Youth Issues in Mental Health

1
Youth Issues in Mental Health

• Developed and Presented by
• Joan Helbing
• Diagnostician
• helbingjoan_at_aasd.k12.wi.us

2

• Important Facts About Mental Illness and
  Recovery
• Mental illnesses are biochemical brain disorders
  that can interfere with a persons ability to
  think, feel, and interact with or relate to other
  people and the environment.  
• They cannot be overcome through "will power" and
  are not related to a person's "character" or
  intelligence.
• Brain disorders fall along a continuum of
  severity. The most serious and disabling
  conditions affect 3-5 million children ages
• five to seventeen (5 9) in the United States. 
  
•  

3
Mental illnesses strike individuals in the prime
of their lives, often during adolescence and
young adulthood. All ages are susceptible, but
the young and the old are especially vulnerable.
4
Studies Show MI Often Begin in Youth, Treatment
Delays Worsen Issues

• One-half of all life-time cases of mental illness
  begin by age 14, and despite effective treatments
  for the disorders, there are long delays between
  the onset of symptoms and seeking treatment.
• These treatment delays- which
• can span decades- lead to more
• severe and difficult-to-treat
• illnesses and to co-existing
• disorders.

5

• Once people do get treatment, few receive care
  that meets minimally accepted standards for
  mental health treatment.
• Anxiety disorders often begin in
• childhood, mood disorders in later
• adolescence and substance
• abuse in the early 20s.
• Three-quarters of all lifetime
• cases begin by age 24!

6

• Researchers say children are less likely to
  receive timely treatment because they rely on
  parents or other adults to recognize symptoms,
  but adults often miss the signs unless they are
  extreme.
• Nearly ½ of those who have one
• mental disorder have one or
• more additional disorders.
• The more disorders a person
• has the more severe each may be.

7
Washington University research showed that mental
illness is now the leading reason for
hospitalization of people ages 5-19.
8
Many of these families of these children have
inadequate health insurance, which does not
provide coverage for the intensive counseling,
therapy and medication that is often needed by
these youth.
9
Causes Are Complicated

• Mental health disorders in children and
  adolescents are caused mostly by biology and
  environment.
• Biological
• Genetics
• Chemical imbalances
• Damage to central nervous system
• Head Injury
• Environmental
• Exposure to environmental toxins
• Exposure to violence
• Stress due to chronic poverty or
• other hardship
• Loss

10
Whats the Big Deal?

• 10 of children and adolescents in the United
  States suffer from serious emotional and mental
  disorders that cause significant functional
  impairment in their day-to-day lives at home, in
  school and with peers
• (Mental Health A Report of the Surgeon General,
  1999).

11
Extent of Mental Disorders in US

• ADHD Attention Deficit Hyperactivity Disorder
• PDD Pervasive developmental disorders
• Sources Office of the Surgeon General and the
  national Institute of Mental Health 1999

12

• Without treatment the consequences of mental
  illness for the individual and society are
  staggering
• unnecessary disability, unemployment, substance
  abuse, homelessness,
• inappropriate incarceration, suicide
• and wasted lives
• The economic cost of untreated
• mental illness is more than 100
• billion dollars each year in the
• United States.

13

• The best treatments for serious mental illnesses
  today are highly effective between 70 and 90 of
  individuals have significant reduction of
  symptoms and improved quality of life with a
  combination of pharmacological and psychosocial
  treatments and supports
• Early identification and treatment
• is of vital importance
• By getting people the treatment they
• need early, recovery is accelerated
• and the brain is protected from
• further harm related
• to the course of illness.

14

• Stigma erodes confidence that mental disorders
  are real, treatable health conditions.
• We have allowed stigma and a now unwarranted
  sense of hopelessness to erect attitudinal,
  structural and financial barriers to effective
  treatment and recovery.
• It is time to take these barriers down!

15
Top 3 Leading Causes of Death in Teens

• Accidents
• Suicide depression is the
• leading cause of loss of
• functioning
• Homicide

16
Illness Development

• Gradual development over time.
• Child may start with another diagnosis, most
  often AD/HD or ODD.
• Sudden onset. Normally
• developing child develops
• significant difficulty within a
• short period of time.

17
Impact

• MIs cause not only
• emotional but cognitive
• problems.
• Problems with thinking clearly,
• paying attention and remembering
• are primary problems of
• Schizophrenia and affective
• disorders.
• thinking skills

18
Data on Poor Outcomes for Children with
Ineffective Treatment or no Treatment at All

• School drop out and failure (50 - highest rate
  of any disability group)
• Juvenile Justice Involvement (70 of youth in the
  JJ system have 1 or more psychiatric illnesses)

19

• Youth Suicide (3rd leading cause of death in
  youth ages 15 to 24) its 2nd in Wisconsin!
• Loss of critical development
• years, with the failure to develop
• social skills, friendships and the
• opportunity to lead productive
• adult lives.

