Download Mental Health in Children and Adolescents

Mental Health Disorders in
Young Children and Youth
A Primer for Youth Workers
Focus of Training
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Understand the difference between
medical/mental health diagnosis and educational
disability
Recognize the characteristics of common mental
health problems/educational disabilities
Respond to children and youth diagnosed with
mental health problems/educational disabilities
Diagnostic Information
in Mental Health
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DSM-IV is the accepted guide to
psychiatric diagnosis
Many disorders show similar symptoms
Some tend to occur together in the same
child
It may take years to reach an accurate
diagnosis as symptoms change with time
and development
Educational Classification
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Some, but not all, children with a mental
health diagnosis will need special
education assistance
Usual school classifications will be
Emotional Disability, Other Health
Impairment, or Autism Spectrum Disorder
Eligibility does not dictate classroom
placement; most of these students
succeed in a general education setting
Educational Eligibility:
Emotional Disability
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“Emotional disability” means an inability to learn or
progress that cannot be explained by cognitive, sensory,
or health factors. The student exhibits one or more of
the following characteristics over a long period of time
and to a marked degree that adversely affects
educational performance:
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A tendency to develop physical symptoms or fears associated
with personal or school problems;
A general pervasive mood of unhappiness or depression;
An inability to build or maintain satisfactory interpersonal
relationships;
Inappropriate behaviors or feelings under normal
circumstances;
Episodes of psychosis.
Educational Eligibility:
Other Health Impairment
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“Other health impairment” means having
limited strength, vitality, or alertness,
including a heightened alertness to
environmental stimuli, that results in
limited alertness with respect to the
educational environment that:
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Is due to chronic or acute health problems
Adversely affects a student’s educational
performance.
Educational Eligibility:
Autism Spectrum Disorder
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Autism spectrum disorder is a lifelong developmental disability that
includes autistic disorder, Asperger’s syndrome, and other pervasive
developmental disorders, as described in the current version of the
American Psychiatric Association’s Diagnostic and Manual of Mental
Disorders. The disability is generally evident before three years of
age and significantly affects verbal, nonverbal, or pragmatic
communication and social interaction skills and results in an adverse
effect on the student’s educational performance. Other
characteristics often associated include the following:
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Engagement in
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Resistance to
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Repetitive activities
Stereotyped movements
Environmental change; or
Change in daily routines
Unusual responses to sensory experiences.
504 Plans
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Federal law that protects qualified individuals
from discrimination based on their disability.
Individuals with disabilities are defined as
persons with a physical or mental impairment
which significantly limits one or more major life
activities. People who have a history of, or who
are regarded as having a physical or mental
impairment that substantially limits one or more
major life activities, are also covered.
Major life activities include caring for one’s self,
walking, seeing, hearing, speaking, breathing,
working, performing manual tasks, and learning.
About Mental Health Diagnoses
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Disorders first Diagnosed in Infancy,
Childhood, or Adolescence
Fetal Alcohol Syndrome
Schizophrenia and other Psychotic
Disorders
Mood Disorders
Anxiety Disorders
Eating Disorders
Disorders First Diagnosed in
Infancy, Childhood, or Adolescence
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Pervasive Developmental Disorders
Attention-Deficit and Disruptive Behavior
Disorder
Tic Disorders
Other Disorders of Infancy, Childhood, or
Adolescence
Pervasive Developmental Disorders
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Autistic Disorder
Rett’s Disorder
Childhood Disintegrative Disorder
Asperger’s Disorder
Pervasive Developmental Disorder - Not
Otherwise Specified (PDD-NOS)
Characteristics of Autism
 Markedly
abnormal or impaired
development in social
interaction.
Characteristics of Autism
 Markedly
abnormal or impaired
development in
communication.
Characteristics of Autism
 Markedly
restricted repertoire
of activities and interests
Asperger’s Syndrome
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Previously thought of as “high functioning
autism.”
The most outstanding characteristic of a child
with Asperger’s is impairment in social
interactions, which may include failure to use or
comprehend nonverbal gestures in others,
failure to develop age-appropriate peer
relationships, and a lack of empathy.
Autism Spectrum Disorder:
Strategies and Accommodations
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Create a structured, predictable environment. Use visual
supports when possible.
Foster a climate of tolerance and understanding.
Avoid long strings of verbal instruction.
Give advance warning of changes in schedules,
transitions, personnel, etc.
Learn each child’s “triggers” to prevent meltdowns.
Do not force eye contact.
Minimize visual and auditory distractions; modify
environment as reasonable for sensory issues.
The brain must sift through
thousands of incoming messages
per second, attending to the
important signals and muffling the
less urgent. A child with an
impaired sensory integration
system may have no way to sort
out the flood of information which
assaults him or her at all times.
Attention Deficit Hyperactivity
Disorder: Symptoms and Behaviors
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Children with inattentive disorder may:
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Have a short attention span
Have problems with organization
Fail to pay attention to details
Be unable to maintain attention
Be easily distracted
Have trouble listening even when spoken to directly
Fail to finish their work
Make lots of mistakes
Be forgetful
Attention Deficit Hyperactivity
Disorder: Symptoms and Behaviors
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Children with hyperactive-impulsive disorder
may:
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Fidget and squirm
Have difficulty staying seated
Run around and climb on things excessively
Have trouble playing quietly
Be “on the go” as if “driven by a motor”
Talk too much
Blurt out an answer before a question is completed
Have trouble taking turns in games or activities
Interrupt or intrude on others
Attention Deficit Hyperactivity
Disorder: Symptoms and Behaviors
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Children with combined attention deficit
hyperactivity disorder show symptoms of
both inattention and hyperactivity or
impulsivity.
Attention Deficit Hyperactivity
Disorder:
Strategies and Accommodations
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Provide consistent structure and clearly define
your expectations.
Allow the child to move about with reason, and
provide breaks for movement.
Have a “secret code” to let the child know he
has gotten off task and must refocus.
Reduce stress and pressure when possible, as
children with ADHD are easily frustrated.
Oppositional Defiant Disorder:
Symptoms and Behaviors
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Sudden, unprovoked anger
Arguing with adults
Defiance or refusal to comply with adult
requests or rules
Blaming others for their misbehavior
Easily annoyed by others
Being resentful and angry
Oppositional Defiant Disorder
Strategies and Accommodations
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Try to avoid power struggles – state your position clearly
and concisely.
Choose your battles wisely.
Establish clear rules and enforce them consistently.
Avoid topics which may be a source of argument.
Discuss strategies for dealing with anger.
Provide consistency, structure, and clear consequences
for misbehavior.
Minimize downtime and plan transitions carefully.
Structure activities so the student with ODD is not left
out or always the last one picked.
Conduct Disorder:
Symptoms and Behaviors
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Bullying or threatening other children
Poor attendance or chronic truancy
Little empathy for others and lack of appropriate
feelings of guilt or remorse
Low self-esteem masked by bravado
Lying to peers or adults
Frequent physical fights; use of weapons
Destruction of property
Conduct Disorder
Strategies and Accommodations
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Remember that praise is important, but needs to be
sincere.
Be aware that adults can unconsciously form and
express negative impressions. Try to monitor your
emotions and communicate a positive regard for the
child.
Remember that children with conduct disorder like to
argue – maintain calm, respect, and detachment.
Give the student options.
Avoid escalating prompts, such as shouting, touching,
nagging, or cornering the child.
Rules should be few, fair, clear, displayed, taught, and
consistently enforced.
Tourette Syndrome:
Symptoms and Behavior
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Repetitive eye blinking
Repetitive clearing of the throat
Repetitive coughing
Repetitive lip licking
Repetitive fist clenching
Imitating or echoing the words of others
Imitating or echoing the motions of others
Leg jerks
Vocal outbursts
Tourette Syndrome:
Strategies and Accommodations
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Concentrate on helping the child develop friendships,
experience trust, feel competent in completing
activities – not stopping the tics.
Teach relaxation and deep breathing exercises.
Teach the child to tune into and recognize their
emotions and levels of frustration – increased
frustration or anxiety can cause an increase in tic
behavior.
Do not punish the child for engaging in tics or what
may appear to be strange habits.
Build a culture of tolerance and acceptance.
Try to identify sensory triggers (bright lights, loud
noises, chaotic activity) and take steps to structure
the environment to avoid these triggers.
Reactive Detachment Disorder
Symptoms or Behaviors
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Destructive to self or others
Absence of guilt or remorse
Denial of accountability – always blaming others
Poor eye contact
Extreme defiance and control issues
Stealing
Lack of cause and effect thinking
Mood swings
False abuse allegations
Sexual acting out
Inappropriately demanding or clingy
Poor peer relationships
Abnormal eating patterns
Preoccupied with gore, fire
Toileting issues
No impulse control
Chronic nonsensical lying
Unusual speech patterns or problems
Bossy – needs to be in control
Manipulative – superficially charming and engaging
Reactive Detachment Disorder
Strategies and Accommodations
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Be predictable, consistent, and repetitive.
Students with RAD are sensitive to changes in
schedules, transitions, surprises, and chaotic
social situations.
Model and teach appropriate social behaviors.
Avoid power struggles – try not to respond
emotionally.
Identify a (supervised) place for the child to go
to regain composure during times of frustration
and anxiety.
Fetal Alcohol Spectrum Disorders
Symptoms or Behaviors
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Early Childhood
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Speech or gross motor delays
Extreme tactile sensitivity or insensitivity
Erratic sleeping and/or eating habits
Poor habituation
Lack of stranger anxiety
Poor or limited abstract reasoning ability
(action/consequence connection, judgment and
reasoning skills, sequential learning)
Fetal Alcohol Spectrum Disorders
Symptoms or Behaviors
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Elementary Years
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Normal, borderline, or high IQ, but immature
Blames others for all problems
Volatile and impulsive, impaired reasoning
School becomes increasingly difficult
Socially isolated and emotionally disconnected
High need for stimulation
Vivid fantasies and perseveration problems
Possible fascination with knives and/or fire
Fetal Alcohol Spectrum Disorders
Symptoms or Behaviors
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Adolescent Years
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No personal or property boundaries
Naïve, suggestible, a follower, a victim,
vulnerable to peers
Poor judgment, reasoning, and memory
Isolated, sometimes depressed and/or suicidal
Poor social skills
Doesn’t learn from mistakes
Fetal Alcohol Spectrum Disorders
Strategies and Accommodations
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Be as consistent as possible. The way something is learned the first
time will have the most lasting effect.
Use a lot of repetition – these children need more time and more
repetition to learn.
Use multi-sensory instruction to build more neurological connections.
Be specific, yet brief – be as concrete as possible.
Increase supervision when possible – with emphasis on positive
reinforcement of appropriate behavior.
Model appropriate behavior – point it out when you see it.
Post all rules and schedules in a fashion the child can understand.
Apply consequences immediately.
Ensure the child’s attention and check for understanding.
Encourage the use of positive self-talk.
Schizophrenia: Symptoms and
Behaviors
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Confused thinking (fiction versus nonfiction)
Vivid and bizarre thoughts and ideas
Hallucinations
Hearing, seeing, feeling, or smelling things that are not present
Delusions
Having beliefs that are fixed and false (i.e., aliens are out to get
them)
Severe anxiety and fearfulness
Extreme moodiness
Severe problems in making and keeping friends
Feelings that people are “out to get them”
Odd behavior, including behavior resembling that of a much younger
child
Disorganized speech
Lack of motivation
Schizophrenia: Strategies and
Accommodations
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Reduce stress by going slowly when
introducing new situations.
Encourage other adolescents to be kind
and to extend their friendship.
Try to identify and capitalize on individual
strengths.
Mood Disorders: Depression
Common Symptoms
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Sadness that won’t go away
Hopelessness
Irritability
School avoidance
Changes in eating and sleeping patterns
Frequent complaints of aches and pains
Thoughts of death or suicide
Self-deprecating remarks
Persistent boredom, low energy, or poor
concentration
Increased activity
Mood Disorders: Depression
Strategies and Accommodations
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Help children use realistic and positive statements about
their performance and outlook for the future.
Acknowledge but don’t minimize the child’s feelings.
Openly recognize and acknowledge positive contributions
and performance.
Depressed children may see things in black and white
terms – all bad or all good. It may help to have
someone else share things from another perspective.
Encourage gradual social interaction.
Ask parents what is helpful at home.
Don’t be afraid to suggest that parents seek outside
help.
Mood Disorders: Bipolar Disorder
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Also know as “manic-depressive” disorder.
A brain disorder that causes unusual shifts in a
person’s mood, energy, and ability to function.
Much more severe than the typical “ups and
downs.”
One percent of the population over 18 may have
bipolar disorder.
In children and younger adolescents, the
episodes are less clearly defined and may cycle
much more quickly, even up to many times per
day.
