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Signs and Symptoms of Mental Illness in Children and Adolescents By: Lia Romero y Vigil Background What is Mental Illness? • A wide range of mental health conditions—disorders that affect your mood, thinking and behavior. • Any of the various forms of psychosis or severe neurosis www.mayoclinic.org www.dictionary.com Mental Illness in Children • • • Nearly 5 million children in the U.S. have some type of serious mental illness In a given year, 20% of American children will be diagnosed with a mental illness Children differ from adults in that they experience many physical, mental, and emotional changes as they progress through their natural growth and development. www.webmd.com/mental-health/mental-illness-children Mental Illness and Alcohol Dependent Families • • Sons of an alcohol dependent parent are more likely to have attention deficit/hyperactivity disorder Daughters are more likely to encounter eating disorders or depression in later life. Kinney, J. (2015). Loosening the Grip: A Handbook of Alcohol Information (11th Ed.). McGraw-Hill Education. Disorders that can occur • • • • Intellectual Developmental Disorder Global Developmental Delay Language Disorder Speech Sound Disorder DSM-5, 2013, American Psychiatric Association • • • • Childhood-Onset Fluency Disorder (Stuttering) Social (Pragmatic) Communication Disorder Autism Spectrum Disorder Attention-Deficit/Hyperactivity Disorder Disorders that can occur (con’t) • • • • • Specific Learning Disorder Motor Disorder Schizophrenia Bipolar Disorder Depressive Disorders DSM-5, 2013, American Psychiatric Association • Anxiety Disorder • Feeding and Eating Disorder • Elimination Disorders • Conduct Disorder Pharmacologic Approaches to Management of Psychiatric Conditions • • • • • • Antipsychotic medications Antidepressants Mood stabilizers Anticonvulsant medications Antianxiety medications Electroconvulsive Therapy Falvo, D.R. (2014). Medical and Psychosocial Aspects of Chronic Illness and Disability. Jones and Bartlett Learning, LLC. Early warning signs for psychosis • • Early warning signs of psychosis can be defined as subjective thoughts, behaviors and feelings of a patient that occur in a phase preceding a psychotic episode or relapse. Three step model was then introduced in the hope that the young person would understand their individual pathway. • • • Step 1: thinking- changes that were felt in their thinking i.e. thoughts regarding others, speed of thoughts. Feelings-changes that were felt in the way they felt i.e. irritability, suspicion behaviors- changes in behavior i.e. energy levels, sleep routines, eating patterns Step 2: timeline of events proceeding backwards from referral to mental health services Step 3: potential triggers and stressors and how they would cope with these Walker, S. & Kelly, M. (2011). The introduction of an early warning signs journal in an adolescent inpatient unit. Journal of Psychiatric and Mental Health Nursing. Early warning signs for Bipolar Disorder • • Children • Severe temper tantrums when told “no” • Tantrums can last for hours and can become violent • Showing odd displays of happy or silly moods and behaviors Teens • May experience a drop in grades, quit sports teams or other activities • Be suspended or arrested for fighting or drug use • Engage in risky sexual behavior • Talk about death or even suicide www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder Mental Illness in Children: Know the Signs • • • Mental illness in children can be hard for parents to identify, therefore many children go untreated. Typically up to the adults in a child’s life to identify mental illness in children, unfortunately many adults do not know the signs and symptoms of mental illness. Even knowing the red flags, it can still be difficult to distinguish signs of a problem from normal childhood behavior. www.mayoclinic.org Mental Illness in Children: Know the Signs Mental Health conditions that affect children • • • • • • Anxiety Disorders Attention-deficit/hyperactivity disorder (ADHD) Autism Spectrum Disorder Eating Disorders Mood Disorders Schizophrenia www.mayoclinic.org Mental Illness in Children: Know the Signs Warning Signs • • • • • • • • Mood changes Intense feelings Behavior changes Difficulty concentrating Unexplained weight loss Physical symptoms-headaches and stomach aches rather than sadness and anxiety Physical harm Substance abuse Warning signs of Mental Illness • • • • Excessive worrying or fear Feeling excessively sad or low Confused thinking or problems concentrating and learning Extreme mood changes, including uncontrollable “highs” or feelings of euphoria www.nami.org/Learn-More/Know-the-WarningSigns • • • • • Prolonged or strong feelings of irritability or anger Avoiding friends and social activities Difficulties understanding or relating to other people Changes in sleeping habits or feeling tired and low energy Changes eating habits such as increased hunger or lack of appetite Warning signs of Mental Illness (con’t) • • • • • • • • Changes in sex drive Difficulty perceiving reality Inability to perceive changes in one’s own