Download Working with youth who have ED/BD diagnoses

**Working with youth
who have mental
health disorders**
By: Debbie Tiger, MS, CTRS
CCH new Youtube video!!
 http://www.youtube.com/watch?v=mRn1
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Cunningham Children’s
Home
 Ages 8-18
 clinical disorder (DSM-5, Axis 1-3 combined now)
 Mental disorder – clinically significant disturbance in an
individual’s cognition, emotion regulation, or behavior
that reflects a dysfunction in the psychological,
biological, or developmental processes underlying
mental functioning. (DSM-5, 2013)
 Presenting problems severely affecting most areas of
life: school, home, work, relationships
 Not able to be maintained in home placement
(runaway, hospitalizations, suspensions from school)
Common child/adolescent
disorders:
 Neurodevelopmental disorders (ID, Global dev.
Delay, Communication disorders, ASD, ADHD,
Specific Learning Dis., Tic Disorders)
 Schizophrenia spectrum and other psychotic
disorders (delusional disorder, schizophrenia,
etc)
 Bipolar and related disorders (BP1, BP2,
Cyclothymic)
 Depressive Disorders (Disruptive Mood
Dysregulation Disorder, Major Depressive
Disorder, Persistent Depressive Disorder)
Common diagnoses cont’d
 Anxiety disorders (separation AD, specific phobia,
social AD, Panic AD, Agoraphobia, GAD)
 OCD- and related disorders (OCD, Body Dysmorphic
Disorder, Hoarding)
 Trauma and Stressor-Related Disorders (RAD, Disinhibited Social Engagement Disorder, PTSD,
Adjustment Dis.)
 Disruptive, impulse control, conduct disorders (ODD,
Intermittent ED, conduct dis., kleptomania, pyromania)
 Substance related disorders (alcohol, caffeine,
cannabis, opioid, stimulants, etc)
Neurodevelopmental
Disorders
 ADHD: inattentive, hyperactive,
impulsive, difficulty organizing, loses
things, easily distracted by extraneous
stimuli, “often unable to play or engage in
leisure activities quietly”, often talks
excessively (DSM-5 2013) **formerly part
of disruptive disorder**
NeuroDD cont’d
 ASD: persistent deficits in social
communication and social interaction across
multiple contexts: social-emotional reciprocity
deficits, nonverbal communication deficits,
deficits in developing, maintaining and
understanding relationships; restricted,
repetitive patterns of behavior, interests,
activities (DSM-5, 2013)-add specifiers,
severity levels.
NeuroDD cont’d
 ID – onset during developmental period;
deficits in intellectual functions
(reasoning, problem solving, abstract
thinking, planning, judgment), deficits in
adaptive functioning. Specify: mild,
moderate, severe, profound.
 Global DD – under age 5, clinical severity
level cannot be reliably assessed
Schizophrenia Spectrum
 Key features – delusions and
hallucinations.
 Generally not diagnosed as having a
schizophrenia spectrum disorder until
late adolescence or young adulthood.
Bipolar Disorders
 BP1 – meets criteria for a manic episode
Could be preceded or followed by hypomanic and depressive
episodes.
 BP2 – meets criteria for hypomanic and
depressive episodes
 Cyclothymic – for at least one year in children
and adolescents, there have been many
periods of hypomanic and depressive episodes
– do not meet full criteria for BP2
 Specifiers – seasonal, rapid cycling etc..
Depressive Disorders
 Disruptive Mood Dysreg. Disorder –
severe recurrent temper outbursts (verbal
rages or physical aggression) that are
grossly out of proportion in intensity or
duration to the situation; inconsistent with
developmental level; 3 X per week; mood
in between outbursts is irritable/angry
most of the day.
Depressive Disorders
(cont’d)
 Major Depressive: depressed mood most of
the day, nearly every day, irritable mood in
children, markedly diminished interest or
pleasure in all activities, weight loss/gain,
insomnia, hyper-somnia, psychomotor
agitation/retardation, feeling worthless,
decreased ability to think/concentrate, thoughts
of death including suicidal thoughts, suicide
attempt or specific plan.
Depressive Disorders
(cont’d)
 Persistent Depressive Disorder (formerly
Dysthymia): Depressed mood most of
the day; presence of at least two
symptoms listed from MDD (abbreviated
list – no suicidal plans).
