Download Common Mental Health Diagnoses of Children

Presented By:
Susan Silva, LCSW
Forensic Interviewer
The Children’s Advocacy Center
of Green River District
What are Mental Illnesses?
 Mental Illness is a disorder of the brain that disrupts a
person’s thinking, feelings, mood, ability to relate to
others, and daily functioning.
 Mental Illnesses are brain disorders that often result in
a diminished capacity for coping with the ordinary
demands of life
CHILDRENS MENTAL HEALTH
DISORDERS
 About 1 in 5 American Children suffer from a
diagnosable mental illness during a given year
 Nearly 5 million American Children and Adolescents
suffer from a serious mental illness- one that
significantly interferes with their day-to-day life.
 U.S. Surgeon General
Serious Emotional Disturbance
 The term “serious emotional disturbance” is used in a
variety of Federal Statutes in reference to children
under the age of 18 with a diagnosable mental health
problem that severely disrupts their ability to function
socially, academically and emotionally. The term does
not signify any particular diagnosis, rather it is a legal
term that triggers a host of mandated services to meet
the needs of these children.
 www.nimh.nih.gov
MAJOR MENTAL ILLNESSES AND
BEHAVIORAL DISORDERS THAT
AFFECT CHILDREN
 Anxiety Disorders
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Post Traumatic Stress Disorder (PTSD)
 Depression/Mood Disorders
 Attention Deficit Disorders (ADD/ADHD)
 Bipolar Disorder
DSM IV TR
Published in 2000
 The DSM-IV-TR is the most current version of the
American Psychiatric Association’s Diagnostic and
Statistical Manual of Mental Disorders (DSM)
 It is the standard classification of mental disorders
used by mental health professionals in the U.S.
 DSM-IV-TR has been designed to use across settings
inpatient
outpatient
partial hospital
clinic
private practice
primary care
WHO USES THE DSM IV-TR?
 Mental health and Health Professionals:
 Psychiatrists
 Psychologists
 Social Workers
 Nurses
 Occupational & Rehabilitation Therapists
 Counselors
THE DSM IV-TR CONSIST OF 3
MAJOR COMPONENTS
 The diagnostic classification
 The diagnostic criteria set
 The description text
Diagnostic Classification
 The diagnostic classification is the list of mental
disorders that are officially part of the DSM system.
 “Making a DSM diagnosis” consist of selecting those
disorders from the classification that best reflect the
signs and symptoms that are affecting the individual
being evaluated.
 With each diagnostic “label” is a diagnostic code used
by clinicians, hospitals and agencies.
 Codes come from the ICD-9-CM, used in the U.S. by
all healthcare professionals.
Diagnostic Criteria Sets
 For each disorder in the DSM, a set of diagnostic
criteria indicate what symptoms MUST be present
(and for how long) in order to qualify for a diagnosis.
It also identifies those symptoms that MUST NOT be
present in order to qualify for a particular diagnosis.
 These criteria are used as guidelines to be informed by
clinical judgment to formulate a diagnosis.
Descriptive Text
 The third component of the DSM is the descriptive text
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that accompanies each disorder with “headings”:
“Diagnostic Features”
“Sub-types and/or Specifiers”
“Recording Procedures”
“Associated Features and Disorders”
“Specific Culture, Age and Gender Features”
“Prevalence”
“Course”
“Familial Pattern”
“Differential Diagnosis”
Multiaxial System of Assessment
 A multiaxial system is an assessment on several
axes…the different domains of information that may
help the clinician plan treatment and predict outcome
of treatment.
 There are five axes included in the DSM-IV-TR
multiaxial classification.
The Multiaxial System of
Assessment … 5 Axes
 A multiaxial system is an assessment on several axes-the different domains of
information that may help the clinician plan treatment and predict outcome.
 There are 5 axes included in the DSM-IV-TR multiaxial classification:
 Axis I: Clinical Disorders
Other Conditions that may be a focus of Clinical Attention
Mood Disorders
Anxiety Disorders
Adjustment Disorders
Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence
(Excluding Mental Retardation…on Axis II)
Multiaxial System cont’d.
 Axis II : Personality Disorders
Mental Retardation
A Personality Disorder is an enduring pattern of inner
experience and behavior that deviates markedly from
the expectations of the individual’s culture, is
pervasive and inflexible, has an onset in adolescence
or early adulthood, is stable over time, and leads to
distress or impairment.
Personality Disorders: prominent maladaptive
personality features and defense mechanisms
Multiaxial System cont’d.