feelings, behavior, or personality Abuse of substances like alcohol or drugs Multiple physical ailments without obvious causes Thinking about suicide Inability to carry out daily activities or handle daily problems and stress And intense fear of weight gain or concern with appearance www.nami.org/Learn-More/Know-the-Warning-Signs Warning Signs in Children • • • • • • Changes in school performance Excessive worry or anxiety, for instance to avoid bed or school Hyperactive behavior Frequent nightmares Frequent disobedience or aggression Frequent temper tantrums www.nami.org/Learn-More/Know-the-Warning-Signs Warning signs • • • • • • • Marked change in school performance Inability to cope with problems and daily activities Noticeable changes in sleeping and/or eating habits Many physical complaints Sexual acting out Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death Abuse of alcohol and/or drugs www.americanpsychiatricfoundation.org • • • • • • • • Warning Signs (con’t) Intense fear of becoming obese with no relationship to actual body weight, purging food or restricting eating Persisting nightmares Threats of self harm or harm to others Self injury or self destructive behavior Frequent outbursts of anger, aggression Threats to run away Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism Strange thoughts and feelings; and unusual behaviors www.americanpsychiatricfoundation.org 11 Warning Signs • • • • • • Feeling very sad or withdrawn for 2 or more weeks Seriously trying to harm or kill yourself, or making plans to do so • • Sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing • • Involved in multiple fights, using a weapon, or wanting badly to hurt others • Severe, out of control behavior that can hurt yourself or others Not eating, throwing up or using laxatives to make yourself lose weight Intensive worries or fears that get in the way of daily activities Extreme difficulty in concentrating or staying still that puts you in physical danger or cause school failure Repeated use of drugs or alcohol Severe mood swings that cause problems in relationships Drastic changes in your behavior or personality m.livescience.com/35938-mental-illnesschildren-warning-signs.html Symptoms in addition to disorder • • • • • • Poor school performance Persistent boredom Frequent complaints of physical symptoms (headaches and stomachaches) Sleep and/or appetite problems like sleeping too much or too little, nightmares, or sleepwalking Behaviors returning to those of a younger age (regressing), like bedwetting, throwing tantrums, or becoming clingy More risk-taking behaviors and/or showing less concern for their own safety www.medicinenet.com Warning Signs in Adolescents • • • • • • Decrease in enjoyment and time spent with friends and family Significant decrease in school performance Strong resistance to attending school or absenteeism Problems with memory, attention or concentration Big changes in energy levels, eating or sleeping patterns Physical symptoms (stomach aches, headaches, backaches) • • • • • • • Feelings of hopelessness, sadness, anxiety, crying often Frequent aggression, disobedience or lashing out verbally Excessive neglect of personal appearance or hygiene Substance abuse Dangerous or illegal thrill-seeking behavior Is overly suspicious of others Sees or hears things that others do not http://www.asmfmh.org/resources/publications/normalteenage-behaviour-vs-early-warning-signs-of-mentalillness/ Ways to talk to your teen • • • • • • • Speak in a calm voice. Say what you mean and be prepared to listen. Try not to interrupt the other person. Avoid sarcasm, whining, threats and yelling. Don’t make personal attacks or be demeaning. Don’t assume your answer is the only answer. • • • • • Try not to use words such as “always” or “never.” • Deal with the now, not the past. • Don’t try to get the last word. • If things get too heated, take a break and come back to the discussion later. • Make allowances for the other person. • Parents: Remember what it was like to be a teen. http://www.asmfmh.org/resources/publicati ons/normal-teenage-behaviour-vs-earlywarning-signs-of-mental-illness/ Mental Illness and the Family: Recognizing Warning Signs and How to Cope In Adolescents • • • • • • • • • Confused thinking In Adolescents • Prolonged depression (sadness or irritability) Feelings of extreme highs and lows Excessive fears, worries and anxieties Social withdrawal Dramatic changes in eating or sleeping habits • • • Growing inability to cope with daily problems and activities Suicidal thoughts Numerous unexplained physical ailments Substance abuse Strong feelings of anger Strange thoughts (delusions) Seeing or hearing things that aren’t there (hallucinations) www.mentalhealthamerica.net Mental Illness and the Family: Recognizing Warning Signs and How to Cope (con’t) In Older Children and PreAdolescents • • • • • • Substance abuse Inability to cope with problems and daily activities Changes in sleeping and/or eating habits Excessive complaints of physical ailments In Older Children and PreAdolescents • • • Intense fear Prolonged negative mood, often accompanied by poor appetited or thoughts of