Exam 3 Part 1 Mental Health Flashcards
How many children suffer from mental health
More than 1 out of 10 (0-17 years old)
How many children received treatment for mental health
less than 20% received treatment
Prevalence of mental health disorders
Prevalence is predicited to rise in the next 15 years by 50% , becoming a major cause of morbidity, mortality and disability
Suicide rates for children 10-14
4th leading cause
Suicide rates for children 15-24
3rd leading cause
Most Common Pediatric Mental Health Disorders
Anxiety disorder (Most Common) Mood disorder Attention Deficit Hyperactivity Disorder Autism Spectrum Disorder Conduct Disorder Eating Disorder Substance Abuse
Undiagnosed, untreated or under-treatment of pediatric illness is linked with
School failure Suicide Substance Abuse Violence Homelessness Incarceration
the most common health concerns for child care providers are
Infectious diseases ( for children < 2 years of age) challenging behaviors
Expulsion rates for children
Higher in child care than elementary school
Fact about mental health and preschool children
high child care staff turnover
children need to be physically and mentally healthy to be ready to enter kindergarten
13-23% of preschool children have mental health problems with higher rate of co-occurrence of other risk factors.
<1% of preschool children received health services
What % of children and adolescents in the U.S. have impaired MH functioning and do not meet criteria for a disorder
16%
What % of school age children with normal functioning have parents with “concerns”
13%
What % of adults in the U.S. with MH disorders had symptoms by the age of 14 years
50%
What % of children and adolescents in the U.S. meet diagnostic criteria for MH disorders with impaired functioning
21%
Facts about Primary Care Clinicians role with MH
PCC have a critical role to play in meeting the needs of children with MH, Massachusetts is now requiring by court order universal MH screening by primary care clinicians for all children on Medicaid in that state.
PCC Provide guidance to families by
help parents find high quality early care & education experience for their children
Complete health forms & care plans for children with special health care needs
Communicate health issues and/or treatment raised in PCC offices or child care program
AAP Stance on MH
Consensus statement addresses 3 issues access, coordination & monitoring.
“these issues should be considered from the standpoint of needs for preventive interventions, direct mental health and substance abuse services.
Barriers to MH Services
Stigma among families to bring up MH concerns with doctors
Inadequate identification of youth with MH issues
MH provider shortage
Inadequate coverage of MH services by both public & private health insurance programs
Complex & fragmented service delivery systems
Barr
iers for APN’s
Lack of time during appointment to address MH
Lack of training, expertise, & comfort with MH identification or treatment.
Lack of payment or compensation for providing MH services.
Lack of knowledge regarding community MH referral services
Lack of MH referral services in the community
Advocacy Among APN’s
Can advocate for patients on many different levels
Can personally choose the level we feel most comfortable & effective at
Can for patients within our time limitations
Can help create the changes we believe are needed in the field of pediatrics
Advocacy at the Individual Patient Level
Increase awareness at your office/ clinic regarding suicide prevention & crisis hotlines
Find numbers for your community help lines
Create posters & wallet sized cards with local numbers
1-800-SUICIDE ( Suicide prevention/crisis)
1-800-273-TALK ( counseling, suicide prevention, mental health referrals)
The SCHIP Children’s Mental Health Parity Act
S. 1337 is a bill to ensure the parity of mental & medical health care in programs operated under the State Children’s Health Insurance Program (SCHIP)
The bill requires that states offering both medical & mental health coverage to children offer mental health coverage that is not more restrictive than medical coverage in terms of “financial requirements & treatment limitations.”
