Understanding a youth’s mental health diagnosis and how to appropriately interact

with them

Understanding a youth’s mental health diagnosis and how to appropriately interact

with them

What is mental illness?• “Mental illnesses are medical conditions that

disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning.”– http://www.nami.org/template.cfm?

section=about_mental_illness

Why do we need them?

• A mental health diagnosis guides treatment– Treatment plans cannot be written without a

diagnosis

• Billing– In order to get reimbursed for services such as

therapy, a youth need to have a billable diagnosis.

Where to get your information

• Speak to the youth’s Clinician

• Consultant

• Caseworker and/or parent/s

What causes mental illness?

• Mental Health Issues can come from a variety of reasons: examples include but are not limited to:– Genetics/biochemistry– Difficult family background-unstable caregivers,

domestic violence, substance abuse– Stressful life events-death, abuse– Biochemistry

Important to Remember:

• Be careful of labeling– Be aware of statements such as “he is ADHD” or

“she is RAD”. Instead, use phrases such as “he has ADHD” or “she has RAD”.

• Their diagnosis is not an excuse to act out; but make sure you understand any limitations they may have

• Do not forget to empower the youth– They will often make statements to suggest they

cannot control their behaviors because of a missed medication or because they have ADHD. Empower them by saying “the medication helps but ultimately you are in control of your behaviors”.

Important to Remember:

Common Diagnosis:• Reactive Attachment Disorder

• Post Traumatic Stress Disorder

• Oppositional Defiant Disorder

• Anxiety Disorders (other than PTSD)

• Mood Disorders

RAD:• Reactive Attachment Disorder:

– Markedly disturbed and developmentally inappropriate ways of relating socially in most contexts; inhibited or disinhibited type.

– Consistent rules, boundaries and consequences are very important

– They will often go into “fight or flight” mode

RAD cont.:– These children have learned at a young age that

“adults cannot be trusted”.

– Do not discuss placement changes at it will increase anxiety and cause sabotaging behaviors.

– Do not promise “adoption” to children with this diagnosis; they will attempt to destroy the relationship and unfortunately, will often win.

PTSD:

• Post Traumatic Stress Disorder: Anxiety Disorder that develops after a traumatic event.

• The event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity.

• The trauma is so overwhelming that it interferes with the individual's ability to cope.

PTSD cont.:

• Common signs and symptoms:– Flashbacks– Nightmares/dreams– Often in a state of hyperarousal– Will sometimes go into fight or flight mode if

triggered

ODD:

• Oppositional Defiant Disorder: A pattern of negative, hostile and defiant behaviors.

– Often loses temper, argues, refuses to comply with requests, blames, lies, easily annoyed or deliberately annoys others.

ADHD:

• Attention Deficit Hyperactivity Disorder: Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development.

ADHD cont:

• Can be predominantly inattentive, hyperactive-impulsive or combined.

• Has to occur in at least 2 or more settings

• Medication does help with symptoms of ADHD

Spectrum Disorders:• Aspergers/Autism/Pervasive Developmental

Disorder:

– Impairment in areas of development such as: social interaction, communication and restricted interest in activities.

– They may have a hard time with peer relationships (or not be interested at all)

Spectrum Disorders cont.:

– Trouble picking up on social cues.

– May have some language delays.

Anxiety Disorders (other than PTSD):

• Other than PTSD, the most common anxiety disorder is Generalized Anxiety Disorder

– Excessive anxiety or worry

– Finds it difficult to control the worry

Anxiety Disorders cont.:

– Restlessness or feeling on edge

– Easily fatigued

– Irritability

– Sleep disturbance

Mood Disorders:

• Major Depressive Disorder– Dysthymis Disorder

• Bipolar Disorder

• Mood Disorder NOS (not otherwise specified)

Mood Disorders cont. Major Depressive

Disorder• Characterized by one or more major

depressive episodes

• Dysthymic Disorder: chronically depressed mood for most of the day more days than not for at least 2 years (does not meet criteria for a major depressive episode)

Mood Disorders cont. Major Depressive

Disorder cont:• Depression looks different in children:

– Irritability– Depression should be considered if there are

changes in behavior without a identifiable trigger

• Take seriously any kind of self harm and/or suicidal thoughts/behaviors.

Mood Disorders cont. Bipolar Disorder:

• There are several different types of Bipolar Disorders

• Generally speaking, this diagnosis if viewed as a “cycle” between depressive symptoms and manic symptoms.

Mood Disorders cont. Mood Disorder NOS:

• Common diagnosis in children

• Usually diagnosed if moods are unstable yet they do not fit any other criteria

Ending Thoughts:

• Make sure to allow the Clinician to make the diagnosis.

• Staff concerns: the treatment team is there to help and support!

Ending Thoughts:

• No matter what the youth’s diagnosis is, use the Teaching Family Model– It gives the child consistency which ultimately

gives them a feeling of safety

• A diagnosis is not permanent!

References:

• National Institute of Mental Health– www.nimh.nih.gov

• National Alliance on Mental Health– www. nami.org

• American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.