Effective Strategies to Work with Youth who Experience Mental
Health Issues
Youth with Mental Health ConcernsJutta DotterweichCornell
[email protected]
Adolescent Health ParadoxAdolescence is physically the
healthiest period of the lifespan
Yet: overall morbidity and mortality rates increase 200% from
childhood to late adolescence
Youth age 13 18:50% experienced mental health symptoms 22% had a
lifetime prevalence of severe symptoms (2010)
During adolescence (most commonly defined as the years between
13 and 21) we are usually in our best physical shape. Young people
gain in strength and speed. They react and process quickly. Their
bodies are increasingly resistant to external and internal
stressors; thus, they are less likely to get sick.At the same time,
however, we see an enormous increase in morbidity and mortality
from childhood to late adolescent a 200% increase.As you can see in
this graph, incidents of injury and mortality are starting to
increaserapidly by age 13, peaking around age 20 and level off by
age 25.Causes for injury, disability or death are most commonly
connected to behavior control/ impulse control problems.How do we
explain this paradox?Common Mental Health CategoriesAnxiety
DisordersMood DisordersLearning DisordersDisruptive Behavioral
DisordersThought DisordersAnxiety DisordersSeparation anxiety
Social anxiety (7%, onset around age 13)Phobias (5% in children,
16% in adolescents (13-17), 3-5% in older people)Panic Disorder
(2-3% adolescents)
8% of teens ages 13-18experience anxiety
disordersObsessive-Compulsive DisorderObsessions: Recurrent and
persistent thoughts, urges or images perceived as
intrusiveCompulsions: Repetitive behaviors or mental acts the
individual is driven to in response to an obsession.
Onset typically late adolescents, can be earlierPrevalence in
adolescence: 1 in 200
Trauma and Stress Related DisordersTraumatic event includes
actual or threatened death, injury or assault to self or someone
closechronic stress (i.e. wars, violent neighborhoods, abuse/
neglect in family home)natural catastrophes
Childs or adolescents response is intense fear, helplessness, or
horrorReactive Attachment DisorderFailure to thrivePoor hygienic
conditionUnderdevelopment of motor coordination; hyper tonicityMay
appear bewildered, unfocusedBlank expressionUnresponsive to social
contact/interactionExcessive familiarity with unknown personscan
give hugs to anyone who approaches them; can go with strangersMay
approach a complete stranger for comfort, food, to be picked up,
etc.InhibitedDisinhibitedPost Traumatic Stress Disorder (PTSD)
Symptoms last longer than a month after eventIntrusive
re-experiencing of the trauma, avoiding trauma reminders, and
persistent state of alertRelated emotional and behavioral
problemsCo-occurs with other disorders (anxiety, ADHD, oppositional
defiant disorder, etc.)15% of girls, 6% of boys who experienced
trauma meet criteria for PTSD (3 50% in juvenile justice)Symptoms
vary according to developmental stages
PTSD in ChildhoodSymptoms: Early & Middle
ChildhoodGeneralized nightmaresPersistent re-experiencing of event
through repetitive play or storytellingPhysical symptomsIncreased
arousal/hyper-vigilanceFailure to progress or regression in
developmental skillsImpaired social relationships/caregiver
relationships
PTSD in AdolescenceFlashbacksPersistent re-experiencing of event
(sometimes through risk-taking behavior)Physical symptomsIncreased
arousal/hyper-vigilanceFailure or regression in academic skills;
concentration problemsImpulsive or aggressive behaviorsAbsence of
future planningMood DisordersDysthymic disorderDepressionBipolar
disorderDisruptive mood dysregulation (2-5%, onset before
age10)
DepressionPersistently sad/irritable
Loss of energy
Loss of interest
Significant change in weight/appetite
Physical agitationActing OutDifficulty sleeping or
oversleepingFeelings of worthlessnessDifficulty
