Week 6 - Children & Adolescents with Mental Health Needs Flashcards
What can depression be expressed through in adolescent?
Through phobias or delinquent behaviors
- Secondary to other disorders (e.g. conduct disorder, school refusal)
How is anxiety expressed in children?
‘Somatize’ - physical complaints such as stomachache, sore throat, headache
What type of anxiety does young children experience?
- Social phobia
- Simple phobias
What type of anxiety does older children experience?
- Panic disorder
- Obsessive compulsive disorder
- Generalised anxiety disorder
What are the crucial factors for persons between the age of 15 and 24?
- Self-identity
- Forming relationships
- Education
- Employment
How does Early Psychosis Intervention Programme (EPIP) help individuals?
- Monitor those with ‘high risk’ of developing psychosis
- Providing early treatment to mitigate the effects of psychosis on young people
What is ‘at risk mental state’ (ARMS) used to describe?
To describe prodromal phase whereby an individual is at risk of developing a psychotic disorder
What are the 3 criterias that leads to confirmation of ARMS?
- Vulnerability group: individuals with family history of a psychotic disorder in a first degree relative, or the individual has a diagnosis of schizotypal personality disorder
- Attenuated symptom group: individuals with attenuated or low grade psychotic symptoms that are deemed to be of sub-threshold frequency or intensity
- Brief Limited Intermittent Psychotic Symptoms (BLIPS): individuals who have experienced psychotic episodes that resolved spontaneously within a week
What model can be used to identify and treat psychosis?
Stress Vulnerability Model: Intrinsic vulnerability + Psychosocial stressors -> Mental illness
- Strong focus on functioning
How can group work equip adolescents with coping strategies?
Groups can provide a sense of belonging and allow them to try out new strategies in a safe setting through
- Discussion-based groups
- Physical activities
- Projective-expressive groups
- Board games
What are some possible themes for adolescents that can be incorporated into group activities?
- Making friends of the opposite gender
- Assertiveness skills
- Dealing with cyber bullies
- Building a healthy routine
- Keeping fit
- Dealing with changes in life
- Accessing community resources
How can we build therapeutic relationships with adolescents?
- Authenticity
- Encourage them to explore & identify their values & beliefs
- Sharing our own opinions, values and beliefs
- Role modelling on how to verbalise feelings in an appropriate manner
- Encourage them to evaluate their own thoughts and help them to link thoughts, feelings and behaviour
What are some general principles of group work?
- Structure and consistency
- Clear rules and boundaries for behaviour
- Avoid power struggle
- Communicating acceptance, trust and safety
What are the challenges that make returning to school more difficult?
- Side effects of medication
- Cognitive difficulties (i.e. sustaining attention)
- Fear of failure & criticism
What programs under supported education can help a person to return & sustain their education & training?
- Basic academic skills for education
- Social & behavioural skills for interaction
- Exploration of educational interest and identification of available opportunities
- Financial ad aipplications
- Studying for entrance examination
- Community resources needed to support educational pursuits (e.g. library)
- Application of materials learned to their educational goals
- Ongoing support group
How can OTs provide supported education to cope with academic demands?
- Teaching strategies such as time management
- Breaking down tasks into smaller chunks
- Teaching advocacy skills
- Liaising with school representatives to provide classroom accommodations
What are the 4 different types of abuse?
- Physical
- Neglect
- Sexual
- Emotional
What are the effects of child abuse on mental function (cognition)?
Impaired development of executive functioning due to toxic stress on the developing brain
- Shorter attention span & hyperkinetic (hyperactivity) behaviour
- PTSD: frequent memories of the event
What are the effects of child abuse on mental function (affective)?
- Fear & anxiety
- Dissociation
- Sense of powerlessness
- Blunt / flat affect
- Shame & guilt
- Poor self esteem
- Impairment of self-identity
- Immature defence mechanism
- Sudden & extreme emotional reaction
- Lack of self-control (sensitive, aggressive, frustration)
What are the effects of child abuse on sensory function?
