Mental Health Issues in Children, Youth and Adolescents

1. Mental Health Issues in Children, Youth and Adolescents Family and Children’s Service of Greater Lynn, Inc. Linda Demerjian, LICSW Jackie Trahan, M. Ed. Lauren Harless, LCSW Maria Alvarado, BA

2. The What and Why of Mental Health in Youth • What is mental health? Mental Health can be defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community (World Health Organization, 2001). • Why is it important? Mental health issues in youth may lead to poor school performance, school dropout, strained family relationships, involvement with the child welfare or juvenile justice systems, substance abuse, and engaging in risky sexual behaviors.

3. Youth Mental Health Statistics • 1 in 5 Children, currently or at some point in their life, have had a seriously debilitating mental disorder. • Half of lifetime cases of mental disorders begin by age 14. • In a given year, only 20% of children with mental disorders are identified and receive services. • About 50% of students age 14 and older who are living with mental illness drop out of high school. • Almost all teens who think about or have attempted suicide have a mental disorder, including depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD) or problems with drug or alcohol abuse. • Suicide is the third leading cause of death in youth ages 10 to 24. • According to a 2012 survey, 25 % of middle school youth and 14% of high school youth in Lynn, MA have “ seriously considered suicide”. (National Alliance on Mental Illness, 2010) (National Institute of Mental Health, 2010) (Northeast Center for Healthy Communities ,2012) (Nock et al., 2013)

4. Depression • Depression is a serious health problem that can affect people of all ages, including children and adolescents. • Depression is generally defined as a persistent experience of a sad or irritable mood as well as “anhedonia,” a loss of the ability to experience pleasure in nearly all activities. • Major depressive disorder, often called clinical depression, is more than just feeling down or having a bad day. It is a form of mental illness that affects the entire person. • Depression changes the way one feels, thinks and acts and is not a personal weakness or a character flaw. • Children and youth with depression cannot just “snap out of it” on their own. If left untreated, depression can lead to school failure, substance abuse, or even suicide.

5. Indicators of Depression • Grumpy, sad, or bored most of the time. • Does not take pleasure in things he/she used to enjoy. • Weight loss or gain. • Change in sleeping patterns. • Feeling hopeless, worthless, or guilty. • Having trouble concentrating, thinking, or making decisions. • Thoughts of death or suicide. • Lack of energy. • Headaches, stomachaches, loss of interest in friends and activities. • Slower speech or movements.

6. Anxiety • Anxiety is the feeling of intense, fear, distress and apprehension that appears out of proportion to the situation. While all children and adults experience this at one time or another, an actual anxiety disorder is an intensified reaction of fear or apprehension that affects daily functioning. • Risk factors may be genetics (a predisposition), family history (substance abuse), traumatic of scarring events, poverty and so forth. • If untreated, the negative experiences of the anxiety compound fears and symptoms over time. • Anxiety disorders that persist into adolescence and adulthood have a high risk of substance abuse (American Psychiatric Association, 2000).

7. Indicators of Anxiety • Fear • Emotional/physical distress • Body Tension • Self-defeating cognitive and behavioral rituals • Sleep and appetite disturbance • Feeling out of control • Difficulty effectively coping • Sense of impending doom or danger • Startle Response • Difficulty concentrating • Irritability • Restlessness • Nightmares • Clinging behavior • School refusal • Poor memory • Clumsy or accident prone • Periods of losing time

8. Attention Deficit Hyperactivity Disorder (ADHD) • A persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed for at least six or more months and is more severe than is typically observed in individuals at a comparable level of development (American Psychiatric Association, 2000.) • ADHD is one of the most common childhood mental health disorders. • The symptoms of ADHD begin in childhood and often persist into adulthood. • The causes and risk factors for ADHD are unknown, but genetic factors likely play a role. (U.S. Department of Health and Human Services, 2011)

9. Indicators of ADHD Inattention • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. • Often has trouble keeping attention on tasks or play activities. • Often does not seem to listen when spoken to directly. • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). • Often has trouble organizing activities. • Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time. • Often loses things needed for tasks and activities. • Is often easily distracted. • Is often forgetful in daily activities. Hyperactivity • Often fidgets with hands or feet or squirms in seat when sitting still is expected. • Often gets up from seat when remaining in seat is expected. • Often excessively runs about or climbs when and where it is not appropriate. • Often has trouble playing or doing leisure activities quietly. • Is often "on the go" or often acts as if "driven by a motor". • Often talks excessively. Impulsivity • Often blurts out answers before questions have been finished. • Often has trouble waiting one's turn. • Often interrupts or intrudes on others. (American Psychiatric Association, 2000)

