Overview of childhood mental health disorders & pre natal exposure to alcohol & drugs

Brenda McCreight, Ph.D.Brenda McCreight, Ph.D.

Overview of Childhood Mental Health Overview of Childhood Mental Health Disorders & Pre-Natal Exposure to Disorders & Pre-Natal Exposure to Alcohol & Drugs Alcohol & Drugs

Fetal Alcohol BrainFetal Alcohol Brain

NAS affected brainNAS affected brain

Characteristics of Fetal Alcohol Characteristics of Fetal Alcohol SyndromeSyndrome

1. Challenges :academic1. Challenges :academic :adhd:adhd :speech/language:speech/language :information processing:information processing :patterning:patterning :sequencing * :sequencing *

Characteristics of Fetal Alcohol Characteristics of Fetal Alcohol SyndromeSyndrome

2. Short impulse control2. Short impulse control3. Inability to relate 3. Inability to relate

behavior to behavior to consequencesconsequences

4. No sense of connection to 4. No sense of connection to societal rulessocietal rules

5. Poor short term memory5. Poor short term memory6. Inconsistent knowledge 6. Inconsistent knowledge

basebase7. Poor personal boundaries7. Poor personal boundaries

8. Confusion under pressure8. Confusion under pressure9. Difficulty grasping 9. Difficulty grasping

abstract conceptsabstract concepts10. Inability to manage 10. Inability to manage

angeranger11. Poor judgement11. Poor judgement12. Appear to be stubborn12. Appear to be stubborn13. Cannot generalize *13. Cannot generalize *

Fetal Alcohol SyndromeFetal Alcohol Syndrome

! Facial dysmorphologyFacial dysmorphology! Central nervous Central nervous

system impairmentsystem impairment! Inability to generalizeInability to generalize! Inability to perceive Inability to perceive

patterns/ sequencespatterns/ sequences! Poor judgementPoor judgement

! Learning disabilities Learning disabilities and/or cognitive and/or cognitive impairmentimpairment

! ImpulsivityImpulsivity! Memory impairment/ Memory impairment/

inconsistent memoryinconsistent memory! Inconsistent Inconsistent

knowledge baseknowledge base! Poor boundaries *Poor boundaries *

Executive FunctionExecutive Function

~ Goal formationGoal formation~ PlanningPlanning~ Carrying out goal-directed plansCarrying out goal-directed plans~ Effective performance *Effective performance *

Secondary ChallengesSecondary Challenges* Mental Health Issues Over 90%Mental Health Issues Over 90%* Disrupted school experience Over 60%Disrupted school experience Over 60%* Trouble with the law Over 60%Trouble with the law Over 60%* Confinement Over 50%Confinement Over 50%* Inappropriate sexual behavior Over 50%Inappropriate sexual behavior Over 50%* Alcohol/drug problems Over 30%Alcohol/drug problems Over 30%* Problems with employment Over 80%Problems with employment Over 80%* Problems with independent living Over 80%Problems with independent living Over 80%

(Streissguth, Kogan and Bookstein, 1996) *

Characteristics of children with Characteristics of children with pre-natal exposure to drugspre-natal exposure to drugs

~ Extreme behaviorsExtreme behaviors~ Lack of patienceLack of patience~ Lack of initiativeLack of initiative~ Poor social skillsPoor social skills~ Poor impulse controlPoor impulse control~ Pre-occupied by subjectsPre-occupied by subjects~ Tendency to perseverateTendency to perseverate~ Sensory challengesSensory challenges~ Cannot playCannot play

~ Lack of fearLack of fear~ Lack of remorseLack of remorse~ Short attention spanShort attention span~ Cannot make transitionsCannot make transitions~ Ritualized behaviorsRitualized behaviors~ AggressionAggression~ Oppositional behaviorsOppositional behaviors~ Incomplete attachmentIncomplete attachment~ Cannot relate behavior to Cannot relate behavior to

consequences *consequences *

Pre-Natal Marijuana ExposurePre-Natal Marijuana Exposure

Impacts pre-frontal brain functionImpacts pre-frontal brain function+ ReasoningReasoning+ Mood regulationMood regulation+ Abstract thoughtAbstract thoughtAfter age threeAfter age three+ Executive function impairedExecutive function impaired+ Attention behaviorAttention behavior+ Visual analysis/hypothesis testing *Visual analysis/hypothesis testing *

