Intoduction and normal development

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Questions and Answers

Which of the following dimensions does NOT affect the perception of child mental illness?

The child's impairment of wellbeing

The social and cultural context

The child's physical health (correct)

The child's development

What aspect of development is impacted by the delay in a child's growth according to the content?

Behavioral patterns

Intellectual capacity

Physical and emotional skills (correct)

Social and cultural understanding

In child psychiatry, who might children be left to communicate with during psychiatric consultations?

Teachers

Social workers

Pediatricians

Parents (correct)

Which is NOT mentioned as a significant issue for children's mental health services?

Communication methods in assessment Signup and view all the answers

What might be a consequence of mental illness at a pre-pubertal stage?

Impact on adolescence development Signup and view all the answers

Why might the response from a parent differ based on the child's age?

Level of development expected Signup and view all the answers

What usually marks the way children are able to express distress?

Various different ways Signup and view all the answers

Which of the following factors is constantly followed to understand a child's behavior?

Weight of the three health/social factors Signup and view all the answers

At what age will a baby typically exhibit anxiety when separated from their mother?

8 months Signup and view all the answers

Which of the following is a characteristic of children in the preschool years?

Learning new skills related to language and social interaction Signup and view all the answers

What development milestone is typically reached by the end of the first year of life?

Pointing at objects Signup and view all the answers

Which aspect is crucial for the practice of child psychiatry?

Knowledge of normal child development Signup and view all the answers

By what age will a baby typically smile selectively?

6 months Signup and view all the answers

What key role can schools play in a child's development?

Acting as a source for prevention and treatment of mental illness Signup and view all the answers

Which of the following is a hallmark of the first year of life?

Understanding simple causal relationships Signup and view all the answers

During which period might children develop frustration and be more likely to throw tantrums?

Year two Signup and view all the answers

Which milestone is a baby unlikely to achieve by the end of the first year?

Walking independently Signup and view all the answers

What key aspect is used to determine if a child's functioning is abnormal?

Comparing with the corresponding normal range for the age group Signup and view all the answers

At what age do children typically begin to walk?

18 months Signup and view all the answers

What is a common behavior in children when their exploratory wishes are frustrated?

Temper tantrums Signup and view all the answers

What should a child be capable of doing by the end of the second year?

Putting two or three words together as a simple sentence Signup and view all the answers

When should temper tantrums diminish?

Before the child starts school Signup and view all the answers

At what age range is fantasy life rich and vivid in children?

2-5 years Signup and view all the answers

What helps a child to sleep and feel comforted during the preschool years?

Transitional objects such as teddy bears or pieces of blanket Signup and view all the answers

What kind of difficulties should be referred to mental health services if persistent and problematic during early childhood?

Feeding and sleeping difficulties, separation anxiety, temper tantrums, oppositional behavior, minor aggression Signup and view all the answers

When do children typically begin to understand and explore their own identity, including differences between males and females?

2-5 years Signup and view all the answers

At what age is bedwetting considered abnormal?

7 years Signup and view all the answers

Which of the following disorders is associated with recurrent episodes in adulthood?

Depressive disorders Signup and view all the answers

What is a common problem in children aged 12 to 16 years?

Fluctuating mood Signup and view all the answers

Which genes have been identified for specific disorders?

Autism Signup and view all the answers

How can a caring relationship affect the risk of depression in adulthood?

Is not protective against child abuse Signup and view all the answers

Why do we use a categorical system to study childhood disorders?

To give 'yes or no' answers for treatment decisions Signup and view all the answers

Which symptom or behavior in childhood is associated with increased substance misuse in adulthood?

Overactivity Signup and view all the answers

Which factor in the environment does NOT protect against?

Child abuse Signup and view all the answers

How do genetic and environmental factors interact?

They make certain exposures more likely to occur Signup and view all the answers

What problem is less common in younger children but can continue into adolescence?

Substance abuse Signup and view all the answers

What diagnostic manual integrates childhood disorders into a chronological fashion with infancy and childhood listed first?

DSM-5 Signup and view all the answers

Which category is not listed under the classification of psychiatric disorders in children and adolescents?

Psychotic disorders Signup and view all the answers

Which statement is true regarding the DSM-5 classification for child psychiatric disorders?

It has subsumed many categories into larger chapters. Signup and view all the answers

How do the rates of emotional and behavioural disorders in low- and middle-income countries compare to those in developed countries?

