The Reason Behind the Behavior

1. The Reason Behind the Behavior Mental Illnesses in Our Youth

2. 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.

3. Major Topics • Brain Research • Diagnosis • Warning Signs • Treatment • The Family • Interventions

4. 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

5. 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)

6. 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

8. 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.

9. 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

10. 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.

11. 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.

12. 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.

13. Common denominators of extreme behavior • High anxiety/separation anxiety • Aggression, rage • Hyper-reactive • Dangerous impulsivity • Disorientation and attention issues • Social phobia • Substance abuse

14. ADHD • 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.

15. Major Depression IRRITABILITY Low energy Frequent physical complaints Low self-esteem Poor concentration Sensitive Grouchy anger Kindling effect 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 A Few Words about Mood Disorders

16. Anxiety Disorders • Obsessions, compulsions, tics are “hard wired” in brain. • Sense of relief from compulsions • Panic attacks • Big need to feel safe

17. 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

18. 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?”

19. Stigma • Old myths, shame, embarrassment • Destroys hope; silences success stories • Systematic discrimination • Nobody is to blame

20. 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

21. Skills for working with children • Flexibility, patience, ability to laugh at oneself/situations • Good conflict management skills • Receptive to change • Open communication

22. 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

23. Strategies • Good working knowledge of symptoms • Good communication with home • Prepared with a variety of approaches to handle shifts in mood • Prepare for transition

24. 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.

25. 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.

26. Problem with Executive Functions • 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

27. 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.

28. 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

29. When feelings are intense … thinking is impaired!!

30. Stress-related Issues • Routine important • Rules posted, few in number, positively stated • Teach organizational skills • Try to avoid sensory overload • Exercise!!! • Graceful Exit Plan

32. Hope on the Horizon • 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

33. 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!