EDUCATING ALL STUDENTS JUNE 7-10, 2016 ST. SIMONS, GEORGIA 2016 IDEAS MENTAL HEALTH ISSUES IN CHILDREN AND YOUTH Torin D. Togut Attorney at Law
GOALS FOR SESSION (1) Will learn what are the primary mental health diagnoses in children. (2) Will learn about the demographics of mental health disorders in children. (3) Will be able to list key Diagnostic Statistic Manual – 5 diagnoses of children with mental health disorders. (4) Will be able to summarize medications and side effects for treatment of mental health disorders in children. (5) Will be able coordinate resources for the treatment and care of children and youth with mental health disorders. (6) Will be able summarize the System of Care in Georgia for the treatment and care of children and youth with mental health disorders. (7) Will be able to strategize with other stakeholders to address the needs of children and youth with mental health disorders. (8) Other
CONFUSION?
WHAT ARE MENTAL HEALTH ISSUES? The term childhood mental disorder means all mental disorders that can be diagnosed and begin in childhood (for example, attention- deficit/hyperactivity disorder (ADHD), Tourette syndrome, behavior disorders, mood and anxiety disorders, autism spectrum disorders, substance use disorders, etc.). Mental disorders among children are described as serious changes in the ways children typically learn, behave, or handle their emotions. Symptoms usually start in early childhood, although some of the disorders may develop throughout the teenage years. The diagnosis is often made in the school years and sometimes earlier. Some children, however, are not recognized or diagnosed with a mental disorder. Source: Centers for Disease Control
WHAT ARE MENTAL HEALTH DISORDERS? A report from the Centers for Disease Control and Prevention (CDC), