Chapter 23 Children and Adolescents Prevalence and comorbidity

Chapter 23 Children and Adolescents

Prevalence and comorbidity n n n ½ of all Americans will meet criteria for DSM-IV disorder 1 in 5 children and adolescents suffer from major psychiatric disorder 2/3 of all young people are not getting the help they need Suicide is 3 rd leading cause of death in age 15 -24 yrs and 6 th in age 5 -14 yrs Mental Health: A Report of the Surgeon General, identified barriers to assessment and treatment remain

Theory n n Childs vulnerability to psychopathology is result complex interactions between biological, psychological, genetic and environmental variables Younger children harder to diagnose than older children ¨ Genetic Factors: autism, bipolar, mental disorders, ADHD, mental retardation ¨ Biochemical Factors: alterations in nr-transmitters with decrease in serotonin and norepinephrine related to depression & suicide ¨ Environmental Factors: put stress on children & adolescents and shape their development

Resiliency n n It is assumed that constitutional resiliency and a supportive environment play roles in keeping disorders from development Studies have shown that resilient child has following characteristics: ¨Temperament that adapts to changes in environment ¨Ability to form nurturing relationships ¨Ability to distance self from emotional chaos in family ¨Social intelligence ¨Ability to problem solve

Mental health assessment n Provides info about problems with thinking, feeling, and behaving: Developmental assessment; provides info about childs maturational level when compared to chronological age, identifies developmental lags and deficits n Methods of collecting data: interviewing, screening, testing, observing, interacting with child, histories from parent n Structured interview and observation n

Mental retardation n n Most common developmental disorder Degree of impairment is determined by assessing IQ with standardized tests such as Wechsler Intelligence Scales for Children Cause may be hereditary IQ level 50 -70 Diagnosis ¨ May have impairments in communication skills, social interactions, self care abilities and disruptive behavior depending on severity

PDD, Autism and Asperger’s syndrome n n PDD (Pervasive Developmental Disorder) ¨ Characterized by severe & pervasive impairment in reciprocal social interaction & communication skills usually accompanied by stereotyped behavior, interests and activities Autism ¨ Behavioral syndrome resulting from abnormal brain function of unknown etiology

Asperger’s syndrome n n n Asperger’s Syndrome ¨ Differs from autism in that it appears to have later onset and does cause delay in cognitive and language development Assessment: 3 presenting characteristics Assessment Guidelines Diagnosis: Defensive Coping, Ineffective Coping Implementation: Ultimate long term outcome is to help children reach full potential by fostering developmental competencies and coping skills

Anxiety disorder n n n Anxiety becomes problem when child or adolescent fails to move beyond fears associated with certain developmental stages or when anxiety interferes with normal functioning Most common mental disorder in this age group Symptoms same as for adult: agoraphobia, GAD, panic disorder, social phobia, OCD, PTSD ¨ Separation Anxiety Disorder: anxiety when separated from parents or home ¨ PTSD; occurs at any age, after a traumatic event ¨ Assessment Guidelines ¨ Diagnosis: Anxiety, Fear, Ineffective Coping ¨ Implementation: Tx on outpt basis with CBT and SSRI’s

Mood disorders n n Symptoms of depression are similar to adult symptoms Adolescents more apt to have psychomotor retardation and hypersomnia Depressive symptoms expressed as irritability and aggressiveness Acting out behaviors can be mood disorder ¨ Assessment: Assessment Guidelines ¨ Diagnosis: Hopelessness, Ineffective Coping ¨ Implementation; suicidal pts hospitalized for evaluation and tx with antidepressants and mood stabilizers. Long term outcome is help pt reach full potential

ADHD and disruptive disorders n n n ADHD ¨ Show inappropriate degree of inattention, impulsiveness and hyperactivity Disruptive Behavioral Disorders ¨ Oppositional Defiant Disorder ¨ Conduct Disorder Assessment: assessment guidelines per disorder Diagnosis; risk for other directed violence Implementation ¨ Behavioral modifications & medications ¨ Correction of faulty personality disorder ¨ Control aggressive behavior ¨ Family involvement

Tourette’s disorder n n n Involves motor & verbal tics that cause marked distress & significant impairment in social and occupational function Tics may appear as early as age 2 but average at age 7 Duration is lifelong but can have periods of remission ¨Assessment; obsessions, compulsions, hyperactivity ¨Diagnosis: Anxiety, Impaired social isolation ¨Implementation: Focus on treatment helping child, family and school understand cope with tic behavior

Therapeutic modalities for child and adolescent disorders n n n Parental Involvement Group Therapy Milieu Therapy Behavioral Modification Removal and Restraint ¨ ¨ ¨ ¨ ¨ Quiet room/ Time out Therapeutic Holding CBT Play therapy/ Dramatic play therapy Therapeutic games Bibliotherapy Therapeutic Drawing Music therapy/ Movement and Dance Therapy Recreational Therapy