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The principles of child psychiatric disorders are distinct from those of adult disorders.
False
Most childhood disorders emerge from a single cause.
False
The maturation of children psychologically and socially has no impact on their disorders.
False
Only three interacting groups of factors contribute to child psychiatric disorders.
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Genetic factors account for the majority of child psychiatric disorders.
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Genetic studies have produced no significant findings for child psychiatric disorders.
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The heritability of anxiety disorders is around 20%.
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Thomas et al. conducted a cross-sectional study in New York.
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The type and site of epilepsy have a significant impact on the psychological disorder.
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The age of onset of seizures has no impact on the child's response to epilepsy.
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Life events can only predispose to or provoke a disorder, but not protect against it.
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The concept of life events is only useful in adult psychiatry.
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Chronic stress has no causal role in the precipitation of psychiatric disorder.
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Children with conduct disorder have a decreased risk of experiencing negative life events.
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Prolonged separation from or loss of parents has no effect on psychological development in infancy and childhood.
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Bowlby's work suggested that prolonged separation from the mother was a minor cause of juvenile delinquency.
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Attachments are formed in the first 6 months of life.
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The Strange Situation Procedure is used to measure attachment in adults.
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Temperamental factors detected before the age of 5 years predisposed to later psychiatric disorder.
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The 'easy children' group was more likely to develop behavioural disorders later in childhood.
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Brain disorders are the least important risk factors for psychiatric problems in childhood.
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The prevalence of psychiatric problems in children with brain disorders is lower than in physically healthy children.
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The effects of brain lesions are less complex in childhood than in adult life.
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The immature brain is less able to compensate for localized damage than the adult brain.
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Early brain damage always results in immediate manifestation of a disorder.
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The consequences of head injury in childhood are highly specific and localized to one area of the brain.
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Intellectual impairment is never a consequence of severe head injury in childhood.
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Epilepsy is never a cause of childhood psychiatric disorder.
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Perinatal mental illness has been shown to have short-term effects on children.
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Children of parents with anxiety disorders have a lower rate of behaviour problems.
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Paternal depression has been shown to have no effect on the early years of life.
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The effects of parental mental health disorders on children are inevitable.
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Mothers who misuse alcohol or drugs have no impact on their children's development.
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Parenting has no impact on the effects of parental depression on children.
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Antenatal depression and anxiety have no association with later childhood disturbances.
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The causes of the effects of parental mental health disorders on children are purely environmental.
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The response to initial separation is used to measure attachment in children.
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Securely attached children are more likely to develop externalizing problems.
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The effect of separation on young infants is dependent on a single factor.
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Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are described in DSM-5 as a single disorder.
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Paternal criminality is a protective factor for psychiatric disorder in childhood.
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Good parenting is a risk factor for psychiatric disorder in childhood.
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Verbal abuse is a protective factor for psychiatric disturbance in children.
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High-quality alternative childcare is associated with increased levels of behavioural problems.
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Exposure to a large amount of alternative care has no correlation with behavioural problems.
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About 80% of infants are securely attached.
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Around 10-15% of children are bullied once or more a week.
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Bullies are more likely to be girls than boys.
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Victims of bullying have a lower prevalence of agoraphobia and generalized anxiety.
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Cyber-bullying is a rare method through which to victimize other peers.
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Good teacher-student relationships are a predictor of the onset of childhood psychiatric disorder.
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Bullies are at a lower risk of young adult psychiatric disorders.
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Victims of bullying have a lower risk of depression and suicidal ideation.
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Social media contact reduces the risk of bullying and victimization.
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The children of divorced parents have more psychological problems than the children of parents who are not divorced, primarily due to the economic difficulties that follow the divorce.
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Children's psychological problems after parental divorce are generally more severe than those of children who remain in conflictual marriages.
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The age of the child at the time of parental death has no impact on their response to bereavement.
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Parental death is associated with a single negative outcome in children.