- Hyper / hypo responsive
- Physical somatic symptom
What are the effects of child abuse on motor function?
- Delayed gross / fine motor skills due to deprivation of sensory / movement opportunities
- Reflex maturation may be incomplete (primitive reflex continue to be present)
- Muscle weakness or paralysis if nerve / brain damage occurs
- Reduced ROM depending on type of injury
- Contractures if condition has existed for some time
What are the effects of child abuse on sleep & leisure?
- Nightmares; trouble sleeping or staying asleep
- Limited leisure interest
What are the effects of child abuse on social participation?
- Isolation
- Delay in acquiring speech / vocabularies to communicate
- Hyper / hypo sexualised behaviour or promiscuity (for sexual abuse victims)
What are the effects of child abuse on play & productivity?
- Reduced occupational performance in play (less imagination, less exploration)
- Handwriting issues
- Difficulty in organising & completing tasks
- Delinquency & truancy
What are some factors to consider when choosing mediums in play therapy?
- Child’s developmental age
- Whether therapy is conducted in groups or alone
- Goals for the child
What are the different types of mediums in play therapy?
- Clay
- Imaginary journey
- Imaginative pretend play
- Miniature animals
- Painting / collage
- Puppet / soft toy
- Sand tray
What are some therapeutic goals to be achieved by the different mediums?
- Gaining mastery over issues & events
- To be powerful through physical expressions
- Encourage expressions of emotions
- Develop problem solving & decision making
- Develop social skills
- Building self-concept & esteem
- Improve communication skills
- Develop insight
How does playing with miniature animals help in therapy?
- Enable child to tell his / her story about perceptions of relationships
- Gain a fuller understanding of his / her place in the family
- Explore fears about his / her future relationships
- Fantasize about future relationships
- Explore possible solutions to relationship problems
What are things to say / not say during miniature animal play?
AVOID
- Asking why questions
- Avoid approving, advising or congratulating or showing expressions -> might influence them
ENCOURAGED
- Making observations & reflective statements
How does sand tray help in therapy?
- Allow child to tell a story of specific events of the past, present or future
- Act out details of the events which are not acceptable to them
- Gain a cognitive understanding of elements of events in their life and find resolution of issues
- Alter their story by projecting their fantasies on it
What are common symbols / objects that can be used in sand tray?
- General items
- Small toys
- Figurines
- Toy animals
What are some ways to start a sand tray session?
- Non-directive: freedom to do whatever they want
- Specific theme: if there is a specific issue to address
- Addressing difficult feelings: helpful to concretise feelings and give it a closure
When and how can we terminate a sand tray session?
WHEN
- Child is unable to continue the story further
- Allocated time is up
HOW
- Therapist summarise themes / issues and check if child wants to do anything else
- Give child the option of dismantling the picture himself/herself or therapist to dismantle after child has left
- Let child know that the picture would not be there in the next session
How does puppets & soft toys help in therapy?
- Allows child to attribute behaviours or personality that are quite different from his / her own
- Helps to protect the child’s inner pain from direct exposure
- To help child gain mastery over issues or events
What are some goals that can be achieved during puppet / soft toy play?
- Develop problem solving & decision making skills
- Develop social skills
- Explore different communication styles through imagines or real events
What are some ways to use puppets in therapy sessions?
- Using puppet spontaneously
- Invite child to create & direct puppet show
- Using puppets in dialogue: for child who is frightened / anxious; child invited to respond on behalf of toy / talk directly to the toy
- Combining with fairy tales or fables: child is invited to act out the story
What are the causes of suicide in individuals?
- Cannot see way out from difficult situations
- Entrenched in negative thoughts and want to seek relief from emotional pain
- Lack of hope about the future due to link between depression & suicidal ideation
How can we manage individuals who are acting on their suicidal thoughts?
