Key Warning Signs: Mental Health Disorders in Children

1. Key Warning Signs: Mental Health Disorders in Children Intervention Strategies for Parents & Professionals

2. Welcome & Agenda • MACMH’S Mission • Defining Mental Health • Biology and Environment • Recognizing Disorders • Intervention Strategies

3. Let us consider… • Why is it important for parents, caregivers & professionals to know about children’s mental health?

4. Innate Engagement • Children are intrinsically motivated to recruit those in their environment to meet their needs • Knowing social & emotional needs will be met creates a feeling of security and trust

5. Deprivation • When children do not have a positive environment or significant relationships the child may show depression and failure to thrive.

6. Protective Factors • A caring adult • High quality childcare • Secure attachment • Strong support network • Stimulating environment • Early Intervention

7. Creating an Emotionally Healthy Environment • Respond to children’s emotional & physical needs with warmth & reassurance • Encourage children to talk about & label feelings • Model problems solving & conflict resolution • Practice solutions and anticipating consequences • Teach children stress reduction techniques

8. Communication • Help children practice listening and talking • Link emotional states to social situations and experiences • Teach children to verbalize rather than act on feelings • Teach children to help others & understand and appreciate similarities & differences between people

9. Role Model • Empathic, supportive adult • Encouraging, hopeful responses • Don’t take behavior personally • Model respectful behavior towards the child • Respect and celebrate individual temperaments

10. What is Mental Health? A state of successful performance of mental function, resulting in productive activities,fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Mental health is the springboard of thinking and communication skills, learning, emotional growth, resilience, and self-esteem.

11. The Continuum of Mental Health The normal emotions we all experience — such as anger, joy, frustration, happiness, loneliness, contentment, even grief and loss — exist on the same continuum as severe alterations in thinking, intense mood swings, or dramatic behavior changes that indicate a diagnosable mental health disorder.

12. Types of Mental Health Disorder Depression • Anxiety • Reactive Attachment Disorder • Bi-polar disorder • AD/HD • Pervasive Developmental Disorder • Fetal Alcohol Spectrum Disorders • Sensory Processing Disorders • Tourette Syndrome • Oppositional Defiance Disorder & Conduct Disorder

13. Recognizing Children’s Mental Health Disorders • Mental health disorders in children are more widespread than most adults believe. • Educators are often among the first people to see that a child may be experiencing a problem. • By understanding the nature of mental health disorders, school personnel can better plan programs that meet their students’ needs and build a positive environment.

14. Children’s Mental Health Facts • One in five (21%) of children have a diagnosable mental, emotional, or behavioral disorder. • One in 10 suffer from a serious emotional disturbance. • 70% of children, however, do not receive mental health services (SGRMH, 1999).

15. The Stigma Barrier • Negative attitudes and beliefs • Fear, rejection, avoidance • Disrespect and discrimination • Discourages individuals and families from getting the help they need

16. Early Intervention • Can reduce the effects an emotional or mental health disorder may have on children and their families. • Can lessen the duration and severity of the disorder. • Can help children learn positive coping strategies and prevent academic and social failure.

17. Three W’s of Intervention • What (Identification*) • Why (Referral*) • Where (Treatment)

18. Childhood Mental Health • All children go through rough times at school, with friends, or in their families. • Stress affects everyone, even kids. • Most common problems, such as sadness after a family move, clear up with time and maturity.

19. Recognizing the Signs • Mental health disorders emerge during ongoing development and at times may look like misbehavior but are NOT the same. • Disorders in infancy, childhood, and adolescence may not have the same symptoms as in adulthood.

20. Recognize Warning Signs • Consider three things if you suspect a child may be experiencing an emotional problem: • Frequency: How often does the child exhibit the symptoms? • Duration: How long do they last? • Intensity: How severe are the symptoms?

21. Influences on Children’s Mental Health • Genetics • Brain physiology • Disruption in neurochemical transmission • Environmental factors • Family stress • Abuse • Deprivation of Basic Needs • Stressful life events • Cultural norms • Personality traits

22. Brain Development • Brain development depends on interaction between the brain cells and their immediate environment. • Both biological and psychosocial factors influence the development of the brain and brain disorders. • Stressful life events, injury, infection, malnutrition, exposure to toxins. childhood maltreatment may lead to mental health disorders.

