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Download Emotional, Behavior, and Mental Disorders in Children
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The Reason Behind the Behavior Mental Illnesses in Our Youth NAMI • Advocacy, support, education • Over 1000 local and state affiliates • Focus is on the severe, persistent brain disorders that can affect one's ability to think, feel, and relate to others and his environment. Major Topics • • • • • • Brain Research Diagnosis Warning Signs Treatment The Family Interventions Childhood-onset brain disorders • Tend to be more severe and more mixed than adult-onset disorders • More difficult to diagnose and treat. • Interfere with development, learning Prevalence • 7 of 10 children – no diagnosable brain disorder • 25% - moderately severe disorder • 5% - marked impairment/SED • Less than 1 in 5 get help. • One-half of life-time cases begin by age 14 • Adults – 21% (GSMS 1998, Surgeon General’s Report 1999, NIMH NCS-R 2005) Brain Research • Mental disorders - Neurobiological Brain Disorders (NBD) • Scientifically proven biologically-based • PET Scans, MRI findings, biochemical and genetic research substantiate scientific, biological basis of disorders • Involve some impairment of thought, perception, feeling and/or behavior Diagnosis • Psychiatrists base diagnosis of emotional, behavioral, and mental disorders on DSM-IV. • Diagnostic Statistical Manual, 4th edition, 1995 is the American Psychiatric Association’s classification of mental disorders. • Symptoms vary from person to person. • Result in reduced ability to cope with life. • Based on disability, duration of symptoms, symptoms of specific disorder. Benefits of Early Recognition • Faster, more complete recovery • Less severe brain disorder with improved prognosis • Individuals more able to recognize illness when less ill and more compliant with treatment/meds • Reduces risk of suicide, depression, substance abuse, unprovoked aggression • Less disruption to psychological, social and educational development Warning Signs: Elementary Difficulty going to sleep, reluctance to take part in activities normal for child’s age; Frequent, unexplainable temper tantrums; Hyperactive behavior/fidgeting; Steady, noticeable decline in school performance; Pattern of deliberate disobedience or aggression; Persistent nightmares; Pronounced difficulties with attention, concentration, organization; Increased irritability. Warning Signs Feeling hopeless, overwhelmed, low self-esteem; Sudden overwhelming fear for no apparent reason; Severe mood swings affecting relationships with others; Drastic change in personality or behavior; and Extreme worries or fears that interfere with friendships, school work, or play. Warning Signs: Pre-teens, Teens Frequent outbursts of anger or inability to cope with problems and daily activities; Lack of close friends; Marked change in school performance, sleeping &/or eating habits Threats of self-harm or injury and toward others; Sexual acting-out; Threaten to run away; Strange thoughts, feelings, or unusual behaviors. Common denominators of extreme behavior • • • • • • • High anxiety/separation anxiety Aggression, rage Hyper-reactive Dangerous impulsivity Disorientation and attention issues Social phobia Substance abuse ADHD • • • • • Quick to arouse in AM “Expert hunters” of long ago Seek stimulus safety (lights, smells, touch) Understimulated cognitive domain “Frantic starts, endless running” like transmission in car. A Few Words about Mood Disorders • Bipolar disorder – Very depressed – Marked impairment – work, school, social – Slow to arouse in AM – With mania – Flight of Ideas, distractible, grandiosity, goofiness, talkative, may be aggressive, rage – Charming, gifted • Major Depression – – – – – – – – IRRITABILITY Low energy Frequent physical complaints Low self-esteem Poor concentration Sensitive Grouchy anger Kindling effect Anxiety Disorders • Obsessions, compulsions, tics are “hard wired” in brain. • Sense of relief from compulsions • Panic attacks • Big need to feel safe Cognitive Distortions ALL-OR-NOTHING THINKING – No shades of gray. OVERGENERALIZATION One event is seen as part of a pattern of failure. MENTAL FILTER Only negative or fearful aspects of a situation are perceived DISQUALIFYING THE POSITIVE Positive experiences discounted/rejected. MIND READING Assuming others are thinking badly of you More Cognitive Distortions • FORTUNE TELLING – Predicting that things will turn out badly. • MAGNIFICATION – Smallest mistake is projected into worst possible outcome. • LABELING AND MISLABELING – Overgeneralizing – “I am stupid.” “I am a loser.” • PERSONALIZATION – “If anything goes wrong, it must be my fault.” • LEARNED HELPLESSNESS – “Nothing ever works for me anyway, so why try?” Stigma • • • • Old myths, shame, embarrassment Destroys hope; silences success stories Systematic discrimination Nobody is to blame What Parents Need • To learn how child reacts in educational setting – Parent needs to report this info to doctor, therapist – May need to develop home-school behavior plan • Focus placed on strengths and needs, not on pathology, programs, available services • To know they are not to blame • To be asked what they need Skills for working with children • Flexibility, patience, ability to laugh at oneself/situations • Good conflict management skills • Receptive to change • Open communication Strategies • Reduce exposure to stress • Help improve coping skills • Provide structure, predictability each day • Use praise, encouragement • Most important – how adults respond to and work with them Strategies • Good working knowledge of symptoms • Good communication with home • Prepared with a variety of approaches to handle shifts in mood • Prepare for transition What Professionals Can Do • Be aware that behaviors that are unusual or interfere with learning may be symptoms of a disorder of child’s brain. • Speak in terms of “differences” not disabilities. • Remind parents they are not to blame. • Let parent, support staff know what warning signs are present. • Refer child to student support team - counselor, school psychologist. What Professionals Can Do • Be vigilant in observing behavior of children. • Divert attention - calming voice, little talking. • Cognitive behavioral intervention - Teach coping skills to child, self-talk strategy, learning to recognize signs of stress, what to do. • Take agitation, threats seriously. Be prepared to use interventions. • Front-end interventions are best. Problem with Executive Functions • • • • • Trouble setting priorities, planning Difficulty with sequence, organization Unaware of future, inflexible Problem with carrying out goals, feedback Inability to suppress, delay response • Production difficulties – unable to self-monitor How to help these children • Problem w/executive function? - Break up directions, check early on. • “This is the problem. This is what you need to do.” • “Instant replay” • Find out what they love. Memory Deficits - TS, OCD, ADD • Cannot control thoughts, worrying, stuck, stuck, stuck…. • Anxiety increases if interrupted. • Problem with working memory, strategy. • Writing, math difficulties may be production problems When feelings are intense … thinking is impaired!! Stress-related Issues • Routine important – Rules posted, few in number, positively stated • Teach organizational skills • Try to avoid sensory overload • Exercise!!! • Graceful Exit Plan Front-end interventions are more effective than back-end interventions. Hope on the Horizon • • • • Research - new treatments, “Decade of the Brain” Advocacy groups fighting stigma Families as equal partners in treatment Full range of services to the child and family address all needs • Strength-based assessment Our Basic Message • Mental illnesses are no-fault brain disorders. • Getting the right diagnosis and proper medication is not easy but treatment works! • Early recognition of symptoms is vital. • Families need support. • Interventions work! • Thank you for all you do!