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Questions and Answers
General practitioners are more likely to refer children with developmental difficulties to a child psychiatrist rather than a paediatrician.
General practitioners are more likely to refer children with developmental difficulties to a child psychiatrist rather than a paediatrician.
False
General practitioners spend most of their time advising parents and rarely refer their children to specialists.
General practitioners spend most of their time advising parents and rarely refer their children to specialists.
True
Children with psychological complications of physical illness are more likely to be referred to a child psychiatrist by general practitioners.
Children with psychological complications of physical illness are more likely to be referred to a child psychiatrist by general practitioners.
False
Emotional, attentional, and conduct disorders are often referred to a child psychiatrist by general practitioners.
Emotional, attentional, and conduct disorders are often referred to a child psychiatrist by general practitioners.
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Referrals to a child psychiatrist are often precipitated by parents or school involvement.
Referrals to a child psychiatrist are often precipitated by parents or school involvement.
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The psychiatric team includes only psychiatrists and psychologists.
The psychiatric team includes only psychiatrists and psychologists.
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Daycare and community-based support completely eliminate the need for inpatient provision.
Daycare and community-based support completely eliminate the need for inpatient provision.
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Managing a child with severe behavioral or eating problems can cause stress for families.
Managing a child with severe behavioral or eating problems can cause stress for families.
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An assertive-outreach approach is essential for the effectiveness of daycare and community-based support services.
An assertive-outreach approach is essential for the effectiveness of daycare and community-based support services.
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Community-based support does not benefit families dealing with children who have severe behavioral problems.
Community-based support does not benefit families dealing with children who have severe behavioral problems.
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Intensive community-based support is explicitly necessary only for adults with severe problems.
Intensive community-based support is explicitly necessary only for adults with severe problems.
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Therapists in child psychiatry typically adopt a single fixed role throughout their practice.
Therapists in child psychiatry typically adopt a single fixed role throughout their practice.
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Medication use in child psychiatry is common and heavily relied upon.
Medication use in child psychiatry is common and heavily relied upon.
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Children have to feel comfortable enough to express their feelings freely for effective psychological treatment.
Children have to feel comfortable enough to express their feelings freely for effective psychological treatment.
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For younger children, play is an insignificant part of psychological treatment.
For younger children, play is an insignificant part of psychological treatment.
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Shaping is a behavioural method that rewards behaviours that come closer to the desired behaviour until it is achieved.
Shaping is a behavioural method that rewards behaviours that come closer to the desired behaviour until it is achieved.
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Psychodynamic psychotherapy has a strong evidence base for use in pre-adolescents.
Psychodynamic psychotherapy has a strong evidence base for use in pre-adolescents.
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Special techniques have been developed specifically for children with aggressive behaviours.
Special techniques have been developed specifically for children with aggressive behaviours.
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Cognitive therapy is equally useful for both younger and older children.
Cognitive therapy is equally useful for both younger and older children.
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Children in long-term foster care have fewer problems than children who have been adopted.
Children in long-term foster care have fewer problems than children who have been adopted.
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Sporadic and distressing contacts with biological parents are helpful to children in foster care.
Sporadic and distressing contacts with biological parents are helpful to children in foster care.
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Closed adoption is when the identities of biological parents, biological kin, and adoptee are not disclosed.
Closed adoption is when the identities of biological parents, biological kin, and adoptee are not disclosed.
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Private domestic adoptions involve prospective adoptive parents and children from different countries.
Private domestic adoptions involve prospective adoptive parents and children from different countries.
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Children who are adopted may experience more difficulties with identity development.
Children who are adopted may experience more difficulties with identity development.
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Severe pervasive developmental disorder can be a reason for inpatient child psychiatric treatment.
Severe pervasive developmental disorder can be a reason for inpatient child psychiatric treatment.
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Embryo adoption involves the donation of embryos and placement in another woman's uterus.
Embryo adoption involves the donation of embryos and placement in another woman's uterus.
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Open adoption does not allow any contact with biological parents.
Open adoption does not allow any contact with biological parents.