23. Early Childhood - Modifiable Brains • “Talking to children, holding them, and rocking them helps their brains organize and grow in a healthy way.” –Dr. Bruce Perry • “The brain gets set in tracks that increasingly get deeper and it’s harder to bump kids out of it. Not because their brains won’t change, but because their brains and behavior are set up along certain pathways.” –Megan Gunnar Ph.D.

24. Learning Changes the Brain • The brain can rewire itself with each new stimulation, experience, and behavior. • A child's ability to learn can increase or decrease by 25 percent or more, depending on whether he or she grows up in a stimulating environment. www.brainconnection.com

25. Brain Based Disorders • Schizophrenia, depression, and bipolar disorder all show clusters in families • Brain scans are showing different processes (Dr. Daniel Amen http://www.amenclinic.com/) • Having a brain that works differently does not excuse behavior • Students and educators need to learn how their brains work and how to make choices

26. Children’s Mental Health Facts • Alcohol, marijuana, inhalants and club drugs are the most frequently used drugs among middle- and high-school youth (SAMHSA,2000). • Twenty percent of youths in juvenile justice facilities have a serious emotional disturbance and most have a diagnosable mental disorder. Up to an additional 30 percent of youth in these facilities have substance abuse disorders or co-occurring substance abuse disorders (OJJDP,2000).

27. More Mental Health Facts • As many as one in every 33 children and one in 8 adolescents may have depression (CMHS, 1998). • Children and teens who have a chronic illness, endure abuse or neglect, or experience other trauma have an increased risk of depression (NIMH, 2000).

28. Depression (warning signs) • Loss of interest in usual activities • Low self esteem, self deprecating remarks • Lack of energy • Difficulty concentrating • Sleep problems • Irritability, restlessness, distracting others • Change in attitude or behavior

29. PET scan of brain for depression A PET scan can compare brain activity during periods of depression (left) with normal brain activity (right). An increase of blue and green colors, along with decreased white and yellow areas, shows decreased brain activity due to depression.

30. More symptoms of depression • Sadness that won’t go away • Joylessness • School avoidance, tardiness • Headaches, stomachaches • Change in eating and sleeping patterns • Regression in Skills • Excess Whining • Persistent lethargy & apathy • Isolation

31. Depression Developmentally • Infancy- Whiny, lethargic, weight loss • Preschoolers - accident prone, excessive or multiple fears, self-deprecating. • 6 to 8 - vague physical complaints, both aggressive and clinging behavior toward parents, avoid new people and challenges. • 9 to 12 - morbid thoughts about death, excessive worry about schoolwork • Adolescent - excessive anger, withdrawal, hypersensitivity to criticism, suicidal thoughts. They may abuse drugs and/or alcohol, engage in cutting, or have eating disorders.

32. Strategies for depression in young children • Hold, comfort, rock and sooth them • Acknowledge their feelings • Verbalize emotional expression • Openly encourage and use positive reinforcement

33. Strategies for Depression • Reduce classroom pressures • Break tasks into smaller parts • Be flexible and reassure students that they can catch up • Recognize and acknowledge positive contributions and performance • Encourage gradual social interaction • Help students use realistic and positive statements about their performance and outlook for the future

34. Depression Interventions • Depression is very serious and should be treated immediately • Encourage a response team approach involving parents, teachers, counselors, & physicians • Chemical dysregulation may require prescription medication • Exercise, sunlight, & teaching coping skills are helpful in reducing symptoms

35. Anxiety Disorder 28 year old woman with chronic anxiety, conflict avoidance shows marked increased focal activity in the right side of her basal ganglia.

36. Anxiety Disorders • Anxiety disorders are brain based conditions that involve hyperarousal of the central nervous system and create intense feeling of fear, worry or apprehension. • Sometimes children’s anxiety is very general; at other times, it may be associated with specific situations, events, or objects.

37. Types of Anxiety • Generalized Anxiety Disorder • Phobias • Social Phobias • Obsessive-Compulsive Disorder • Panic Disorder • Post-Traumatic Stress Disorder (PTSD)

38. Anxiety (warning signs) • Excessive and irrational fears • Feels worthless or guilty a lot • Has worries that last for long periods of time • Anxious or worried a lot more than other children • Somatic complaints • Low self-esteem

39. Warning signs of anxiety • Frequent absences • Refusal to join in social activities • Isolating behavior • Many physical complaints • Excessive worry about homework or grades • Falling grades • Frequent bouts of tears • Frustration • Fear of a new situation • Separation anxiety

40. Strategies for Anxiety • Do • Acknowledge the fear: “That must be scary to think about.” • Reflective listening: “Sounds like you are not sure you can do well on the math test.” • Decide what you can do: “I have my phone right here. If your mom is late, we’ll call her.” • Do Not • Discount the child’s feelings: “That will never happen.” or “There’s nothing to worry about.”