11 in in 1010 children in the U.S. has a children in the U.S. has a mental illness severe enough to mental illness severe enough to cause some level of impairment.cause some level of impairment.(National Institute of Mental Health, U.S., 2000) *(National Institute of Mental Health, U.S., 2000) *

DepressionDepression

! Persistent sadness Persistent sadness and/or irritabilityand/or irritability

! Low self-esteemLow self-esteem! Loss of interest in Loss of interest in

normally enjoyed normally enjoyed activitiesactivities

! Change in appetite Change in appetite and/or sleeping and/or sleeping patternspatterns

! Difficulty Difficulty concentratingconcentrating

! Physical ailmentsPhysical ailments! Increase or decrease Increase or decrease

in overall activity levelin overall activity level! Suicidal ideation or Suicidal ideation or

attempts *attempts *

1 in 33 children, 1 in 8 adolescents

Conduct DisorderConduct Disorder

� Aggression to people or animalsAggression to people or animals� Destruction of propertyDestruction of property� Deceitfulness and/or theftDeceitfulness and/or theft� Serious violation of rules in the home, the Serious violation of rules in the home, the

community and school *community and school *

Intermittent Explosive DisorderIntermittent Explosive Disorder

! Incidents of acts of aggression that result Incidents of acts of aggression that result in serious assaults against people or in serious assaults against people or propertyproperty

! The degree of aggression is grossly out of The degree of aggression is grossly out of proportion to the triggers *proportion to the triggers *

Oppositional Defiant DisorderOppositional Defiant Disorder

! Frequent loss of Frequent loss of temper temper

! ArgumentativeArgumentative! Openly defiant and Openly defiant and

non-compliantnon-compliant! Deliberately annoys Deliberately annoys

othersothers

! Blames othersBlames others! Easily annoyed by Easily annoyed by

othersothers! Angry and resentfulAngry and resentful! Spiteful and Spiteful and

vindictive*vindictive*

Obsessive Compulsive DisorderObsessive Compulsive Disorder

! Recurring and persistent Recurring and persistent thoughts, images, thoughts, images, impulses that are beyond impulses that are beyond normal worries and are normal worries and are intrusive and create intrusive and create anxiety and/or anxiety and/or depressiondepression

! Are time consuming and Are time consuming and interfere with daily interfere with daily activitiesactivities

! Driven to repeat the Driven to repeat the behaviors, such as behaviors, such as hand washing, hand washing, blinking, repeating blinking, repeating words silently, words silently, checking on items, checking on items, etc. And must be done etc. And must be done so according to rigid so according to rigid rules *rules *

Bipolar DisorderBipolar Disorder

! An expansive or An expansive or irritable mood that irritable mood that changes rapidlychanges rapidly

! DepressionDepression! RagesRages! Defiance of authorityDefiance of authority! Agitation, Agitation,

distractibilitydistractibility

! Over or under Over or under sleepingsleeping

! Impaired judgement, Impaired judgement, impulsivityimpulsivity

! Dare-devil behaviorsDare-devil behaviors! Craving for Craving for

carbohydratescarbohydrates! Delusions and Delusions and

hallucinations *hallucinations *

Tourette SyndromeTourette Syndrome

! Repeated and Repeated and involuntary body involuntary body movementsmovements

! Uncontrollable Uncontrollable vocalizationsvocalizations

! Symptoms can include- Symptoms can include- rapid eye blinking, throat rapid eye blinking, throat clearing, sniffing, rapid clearing, sniffing, rapid movement of arms and movement of arms and legs, yelling, yelping, legs, yelling, yelping, jumping, touching things, jumping, touching things, smelling things or people, smelling things or people, hitting or biting self, hitting or biting self, copralalia (swearing), copralalia (swearing), compulsions and compulsions and ritualistic behaviors, ritualistic behaviors, attention deficit disorder.*attention deficit disorder.*

