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OTY3102 Play, School & Transition > Week 6 - Children & Adolescents with Mental Health Needs > Flashcards

Week 6 - Children & Adolescents with Mental Health Needs Flashcards

1
Q

What can depression be expressed through in adolescent?

A

Through phobias or delinquent behaviors

  • Secondary to other disorders (e.g. conduct disorder, school refusal)
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2
Q

How is anxiety expressed in children?

A

‘Somatize’ - physical complaints such as stomachache, sore throat, headache

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3
Q

What type of anxiety does young children experience?

A
  • Social phobia
  • Simple phobias
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4
Q

What type of anxiety does older children experience?

A
  • Panic disorder
  • Obsessive compulsive disorder
  • Generalised anxiety disorder
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5
Q

What are the crucial factors for persons between the age of 15 and 24?

A
  • Self-identity
  • Forming relationships
  • Education
  • Employment
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6
Q

How does Early Psychosis Intervention Programme (EPIP) help individuals?

A
  • Monitor those with ‘high risk’ of developing psychosis
  • Providing early treatment to mitigate the effects of psychosis on young people
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7
Q

What is ‘at risk mental state’ (ARMS) used to describe?

A

To describe prodromal phase whereby an individual is at risk of developing a psychotic disorder

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8
Q

What are the 3 criterias that leads to confirmation of ARMS?

A
  1. 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
  2. Attenuated symptom group: individuals with attenuated or low grade psychotic symptoms that are deemed to be of sub-threshold frequency or intensity
  3. Brief Limited Intermittent Psychotic Symptoms (BLIPS): individuals who have experienced psychotic episodes that resolved spontaneously within a week
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9
Q

What model can be used to identify and treat psychosis?

A

Stress Vulnerability Model: Intrinsic vulnerability + Psychosocial stressors -> Mental illness
- Strong focus on functioning

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10
Q

How can group work equip adolescents with coping strategies?

A

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
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11
Q

What are some possible themes for adolescents that can be incorporated into group activities?

A
  • 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
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12
Q

How can we build therapeutic relationships with adolescents?

A
  • 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
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13
Q

What are some general principles of group work?

A
  • Structure and consistency
  • Clear rules and boundaries for behaviour
  • Avoid power struggle
  • Communicating acceptance, trust and safety
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14
Q

What are the challenges that make returning to school more difficult?

A
  • Side effects of medication
  • Cognitive difficulties (i.e. sustaining attention)
  • Fear of failure & criticism
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15
Q

What programs under supported education can help a person to return & sustain their education & training?

A
  • 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
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16
Q

How can OTs provide supported education to cope with academic demands?

A
  • Teaching strategies such as time management
  • Breaking down tasks into smaller chunks
  • Teaching advocacy skills
  • Liaising with school representatives to provide classroom accommodations
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17
Q

What are the 4 different types of abuse?

A
  • Physical
  • Neglect
  • Sexual
  • Emotional
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18
Q

What are the effects of child abuse on mental function (cognition)?

A

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
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19
Q

What are the effects of child abuse on mental function (affective)?

A
  • 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)
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20
Q

What are the effects of child abuse on sensory function?

A
  • Hyper / hypo responsive
  • Physical somatic symptom
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21
Q

What are the effects of child abuse on motor function?

A
  • 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
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22
Q

What are the effects of child abuse on sleep & leisure?

A
  • Nightmares; trouble sleeping or staying asleep
  • Limited leisure interest
23
Q

What are the effects of child abuse on social participation?

A
  • Isolation
  • Delay in acquiring speech / vocabularies to communicate
  • Hyper / hypo sexualised behaviour or promiscuity (for sexual abuse victims)
24
Q

What are the effects of child abuse on play & productivity?

A
  • Reduced occupational performance in play (less imagination, less exploration)
  • Handwriting issues
  • Difficulty in organising & completing tasks
  • Delinquency & truancy
25
Q

What are some factors to consider when choosing mediums in play therapy?

A
  • Child’s developmental age
  • Whether therapy is conducted in groups or alone
  • Goals for the child
26
Q

What are the different types of mediums in play therapy?

A
  • Clay
  • Imaginary journey
  • Imaginative pretend play
  • Miniature animals
  • Painting / collage
  • Puppet / soft toy
  • Sand tray
27
Q

What are some therapeutic goals to be achieved by the different mediums?

A
  • 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
28
Q

How does playing with miniature animals help in therapy?

A
  • 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
29
Q

What are things to say / not say during miniature animal play?

A

AVOID

  • Asking why questions
  • Avoid approving, advising or congratulating or showing expressions -> might influence them

ENCOURAGED

  • Making observations & reflective statements
30
Q

How does sand tray help in therapy?

A
  • 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
31
Q

What are common symbols / objects that can be used in sand tray?

A
  • General items
  • Small toys
  • Figurines
  • Toy animals
32
Q

What are some ways to start a sand tray session?

A
  • 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
33
Q

When and how can we terminate a sand tray session?

A

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

34
Q

How does puppets & soft toys help in therapy?

A
  • 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
35
Q

What are some goals that can be achieved during puppet / soft toy play?

A
  • Develop problem solving & decision making skills
  • Develop social skills
  • Explore different communication styles through imagines or real events
36
Q

What are some ways to use puppets in therapy sessions?

A
  • 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
37
Q

What are the causes of suicide in individuals?

A
  • 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
38
Q

How can we manage individuals who are acting on their suicidal thoughts?

A
  • 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
39
Q

What are the characteristics that suggest serious suicidal intent?

A
  • 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
40
Q

What are the reasons for Deliberate Self Harm (DSH)?

A
  • 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
41
Q

What is DSH associated with?

A
  • Affective & anxiety disorders
  • Trauma
  • Psychosis
  • Personality disorder
42
Q

What are some intervention principles of DSH?

A
  • 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
43
Q

How does the self-soothing strategies (sensory approach) help with DSH?

A
  • 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
44
Q

How does Conduct Disorder (CD) develop and what might it lead to?

A

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
45
Q

What are the types of OT intervention used for CD?

A

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)
46
Q

How can parent training as an intervention help in CD?

A

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
47
Q

What is considered gaming addiction?

A

When gaming starts to take up a large portion of one’s time which affects
- health
- hygiene
- commitments (school, work)
- relationships

48
Q

What are the effects of gaming addiction on cognition & affective?

A
  • 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
49
Q

What are the effects of gaming addiction on productivity?

A
  • Tired & sleepy in class
  • Skipping lessons / school to game
50
Q

What are the effects of gaming addiction on sleep, leisure and social participation?

A
  • Long gaming hours and little sleep hours to compete with players at different time zones
  • Little energy for leisure activities and social participation
51
Q

What are the effects of gaming addiction on self-care?

A
  • Ignoring ADLs such as eating and bathing
  • Spending all their money on games
52
Q

What are some interventions for gaming addictions?

A

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)
53
Q

How can we establish healthy routines with individuals?

A

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

54
Q

What are some strategies for gaming addiction to establish a healthy routine?

A
  • 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)

OTY3102 Play, School & Transition (10 decks)

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