Child Neuropsychiatry: Elements and Piaget's Theory

Elements of Child Neuropsychiatry

• Pediatric neuropsychiatry is a medical specialty dealing with neurological and psychiatric disorders in children and adolescents aged 0-18.
• Conditions may cause neuropsychological disabilities requiring care and functional rehabilitation.
• It integrates neurology, psychiatry, and rehabilitative medicine, in contrast to the adult approach where these specializations are more separate.
• A multidisciplinary team approach ensures an integrated and comprehensive approach to the patient, taking into account environmental and family context.

Professional Roles and Piaget's Theory

• Professionals involved encompass child neuropsychiatrists, psychologists, rehabilitation therapists, social workers, administrative staff, and nurses.
• Piaget posits learning is about knowledge acquisition and modification through assimilation, accomodation and adaptation.
• Assimilation refers to the integration of acquired reality into an individual's organizational structures.
• Accomodation modifies cognitive frameworks in response to new experiences to achieve equilibration through flexibility and plasticity of the central nervous system.

Bion and Winnicott - Learning from Experience

• Bion defines learning from experience as going from feeling and sensory experience to thinking, and from perceiving an experience to mentally processing it.
• Caregivers aid in the emotional processing of the child's experiences, forming memories and the ability to dream, with experiences "metabolized" through thought into sensations/emotions.
• Winnicott indicates that the mother helps in the first months of a child’s birth in three ways: holding, handling and maternal preoccupation.
• Holding is a mother's ability to mentally contain the child's anxieties.
• Handling refers to primary care of the child with physical touch and affection.
• Primary maternal preoccupation is a maternal mental state growing in late pregnancy that enables her to empathically identify and respond to the child's needs.

Attachment Theory

• Attachment theory focuses on the reciprocal influence within the mother-child dyad, where maternal and child behaviors are interconnected, also with environmental factors.
• Secure attachment enables a child to explore their environment from a secure base, be soothed upon the mother's return after separation, and have tension subside when comforted.
• Anxious-resistant attachment presents disinterest in the environment, high tension, inability to calm down at the mother's return because of inconsistent and unappropriate maternal responses to the child's needs
• Anxious-avoidant attachment causes muted response to separation and low tension due to apparent deactivation of attachment behaviors from parental rejection or disavowal of needs, and avoidance of the mother.
• Disorganized-disoriented attachment is manifested through confused behaviors, disorganized sequences, and strange behaviors common in children whose mothers experienced unresolved trauma or loss.
• Ainsworth’s Strange Situation shows affective relationships influence a child's ability to regulate emotions and engage in organized and congruent behaviors.

Personality Formation and Attachment Styles

• Personality develops by affective and social exchanges with attachment figures, building an internal representation of relationships with mental models of themselves and their attachment figures.
• These Internal Working Models filter information from the external world.
• Mental models are cognitive structures that organize memories of interactions with significant figures that regulate and organize a child's actions towards parents and in new situations.
• Securely attached children create a mental model of themselves as worthy, view others as supportive, and actively participate in interactions.
• Anxiously attached children understand themselves as vulnerable, and perceive others as unreliable, expressing exaggerated emotions to control relationships.
• Avoidantly attached children see themselves as unworthy of love, perceive others as hostile, and suppress emotions to avoid dependency.

Neuroscience and Empathy

• Mirror neurons, which activate both when performing an action and observing the same action in another, strengthens connection between mother and child.
• Empathy is the ability to understand and share the feelings of another, involving immediate emotional resonance.
• The child's system integrates neurobiological/genetic potential, which includes temperament and resilience, with the environment.
• The environment encompasses socio-cultural, relational, and life experiences, including trauma and stress.
• Phenotype morphological and functional characteristics are an expression of both genotype and environmental influences.
• Brain plasticity allows for constant updating of the connections that enable it to change, adapt, and eliminate others, with restructuring maximized in early development.

Trauma

• Evolutionary trajectories are developmental pathways influenced by both neurobiological factors and environment, indicating “trends” in clinical condition.
• Trauma is a sudden, unexpected, and violent “wound” that disrupts one’s psychological state.
• This disturbing experience can lead to post-traumatic stress disorder(PTSD).
• Cumulative trauma is a accumulation of early repeated traumas lacking protective support leading to boundary loss and excessive intrusion.