41. More Strategies for Anxiety • Allow students to redo assignments and retake tests to improve scores • Reduce work load and be flexible with deadlines • Increase teacher to student interaction regarding assignments • Encourage regular attendance, post schedules, detailed course outlines, and establish routines • Create a low competition environment • Teach relaxation techniques • Use cooperative learning and peer mentoring

42. Reactive Attachment Disorder • Deprivation or maltreatment disorder • Emotionally blunted • Frozen watchfulness • Avoids social interactions • May resist comforting • May be extroverted around strangers

43. 3 Patterns RAD • Emotional withdrawn or inhibited pattern rarely seeks comfort from stress • Indiscriminate or disinhibited pattern will not form selective attachments but will seemingly attach to relative strangers-lacks typical shyness of young children • Combination of the two.

44. Defining Bipolar Disorder Bipolar Disorder - is characterized by episodes of major depression as well as episodes of mania - periods of abnormally and persistently elevated mood or irritability accompanied by at least three of the following symptoms: overly-inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; increased goal-directed activity or physical agitation; and excessive involvement in pleasurable activities that have a high potential for painful consequences. National Institute of Mental Health, 2005

45. Bi-Polar Disorder Separation Anxiety･Rages & Explosive Temper Tantrums (lasting up to several hours) Irritability･Oppositional Behavior･ Frequent Mood Swings Distractibility･ Hyperactivity Impulsivity･Restlessness/Fidgetiness･Silliness, Goofiness Giddiness･Racing Thoughts･ Carbohydrate Cravings･ Aggressive Behavior･Grandiosity･ Risk-Taking Behaviors･ Depressed Mood･Lethargy･ Low Self-Esteem･ Social Anxiety Difficulty Getting Up in the Morning Oversensitivity to Emotional or Environmental Triggers

46. Bipolar tendencies • ･Bed-Wetting (especially in boys)Night Terrors･Rapid or Pressured Speech･Obsessional Behavior･Excessive Daydreaming･Compulsive Behavior･Motor & Vocal Tics･Learning Disabilities･Poor Short-Term Memory･Lack of Organization･Fascination with Gore or Morbid Topics･Hypersexuality･Manipulative Behavior･Bossiness･Lying･Suicidal Thoughts･Destruction of Property･Paranoia･Hallucinations & Delusions

47. Case study • Randy is an endearing five year-old boy with an engaging smile. And yet, he has a history of tempestuous behavior that has followed him since infancy. He is bright, articulate, a fast learner - and as unpredictable as a tornado. From the time he cut his first tooth, he began biting - often drawing blood. At one and a half years old, Randy was dismissed from pre-school for aggressive behavior. He consistently scores high marks for academics, but has a string of "needs improvement" comments in all areas of behavior. He is loving, cuddling, wanting to be held one minute; screaming and raging with veins bulging from his neck the next.

48. Strategies for Bi-PolarDisorder • Flexibility to accommodate rapid changes in student’s ability to perform • Identify a place for the child to go to regain self-control and a plan to help calm themselves • Try soothing music, drawing, walking • When energy is low, reduce demands; when energy is high, increase opportunities for learning • Provide opportunities for relaxation and exercise

49. Disruptive Behaviors • Oppositional Defiant Disorder-angry, defiant, noncompliant, resentful, annoy and blame others • Conduct Disorder - aggressive behavior toward people or animals, destruction of property, deceitfulness, theft, serious violations of rules

50. Defining Behavior Disorders • Oppositional Defiant Disorder (ODD) tends to manifest as resistance and negativity towards authority figures. • Oppositional behaviors demonstrated in 18-36 month-old children and in teenagers may be part of a normal developmental phase so be alert for intensity and duration of symptoms. • Conduct Disorder (CD) symptoms tend to be broader and represent behaviors that oppose societal rules and/or may represent a violation of the basic rights of others.