Similar Signup and view all the answers

Which of the following is categorized under emotional (internalizing) disorders?

Adjustment reaction Signup and view all the answers

Which classification system provides a multiaxial scheme that includes six axes such as clinical psychiatric syndromes, developmental delays, and medical conditions?

ICD-10 Signup and view all the answers

Which disorder is more frequent in females?

Eating disorders Signup and view all the answers

Which disorder is equally common before puberty in both males and females?

Depression Signup and view all the answers

Which disorder is more frequently observed in males?

Tic disorders Signup and view all the answers

What is a common outcome for children with ADHD as they grow into adulthood?

A substantial number remain relatively impaired Signup and view all the answers

Which disorder is known to rarely persist into adulthood once treated?

Separation anxiety Signup and view all the answers

Which psychiatric disorder is described as having a low rate of remission if left untreated?

Agoraphobia Signup and view all the answers

Which disorder is more common in males and can persist into adulthood?

ADHD Signup and view all the answers

Which of the following disorders has an increased persistence rate into adulthood?

Social anxiety disorder Signup and view all the answers

What protective factors may reduce the likelihood of developing adult depressive disorders?

Positive emotional style and family bonding Signup and view all the answers

Which condition rarely persists into adulthood if identified during childhood?

Separation anxiety disorder Signup and view all the answers

What is the pooled prevalence of mental disorders worldwide in children and adolescents?

13% Signup and view all the answers

What percentage of adolescents suffer from anxiety disorders according to the most recent National Comorbidity Study in the US?

31% Signup and view all the answers

Which condition has the earliest median age of onset according to the most recent National Comorbidity Study in the US?

Anxiety disorders Signup and view all the answers

What is the prevalence of conduct and emotional problems in UK adolescents over the past two decades?

It has substantially increased Signup and view all the answers

Which gender sees a higher frequency of mental disorders before puberty?

Males Signup and view all the answers

Which disorder has a prevalence of 3% according to the systematic review and meta-analysis?

ADHD Signup and view all the answers

What is a risk factor for mental, emotional, and behavioral disorders in the 'Community/policy' domain?

Neighborhood policy and crime rates Signup and view all the answers

Which area of residence has higher rates of psychiatric problems in children?

Urban areas Signup and view all the answers

What is the overall prevalence of disorders with severe impairment and/or distress in US adolescents?

22% Signup and view all the answers

What percentage of children and adolescents have a disruptive disorder according to the worldwide prevalence study?

6% Signup and view all the answers

According to the DSM-5, which category includes Autism Spectrum Disorders?

Neurodevelopmental Disorders with Onset in the Developmental Period Signup and view all the answers

What is the equivalent ICD-10 category for Attention-Deficit Hyperactivity Disorders in DSM-5?

Specific Developmental Disorders of Scholastic Skills Signup and view all the answers

Which category does Intellectual Disability fall under in DSM-5?

Neurodevelopmental Disorders with Onset in the Developmental Period Signup and view all the answers

What category does Communication Disorders belong to in ICD-10?

Specific Developmental Disorders of Speech and Language Signup and view all the answers

Among the following, which disorder is characterized by hyperactivity in ICD-10?

Hyperkinetic Disorders Signup and view all the answers

What was the prevalence rate of psychiatric disorders found in the Isle of Wight study?

7% Signup and view all the answers

Which disorder was most common in the UK study conducted in 2000 among children aged 5-15 years?

Conduct Disorder Signup and view all the answers

Which disorder falls under 'Other Behavioural and Emotional Disorders' in ICD-10?

Feeding Disorders Signup and view all the answers

Which category describes Motor Disorders in ICD-10?

Specific Developmental Disorder of Motor Function Signup and view all the answers

Which category in ICD-10 includes disorders like conduct and emotional disorders?

F9 Behavioural and Emotional Disorders with Onset Usually Occurring in Childhood and Adolescence Signup and view all the answers

Study Notes

Child Mental Illness

A significant proportion of adult mental illness originates before the age of 18 years.
Three underlying dimensions of child mental illness affect perception of problems:
- Child's impairment of wellbeing: experiencing significant periods of time with learning and social problems, often with early onset.
- Child's development: delays in physical and emotional development can impact capacity.
- Social and cultural context: verbal and non-verbal communication with others affects perception.

