Unit 6: AOTA Anxiety, Depression Article

Question 1

OT’s use meaningful activities to help children and youth participate in…

Answer 1

what they need and or want to do in order to promote physical and mental health and well-being.

Question 2

Occupational therapy practitioners focus on participation in the following areas:

Answer 2

Education, play and leisure, social participation, activities of daily living
(ADLs; e.g., eating, dressing, hygiene), instrumental activities of daily living
(IADLs; e.g., meal preparation, shopping), sleep and rest, and work.
-These are the usual occupations of childhood.

Question 3

Task analysis is used to identify…

Answer 3

Factors (ex. sensory, motor, social-emotional , cognitive) that may limit successful participation across various settings, such as school, home, and community.
Activities and accommodations are used in intervention to promote successful performance in these settings.

Question 4

About Anxiety

Answer 4

• Everyone experiences anxiety as a response to stress from time to time, even children.
• Mild anxiety can help a young person cope with a difficult or challenging situation, such as taking an exam, by channeling that anxiety into positive behaviors (ex. reviewing course material ahead of time in order to prepare for the exam)
• When anxiety is constantly present and appears to be an irrational fear of familiar activities or situations, then it is no longer a coping mechanism but rather a disabling condition

Question 5

Anxiety Disorders Diagnosis Period

Answer 5

These disorders often begin in childhood as early as 6 years of age, or in adolescence, and can interfere significantly with the performance of everyday occupations

Question 6

The DSM identifies 5 types of anxiety disorders:

Answer 6

• Obsessive-Compulsive Disorder (OCD)
• Posttraumatic Stress Disorder (PTSD)
• Social or Specific Phobias
• Panic Disorder
• Generalized Anxiety Disorder.

Question 7

Common symptoms of Anxiety Disorders:

Answer 7

1. Excessive, unexplained worry
2. Difficulty managing the worry
3. Restlessness or unexplained nervous energy
4. Tiring easily
5. Difficulty concentrating or loss of thoughts
   (“mind going blank”)
6. Irritability
7. Muscle tension
8. Sleep disturbances

Question 8

Brain imaging for Anxiety Disorders

Answer 8

Can now demonstrate the biology of anxiety disorders
-These types of studies have revealed atypical brain activity in children with anxiety disorders (ex. not being able to differentiate between threatening versus non-threatening situations), as well as brain circuitry changes during adolescence which make females more prone than males to developing mood
and anxiety disorders.
-Research is also helping determine effective treatment methods other than prescribed medications, such as family-based cognitive behavioral therapy and social skills training

Question 9

How do Anxiety Disorders Impact Participation?

Answer 9

• Anxiety symptoms can interfere with a child’s ability to engage in school activities, chosen occupations, and social opportunities.
• Fear of failure, concern about having a panic attack, or fear of embarrassment can lead to a child’s lack of participation even though he or she may want to be engaged.
• These experiences can lead to social isolation and result in poor occupational performance in all life skill areas.

Question 10

How Do Anxiety Disorders Impact Emotional Health?

Answer 10

• Decreased participation in social situations and occupations can exacerbate feelings of low self-esteem, distort a child’s self-image, and disrupt habits, routines, and roles.
• Overall quality of life and well-being are affected because of the underlying symptoms.

Question 11

Children who experience anxiety disorders may be challenged in the following areas of occupation: (occupational performance)

Answer 11

• Social Participation
• ADL’s
• Education
• Work
• Play/Leisure
• Rest

Question 12

Anxiety: Social Participation (occupational performance)

Answer 12

• May avoid social situations due to fear of being in an unfamiliar setting, embarrass- ing themselves, or having a panic attack
• May “flee” when uncomfortable
• Can appear irritable and unapproachable
to other children
• May choose to withdraw as a way to
manage symptoms
• Overall discomfort interferes with enjoy-
ment of social activities

Question 13

Anxiety: ADLs (occupational performance)

Answer 13

• Excessive worry, poor concentration, slowed information processing, and fatigue can disrupt daily routines and the ability to carry out bathing, toileting, dressing, and eating tasks
• May demonstrate poor initiation and low motivation

Question 14

Anxiety: Education (occupational performance)

Answer 14

• Potential for social isolation at recess and in the cafeteria
• Difficulty concentrating and processing information can interfere with activity engagement, ability to understand and follow instructions, and completion of assignments
• May lose train of thought due to intrusion of worrisome thoughts
• Generally avoids speaking up in class or calling attention to self

Question 15

Anxiety: Work (occupational performance)

Answer 15

• May avoid work settings where there is a need to interact with the public and/or the environment is busy and unpredictable

Question 16

Anxiety: Play/Leisure (occupational performance)

Answer 16

• Tendency to engage in familiar occupa- tions, either alone or with a good friend
• May find it hard to relax and enjoy themselves

Question 17

Anxiety: Sleep/Rest (occupational performance)

Answer 17

Can be disrupted due to worry, which leads to daytime fatigue

Question 18

Occupational Therapy Practitioners can play an important role in addressing anxiety disorders in…

Answer 18

Children in a variety of settings, including schools, communities, and home.

Question 19

-In each setting, intervention may focus on a number of areas, including…

Answer 19

Establishment of routines and habits, enjoyable activities that promote optimal levels of arousal or relaxation, and strategies for managing symptoms to enhance occupational performance.

• These services can help children build self-esteem and establish supportive relationships with family members, school personnel, and peers.
• Occupational therapy practitioners can play a critical role in working with teachers and other school personnel, as well as with family members to address the occupational performance needs of children with anxiety disorders.

Question 20

Promotion: Anxiety (levels of intervention)

Answer 20

Occupational therapy practitioners can promote whole population approaches fostering mental health at the universal level (e.g., school-wide efforts to reduce stress and sensory overload throughout the day, such as inclusive recess experiences).

Question 21

Prevention: Anxiety (levels of intervention)

Answer 21

Practitioners may introduce targeted interventions to help at-risk students manage their symptoms more easily without necessarily singling them out (ex. collaborating with teachers to create sensory-friendly environments that incorporate self-regulating strategies within the classroom, such as making fidget toys available, providing quiet corners in which to work, and offering relaxation breaks).

Question 22

Intensive/Individualized: Anxiety (levels of intervention)

Answer 22

Occupational therapy practitioners can collaborate with teachers to implement classroom interventions designed to enhance an anxious child’s occupational performance (ex. modifying assignments by breaking them down into smaller steps, allowing flexible deadlines for harder assignments, reducing homework load, creating opportunities for stress reduction, adhering to a sensory diet, or partnering with a friend during more challenging learning activities).

Question 23

Home Treatment for Anxiety

Answer 23

• Work with families to establish daily routines that include time together, as well as time alone for de-stressing.
• Educate family members about anxiety symptoms and how they can interfere with functioning. Help develop coping strategies (e.g., sleep hygiene routine, quiet retreat, sensory diet, sensory modulation kit).
• Encourage enjoyable family activities that alleviate stress and promote social participation.

Question 24

School Treatment for Anxiety

Answer 24

Educate all school personnel about anxiety disorders and how they impact learning and socialization (ex. in-service sessions, handouts).

• Promote sensory-friendly areas indoors (ex. create sensory modulation areas in classrooms) and outdoors (ex. create a reflective garden or nature trail on the edge of the playground).
• Encourage school curriculum that supports stress management and promotes socialization (ex. yoga, team-building activities, walking clubs).
• Promote inclusive after school activities.

Question 25

Community Treatment for Anxiety

Answer 25

• Partner with local after-school and community organizations to create activities that help youth manage stress (ex. community service projects, exercise clubs).
• Reach out to parent groups or youth service organizations to educate members about anxiety disorders and offer strategies for managing symptoms (ex. ask to speak at a meeting, create a handout with helpful hints, write an article for a newsletter or community newspaper).

Question 26

Strategies for Managing Anxiety

Answer 26

• Create a sensory modulation kit and/or a sensory diet.
• Use Cognitive Behavioral Therapy (CBT) and Social and Emotional Learning (SEL) to help students develop skills to recognize and manage their emotions, thoughts, and behaviors.
• Teach relaxation techniques and positive self-talk that students can use in the classroom and at home.
• Promote participation in meaningful leisure activities.

Question 27

About Depression

Answer 27

Everyone feels sad or “blue” at times, even children and teens.
-However, youth who experience prolonged and variable periods of sadness may have a more serious medical condition, such as major depressive or dysthymic disorders.

Question 28

-Depression Classification

Answer 28

• Classified as a mood disorder with cyclical symptoms that can disappear and reappear.
• These symptoms can interfere with a young person’s thoughts, feelings, and behaviors, resulting in difficulties with occupational performance and overall well-being.

Question 29

Depression in children and teens is considered one of the most serious illnesses due to…

Answer 29

Its impact on functioning and mental health, creating a significant risk for suicide.

• According to the Centers for Disease Control and Prevention (2012), 8% of females and 5% of males between 12-17 years report depression on a Patient Health Questionnaire -Two-thirds of teens who experience symptoms do not seek help, and therefore do not get identified.
• Symptom presentation varies among youth and should be assessed on an individual basis.

