Chapter 21: Behavioral and Psychiatric Disorders in Children with Disabilities

1. Chapter 21: Behavioral and Psychiatric Disorders in Children with Disabilities Pages 297-311 Presented By Sonya Felmly

2. Objectives • After this presentation you will be able to…. 1. Describe different psychiatric and behavioral disorders 2. Match treatment with the correct disorder

3. Why? • Dual Diagnosis is a term applied to the co-existence of the symptoms of both intellectual or developmental disabilities and mental health problems • Causes: • Stress- in social situations • These negative social conditions include social rejection, stigmatization, and the lack of acceptance in general. • Lack of communication skills • Heredity • Limited coping skills • unknown

4. Statistics • Wright, Rutter, Graham, and Yule found emotional disturbances in 7%-10% of children who do not have any disabilities. • They also found 30%-42% of children with intellectual disabilities had psychiatric disorders • Gillberg found 57% of children and adolescents with mild intellectual disabilities and 64% with severe intellectual disabilities met the criteria for psychiatric disorders.

5. Oppositional Defiant Disorder • Children must exhibit negative, hostile, and defiant behaviors for at least six months. • Children must have at least four of the eight symptoms. • Often loses temper • Often argues with adult • Often breaks rules or fails to comply with adult requests • Deliberately annoys people • Blames others for one’s mistakes • Is touchy or easily annoyed • Is angry and resentful • Is spiteful and vindictive Most diagnosis are usually given to preadolescent children.

6. Conduct Disorder • To be diagnosis with conduct disorder the child must exhibit behaviors in which peoples rights are violated, norms are ignored, and rules are broken for at least 12 months. • Four main problem areas include • Aggression towards people and animals • Destruction of property • Deceitfulness or theft • Serious violation of rules

7. Treatment for ODD and CD • Same behavior management techniques that are used for children with ADHD. • Medication • Behavioral Therapy • Includes setting consistent limits, behavioral expectations, and consequences for violating the limits • Expectations must be the same at home and school • Positive Reward System • Prize box at the end of the week • Tokens to buy time at the computer or in front of the TV

8. Impulse Control Disorders • Explosive Disorder • Diagnosis after the child demonstrates several episodes of failing to resist aggression • Example: A child wants to go outside instead of eating their dinner. The child's parent tells them they can go outside after dinner. The child throws their food across the room, throws their chair, and hits their baby brother. • Treatment • Beta blockers such as propranolol, and certain antiepileptic/mood stabilizers.

9. Impulse Control Disorders • Trichotillomania • Child pulls out their hair and sometimes eats it • There is a sense of relief when the child pulls out their hair. • Eating hair can be very dangerous and might require surgery to get it out of the body • Treatment • Medicine • Cognitive- Behavior Therapy

10. Generalized Anxiety Disorder • Children have at least six months of anxiety and worry about situations. • Situations include school, play, sports, friends, and family • Other symptoms can include.. • Being keyed up, being easily fatigued, having problems concentration, and experiencing irritability, muscle tension, and disturbed sleep. • Treatment • Cognitive-Behavioral Therapy • To reduce worry • Medication

11. Panic Disorder • Panic Attacks usually do not begin until puberty • Panic Attacks include at least four of these symptoms • Rapid or racing heartbeat • Sweating, trembling, or shaking • Feeling short of breath or as it smothering • Feeling as if choking • Chest pain or discomfort • Nausea or abdominal distress • Feeling dizzy, lightheaded, or faint • Feeling of unreality or detachment • Fear of losing control or going crazy • Fear of dying • Numbness and tingling • Hot flashes or chills

12. Panic Disorder • Treatment- • High-potency benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin) • Cognitive- behavioral therapy • Develop a list of things that triggers panic attacks • Patients work through the list (facing the different issues)

13. Social Phobia • A fear of doing something embarrassing in front of others including strangers. • In order to be diagnosed with social phobia the child has appropriate relationships with family and friends but is afraid of other peers and adults. • The child might cry, have a tantrum, freeze or shrink from situations with unfamiliar people. • Symptoms must last for more than 6 months. • Treatment- • Cognitive-behavioral therapy • Reduce anxiety in social settings • Speech classes/acting classes

14. Obsessive-Compulsive Disorder • A child with OCD has obsessions, compulsions, or both. • Obsessions are reoccurring thoughts, images, or impulses that cause anxiety. • Compulsions are repetitive behaviors or mental acts that are done to neutralize and obsession. • Hand washing, counting, arranging, tapping, touching, and hoarding • To be diagnosed with OCD the obsessions and compulsions must occupy more than one hour per day and interfere with everyday functioning.

15. Obsessive-Compulsive Disorder • Treatment • Cognitive-behavioral Therapy • Exposure and Response Prevention • Example- A child with a fear of germs would be asked to touch a doorknob and then they are not permitted to wash their hands. • Medications • Zoloft, Prozac, Luvox

16. Posttraumatic Stress Disorder • Anxiety disorder that happens after a traumatic event in which a person witnesses a death, serious injury, or threat. • Children with a developmental disability might occur after physical abuse or after the injury that caused the disability. • Children with intellectual disorders are more prone to PTSD because they have limited coping skills. • To be diagnosed with PTSD the child must demonstrate symptoms for at least one month and symptoms must interfere with daily life functioning.