Mental Health Parity Act of 2007
S. 558/H.R. 1424 improves the mental health of all Americans, esp. children and adolscents
Requires business that offer mental health insurance to provide equal coverage for both physical & mental health services
Requires parity in co-payments, deductibles, out-of-pocket expenses, covered hospital days, outpatient visits, and substance abuse treatment
Primary Care Advantages
Longitudinal, trusting relationship Opportunities for prevention Screen for psychosocial problems Intervene early Recognize & address barriers Assessment / Treatment Referral & coordination
Addressing Mental Health Concerns in Primary Care: A Clinical Toolkit
Community Resources
Health Care Financing
Support for Children & Families
Clinical Information Systems/Delivery System Redesign
Improving MH Services in Primary Care: Reducing Administrative & Financial Barriers to Access & Collaboration
Outlines issues and potential solutions
Make recommendation to insurance purchasers, payers & managed behavioral health organizations
Enhancing Pediatric MH Care: Report from AAP TFOMH
Strategies for Preparing a Community
Strategies for Preparing a Primary Care Office
Algorithms for Primary Care
The Future of Pediatric MH Competencies for Pediatric Primary Care (policy statement)
System-Based Practice Patient Care Medical Knowledge Practice-Based Learning & Improvement Interpersonal & Communication Skills Professionalism
Sleep: Pearls for Primary Care
Changes in sleep patterns may be an early symptom of mental illness Sleep debt destabilizes frontal lobe Lack of sleep worsens all mood disorders Parent with sleep debt is more irritable Sleep diary may be useful Consider role of media/ phone Consider obstructive sleep apnea Work on sleep first or simultaneously
Average Sleep Needs by Age
18 months 11.5 hrs per night & 2hrs nap 2-3 yrs 11-11.5 hrs per night & 1-1.5 hrs nap 4-6 yrs 10.75-11.5 hrs per night 7-11 yrs 9.5-10.5 hrs per night 12-18 yrs 8.25-9.25 hrs per night
Types of Learning Differences: Dyslexia
A language & reading disability
Types of Learning Differences: Dyscalculia
Problems with arithmetic & math concepts
Types of Learning Differences: Dysgraphia
A writing disorder resulting in illegibility
Types of Learning Differences: Dyspraxia (Sensory Integration Disorder)
Problems with motor coordination
Types of Learning Differences: Central Auditory
Processing disorder difficulty processing & remembering language-related tasks
Types of Learning Differences: Non-verbal Learning Disorders
Trouble with nonverbal cues: body language, poor coordination, clumsy
Types of Learning Differences: Visual Perceptual/ Visual Motor Deficit
Reverses letters, cannot copy accurately
Types of Learning Differences: Language Disorders (Aphasia/Dysphasia)
Trouble understanding spoken language, poor reading comprehension
Anxiety:
Mood state characterized by strong, negative emotions & bodily symptoms in which an individual apprehensively anticipates future danger or misfortune
Fear
immediate alarm reaction to current danger
Anxiety disorder
excessive & debilitating anxiety with negative emotion & fear
Developmental Consideration of Anxiety
Anxiety is an adaptive emotion that readies children both physically & psychologically to cope with danger
Developmental Consideration of Anxiety
Infancy- loud noises, being startled, strangers (6-9months)
Toddlerhood: dark (around 4), separation
School-age- injury, natural disasters
Adolescence- competency-based concerns, health of self & others.
Most fears resolve with time and do not require treatment.
Specific Phobia DSM Criteria
Marked & persistent fear that is excessive & unreasonable, cued by the presence of anticipation of a specific object or situation.
Exposure to phobic stimulus almost invariably provokes an immediate anxiety response.
Duration of 6 months
Types: animals, natural environment (storms), blood-injection-injury, situations ( bridges, elevators)
Developmental Considerations- DSM IV qualifiers for children (anxiety)
anxiety may be expressed by crying, tantrums, freezing or clinging.
Unlike adults, children are not required to acknowledge that fears are unreasonable or excessive.
Development Consideration- Difficulties in recognizing symptoms for anxiety
internalizing symptoms- less observable
Internalizing symptoms less aversive
Anxiety- Cognitive
Anxious thoughts develop in response to cognitive distortions in the attention, interpretation, and memory components of information processing
Anxiety- Physical
Brain send messages to sympathetic nervous system: fight or flight response.