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Children in intensive community services are those less severely disturbed and not at risk of self-harm.
Children in intensive community services are those less severely disturbed and not at risk of self-harm.
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Foster care adoption refers to adopting a child who was initially placed in foster care.
Foster care adoption refers to adopting a child who was initially placed in foster care.
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Dynamic psychotherapy is more effective than cognitive behavioural therapy and counselling.
Dynamic psychotherapy is more effective than cognitive behavioural therapy and counselling.
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Parent training is commonly used for a range of child psychiatric problems, including conduct disorder and ADHD.
Parent training is commonly used for a range of child psychiatric problems, including conduct disorder and ADHD.
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Group therapy and art therapy are no longer offered to children with severe difficulties in the UK.
Group therapy and art therapy are no longer offered to children with severe difficulties in the UK.
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Family therapy is contraindicated if the child's problems do not seem to be closely related to family function.
Family therapy is contraindicated if the child's problems do not seem to be closely related to family function.
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Internet-based cognitive behavioural therapy shows positive effects for anxiety in children over the age of 18.
Internet-based cognitive behavioural therapy shows positive effects for anxiety in children over the age of 18.
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A behavioural approach in parent training involves the analysis and correction of specific problems of particular parents and children.
A behavioural approach in parent training involves the analysis and correction of specific problems of particular parents and children.
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Family therapy always focuses on the individual's symptoms rather than family functioning.
Family therapy always focuses on the individual's symptoms rather than family functioning.
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Most research in parent training has been conducted with parents of children with mood disorders.
Most research in parent training has been conducted with parents of children with mood disorders.
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Social workers in the UK have statutory duties with regard to the protection and safeguarding of children at risk within the family.
Social workers in the UK have statutory duties with regard to the protection and safeguarding of children at risk within the family.
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Occupational therapists only work in day-patient units and not in the community.
Occupational therapists only work in day-patient units and not in the community.
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Special educational arrangements are often needed for children attending outpatient clinics.
Special educational arrangements are often needed for children attending outpatient clinics.
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Residential care is seldom arranged for children under 5 years of age.
Residential care is seldom arranged for children under 5 years of age.
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Social workers do not provide family therapy but may provide individual counselling for the child and family members.
Social workers do not provide family therapy but may provide individual counselling for the child and family members.
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Occupational therapists do not devise measures to improve parent-child interaction.
Occupational therapists do not devise measures to improve parent-child interaction.
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Residential care is an appropriate setting for children under extreme parental rejection or unstable home environments.
Residential care is an appropriate setting for children under extreme parental rejection or unstable home environments.
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Foster care is only provided for long-term arrangements.
Foster care is only provided for long-term arrangements.
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Social workers help parents solve problems with finances and accommodation.
Social workers help parents solve problems with finances and accommodation.
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Residential care is associated with higher rates of adult criminal convictions, depression, and low self-efficacy.
Residential care is associated with higher rates of adult criminal convictions, depression, and low self-efficacy.
