ADHD study day in Liverpool

We heartily recommend this forthcoming ADHD and Allied Neurodevelopmental Services Symposium conference, organised by the ADHD Foundation. The conference will take place over two days in Liverpool on the 5th– 6th November 2015.

The presentations on the 5th November would be of interest to anyone working in a clinical capacity with adults/ young people with ADHD. The conference on the 6th November  is more focused upon how we achieve outstanding educational outcomes for children and  young people with ADHD.

Highlights of the conference on the 5th November include:

  • Examples of a range of new models of Service design, multiagency approaches and transformed ADHD Pathways from around the UK.
  • Latest developments in the National Autism Project.
  • Latest developments using digital technology in assessing core signs of ADHD.
  • New research in ADHD and Drug Use and ADHD and Neurofibromatosis.
  • Recent research into a significantly underrepresented group, Girls and Young women and ADHD.

Highlights of the conference on the 6th November include:

  • The results of a ten year research project in London into effective SEND provision and developing the role of the SENCO.
  • Lesley Cox, Lead HMI for SEND and Disability for OFSTED presenting “How OFSTED evaluate outstanding SEND provision.“
  • Girls and ADHD.
  • Using innovative technology in school to increase self regulation for learners with ADHD and increase attainment.
  • Workshops on outstanding practice with learners with dyslexia, dyscalculia and Tourette’s syndrome.

 

See below for more information on this conference, details of the speakers, booking arrangements and information about our conference dinner on the evening of the 5th November with Rory Bremner as the after dinner speaker. If you require any more information, please contact ella.duxbury-davies@adhdfoundation.org.uk

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National trainee day for paediatric mental health

Date:     7th January 2016

Venue: Conference Room, Children’s Neurosciences Centre, St Thomas’ Hospital, First Floor, Block D, South Wing, Westminster Bridge Road, London SE1 7EH. Tel: 020 7188 7188

This training day is designed to provide information and practical advice on various diagnostic and management issues related to mental health of patients and/or their family across acute and community paediatrics. We have focussed topics around those “most wanted” by Paediatric Trainees in a recent UK-wide survey.

Programme:10:00     Registration and coffee

10:15     Medically unexplained symptoms

Dr Lee Hudson, Consultant Paediatrician,  Great Ormond Street Hospital & Honorary Research Associate, Institute of Child Health

11:15     Self harm and emergency assessment

Dr Esther Sabel, Consultant Child and Adolescent Psychiatrist, Hertfordshire CAMHS

12:15     Lunch

13:00     Eating disorders – what do Paediatricians need to know and do?

Dr Nasima Matine, Consultant Child and Adolescent Psychiatrist, The Phoenix Centre, Cambridge

13:45     Behavioural and emotional difficulties – workshop

Dr Nicola Herberholz, Consultant Paediatrician/Paediatric Mental Health and Dr Bo Fischer Specialist Registrar in Paediatrics/Paediatric Mental Health

14:45     Coffee                                                                                                            

 15:00     Paediatric liaison

Dr Rory Conn, Specialty trainee Child and Adolescent Mental Health and Darzi Fellow in Quality Improvement and Patient Safety, Great Ormond Street Hospital

15: 45    Overview of psychological therapies and their indications

Dr Sophie Bennett, Research Associate, UCL Institute of Child Health & Honorary Clinical Psychologist, Great Ormond Street Hospital

16:30     Close and certificates

All for £50! Bargain!!

 Download application below! 

2nd_Paediatric_Mental_Health_Traingin_Day_Final

Contact :      Bo Fischer                           bo.fischer@nhs.net

Nicola Herberholz            nicola.herberholz@nhs.net

How paediatric trainees can attain mental health competences in everyday practice

Paediatrics has taken baby steps towards embracing mental health as an integral part of practice. One area where there has been progress is the incorporation of mental health into curricula. This is great, but the problem is that no-one had thought through how to achieve these time-consuming skills in the maelstrom of training.

We held a workshop last week to examine this question at the BACCH national trainee day. We had a highly engaged group who came up with a ton of suggestions. Here’s a summary with some pointers.

We put aside the curriculum document, which is a little vague in its wording, and instead talked about what would useful in practice:

1) mental state examination- how to do it, and interpret it.

