Questions and Answers
Selective mutism is also known as elective mutism.
True
Children with selective mutism typically have higher language scores compared to their peers.
False
The onset of selective mutism usually occurs between the ages of 4 and 6.
False
Selective mutism can occur in approximately 1 in 100 children.
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A common comorbidity with selective mutism is social phobia.
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Selective mutism assessment is straightforward because children readily speak to psychiatrists.
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Selective mutism has a remission rate of 58% after 13 years from the first referral.
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Stammering is equally common in boys and girls.
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Cognitive behavioural therapy is often the last choice of intervention for childhood disorders.
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Psychotic symptoms are uncommon before the age of 9.
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Dementing disorders are common in childhood due to various organic brain diseases.
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After entering school, 0.3-1% of children will continue to stammer.
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The cause of stammering is well understood and primarily linked to psychiatric disorders.
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Hallucinations and delusions are the most commonly reported symptoms of childhood psychosis.
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Tic disorders are characterized by the absence of Gilles de la Tourette syndrome.
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Most children with stammering improve regardless of treatment.
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The criteria for diagnosing childhood schizophrenia differ from those used for adults.
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A diagnosis of schizophrenia can be made if hallucinations or delusions are present for at least 6 months.
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Schizophrenia is more prevalent in girls than in boys.
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Effective treatments for early-onset schizophrenia are well established.
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Many young people with early-onset schizophrenia respond adequately to available drugs without major side effects.
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Gender dysphoria in children is characterized by a strong desire to embrace the same gender.
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Suicide is the leading cause of death among adolescents.
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There is substantial evidence supporting the effectiveness of psychosocial treatment for self-harm and suicide.
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Children with chronic health conditions may experience psychological challenges due to factors like poverty and single-parent family.
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Psychiatric illnesses in children do not influence adherence to medical treatments.
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Adherence to medical treatments in children is commonly reported to be between 30% to 50%.
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Cognitive behavioral therapy is effective for treating anxiety in children with chronic physical illnesses.
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Most childhood cancer survivors do not adapt well after treatment.
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Support for parents of children with chronic illnesses is unnecessary as they can manage on their own.
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A child's chronic physical illness can lead to emotional reactions in parents that resemble those of bereavement.
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It is advisable to introduce children to hospital staff before their admission.
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Emotional support is not considered important during the treatment of childhood cancer.
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Brothers and sisters of children with medical illnesses may feel neglected due to the focus on the ill child.
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Cannabis and 'ecstasy' are the only drugs commonly abused in adolescence.
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Solvent abuse typically lasts for a long duration in adolescents.
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There is no connection between conduct disorder and drug taking during adolescence.
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Most adolescents who experiment with drugs do so for extended periods and become regular users.
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The developing brain is less vulnerable to substance misuse than an adult brain.
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Younger adolescents require an interviewing approach similar to that used for adults.
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Adolescent psychiatric clinics typically see a larger proportion of adolescents than other age groups.
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Inpatient facilities for adolescents are usually extensive and well-resourced.
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Feelings of alienation and low self-esteem can contribute to persistent drug use among adolescents.
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All adolescents seen by psychiatrists attend willingly.
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Adolescence is characterized by high resistance to peer influences and low risk perception.
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Psychiatric disorders are significantly more common in adolescence than in childhood.
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Eating disorders in adolescence require the involvement of family members in treatment.
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Substance use disorders peak around age 25 years in adolescents.
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The prefrontal cortex develops significantly during late adolescence.
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The problems of adolescence are always conspicuous and predictable.
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Adolescents often seek out calm and stress-free situations when making decisions.
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Conduct disorder is less frequent in adolescence than in childhood.
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Systemic family therapy has been shown to be ineffective for anorexia nervosa in adolescents.
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Around 87% of 16-year-olds have 'ever' used alcohol, according to a 36-country average.
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Study Notes
Selective Mutism
- Selective mutism, also known as elective mutism, involves a child's refusal to speak in specific social situations, often speaking normally at home.
- Affects speech proficiency, with children showing lower standardized language scores than peers.
- Commonly co-occurs with anxiety disorders, particularly social phobia, and is classified under anxiety disorders in DSM-5.
