4 Zerina= Mental Health Disorders - Kids

8/2/2019 4 Zerina= Mental Health Disorders - Kids

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MENTAL HEALTH DISORDERSA REALITY FOR YOUNG PEOPLE

BERMA CHOONOO

THABISA MBIZA

KHANYA NCO

THEMBI .SIKHOVA


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IN OUR IN COUNTRY ...

It is normal to see young people as perpetrators of horrific crimes

Suicide is growing amongst school going childrenMore schools are opting to medicate children

Schools rendered inoperable by gangsterism

Bullying becoming a growing phenomenon in schools

WHY?....WHAT SIGNS ARE WE MISSING ... ??


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POVERTY VS CHILDRENSMENTAL HEALTH

Does poverty by default imply that young people from thosecommunities, being vulnerable, are therefore easily

targeted for destruction....

Mental Health of poor children are falling through thegaps...are our juvenile delinquents children trying to copewith mental health conditions that were never diagnosed

Children from poverty stricken communities have to copeoften without any support in an environment whereeverybody needs to focus on their own survival


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DYSFUNCTIONAL BEHAVIOURAL PATTERNSIN YOUNG PEOPLE

Does poverty contribute to young people migrating towards todysfunctional behavioural patterns like....

Self Mutalisation

Intellectual Disabilities

Anxiety Disorders

Behavioural Disorders


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SELF-MUTALISATIONAETIOLOGY

Multi-factorial with elements of compulsion and addiction associated withchildhood trauma, loss, abandonment & abuse.

DSM IVNot a Mental Disorder found in Borderline Personality Disorders because ithas self-mutalisation as its main diagnostic criteria.

DEFINITIONDeliberate physical self-injurious behaviour e.g. self-cutting, trichillotomania(pulling out own hair) burning.

MANIFESTATION

Face slapping, head banging, biting parts of body, pinching, scratching, eyepoking, repeated vomiting & rumination (reingesting vomited food), eating non-edible substances (cigarettes, faeces)

PROGNOSIS Completely treatable. Individuals can fully recover from condition with correctintervention.

AGE GROUP Primary School - Adults

TREATMENTOutpatient (Cognitive analytic therapy, Psychodramatic psychotherapy, Family therapyInpatient - therapy with Psychologist, Nurse Therapist, Occupational Therapist


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REASONS

Erikson Psychosocial Stages Adolescence = Identity vs Confusion

Implies they are a very difficult coping stage self-mutalisation easy release

Some disclosed reasons sexual, physical and emotional abuse low self-esteem or self-hatred fear of rejection being neglected, isolated or separated from a loved one stress about school work/examinations bullying/harassment break up of family (e.g. parental divorce) unwanted pregnancy difficulties with sexuality/race/culture/religion feelings of guilt, anxiety, loneliness, grief, anguish or anger

In the minority of cases in which self-harm is disclosed reasonsmay include:

to show desperation to others to change the behaviour of others to make other people feel guilty to seek help

Oxford Journals, Innnovait, Medicine. Volume 1, Issue 11. Pp. 750-758


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SELF-MUTALISATIONPATHWAYS

Excessive Stress

Feeling overwhelmed, unable to cope

Self-mutilation

Feeling relieved, in control, and calm

Dissociation

Feeling numb, overwhelmed, unreal

Self-mutilation

Feeling real, alive, able to function better

(Aron Lipman.Dept Applied Psychology. NYU)


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PREVALENCE IN SOUTH AFRICA

General onset age = 12 years, span all races

Frequency : 1 in 5-10 children self-harm/mutilate

No official statistics on self-mutalisation but

there are an many websites dedicated to the topic in South Africa

Plenty of support networks available

Numerous research papers available in South Africa

There is a misconception that Self-Mutalisationis a White-Peoples problem most of the people thatuse help-line facilities are people from non-white communities

Most people going to formal treatment are people from affluent communities as treatment is expensive

Unlike with substance abuse support facilities SA does not have State sponsored facilities which caterspecifically for Self-Mutalisation/Harm but cases are treated in various State institutions that caters for it inconjunction with other disorders


