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Jutta Dotterweich Cornell University [email protected] www.actforyouth.net Adolescence is physically the healthiest period of the lifespan 0.12 0.1 Yet: overall morbidity and mortality rates increase 200% from childhood to late adolescence Youth age 13 – 18: 50% experienced mental health symptoms 22% had a lifetime prevalence of severe symptoms (2010) 0.08 female 0.06 male 0.04 0.02 0 0 10 20 30 Age 40 50 60 70 Anxiety Disorders Mood Disorders Learning Disorders Disruptive Behavioral Disorders Thought Disorders • • • • Separation anxiety Social anxiety (7%, onset around age 13) Phobias (5% in children, 16% in adolescents (13-17), 3-5% in older people) Panic Disorder (2-3% adolescents) 8% of teens ages 13-18 experience anxiety disorders Obsessions: Recurrent and persistent thoughts, urges or images perceived as intrusive Compulsions: Repetitive behaviors or mental acts the individual is driven to in response to an obsession. Onset typically late adolescents, can be earlier Prevalence in adolescence: 1 in 200 Traumatic event includes ─ actual or threatened death, injury or assault to self or someone close ─ chronic stress (i.e. wars, violent neighborhoods, abuse/ neglect in family home) ─ natural catastrophes Child’s or adolescent’s response is intense fear, helplessness, or horror Failure to thrive Poor hygienic condition Underdevelopment of motor coordination; hyper tonicity May appear bewildered, unfocused Blank expression Unresponsive to social contact/interaction Inhibited Excessive familiarity with unknown persons can give hugs to anyone who approaches them; can go with strangers May approach a complete stranger for comfort, food, to be picked up, etc. Disinhibited o o o o o o Symptoms last longer than a month after event Intrusive re-experiencing of the trauma, avoiding trauma reminders, and persistent state of alert Related emotional and behavioral problems Co-occurs with other disorders (anxiety, ADHD, oppositional defiant disorder, etc.) 15% of girls, 6% of boys who experienced trauma meet criteria for PTSD (3 – 50% in juvenile justice) Symptoms vary according to developmental stages Symptoms: Early & Middle Childhood Generalized nightmares ─ Persistent re-experiencing of event through repetitive play or storytelling Physical symptoms ─ Increased arousal/hyper-vigilance ─ Failure to progress or regression in developmental skills ─ Impaired social relationships/caregiver relationships ─ Flashbacks Persistent re-experiencing of event (sometimes through risk-taking behavior) Physical symptoms Increased arousal/hyper-vigilance Failure or regression in academic skills; concentration problems Impulsive or aggressive behaviors Absence of future planning • • • • Dysthymic disorder Depression Bipolar disorder Disruptive mood dysregulation (2-5%, onset before age10) Persistently sad/irritable Difficulty sleeping or oversleeping Loss of energy Feelings of worthlessness Loss of interest Difficulty concentrating Significant change in weight/appetite Recurrent thoughts of death/suicide Physical agitation Likelihood of onset increases with puberty 11% of adolescents have a depressive disorder by age 18 (NIMH) Rate for females 1.5 – 3 times higher than for males Severe changes in mood Inflated self-esteem Great energy increase Increased talking Distractibility Increased goal-directed activity or physical agitation Disregard of risk Decreased appetite May be delusional MANIC SYMPTOMS Onset usually late adolescence DEPRESSION Attention Deficit Hyperactivity Disorder – ADHD (3-7% of school-age children Dyslexia (specific learning disorders) (5-15% among school-age children) ─ Boys 3 times more like to be affected ─ Often associated with anxiety disorders and depression ─ No cognitive impairment Inattention or inconsistent attention Hyperactivity Impulsivity Oppositional/Defiant Disorder (1-11%) ─ contrariness, constantly arguing & swearing Conduct Disorder (2-10%) ─ aggression to people and animals, deceitful, destruction of property Schizophrenia or Psychotic Disorder: Delusions – false beliefs Hallucinations – sensations that nobody else has Disorganized Thinking – trouble organizing thoughts logically Onset usually late adolescence/early adulthood Lifetime prevalence 0.3-0.7% Persistent deficits in social communication and interaction Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities 3 levels of severity depending on functioning level of first two symptoms Hyper – or hyporeactivity to sensory input Intellectual impairment • Asperger’s (outdated category): normal or high intelligence Prevalence close to 1% of population Hyperactivity Aggression/self-injurious behavior Withdrawal Immaturity Learning difficulties Common Side Effects ─ ─ ─ ─ ─ Drowsiness Increased or decreased appetite Headaches Nausea Dizziness Meet Sam He is more than his diagnosis and behavior problems Stress signals involve feelings, thoughts, behaviors and physical reactions Identify triggers for stress • Observation • Conversation with youth • In residential settings ask staff Positive appraisal – reframing the situation Problem-focused coping – brainstorming and planning to resolve conflict, acquire resources and supports Emotion-focused coping – manage or reduce emotional distress (cognitive or behavioral strategies) Meaning-focused coping – search for meaning in adversity and draw on values, beliefs and goals Clutter, disorganization Lighting Noise level Time of day (daily routine, structure) Community settings – crowds, noise, activity level Proximity Prompts Hurdle help Time away Redirection Planned ignoring and positive attention Directive statements Caring gesture Attentive listening Respectful questioning Empathic communication Facial Expression 55% + Tone of Voice 38% + Words 7% • • • • • • Silence Eye Contact Facial expression Posture (e.g., leaning forward) _______________ Minimal encouragement (“uh-huh,” go on, etc.) Tone of voice Listening for meaning Attentive to speaker Reflecting facts and feelings Interpreting meaning, feelings Withholding opinions and judgment National Institute of Mental Health http://www.nimh.nih.gov/index.shtml NYS Office of Mental Health http://www.omh.ny.gov/ American Academy of Child & Adolescent Psychiatry http://www.aacap.org CDC - ACE Study http://www.cdc.gov/violenceprevention/aces tudy Collaborative for Academic, Social, and Emotional Learning http://www.casel.org/sel/families.php US Reach Out http://us.reachout.com/the_facts Kids Health (for teens) http://kidshealth.org/teen/your_mind/#cat 20123