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Children who experience the death of a parent before the age of 5 are more likely to have suicidal thoughts and actions.
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The effects of parental divorce on children are generally evident within the first year after the divorce.
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The majority of children who experience parental divorce show a decline in their well-being.
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Parental divorce is associated with a single negative outcome among children, but the effect size is small in magnitude.
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Bereavement may have long-term effects on development, especially if the child was old at the time of the parent's death, and if the death was sudden or violent.
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The importance of the school environment has been recognized in promoting mental health in children, but not in teachers.
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Rates of childhood psychiatric disorder are lower in areas of social disadvantage.
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Bullying often takes place outside the school context and is prevalent across schools in both high- and low-income countries.
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The size of the school and the age of its buildings are important factors that affect rates of psychiatric disorder.
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Only victims of bullying are at risk for psychiatric problems in childhood and beyond.
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Olweus's definition of bullying emphasizes unintentional or accidental acts that are carried out repeatedly and over time.
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The effects of neighbourhood on childhood psychiatric disorder are only indirect.
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Social and cultural factors have a minimal impact on the development of children.
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In the early years of childhood, social factors act directly on the patterns of family life.
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When treating an acute episode of schizophrenia, it is recommended to initiate antipsychotic medication at the highest end of the licensed dose range.
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In the maintenance and relapse prevention phase of schizophrenia treatment, it is recommended to withdraw medication abruptly.
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In the treatment of schizophrenia, psychological interventions are only necessary during the acute episode.
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Depot formulations of antipsychotic medication are not recommended for patients with adherence issues.
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In the treatment of schizophrenia, sedation is usually achieved through increasing the dose of antipsychotic medication.
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The choice of antipsychotic medication is based solely on the patient's medical history.
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Study Notes
Causes of Child Psychiatric Disorders
- Most childhood disorders emerge from a complex interaction between neurodevelopmental vulnerabilities and environmental factors
- Four interacting groups of factors contribute to the development of psychiatric disorders in children:
- Heredity
- Temperament
- Physical impairment (especially brain damage)
- Environmental factors in the family and society
Genetic Factors
- Children with psychiatric problems often have parents who suffer from a psychiatric disorder
- Genetic factors account for a significant part of this association (around 40% heritability)
- Population-based twin studies indicate a significant genetic contribution to some psychiatric disorders, especially ASD, hyperactivity, and anxiety disorders
Temperament and Individual Differences
- Temperamental differences in early childhood can predispose to later psychiatric disorder
- Two groups of children:
- "Difficult children" who respond to new stimuli with withdrawal, slow adaptation, and intense behavioral response
- "Easy children" who respond to new stimuli with a positive approach, rapid adaptation, and a mild behavioral response
- Later studies confirm an association between temperamental styles and subsequent childhood psychopathology
Brain Disorders
- Brain disorders, such as traumatic injury, epilepsy, infections, tumors, neurodegenerative conditions, are important risk factors for psychiatric disorder
- The prevalence of psychiatric problems is higher in children with brain disorders (around 34%)
- Children with brain injury are more likely to develop psychiatric disorder if they encounter adverse psychosocial influences
- The effects of brain lesions are more complex in childhood due to the brain's developmental stage
Environmental Factors
- Life events, such as separation, divorce, or the death of a parent, can predispose to psychiatric disorder
- The psychological impact of life events is influenced by factors such as temperament, cognitive style, and previous life experience
- Chronic stress, poverty, and discrimination can also contribute to the development of psychiatric disorder
Family Influences
- A stable and secure family background with emotional warmth, acceptance, and constructive discipline is essential for healthy psychological development
- Prolonged separation from or loss of parents can have a profound effect on psychological development in infancy and childhood
- Poor relationships in the family, including overt conflict between parents, can have adverse effects on children
- Maternal deprivation and attachment: Bowlby's work on attachment suggests that internal models of self, others, and relationships are formed in early childhood and persist through life
Attachment
- Attachments are formed in the second 6 months of life
- Secure attachment is associated with healthy psychological development and is characterized by an appropriate balance between security and exploration
- Insecure attachments (avoidant, disorganized, resistant-ambivalent) are associated with increased risk of psychiatric disorder
- Attachment styles tend to be stable across childhood and adolescence
Family Risk Factors
- Multiple risk factors, including severe marital conflict, low social status, paternal criminality, and parental psychiatric disorder, increase the risk of psychiatric disorder in children
- Placement in care away from the family also increases the risk of psychiatric disorder
Protective Factors
- Good parenting, strong affectionate ties within the family, sociability, and the capacity for problem-solving in the child reduce the risk of psychiatric disorder
- Support outside the family from individuals, school, or church can also be protective
Effects of Parental Separation
- Children of divorced parents have more psychological problems than those whose parents are not divorced.
