Transcript Pediatric and Adolescent Mental Health

Pediatric and Adolescent
Mental Health
John Sargent, M.D.
Goals of Child Rearing
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Optimal development
Effective emotional, cognitive and
behavioral functioning
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Capacity for meaningful occupational
participation
Satisfying relationships and family life
Rewarding recreational experiences
Successful adaptation to and participation
in one’s neighborhood and community
Recognizing Intrinsic Differences
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Physical Status
Intellectual capacity
Temperament
Culture and ethnicity
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Family relationships
Socio economic status/access to resources
Capacity for modulation of emotions
Capacity to manage and direct behavior
Unique Characteristics of Child
Mental Health Problems
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Often represent gene-environmental
interactions
Symptoms of the disorder often worsen the
disorder
Impact development and overall skill
acquisition
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Affect and are affected by family relationships and
family behavior
Early recognition and early effective treatment
significantly reduce mortality and morbidity
Sources of resilience and risk strongly influence
the occurrence and course of child and
adolescent mental health problems
Sources of Resilience
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High intelligence
Even temperament
Physical attractiveness
Special skills and abilities
Commitment of caretaker to child’s
well being and development
Strong social support for family and
caretaker
Sources of Risk
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Poverty
Recent move or immigration
Marked marital or post separation conflict
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Family violence, abuse or neglect
Community disruption
Poor resource availability
Types of Child and Adolescent
Mental Health Problems
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Disorders of Social Interaction
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Internalizing Disorders
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Autism
Aspergers Syndrome
Anxiety Disorders
Depression
Trauma Responses
Externalizing Disorders
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Attention Deficit Hyperactivity Disorder
Conduct Disorder
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Appetite Disorders
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Mental Retardation
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Eating Disorder
Substance Abuse
Self-Harming Behavior
Learning Disability
Early onset major mental illness
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Schizophrenia
Bipolar Disorder
Mental Health Treatment Options for
Children and Adolescents
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Individual Psychotherapy
Family education and psychotherapy
Psychopharmacology
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Special education programs
Treatment programs
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Inpatient residential
Day treatment
Legal responses
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Detention
Group homes
Probation
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Community treatment
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Home based therapy
Therapeutic foster care
Mentoring programs
Crisis intervention
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Mobile crisis unit
Police with special training
Goals of Treatment
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To enhance the child’s adaptation to
his environment
To support the community’s efforts to
accommodate to the child’s unique
differences
Specific Child Psychiatric Syndromes
and Treatment
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Autism and Asperger’s
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Spectrum of poor socializing ability
Generally require educational/behavioral
program
May require medication for anxiety,
aggressiveness or hyperactivity
Prognosis depends on language development
and intellectual capacity
Attention Deficit Hyperactivity Disorder
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3 – 6% of population
Onset before age 7
Problems with concentration, activity level and organization
Concerns at home, school and with peers
Treatment includes
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Stimulants
Educational support
Parental supervision
Consistency
Depression
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3% of children
5 – 8% of adolescents
Risk for suicidal behavior
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School failure
Poor relationship and occupational outcome
Treatment: combination of psychotherapy
and SSRI medication
Major issue
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Early identification
Appropriate treatment
Anxiety Disorders
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5% of children
Excessive worry interfering with function
Obsessive Compulsive Disorder most common
Worry is alleviated by rigid and time consuming
compulsions, counting, washing and checking
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Social anxiety is frequently troubling during adolescence
interfering with social relationships and self=esteem
Treatment can be very effective
Post Traumatic Stress Disorder
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Significant trauma through abuse, neglect,
illness, accident or other traumatic
expericene
Symptoms include arousal changes,
avoidance and reexperencing
Can be persistent and seriously disabling
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Often complicated by depression,
substance abuse and risk taking behavior
Psychotherapy highly effective, especially if
initiated early
Eating Disorders
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1 – 3% of adolescent and young adult
women
Bulimia (recurrent binge eating and
purging) can be chronic and relapsing
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Anorexia has 5 – 10% mortality rate
and can be chronic
Early treatment most effective
Requires multidisciplinary treatment
approach
Conduct Disorder
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More common in boys
Cruelty to animals often an early symptom
Can persist and develop into antisocial
personality and lifelong criminality
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Linked to poor parental supervision and
family violence
Often associated with substance abuse
Positive relationship with school and with
prosocial peers are good prognostic signs
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Placement away from home and with
similar youth does not improve the problem
Home based, intensive family treatment
leads to 75% recovery rate
Substance Abuse
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Has declined in youth in the past 15 years
Frequently associated with other
psychiatric disorders and complicates their
treatment
Use of several drugs is common
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Drug abuse is associated with poor family
relationships and poor parental supervision
Treatment is based on improving family
relationships and building the child’s skills
and abilities
Bipolar Disorder
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Can occur in childhood and adolescence
Mood fluctuations are associated with marked
irritability, temper outbursts and impulsivity
Can be difficult to treat and is often chronic
Frequently occurs in families with other member
swith Bipolar Disorder which can complicate
treatment
Concluding Remarks
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Decreasing stigma remains essential
Parity in insurance coverage and improved
access to effective care for poor and
underinsured are extremely important
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Planning for transition to adulthood
significant
Social and human costs of non treatment
are enormous
Competence and human connections are
important treatment goals
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There is great need for more Child and
Adolescent Psychiatrists (only 7000 in USA
for 7.5 million seriously affected children)
Effective treatments are available and lead
to more productive and satisfying lives for
children and their families