1 / 40

Child and Adolescent Mental Health

Child and Adolescent Mental Health. Cognitive development. Moves from concrete thinking to “formal operations” Abstract thinking

jana-bryant
Download Presentation

Child and Adolescent Mental Health

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Child and Adolescent Mental Health

  2. Cognitive development • Moves from concrete thinking to “formal operations” Abstract thinking • Level of thinking allows the person to transfer information from one situation to another, deal efficiently with complex problems, and plan realistically for the future. • Physical development precedes cognitive development • The last part of the brain to mature is the prefrontal cortex • Adolescence is a time of profound change in brain function.

  3. Mental Health Problems of school Age Children • 10-13% of children have serious MH problems • 655,000 Texas children

  4. Etiology of MH Problems • Genetics: strong for depression, Anxiety, OCD, Tic disorders, ADHD, bipolar • Environment: Abuse and neglect, (actually causes a change is the structure of the brain) • Fetal Alcohol Syndrome, Brain damage, poverty of thought ( mental retardation) • Neurological Anomalies • Developmental disorders- MR-IQ below 70 , Axis II • Pervasive developmental disorders-Autism, Asperger’s, PDD-NOS, Etc.

  5. Resiliency in Children Resiliency in Children • Psychosocial disadvantage: multiple risk factors • Do not develop a psychiatric disorder • Well-adjusted adult • Environmental and constitutional elements • Not well understood • Relative or community cares for the child • Absence of Neglect • Ability to internalize and define themselves • Foster resiliency • Predictable family environment • Structure • Therapeutic milieu

  6. Content • Developmental Disorders • Attention Deficit and Disruptive Behavior DisordersInternalization Disorders • TIC Disorders • Psychotic Disorders • Other Psychiatric Disorders • Eliminations Disorders • Psychotic Disorders • Mood Disorders • Depression • Bipolar Disorder • Psychopharmacology • Cognitive Behavioral Therapy

  7. Developmental Disorders • Mental Retardation • IQ< 70 • Pervasive Developmental Disorders • Autistic Disorder • Asperger’s Disorder • Pervasive Developmental Disorder NOS • Specific Developmental Disorders • Learning Disorder • Communication Disorders • Speech and language disorders are strongly associated with psychiatric disorders

  8. Attention Deficit and Disruptive Behavior Disorders • ADD • Attention Deficit Disorder (Hyperactive type) • Attention Deficit Disorder (Withdrawn type) • Oppositional Defiant Disorder • Conduct Disorder

  9. Attention Deficit Hyperactive Disorder (ADHD) • Inattention • Impulsivity • Overactivity • Restless overactive distractible reckless disruptive • Up to 11% of school age children • Psychological adversity

  10. ADHD • The Frontal Lobe • Subtle Dysfunction in the Frontal Lobe • Reduced metabolic activity • Hypoperfusion

  11. Treatment ADHD • Problem in the Frontal lobe, which is responsible for planning, attention, regulation of motor activity-Brain under active • Not enough dopamine available

  12. Medication: Stimulants • Medication: Stimulants • Ritalin (methylphenidate) • Dexedrine (dextroamphetamine) • Adderall (D,L dextroaamphetamine) • Also used for weight loss • Extended release Ritalin LA; Metadate CD, Concerta and Vyvanse decrease dosing to once daily • Adderall XR is also extended release

  13. Non-extended release Administer regular stimulants just prior to meals to decrease anorexia Require noon dosing and a smaller dose in the evening to prevent rebound Last dose is given at 1600 Side effects Anorexia Weight loss Lowers the seizure threshold Abnormal movements Labile mood Insomnia, Hyper-focused over focused on details Agitation Medication issues for Stimulants

  14. Non-Stimulant • Tricyclic Antidepressants • Imipramine, Desipramine, Clomipramine • Concern about cardiac conduction • Clonidine (Catapress) • Developed as an antihypertensive • Reduce norepinephrine activity in the brain

  15. Has a different mode of action, not a schedule II drug Capsule form of 10,18,25,40,60 mg Effects reuptake of Norepinephrine Side effects Most common: dyspepsia, nausea, vomiting, fatigue, appetite decreased, dizziness, and mood swings Less common: insomnia, sedation, depression, tremor, itching, dry eyes, sexual dysfunction Adverse events: Increased heart rate and blood pressure; ventolin inhalers can increase Drug interactions: Paxil and Prozac Non-Stimulant: Atomoxetine/Strattera

  16. Disruptive Behavior Disorders • Oppositional Defiant Disorder • Enduring pattern of disobedience • Argumentative • Explosive (Impulsive) • Frequently in conflict with adults • Tendency to blame others • Comorbid Diagnosis with ADHD, anxiety and mood disorders

  17. Disruptive Behavior Disorders • Conduct Disorder • More serious violations of social standards • Higher than expected rates of ADHD, depression and learning disorders • Associated with Antisocial Personality Disorder (if the child does not make changes in behavior)

