Childhood Mental Health Flashcards
Mental Health disorders affect:
- Regulation/control of behaviors
- Interaction/collaboration with others
- Forming/maintaining friendships
- Relating to/taking directions from adults
- Attending to tasks
Incidence of Mental Health Disorders in Children
1 in 5 children has a mental health disorder
Settings for Mental Health Intervention
- Psychiatric units in acute care hospitals
- Independent psychiatric hospitals
- Day tx centers
- Community mental health centers
- Public schools
Multidimensional Factors of Mental Health
- BIOLOGICAL: biochemical imbalances, genetics, etc.
- SOCIOCULTURAL: culture, race, economic status, etc.
- SOCIAL: human context (family, ppers, community, etc.)
- PSYCHOLOGICAL: cognition, personality, self-concept, etc.
**An INTEGRATIVE MODEL that considers all four of these is used to understand each child’s disorder.
Neurodevelopmental Disorders
Interfere with successful engagement in personal, social, academic or occupational functioning. Includes: • ADHD • Motor disorders • Tic disorders • Specific learning disorders (SLDs)
ADHD
2 presentations:
- Inattentive
- Hyperactivity-impulsivity
• Symptoms must be present before 7 yr and last at least 6 mo
• Must interfere with child’s performance
• ID’d by multidisciplinary health care team
• Interventions: sensory integration, behavior mgmt. programs, classroom/home modifications, meds
• Possible FOR: applied behavioral
Motor Disorders
Deficits in acquisition and execution of coordinated movements.
• Clumsiness
• Slow to perform daily occupations
• Movements stereotypic and purposeless
• Interferes with social, academic and adaptive functioning
Tic Disorders
(ie: Tourette Syndrome)
• Genetic disorder, onset at 6-7 yo
• Repetitive, involuntary motor and vocal tics
• Related comorbidities: ADHD, behavior problems, learning disabilities, OCD
• Interventions: meds, behavioral mgmt. programs, anxiety/anger mgmt. programs
• Include social participation goals to prevent onset of bullying!
Specific Learning Disorder (SLD)
- 5-15% of school-aged children
- Perform below average; severe discrepancy betw ability and achievement
- Mild, moderate, and severe
- Dyslexia: reading disability
- Dysgraphia: writing disability
- Dyscalculia: math disability
- Interventions: based on symptoms; may include sensory integration, coaching techniques, cognitive-behavioral therapy, or compensatory strategies
Disruptive, Impulse-Control, and Conduct Disorders
- Socially disruptive behaviors
- Violate rights of others (aggression; property destruction)
- Problems with emotions (anger, irritation) and behaviors (aggression, defiance)
Childhood-Onset Conduct Disorder
- Long-standing behaviors that violate rights of others and rules of society.
- Physical aggression toward others (incl animals)
- Mugging, shoplifting, burglary
- Destruction of property
- Breaking rules
- Impaired school performance
- Skipping school/suspensions
- At risk for poor outcomes (dropping out, unemployment)
Oppositional Defiant Disorder
- Negative, hostile, defiant behaviors, uncharacteristic of other children
- Outbursts of temper
- Hostility toward authority
- Poor academics
- Few friendships
- Ignoring others’ feelings
- May be indication of underlying major depression
- Interventions: behavior programs that establish limits; strategies to develop self-regulatory behaviors; strategies for constructive expression of emotions
Intermittent Explosive Personality Disorder
- Recurrent aggressive behavior outbursts
- Magnitude out of proportion to provocation
- Not premeditated
- Impulsive and/or anger based
- Deficits in social, academic, adaptive functioning
- May result in criminal charges if against property/person
Anxiety Disorders
- Prevalence: 13 in 100; more common in females
- Normal adaptive response to stress (palpitations, pain, restlessness, etc.) maladaptive if interferes with functioning
- Extreme: raised heart rate, vomiting
- Difficulty making decisions, learning, concentrating, perceiving situations
- Poor school attendance, low self-esteem, adjustment difficulties, poor social skills
Generalized Anxiety Disorder (GAD)
Excessive anxiety and worrying without a trigger.
• About future, school performance, family health
• Cannot control fears, resulting in:
- Irritability
- Negative self-image
- Inability to relax
- Difficulty concentrating
- Disrupted sleep
• Difficulties with performance in all areas of occupation
Separation Anxiety Disorder
Extreme anxiety when anticipating separation from home/caregiver.
• Refusal to go to school or overnights
• Nightmares of separation
• Somatic/physical symptoms (headaches, dizziness, palpitations, stomachaches, nausea)
• Delayed social development
• Poor academic performance
Social Anxiety (Social Phobia) Disorder
Specific, persistent and recurring fear of social situations.
• Panic attacks
• Avoidance of phobia is disabling
• Interventions: cognitive-behavioral therapy, meds, relaxation strategies, play/creative activities
OCD
Characterized by intrusive, disruptive thoughts that cause anxiety.