 Substance/medication induced
depression, due to a medical condition
Anxiety Disorders
 Separation AD: excessive fear or anxiety
concerning separatin from individual
attached to; excessive worry about losing
major attachment figures (harm, illness,
disasters etc.); excessive worry about
possible events (lost, being kidnapped);
reluctance to go out, away from home, to
school; fear of being alone, repeated
nightmares about the theme of
separation.
Anxiety Disorders (cont’d)
 Specific Phobias: marked fear or anxiety
about a specific object/situation: flying,
heights, animals, blood.
 Social Anxiety Dis.(social phobia):
marked fear or anxiety related to social
situations, being exposed to scrutiny
(being observed eating, giving a speech,
meeting unfamiliar people)
Anxiety Disorders (cont’d)
 Panic Disorder – panic attacks, abrupt surge of
intense fear that reaches a peak within
minutes. Symptoms: pounding heart,
sweating, shaking, shortness of breath, dizzy,
chills, numbness, de-realization, fear of losing
control, fear of dying.
 Agoraphobia – fear/anxiety related to use of
public transportation, being in open spaces,
enclosed spaces, being in a crowd, standing in
line, being outside of home alone (fear escape
might be difficult)
Obsessive Compulsive and
related disorders
 OCD: intrusive, recurrent, persistent
thoughts, impulses or images (not simply
excessive worries about real-life),
obsessional thoughts; Compulsion repetitive bxs, aimed at preventing or
reducing distress. Over-importance on
thoughts – believe having a bad thought
is as bad as acting on it.
OCD and related (cont’d)
 Body Dysmorphic Disorder: preoccupation
with one or more defects, flaws that are not
observable or appear slight to others. Perform
repetitive mirror checking, excessive grooming,
skin picking, seeking reassurance, comparing
to others.
 Hoarding
 Trichotillomania
 Excoriation
Trauma and Stressor
related disorders
 RAD: Disturbed and developmentally inappropriate
social relatedness in most contexts before age 5;
excessively inhibited, or highly ambivalent (resist
comforting, avoidance); minimal responsiveness,
limited positive affect; Pathogenic care is part of child’s
history (disregard for basic needs, emotional and
physical, frequent change in primary caregivers).
 Disinhibited Social Engagement Dis. (formerly part of
RAD): pattern of bx, child approaches/interacts with
unfamliar adults, overly familiar verbal/physical
interactions, willingness to go with an unfamiliar adult
Trauma/Stressor Dis.
(cont’d)
 PTSD – exposure to actual or threatened
death, serious injury, or sexual violence
(directly, witnessing, learning event happened
to close family member/friend, experiencing
repeated or extreme exposure to details)
Symptoms: disorganized, agitated, intense
fear, helplessness, horror, recurrent
thoughts/feelings, flashbacks, distress when
triggered, illusions, nightmares.
Trauma/Stressor Dis.
(cont’d)
 PTSD – persistent avoidance of stimuli
associated with trauma
 Negative alterations in cognitions/moods
– to manage and avoid – negative
coping, reactivity (exaggerated startle
response, hypervigilance, problems
concentrating, sleep disturbance, selfdestructive)
Tips for working with youth
with ED/BD diagnoses:
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Know your clientele
Professional boundaries
Develop a relationship
Firm, consistent limits/boundaries
Offer choices; no power struggles
Problem solve; be curious
Empathy, caring
HUMOR
Tips (cont’d):
 If you know a client has an ED or BD
diagnoses:
ask client how staff can assist them
ask client what triggers them
ask parent/guardian for guidance
time away to re-group; re-set time,
distance, distract
develop plans; be pro-active
Tips (cont’d):
 SAFETY
 Belonging, Independence, Generosity,
Mastery – Circle of Courage (Brendtro,
Brokenleg, Van Bockern, 1990)
 Nurtured Hearts: Truth of the moment–
energizing positives – low energy to
negatives
Recreation at CCH
 IIAA – residential sports association
 Cooperative games
 Educational groups –anti-bullying,
relationship skills, social skills, friendship
skills, anger management, coping skills
 Pet Therapy, Self Awareness, relaxation,
exploring senses
 Sports skill development, fitness