Stress and Epigenetics

• Common reactions in the 72 hours following an event include fight, flight, freeze, and faint.
• Dissociation is distancing oneself from the experience.
• Stress from physical, chemical, or psychological factors can create lasting tension and defence mechanisms.
• Excessive and prolonged stress is pathogenic.
• Stress responses involve activation of the hypothalamus (releasing noradrenaline and cortisol) with endorphin release and cytokine production.
• Epigenetic factors during prenatal development include maternal stress altering the fetus' developing brain.
• Postnatal factors with low care and separation can increase stress, activating the amygdala and hypothalamic axis.

Interrelations and Maternal Pathology

• SNC development includes neuronal multiplication, migration, stabilization, and sensory stimulation.
• Cognitive and affective relations between mother and child are linked, characterized by cognitive functions for planning and motivation for decision-making.
• "Maternity blues," or "milk tears", is a benign condition between the third and fourth day postpartum, includes mood swings and is usually resolved within a week.
• Postpartum depression, occurring in 9-22% of mothers, has episodes in the first 3-4 weeks after birth and has the features of major depression.
• Postpartum psychosis occurs in 1.5/1000 births with rapid onset between 48 hours and 2 weeks postpartum presenting with insomnia, delusions, confusion and mood swings.
• Obsessive-compulsive disorder is found in 0.7-9% prevalence focused on need to control and obsessive-compulsive symptoms usually postpartum.
• Mother-child relationship disorders involve maternal alienation from the child because of inadequate emotional responses.

Principal symptoms and regulation

• Main indicators of parent-infant disorders encompasses regret over pregnancy, animosity towards baby, escapism and failure show affection towards the child.
• Depressed mothers tend to show lower rates of breastfeeding. Those with negative experiences breast feeding show depressive episodes..
• "Regulation" is the process of external environment, balancing emotions, self-control, and regulating states.
• Regulation difficulties in infants are difficulties handling sensory input, motor skills and attention.
• Challenges in organizing calmness, alertness, and positive affect.
• Lack of inhibitory mechanisms to develop physiological/behavioral reactivity, and environmental adaption.
• Porges suggests it may lie in an inability to modulate vagal tone.
• Main features in dysregulation contain atypical sensory reactivity, motor and processing difficulties, as well as attentional challenges.

Regulation disorder diagnosis and communication

• Diagnosis presents in an infant expressing problems in sleep, self-soothing or feeding.
• Additional problems involve routine changes, managing caregiving, or emotional instability.
• Sleep disturbance presents permanent regulation which causes issues with sleep, night wake ups
• Trouble arises calming themselves offering confort in finger, sight soothers which cause agitation
• Eating challenges emerge where times are unfixed showing a discomfort during food times.

Communication and Regulation

• Lack of eating patterns emerges from refusals, or selective diets as routine alterations that affect how one stabilizes when upset.
• Caregiving changes present agitation which surpasses longer period of time
• Care giving issues arise during personal hygiene and play which trigger negativity with many complications.
• Tipologies of temperament are often characterized as hyper, hypo and organized and include regulatory styles.
• Emotional regulation occurs when care givers module feelings and in some scenarios avoid and freeze
• The goal of parental care revolves avoiding the internal stress experience
• Communication development is characterized through preverbal, intentional and verbal stages.
• Pre verbal phase correlates with developing communication (predictor)
• Pre-intential phase involves behaviors that develop a value which signals something to an adult
• Intentional phase causes communication by producing results.

Communication and Neurosciences

• Development is characterized of using intention to communicate (obtaining a goal) this is separated by two modalities (requests by child / statements)
• Distinct language contains speaking a multitude of messages but producing a a reduced sense of language
• Social regulations indicate if the child feels welcome
• Early experiences are critical in laying the foundations of communication and language skills related to caregiver response.

Communication vs Speech Disorders

• Vertical construction is built from a dialogic interaction where others include more expansive elements, while morphosintactical are patterns are constructed between verbal and non expression.
• Morhosyntacical style is formed from combining a combination of forms of expressions while holophrasing.
• During phonological the stages of sounds is developed when there is a game and lallation are heard.
• Error happens such as simplifying the sylabization
• The whole communication consists of conforming/ and not conforming, and or irrelevant responses