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Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Personality Disorder (NOS) Not Otherwise Specified
Multiaxial System cont’d.
 Mental Retardation
The essential feature of Mental Retardation is significantly general intellectual functioning that is accompanied by
significant limitations in adaptive functioning in at least 2
skill areas : communication, self-care, home living,
social/interpersonal skills, use of community resources,
self-direction, functional academic skills, work, leisure,
health and safety.
The onset must occur before 18 years of age.
Significantly sub-average intellectual functioning is defined
as an IQ of about 70 or below.
Multiaxial System cont’d.
 Axis III : General Medical Conditions
A General Medical Condition can be directly etiological to
the development or worsening of mental symptoms and
that the mechanism for this effect is PHYSIOLOGICAL.
Examples: Endocrine, Nutritional & Metabolic Diseases
Immunity Disorders
Diseases of the Nervous System
Diseases of the Digestive System
Diseases of the Respiratory System
Injury & Poisoning
Multiaxial System cont’d.
 Axis IV : Psychosocial and Environmental Problems
Examples: Familial or Interpersonal Stressors
A negative life event
Environmental Deficiency
Problems with a primary support group
Educational Problems
Housing Problems
Economic Problems
Problems related to interaction with the legal system/crime
Multiaxial System cont’d.
 Axis V : Global Assessment of Functioning (GAF)
Axis V is for reporting the clinician’s judgment of an
individual’s overall level of functioning.
“GAF= ,” followed by a GAF rating from 0-100, followed by
the time period reflected by the rating in the parenthesis:
“(Current)”
“(Highest level in past year)”
“(At Discharge)”
Depression/Mood Disorders
 Depression in children may include: apathy, irritability
and persistent sadness.
 A depressed child may seem bored and unusually
irritable; there may be changes in school performance,
sleep & behaviors.
 Types of Depression:
 Dysthymia
 Major Depression
Dysthymia
 A chronic type of depression, a person’s moods are
regularly low
 Low dark, sad mood nearly every day for at least 2 years
 Symptoms are less severe than with Major Depression
 Feelings of hopelessness
 Insomnia or hypersomina
 Low energy or fatigue
 Low self-esteem
 Poor appetite or overeating
 Poor concentration
Major Depression
 Symptoms
 Consistently low or irritable mood
 Loss of pleasure in usual activities
 Trouble sleeping or excessive sleeping
 Dramatic change in appetite; weight increase or decrease
 Fatigue-lack of energy
 Feelings of worthlessness, self-hate and inappropriate guilt
 Extreme difficulty in concentration
 Slowed or agitated physical movements
 Inactivity and with-drawl from usual activities
 Feelings of hopelessness and helplessness
 Recurring thoughts of death or suicide
 5 or more symptoms must be present for at least 2 weeks
Attention Deficit Disorder
(ADD/ADHD)
 The main features are INATTENTION,
HYPERACTIVITY and IMPULSILITY.
 In general, impulsiveness and hyperactivity are
observed before one notices the lack of attention,
which often appears later
3 Subtypes of ADHD:
 Hyperactive- Impulsive type symptoms of
hyperactivity and impulsivity have been shown for at
least 6 months to an extent that it is disruptive and
inappropriate for the individuals developmental level.
 Predominantly Inattentive type: Inattention for at least
6 months to extent that it is disruptive and
inappropriate for the child’s development level
 Combined Type: Combination of Symptoms for at
least 6 months
Attention Deficit Disorder
 The cause of Attention Deficit Disorder in Children is
currently unknown. It’s speculated that some subtle brain
damage may be responsible occurring in the womb shortly
after birth, or dietary intolerance, or an unknown viral
infection affecting the brain
 Attention Deficit Disorder in children is one of the short
attention span, impulsiveness, and hyperactivity that starts
before age 7. Attention deficit disorder is more common in
boys, especially first born boys. Remission or symptom
reduction may happen around 12 years old with overactivity
being the first to go followed by distractibility.
Symptoms of ADD/ADHD
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Hyperactive
Emotional outbursts
Short attention span
Unable to finish things
Does not listen when spoken to
Does not follow instructions
Dislikes tasks that require concentration
Carless mistakes in school work
Loses things
Easily distracted
Forgetfulness
Fidgets with hands or fee while seated
Runs about or climbs excessively as if “driven by a motor”
Talking excessively
Blurts out answers before questions are finished
Butts into conversations or games
Poor school performance and learning problems
Poor social skills
Problems related to ADD/ADHD
 Learning Disabilities-20-30% of these children have a
learning disability. Difficulty understanding certain
sounds or words difficulty expressing oneself in words.