Differences Between Child and Adult Psychiatry

Child psychiatry practice differs from adult psychiatry.
Assessment of children differs from that of adults.

Key Issues in Children's Mental Health Services

Complexity of comparing children to a generic 'normal adult' standard.
Importance of considering internal and external factors affecting the child's behavior.
Trust issues: who is trusted to communicate with the child?
Impact of child's development on mental problem outcomes (e.g., mental illness at pre-pubertal stage affecting adolescence).
Need to consider stress and coping mechanisms in addition to standard examination topics.

Child Development and Response to Stress

Children respond to trouble and distress in different ways, depending on age.
Examples: a 7-year-old child may behave like a 5-year-old in a stressful situation.
Parents' responses to the child's behavior also vary with age.
Children express distress in various ways, and evidence is often obtained through demonstrations of difficulties.

Normal Development in Child Psychiatry

Child psychiatry practice requires knowledge of normal childhood development
Normal development is influenced by genetics, environment, and social factors
Development should be compared to the normal range for the child's age group

Developmental Milestones

Year Two

Children begin to seek independence and may throw tantrums
Tantrums decrease in frequency as children get older
Children start to learn to point and understand simple sentences

Preschool Years

A period of rapid language development and social interaction
Children learn new skills during this period

The First Year of Life

A time of rapid motor, sensory, and social development
Smile at faces: 3 weeks
Selective smiling: 6 months
Fear of strangers: 8 months
Anxiety when separated from mother: shortly after 8 months
Forming a close and secure relationship with caregiver: by the end of the first year
Established pattern of sleeping and feeding, and weaning onto solid foods: by the end of the first year
Ability to point at objects and understand simple causal relationships: by the end of the first year
Making sounds, saying 'mama', 'dada', and one or two other words: by the end of the first year

Child Development in Year Two

Children typically begin to walk by 18 months old
They start to learn self-control and regulate their behavior
Temper tantrums are common, especially when their exploratory desires are frustrated
These tantrums are short-lived and decrease as the child learns to accept boundaries
Children develop gestural communication, pointing at things to share their interest with others
By the end of the second year, children can combine two to three words to form simple sentences

Preschool Years (2-5 Years)

Intellectual abilities increase, with significant advancements in language complexity
Social development occurs as children learn to navigate family dynamics
Children begin to identify with parents and internalize their moral standards
Social skills rapidly develop through interactions with siblings, peers, and adults
Temper tantrums continue, but decrease in frequency and intensity before school age
Attention span and concentration increase steadily
Children are naturally curious, asking many questions about their environment
Fantasy life is vivid and rich, allowing children to temporarily escape reality and fulfill desires
Transitional objects like teddy bears or blankets provide comfort and reassurance
Children begin to explore their own identity, recognizing differences between males and females
Sexual play and exploration are common during this stage
Defense mechanisms develop to cope with anxiety from intolerable emotions
Common mental health issues in this age group include difficulties with feeding, sleeping, separation anxiety, and minor aggression
Persistent issues should be referred to mental health services

Developmental Psychopathology

The stage of development determines whether behavior is normal or pathological, e.g., bedwetting is normal at 3 years but abnormal at 7 years.
Life events affect children differently at various stages of development, e.g., infants under 6 months can adapt to new caregivers, while children aged 6 months to 3 years show distress when separated from familiar caregivers.
Psychopathology can change as the child grows older, e.g., anxiety disorders in childhood tend to improve, depressive disorders often recur, and conduct disorders can lead to aggression and substance abuse.

Common Problems in Later Childhood and Early Adolescence

Common problems in this age group (12-16 years) include fluctuating mood, anxiety, relationship difficulties, disobedience, truancy, substance experimentation, fighting, and stealing.
Schizophrenia and bipolar disorder may onset during this period, but are uncommon.

The Influence of Genes

Susceptibility genes have been identified for autism, ADHD, and specific reading disorder.
However, identified genes explain only a small amount of variance for most disorders, suggesting multiple genes of small effect.
Environmental factors also play a key role, as neurodevelopmental disorders display remarkable syndromal overlap despite genetic differences (heterogeneity).

The Influence of the Environment

Environmental factors can predispose to, precipitate, or maintain disorders.
They can also protect against the effects of other causative agents, e.g., a caring relationship can reduce the risk of depression in adulthood following poor parental care in childhood.
Genetic and environmental factors interact, affecting the likelihood of exposures or their expression.