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OT ROLE

Interventions Holistic:the individual, prepare the person to deal with triggers in environment they are returning toaddresses the effect of the condition on occupational performance

Therapy Methods

Group: ADLs, Leisure activities, Coping skills, Support groupsIndividual: Specific needs

ApproachEducational (Individual & Community)Rehabilitative (Individual)

Frame of ReferencePsychotherapy but OT needs to be specifically trained in this field


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OT INTERVENTION

AIM Reduce need for mutalisation Provide alternative and appropriate adaptive responses

ADDRESSActivities of daily living, Work/productive activities, Play/leisure activities

HOW SENSORY INTEGRATION TECHNIQUES Wilbarger Protocol: Deep Pressure Brushing, Joint Compressions, Sensory Diet Weighted pressure vests across back and chest gives a sense of control The Sensory-Modulation Room offers a combination of sensorimotor activities with calming and alerting options for all

sensory areas. Use purposeful activities to achieve optimal functional outcomes

Engage in Sensory based therapy to give individual an understanding of the relevant sensoryrelationship between the human brain, human behaviour, environmental stimuli related to improve optimalfunctioning


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SELF MUTALISATION & POVERTY

Self-mutilators from poorer communities are at bigger risk of accidental suicide because it goesundetected for years until they accidentally cut themselves too deep

In most cases these people self-mutilate all their lives without it visibly impacting on their lives they liveseemingly normal lives

Most govermental research or efforts are focussed on Risk Behaviours which could lead to HIV/Aids,Substance abuse,Teenage Pregnancy Self-mutalisation is

Often mentioned as a by-product of depression

Most research do not necessarily look Self harm directly


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HELP IN SOUTH AFRICA

The S A Depression and Anxiety Group

* National tel no: (011) 783 1474

* Suicide Helpline: 0800 567 567

* SMS Crises line: 31393 (SMS problem to them - they reply immediately)

Treatment entails formal intervention

Numerous Help Line provide assistance

www.childline.org.za: Tel: 08000 55 555 - Trained counsellors are available 24 hours a day

Lifeline: Toll free no: 0861 322 322


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The term learning disability is used to describe a number of deficits related to interpreting visual or

auditory information &/ or the ability to link information from different parts of the brain.

(Crepeau et. al 2003)Dyslexia Difficulty reading Problems reading, writing, spelling, speakingDyscalculia Difficulty with math Problems doing math problems,

understanding time, using moneyDysgraphia Difficulty with writing Problems with handwriting, spelling,

organizing ideasDyspraxia (Sensory

Integration Disorder)Difficulty with fine motor

skillsProblems with handeye coordination,

balance, manual dexterityDysphasia/Aphasia Difficulty with language Problems understanding spoken language,

poor reading comprehensionAuditory Processing Disorder Difficulty hearing

differences between

soundsProblems with reading, comprehension,

languageVisual Processing Disorder Difficulty interpreting

visual informationProblems with reading, math, maps, charts,

symbols, pictures

LEARNING DISABILITIES


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OTHER DISORDOERS WHICH MAKELEARNING DIFFICULT

ADHD

Why>>>>>>>>>>>>>>>>>.

Autism

Why>>>>>>>>>>>>>>>>>>>>>.


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DSM IV DIAGNOSIS

315.00 Reading Disorder

315.1 Mathematics Disorder

315.2 Disorder of Written Expression

315.9 Learning Disorder Not Otherwise Specified

What about the medication which are

given to these children

take aboutritalin pros & cons


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ROLE OF PARENTS

Learn about learning disabilities.

Praise your child when he or she does well.

Find out the ways your child learns best.

Let your child help with household chores. Make homework a priority.

Talk to other parents whose children have learning disabilities.


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ROLE OF TEACHERS

Learn as much as they can about the different types of IDs.

Find out and emphasize what the student's strengths and interests are.

Provide instruction and accommodations to address the student's special needs.

Establish a positive working relationship with the student's parents.


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ROLE OF OT

Assessment

Goal Setting

Aids and Adaptations

Personal Skills

Caregivers and Family


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IMPACT OF POVERTY

Children that come from a low socioeconomic environment are more likely to have intellectual difficulties.