Reading or spelling disabilities and problems working
arithmetic disorders. 8% of elementary school
children.
 A child with ADHD may struggle with learning, but
he/she can often learn once successfully treated for
ADD/ADHD
Oppositional Defiant Disorder
 ½ of all children with ADHD are affected especially boys
 Symptoms of ODD
 Often gets angry and loses temper (short fuse).
 Often argues, especially with adults and those in authority.
 Often refuses to follow directions given by an adult, fails to
comply with adult requests.
 Often annoys others deliberately.
 Often blames misbehavior or mistakes on others.
 Often is annoyed by others, seems touchy.
 Often is angry, resentful.
 Often shows vindictive or spiteful behavior.
Conduct Disorder
 A repetitive and persistent patter of behavior in which
the basic rights of others or major age- appropriate
social norms or rules are violated.
 Symptoms of Conduct Disorder
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Frequent bullying or threatening
Often starts fights
Used a weapon that could cause serious injury
Physical cruelty to people
Physical cruelty to animals
Theft with confrontation
Forced sex upon someone
Bi-Polar Disorder or Manic
Depression
 Bipolar Disorder is a serious mental illness. It can run
in families, and usually starts in late adolescent or
early adulthood.
 Because there are some symptoms that can be present
in both ADHD and Bi-Polar Disorder it is often
difficult to differintate between the two conditions.
 People who have Bi-Polar have dramatic mood swings.
 People who have Bi-Polar Disorder can go from overly
energetic “high” or irritable to sad and hopeless and
the back again. There can be normal moods in
between.
Bi-Polar or Manic Depression
 The “Up” feeling is called “MANIA” and the down
feelings is Depression!!
 Bi-Polar Disorder in children often involves a faster
cycling of the extreme mood states, even within one
hour.
 Children may also experience the symptoms of mania
and depression simultaneously. Experts describe this
pattern as a CHRONIC MOOD DYSREGULATIONS.
Bi-Polar or Manic Depression
 The symptoms which can overlap between ADHD and
Bi-polar disorder include high levels of energy and
reduced need for sleep.
 But elated mood and grandiosity an inflated sense of
superiority are distinctive signs of Bi-Polar Disorder.
Anxiety Disorders
 Anxiety is the fearful anticipation of further danger or problems accompanied
by an intense unpleasant feeling (DYSPHORIA) or physical symptoms.
 Anxious children are often overly tense or uptight. Some may seek a lot of
reassurance, and their worries may interfere with activities in their daily life.
 Anxious children have many worries about things before they happen.
 They may have repetitive, unwanted thoughts (obsessions) or actions
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(compulsions).
Fears of embarrassment or making mistakes
Low self-esteem and lack self-confidence
These fears cause significant distress and interfere with usual activities.
Also, restlessness, fatigue, difficulty concentrating, irritability and muscle
tension
Anxiety Disorders cont’d.
Anxiety in children may present as:
Separation Anxiety Disorder :
Excessive anxiety concerning separation from home or from those to
whom the child is attached
Generalized Anxiety Disorder:
Excessive anxiety and worry about events or activities with difficulty
controlling these worries
Phobias:
Persistent, irrational fears of a specific object, activity or situation
(heights, flying, animals, seeing blood)
These intense fears cause the child or adolescent to avoid the object,
activity, or situation.
Anxiety Disorders cont’d.
 Panic Disorder:
The presence of recurrent, unexpected panic attacks
and persistent worries about having attacks.
Panic attacks refer to the sudden onset of intense
apprehension, fearfulness or terror, often associated
with feelings of impending doom. Also, there may be
shortness of breath, chest pain or discomfort, choking
or smothering sensations, and fear of “going crazy” or
losing control.
Anxiety Disorders cont’d.
 Post Traumatic Stress Disorder
All children & adolescents experience stressful events which
can affect them both emotionally and physically. A child or
adolescent who experiences a catastrophic event may
develop ongoing difficulties known as Post Traumatic
Stress Disorder (PTSD).
A diagnosis of PTSD means that an individual experienced an
event that involved a threat to one’s own or another’s life or
physical integrity and that this person responded with
intense fear, helplessness, or horror.
J.Hamblen,PhD&E.Barnett,PhD
Anxiety Disorders cont’d.