20
EBPs for Mental Illnesses in Children

• There are a number of evidence-based psychosocial
  interventions and medications for children and
  adolescents living with mental illnesses.
• There are also a number of home and community
  based service interventions that have proven to
  be effective for children with mental illnesses
  and their families.

21
Treatment Barriers

• Insurance parity
• Early identification
• Provider shortage Four times more child and
  adolescent psychiatrists are needed to
• treat children with MI.
• Fragmented services, overly
• complex and bureaucratic
• systems
• Stigma

22
Treatment Options

• Educational
• Psychological
• Behavioral
• Medical

23
Educational Considerations

• predictability of routines
• structure
• opportunity for choice
• shorter work periods
• lower student-teacher ratio
• individualized instruction
• frequent teacher check-backs
• motivating and interesting curricula
• use of positive reinforcers

24
Psychological Support

• The child may need professional support to better
  understand his disorder and impact on his life.
• The family may need support to learn how to be
  supportive of this child who presents
• many challenges.

25
Behavioral Support

• Positive behavioral interventions can and do make
  a difference for many children with brain
  disorders.
• Special strategies may be utilized at school to
  help the child.
• These strategies may be help-
• ful at home as well.

26
Medication Considerations
Control Symptoms, do not cure Response
varies Duration may be temporary, indefinite,
or intermittent Some medications must be taken
over time to reach therapeutic level All
medications have side effects Monitoring is
essential Medications have a variety of
applications and may be used for different
reasons
27
Why are EBPs Important?(Evidence-Based practice)

• EBP treatment and services improve outcomes for
  children and families. They have been shown to
• Improve school performance and attendance
• Improve peer and family relations and
• Reduce the symptoms of mental illnesses in
  children.
• Presentation by Barbara J. Burns, Ph.D. for CMS,
  June 2006.

28
Fall 2006 NAMI Leadership Conference
There Is a Great Divide Between
What We Know
What We Do
What We Know
And What We Do
29
Wellwhat is AD/HD?

• A Biological Disorder
• AD/HD is one of the most researched areas in
  child and adolescent mental health. However, the
  precise cause of the disorder
• is still unknown.

30
(No Transcript)
31
What do the Kids Say?

• My head is just like a TV set-except it has no
  channel selector. I get all the programs on my
  screen at the same time.

32

• when I sit in class, I keep having mind
  shifts. I never know when my mind is
• gonna shift away so I lose whats
• happening.

33

• I like to move around a lot. When I sit still,
  I get tired. I get bored. I need action.

34
Coping with Common Challenges(A Bakers Dozen)

• Disorganization
• Inattention
• Forgetfulness
• Impulsivity
• Impaired sense of time
• Sleep problems
• Messy handwriting

35
Coping with Common Challenges

• Work slowly or rush through things
• Slow processing speed vs careless errors
• Difficulty with written expression
• Difficulty remembering facts and formulas
• Procrastination difficulty getting started
• Difficulty controlling emotions
• Restlessness/hyperactivity

36
Defining Depression

• Depression in children is characterized by a
  persistent sad mood loss of interest or pleasure
  in activities that were once enjoyed significant
  change in body weight or appetite difficulty
  sleeping or oversleeping physical slowing or
• agitation loss of energy feelings
• worthlessness or inappropriate guilt
• difficulty thinking or concentrating
• recurrent thoughts of death or suicide
• and, at times, suicidal tendencies.
• National Institute of Mental Health, 2005

37
Depression Mood ChangesSigns and Symptoms

• Negative thoughts
• Suicidal ideation
• Unrealistic negative self-worth-look for evidence
  of
• personal faults
• Increased worry or
• fear

• Depressed mood
• Feelings of hopelessness
• Loss of interest/pleasure
• Irritable mood/anger
• Distractibility
• Excessive guilt/self-blame

38
Key Points for Depression

• Depression can impact classroom and everyday
  functioning in many ways.
• Depression is a sleep and energy disorder.
• Depressive disorders in children are brain-based.
• There are many effective interventions
• that can be used at home and in the
• classroom.

39
Defining Dysthymia

• Dysthymia is a less severe yet typically more
  chronic version of depression and is diagnosed in
  children and adolescents when a depressed mood
  persists for at least one year and is accompanied
  by at least two other depressive symptoms.
• National Institute of Mental Health, 2005

40
Depression Cognitive Changes Signs and Symptoms

• Difficulty concentrating
• Delayed mental reasoning
• Impaired ability to think
• Problems making decisions

• Slow movement, speech, and thinking
• Disinterest in normally pleasurable activities
• Forgetful

41
Depression Physical Changes Signs and Symptoms

• Psychomotor agitation
• abnormal activity level/ movement
• pacing
• hand wringing
• pulling/rubbing skin
• Small tasks require great effort and are
  exhausting
• Appears oppositional-work refusal

• Changes in appetite
• (overeating and/or under eating)
• Sleeping problems
• (excessive or insomnia)
• Fatigue, lethargy (tired all the time)
• Slow reaction time
• Slow gait

