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Literature summary and lecture notes ACAP 2024
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Advanced Child and Adolescent PsychiatryApril 2024
1. Introduction
Difference between specialists- psychiatrist is medical specialist.
Child and adolescent development and disorders:
- normal development/atypical development/complex disorder.
- This course covers mostly complex disorders (aside from autism).
Factors that influence client outcome can be divided into 4 areas:
1. Extra-therapeutic factors
2. Expectancy effects
3. Specific therapy techniques
4. Common factors (empathy, warmth, therapeutic relationship)
Alliance and expectancy are active ingredients of treatment.
Treatment relationship
- Interpersonal skills: verbal fluency, interpersonal perception, affective
modulation and expressiveness, warmth and acceptance, empathy and
focus on other.
- Establish trust.
- Awareness of clients age, culture and context
- adjusting therapy when there is resistance or not adequate progress.
- Communicate hope & optimism to your client. But not making false
promises.
- Awareness of own psychological process and do not inject own
material in therapy.
Basic attitude towards families
- Parents are competent and experts about their child, treatment team is
expert on theoretical knowledge about the disorder and treatment.
- Parents stay with their children; therapists come and go.
- Goal is not to cure but to find new healthier balances.
- Non-violent resistance
Working with children and young people vs adult mental health care:
- Working with different developmental phases
- Always working with families/caretakers
- Working with schools, community and legal system
Quiz:
According to Lian Nijland's Introduction lecture, what is a key difference
between working in mental health care with children/young people compared
to adults? The role of family involvement and other stakeholders is typically
more prominent in child and adolescent psychiatry.
2. Autism
Presentation Mirjam Rinne-Albers:
- Women with autism/growing awareness phenotypes/features and causes.
- Phenotypes are observable characteristics of an individual. In autism:
behavioral aspects. Difference boys and girls = externalizing and
, internalizing behaviors. Externalizing problems are often noticed
because it can be disruptive.
- Genes: autism is a neurodevelopmental disorder and biased towards
males, epigenetics are important when discussing the gene-environment
interaction: “female-protective-effect”. girls need to inherit more
factors related to autism than boys do to show traits of the condition- they
are more resistant.
- Biological difference: brain patterns, autism brain is more wired,
especially the short tracks. Boys often show externalizing symptoms due
to impairments in motor brain areas and language areas (therefore: more
noticeable)
- Social-cultural influence: upbringing, education, peer-relationships.
Different social environments- experience different social challenges –
different phenotypes.
- Women turn inward; she is ‘shy’. What happens in girl groups is that one
of the girls become protective and mother them + different social
environments mean different social challenges/different phenotypes.
- Diagnosing girls: often they can adapt a lot, until a certain point. At some
point it gets too much, and it can translate into depression and anxiety.
Secondary conditions occur – after diagnosis they can regulate better and
understand their internal behaviors.
- Assessment instruments: biased towards males, male to female ratio is
3:1- the diagnostic processes less likely to identify females. Leads to
underdiagnosis in girls.
- Girls with ASD learn compensatory behaviors such as
camouflaging/masking leads to physical/emotional exhaustion, needing
time alone to recover, identity issues etc.
- Differential diagnosis is often a secondary condition as a consequence
from initial diagnosis. definition: when you are trying to find a right
diagnosis, you first guess which it could be, after that you start seeking
symptoms and find the correct diagnosis.
- Assessment tools: IQ test,
- Treatment: psychoeducation, family therapy, pharmacotherapy (some
anti-psychotic meds work well), music/creative therapy, educational
therapy, social skills training.
Assigned literature:
CONSTANTINO (2016) JN, Charman T. Diagnosis of autism spectrum
disorder: reconciling the syndrome, its diverge origins, and variation in
expression
Aim: to discuss the diagnosis of autism spectrum disorder, including the
variability in its presentation and the different origins of the disorder, in order
to improve understanding and recognition of the condition.
Future advancements in autism spectrum disorder (ASD) classification aim to
enhance diagnosis by:
- Recognizing ASD as the severe end of a continuum in social communication
abilities.
- Standardizing symptom assessment by sex and mental age.
- Specifying relationships between autistic symptoms and other influences
on child development.
- Incorporating subclinical symptoms into a comprehensive nosology.
- Identifying specific causal influences and their associated symptoms.
, - Categorizing pleiotropic effects of known ASD causes.
- Including motor coordination impairments in diagnostic criteria.
- Establishing protocols for efficient diagnosis in healthcare settings.
- Defining impairments in adaptive functioning for service eligibility.
DEAN (2014) M, Kasari C, Shih W, Frankel F, et al., The peer relationships of
girls with ASD at school: comparison to boys and girls with and without
ASD. Journal of Child Psychology and Psychiatry 2014; 55; 11; 1218-1225.
Results: Consistent with typically developing populations, children with ASD
preferred, were accepted by, and primarily socialized with same-gender
friends. With fewer nominations and social relationships, girls and boys with
ASD appear more socially similar to each other than to the same-gender
control group. Additionally, girls and boys with ASD showed higher rates of
social exclusion than their typically developing peers. However, boys with
ASD were more overtly socially excluded compared to girls with ASD,
who seemed to be overlooked, rather than rejected.
Conclusions: Our data suggest a number of interesting findings in the social
relationships of children with ASD in schools. Like typically developing
populations, children with ASD identify with their own gender when socializing
and choosing friends. But given the social differences between genders, it is
likely that girls with ASD are experiencing social challenges that are different
from boys with ASD. Therefore, gender is an important environmental factor
to consider when planning social skills interventions at school.
This study examined the social relationships of girls and boys with ASD,
considering gender differences. Data on peer nominations revealed patterns
of social preferences, acceptance, connections, and rejection. While typically
developing girls received more friend nominations, girls with ASD had
fewer friendships and were often overlooked. Children with ASD
tended to socialize with same-gender peers, but had fewer playmates
and were on the periphery of social groups compared to typically developing
children. Girls with ASD faced unique challenges in social integration
compared to boys with ASD or typically developing girls.
KETELAARS (2017) MP, In ‘t Veld A, Mol A, Swaab H, Bodrij F, van Rijn S. Social
attention and autism symptoms in high functioning women with autism
spectrum disorder. Research in Developmental Disabilities 2017; 64; 78-86.
This study investigates social attention patterns in females with Autism
Spectrum Disorder (ASD) compared to typical females. The findings
suggest that women with ASD exhibit atypical gaze behavior,
focusing less on the face, which may impact their understanding of
social communication. There is also a correlation between social attention
and autism symptoms, indicating that social attention is a core
impairment in individuals with ASD.
We identified subtle social attention impairments in our study, although
analyzing visual scanning patterns did not reveal a specific impairment such
as increased focus on the mouth or decreased focus on the eyes.
Interestingly, we did observe a normal initial orienting response, as
evidenced by a normal time to first fixate on the face. The duration of fixation
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