Child psychiatry 1 Flashcards
(30 cards)
What is Child and Adolescent Psychiatry?
A branch of medicine and psychiatry focusing on the assessment, diagnosis, and treatment of psychiatric illnesses in children, considering biological, psychological, and social factors.
What is the primary purpose of a child psychiatric assessment?
To assess the child’s mental and emotional state through a comprehensive examination of various factors including cognitive, emotional, family, and social aspects.
What are treatment options for children/adolescents?
Treatment may include individual, group, or family psychotherapy, medication, or consultation with other professionals such as schools, juvenile courts, social agencies, or community organizations.
Describe the social context for the development of C/A psychiatry:
*The rise of industrialization and decreasing community tolerance for the mentally ill led to their institutionalization.
*This contributed to the medical profession’s role in treating mental illness.
*19th century: recognition of childhood as a distinct developmental stage, with increasing awareness of children’s vulnerability to social and environmental deprivation
*Impact of wars on approaches to MH
*Bowlby and Winnicott: research on attachment and child development
What were behavioral disorders in children historically viewed as during the 19th century
Moral failings that warranted punishment.
Who is credited with the development of attachment theory in the 1950s?
Bowlby.
What does the concept of ‘neurodevelopment’ refer to?
The coordinated development of the brain and its functions during childhood and adolescence.
Prenatal brain development (Before Birth)
White Matter and Brain Connectivity:
* White matter connections and long-range inter- and intrahemispheric projections are established.
* Cortical neurons are generated
* Early cortical connections with subcortical structures (e.g., hippocampus, amygdala, thalamus) play a role in shaping later specialization of brain functions.
Perinatal period of brain development (Around Birth)
Critical Brain Development:
* Critical for establishing, developing, and consolidating brain connectivity.
* Neurons reach their adult locations and the folding of the cerebral cortex is completed
Neontal period of brain development (First 28 Days of Life)
Consolidation of Connections:
* Thalamus-cortex connections are consolidated.
* Axonal growth continues
* Synaptic density begins to increase, particularly in regions like the visual cortex
Postnatal period of brain development (After Birth and Early Childhood)
Continued Brain Development:
* Genetic and environmental factors greatly influence brain development.
* Dendritic and synaptic density continues to increase, especially in areas like the visual cortex.
* Synaptic pruning
* Brain structures reach an adult-like appearance by age two.
* Major neural tracts become evident by three years of age.
Brain development in childhood and adolescence
Ongoing change and refinement
* Myelination with corpus callosum enhances conduction speed between LH and RH.
* Brain activity and behavioural responses advance: fMRI shows widespread activation in younger children, whereas older children exhibit more selective regional activation.
* Synaptic pruning: important in specialisation
Environmental factors in brain development in C/A
*Synaptic pruning influenced by environment
*Positive environmental influences have good outcomes for development
*E.g. children who experienced institutionalized care but were later placed in enriched adoptive families performed better in terms of physical, social, and cognitive functions
Neurobiological changes in adolescent development
*Physical: increased height, weight, strength, the development of body hair, voice changes, and sexual arousal
*Emotional: heightened emotional responses and hormonal changes that influence their decisions
*Cognitive development: move from concrete to abstract thinking, better at processing information, reward, aversion, emotional regulation and inhibitory control development in brain contribute to a tendency toward risk-taking.
Prefrontal cortex
*Development of prefrontal cortex (crucial for planning, problem-solving, and decision-making).
*Myelination increases, covering nerve fibers more extensively with myelin, which improves the efficiency of signal transmission.
*Synaptic pruning eliminates unnecessary connections, refining the brain’s ability to process information efficiently.
How do neurodevelopmental disorders arise?
*Seen as adaptive variants of typical development
*Prematurity
*Biological/environmental factors e.g. social and emotional environment
What forms the foundation of mental health?
Infant social and emotional development
How does social and emotional development begin to develop
*Before birth: parental fantasies and hopes begin to form, setting the stage for the attachment process
*First weeks: the baby displays behavioral states and neonatal capacities such as imitation, initiation of interaction, and the ability to regulate interactions with caregivers
*Intuitive parenting ensure emotional needs are met.
What is attachment?
Attachment refers to the emotional bond formed between an infant and their primary caregiver
What is the impact of secure attachment on the baby?
Helps babies feel safe, valued, and protected, which is essential for optimal brain development and mental health.
Key factors in development of attachment
*Sensitivity: caregiver’s ability to respond appropriately to the infant’s needs
*Parent-infant interaction: central to attachment
*Internal working model
What is an internal working model?
*The internalized representations of the interactions between the infant and their attachment figures.
*The representations can be behavioral, emotional, cognitive, verbal, non-verbal, sensory, and covert or overt.
*These internalized patterns influence the child’s future interactions, operating often at an unconscious level.
What are attachment figures? What is their role?
*Caregivers, typically the baby’s parents, with which they form the attachment relationship
*These attachment figures act as a secure base, providing a haven of safety that supports the infant’s emotional and psychological development.
What is Infant Mental Health?
*The young child’s capacity to experience, express, and regulate emotions, form secure relationships, and engage in play and learning (HSE, 2019).