Question 30

Depression during adolescence is often accompanied by comorbid diagnoses such as…

Answer 30

Anxiety, bipolar disorder, and substance abuse

Question 31

Some symptoms of depression that can appear in youth include:

Answer 31

• Loss of enjoyment or interest in activities and other people
• Difficulty with cognitive tasks—especially concentration and decision-making
• Sudden, enduring changes in affect, such as an increase in irritability
• Sudden, enduring changes in behavior, such as resistance to participation in social activities with
family and/or friends, school avoidance, and a preference for being alone
• Changes in sleep patterns, e.g., having difficulty falling asleep or awakening early
• Changes in activity levels, e.g., low energy and rapid fatigue or excitability
• Changes in appetite, such as eating too much or too little
• Increased feelings of incompetence, hopelessness, and helplessness
• Expressions of worthlessness and thoughts of unfounded guilt

Question 32

Who’s at risk of developing a mood disorder such as depression?

Answer 32

1. Children with a family history of mood disorders, such as Major Depression, Dysthymia or Bipolar Disorder
2. Children who live in unstable situations that might include • financial uncertainty or poverty
   • substance use/abuse
   • high levels of conflict
   • frequent moves

Question 33

Depression: Social Participation (occupational performance)

Answer 33

• Isolation due to a loss of interest/enjoyment, feelings of inadequacy, and low energy.
• Family stress and tension can result from the youth’s social withdrawal.

Question 34

Depression: ADL’s (occupational performance)

Answer 34

• Changes in eating patterns
• Loss of interest in self-care,
such as bathing regularly and/ or wearing clean clothes.

Question 35

Depression: Education (occupational performance)

Answer 35

• Difficulty with concentration and other cognitive tasks interferes with engaging in and completing assignments.
• May be labeled as “lazy” or disinterested.
• May refuse to attend school, complain of feeling ill often, or ask to leave early.

Question 36

Depression: Work (occupational performance)

Answer 36

• Similar cognitive challenges as demonstrated in school.
• May appear disinterested in tasks.
• May arrive late or not at all.
• Slow or inadequate work, e.g., may misunderstand directions,
leave out steps, etc.

Question 37

Depression: Play/Leisure (occupational performance)

Answer 37

• May show disinterest in previ- ously enjoyed leisure activities.

Question 38

Depression: Sleep/Rest (occupational performance)

Answer 38

Disruptions in sleep patterns, such as difficulty falling or staying asleep, add to constant fatigue.

Question 39

Occupational Therapy Practitioners can serve an important role in addressing depression in…

Answer 39

Youth because of its negative impact on all areas of occupational performance. OTs can offer guidance, support, and interventions to youth, families, and other disciplines in a variety of settings, such as home, school, and community.

Question 40

Promotion: Depression (levels of intervention)

Answer 40

Whole population approaches fostering mental and physical health at the universal level (e.g., school-wide efforts to promote healthy lifestyles, self-esteem, acceptance of individual differences, non-tolerance of bullying, resources for support, etc.).
-Educate about the value of enjoyable activities in improving mood. Encourage children to share feelings and experiences through everyday conversation, social interaction, and creative expression.

Question 41

Prevention: Depression (levels of intervention

Answer 41

Targeted interventions focusing on at-risk groups, such as those living in unstable situations or those showing new occupational performance difficulties (e.g., small group after-school clubs that promote self-esteem, sensory modulation, and non-threatening socialization and social skill-building).

Question 42

Intensive: Depression (levels of intervention)

Answer 42

Interventions designed for those dealing with decreased occupational performance due to depression (e.g., modified school demands and schedule, targeted sensory processing needs, family education).

Question 43

Home Treatment for Depression

Answer 43

• Work with youth and family to develop low-stress home routines that incorporate opportunities for success with chores, homework, and social interactions.
• For instance, to avoid feeling pressured and stressed, the therapist might work with the family to: promote a morning routine that allows extra time for the youth to move at his/her pace; provide education about the impact of specific symptoms on occupational performance; focus on the youth’s favorite activities as a means of fostering engagement and success; and facilitate quiet social opportunities with one good friend and/or family member to enhance social participation.

Question 44

School Treatment for Depression

Answer 44

• Collaborate with the teacher(s) and other school staff to raise awareness of the youth’s performance challenges that are related to illness.
• Modify assignments as well as the environment when possible in order to reduce stress and to create a positive learning situation. If the youth cannot get out of bed early enough each day due to side-effects of medications or symptoms, then an adapted school schedule may need to be developed.

Question 45

Community Treatment for Depression

Answer 45

Become an integral part of the youth’s intervention team by helping to set realistic functional goals. Offer opportunities for participation in low-stress social situations and enjoyable activities/interests that do not challenge the youth’s sense of security or self-worth, e.g., avoid venues with high sensory input and activity until the youth feels better.

