Children and Adolescents: Prevalence, Comorbidity, and Mental Health Assessment

1. Chapter 23 Children and Adolescents

3. Prevalence and comorbidity • ½ of all Americans will meet criteria for DSM-IV disorder • 1 in 5 children and adolescents suffer from major psychiatric disorder • 2/3 of all young people are not getting the help they need • Suicide is 3rd leading cause of death in age 15-24 yrs and 6th in age 5-14 yrs • Mental Health: A Report of the Surgeon General, identified barriers to assessment and treatment remain

4. Theory • Childs vulnerability to psychopathology is result complex interactions between biological, psychological, genetic and environmental variables • Younger children harder to diagnose than older children • Genetic Factors: autism, bipolar, mental disorders, ADHD, mental retardation • Biochemical Factors: alterations in nr-transmitters with decrease in serotonin and norepinephrine related to depression & suicide • Environmental Factors: put stress on children & adolescents and shape their development

5. Resiliency • It is assumed that constitutional resiliency and a supportive environment play roles in keeping disorders from development • Studies have shown that resilient child has following characteristics: • Temperament that adapts to changes in environment • Ability to form nurturing relationships • Ability to distance self from emotional chaos in family • Social intelligence • Ability to problem solve

6. Mental health assessment • Provides info about problems with thinking, feeling, and behaving: • Developmental assessment; provides info about childs maturational level when compared to chronological age, identifies developmental lags and deficits • Methods of collecting data: interviewing, screening, testing, observing, interacting with child, histories from parent • Structured interview and observation

7. Mental retardation • Most common developmental disorder • Degree of impairment is determined by assessing IQ with standardized tests such as Wechsler Intelligence Scales for Children • Cause may be hereditary • IQ level 50-70 • Diagnosis • May have impairments in communication skills, social interactions, self care abilities and disruptive behavior depending on severity

8. PDD, Autism and Asperger’s syndrome • PDD (Pervasive Developmental Disorder) • Characterized by severe & pervasive impairment in reciprocal social interaction & communication skills usually accompanied by stereotyped behavior, interests and activities • Autism • Behavioral syndrome resulting from abnormal brain function of unknown etiology

9. Asperger’s syndrome • Asperger’s Syndrome • Differs from autism in that it appears to have later onset and does cause delay in cognitive and language development • Assessment: 3 presenting characteristics • Assessment Guidelines • Diagnosis: Defensive Coping, Ineffective Coping • Implementation: Ultimate long term outcome is to help children reach full potential by fostering developmental competencies and coping skills

10. Anxiety disorder • Anxiety becomes problem when child or adolescent fails to move beyond fears associated with certain developmental stages or when anxiety interferes with normal functioning • Most common mental disorder in this age group • Symptoms same as for adult: agoraphobia, GAD, panic disorder, social phobia, OCD, PTSD • Separation Anxiety Disorder: anxiety when separated from parents or home • PTSD; occurs at any age, after a traumatic event • Assessment Guidelines • Diagnosis: Anxiety, Fear, Ineffective Coping • Implementation: Tx on outpt basis with CBT and SSRI’s

11. Mood disorders • Symptoms of depression are similar to adult symptoms • Adolescents more apt to have psychomotor retardation and hypersomnia • Depressive symptoms expressed as irritability and aggressiveness • Acting out behaviors can be mood disorder • Assessment: Assessment Guidelines • Diagnosis: Hopelessness, Ineffective Coping • Implementation; suicidal pts hospitalized for evaluation and tx with antidepressants and mood stabilizers. Long term outcome is help pt reach full potential

12. ADHD and disruptive disorders • ADHD • Show inappropriate degree of inattention, impulsiveness and hyperactivity • Disruptive Behavioral Disorders • Oppositional Defiant Disorder • Conduct Disorder • Assessment: assessment guidelines per disorder • Diagnosis; risk for other directed violence • Implementation • Behavioral modifications & medications • Correction of faulty personality disorder • Control aggressive behavior • Family involvement

13. Tourette’s disorder • Involves motor & verbal tics that cause marked distress & significant impairment in social and occupational function • Tics may appear as early as age 2 but average at age 7 • Duration is lifelong but can have periods of remission • Assessment; obsessions, compulsions, hyperactivity • Diagnosis: Anxiety, Impaired social isolation • Implementation: Focus on treatment helping child, family and school understand and cope with tic behavior

14. Therapeutic modalities for child and adolescent disorders • Parental Involvement • Group Therapy • Milieu Therapy • Behavioral Modification • Removal and Restraint • Quiet room/ Time out • Therapeutic Holding • CBT • Play therapy/ Dramatic play therapy • Therapeutic games • Bibliotherapy • Therapeutic Drawing • Music therapy/ Movement and Dance Therapy • Recreational Therapy