Youth Issues in Mental Health : Youth Issues in Mental Health Developed and Presented by:
Joan Helbing
Diagnostician
helbingjoan@aasd.k12.wi.us
Slide2 : Important Facts About Mental Illness and Recovery:
Mental illnesses are biochemical brain disorders that can interfere with a person’s 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.
Slide3 : 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.
Studies Show MI Often Begin in Youth, Treatment Delays Worsen Issues : 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.
Slide5 : 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 20’s.
Three-quarters of all lifetime
cases begin by age 24!
Slide6 : 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.
Washington University research showed that mental illness is now the leading reason for hospitalization of people ages 5-19. : Washington University research showed that mental illness is now the leading reason for hospitalization of people ages 5-19.
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. : 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.
Causes Are Complicated : 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
What’s the Big Deal? : What’s 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).
Extent of Mental Disorders in US : 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
Slide12 : 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.
Slide13 :
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.
Slide14 : 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!
Top 3 Leading Causes of Death in Teens : Top 3 Leading Causes of Death in Teens Accidents
Suicide: depression is the
leading cause of loss of
functioning
Homicide
Illness Development : 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.
Impact : Impact
MI’s 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
Data on Poor Outcomes for Children with Ineffective Treatment or no Treatment at All : 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);
Slide19 : Youth Suicide (3rd leading cause of death in youth ages 15 to 24); it’s 2nd in Wisconsin!
Loss of critical development
years, with the failure to develop
social skills, friendships and the
opportunity to lead productive
adult lives.
EBPs for Mental Illnesses in Children : 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.
Treatment Barriers : 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
Treatment Options : Treatment Options
Educational
Psychological
Behavioral
Medical
Educational Considerations : 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
Psychological Support : 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.
Behavioral Support : 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.
Slide26 : 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
Why are EBPs Important? (Evidence-Based practice) : 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.
Slide28 : Fall 2006 NAMI Leadership Conference What We Know What We Do There Is a Great Divide Between… What We Know And What We Do
Well…what is AD/HD? : Well…what 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.
What do the Kids Say? : 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.”
Slide32 : “when I sit in class, I keep having ‘mind shifts’. I never know when my mind is
gonna shift away so I lose what’s
happening.”
Slide33 :
“I like to move around a lot. When I sit still, I get tired. I get bored. I need action.”
Coping with Common Challenges (A Baker’s Dozen) : Coping with Common Challenges (A Baker’s Dozen)
Disorganization
Inattention
Forgetfulness
Impulsivity
Impaired sense of time
Sleep problems
Messy handwriting
Coping with Common Challenges : 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
Defining Depression : 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
Depression: Mood Changes Signs and Symptoms : Depression: Mood Changes Signs and Symptoms
Depressed mood
Feelings of hopelessness
Loss of interest/pleasure
Irritable mood/anger
Distractibility
Excessive guilt/self-blame Negative thoughts
Suicidal ideation
Unrealistic negative self-worth-look for evidence of
personal faults
Increased worry or
fear
Slide38 : 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.
Defining Dysthymia : 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
Depression: Cognitive Changes Signs and Symptoms : 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
Depression: Physical Changes Signs and Symptoms : Depression: Physical Changes Signs and Symptoms Changes in appetite
(overeating and/or under eating)
Sleeping problems
(excessive or insomnia)
Fatigue, lethargy (tired all the time)
Slow reaction time
Slow gait Psychomotor agitation
abnormal activity level/ movement
pacing
hand wringing
pulling/rubbing skin
Small tasks require great effort and are exhausting
Appears oppositional-work refusal
School-wide Interventions : School-wide Interventions
Classroom Interventions : Classroom Interventions
Defining Bipolar Disorder : 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
Bipolar Disorder : Bipolar Disorder Mood/Cognitive Symptoms of Mania
Abnormally elevated mood/irritability
Hallucinations
Delusions
Grandiose statements about self
Racing thoughts
Inflated self-esteem
Bipolar Disorder : 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
School-wide Interventions : School-wide Interventions
Classroom Interventions : Classroom Interventions
The Full Effect of Anxiety : The Full Effect of Anxiety Interpersonal Relationships Performance Behaviors Dr. L. Read Sulik
Anxiety: Mood Changes Signs and Symptoms : 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
Anxiety: Cognitive Changes Signs and Symptoms : Anxiety: Cognitive Changes Signs and Symptoms
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
Automatic negative thinking
Excessive worry about
homework
grades
assignments
tests
Anxiety: Physical Changes Signs and Symptoms : Anxiety: Physical Changes Signs and Symptoms 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
Avoids group functions/isolates self
Frequent absences
Fatigue
Nightmares, sleep disruption
Dry mouth, dizziness, nausea, diarrhea
Aggressive actions
Obsessions and compulsions
School-wide Interventions : School-wide Interventions
Classroom Interventions : Classroom Interventions
Slide55 : 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
Slide56 : *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
Help! : 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.
How Can We Help At School? : 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
Slide59 : Would You Ever Say…
…to a student who has a visual impairment, “Look at the
board! Can’t you see what it says?”
…to a student who has a hearing impairment, “You weren’t
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
don’t 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 aren’t 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.
Bridging the Gap Between Science and Service : Fall 2006 NAMI Leadership Conference Bridging the Gap Between Science and Service
NO…but education will help! : NO…but education will help!
Resources : Resources Books
Videos/DVD’s
Web sites
Parent Support Groups
(CHADD) www.chadd.org
Wisconsin Family Ties
www,wifamilyties.org
NAMI (National Alliance on
Mental Illness)
www.nami.org