Question 46

DID YOU KNOW?

Answer 46

Suicide is the third leading cause
of death of 10-24 year olds. It is important to refer someone who has suicidal thoughts or expression to trained professionals and not ignore these signs, either written, verbal, or creative

Question 47

Posttraumatic stress disorder (PTSD)

Answer 47

Classified as a trauma- and stressor-related disorder that develops after being exposed to or witnessing a traumatic event that is life-threatening. or threatens the integrity of one’s self or others

Question 48

A traumatic event may include… (PTSD)

Answer 48

Directly experiencing or witnessing emotional, physical, or sexual abuse; sexual violence; domestic or workplace violence; medical incidents or catastrophes (ex. waking during surgery); severe motor vehicle accidents; natural or human-made disasters; war exposure (civilians, military personnel); incarceration as a prisoner of war; actual or threatened assault; being kidnapped or taken hostage; torture; terrorist attacks; witnessing unnatural death; or learning about serious, violent, or accidental events that affect family or close friends

Question 49

The symptoms of PTSD cause…

Answer 49

Significant distress that impacts social and occupational participation to a degree that is clinically significant.

• Difficulty is often evident in the person’s ability to functionally engage in self-and home-care activities, education and work roles, and social and leisure interests.
• The ability to develop and maintain relationships is often negatively affected, and there is an increased probability of self-injurious behaviors (ex. substance abuse, self-mutilation).

Question 50

Although the diagnostic criteria for PTSD in young children (6 years and less) is similar to that of older children, adolescents, and adults, there is often a difference in how the symptoms and behaviors manifest…

Answer 50

For instance, younger children may or may not demonstrate significant distress when experiencing intrusive memories, which are often reenacted during play.

• Younger children with PTSD often have significant feelings of shame, guilt, fear, sadness, and confusion; therefore, they may become socially withdrawn, demonstrate problematic behaviors, and have significant difficulty with caregivers, siblings, and peer relationships.
• Additionally, there is often a marked decrease in activity participation, including play constriction and difficulty with school performance

Question 51

The Role of Occupational Therapy With Persons With PTSD

Answer 51

Occupational therapy practitioners are qualified mental health professionals who assist people experiencing barriers to engage in meaningful roles and occupations to increase their participation, health, and wellness

• They work with individuals of all age ranges, in all phases of recovery, by helping them and their caregivers identify and address recovery-based needs and strategies within the context of real-life demands
• The term occupation refers broadly to everyday activities and roles that are meaningful and/or necessary to the individual (ex. activities of daily living; work; educational activities; roles such as parent, spouse, worker, and friend)

Question 52

Occupational therapists conduct… (OT role in therapy with PTSD)

Answer 52

Comprehensive and collaborative evaluation to identify strengths and barriers to occupational performance and their cause(s) (ex. needs, trauma triggers, environmental barriers).

• They provide individual and group therapy sessions related to the impact of trauma, phases of recovery, and health/wellness strategies, often in collaboration with other professionals.
• They also provide consultation to organizations and policymakers and may work in supervisory, managerial, and case management positions in this area of practice.

Question 53

Some examples of occupational therapy interventions for PTSD include:

Answer 53

• Provide individual and/or group sessions that focus on addressing trauma triggers and warning signs; developmental issues related to early childhood trauma; symptom stabilization; and learning new coping, health, and wellness strategies (e.g., stress management and relaxation techniques, sensory processing–related techniques).
• Provide training to clients, caregivers, and interdisciplinary staff in adaptive or modified self- and home care, work, or school-based strategies, so as not to inadvertently trigger hypersensitivity patterns, dissociation, flooding, or flashbacks.
• Help clients increase their participation in meaningful roles and activities (e.g., create and use a daily schedule to identify triggers and helpful strategies, identify and obtain the type and amount of support necessary for successful participation, create and use a sensory diet, implement exposure techniques).
• Assist clients and caregivers in determining the needs and resources for home modifications for clients who also have physical barriers to participation.
• Promote veterans’ awareness of the impact of wartime driving experiences on PTSD and assist them in addressing reactions to civilian driving situations.

Question 54

Where Are Occupational Therapy Services Provided for PTSD?

Answer 54

Individuals with PTSD may receive occupational therapy services across a large variety of settings, including acute-, short-, and long-term-care facilities (e.g., hospitals, rehabilitation centers), partial hospitalization programs, outpatient clinics, schools, adoption and foster care agencies, day programs, supported work environments, community-based programs, home care, resi- dential programs, club houses, forensic settings, independent living and skilled nursing facilities, and military-based settings, such as Veterans Administration (VA) hospitals.