Child and Adolescent Psychiatry

Transcription

1 Child and Adolescent Psychiatry General aspects Clinical observation Psychiatric disorders Educational strategies Benjamin Mac Donald, kand. Psyk. Childrens Psychiatric Dept. Risskov Psychiatric Hospital Continuum Hemmingsen et al.,

2 Temporal perspective? Maladaptive Adaptive Prevalence about one child in five has a mental health problem that significantly impairs functioning and percent meet diagnostic criteria for a specific psychological disorder Many other children have emerging problems that place them at risk for later development of psychological disorder Mash& Wolfe,

3 Course Psychiatric diseases progress dynamically Hence there is no clear connection between the psychiatric diagnosis and psychiatric patient s social level of functioning Hemmingsen et al., 2000 Clinicalobservation sourcesof information Not an exhaustive or non-overlapping list Appearance Age-appropriate appearance, height, and weight Clothes Hygiene Contact Formal contact skills Emotional contact skills(reserved, normal, unattuned) Eye contact Facial expressions. Smiling and smiling back Gesture 3

4 Clinical observation Language Impressive and expressive Participation in conversation Voicing Latency Pace of speech Sentence construction, word-finding Neologisms(construct own words) Mutism Echolalia(parrot-talk) Motor skills Fine and gross motor skills Coordination (In)voluntary movements Activity level Clinical observation Cognitive Attention Intelligence Empathy Recognition of difficulties Knowledge of social rules and norms Sense of reality Emotion Temperament Attitude Mood level(depressed, neutral, elated) Behavior Cooperation Play Independence Family dynamics, e.g. attached to parents, supported by parents 4

5 Clinical observation Therapeutic aspects Transference, counter-transference Defense mechanisms Clinical assessment The background of the descriptions E.g. psychotic, depressed, or under the influence Case formulation Predisposing Individualand contextualfactors thatrenders the child vulnerable to a psychiatric disorder Precipitating Developmental factors or stressors Perpetuating Individualand contextualfactors thatmaintaina disorder Protective Individualand contextualfactors thatameliorate a disorder 5

6 The bio-psycho-social model Psychological factors Health Social factors Biological factors The bio-psycho-social model A holistic approach Points to the importanceof biological, psychological, and sociologicalapproachesin understanding health and illness Interaction between factors Multicausal development Jørgensen & Pedersen,

7 Obsessions OCD E.g. harm, contamination Compulsions E.g. checking, counting, touching, arranging, washing Sempleet al., 2005 Autism spectrum disorders Abnormal social relatedness/interaction E.g. failure to develop peer relationships, inadequate eye contact, lack of empathy, impaired mentation Abnormal communication or play E.g. delayorlackof spokenlanguage, stereotypedand repetitive language, lack of developmentally appropriate play Restricted, repetitive and stereotyped behaviors E.gencompassinginterests, restistanceto change, stereotypes and motor mannerisms Sempleet al.,

8 Autism spectrum disorders Social interaction Triad of impairments Social communication Social imagination 8

9 Aspergers syndrome Same qualitative disturbance of social interaction as in infantile autism, as well as restricted and repetitive patterns of behavior and interests (special interests). No general delay of language or cognitive development. Physical clumsiness and atypical (peculiar or odd) use of language are often reported. Language disorders Expressive dysphasia Ability to use expressive spoken language underdeveloped Often abnormalities in articulation Normal language comprehension Impressive dysphasia Language comprehension underdeveloped Expressive dysphasia Often abnormalities in word-sound production 9

10 Attention disorder ADHD E.g. easilydistracted, cannotsustainattention, doesn t listen Impulsivity E.g. continuallyinterrupting, blurtingout answers, difficulty waiting ones turn Hyperactivity E.g. moving, running about, fidgeting Sempleet al., 2005 Preschool Primary School Adolescence Adulthood Inattentive Short play sequences (<3 min); leaving activities incomplete; not listening Brief activities(<10 min); premature changes of activity; forgetful; disorganized; distracted by environment Persistence less thanpeers (<30 min);lackof focus on details of a task; poor planning ahead Detailsnot completed; appointments forgotten; lack of foresight Overactive Whirlwind Restless when calm expected Fidgety Subjective sense of restlessness Impulsive Doesnot listen; no senseof danger Acting out of turn, interrupting other children and blurting out an answer; thoughtless rule-breaking; intrusions onpeers; accidents Poor selfcontrol; reckless risk-taking Motorand otheraccidents; premature and unwise decisionmaking; impatience Taylor & Sonuga Barke,

11 ADHD Impulsivity Girls Impulsive in the social area ADD Attention Quiet, daydreaming Tics Involuntary movements E.g. eye twitching, shoulder shrugging Unintended sounds E.g. sniffing, grunting 11

12 Tics The type typicallyvariesover time with complex tics appearing after some time The frequencyrises and falls, and exacerbations are often related to stress Sempleet al., 2005 Conduct disorder A continouspattern of antisocial, aggressive and oppositional behavior E.g. insubordination, provocativebehavior, vindictiveness, mendacity, vandalism, arson, theft, sexual coercion 12

13 Structure Clarity Educational strategies Predictability Transparency Educational toolbox Setting Small frame Reduction of stimuli Breaks Appointments in the morning Vizualization Pictograms Schedules Lean onthe watch Show how to participate Verbal information Making the abstract concrete Short, simple, concrete explanations Ensure that the child understands what is said Information about treatment Information about start, shifts, breaks, and end of treatment Enhance positive attention and reduce negative attention 13

14 In the dental clinic Predictability Whatis the plan for today the plan for the entire treatment Ongoing information about the next step Ongoing preparation about shifts Clarity Clarityaboutthe rulesin the clinici.e. the do sand don ts Praisefor appropriatebehavior for compliancewith the rules Behavioral correction if the rules are breached. Limits In the dental clinic, cont d Frequent breaks It is importantto preparethe childif treatment requires long periods of time without breaks Make clear-cut agreements about when to take breaks Sum up Now I onlyneedto do twomore things, then we lltakea break Shielding (preferrable) Reduce disturbing elements both visual and auditive Fixed appointments In the beginning of the day. Decreases delays 14