Interacting Factors for Interacting Factors for Relationship FormationRelationship Formation

� Sense of other > the ability to perceive Sense of other > the ability to perceive othersothers

� Attachment > ability to engage in Attachment > ability to engage in reciprocal relationshipsreciprocal relationships

� Emotional regulation > ability to self-Emotional regulation > ability to self-regulate affect and to self-monitor *regulate affect and to self-monitor *

Perception of the relationship is Perception of the relationship is filtered through>filtered through>

· GeneticsGenetics· BiologyBiology· Neurological systemsNeurological systems· Development level/stageDevelopment level/stage� Environment *Environment *

Lack of an “inner place” results in >Lack of an “inner place” results in >

� No place to return toNo place to return to� Inability to consider Inability to consider

optionsoptions� No predictabilityNo predictability� Cannot regulate thoughtCannot regulate thought� Cannot priorizeCannot priorize� Cannot contemplate the Cannot contemplate the

futurefuture� Context sensitiveContext sensitive

� Cannot postpone anything Cannot postpone anything because it disappears because it disappears when the person is not when the person is not thinking about itthinking about it

� Changing your mind feels Changing your mind feels like losing your mindlike losing your mind

� Past is not connected to Past is not connected to the presentthe present

� Fill the inner place with Fill the inner place with addictive, behaviors and addictive, behaviors and compulsions *compulsions *

StrategiesStrategies

Prioritize the learning and emotional needs Prioritize the learning and emotional needs for each: for each:

> YearYear> MonthMonth> WeekWeek> DayDay> HourHour * *


Plan for some fun/success in each dayPlan for some fun/success in each dayProvide a reduced stimulation work-stationProvide a reduced stimulation work-stationAllow for fidgeting, restlessness, boredomAllow for fidgeting, restlessness, boredomMake each learning activity shortMake each learning activity shortGive concrete instructions/use concrete Give concrete instructions/use concrete

languagelanguageBreak tasks down into smaller chunks *Break tasks down into smaller chunks *


Make the rules and consequences clear and Make the rules and consequences clear and consistentconsistent

Reduce choices/teach choicesReduce choices/teach choicesUse in/out baskets for workUse in/out baskets for workRemind the child of the schedule each dayRemind the child of the schedule each dayPrepare ahead for change in routinePrepare ahead for change in routineTeach sequencing *Teach sequencing *


Teach generalizationTeach generalizationUse the child’s languageUse the child’s languageTeach how to make a checklist, keep a Teach how to make a checklist, keep a

calendarcalendarTeach the most difficult subjects during the Teach the most difficult subjects during the

child’s most productive part of the day *child’s most productive part of the day *


Watch for irritability, mood swings- be Watch for irritability, mood swings- be proactiveproactive

Be aware of peer problems- alienation, Be aware of peer problems- alienation, isolation, depressionisolation, depression

Repeat, re-teach, retrainRepeat, re-teach, retrainStop using anything that does not work *Stop using anything that does not work *


Emotional age and chronological age may be Emotional age and chronological age may be very differentvery different

Develop strategies for “freezing”Develop strategies for “freezing”Experiment with different strategiesExperiment with different strategiesFind a mentor or support group *Find a mentor or support group *


Reduce homework/work with parents on Reduce homework/work with parents on homeworkhomework

Make the child a partner in his/her education Make the child a partner in his/her education and therapy *and therapy *

QualitiesQualities

» Demonstrate flexibility/adaptabilityDemonstrate flexibility/adaptability» Well informed/trained on adoption Well informed/trained on adoption

dynamics and issuesdynamics and issues» High self-esteem in mother or primary High self-esteem in mother or primary

caregivercaregiver» Ability to accept differenceAbility to accept difference» Resolution of own past traumas *Resolution of own past traumas *

QualitiesQualities

» Demonstrate stress management skillsDemonstrate stress management skills» Demonstrate strong advocacy skillsDemonstrate strong advocacy skills» Demonstrate problem solving skillsDemonstrate problem solving skills» Have strong support networkHave strong support network» Sense of humorSense of humor» Are older *Are older *