10. Trauma • Trauma can be defined as a physical or psychological threat or assault to a child’s physical integrity, sense of self, safety or survival or to the physical safety of another person significant to the child (Vermont CUPS Handbook, 2005). Children may experience trauma as a result of a number of different circumstances, such as • Abuse, including sexual , physical, emotional • Exposure to Domestic Violence • Severe natural disaster (earthquake, flood, fire, and tornado) • War or military actions • Abandonment • Witness to violence in school setting, neighborhood • Personal attack by another person • Kidnapping • Severe bullying • Medical procedure, accident, serious illness or surgery

11. Indicators of Trauma • Difficulty sleeping • Hyper alert and a heightened startle response • Agitation • Avoidance of physical contact or eye contact • Terrified responses to sight, sound that remind the child/youth of the traumatic experience (example, the smell of alcohol, police siren, a dog) • Re-enactment of the traumatic experience • Substance Abuse (adolescents) Who is at greater risk? • Children and youth who are victims of physical and sexual abuse, usually by trusted caregivers. • Children and adolescents who are victims of domestic violence in their families or in a school or community setting.

12. Risk Factors for Mental Health Issues (Community Action Network, 2010)

13. Individual Level Community Level • Educate self further about mental health (know the warning signs). • Monitor youth’s behaviors. • Take into consideration youth’s developmental stage. • Thoroughly access youth’s background and situation. • Develop relationships and/or consult with mental health professionals (psychologist, psychiatrists and social workers). • Contact caregivers when concerns/warning signs arise. • If possible, openly discuss mental health with youth in the schools, classroom, program, center etc. • Conduct meetings, presentations, conferences and/or conversation around mental health to increase awareness and reduce social stigma. • Train staff, childcare workers, school faculty, parents etc. to recognize the risk factors and warning signs of mental health issues. • Collaborate with mental health professionals to implement or improve programs. • Consider and support policy that improves access to mental health services. • Promote tolerance and understanding of those suffering from mental illness. What can we do?

14. Assessment of Youth and Substance Abuse • In adolescents, substance abuse highly correlates with mental health issues, especially trauma (National Child Traumatic Stress Network, 2008). • Determine if substance abuse is occurring - During the past 12 months, have you: Drank any alcohol (more than a few sips)? Smoked any marijuana or hash? Used anything else to get high? (includes illegal drugs, over the counter and prescription drugs, and things that you sniff or “huff”.) • Gain history of the substance abuse • What kinds of substances are/were used? • How often and under what circumstances? (frequency and pattern) • Has anyone expressed concern over your use of alcohol and/or other substances? • Do you have concerns about your use? • Do family members or friends use? Under what circumstances? • Make an appropriate referral Research recommends treating substance abuse and mental health issues concurrently. (Massachusetts Department of Public Health Bureau of Substance Abuse Services, 2009)

15. Mental Health Providers Non-Mental Health Providers

16. Local Youth Mental Health Resources • Lynn Community Health Center, Behavioral Health Services 20 Central Ave., Lynn MA 01902 (781)477-7222 • Elliot and Community Human Services 95 Pleasant St., Lynn, MA 01901 (781) 581-4400 • Family and Children’s Service of Greater Lynn, Inc. 111 N. Common St., Lynn, MA 01902 (781) 581-6614 • Children Friends and Family Services 112 Market St. 2nd Fl, Lynn, MA 01902 (781) 592-5691 • Catholic Charities 117 N. Common St., Lynn, MA 01902 (781) 593-2312 • Psychiatric Associates of Lynn 270 Union St., Lynn, MA 01901 (781) 268-2200 • Mass General at North Shore Medical Center 57 Highland Ave. Salem, MA 01970 (978) 354-2700

