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Mental Health - Child


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Mental Health Commission of Canada (MHCC)
- Evergreen: a child & youth mental health framework for Canada
- "the mental health of young people has not been a priority across Canada
- it is common for infants brought up in harsh environments to end up with mental health issues

Mental Health Problems:
- leading cause of disability
- 14% of children aged 4-17 years
- fewer than 25% of these child/youth receive treatment

Statistics - Child & Adolescent Mental Health
- 5% of male youth & 12% female youth aged 12-19 years. MD episode
- 2nd highest hospitalization rates for young people 15-24 due to mental illness
- increasing rates
- society, parenting and bullying impacts these rates
- rate of suicide is 3 times higher in Labrador than in NL
- 1/5 children who need mental health services receives treatment
- NL 20% of deaths aged 10-19 years due to suicide 22% aged 15-24

- 20% child/adolescent mental health disorders linked to faulty parenting! [myth!]
- research into child/youth mental health lags behind other research activities in Canada [fact]
- mental health promotion & social determinants of health impact mental health/well-being [fact]
- influenced by stigma & decrease in mental health literacy [fact: this factor influences whether or not people seek treatment]

DSM-IV-TR (2000)
- separate section for disorders in infancy/childhood & adolescence
- Axis I: disorders (categories: developmental, disruptive behaviours, mood & anxiety, tic, & psychotic disorders
- Axis II: mental retardation

- psychiatric problems less easily diagnosed in children/youth
- should be viewed within the context of growth & developmental models
- no single cause can explain child & adolescent psychopathy [there is a multitude of factors]

Pervasive Developmental Disorders (PDDs):
- group of syndromes: impact child's development in several areas
- very rigid in their thinking
- not due to an intellectual disability
- Categories:
1. Autistic disorder
2. Asperger's disorder
3. Rett's disorder
4. Childhood disintegrative disorder
5. PDD (NOS)

Autistic Disorder
- Core features: cause unknown
- impairments in SOCIALIZATION
- impairments in COMMUNICATION
- restricted repertoire of behaviours
- Onset: early age (before the age of 30 months)
- dramatic rise in incidence
- more common in boys

Treatment for Autism:
- early detection: Screening tool 18 months. Checklist for Autism in Toddlers
- Behavioural interventions (CBT)
- social skills training (need structure; very rigid environment)
- Occupational therapies
- Pharmacotherapy (no medication effective)
- ex. Risperidone (Risperdal) - which receptors does it block? Atypical antipsychotic; given to decrease agitation - be concerned about physical safety; they can get in fights or run out into the road because they do not have the understanding

Asperger's Disorder
- more common in boys
- major difficulties in social interaction
- restricted, repetitive patterns of behaviour
- display stereotypic behaviours (ex. rocking)
- delay may not become apparent until pre-school or school age
- cause - genetic/environmental (cause is unknown)
- this disorder is under a spectrum of autism
- they get very fascinated by things

Treatment for Asperger's Disorder
- psychopharmacology: may include SSRI's, antidepressants, atypical antipsychotics & anticonvulsants
- social/self-care skills [need structure; can be aggressive]
- nursing assessment ongoing
- assess for self-injury/aggression
- family education
- community supports

Disruptive Behaviour Disorders:
- attention-deficit hyperactive disorders (ADHD) [can extend into adulthood]
- oppositional defiant disorder
- conduct disorder
- disorders characterized by "acting out" [externalizing disorder]
- internalizing disorders are also common - ex. depression
- more common in boys

Attention Deficit Disorder (ADHD):
- table 28.2 (p.689) DSM-IV-TR
- 6 or more symptoms (of inattention) that persist for at least 6 months
- 3 core symptoms:
1. Inattention [easily side-tracked]
2. Impulsiveness [concern with safety]
3. Hyperactivity
- most common psychiatric disorder of childhood

Cause of Attention Deficit Disorder (ADD):
- much work on investigating cause [multifactorial]
- genetic studies show evidence of abnormalities of DOPAMINE transporter
- obstetrical complications
- psychosocial factors
- lack of omega 3 fatty acids may contribute

Attention Deficit Hyperactive Disorder (AHDH) Assessment:
- comorbidity with other psychiatric conditions
- clinical assessment [parent/child interview] - separate assessments from parent and child
- physical health history
- school information
- use of rating scales (ADHD) - box 28.3 (p.692)
- neuropsychological tests
- nutritional assessment

Attention Deficit Hyperactive Disorder (ADHD) Interventions:
- pharmacotherapy [table 28.3 - pg. 693]
- most common - Methylphenidate (Ritalin) - box 28.4 (p.693)
- take drug as prescribed ["drug holidays"] - stop taking it for a few days
- drug therapy is used in combination with behavioural therapy
- Behavioural programs [positive reinforcement - every time the child does something right, they receive a token]
- Family therapy/counselling/education

Oppositional Defiant Disorder:
- recurrent pattern of hostile, disobedient behaviours [without seriously violating the basic rights of others]
- they don't care about anyone else - everything is about them
- behaviour evident at home but may not be elsewhere
- usually evident before 8 years of age
- more common in males
- even though they are young, they can be very sexually provocative

Conduct Disorder
- persistent pattern of behaviour rights of others [rules/norms] are violated
- types of behaviours:
1. Aggression toward people & animals
2. Destruction of property
3. Deceitfulness or theft
4. Serious violation of rules
- more common in boys
- Subtypes: Childhood onset & adolescent onset
- may coexist with other psychiatric disorders
- it is "all about them" - they don't care about anyone else
- they do not have empathy or feel guilt for what they do - usually leads to personality disorder
- small percentage grow out of this
- symptoms are more apparent

Treatment of these disorders:
- assessment - multiple sources
- teaching adaptive coping
- aggressive behaviours [medications - limited evidence]
- cognitive-behavioural therapy (CBT)
- family therapy - parent training
- time-out [box 28.6]
- the whole team needs to be consistent in their approach

Tic Disorders
1. Tourette's disorder
2. Chronic motor or vocal tic disorder
3. Transient tic disorder
4. Tic disorder (NOS)

- ages of onset: 7 years (for most)
- characterized by rapid, recurring, on rhythmic, stereotypic movements or vocalization

Tourette's Disorder
- involves multiple motor tics & one or more vocal tics
- can occur simultaneously or at different periods during the illness
- common in children with autism
- causes: unclear (genetic) - they think it may be genetic but they are not sure
- treatment: no cure (psychopharmacology) - no drug treatments - any drugs given are used to control symptoms
- assessment family & school
- some of the tics may diminish as they move into adulthood

Mood Disorders:
- 1/5 children & adolescents will experience an episode of major depressive disorder (MDD)
- most frequently diagnosed in this population are: major depressive disorder, dysthymic & bipolar disorder
- about 1/3 of these adolescents & children receive care
- numerous negative associated features: further episodes of depression, impaired social & academic relationships, NICOTINE dependence, abuse of alcohol & other substances, risky sexual behaviour, teenage childbearing, early marriage and increased risk of suicide
- nicotine and alcohol may be used to deal with symptoms
- difference between adults and children in the way they present: irritability is a key feature for children: adults display hopelessness, helplessness and powerlessness
- substantial increase in use of psychotropic drugs
- **safety & effectiveness for many of these drugs (is lacking black box warning)

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