TO BE COMPLETED


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CONDUCT DISORDERSDEFINITION

Refers to a group of behavioural and emotional problems in youngsters that result in them having greatdifficulty following rules and behaving in a socially acceptable way.

They are often viewed by other children, parents and social agencies as bad or delinquent, rather thanmentally ill.

CD involves more deliberate aggression, destruction, deceit, and serious rule violations such as staying put allnight and chronic school truancy.

ETIOLOGY

Involves an interaction of genetic/constitutional, familial and social factors.

May inherit decreased baseline autonomic nervous system activity requiring greater stimulation to achieveoptimal arousal.

Hereditary factor may account for high level of sensation-seeking activity associated with CD

DIAGNOSIS

Children who exhibit conduct disorder behaviours should receive a comprehensive evaluation as manychildren wit a conduct disorder may have coexisting conditions such as mood disorders, anxiety, PTSD,substance abuse, ADHD, learning problems, or thought disorders which can also be treated.


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DSM-IV CLASSIFICATION

persistent pattern of behaviour in which the basic right of others or major age-appropriate social

norms are violated.

2 major subtypes of CD defined by the DSM-IV:

The childhood-onset type:

defined by the presence of 1 criterion characteristic of CD before the age of 10 years.

typically boys displaying high levels of aggressive behaviour.

tend to meet the criteria for ADHD.

Poor peer and family relationships are present, and these problems tend to persist through adolescence and adulthood.

Adolescent-onset type:

defined by the absence of any criterion characteristic of CD after an individual is aged 10 years.

tend to be less aggressive and have more normative peer relationships.

often display their conduct behaviour in a company of a peer group engaged in these behaviours (e.g. gangs).

less likely to fit in the criteria of ADHD; however, the diagnosis f ADHD is still possible. These individuals are far lesslikely to develop adult antisocial personality behaviours.


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MANIFESTATIONS

1. Aggression to people and animals

Bullies, threatens or intimidates others

Often initiates physical fights

Has used a weapon that could cause serious physical harm to others (e.g. a bat, brick, brokenbottle, knife or gun)

Steals from victim while confronting them (e.g. taking other childrens lunches forcefully)

Forces someone into sexual activity

2. Destruction of property Deliberately engaged in fire setting with the intention of casing damage

Deliberately destroys others properties


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MANIFESTATIONS

3. Deceitfulness, lying or stealing

Has broken into someone elses building, house or car

Lies to obtain goods, favours or to avoid obligations

Steals items without confronting a victim (e.g. shoplifting)

4. Serious violation of rules

Often stays out at night despite parental objections

Runs away at school

Is often truant at school


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PROGNOSIS

For an individual with adolescent-onset type is much better than for a person with child-onset type.

About 30% of conduct disorder children continue with similar problems in adulthood.

More common in males than females.

Substance abuse is very high. About 50-705 of 10 year old children with CD will abuse substances 4years later.

Cigarette smoking is also very high

Recent study showed that girls with CD have much worse physical health than those without CD

were almost 6 times more likely to abuse drugs or alcohol,

8 times more likely to smoke cigarettes daily,

twice as likely to have STIs, had twice the number of sexual partners and 3 times as likely to fall pregnant.

Most often end up having mood and anxiety disorders as adults.


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POVERTY

Poverty Children from poor or low-income families more likely to suffer from mental illness, with

children in poor families having a higher rate of mental health problems than their near-poor and non-poor counterparts.

The inability of parents to take care of their children and the emotional turmoil that comeswith poverty exerts a lot of strain on to the parents, subsequently on children as well.

Struggling to meet the ends, survival is their number one goal and family relationships andquality time falls far behind and children that grow under such circumstances feel neglected,unloved and unappreciated inconsistent parental availability and discipline.

As a result, children do not experience a relationship between their behavior and itsconsequence.


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OTHER FACTORS

FAMILY

Lack of parenting skills, inconsistent parenting or overly permissive can contribute to their childrendeveloping CD.