Symptoms are excessive in intensity or duration
Anxiety- Behavioral
Action (or inaction) that individuals take to prevent exposure to feared stimuli or to reduce anxiety associated with exposure to the feared stimuli
Disorder DSM Criteria: Symptoms
Excessive distress when separation from attachment figure is anticipated
Excessive worry about losing or possible harm to figure
Excessive worry that an event will lead to separation
Reluctance or refusal to go to school because of separation fear
Disorder DSM Criteria: Symptoms
Excessive fear or reluctance to be alone
Reluctance or refusal to go to sleep without being near attachment figure
Nightmares involving theme of separation
Complaints of physical symptoms when separation occurs/ is anticipated
Social Phobia DSM Criteria
Marked & persistent fear of one or more social or performance situations in which child is exposed to unfamiliar people or possible scrutiny by others
The child fears he/she will act in a way that will be humiliating or embarrassing
Exposure to situation provokes considerable anxiety
Feared situations are avoided or else endured with intense anxiety and distress
Social Phobia: Clinical Features
A child with social phobia is one who displays phobic responses to one or more social situation:
- speaking, eating or drinking in front of others
- initiating or maintaining conversations
- speaking to adult authority figures
- Other situations that may elicit concerns over being embarrassed / humiliated
Social Phobia: Clinical Features
Children with social phobias also experience anticipatory anxiety well before actually confronting these situation
Unfortunate cycle
1.anticipate awkwardness / poor performance
2.increased anxiety
3.actual awkwardness/poor performance
Can interfere with the child’s ability to function in a wide range of areas
Social Phobia : Associated Features
Children with social phobia can also show a range of associated features:
1.being overly sensitive to criticism
2.having low levels of self-esteem
3.having inadequate social skills
School performance may be impaired due to test anxiety & failure to participated in classroom activities.
Social anxieties can result in school refusal
Relatively rare in the general child population
Social Phobia; Associated Features
Prevalence estimates 1-3% are suggested by cross-sectional research
No gender difference.
Among the children referred to an anxiety disorders clinic, 20% met DSM criteria for a diagnosis of social phobia.
Social phobia dose not seem to be uncommon among children displaying anxiety related problems
General Anxiety Disorder (GAD)
Excessive anxiety , unrealistic worries, and fearfulness, not related to a specific object or situation.
Child finds it difficult to control worry.
Plus 1 of the following symptoms
a. Restlessness or feeling keyed up/ on edge
b. being easily fatigued
c. difficulty concentrating or mind going blank
d. irritability
e. muscle tension
f. sleep disturbance.
GAD
What If? statements
Marked degree of subjective distress & excessive worry about a thing including:
1.the appropriateness of past behavior
2.possible injury or illnesses ( to themselves or others)
3.the possibility of major calamitous events
4.their ability to live up to expectations
5.their competencies in various areas
6.being accepted by others
7.other things related to concerns about the future.
GAD: Clinical Characteristics
Children tend to be perfectionistic, worrying about what others will think of them or their performance.
Engage in excessive approval seeking and frequent solicitations of reassurance.
Anxiety levels contributes to physical symptoms: headaches, dizziness, shortness of breath, upset stomach and problems with sleeping, which may also become a source of concern or worry.
GAD: Clinical Characterisitics
Some children also develop “nervous habits” such as nail biting, and hair pulling
In a review of epidemiological studies suggests prevalence estimates of 3-5% with younger children (< 11 years)
Prevalence rates for adolescents across studies ranged from 4-7%
GAD is somewhat more frequently seen in adolescents
No significant gender differences
Characteristic of Anxiety Disorders: Cognitive disturbances
Interference with academic performance Attentional biases (toward threat) Cognitive biases (negative spin on ambiguous situations)
Characteristic of Anxiety Disorders: Physical symptoms
sleep
aches/pains
Characteristics of Anxiety Disorders: Social & Emotional deficits
Interference
Low self-esteem
Loneliness
Cognitive-Behavioral Therapy
Components
- Psychoeducation about nature of symptoms
- Skill Building
a. cognitive restructuring
b. positive self-talk
c. problem solving
d. approach-oriented coping
e. relaxation strategies - Exposure
- Role Play
- Contingency reinforcement: rewards