- Two main effects of childhood parental separation: economic difficulties and exposure to interpersonal conflict.
- Distress and dysfunction in children are greatest in the year after the divorce, but diminish after 2 years.
- Parental divorce is associated with multiple negative outcomes among children, although effect sizes are small in magnitude.
Effects of Death of a Parent
- Children's response to parental death varies with age.
- Children under 4-5 years old react with despair, anxiety, and regression to separation.
- Children aged 5-11 years become depressed and overactive, and may show disorders of conduct.
- Children over 11 years old respond similarly to adults.
- Bereavement may have long-term effects on development, especially if the child was young at the time of the parent's death.
Social and Cultural Factors
- Family has the most effect on children's development, but wider social influences are also important.
- Rates of childhood psychiatric disorder are higher in areas of social disadvantage.
- Important features of inner-city life include lack of play space, inadequate social amenities, exposure to violence, overcrowded living conditions, and lack of community involvement.
Effects of School
- Schools can play a crucial role in promoting mental health in children and teachers.
- Rates of child psychiatric referral and delinquency vary between schools.
- Factors that don't affect rates of psychiatric disorder include the size of the school and the age of its buildings.
Bullying and Teacher-Pupil Relationships
- Bullying often takes place within the school context and is prevalent across schools.
- Both bullies and victims of bullying are at risk for psychiatric problems in childhood and beyond.
- Being involved in bullying can result in serious long-term consequences and adjustment problems.
- Around 2-8% of children are bullied once or more a week.
- Victims of bullying are at a higher risk of emotional problems, disruptive behaviors, and psychiatric disorders.
Acute Episode of Schizophrenia
- Initiate antipsychotic medication at the lower end of the licensed dose range
- Avoid using loading doses (‘rapid neuroleptization’)
- Use adjunctive benzodiazepines if sedation is needed
- Choose the drug based on patient preference, effects of previous treatments, and relative liability of the drug to cause serious side effects (especially extrapyramidal and metabolic syndromes)
- Titrate the dose within the licensed range, monitoring for effects and side effects
- Aim to achieve the optimum dose with good adherence for 2 weeks
- If no response at that time, consider changing the drug
- Record the indications for medication, the anticipated benefits and time course, and discussions with the patient and carers
- Consider psychological interventions whenever medication is being introduced or changed
Maintenance and Relapse Prevention
- Continue medication for a year, or longer, using the same principles as for the acute episode
- Ensure that the dose, duration, and adherence are adequate before switching drug
- Withdrawal of the drug should be gradual, and the mental state should be monitored
- Continuous treatment is more effective than intermittent treatment
- Monitor adherence regularly
- Monitor for side effects, including metabolic syndrome, regularly
- Consider depot formulations, especially if adherence is a problem
- Always consider psychological interventions together with pharmacological options
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Description
Understanding the causes of child psychiatric disorders, including the interaction between neurodevelopmental vulnerabilities and environmental factors, as well as developmental aspects.
