Affective Disorders in Children

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Affective Disorders in Children

• Jeff Baker, Ph.D.

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Reiger, Goldberg, and Taube (1978) Kelleher
Long (1994, 2000)

• Provided convincing evidence that most of the
  mental health care for children in the US is
  provided in primary care facilities.
• There are many barriers to the provision of
  psychosocial services in primary care.
• Pediatricians spend an average of 14 minutes with
  each patient (Ferris, 1998).

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Models of Collaboration

• Tertiary Provider
• Consultant
• Interdisciplianry Team Member
• Community Collaborator
• Diagnostic Codes
• DSM-PC
• Behavioral Health Codes

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Health Care Needs of Low-Income Children

• 43 million people in the US have been classified
  as medically underserved.
• CHIPS 1997
• Medicaid
• Families with income 200 below the federal
  poverty level may participate.

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Childhood Affective Disorders

• Anxiety in Childhood
• Depression in Childhood
• Childhood Suicide

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Generalized Anxiety Disorder

• Excessive anxiety or worry about several events
  or activities
• Difficulty controlling the worry
• restlessness
• poor concentration
• irritability
• sleep disturbance

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Separation Anxiety

• constant thoughts and fears about safety of self
  and parents
• refusing to go to school
• frequent stomachaches and other physical
  complaints
• extreme worries about sleeping away from home
• overly clingy behavior at home
• panic or tantrums at times of separation from
  parents
• usually seen in children under age 13

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Selective Mutism

• Consistent failure to speak in specific social
  situations (usually school) - 1 month
• Person speaks in other situations (home, with
  family)
• Often use nonverbal communication
• Are able to speak

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Assessment and Treatmentof Childhood Anxiety

• Omnibus measures such as Child Behavior Checklist
  or Behavior Assessment System for Children
• Revised Childrens Manifest Anxiety Scale
• State-Trait Anxiety Inventory for Children
• pharmacological intervention, psychotherapy
  (indiv. and/or family therapy), school
  intervention

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Childhood Depression

• Persistent sadness and/or irritability
• Low self-esteem or feelings or worthlessness. A
  child may make such statements as, "I'm bad. I'm
  stupid. No one likes me."
• Loss of interest in previously enjoyed activities
• Change in appetite (either increase or decrease)
• Change in sleep patterns (either increase or
  decrease)
• Difficulty concentrating
• Headaches, stomachaches or other physical pains
  that seem to have no cause
• Changes in activity level. The child either
  becomes more lethargic or more hyperactive.
• Recurring thoughts of death or suicide

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Childhood Depression (contd)

• developmental differences in depressive
  symtomotology
• 6-12 sad affect, somatic complaints,
  irritability, sleep difficulties, school refusal
• 12-16 inability to tolerate routine, social
  isolation, rebelliousness/opposition, stealing,
  running away/truancy
• 15-20 hypersomnia, drug abuse, promiscuity,
  suicidal ideation/intent

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Childhood Mental Health

• Risk factors for developing a mental disorder or
  experiencing problems in social-emotional
  development include prenatal damage from exposure
  to alcohol, illegal drugs, and tobacco low birth
  weight difficult temperament or an inherited
  predisposition to a mental disorder external
  risk factors such as poverty, deprivation, abuse
  and neglect unsatisfactory relationships
  parental mental health disorder or exposure to
  traumatic events.

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Additional Risk Factors

• Minorities including African Americans, gay
  males, lesbians and bisexual teens have much
  higher rates of attempted suicide. In fact, it is
  estimated that the rate is 300 higher than the
  national average. Rejection, powerlessness,
  prejudice and low self-esteem are common problems
  among these minority groups. These kids often
  experience social stigma and prejudice on a daily
  basis and, all too often are the target of
  bullies who are relentless in their effort to
  inflict pain and emotional suffering.

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Childhood Suicide

• Suicide rate has quadrupled since 1950
• Accounts for about 12 percent of deaths
• Ideation occurs in all age groups, greatest
  frequency with depressive disorder
• Completed suicide 5x higher in boys, attempts 3x
  higher in girls
• Firearms accounts for the method of most
• Hanging (boys) is the 2nd most used method
• Risk factors include family hx, exposure to
  family violence, impulsivity, substance abuse,
  and availability of lethal methods.
• increases dramatically from childhood to
  adolescence
• boygirl ratio equal during childhood (6-12)
• ratio shifts to girls being twice as likely to be
  depressed after puberty (13 and older)

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Child and Adolescent Suicide

• 3rd leading cause of death (1999)
• 90 of children and adolescents who commit
  suicide have a mental disorder
• child - in 1992, 314 children (14 and younger)
  successfully committed suicide
• adolescent - in 1992, 4,693 adolescents (15-21)
  successfully committed suicide
• Must question, as parents appear unaware.

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Warning Signs of Suicide

• Change in eating and sleeping habits
• Withdrawal from friends, and family and regular
  activities
• Violent actions, rebellious behavior
• Drug or alcohol abuse
• Unusual neglect of personal appearance
• Frequent complaints about physical symptoms,
  often relating to emotions, such as stomach
  aches, headaches, fatigue, etc.
• Give verbal hints with statements such as "I
  won't be a problem for you much longer" "nothing
  matters" "it's no use" or "I won't see you again"
  
• Put his or her affairs in order--for example,
  give away personal possessions, clean his or her
  room, throw away important belongings etc.
• Become suddenly cheerful after a period of
  depression

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Assessing for Suicide

• intent - seriousness of intent for suicidal
  behavior
• plan - is there a specific plan devised on how to
  kill him/herself
• means - does he/she have access to the planned
  method (is there a gun available?)
• lethality - how lethal is the method?
• time - when does he/she plan doing this

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Myths about Suicide

• people who talk about suicide dont really do it
• suicidal people are fully intent on dying
• people who make attempts are only trying to get
  attention
• children dont know enough to kill themselves (or
  would never think of it)
• talking to a child about suicide might "put the
  thought into their head"

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Childrens Moods Medication (2003)