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**Working with youth who have mental health disorders**


**Working with youth who have mental health disorders** By: Debbie Tiger, MS, CTRS * * * * * * * * * * * CCH new Youtube video!! http://www.youtube.com/watch?v ... – PowerPoint PPT presentation

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Title: **Working with youth who have mental health disorders**

Working with youth who have mental health
  • By Debbie Tiger, MS, CTRS

CCH new Youtube video!!
  • http//www.youtube.com/watch?vmRn1El5hH5E -
    Hope Begins Here video

Cunningham Childrens Home
  • Ages 8-18
  • clinical disorder (DSM-5, Axis 1-3 combined now)
  • Mental disorder clinically significant
    disturbance in an individuals 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

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,
  • Bipolar and related disorders (BP1, BP2,
  • Depressive Disorders (Disruptive Mood
    Dysregulation Disorder, Major Depressive
    Disorder, Persistent Depressive Disorder)

Common diagnoses contd
  • 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,
    Dis-inhibited Social Engagement Disorder, PTSD,
    Adjustment Dis.)
  • Disruptive, impulse control, conduct disorders
    (ODD, Intermittent ED, conduct dis., kleptomania,
  • 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 contd
  • 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 contd
  • 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

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
  • 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 (contd)
  • 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

Depressive Disorders (contd)
  • 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 (contd)
  • 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 (contd)
  • 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
  • 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 (contd)
  • 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
  • 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 childs 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. (contd)
  • 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. (contd)
  • 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,

Tips for working with youth with ED/BD diagnoses
  • Know your clientele
  • Professional boundaries
  • Develop a relationship
  • Firm, consistent limits/boundaries
  • Offer choices no power struggles
  • Problem solve be curious
  • Empathy, caring

Tips (contd)
  • 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,
  • develop plans be pro-active

Tips (contd)
  • 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
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