QualitiesQualities

Single ParentSingle Parent– economic securityeconomic security– job flexibilityjob flexibility– good self-care skillsgood self-care skills– babysitting/respite/back-up *babysitting/respite/back-up *

InterventionsInterventions

� Provide a stable, predictable, controlled Provide a stable, predictable, controlled environmentenvironment

� Create possibility for attachmentCreate possibility for attachment� Teach problem solving and conflict resolutionTeach problem solving and conflict resolution� Create successful dependenceCreate successful dependence� Set up opportunities for successSet up opportunities for success� Consistent reminders of the “rules”Consistent reminders of the “rules”� Teach how to act attached *Teach how to act attached *

Key Words for Care ProvidersKey Words for Care Providers

» PatiencePatience» ScheduleSchedule» RoutineRoutine» ConsistencyConsistency» Care with transitionsCare with transitions» StructureStructure» RepetitionRepetition» Control of the environment *Control of the environment *

Symptoms of NAS WithdrawalSymptoms of NAS Withdrawal

– WakefulnessWakefulness– IrritabilityIrritability– Tremors, body temperature variesTremors, body temperature varies– High pitched cryHigh pitched cry– HypertoniaHypertonia– DiarrheaDiarrhea– Respiratory distressRespiratory distress– ApneaApnea– Weight loss or slow weight gain *Weight loss or slow weight gain *

Common Challenges for Pre-Common Challenges for Pre-Natally Exposed ToddlersNatally Exposed Toddlers

~ HypersensitivityHypersensitivity~ Tactile defensivenessTactile defensiveness~ Eye contact avoidanceEye contact avoidance~ RockingRocking~ Sound avoidanceSound avoidance~ Seizure disorderSeizure disorder~ Cardiovascular problemsCardiovascular problems~ Delayed languageDelayed language~ Hyperactivity/attention Hyperactivity/attention

problemsproblems

~ Disorganized behaviorsDisorganized behaviors~ IrritabilityIrritability~ Poor social interaction Poor social interaction

skillsskills~ Excessive muscle toneExcessive muscle tone~ Abnormal posturingAbnormal posturing~ Upper respiratory Upper respiratory

problemsproblems~ Fragile immune system *Fragile immune system *

Management and InterventionsManagement and Interventions

• Normalize activity and Normalize activity and behaviorsbehaviors

• Create an effective Create an effective feeding patternfeeding pattern

• Stabilize weightStabilize weight• Create calm and Create calm and

ability to sleepability to sleep

• Simple InterventionsSimple Interventions• 30% to 50% of babies 30% to 50% of babies

will improve with only:will improve with only:• Swaddling to reduce Swaddling to reduce

sensory overloadsensory overload• Frequent small feedings Frequent small feedings

of an enhanced formulaof an enhanced formula• Close monitoring of vital Close monitoring of vital

signs *signs *

ImpactImpact

Toddlers Toddlers (ages12-30 months)(ages12-30 months)+ Play was less age Play was less age

appropriateappropriate· more limited more limited · more impulsivemore impulsive· throwing and batting throwing and batting

objectsobjects

> Less security attached Less security attached to caregiversto caregivers

> Language and/or Language and/or behavioral problemsbehavioral problems

> Cannot tolerate Cannot tolerate frustrationfrustration

> DistractibleDistractible> Disorganized Disorganized

behavior*behavior*

ImpactImpact

Pre-School (ages 3-5 years)Pre-School (ages 3-5 years)> Highly sensitive to environmentHighly sensitive to environment> Language delaysLanguage delays> Poor task organizing and processingPoor task organizing and processing> Poorly attached to caregiverPoorly attached to caregiver> Poor social skillsPoor social skills> Aggression/passivity *Aggression/passivity *

ImpactImpact

– Highly sensitive to environmentHighly sensitive to environment– Language delaysLanguage delays– Poor task organization and processingPoor task organization and processing– Poorly attached to caregiverPoorly attached to caregiver– Poor social skillsPoor social skills– Aggression/passivity *Aggression/passivity *

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mailto:[email protected]

Brenda McCreight, PhD.Brenda McCreight, PhD.

Education

Overview of childhood mental health disorders & pre natal exposure to alcohol & drugs