- Grounding techniques: bringing awareness to sensations (pay attention to your body against the chair)
- Deep breathing / box technique
- Holding the space for them; being there with them
What are the characteristics that suggest serious suicidal intent?
- Suicidal note
- Carrying out the act in isolation
- Timed so that intervention is unlikely
- Precautions to avoid discovery
- Preparations made in anticipation of death (letters, allocation of belongings, etc)
- Other people informed beforehand of the individual’s intention
What are the reasons for Deliberate Self Harm (DSH)?
- Seek relief from tension / emotional pain
- To overcome feelings of numbness, emptiness or detachment
- To have a sense of control
- To avoid a perceived difficult situation
- To communicate distress
- As revenge towards a significant other
- As self-punishment
What is DSH associated with?
- Affective & anxiety disorders
- Trauma
- Psychosis
- Personality disorder
What are some intervention principles of DSH?
- Helping them to acquire self-soothing strategies
- Healthy ways of expressing emotions (i.e. creative media)
- Problem solving difficult media (using CBT/creative media)
- Crisis management planning (similar to WRAP)
- Instilling hope
- Sensory room / mindset gym
How does the self-soothing strategies (sensory approach) help with DSH?
- Helps to promote healthier way of regulating emotions
- Helps individual to gain more control over the thoughts and feelings
- Distress Tolerance Checklist: to help identify soothing strategies & rate the effectiveness of it after using
- Individuals can create a self-soothing sensory kit after
How does Conduct Disorder (CD) develop and what might it lead to?
Oppositional Defiant Disorder (ODD) -> Conduct Disorder (CD) -> Antisocial Personality Disorder (ASPD)
- ADHD is a co-occuring condition in half of the children with ODD / CD
What are the types of OT intervention used for CD?
Emotional management
- labelling and verbalising emotions instead of acting it out
- channeling emotions using appropriate activities (defense sublimation) such as punching bag or heavy work
Developing prosocial behaviours
- rules and limits to enable individuals to learn about social behaviours
- behavioural modification reward system to reward positive behaviour (needs to be consistent)
How can parent training as an intervention help in CD?
INITIAL PHASE
- Strengthening parent-child attachment relationship
SUBSEQUENTLY
- Parents to establish control over disruptive behaviour through age-appropriate instructions for behaviour
- Providing consistent negative and positive consequences
- Training parents to identify ABC for their children and themselves
What is considered gaming addiction?
When gaming starts to take up a large portion of one’s time which affects
- health
- hygiene
- commitments (school, work)
- relationships
What are the effects of gaming addiction on cognition & affective?
- Spending increasingly more time & money on computer games to feel the same amount of excitement
- Depressed, restless or irritable when others try to cut down / withdraw usage
- Aggressive / abusive when prevented from playing
What are the effects of gaming addiction on productivity?
- Tired & sleepy in class
- Skipping lessons / school to game
What are the effects of gaming addiction on sleep, leisure and social participation?
- Long gaming hours and little sleep hours to compete with players at different time zones
- Little energy for leisure activities and social participation
What are the effects of gaming addiction on self-care?
- Ignoring ADLs such as eating and bathing
- Spending all their money on games
What are some interventions for gaming addictions?
Key intervention goal: establish habits, roles, routines that are lost
- Start by engaging in leisure and creative activities that are of interest to them (one that elevates mood, promote self-esteem, give rise to nice end-products)
- Youth appropriate activities (board games, physical activities, cooking / baking)
How can we establish healthy routines with individuals?
Occupational Questionnaire from MOHO
- to establish balanced time use; after client is stabilized
- important to include family and friends in the engagement of these daily occupations
What are some strategies for gaming addiction to establish a healthy routine?
- Developing an agreement and a way for adolescent to stay away from venues and social circle that encourages gaming
- Agreement on internet usage
- Managing stressors so that they would not resort to gaming to relieve stress
- Preventing relapse (working with people around them)
