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Juvenile Offenders with Mental Health Disorders: Who They Really Are

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... Must have 4 or more symptoms Lasting at least 6 months Cannot be diagnosed if only occurring during mood disorder Conduct Disorder Aggression towards people ... – PowerPoint PPT presentation

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Title: Juvenile Offenders with Mental Health Disorders: Who They Really Are


1
Juvenile Offenders with Mental Health Disorders
Who They Really Are
  • Jeannie Von Stultz, Ph.D.
  • Director of Mental Health Services
  • Bexar County Juvenile Probation

2
DSM-IV
  • Diagnostic and Statistical Manual of Mental
    Disorders
  • Published by American Psychiatric Association
  • Diagnostic Categories are proposed and determined
    by work groups of mental health professionals (MD
    and PhD)
  • Revisions began 2007

3
Difficult to Diagnose Children
  • Ongoing development
  • Normal behavior varies Influenced by culture
    and/or trends
  • Symptoms present differently in adolescents
  • Childhood diagnoses share many symptoms

4
Factors Influencing Diagnosis
  • Psychological testing Snap shot
  • Psychiatric Evaluation Snap shot
  • Behaviors occur in specific circumstances
  • No problems at home
  • No problems at school

5
Factors Influencing Diagnosis
  • Symptoms not observed
  • Sleeping Habits
  • Eating Habits
  • Undiagnosed Medical Problems
  • Undiagnosed Learning Problems
  • Medication/Drug Side Effects

6
Factors Influencing Diagnosis
  • Limited assessment tools
  • Difficult to obtain information through fill in
    the blank or computer tests
  • For a diagnosis, many symptoms must be considered
    lengthy assessment (DISC)
  • Shorter tests are only screening tools often
    misses underlying emotional problems

7
Factors Influencing Diagnosis
  • Collateral information is invaluable
  • Professionals who observe child regularly
  • Professionals who witness particular symptom
  • Diagnoses change as clinician gains knowledge
  • List of rule-out possibilities

8
Prevalent Diagnostic Categories
  • Oppositional Defiant
  • Conduct Disorder
  • Major Depressive Disorder
  • Bipolar Disorder
  • Attention Deficit Hyperactivity Disorder

9
Oppositional Defiant Disorder and Conduct Disorder
  • Most obvious diagnoses
  • Disruptive Behavior Disorders
  • Symptoms focus on behavior not mood
  • Easy to identify
  • Children do not recognize mood
  • Not going to say I feel depressed

10
Oppositional Defiant Disorder and Conduct Disorder
  • Majority of disciplinary children qualify
    automatically
  • Statistics can be misleading
  • Allows for treatment even if not an emotional
    problem (mood disorder)

11
Oppositional Defiant Disorder
  • Often loses temper
  • Argues with adults
  • Actively defies rules
  • Deliberately annoys people
  • Blames others for their mistake
  • Easily annoyed
  • Often angry
  • Vindictive

12
Oppositional Defiant Disorder
  • Must have 4 or more symptoms
  • Lasting at least 6 months
  • Cannot be diagnosed if only occurring during mood
    disorder

13
Conduct Disorder
  • Aggression towards people/animals
  • Often bullies/threatens/intimidates
  • Often initiates fights
  • Has used a weapon that can cause harm
  • Physically cruel to people
  • Physically cruel to animals
  • Stolen while confronting victim
  • Forced someone into sexual activity

14
Conduct Disorder
  • Destruction of property
  • Deliberately setting fires intending damage
  • Deliberately destroying property
  • Deceitfulness or theft
  • Broken into someone elses house/car/etc
  • Often lies to get things or avoid obligations
  • Stolen items without confrontation

15
Conduct Disorder
  • Serious violations of rules
  • Stays out all night despite parental limits
    beginning before 13
  • Run away from home overnight at least 2xs
  • Truant from school beginning before 13
  • Must have 3 or more symptoms
  • Within past 12 months

16
Conduct Disorder
  • Can have co-occurring mood disorder
  • Can be CD without much criminal behavior
  • Cannot qualify for Antisocial Personality
    Disorder until 18
  • Not all Conduct Disorders grow up to be
    Antisocial
  • All Antisocial Personality Disorders must have
    had Conduct Disorder by 15

17
ODD and CD Treatment Options
  • Not effective
  • Medication
  • Traditional psychotherapy
  • Effective
  • Quality parent training programs which emphasize
    consistency, empathy, limit-setting
  • Multisystemic therapy approaches that provide
    intensive family-focused treatment

18
Major Depressive Disorder
  • Pervasive depressed mood
  • Loss of interest
  • Weight loss/gain or decreased appetite
  • Sleep difficulties
  • Psychomotor agitation/retardation
  • Fatigue
  • Feelings of worthlessness/guilt
  • Poor concentration/indecisiveness
  • Recurrent thoughts of death/suicide

