Transcript Emotional, Behavior, and Mental Disorders in Children and

The Reason Behind the Behavior
Mental Illnesses in Our Youth
NAMI
• Advocacy, support, education
• Over 1000 local and state affiliates
• Focus is on the severe, persistent brain
disorders that can affect one's ability to
think, feel, and relate to others and his
environment.
Major Topics
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Brain Research
Diagnosis
Warning Signs
Treatment
The Family
Interventions
Childhood-onset brain disorders
• Tend to be more severe and more mixed
than adult-onset disorders
• More difficult to diagnose and treat.
• Interfere with development, learning
Prevalence
• 7 of 10 children – no diagnosable brain
disorder
• 25% - moderately severe disorder
• 5% - marked impairment/SED
• Less than 1 in 5 get help.
• One-half of life-time cases begin by age 14
• Adults – 21%
(GSMS 1998, Surgeon General’s Report 1999, NIMH NCS-R 2005)
Brain Research
• Mental disorders - Neurobiological Brain
Disorders (NBD)
• Scientifically proven biologically-based
• PET Scans, MRI findings, biochemical and
genetic research substantiate scientific, biological
basis of disorders
• Involve some impairment of thought, perception,
feeling and/or behavior
Diagnosis
• Psychiatrists base diagnosis of emotional,
behavioral, and mental disorders on DSM-IV.
• Diagnostic Statistical Manual, 4th edition, 1995 is
the American Psychiatric Association’s
classification of mental disorders.
• Symptoms vary from person to person.
• Result in reduced ability to cope with life.
• Based on disability, duration of symptoms,
symptoms of specific disorder.
Benefits of Early Recognition
• Faster, more complete recovery
• Less severe brain disorder with improved
prognosis
• Individuals more able to recognize illness when
less ill and more compliant with treatment/meds
• Reduces risk of suicide, depression, substance
abuse, unprovoked aggression
• Less disruption to psychological, social and
educational development
Warning Signs: Elementary
Difficulty going to sleep, reluctance to take part in
activities normal for child’s age;
Frequent, unexplainable temper tantrums;
Hyperactive behavior/fidgeting;
Steady, noticeable decline in school performance;
Pattern of deliberate disobedience or aggression;
Persistent nightmares;
Pronounced difficulties with attention, concentration,
organization;
Increased irritability.
Warning Signs
Feeling hopeless, overwhelmed, low self-esteem;
Sudden overwhelming fear for no apparent reason;
Severe mood swings affecting relationships with
others;
Drastic change in personality or behavior; and
Extreme worries or fears that interfere with
friendships, school work, or play.
Warning Signs: Pre-teens, Teens
Frequent outbursts of anger or inability to cope with
problems and daily activities;
Lack of close friends;
Marked change in school performance, sleeping &/or
eating habits
Threats of self-harm or injury and toward others;
Sexual acting-out; Threaten to run away;
Strange thoughts, feelings, or unusual behaviors.
Common denominators of extreme
behavior
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High anxiety/separation anxiety
Aggression, rage
Hyper-reactive
Dangerous impulsivity
Disorientation and attention issues
Social phobia
Substance abuse
ADHD
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Quick to arouse in AM
“Expert hunters” of long ago
Seek stimulus safety (lights, smells, touch)
Understimulated cognitive domain
“Frantic starts, endless running” like transmission
in car.
A Few Words about Mood Disorders
• Bipolar disorder
– Very depressed
– Marked impairment
– work, school, social
– Slow to arouse in AM
– With mania – Flight
of Ideas, distractible,
grandiosity, goofiness,
talkative, may be
aggressive, rage
– Charming, gifted
• Major Depression
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IRRITABILITY
Low energy
Frequent physical complaints
Low self-esteem
Poor concentration
Sensitive
Grouchy anger
Kindling effect
Anxiety Disorders
• Obsessions, compulsions, tics are “hard
wired” in brain.
• Sense of relief from compulsions
• Panic attacks
• Big need to feel safe
Cognitive Distortions
ALL-OR-NOTHING THINKING – No shades of gray.
OVERGENERALIZATION
One event is seen as part of a pattern of failure.
MENTAL FILTER
Only negative or fearful aspects of a situation are perceived
DISQUALIFYING THE POSITIVE
Positive experiences discounted/rejected.
MIND READING
Assuming others are thinking badly of you
More Cognitive Distortions
• FORTUNE TELLING – Predicting that things will turn
out badly.
• MAGNIFICATION – Smallest mistake is projected into
worst possible outcome.
• LABELING AND MISLABELING – Overgeneralizing –
“I am stupid.” “I am a loser.”
• PERSONALIZATION – “If anything goes wrong, it must
be my fault.”
• LEARNED HELPLESSNESS – “Nothing ever works for
me anyway, so why try?”
Stigma
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Old myths, shame, embarrassment
Destroys hope; silences success stories
Systematic discrimination
Nobody is to blame
What Parents Need
• To learn how child reacts in educational setting
– Parent needs to report this info to doctor,
therapist
– May need to develop home-school behavior
plan
• Focus placed on strengths and needs, not on
pathology, programs, available services
• To know they are not to blame
• To be asked what they need
Skills for working with children
• Flexibility, patience, ability to laugh at
oneself/situations
• Good conflict management skills
• Receptive to change
• Open communication
Strategies
• Reduce exposure to stress
• Help improve coping skills
• Provide structure, predictability each day
• Use praise, encouragement
• Most important – how adults
respond to and work with them
Strategies
• Good working knowledge of symptoms
• Good communication with home
• Prepared with a variety of approaches to
handle shifts in mood
• Prepare for transition
What Professionals Can Do
• Be aware that behaviors that are unusual or
interfere with learning may be symptoms of a
disorder of child’s brain.
• Speak in terms of “differences” not disabilities.
• Remind parents they are not to blame.
• Let parent, support staff know what warning signs
are present.
• Refer child to student support team - counselor,
school psychologist.
What Professionals Can Do
• Be vigilant in observing behavior of children.
• Divert attention - calming voice, little talking.
• Cognitive behavioral intervention - Teach coping
skills to child, self-talk strategy, learning to
recognize signs of stress, what to do.
• Take agitation, threats seriously. Be prepared to
use interventions.
• Front-end interventions are best.
Problem with Executive Functions
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Trouble setting priorities, planning
Difficulty with sequence, organization
Unaware of future, inflexible
Problem with carrying out goals, feedback
Inability to suppress,
delay response
• Production difficulties
– unable to self-monitor
How to help these children
• Problem w/executive function? - Break up
directions, check early on.
• “This is the problem. This is what you need to
do.”
• “Instant replay”
• Find out what they love.
Memory Deficits - TS, OCD, ADD
• Cannot control thoughts, worrying, stuck, stuck,
stuck….
• Anxiety increases if interrupted.
• Problem with working memory, strategy.
• Writing, math difficulties may be
production problems
When feelings
are intense
… thinking is impaired!!
Stress-related Issues
• Routine important
– Rules posted, few in number, positively stated
• Teach organizational skills
• Try to avoid sensory overload
• Exercise!!!
• Graceful Exit Plan
Front-end interventions are more
effective than back-end
interventions.
Hope on the Horizon
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Research - new treatments, “Decade of the Brain”
Advocacy groups fighting stigma
Families as equal partners in treatment
Full range of services to the child and family
address all needs
• Strength-based assessment
Our Basic Message
• Mental illnesses are no-fault brain disorders.
• Getting the right diagnosis and proper medication
is not easy but treatment works!
• Early recognition of symptoms is vital.
• Families need support.
• Interventions work!
• Thank you for all you do!