Mood Disorders: Bipolar Disorder
Symptoms and Behaviors
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An expansive or irritable mood
Depression
Rapidly changing moods lasting a few hours to a few days
Explosive, lengthy, and often destructive rages
Separation anxiety
Defiance of authority
Hyperactivity, agitation, and distractibility
Strong and frequent cravings, often for carbohydrates and sweets
Impaired judgment, impulsivity, racing thoughts, and pressure to
keep talking
Dare-devil behaviors
Inappropriate or precocious sexual behavior
Delusions and hallucinations
Grandiose belief in one’s own abilities that defy the laws of logic
(become a rock star overnight, for example)
Mood Disorders: Bipolar Disorder
Strategies and Accommodations
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Understand that the child with bipolar disorder
may cycle rapidly and be unpredictable –
something which seems to be “working” may
suddenly cause problems.
Identify a “safe” place where the child can go
until he regains control.
Children with bipolar disorder generally have
very poor social skills, and would benefit from
direct instruction in social interaction skills.
Don’t be afraid to suggest that parent’s seek
outside help.
Anxiety Disorders
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The most common anxiety disorders affecting
children are:
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Generalized Anxiety Disorder
Phobias
Social Phobia
Panic Disorder
Obsessive-Compulsive Disorder
Post Traumatic Stress Disorder
Adjustment Disorder
Write the “Pledge of Allegiance” under the
following conditions:
Keep a running count of the number
of times you write the letter “e” – if
you lose count, you must start over
Every time you hear the smack on the
table, jerk your head sharply to the
right
Anxiety Disorders
Obsessive-Compulsive Disorder
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Recurrent, persistent, intrusive thoughts
or impulses
May perform behaviors in a ritualistic
manner
Children with OCD may experience a high
level of anxiety and shame about their
thoughts and behavior
Anxiety Disorders: Post Traumatic
Stress Disorder
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Flashbacks, hallucinations, nightmares, recollections, reenactment, or repetitive play referencing the event
Emotional distress from reminders of the event
Physical reactions from reminders of the event
Fear of certain places, things, or situations that remind
them of the event
Denial of the event
A sense of foreshortened future
Difficulty concentrating and easily startled
Irritability
Impulsiveness
Anger and hostility
Depression and overwhelming sadness or hopelessness
Anxiety Disorders: Strategies and
Accommodations
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Try to accommodate situations the child has no control
over
Educate the child’s peers about particular symptoms,
such as the compulsions of OCD
Be attentive to changes in the child’s behavior, which
may indicate added stress
Avoid belittling a child’s fear or anxiety; instead, validate
the concern without confirming that the fear is real.
Model positive self-talk
Help children verbalize their feelings and fears
Teach relaxation and deep breathing techniques
Adjustment Disorder: Symptoms
and Behaviors
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Appear subdued, irritable, anxious, or withdrawn
Resist going to sleep
Have frequent tantrums
Regress in the ability to toilet independently
Have increased separation anxiety
Exhibit acting out behaviors that are
uncharacteristic for the child, such as biting or
hitting
Adjustment Disorder
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Can be further categorized by the specific
symptoms experienced:
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Adjustment disorder with depressed mood
Adjustment disorder with anxiety
Adjustment disorder with mixed anxiety and
depressed mood
Adjustment disorder with disturbance of conduct
Adjustment disorder with mixed disturbance of
emotions and conduct
Adjustment disorder, unspecified
Adjustment Disorder: Strategies
and Accommodations
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Be attuned to how environmental changes
impact a child
Help prepare children for changes
Allow the child time to adjust to change
Do all you can to reassure the child that
someone is in control and that their life will go
on with as little disruption as possible
Share concerns with parents, being sure to focus
on the child’s behaviors and avoid drawing
conclusions about whether the behaviors are
indicative of a mental health problem
Eating Disorders: Anorexia
and Bulimia
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Increasingly seen in younger and younger
children, with children as young as 4 or 5
expressing the need to diet.
Mostly seen in females, although 10-20
percent of adolescents with eating
disorders are male.
Anorexia and bulimia can exist together or
separately.
Eating Disorders
Symptoms or Behaviors of Note
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Perfectionist attitude
Impaired concentration
All or nothing thinking
Depressed mood or mood swings
Self-deprecating statements
Irritability
Lethargy
Anxiety
Fainting spells and dizziness
Headaches
Hiding food
Avoiding snacks or activities
Frequent trips to the bathroom
Eating Disorders
Strategies and Accommodations
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Stress acceptance in your setting; successful
people come in all shapes and sizes.
Watch what you say. Comments like “You look
terrible,” “I wish I had that problem” are often
hurtful and discouraging.
Stress progress, not perfection.
Avoid high levels of competition.
Reduce stress when possible.
Evaluation
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Please complete the evaluation and leave it
Be sure to note any topics for future training