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

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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

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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

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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.

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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.

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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.

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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.

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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

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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

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Pervasive Developmental Disorders

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

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Characteristics of Autism

• Markedly abnormal or impaired development in
  social interaction.

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Characteristics of Autism

• Markedly abnormal or impaired development in
  communication.

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Characteristics of Autism

• Markedly restricted repertoire of activities and
  interests

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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.

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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.

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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.
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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

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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

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Attention Deficit Hyperactivity Disorder
Symptoms and Behaviors

• Children with combined attention deficit
  hyperactivity disorder show symptoms of both
  inattention and hyperactivity or impulsivity.

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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.

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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

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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.

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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

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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.

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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

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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.

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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

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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.

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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)

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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

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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

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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.

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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

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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.

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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

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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.

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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.

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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)

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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.

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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

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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
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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

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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

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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

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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

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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

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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

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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.

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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

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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.

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Evaluation

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