Transcript Mental Health for school Aged Children
9851102378 Arun Raj Kunwar, M.D.
Adult and Child & Adolescent Psychiatrist [email protected]
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity Mental health is an integral part of this definition
Mental health can be conceptualized as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
Hundreds of millions of people worldwide are affected by mental, behavioral and substance use disorders Globally number of people suffering from MDs: Depression: 5-8% Anxiety: 8-10% Schizophrenia: 1% Bipolar Disorder: 1% Alcohol use disorders/Drug use disorders:10-20%
Almost 1out of 4 person suffers from MD in a given year About 6%, or 1 in 17 suffer from serious MD Mental disorders are the leading cause of disability in the U.S. and Canada for ages 15 44
Approximately 20% of C & A suffer psychiatric disorders.
Between 7 and 12 Million American youth suffer from mental, behavioral, or developmental disorders at any given time. 5/6/2020 6
Children comprises more than 1/3 rd population of Nepali About 10-20% of these children suffer from mental health problems More than 50% of adult MDs start prior to 14 years of age
ADHD (Attention Deficit Hyperactivity Disorder) Disruptive Behavior Disorder Mental retardation/Autism Learning disability: reading, writing, math Language disorder: expressive/receptive/ Mixed
Intermittent Explosive Disorder Childhood depression Anxiety disorders: Selective mutism, School phobia, Separation anxiety, Social anxiety Pica Tic disorders Sleep disorder Bedwetting
Eating disorder Substance use disorder: nicotine, alcohol and other substances Child neglect/ abuse Bullying Suicide
“All they need to do is go to school, study and follow directions”
Life according to parents/ social expectations Home work/ good grades Friends/ social acceptance Body image/ weight issues
Bodies are changing/Similarly brain is changing Peer pressure Realities/perception are different for children
Body image/ identify issues/ need to be different/ ideologies They think they know all (figured it all out) Change in sleep cycle
Nobody teaches us how to parent Learn from how we were raised Usual type Authoritarian Permissive Democratic
Parents’ word is law, parents have absolute control Misconduct is punished Affection and praise are rarely give Parents try to control children's’ behavior and attitudes They value unquestioned obedience Children are told what to do, how to do it, and where to do it, and when to do it
• Obedient • Distrustful • Discontent • Withdrawn • Unhappy • Hostile • Not High Achievers • Often Rebel Children are strictly controlled, either by punishment or guilt, prevents from making a conscious choice
Parents allow their children to do their own thing Little respect for order and routine Parents make few demands on children Discipline is lax Parents are resources rather than standard makers (Cash Cow) Rarely punish Non controlling, non-demanding Usually warm Children walk all over the parents
• Aggressive • Least self— reliant • Least self controlled • Least exploratory • Most unhappy Children receive so little guidance that they often become uncertain and anxious about whether they are doing the right thing.
Middle ground between the two above Stress freedom along with rights of others and responsibilities of all Parents set limits and enforce rules Willing to listen receptively to child’s requests and questions Both loves and limits
Children contribute to discussion of issues and make some of their own decisions Exert firm control when necessary, but explain reasoning behind it Respect children’s interest, opinions, unique personalities Loving, consistent, demanding Combine control with encouragement Reasonable expectations and realistic standards
• Happy • Mostly self reliant • Mostly self controlled • Content, friendly, generous • Cooperative • Less likely to be seriously disruptive or delinquent Children learn how to formulate goals They also experience the satisfaction that comes from meeting responsibilities and achieving success.
Consciously express love for child through Words /Attentiveness and Interest ◦ Frequent and liberal praise for any progress or good action ◦ ◦ Do not emphasize academics over inherent value of child Pay attention to what children do right. Children thrive on positive attention and are more likely to repeat a behavior if you notice it and comment on it
Avoid negative comments/ criticism Provide constructive criticism Understand the intent before running to punishment Sometimes kids are kids/ best to ignore Give the message that mistakes are a chance for learning Offer choices whenever possible to provide practice in making decisions
Have set rules and set consequences that match misbehavior 1.
Set Rewards and Punishment 2.
3.
Make it Predictable Follow through consistently, firmly and immediately with consequences 4.
Remain emotionally calm—model emotional control .
Set routines for meals and bedtimes that establish stability Empathy: Develop your child’s ability to put himself in the shoes of others and grow more sensitive
Help your child learn how to express frustration, disappointment and anger without hurting others or retreating into sullenness.
Establish basic rules of conduct: no hitting, kicking, biting, spitting, (no hands allowed), and no hurting others through our words.
