Youth with Mental Health Concerns

1. Youth with Mental Health Concerns Jutta Dotterweich Cornell University jd81@cornell.edu www.actforyouth.net

2. Adolescent Health Paradox Adolescence is physically the healthiest period of the lifespan Yet: overall morbidity and mortality rates increase 200% from childhood to late adolescence Youth age 13 – 18: 50% experienced mental health symptoms 22% had a lifetime prevalence of severe symptoms (2010)

3. Common Mental Health Categories Anxiety Disorders Mood Disorders Learning Disorders Disruptive Behavioral Disorders Thought Disorders

4. Anxiety Disorders 8% of teens ages 13-18 experience anxiety disorders • Separation anxiety • Social anxiety (7%, onset around age 13) • Phobias (5% in children, 16% in adolescents (13-17), 3-5% in older people) • Panic Disorder (2-3% adolescents)

5. Obsessive-Compulsive Disorder Obsessions: Recurrent and persistent thoughts, urges or images perceived as intrusive Compulsions: Repetitive behaviors or mental acts the individual is driven to in response to an obsession. Onset typically late adolescents, can be earlier Prevalence in adolescence: 1 in 200

6. Trauma and Stress Related Disorders Traumatic event includes • actual or threatened death, injury or assault to self or someone close • chronic stress (i.e. wars, violent neighborhoods, abuse/ neglect in family home) • natural catastrophes Child’s or adolescent’s response is intense fear, helplessness, or horror

7. Inhibited Disinhibited Reactive Attachment Disorder • Failure to thrive • Poor hygienic condition • Underdevelopment of motor coordination; hyper tonicity • May appear bewildered, unfocused • Blank expression • Unresponsive to social contact/interaction • Excessive familiarity with unknown persons • can give hugs to anyone who approaches them; can go with strangers • May approach a complete stranger for comfort, food, to be picked up, etc.

8. Post Traumatic Stress Disorder (PTSD) • Symptoms last longer than a month after event • Intrusive re-experiencing of the trauma, avoiding trauma reminders, and persistent state of alert • Related emotional and behavioral problems • Co-occurs with other disorders (anxiety, ADHD, oppositional defiant disorder, etc.) • 15% of girls, 6% of boys who experienced trauma meet criteria for PTSD (3 – 50% in juvenile justice) • Symptoms vary according to developmental stages

9. PTSD in Childhood Symptoms: Early & Middle Childhood • Generalized nightmares • Persistent re-experiencing of event through repetitive play or storytelling Physical symptoms • Increased arousal/hyper-vigilance • Failure to progress or regression in developmental skills • Impaired social relationships/caregiver relationships

10. PTSD in Adolescence Flashbacks Persistent re-experiencing of event (sometimes through risk-taking behavior) Physical symptoms Increased arousal/hyper-vigilance Failure or regression in academic skills; concentration problems Impulsive or aggressive behaviors Absence of future planning

11. Mood Disorders • Dysthymic disorder • Depression • Bipolar disorder • Disruptive mood dysregulation (2-5%, onset before age10)

12. Depression Persistently sad/irritable Loss of energy Loss of interest Significant change in weight/appetite Physical agitation • Difficulty sleeping or oversleeping • Feelings of worthlessness • Difficulty concentrating • Recurrent thoughts of death/suicide Likelihood of onset increases with puberty 11% of adolescents have a depressive disorder by age 18 (NIMH) Rate for females 1.5 – 3 times higher than for males Different Expressions Withdrawal Acting Out

13. Bipolar Disorder MANIC SYMPTOMS Onset usually late adolescence DEPRESSION Severe changes in mood Inflated self-esteem Great energy increase Increased talking Distractibility Increased goal-directed activity or physical agitation Disregard of risk Decreased appetite May be delusional

14. Learning Disorders • Boys 3 times more like to be affected • Often associated with anxiety disorders and depression • No cognitive impairment • Attention Deficit Hyperactivity Disorder – ADHD (3-7% of school-age children • Dyslexia (specific learning disorders) (5-15% among school-age children)

15. Main Symptoms of ADD/ADHD Inattention or inconsistent attention Hyperactivity Impulsivity

16. Disruptive Behavior Disorders Oppositional/Defiant Disorder (1-11%) • contrariness, constantly arguing & swearing Conduct Disorder (2-10%) • aggression to people and animals, deceitful, destruction of property

17. Thought Disorders Schizophrenia or Psychotic Disorder: Delusions – false beliefs Hallucinations – sensations that nobody else has Disorganized Thinking – trouble organizing thoughts logically Onset usually late adolescence/early adulthood Lifetime prevalence 0.3-0.7%

18. Autism Spectrum (Asperger’s) • Persistent deficits in social communication and interaction • Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities • 3 levels of severity depending on functioning level of first two symptoms • Hyper – or hyporeactivity to sensory input • Intellectual impairment • Asperger’s (outdated category): normal or high intelligence Prevalence close to 1% of population

19. General Behavior Patterns • Hyperactivity • Aggression/self-injurious behavior • Withdrawal • Immaturity • Learning difficulties

20. Psychotropic Medication Common Side Effects • Drowsiness • Increased or decreased appetite • Headaches • Nausea • Dizziness

21. Stigma Alert Meet Sam He is more than his diagnosis and behavior problems

22. Stressors and Triggers Stress signals involve feelings, thoughts, behaviors and physical reactions Identify triggers for stress • Observation • Conversation with youth • In residential settings ask staff

23. Coping Strategies • Positive appraisal – reframing the situation • Problem-focused coping – brainstorming and planning to resolve conflict, acquire resources and supports • Emotion-focused coping – manage or reduce emotional distress (cognitive or behavioral strategies) • Meaning-focused coping – search for meaning in adversity and draw on values, beliefs and goals

24. Environmental Factors Clutter, disorganization Lighting Noise level Time of day (daily routine, structure) Community settings – crowds, noise, activity level

25. Behavior Management Techniques • Proximity • Prompts • Hurdle help • Time away • Redirection • Planned ignoring and positive attention • Directive statements • Caring gesture

26. Communication Strategies • Attentive listening • Respectful questioning • Empathic communication

27. Meaning in Spoken Communication Facial Expression + Tone of Voice + Words 7% 55% 38%

28. Non-Verbal Techniques • Silence • Eye Contact • Facial expression • Posture (e.g., leaning forward) _______________ • Minimal encouragement (“uh-huh,” go on, etc.) • Tone of voice

29. Active/Empathic Listening Listening for meaning • Attentive to speaker • Reflecting facts and feelings • Interpreting meaning, feelings • Withholding opinions and judgment

30. Open vs. Closed Questions

31. Web Resources • National Institute of Mental Health http://www.nimh.nih.gov/index.shtml • NYS Office of Mental Health http://www.omh.ny.gov/ • American Academy of Child & Adolescent Psychiatry http://www.aacap.org • CDC - ACE Study http://www.cdc.gov/violenceprevention/acestudy

32. Collaborative for Academic, Social, and Emotional Learning http://www.casel.org/sel/families.php US Reach Out http://us.reachout.com/the_facts Kids Health (for teens) http://kidshealth.org/teen/your_mind/#cat20123