17. Posttraumatic Stress Disorder • Symptoms- Reexperiencing the trauma -Dreams, flashbacks Avoidance and numbing -avoids thoughts, feelings, people, places -unable to recall important aspects of the event -decreased interest or participation in activities Increased arousal -difficulty sleeping -angry outburst -difficulty concentrating Treatment psychotherapy and play therapy -patients must talk through thoughts and events that remind them of the trauma

18. Major Depression • Children with major depression exhibit a 2 week period with at least five of the following symptoms • Depressed mood by subjective report or as observed by others • Decreased interest or pleasure in most activities • Significant change in weight or appetite • Insomnia or hypersomnia • Psychomotor agitation or retardation • Fatigue or loss of energy • Feelings of worthlessness or guilt • Decreased concentration or indecisiveness • Recurrent thoughts of death and dying Treatment • Medicine • Psychotherapy

19. Bipolar Disorder • Consists of changes between depression and mania or both together • A manic episode consists of a period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week. • Mood disturbance must have at least three of the following if happy and four if irritable. • Inflated self-esteem • Decreased need for sleep • More talkative • Flight of ideas • Distractibility • Increased goal directed activity or psychomotor agitation • excessive involvement in pleasurable activities that have high potential for painful consequences

20. Bipolar Disorder • Treatment • Mood stabilizers • Antipsychotic medications • Risperdal, Abilify, Zyprexia, Seroquel, Geodon • Children with bipolar must have consistent bedtimes and routines so the lack of sleep does not participate to manic or a mixed episode.

21. Psychotic Disorders • Schizophrenia • Two or more of the following symptoms for at least a one month period • Delusions (someone is following you) • Hallucinations (hearing voices when no one is talking) • Disorganized speech and grossly disorganized or catatonic behavior Treatment -antipsychotic medication **Youtube the 20/20 on children with schizophrenia

22. Eating Disorders • Rumination • Repeatedly regurgitate without nausea or gastrointestinal illness for at least 1 month • Self-stimulatory behavior for children with intellectual disabilities • Binge Eating • Large amounts of food during a short period of time • Do not use purging • Risk for choking, and death • Obesity

23. Maladaptive Behavior Disorders • Self-Stimulating Behavior • Biting their hands, banging their heads, picking at their skin, poking their eyes, and hitting themselves with their fist. • May do this once or twice a day or several hundred times an hour • Tissue destruction, infection, internal injury, loss of vision , and even death • Occur in fewer than 5% of people with disabilities

24. Treatment • Educational Interventions • -self-contained classroom • -one on one support • -therapy sessions with the school counselor and a behavioral psychologist • Rehabilitation Therapy • - language impairments contribute to behavior problems • - teaching functional communication skills • - speech-language therapy and other communication systems (PECS) • -Physical and Occupational Therapy • -motor function

25. Treatment • Psychotherapy • - Table 21.2 on page 306 • - The table shows the different types psychotherapy and uses in different disorders • -Goals of therapy are to relieve symptoms and help the child to understand the nature of his or her disability. -Including feelings to recognize their strengths. • - social skills • - peer pressure, rejection, stigmatization, and exploitation • Behavior Therapy (most widely researched psychotherapeutic intervention for children and adolescents with disabilities.

26. Treatment • Pharmacotherapy • -use of medicine • - table 21.3 on page 308 gives all of the different medicines and which psychiatric disorder it treats • Antidepressants • Treat major depression and anxiety disorders (OCD, generalized anxiety disorder, separation anxiety) • Antihypertensive • - beta blockers • - explosive and aggressive behavior, tourette syndrome, ADHD

27. Treatment • Benzodiazepines • -reduces anxiety • - children with developmental disabilities may become agitated rather than clam and sleepy • -can not be used over a longer period of time • Mood Stabilizers • -Treat bipolar disorder and aggressive behaviors • Stimulants and Atomxetine • - Treats ADHD and ASD • - side effects include loss of appetite, insomnia, tics, headache, and gastrointestinal side effects • - controls hyperactive/impulsive symptoms

28. Physical Education • Modify Rules of the game so students are very successful • Modify Equipment • Soft • Can not eat • Consistency • Routines are the same • Kids know what to expect!

29. Summary • Children with developmental disabilities are more likely to develop psychiatric and behavioral disorders. • Psychiatric and behavioral disorders can interfere with the child’s daily living if it goes untreated. • Behavioral disorders include oppositional defiant, conduct , intermittent explosive, and trichotillomania. • Anxiety disorders include panic disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder

30. Summary • Mood disorders included major depression and bipolar disorder. • Other disorders that were discussed was schizophrenia, eating disorders, adjustment disorders, and maladaptive behavior disorders. • There are several different ways to help treat all of these disorders. Some ways can include rehabilitation therapy, psychotherapy, and pharmacotherapy. • Don’t forget to look at page 308 in your book to see the table of medications used to treat psychiatric disorders!