblings and parents - ASD

Answer 39

depression, OCD, anxiety | career in engineering, maths, computers

Question 40

Managing ASD

Answer 40

recognise, describe, acknowledge reduce demands psychopharmacology

Question 41

Oppositional defiance - key features

Answer 41

``` refuse to obey adults argues with adults, lose temper deliberately annoys people easily annoyed spiteful or vindictive ```

Question 42

What is ODD linked to?

Answer 42

impaired parenting adversity behaviour is learned

Question 43

ADHD linked to..

Answer 43

poor cognitive control often remorseful stronger genetics

Question 44

H2M children factors

Answer 44

child - temperament, ADHD parent - poverty, depression lack of positive experience

Question 45

H2M effective management

Answer 45

parent training programmes | multi systemic therapy

Question 46

Outcome risks of H2M children

Answer 46

antisocial behaviour substance misuse long term mental health

Question 47

Parent training

Answer 47

``` group, individual/self taught 1-2hrs/week for 8-12 weeks social learning theory positive reinforcement develop positive relationships ```