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

1. **Working with youth who have mental health disorders** By: Debbie Tiger, MS, CTRS

2. CCH new Youtube video!! • http://www.youtube.com/watch?v=mRn1El5hH5E - Hope Begins Here video

3. Cunningham Children’s Home • Ages 8-18 • clinical disorder (DSM-5, Axis 1-3 combined now) • Mental disorder – clinically significant disturbance in an individual’s 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 school)

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

5. Common diagnoses cont’d • 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, pyromania) • Substance related disorders (alcohol, caffeine, cannabis, opioid, stimulants, etc)

6. 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**

7. NeuroDD cont’d • 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.

8. NeuroDD cont’d • 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

9. Schizophrenia Spectrum • Key features – delusions and hallucinations. • Generally not diagnosed as having a schizophrenia spectrum disorder until late adolescence or young adulthood.

10. 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 episodes • 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..

11. 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.

12. Depressive Disorders (cont’d) • 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 plan.

13. Depressive Disorders (cont’d) • 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

14. 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.

15. Anxiety Disorders (cont’d) • 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)

16. Anxiety Disorders (cont’d) • 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 dying. • 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)

17. 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.

18. OCD and related (cont’d) • 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 others. • Hoarding • Trichotillomania • Excoriation

19. 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 child’s 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

20. Trauma/Stressor Dis. (cont’d) • 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.

21. Trauma/Stressor Dis. (cont’d) • 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, self-destructive)

22. 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 • HUMOR

23. Tips (cont’d): • 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, distract develop plans; be pro-active

24. Tips (cont’d): • SAFETY • Belonging, Independence, Generosity, Mastery – Circle of Courage (Brendtro, Brokenleg, Van Bockern, 1990) • Nurtured Hearts: Truth of the moment– energizing positives – low energy to negatives

25. 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