- Onset typically occurs between 3 and 5 years of age after normal speech development.
- Clinically significant cases are rare, estimated at approximately 1 in 1000 children.
- Diagnosis can be challenging as children often do not speak during clinical assessments, relying heavily on parental feedback.
Assessment of Childhood Disorders
- Key to ask parents about speech and comprehension levels at home.
- Treatment aims to reduce anxiety and encourage speaking in more situations.
Cognitive Behavioral Therapy
- Cognitive behavior therapy and/or play therapy are first-line interventions.
- Selective mutism has a low remission rate of 58% after 13 years since referral.
- Correlated with risks for phobias, social anxiety, depression, substance abuse, and more severe mental illness based on a 2015 study.
Stammering (Child-Onset Fluency Disorder)
- Characterized by disruptions in speech fluency, such as repetitions and blocks, more common in boys.
- Usually a transient issue at language onset; prognosis worsens past age 7.
- Approximately 0.3-1% of school-age children continue to stammer.
- Etiology likely includes genetic, brain injury, and anxiety components.
- Treatment includes speech therapy and techniques like fluency shaping and stuttering modification.
Tic Disorders
- Include conditions such as Gilles de la Tourette syndrome, with further details available in specialized literature.
Dementia
- Extremely rare in childhood, usually linked to organic brain diseases like lipidosis or leucodystrophy.
- Prognosis is typically poor, with many cases being fatal.
Psychosis and Early-Onset Schizophrenia
- Psychotic symptoms more frequent in younger children (9-12 years) than older adolescents (13-18 years).
- A 2012 study found 17% of children and 7.5% of adolescents report such symptoms.
- Symptoms include hallucinations and delusions, with significant developmental risk factors involved.
- Assessment of all preadolescent psychiatric patients for these symptoms is advisable, as they correlate with behavioral issues like self-harm.
Treatment of Early-Onset Schizophrenia
- Diagnosis is the same as for adults, requiring symptoms for at least 1 month.
- Effective treatments are less well established than for adults, often combining antipsychotics with psychoeducation.
- Early detection and intervention are emphasized due to less favorable treatment response in children and potential metabolic side effects.
Gender Dysphoria
- Characterized by a strong desire to be or insistence that one is of the other gender.
Suicidal Behavior and Self-Harm
- Major public health issues in adolescents, with high rates of self-harm during teenage years.
- Suicide is the second leading cause of death; contributors include genetic factors, psychiatric and social influences, with little evidence for effective treatment.
Impact of Childhood Physical Illness
- Hospitalized children with medical illnesses have higher emotional disorder risks, with estimates of psychological distress ranging from 20% to over 35%.
- Chronic conditions correlate with emotional challenges, particularly if compounded by family dynamics and economic factors.
Non-Adherence to Medical Treatments
- High rates of non-adherence to medical treatments (50-80%); factors include family systems and psychiatric illness.
Addressing Childhood Asthma and Cancer
- Managing asthma requires understanding adherent factors and stress management.
- Though childhood cancer is rare, psychological support is essential during key treatment phases to aid adaptation.
Mental Health Services in Hospital Settings
- Integrated psychiatric services within general hospitals enhance care for children with medical illnesses.
Challenges for Parents
- The severity of a child's illness profoundly affects parental emotional responses and family dynamics; support systems are crucial for balance.
Adolescent Population Considerations
- This period features critical brain development and significant behavioral changes, emphasizing the need for tailored mental health services.
- Psychological issues in adolescence can mimic adult patterns but require specific diagnostic skills to differentiate them from normative emotional responses.
Substance Use Disorders
- Among the most common psychiatric issues in youth, substance use peaks around age 20 and can lead to long-term addiction.
Effective Communication and Assessment
- Building rapport with adolescents important for effective assessment; involves adapting communication methods to fit their developmental stage.
Admission Reasons for Adolescents
- Adolescents may require hospitalization for severe symptoms or dangerous behaviors linked to psychiatric issues.
Child Maltreatment
- Recognizes the various forms of maltreatment as defined by health authorities, highlighting the importance of protective interventions.
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Description
A condition where a child refuses to speak in certain social situations, despite speaking normally in others. Often accompanied by comorbid anxiety disorders.