Maternal depression, parent alcoholism and/or criminal and antisocial behaviours of either parent havebeen linked to CD.

A lack of male role models is also a major causative factor arising in both sexes but mostly in boychildren.

Other parental factors include divorce (in particular where there is severe conflict between parents),violence, poverty, long-term unemployment and on-going ill health of a parent (or any other close familymember).

Middle children and male children in large families are most likely at risk of developing CD.


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OTHER FACTORS

SCHOOL

Teachers attitudes toward individual children can play a role in children developing CD,

Poor reading and writing abilities (at least one study has shown that the average reading ability of CD isup to 3 years behind their peers),

Teacher to pupil ratio, Sex of the teachers (male teachers usually have firmer boundaries, and the ability to enforce those

boundaries).

HOW ARE THE BEHAVIOURS OF THESE

CHILDREN CONTAINED THRUMEDICATION, WHAT ARE THE SIDEEFFECTS OF THESE MEDS DO THESEMEDS MAKE THEN VIOLENT


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TREATMENT

Treatment of children with conduct disorder can be complex and challenging.

Treatment can be provided in a variety of different settings depending on the severity of the behaviours.

Treatment for conduct disorders is rarely brief since establishing new attitudes and behaviour patternstakes time. However, early treatment offers a child a better chance for considerable improvements andhope for a more successful future.

information from the child, family, teachers and other medical specialties to understand the cause of thedisorder.

Behaviour therapy and psychotherapy are usually necessary to help the child appropriately express ancontrol anger.

Treatment may also include medication in some youngsters, such as those with difficulty paying attention,impulse problems and/or those with depression.


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TREATMENT APPROACH

Educative

the client, family, teachers and social agencies

Role play, anger management


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ANXIETY DISORDERSA blanket covering several forms of mental illnesses of abnormal and

pathological fear and anxiety.


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DIAGNOSIS

Usually on the patients history or symptoms.

For children: through collaterals information.

Occupational Therapist: assesses interaction with peers and behaviour around adults.

Semi-structured interview:

Anxiety Disorder Interview Schedule,

Anxiety Inventory for Children,

Child Behaviour Checklist

Teachers Report form.


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TYPES

Panic disorder:

feelings of terror that strike suddenly and repeatedly with no warnings.

Obsessive compulsive disorder:

constant thoughts and fears causing performance of certain rituals or routine.

Specific phobia:

intense fear of specific object or situation.

Social anxiety disorder:

also called social phobia.


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SOCIAL PHOBIA

According to the DSM-IV a marked or persistent fear of exposure to unfamiliar situations.

One year prevalence range from 5-8 percent.

Onset is 15.5 years.

SYMPTOMS IN CHILDREN Tantrums

Crying

Freezing

Clinging to parents or other familiar people,

Mutising (not wanting to talk).


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CAUSES

Neurobiological factors

Position emission tomography

Temperament

Psychosocial factors

CAN THESE CONDITIONS BE MANAGEDTHRU MEDICATION IMPACT ON KIDS


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TREATMENT

Occupational Therapy: providing better information about community services.

Easing the psychological and financial burdens

Selection of medication depends on the subtype of the patients social phobia.

Cognitive Behavioural Therapy

Moderately successful at one year followup.

Others: Family Therapy & Relaxation Techniques


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ROLE OF POVERTY

Among low-income children and youth have mental health problems.

Low socio economic status found to be the strongest predictor in early childhood of emotionalproblems.

Mechanism that increases childrens vulnerability Risk factor for the development of mental health disorders.

to mental health disorders.


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PROGNOSIS

Good given early diagnosis & appropriate treatment.

If untreated:

Underachievers

Substance abuse/dependence

Major depression and committing suicide.


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REFERENCES

The SA Depression and Anxiety Support Group Inc.

Tillfors, Maria., Tomas Furmark., Marteinsdottir, Ina ., et al. (2001). "Cerebral Blood Flow in Subjects withSocial Phobia During Stressful Speaking Tasks: A PET Study."American Journal of Psychiatry ,158,1220-1226.

http://www.joymag.co.za/article.php?id=18

4 Zerina= Mental Health Disorders - Kids

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