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Mental Health Disorders in Young Children and Youth

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Title: Mental Health Disorders in Young Children and Youth


1
Mental Health Disorders in Young Children and
Youth
  • A Primer for Youth Workers

2
Focus of Training
  • 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

3
Diagnostic Information in Mental Health
  • 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

4
Educational Classification
  • 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

5
Educational Eligibility Emotional Disability
  • 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
  • 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.

6
Educational EligibilityOther Health Impairment
  • 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
  • Is due to chronic or acute health problems
  • Adversely affects a students educational
    performance.

7
Educational EligibilityAutism Spectrum Disorder
  • Autism spectrum disorder is a lifelong
    developmental disability that includes autistic
    disorder, Aspergers syndrome, and other
    pervasive developmental disorders, as described
    in the current version of the American
    Psychiatric Associations 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
    students educational performance. Other
    characteristics often associated include the
    following
  • Engagement in
  • Repetitive activities
  • Stereotyped movements
  • Resistance to
  • Environmental change or
  • Change in daily routines
  • Unusual responses to sensory experiences.

8
504 Plans
  • 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 ones
    self, walking, seeing, hearing, speaking,
    breathing, working, performing manual tasks, and
    learning.

9
About Mental Health Diagnoses
  • Disorders first Diagnosed in Infancy, Childhood,
    or Adolescence
  • Fetal Alcohol Syndrome
  • Schizophrenia and other Psychotic Disorders
  • Mood Disorders
  • Anxiety Disorders
  • Eating Disorders

10
Disorders First Diagnosed in Infancy, Childhood,
or Adolescence
  • Pervasive Developmental Disorders
  • Attention-Deficit and Disruptive Behavior
    Disorder
  • Tic Disorders
  • Other Disorders of Infancy, Childhood, or
    Adolescence

11
Pervasive Developmental Disorders
  • Autistic Disorder
  • Retts Disorder
  • Childhood Disintegrative Disorder
  • Aspergers Disorder
  • Pervasive Developmental Disorder - Not Otherwise
    Specified (PDD-NOS)

12
Characteristics of Autism
  • Markedly abnormal or impaired development in
    social interaction.

13
Characteristics of Autism
  • Markedly abnormal or impaired development in
    communication.

14
Characteristics of Autism
  • Markedly restricted repertoire of activities and
    interests

15
Aspergers Syndrome
  • Previously thought of as high functioning
    autism.
  • The most outstanding characteristic of a child
    with Aspergers 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.

16
Autism Spectrum DisorderStrategies and
Accommodations
  • 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 childs triggers to prevent
    meltdowns.
  • Do not force eye contact.
  • Minimize visual and auditory distractions modify
    environment as reasonable for sensory issues.

17
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.
18
Attention Deficit Hyperactivity Disorder
Symptoms and Behaviors
  • Children with inattentive disorder may
  • 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

19
Attention Deficit Hyperactivity Disorder
Symptoms and Behaviors
  • Children with hyperactive-impulsive disorder may
  • 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

20
Attention Deficit Hyperactivity Disorder
Symptoms and Behaviors
  • Children with combined attention deficit
    hyperactivity disorder show symptoms of both
    inattention and hyperactivity or impulsivity.

21
Attention Deficit Hyperactivity Disorder
Strategies and Accommodations
  • 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.

22
Oppositional Defiant Disorder Symptoms and
Behaviors
  • 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

23
Oppositional Defiant DisorderStrategies and
Accommodations
  • 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.

24
Conduct Disorder Symptoms and Behaviors
  • 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

25
Conduct DisorderStrategies and Accommodations
  • 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.

26
Tourette Syndrome Symptoms and Behavior
  • 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

27
Tourette Syndrome Strategies and Accommodations
  • 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.

28
Reactive Detachment DisorderSymptoms or Behaviors
  • 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

29
Reactive Detachment DisorderStrategies and
Accommodations
  • 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.

30
Fetal Alcohol Spectrum DisordersSymptoms or
Behaviors
  • Early Childhood
  • 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)

31
Fetal Alcohol Spectrum DisordersSymptoms or
Behaviors
  • Elementary Years
  • 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

32
Fetal Alcohol Spectrum DisordersSymptoms or
Behaviors
  • Adolescent Years
  • 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
  • Doesnt learn from mistakes

33
Fetal Alcohol Spectrum DisordersStrategies and
Accommodations
  • 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 childs attention and check for
    understanding.
  • Encourage the use of positive self-talk.

34
Schizophrenia Symptoms and Behaviors
  • 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

35
Schizophrenia Strategies and Accommodations
  • 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.

36
Mood Disorders DepressionCommon Symptoms
  • Sadness that wont 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

37
Mood Disorders DepressionStrategies and
Accommodations
  • Help children use realistic and positive
    statements about their performance and outlook
    for the future.
  • Acknowledge but dont minimize the childs
    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.
  • Dont be afraid to suggest that parents seek
    outside help.

38
Mood Disorders Bipolar Disorder
  • Also know as manic-depressive disorder.
  • A brain disorder that causes unusual shifts in a
    persons 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.

39
Mood Disorders Bipolar DisorderSymptoms and
Behaviors
  • 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 ones own abilities that defy
    the laws of logic (become a rock star overnight,
    for example)

40
Mood Disorders Bipolar DisorderStrategies and
Accommodations
  • 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.
  • Dont be afraid to suggest that parents seek
    outside help.

41
Anxiety Disorders
  • The most common anxiety disorders affecting
    children are
  • Generalized Anxiety Disorder
  • Phobias
  • Social Phobia
  • Panic Disorder
  • Obsessive-Compulsive Disorder
  • Post Traumatic Stress Disorder
  • Adjustment Disorder

42
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
43
Anxiety DisordersObsessive-Compulsive Disorder
  • 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

44
Anxiety Disorders Post Traumatic Stress Disorder
  • Flashbacks, hallucinations, nightmares,
    recollections, re-enactment, 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

45
Anxiety Disorders Strategies and Accommodations
  • Try to accommodate situations the child has no
    control over
  • Educate the childs peers about particular
    symptoms, such as the compulsions of OCD
  • Be attentive to changes in the childs behavior,
    which may indicate added stress
  • Avoid belittling a childs 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

46
Adjustment Disorder Symptoms and Behaviors
  • 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

47
Adjustment Disorder
  • Can be further categorized by the specific
    symptoms experienced
  • 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

48
Adjustment Disorder Strategies and
Accommodations
  • 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 childs behaviors and avoid drawing
    conclusions about whether the behaviors are
    indicative of a mental health problem

49
Eating Disorders Anorexia and Bulimia
  • 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.

50
Eating DisordersSymptoms or Behaviors of Note
  • 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

51
Eating DisordersStrategies and Accommodations
  • 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.

52
Evaluation
  • Please complete the evaluation and leave it
  • Be sure to note any topics for future training
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