 PTSD
 In a fact sheet from the National Center for PTSD on
PTSD in Children and Adolescents, Dr. Jessica
Hamblen & Dr. Erin Barnett provide the following
statistics:
 Child protection services in the U.S. receive
approximately 3 MILLION referrals each year,
representing 5.5 MILLION children. Those figures
may only represent a portion of the child
maltreatment cases that occur; researchers estimate
that two-thirds of maltreatment cases are unreported.
Anxiety Disorders cont’d.
 Of those cases referred, about 30% are substantiated
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and occur in the following frequencies:
65% NEGLECT
18% PHYSICAL ABUSE
10% SEXUAL ABUSE
7% PSYCHOLOGICAL ABUSE
 In addition, anywhere from 3 to 10 million children are
exposed to DOMESTIC VIOLENCE each year, 40-60%
of which cases also involve CHILD PHYSICAL ABUSE.
PTSD cont’d.
 How many children develop PTSD?
Studies of the general population have examined rates
of exposure and PTSD in children and adolescents.
Results from these studies indicate that 15-43% of girls
and 14-43% of boys experience at least one traumatic
event. Of those children and adolescents who have
experienced a trauma, 3-15% of girls and 1-6% of boys
could be diagnosed with PTSD.
PTSD cont’d.
 A child’s risk of developing PTSD is related to the
seriousness of the trauma, whether the trauma is
repeated, the child’s proximity to the trauma, and
his/her relationship to the victim(s).
 Following the trauma, children may initially show
agitated or confused behavior. They may also show
intense fear, helplessness, anger, sadness, horror or
denial.
 A child or adolescent who experiences traumatic or
catastrophic event(s) may develop ongoing difficulties.
PTSD cont’d.
 A child with PTSD may also re-experience the
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traumatic event(s) by:
Having frequent memories of the event(s), or in young
children, play in which some or all of the trauma is
repeated over and over
Having upsetting and frightening dreams
Acting or feeling like the experience is happening
again
Developing repeated physical or emotional symptoms
when the child is reminded of the event(s)
PTSD cont’d.
 Children with PTSD may also show the following
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symptoms:
Worry about dying at an early age
Losing interest in activities
Showing more sudden and extreme emotional reactions
Showing irritability or angry outbursts
Having problems concentrating
Acting younger than their age (clingy or whiny behavior,
thumb sucking)
Showing increased alertness to the environment
Repeating behavior that reminds them of the trauma
PTSD cont’d.
 The symptoms of PTSD may last from several months
to many years.
 COMPLEX PTSD … CHRONIC TRAUMA
 The diagnosis of PTSD accurately describes the
symptoms that result when a person experiences a
short-lived trauma.
 Chronic Traumas continue or repeat for months or
years at a time.
Complex PTSD
 Clinicians and researchers have found that the current
PTSD diagnosis often does not capture the severe
psychological harm that occurs with prolonged,
repeated trauma.
 Dr. Judith Herman of Harvard University suggests that
a new diagnosis, COMPLEX PTSD, is needed to
describe the symptoms of long-term trauma.
Another name sometimes used to describe this cluster
of symptoms is: Disorders of Extreme Stress Not
Otherwise Specified (DESNOS).
Complex PTSD cont’d.
 Dr. Herman notes that during long-term traumas, the victim is
generally held in a state of captivity, PHYSICALLY or
EMOTIONALLY.
 In these situations the victim is under the CONTROL of the
perpetrator and unable to flee.
Examples of such traumatic situations include:
Concentration camps
Prisoner of War camps
Prostitution brothels
Long-term domestic violence
Long-term child physical abuse
Long-term child sexual abuse
Organized child exploitation rings
Acute Stress Disorder
 Acute Stress Disorder (ASD) is an anxiety disorder
characterized by a cluster of dissociative & anxiety
symptoms that occur within a month of a traumatic
stressor. It was added to the DSM-IV-TR to distinguish
time-limited reactions to trauma from the farther-reaching
and longer-lasting PTSD.
 ASD, like PTSD, begins with exposure to an extremely
traumatic, horrifying, or terrifying event.
 Unlike PTSD, however, ASD emerges sooner & abates more
quickly; it id also marked by more dissociative symptoms.
Acute Stress Disorder cont’d.
 Symptoms:
 Acute stress disorder may be diagnosed in individuals who
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have lived through or witnessed a traumatic event to which
they responded with intense fear, horror, or helplessness,
and are currently experiencing 3 or more of the following
DISSOCIATIVE symptoms:
Psychic numbing
Being dazed or less aware of surroundings
Derealization
Depersonalization
Dissociative amnesia