concentratingRecurrent thoughts of death/suicideDifferent
ExpressionsWithdrawalLikelihood of onset increases with puberty11%
of adolescents have a depressive disorder by age 18 (NIMH)Rate for
females 1.5 3 times higher than for malesBipolar DisorderSevere
changes in moodInflated self-esteemGreat energy increaseIncreased
talkingDistractibilityIncreased goal-directed activity or physical
agitationDisregard of riskDecreased appetiteMay be delusional
DEPRESSIONMANIC SYMPTOMSOnset usually late adolescenceLearning
DisordersAttention Deficit Hyperactivity Disorder ADHD (3-7% of
school-age children Dyslexia (specific learning disorders) (5-15%
among school-age children) Boys 3 times more like to be affected
Often associated with anxiety disorders and depression No cognitive
impairmentMain Symptoms of ADD/ADHDInattention or inconsistent
attentionHyperactivityImpulsivity
Disruptive Behavior DisordersOppositional/Defiant Disorder
(1-11%) contrariness, constantly arguing & swearingConduct
Disorder (2-10%) aggression to people and animals, deceitful,
destruction of property
Thought DisordersSchizophrenia or Psychotic Disorder:
Delusions false beliefs
Hallucinations sensations that nobody else has
Disorganized Thinking trouble organizing thoughts logically
Onset usually late adolescence/early adulthoodLifetime
prevalence 0.3-0.7%Autism Spectrum (Aspergers)Persistent deficits
in social communication and interactionRestricted, repetitive, and
stereotyped patterns of behavior, interests, and activities3 levels
of severity depending on functioning level of first two
symptomsHyper or hyporeactivity to sensory inputIntellectual
impairmentAspergers (outdated category): normal or high
intelligence
Prevalence close to 1% of population
General Behavior PatternsHyperactivityAggression/self-injurious
behaviorWithdrawalImmaturityLearning difficulties19Psychotropic
MedicationCommon Side EffectsDrowsinessIncreased or decreased
appetiteHeadachesNauseaDizziness
Stigma AlertMeet SamHe is more than his diagnosis and behavior
problems
Stressors and TriggersStress signals involve feelings, thoughts,
behaviors and physical reactionsIdentify triggers for
stressObservationConversation with youthIn residential settings ask
staff
Coping StrategiesPositive appraisal reframing the
situationProblem-focused coping brainstorming and planning to
resolve conflict, acquire resources and supportsEmotion-focused
coping manage or reduce emotional distress (cognitive or behavioral
strategies)Meaning-focused coping search for meaning in adversity
and draw on values, beliefs and goals Environmental FactorsClutter,
disorganizationLightingNoise levelTime of day (daily routine,
structure)Community settings crowds, noise, activity level Behavior
Management TechniquesProximityPromptsHurdle helpTime
awayRedirectionPlanned ignoring and positive attentionDirective
statementsCaring gestureCommunication StrategiesAttentive
listeningRespectful questioningEmpathic communication
Facial ExpressionTone of VoiceWords++55%38%7%Meaning in Spoken
CommunicationNon-Verbal TechniquesSilence Eye ContactFacial
expressionPosture (e.g., leaning forward)_______________
Minimal encouragement (uh-huh, go on, etc.)Tone of voice
Active/Empathic ListeningListening for meaningAttentive to
speakerReflecting facts and feelingsInterpreting meaning,
feelingsWithholding opinions and judgment
29Open vs. Closed Questions
Web ResourcesNational Institute of Mental Health
http://www.nimh.nih.gov/index.shtml NYS Office of Mental Health
http://www.omh.ny.gov/ American Academy of Child & Adolescent
Psychiatry http://www.aacap.org CDC - ACE
Studyhttp://www.cdc.gov/violenceprevention/acestudy
Collaborative for Academic, Social, and Emotional Learning
http://www.casel.org/sel/families.php
US Reach Out http://us.reachout.com/the_facts
Kids Health (for teens)
http://kidshealth.org/teen/your_mind/#cat20123
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