• Compulsive, ritualistic, repetitive patterns of behavior to reduce anxiety
• Rearranging, hand washing, excessive checking
• Obsessive thoughts that are irrational concerns or fears
• Disgust with germs, fear that harm will come to family member, etc.
Other Compulsive Disorders
- Body Dysmorphic Disorder: preoc with perceived physical flaws/deficits
- Hoarding Disorder: difficulty getting rid of items (indecisiveness/avoidance)
- Trichotillomania: hair pulling
- Excoriation: skin picking
Trauma and Stress-Related Disorders
- Reactive Attachment Disorder: pattern of delayed attachment behaviors (child minimally turns to caregiver for comfort, etc.)
- Disinhibited Social Engagement Disorder: pattern of behavior when child is overly familiar with strangers
Acute and Post-Traumatic Stress Disorder (ASD/PTSD)
Both develop in response to a traumatic event.
• ASD is immediate stress response to trauma that lasts 1 mo
• PTSD symptoms last longer than 1 mo
• Recurring nightmares
• Repeated memories of event
• Difficulty sleeping
• Changes in eating habits
• Complaints of physical symptoms
• Difficulties with all areas of occupation
Comorbid Disorders: panic attacks, substance abuse.
Disruptive Mood Dysregulation Disorder
- Child betw 7-18 yo who is angry/irritable all the time.
- Verbal or behavioral outbursts at least 3 times/week across environments
- Aggressive, destructive acts against property, self, or others
Major Depressive Disorder
Most common mood disorders are major depression, minor depression, and brief recurrent depression.
• No single cause; biological, social, sociocultural, and psychological factors can increase likelihood (physical/emo/sex abuse, neglect, lack of affection)
• many functional difficulties (poor concentration, not completing tasks, learning difficulties, aggressiveness)
• Shows: irritability, pessimism, somatic complaints, social withdrawal, changes in weight, low self-esteem/body image, agitation, poor school attendance
• Comorbidities: phobias, substance abuse, sexual promiscuity
• Consider multidimensional model
• Risk of suicide
• Interventions: meds, supervision in safe environment
Bipolar Disorder
- Genetic predisposition
- 2 extremes of mood: Depression and Mania
- Extreme moods go in cycles
- Poor school performance
- Few social relationships
- Disorganization
- Difficulty regulating behavior
Schizophrenia
- Serious, chronic condition
- Positive symptoms of an acute episode: delusions, hallucinations, disorganized speech, disorganized motor behavior
- Negative symptoms: lethargy, blunted affect
- Prodromal stage: before first acute psychotic episode; withdrawal from activities and social contacts; may self-medicate
- Interventions: meds, facilitate development of age-approp skills
Rumination Disorder
Regurgitates food repetitively. May re-chew, swallow, or spit out the food.
Enuresis
Repeated elimination of urine involuntarily or intentionally in inappropriate places (at least 2 occurrences per week for 3 mo)
Encopresis
Repeated elimination of feces in inappropriate places (at least once a month for 3 mo)
Sleep-Wake Disorders
Individual has poor quality, timing, and amount of sleep.
• Insomnia: difficulty going/staying asleep
• Breathing-related disorders:
- Obstructive Sleep Apnea Hypopnea Disorder (repeated episodes of obstruction of pharyngeal airway)
- Sleep-related Hypoventilation (episodes of shallow breathing)
- Parasomnias (experiential or physiological events that occur while sleeping—sleepwalking, sleep terrors, nightmares)
Substance-Related Disorders
- Misuse of drugs, toxins, meds
- Abuse: pattern of use causes adverse consequences
- Dependence/Addiction: pattern of continued use despite serious cognitive, behavioral, physiological symptoms
- At least 3 of following: tolerance, unpleasant withdrawal, using increasing amt, desires to stop but fails, excessive time spent, neglect of/decline in occupational performance, continued use
Inhalant-Related Disorder
- Common among children/adolescents
- Huffing/sniffing (gas, glue)
- Can cause psychotic experiences
- Can cause serious medical/life-threatening conditions
- Neglect of self-care
- Decreased attendance and performance in school
Data Gathering/Evaluation of Mental Health
• OTR determines assessment to be used, and interprets data
• Observation one of most important tools
• Review of records, interviews, structured assessments
• Structured Evaluations:
- Piers-Harris Scale
- Child Occupational Self-Assessment
- Volitional Questionnaire
Intervention Planning for Mental Health
- Guided by FOR
- Considers strengths and weaknesses
- Establishes long-term and short-term goals
- Determines interventions
- Includes frequency/duration
Intervention Implementation for Mental Health
- Use of techniques/strategies based on selected FOR
- Typically in groups
- May be on individual basis
- Types of groups: imaginative play, life skills, social skills, task skills
Intentional Relationship Model (IRM)
Method of therapeutic use of self for mental health disorders.
• Advocating, collaborating, empathizing, encouraging, instructing, problem-solving