42
School-wide Interventions
43
Classroom Interventions
44
Defining Bipolar Disorder

• Bipolar Disorder - is characterized by episodes
  of major depression. as well as episodes of mania
  - periods of abnormally and persistently elevated
  mood or irritability accompanied by at least
  three of the following symptoms overly-inflated
  self-esteem decreased need for sleep increased
  talkativeness racing thoughts distractibility
  increased goal-directed activity or physical
  agitation and excessive involvement in
  pleasurable activities that have a high
• potential for painful consequences.
• National Institute of Mental Health, 2005

45
Bipolar Disorder

• Mood/Cognitive Symptoms of Mania
• Abnormally elevated mood/irritability
• Hallucinations
• Delusions
• Grandiose statements about self
• Racing thoughts
• Inflated self-esteem

46
Bipolar Disorder

• Physical/Behavioral Symptoms of Mania
• Increased talkativeness
• Uncontrollable temper tantrums
• Abnormally active/hyperactive
• Excessive energy
• Pressured speech
• Excessive risk-taking/daredevil behavior
• Hyper-sexuality
• Atypical speech patterns
• Active much of the night/decreased
• need for sleep

47
School-wide Interventions
48
Classroom Interventions
49
The Full Effect of Anxiety
Behaviors
Interpersonal Relationships
Performance
Dr. L. Read Sulik
50
Anxiety Mood Changes
Signs and Symptoms

• Fight-or-flight response
• Freeze or shut down
• Quick to anger
• Fearful/panicky
• Excessive worry

• Low tolerance for frustration
• Irritability
• Looks terrified
• Sadness
• Hypersensitivity/
• feelings easily hurt

51
Anxiety Cognitive Changes Signs and Symptoms

• Automatic negative thinking
• Excessive worry about
• homework
• grades
• assignments
• tests

• Sluggish thinking/slow to participate
• Avoids or does not complete tasks
• Memory difficulty
• Difficulty concentrating
• Lack of confidence in skill and ability/gives up
  easily

52
Anxiety Physical ChangesSigns and Symptoms

• Avoids group functions/isolates self
• Frequent absences
• Fatigue
• Nightmares, sleep disruption
• Dry mouth, dizziness, nausea, diarrhea
• Aggressive actions
• Obsessions and compulsions

• Chest pain, increased heart rate, chills,
  trembling, profuse sweating
• Shortness of breath
• Abdominal distress
• Hypersensitivity to environmental stimuli (e.g.
  lights, sound, touch, smells)
• Flat affect/appears detached
• Cries frequently

53
School-wide Interventions
54
Classroom Interventions
55
Parent Perspective
When parents were encouraged to reflect back on
their child's educational experience and try to
determine the things that might have been missing
but would have been helpful to their child, the
following were generated What might have
helped... empathy and understanding of child's
disorder by all staff that worked with
him/her appropriate accommodations and
modifications made on a daily basis or as
needed

• course requirements modified as needed/when
  needed
• alternative assignments when needed
• extended time-lines for work when needed
• homework waiver when needed
• testing/project options
• primary contact
  person-especially at
• secondary level
• delayed start time if needed

56
part time flexible day as needed homebound
option when needed realistic goals ("parents
are worried about keeping the child
alive...school is concerned about
credits.") outcome based vs completing ALL
activities for "credit empathy from
peers
57
Help!

• Individuals can help!
• Service organizations can help!
• Libraries, recreational programs,
• kind and sensitive neighbors,
• extended family members,
• small business owners-anyone
• who has contact with children.

58
How Can We Help At School?

• Knowledge of mental illness in children and its
  impact on school performance and social
  interactions
• Understanding and empathy
• Acceptance
• No bullying polices and enforcement
• Flexibility
• Adjustable and realistic expectations based
• on where the child is now
• Personal attention
• Positive feedback and encouragement
• Recognize efforts
• Utilize school student services as needed
• Cooperation with treatment
• recommendations
• Parent communication

59
Would You Ever Say to a student who has a
visual impairment, Look at the board! Cant
you see what it says? to a student who has a
hearing impairment, You werent listening,
I just gave that direction! to a student with a
physical disability, Get up and get it
yourself! to a child with a learning
disability, This is so easy, why dont you
understand this? to a child with AD/HD, If you
were paying attention, you would have heard
my directions. to a child with severe
depression, Pull yourself together,
things arent that bad. Treating a
child with a brain disorder like he/she is a
behavior problem (punishing) is doing the same
thing because we holding the individual
personally responsible for having a chemical
imbalance in their brain.
60
Bridging the Gap Between Science and Service
Fall 2006 NAMI Leadership Conference
61
(No Transcript)
62
NObuteducation will help!
63
Resources

• Books
• Videos/DVDs
• Web sites
• Parent Support Groups
• (CHADD) www.chadd.org
• Wisconsin Family Ties
• www,wifamilyties.org
• NAMI (National Alliance on
• Mental Illness)
• www.nami.org