death Frequent outbursts of anger Changes in ability to manage responsibilities- at home and/or at school Defiance of authority, truancy, theft, and/or vandalism www.mentalhealthamerica.net Mental Illness and the Family: Recognizing Warning Signs and How to Cope (con’t) In Younger Children • • • • • • • • Changes in school performance Poor grades despite strong efforts Changes in sleeping and/or eating habits Excessive worry or anxiety (i.e. refusing to go to bed or to school) Hyperactivity Persistent nightmares How to cope • • • • • Accept your feelings Handling unusual behavior Establish a support network Seeking counseling Taking time out Persistent disobedience Frequent temper tantrums www.mentalhealthamerica.net Why it’s hard to make a diagnosis of Bipolar Disorder • • • • One complexity is related to timing is the age at which the symptoms began. Kids are more likely to feel irritable and angry than sad or euphoric. Kids are not as able as adults to verbalize feeling states. They know that they feel bad, but they may not be able to be more specific. Children do not have the coping abilities of adults, so when they feel bad they act up in ways that look like misbehavior. Argumentative, defiant, uncompromising, and impulsive in much the same way that kids do who have conduct disorder, hyperactivity, or ADD. Ramirez Basco, M. (2015). The Bipolar Workbook: Tools for Controlling Your Mood Swings. The Guilford Press. Bipolar Disorder and its treatment affects in children Have different symptoms than adults do Switch more quickly between manic and depression, more mixed states Mania often appears as irritability or rage, may be misdiagnosed as ADHD More destructive outbursts, rather than excited or euphoric What Helps and What Hurts www.DBSAlliance.org What Helps • • • • • • • I know you have a real illness and that’s what causes these thoughts and feelings. I may not be able to understand exactly how you feel but I care about you and want to help. You are important to me. Your life is important to me. Tell me what I can do now to help you. You might not believe it now, but the way you’re feeling will change. You are not alone in this. I’m here for you. Talk to me. I’m listening. What Hurts • • • • • • • It’s all in your head. We all go through times like this. You have so much to live for—why do you want to die? What do you want me to do? I can’t change your situation. Just snap out of it. Look on the bright side. You’ll be fine. Stop worrying. Here’s my advice… “The Storm in my Brain” www.DBSAlliance.org Wellness of Mental Illness • • • Good treatment plan • • • Medication Talk therapy to help with coping skills Support from a peer run group Just because you seek treatment does not mean you are a weak or a failure; it means you have the strength and courage to look for a way to feel better. Wellness, or recovery, is a return to a life that you care about. Recovery happens when your illness stops getting in the way of your life. 2012, Depression and Bipolar Support Alliance Creating a Wellness Plan • Setting Goals • Creating the Life that You Want: Ten Steps to Accomplishing a Goal • Wellness Achievement and Maintenance • Crisis Plan Management • Getting the most from your health care provider (HCP) Stigma Definition • The bodily signs designed to expose something unusual and bad about the moral status of the signifier. (Goffman, E., 1963, 45) Moral Career • • • • Two phases Through which the stigmatized person learns and incorporates the stand-point of the normal, acquiring thereby the identity beliefs of the wider society and a general idea of what it would be like to possess a particular stigma. Through which he learns the he possesses a particular stigma and, and this time in detail, the consequence of possessing it. Four patterns are formed to establish the foundation for later development: (Goffman, E., 1963, 45) Four Patterns • • • • Involves those with an inborn stigma who become socialized into their disadvantageous situation even while they are learning and incorporating the standards against which they fall short. Derives from the capacity of a family, and to a much lesser extent a local neighborhood, to constitute a protective capsule for its young. Illustrated by one who becomes stigmatized late in life, or learns late in life that he has always been discreditable. Illustrated by those who are initially socialized in an alien community, whether inside or outside the geographical boundaries of the normal society, and who then must learn a second way of being that is felt by those around them to be the real and valid one. (Goffman, E., 1963, 45-49) Visibility • • • • • How well or how badly the stigma is adapted to provide means of communicating that the individual possesses it. Visibility must be distinguished from three other notions that are often confused with it, before the term can be safely used in the corrected version. Must be distinguished from its ‘known-about-ness’. Must be distinguished from one of its bases, particularly, obtrusiveness. Must be disentangled from certain possibilities of what can be called its ‘perceived focus’. (Goffman, 1963, 65-66) Any Questions?