Advice: this is an area where a quite common sense exercise has been made unnecessarily mysterious. The idea is simply to record the appearance, manner and pattern of communication employed by the person in front of you. In this sense, great novelists are masters of the mental state exam. There are few great novelists working in paediatrics, though, so an acronym helps you to remember some of the important aspects.
A- Appearance and Behaviour
S- Speech
E- Emotion [mood and affect]
P- Perception [Hallucination and illusion]
T- Thought content and process
I- Insight and Judgement
C- Cognition (how information is processed)

2) tools to assess mood problems

Low mood and especially, anxiety are extremely common in community paediatric clinic, and can generally be elicited by features of the standard history and a few selected questions, as below.
Anxiety: history of avoidant behaviors, agitation in certain situations and specifically voiced fears
Always ask: is she a worrier?
Low mood: history of loss of previous interests, lack of enthusiasm, withdrawal e.g. into computer games
Always ask: do you ever feel like you’re worthless?
There are now two questions: how do I decide which children require specialist assessment, and what do I do with those that don’t, or those that are awaiting CAMHS input?
The first question I’d probably best answered by pointing to some useful, freely available questionnaires that can be given to families to fill out. RCADS covered anxiety and depression, as does the mood and feelings questionnaire.
Managing mental health difficulties before or instead of CAMHS assessment is difficult. We have written the 5 minute tips series to help you, but essentially you need to work with the family to produce a story about why the symptoms are happening, and use that story to tease out areas of resilience and protective factors, which you can then use to improve the situation. You will also need to incorporate some standard advice, as lain out here for anxiety, and here for depression.

3) Involving local CAMHS in your training
It’s important to remember that CAMHS teams are small, and beleaguered. Also, there are increasing pressures on community paediatric teams to increase productivity. Training in mental health, across different teams/ trusts, is obviously harder to attain.
On the other hand, there are some essential experiences that ought to be possible:
Attend a CAMHS referral meeting, and learn how many referrals they get, and how many other options there are for emotional and behavioural problems other than CAMHS.
Observe a few CAMHS assessments, just to see how the approach differs from community paeds
Discuss some of your cases with a psychiatrist, not in order that they take them on, but to see another perspective.
Joint clinics can be great: my personal experience is that this works best with non-doctors who work in CAMHS- they value your medical experience while you will learn from their approach and skills. If they want you to see for a clinical reason (possible ASD, genetics) you can also ching it as a referral to your own service, so your bosses will be happy (and it’s a good model of care).

4) accessing e-learning
There is a ton of e-learning relevant to the mental health aspects of community at Mind Ed. The core curriculum is a useful introduction, the specialist CAMHS section pushes you on, and for the overlap between mental health and community, there are some Healthy Child Programme sessions that can be accessed via Mind Ed.
Finally, there is even a paediatric learning path if you log in!

5) supporting parents to deal with behavioral problems
Coming soon..

6) a new study day
We want to do a study day on mental health for community paeds trainees. Current ideas for content include
Medication workshop
Role of OT
Explanation of psychotherapy for children
How to give behavioural advice

Let me know what you think

5 minute tips for anxiety in children and young people

This post allows you to give brief advice if it send that a child has problems with anxiety. It should be read after you have gone through our introductory post, and is intended for non specialists working in health services.

When to think of anxiety
Excessive anxiety is common in childhood, but is particularly common in chronic or recurrent pain (up to 80%) and in developmental conditions, especially autistic spectrum disorders.

What are the key questions to ask
Worries: in quiet moments, does the child worry about going to school, harm coming to their family or themselves, any imaginary creatures or anticipated events
Avoidance: anything that the child doesn’t do, or doesn’t want to do
Sleep: difficulty settling, frequent waking, nightmares
Eating: restrictive patterns, poor appetite

Safety checks: (seek advice if these are happening)
Is the child harming themselves, or consider doing so?
Does the child feel worthless?

What advice can you give?

There are two main forms that therapy takes, both of which can be applied in a ‘low-voltage’ fashion in non-specialist settings.

Firstly, it is helpful to draw out the thoughts and beliefs that underlie the anxiety.  This is not so that the adult can dismiss them as silly or mistaken, but so the child can be helped to compare the harmful cognitions with their other beliefs and feelings (e.g. monsters aren’t real) which can then be used to challenge the anxiety. Equally, it’s important when a child is worried about a particular event to talk through what consequences may result, and again check that the child really thinks these consequences are likely, and plausible. In some cases, especially involving social situations, it may that the child’s fears are justified, in  which case negotiation with third parties (teachers, family) would be useful.

Secondly, some kind of graduated exposure is often helpful. Say the child is scared of going to the toilet alone. Going with a parent, but with the parent then standing in the doorway would be a good start, which the child could be rewarded for. Next time, they would need to tolerate the parent being in the hallway in order to earn a reward, and so on.

These techniques are explained further in resources

Resources

This fact sheet can be a useful start for parents . Simple-ways-to-help-children-with-fears-and-anxieties

Cathy cresswell’s article in the Archives of Disease in Childhood is very good, as is her book for parents

The Mind Ed portal has a lot of information on anxiety. It’s designed for professionals, but there is really no reason why a motivated parent can’t access it, especially

The worried child

Anxiety disorders

The session on school avoidance is excellent, and there are loads of generalisable tips in it