17. Discussion Questions?

18. References Akinbami, L., Liu, X., Pastor, P., & Reuben, C. (2011). Attention Deficit Hyperactivity Disorder Among Children Aged 5-17 Years in the United States, 1998-2009. NCHS Data Brief, 70. Retrieved January 10, 2013, from http://www.cdc.gov/nchs/data/databriefs/db70.PDF American Association of Suicidology, Suicide Prevention is Everyone's Business. (n.d.). American Association of Suicidology Suicide Prevention is Everyone's Business. Retrieved January 14, 2013, from http://www.suicidology.org/home Cash, Ralph E, Ph.D., NCSP. (2001). Social/Emotional Development. Depression in Children and Adolescents. Information for Families and Educators. Retrieved January 11, 2013 from National Association of School Psychologists: http://www.nasponline.org/resources/handouts/social%20 template.pdf CDC - Mental Health Basics - Mental Health. (2011, July). Centers for Disease Control and Prevention. Retrieved January 10, 2013, from http://www.cdc.gov/mentalhealth/basics.htm Children's Mental Health. (n.d.). American Psychological Association (APA). Retrieved January 14, 2013, from http://www.apa.org/pi/families/children-mental-health.aspx Depression Health Center. (2011). Depression in Children and Teens - Topic Overview. Retrieved January 11, 2013 from: WebMD: http//www.webmd.com/depression-in-childhood-and-adolescence-topic overview Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, DC: American Psychiatric Association. Facts on Children's Mental Health in America. (n.d.). NAMI: National Alliance on Mental Illness: Child & Adolescent Action Center. Retrieved January 14, 2013, from http://www.nami.org/ Finding help for young children with social-emotional-behavioral challenges and their families: The Vermont children's upstream services (CUPS) handbook. (2005). Waterbury: Vermont Department of Health, Division of Mental Health. Making the Connection: Trauma and Substance Abuse. (2008, June). The National Traumatic Stress Network. Retrieved January 10, 2013, from http://www.nctsn.org/sites/default/files/assets/pdfs/SAToolkit_1.pdf Massachusetts Adolescent Mental Health Facts - The Office of Adolescent Health. (2012, October 15). United States Department of Health and Human Services. Retrieved January 10, 2013, from http://www.hhs.gov/ash/oah/adolescent-health-topics/mental-health/states/ma.html

19. References Continued National Institute of Mental Health. Children’s Mental Health Awareness. Depression in Children and Adolescents Fact Sheet. Retrieved January 11, 2013 from: http://www.nimh.nih.gov/depression...children-and-adolescents/index.sh National Institute of Mental Health. Mental Illness: Depression in Children and Adolescents fact Sheet. Retrieved January 14, 2013 from: http://www.nimh.nih.gov/health/topics/depression/depression-in-children-and-adolescents.shtml NIMH · NIMH Statistics. (2009). NIMH Home. Retrieved January 10, 2013, from http://www.nimh.nih.gov/statistics/index.shtml Nock, M., Green, J. G., Hwang, I., McLaughlin, K., Sampson, N., Zaslavsky, A., et al. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents results from the national comorbidity survey replication adolescent supplement. JAMA Psychiatry , 1, 1-11. Prescription for Wellness: Risk Factors Related to Children's Mental Health. (2010, April 18). Community Action Network - Home | Community Action Network. Retrieved January 10, 2013, from http://www.caction.org/health/PrescriptionForWellness/MentalHealth/Child/RiskFactors.htm Provider Guide: Adolescent Screening, Brief Intervention, and Referral to Treatment for Alcohol and Other Drug Use Using the CRAFFT Screening Tool. (2009, March). Massachusetts Child Psychiatry Access Project. Retrieved January 10, 2013, from http://www.mcpap.com/pdf/CRAFFT%20Screening%20Tool.pdf Schwarz, S. (2009, June). Adolescent Mental Health in the United States Facts for Policy Makers . National Center for Children in Poverty. Retrieved January 14, 2013, from http://www.nccp.org/publications/pub_878.html The 2012 Youth at Risk Behavior Survey. (2012). Lynn, MA: Northeast Center for Health Communities. Wille, N., Bettge, S., & Ravens-Sieberer, U. (2008). Risk and protective factors for children's and adolescents' mental health: results of the BELLA study. European Child & Adolescent Psychiatry, 1, 33-47. Retrieved January 10, 2013, from the PubMed database.