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Youth with Mental Health Concerns. Jutta Dotterweich Cornell University jd81@cornell.edu www.actforyouth.net. Adolescent Health Paradox. Adolescence is physically the healthiest period of the lifespan
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Youth with Mental Health Concerns Jutta Dotterweich Cornell University jd81@cornell.edu www.actforyouth.net
Adolescent Health Paradox Adolescence is physically the healthiest period of the lifespan Yet: overall morbidity and mortality rates increase 200% from childhood to late adolescence Youth age 13 – 18: 50% experienced mental health symptoms 22% had a lifetime prevalence of severe symptoms (2010)
Common Mental Health Categories Anxiety Disorders Mood Disorders Learning Disorders Disruptive Behavioral Disorders Thought Disorders
Anxiety Disorders 8% of teens ages 13-18 experience anxiety disorders • Separation anxiety • Social anxiety (7%, onset around age 13) • Phobias (5% in children, 16% in adolescents (13-17), 3-5% in older people) • Panic Disorder (2-3% adolescents)
Obsessive-Compulsive Disorder Obsessions: Recurrent and persistent thoughts, urges or images perceived as intrusive Compulsions: Repetitive behaviors or mental acts the individual is driven to in response to an obsession. Onset typically late adolescents, can be earlier Prevalence in adolescence: 1 in 200
Trauma and Stress Related Disorders Traumatic event includes • actual or threatened death, injury or assault to self or someone close • chronic stress (i.e. wars, violent neighborhoods, abuse/ neglect in family home) • natural catastrophes Child’s or adolescent’s response is intense fear, helplessness, or horror
Inhibited Disinhibited Reactive Attachment Disorder • Failure to thrive • Poor hygienic condition • Underdevelopment of motor coordination; hyper tonicity • May appear bewildered, unfocused • Blank expression • Unresponsive to social contact/interaction • Excessive familiarity with unknown persons • can give hugs to anyone who approaches them; can go with strangers • May approach a complete stranger for comfort, food, to be picked up, etc.
Post Traumatic Stress Disorder (PTSD) • Symptoms last longer than a month after event • Intrusive re-experiencing of the trauma, avoiding trauma reminders, and persistent state of alert • Related emotional and behavioral problems • Co-occurs with other disorders (anxiety, ADHD, oppositional defiant disorder, etc.) • 15% of girls, 6% of boys who experienced trauma meet criteria for PTSD (3 – 50% in juvenile justice) • Symptoms vary according to developmental stages
PTSD in Childhood Symptoms: Early & Middle Childhood • Generalized nightmares • Persistent re-experiencing of event through repetitive play or storytelling Physical symptoms • Increased arousal/hyper-vigilance • Failure to progress or regression in developmental skills • Impaired social relationships/caregiver relationships
PTSD in Adolescence Flashbacks Persistent re-experiencing of event (sometimes through risk-taking behavior) Physical symptoms Increased arousal/hyper-vigilance Failure or regression in academic skills; concentration problems Impulsive or aggressive behaviors Absence of future planning
Mood Disorders • Dysthymic disorder • Depression • Bipolar disorder • Disruptive mood dysregulation (2-5%, onset before age10)
Depression Persistently sad/irritable Loss of energy Loss of interest Significant change in weight/appetite Physical agitation • Difficulty sleeping or oversleeping • Feelings of worthlessness • Difficulty concentrating • Recurrent thoughts of death/suicide Likelihood of onset increases with puberty 11% of adolescents have a depressive disorder by age 18 (NIMH) Rate for females 1.5 – 3 times higher than for males Different Expressions Withdrawal Acting Out
Bipolar Disorder MANIC SYMPTOMS Onset usually late adolescence DEPRESSION Severe changes in mood Inflated self-esteem Great energy increase Increased talking Distractibility Increased goal-directed activity or physical agitation Disregard of risk Decreased appetite May be delusional
Learning Disorders • Boys 3 times more like to be affected • Often associated with anxiety disorders and depression • No cognitive impairment • Attention Deficit Hyperactivity Disorder – ADHD (3-7% of school-age children • Dyslexia (specific learning disorders) (5-15% among school-age children)
Main Symptoms of ADD/ADHD Inattention or inconsistent attention Hyperactivity Impulsivity
Disruptive Behavior Disorders Oppositional/Defiant Disorder (1-11%) • contrariness, constantly arguing & swearing Conduct Disorder (2-10%) • aggression to people and animals, deceitful, destruction of property
Thought Disorders Schizophrenia or Psychotic Disorder: Delusions – false beliefs Hallucinations – sensations that nobody else has Disorganized Thinking – trouble organizing thoughts logically Onset usually late adolescence/early adulthood Lifetime prevalence 0.3-0.7%
Autism Spectrum (Asperger’s) • Persistent deficits in social communication and interaction • Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities • 3 levels of severity depending on functioning level of first two symptoms • Hyper – or hyporeactivity to sensory input • Intellectual impairment • Asperger’s (outdated category): normal or high intelligence Prevalence close to 1% of population
General Behavior Patterns • Hyperactivity • Aggression/self-injurious behavior • Withdrawal • Immaturity • Learning difficulties
Psychotropic Medication Common Side Effects • Drowsiness • Increased or decreased appetite • Headaches • Nausea • Dizziness
Stigma Alert Meet Sam He is more than his diagnosis and behavior problems
Stressors and Triggers Stress signals involve feelings, thoughts, behaviors and physical reactions Identify triggers for stress • Observation • Conversation with youth • In residential settings ask staff
Coping Strategies • Positive appraisal – reframing the situation • Problem-focused coping – brainstorming and planning to resolve conflict, acquire resources and supports • Emotion-focused coping – manage or reduce emotional distress (cognitive or behavioral strategies) • Meaning-focused coping – search for meaning in adversity and draw on values, beliefs and goals
Environmental Factors Clutter, disorganization Lighting Noise level Time of day (daily routine, structure) Community settings – crowds, noise, activity level
Behavior Management Techniques • Proximity • Prompts • Hurdle help • Time away • Redirection • Planned ignoring and positive attention • Directive statements • Caring gesture
Communication Strategies • Attentive listening • Respectful questioning • Empathic communication
Meaning in Spoken Communication Facial Expression + Tone of Voice + Words 7% 55% 38%
Non-Verbal Techniques • Silence • Eye Contact • Facial expression • Posture (e.g., leaning forward) _______________ • Minimal encouragement (“uh-huh,” go on, etc.) • Tone of voice
Active/Empathic Listening Listening for meaning • Attentive to speaker • Reflecting facts and feelings • Interpreting meaning, feelings • Withholding opinions and judgment
Web Resources • National Institute of Mental Health http://www.nimh.nih.gov/index.shtml • NYS Office of Mental Health http://www.omh.ny.gov/ • American Academy of Child & Adolescent Psychiatry http://www.aacap.org • CDC - ACE Study http://www.cdc.gov/violenceprevention/acestudy
Collaborative for Academic, Social, and Emotional Learning http://www.casel.org/sel/families.php US Reach Out http://us.reachout.com/the_facts Kids Health (for teens) http://kidshealth.org/teen/your_mind/#cat20123