19
Major Depressive Disorder
  • In Children vs Adults
  • Mood may be irritable instead of depressed
  • Irritability may lead to aggressive behavior
  • May think others are overly critical instead of
    being self-critical
  • More likely to have anxiety symptoms
  • More likely to have physical complaints

20
Major Depressive Disorder
  • At least 5 symptoms
  • Must be present for at least 2 weeks
  • Typically lasts 6 months
  • Dysthymic Disorder
  • Lower grade depression 2 symptoms
  • Longer duration 1 year
  • Not caused by medical condition
  • Not induced by substance use
  • May initiate substance use

21
MDD Treatment Options
  • Evaluation of treatment in infancy stage
  • Research on meds is limited in children
  • SSRIs supported effectiveness
  • Paxil, Prozac, Luvox, Zoloft
  • Several newer meds with limited research
  • Wellbutrin, Lexapro, Effexor, Celexa, Cymbalta

22
MDD Treatment Options
  • Cognitive behavioral approach seems to be
    promising
  • Intensive
  • Social skills training
  • Assertiveness training
  • Relaxation training
  • Family therapy

23
Bipolar Disorder
  • Manic Episode
  • Elated Mood
  • Inflated self-esteem
  • Decreased need for sleep
  • More talkative or pressured talk
  • Flight of ideas
  • Distractibility
  • Increase in activity or physical agitation
  • Excessive involvement in pleasurable activities

24
Bipolar I Disorder
  • Must have history of manic episode
  • Manic episodes often precede or follow a major
    depressive episode
  • Several variations of the disorder depending on
    frequency and patterns of mood

25
Bipolar II Disorder
  • Lower intensity hypomanic episode
  • Similar symptoms as manic
  • Not as impairing
  • Not so manic episode
  • Major depressive episode

26
Bipolar Disorder
  • Children vs Adults
  • Elated mood
  • Exceptionally silly behavior or laughing
  • Irritability
  • Grandiosity
  • Believes rules/consequences do not apply to them
  • Smarter than others
  • Capable of doing things without risk of injury
  • Difficult to determine in children

27
Bipolar Disorder
  • Children vs Adults
  • Flight of ideas
  • Jumping from topic to topic
  • Cycles quickly
  • Irritable or elated
  • Depressed

28
Bipolar Treatment Options
  • Research in infancy stage
  • Psychotropic medication in conjunction with
    cognitive therapy most promising
  • Mood Stabilizers
  • Abilify
  • Lithium
  • Depakote - anticonvulsant
  • Tegretol - anticonvulsant

29
Bipolar Treatment Options
  • Atypical Antipsychotics
  • Respirdal
  • Clozaril
  • Zyprexa
  • Geodon
  • Seroquel

30
Attention Deficit Hyperactivity Disorder
  • Inattention
  • Fails to attend to details
  • Difficulty sustaining attention
  • Doesnt seem to listen when spoken to
  • Doesnt follow through with instructions
  • Difficulty organizing tasks

31
Attention Deficit Hyperactivity Disorder
  • Inattention
  • Avoids tasks that require sustained attention
  • Loses things necessary for tasks
  • Easily distracted by stimuli
  • Forgetful in daily activities

32
Attention Deficit Hyperactivity Disorder
  • Hyperactivity
  • Often fidgets/squirms
  • Often leaves seat
  • Runs around or feels restless
  • Difficulty playing quietly
  • Often on the go

33
Attention Deficit Hyperactivity Disorder
  • Hyperactivity
  • Talks excessively
  • Blurts out answers before question finished
  • Difficulty waiting turn
  • Often interrupts

34
Attention Deficit Hyperactivity Disorder
  • Must have 6 or more symptoms from at least one of
    the categories
  • Type will be based on predominant symptoms
  • Can have 6 or more from both categories
  • Must last longer than 6 months

35
Bipolar vs ADHD
  • Difficult to differentiate
  • Symptoms shared
  • Irritability
  • Hyperactivity
  • Distractibility

36
Bipolar vs ADHD
  • Symptoms more common in Bipolar
  • Elated mood
  • Grandiose behaviors
  • Flight of ideas
  • Decreased need for sleep
  • Hypersexuality

37
ADHD Treatment Options
  • Psychotropic Medication
  • Strattera
  • Vyvanse
  • Daytrana
  • Adderall
  • Cylert
  • Concerta
  • Ritalin

38
ADHD Treatment Options
  • Medication side effects
  • Sleep disturbance
  • Eating disturbance
  • Weight loss

39
ADHD Treatment Options
  • Therapy
  • Parent training
  • Social skills training
  • Educational support

40
Shared Symptoms
  • Irritability
  • Aggressiveness
  • Inattentiveness
  • Fatigue
  • Sleep disturbance
  • Eating disturbance
  • Blaming Others
  • Distractibility
  • Talkativeness
  • Hyperactivity
  • Unable to follow instructions
  • Argumentative
  • Impulsivity (criminal behavior)
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