Prepare child for challenging and problematic situations by modeling and practicing ◦
Making friends
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Dealing with anger and fears Dealing with bullies
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How to greet others Empathy
Be around your kid Spend quality time- does not always have to be doing things Go for a walk/ bicycle/ cook together Talk to your child about regular things in life If they don't want to tell you something do not force- if they feel comfortable they will tell you Let them know you are there for them
Bedtimes, meals, and car rides are often good times As often as possible, have family dinners where you can share news, discuss problems, and make plans Research shows that children who have dinner with their families several times a week are less likely to smoke or use illegal drugs, have sex at young ages, and get into serious fights
Parents often think that teachers are opponent Teachers are there to help your child If there are concerns, don't confront, tell them you are here to work together/solve problem before going to principal If there are special problems at home (financial/ sickness/conflict), let teacher know in advance than find out after through your child’s acting up at class
Ask your children about their day. Use open ended questions: "What was the most fun thing about school today?" Communicate frequently with your children's teachers about your children's progress and how to help them out at home.
Attend school activities as often as possible.
Be aware of your children’s homework (Diary/ E-mail) Set a time and place for them to do it Be around to answer questions Do not do the homework for them
Becoming self sufficient- brings self confidence Start with ADLs (Activity of Daily living) picking their clothes, fixing their room, follow organize books/home work Help around the house hold chores-cleaning/ laundry/ cooking
TEACH THEM NOTHING IS FOR FREE
Academic deterioration Changes in behavior Isolation Irritability/ easily angry Loss of interest Relationship problems (friends and family) Sleep problems
Weight changes Restlessness Feeling of hopelessness Excessive cleanliness Bizarre feelings/experiences/behavior Frequent drug and alcohol use Suicidal/homicidal thoughts
You know your child best Don’t ignore if you feels something is off Not himself, snappy or more quiet than usual is trying to tell us something
Don’t wait till crisis- too often we look back and say I thought/felt unusual Don’t ignore if a child seems sad, withdrawn, distant, more moody than usual, or angry Greater confrontation between this child and siblings, if friends stop calling or coming over, or if the child can’t seem to find his place in school
Sad/depressed/irritable mood Lack of interest/ motivation Loss of pleasure Academic failure Sleep problems Suicidal thoughts
Constant worry/ anxious and nervous Panic disorder, Obsessive-compulsive disorder, Post-traumatic stress disorder, Generalized anxiety disorder, and Phobias (social phobia, agoraphobia, and specific phobia)
Defiant Oppositional Aggressive/hostile No regards for other people’s right Constant violation of rules and laws Lying/ stealing Truancy/ runaway
Children should not be using any alcohol or drugs at all Most of them are likely to experiment Most of the addiction will develop at this age -Easy availability -Peer pressure -Escaping -Concurrent family use
In 2006, 33,300 (approximately 11 per 100,000) people died by suicide in the U.S Leading cause of death in teenagers More than 90 percent of people who kill themselves have a diagnosable mental health problems, most commonly a depressive disorder or a substance abuse disorder.
School Failure School dropout: Approximately 50% of students with mental illness drop out of high school; this is the highest dropout rate of any disability group. High rate of crime and violence Many youth with unidentified and untreated mental illness also end up in jail and prisons (65% of boys and 75% of girls at jails have MH problems)
Increased drug and alcohol use Long term Mental illness Long Term Disability Suicide is the third leading cause of death in youth and almost 90% of children and adolescents who commit suicide have a mental disorder.
Child Behavioral Check List 100 questions Screening for ADHD/Behavior issues/ Depression/Anxiety/Psychosis If Negative- Good/ Well adjusted If anything Positive- Needs full evaluation for conformation
Dr Kunwar: 9851053605 [email protected]
Mr. Rogers: 9849630051 [email protected]
Lack of social acceptance and prejudice against LGBT-makes their life very difficult LGBT youth are in very high risk for mental health problems One- third of LGBT youth attempt suicide
Most of the Mental health problems/ illness are treatable Identify early and manage early Helps to prevent future consequences
Mental health can be conceptualized as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
SDQ ask about 25 attributes, some positive and others negative 1) emotional symptoms (5 items) 2) conduct problems (5 items) 3) hyperactivity/inattention (5 items) 4) peer relationship problems (5 items) 5) prosocial behavior (5 items)
This is just a screening If they score below radar: They are well adjusted If they score positive: They need to be interviewed for possible MH problems.
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