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Study Notes
Psychiatric Treatment for Children and Their Families
The Role of the Primary Care Team
- General practitioners and other primary care team members refer only a small proportion of children to a child psychiatrist or paediatrician
- Referrals are more likely for children with:
- Developmental difficulties
- Physical symptoms with a probable psychological cause
- Psychological complications of physical illness
- Emotional, attentional, and conduct disorders are more likely to be referred to a child psychiatrist
The Psychiatric Team
- Provides daycare and community-based support, which can help alleviate some of the effects of managing a child with severe behavioral or eating problems
- Requires well-staffed and experienced teams of professionals with an assertive-outreach approach
Treatment for Problems that Led to Neglect or Abuse of the Child
- Children in foster care have better outcomes than those in residential care, but may have more problems than those who have been adopted
- Factors influencing outcomes in foster care include:
- Prenatal exposure to substances
- Age of the child
- Presence of biological children in the fostering family
- Sporadic and distressing contacts with biological parents can be harmful to the child
Adoption
- The process of transferring parental responsibilities from one person to another
- Can be open or closed
- Open adoption allows for contact with biological parents
- Closed adoption does not disclose biological parents' identities
- Closed adoption is becoming less prevalent due to its potential negative effects on adoptees
Types of Adoptions
- Private Domestic Adoptions: Charities and organizations bring together prospective adoptive parents and children within the same country
- Foster Care Adoption: Adoption of a child initially placed in foster care
-
International Adoption: Placement of a child from another country
- Different countries have different laws regarding international adoption
Embryo Adoption
- Donation of embryos to another individual or couple, followed by placement in the woman's uterus to facilitate pregnancy
Psychological Impacts of Adoption
- Can vary widely depending on the type of adoption, age of the child, and experiences prior to adoption
- Common areas of concern include:
- Loss and grief for biological parents
- Identity development
- Poor self-esteem
Intensive Treatments
- Intensive Community Services and Inpatient Care: Essential components of child psychiatry provision, particularly for severely disturbed children
- Inpatient care is necessary for:
- Severity of disorder
- Uncertainty of diagnosis
- Child psychiatric inpatient units require:
- Easy access to paediatric advice
- Space for play and schooling
- Informal design with close observation
- Provision for mothers to stay with younger children
Child Psychiatry
- Therapists work in a family-centred approach, adapting to the needs of the child and family
- They liaise with professionals such as paediatricians, teachers, and social workers
- Teachers often help with behaviour management in the classroom or provide advice on managing certain behaviours
Medication
- Limited use in child psychiatry due to potential adverse effects on the developing brain
- Evidence base for medication use is limited
- Primarily used for:
- Depression
- Severe anxiety
- ADHD
- Sleep disorders
- Psychosis
- Obsessional disorders
- Tics
- Dosages must be carefully checked
Psychological Treatments
- Management: A warm and secure relationship with the therapist is crucial
- Children need to feel comfortable expressing their feelings freely
- Play is an important part of treatment for younger children
- Children may see the therapist as an extension of their parents
- Focus on positive reinforcement over punishment
Common Treatments
-
Behavioural Methods: Used to encourage new behaviours
- Shaping
- Reinforcing behaviour
- Removing reinforcement
- Ignoring unwanted behaviour
- Cognitive Behaviour Therapy: Helps children understand how their thoughts affect their actions
- Systemic Family Therapy: Often used to address family relationships
- Psychodynamic Psychotherapy: Evidence base is poor for pre-adolescents
Aggressive Behaviour
- Special techniques have been developed for children with aggressive behaviours
Therapies for Children and Adolescents with Mental Health Problems
- Psychodynamic Therapies: Less effective than cognitive-behavioural therapy and counselling
- Parent Training: Used for a range of child psychiatric problems, improves parenting skills
- Family Therapy: Focuses on the family, viewing a child's symptoms as a result of family malfunctioning
- Internet-Based Therapies: Shows positive effects for depression and anxiety in those over 18
Social Work
- Social workers play a key role in the care of children with psychiatric disorders and their families
- They have statutory duties regarding child protection and safeguarding
- They help parents improve their skills and solve problems with finances or accommodation
Occupational Therapy
- Occupational therapists play a valuable role in assessment, psychological treatment, and improving parent-child interaction
- They work closely with teachers in assessing and providing therapeutic activities for children
Special Education
- Children who attend outpatient clinics may benefit from additional educational arrangements
- Special teaching may be needed to restore confidence and remedy delays in writing, reading, and arithmetic
Substitute Care
-
Residential Care: Provided for children with:
- Profound intellectual and neurodevelopmental disorders
- Emotional and behavioural problems due to unstable home environments or parental rejection
- Residential care has a long history in providing services for children with a range of problems
- It can provide therapeutically planned behavioural health interventions in a 24-hour structured care environment
Fostering and Adoption
- Foster care may be of three kinds:
- Short-term emergency care
- Long-term foster care
- Permanent foster care
- Children in foster care are a population vulnerable to physical and sexual abuse
- Evidence suggests that residential care is associated with adult criminal convictions, depression, and low self-efficacy
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