  18. Pervasive Developmental Disorders • Impairment across multiple domains (impairment is global) • Psychological Impairment • Social Impairment • Academic Impairment • May meet the standard for Mental retardation

  19. Pervasive Developmental Disorders • Characterized by impairments across all domains of development • Delayed social development • Stereotypical behaviors • Hand-flapping • Rocking and spinning • Peculiar preoccupations • Water moving objects • Women’s noses • Water • Second story window • Rigid and intolerant of change

  20. PDD’s Are now viewed as being on the same spectrum, differentiated by severity of symptoms and impairment

  21. Pervasive Developmental Disorders • Autistic Disorder • Asperger’s Disorder • Pervasive Developmental Disorder NOS

  22. Autistic Disorder • Early Age of onset • 30 months of age • Constant delayed development • Social relatedness is profoundly impaired • Aloof and indifferent to others • Prefer inanimate objects to human contact • Stereotypical Behaviors • Rocking and Hand flapping

  23. Autistic Disorder • Communications • Delayed and deviant • Abnormal intonation • Pronoun reversals • Echolalia • Insistence on sameness and preoccupation with peculiar interests • Fans • Air conditioners • Train schedules • Windows • Water • The vaccination controversy

  24. Asperger’s Disorder • Less likely to be mentally retarded • Communication handicap is less severe • Concrete interpretation of language • Stilted and abnormal intonation • Higher performing • Social interactions impaired • Impaired reading of social cues • Clumsy • Difficulty with transition • Preoccupation with matters of private interest

  25. Pervasive Developmental Disorder NOS • Does not meet criteria for more specific type of PDD • Traits of both Autism and Asperger’s

  26. Tic Disorders • Tourette’s Syndrome-Movement disorder defined by the presence of motor and phonic tics: Rare 1 to 2 per thousand • Motor Tics-rapid, jerky movements of eyes, face, neck, and shoulders • Phonic tics: grunting, throat clearing, and repetitive noises • Can be words or obscenities • Medications: • haloperidol (Haldol) • clonidine (Catapress)

  27. Other Psychiatric Disorders • Childhood Schizophrenia- 2 cases per 100,000 • Anxiety Disorders: Separation anx. and OCD • Elimination Disorders-often accompany other disorders or as response to stress • Enuresis –bedwetting and/or incontinence during the day • Encopresis—fecal incontinence, soiling or inappropriate depositing of feces • Fecal impaction may cause or result

  28. Other Psychiatric Disorders, cont’d • Bipolar D/O and Schizophrenia—Primarily dx. in adolescence • Depression: risk increases when a parent is depressed. • How are the symptoms of depression in children and adolescents different from the symptoms seen in adults?

  29. Depression Symptoms Specific to Younger Populations • In Children • Lack of verbal skills affects expression: may be irritable or resistant • In Adolescents • Blues in boys; aggressive behavior or acting out • Blues in girls; anxiety, eating disorders, and or self-cutting. • 2 symptoms to be concerned about: difficulty concentrating and negative statements about themselves and their place in life (peer group, family, school); like “I’m stupid”

  30. Pharmocotherapy • Antidepressants • SSRIs : fluoxetine (Prozac)  sertraline (Zoloft)  fluvoxamine (Luvox)  paroxetine (Paxil) citalopram (Celexa) escitalopram (Lexapro) • None are yet officially FDA approved! Also used for OCD

  31. Pharmacotherapy, cont’d • SSRIs, cont’d • Activating effects may precipitate hypomania, mania or suicide • TCAs –have been used for many years but effectiveness not proven

  32. Pharmacotherapy, cont’d • Antipsychotic Agents • For aggressive behavior, self-injury, tics, psychotic symptoms • Typicals: Highly correlated with EPSEs (rarely used) • Atypicals: Weight gain problematic; fatty livers (Zyprexa prn)

  33. Nursing Interventions • Simple instructions; Do not say-”Clean your room” say- “Put the dirty clothes in the hamper”, Then,” Make your bed” • Teaching the family about ADHD • Assess family HX and how successful • Listen, support groups, books • Communicate with teachers, School

  34. Cognitive Behavioral Therapy • Milieu • Negative Reinforcement • Positive Reinforcement • Extinction • Consistency • Points • Levels • Cost Response

  35. Social Skills Training • Recognize the impact of their behavior • Fail to recognize the impact on others • Instructions • Role Playing • Positive Reinforcement

  36. Problem-Solving Skills • Misinterpret the intentions of others • Perceiving hostility when none is intended • Teaches a different interpretation of the behaviors of others • Options for a response • Each option is evaluated for the consequence • What to say: • What happened? • What did you do? • How did that work for you? • What can you do next time?

  37. Parent Teaching • Importance of clear limits • Positive reinforcement • Praise • Positive attention • Tangible rewards • Point Systems • Mild punishment • Time out

  38. Psychotherapy • Individual Therapy • Group Therapy • Family Therapy • Passes to go home prior to being discharged

  39. Community Resources • Support groups, camps, web resources, and literature

  40. The End

More Related