The Dividing Line between Normal and Abnormal

Common childhood disorders exist on a continuum with normal behavior, but are studied using a categorical system.
A cut-off point is arbitrary, and children who fall just below the threshold can still have problems and need help.
Even mild depressive symptomatology can be associated with poor academic performance.

Continuities and Discontinuities

Some childhood symptoms and behavior problems are associated with problems in adulthood, increasing the likelihood of adverse outcomes, e.g., substance misuse and suicidality.
Overactivity and difficulties in behavioral management in childhood can have long-term consequences.

Classification of Psychiatric Disorders in Children and Adolescents

Seven categories of psychiatric disorders in children and adolescents: adjustment reactions, autism spectrum disorders (ASD), specific developmental disorders, conduct disorders, attention-deficit hyperactivity disorders, emotional disorders, and symptomatic disorders.

DSM-5 and ICD-10 Classifications

Both classification systems are complex.
DSM-5: disorders of childhood are integrated into other sections, no longer in a separate 'infancy, childhood and adolescence' section.
DSM-5: chapters organized chronologically, with infancy and childhood diagnoses listed first.

Epidemiology of Psychiatric Disorders in Children and Adolescents

Behavioural and emotional disorders are common in childhood.
Rates of emotional and behavioural disorders vary according to diagnostic criteria and methods used.
Similar rates of emotional and behavioural disorders in developed and low- to middle-income countries.

Classification of Main Childhood Psychiatric Disorders

DSM-5 and ICD-10 are two classification systems used to categorize childhood psychiatric disorders.
Neurodevelopmental disorders, autism spectrum disorders, attention-deficit hyperactivity disorders, intellectual disability, and communication disorders are classified under DSM-5.
ICD-10 categorizes these disorders into F8 Disorders of Psychological Development, F9 Behavioural and Emotional Disorders with Onset Usually Occurring in Childhood and Adolescence, and other related categories.

Prevalence of Child Psychiatric Disorders

A landmark study on the Isle of Wight in 1970 found a prevalence of approximately 7% for psychiatric disorders among 10-11 year olds.
Boys had higher rates of psychiatric disorders compared to girls.
Subsequent studies have confirmed these findings, with a prevalence of nearly 10% among 5-15 year olds, and 20% among 14-year olds.
Conduct disorder and emotional disorders are the most common conditions, with a prevalence of 5% and 4% respectively.

Epidemiology

A systematic review and meta-analysis reported a pooled prevalence of mental disorders worldwide of 13% among children and adolescents.
Anxiety disorder had a prevalence of 7%, depressive disorder 3%, ADHD 3%, and any disruptive disorder 6%.
In adolescence, the prevalence of anxiety disorders was 31%, behavior disorders 19%, mood disorders 14%, and substance use disorders 11%.
The overall prevalence of disorders with severe impairment and/or distress was 22%.

Variations with Gender and Age

Before puberty, disorders are more frequent among males than females.
After puberty, disorders are more frequent among females.
Particular disorders vary in frequency according to gender and age.
Rates of psychiatric problems differ between urban and rural areas, with higher rates in urban areas.

Comorbidity

Studies using DSM criteria find high rates of comorbidity between childhood disorders.
For example, in the National Comorbidity study, 40% of children had comorbid disorders.

Disorders by Gender

Autism spectrum disorders, specific developmental disorders, ADHD, oppositional and conduct disorders, juvenile delinquency, nocturnal enuresis, and tic disorders are more frequent in males.
Depression, anxiety disorders, eating disorders, and deliberate self-harm are more frequent in females.
Depression before puberty and selective mutism are equally frequent in both genders.

Disorders by Age

Depressive disorders, mania, psychosis, agoraphobia, eating disorders, substance abuse, deliberate self-harm, and juvenile delinquency usually begin after puberty.

Outcomes of Child and Adolescent Mental Illness

Most mild symptoms and behavioral or developmental problems are short-lived.
Severe conditions often persist for years, with 75% of children with conduct disorder and 50% of those with emotional disorders still affected 4 years later.
Anxiety disorders, depression, and ADHD can persist into adulthood.
A family history of emotional disorders and the presence of comorbid difficulties are associated with a risk of recurrence.

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Description

Learn about child mental illness, its underlying dimensions and how they affect perception of problems. Understand the impact of impairment on wellbeing and development.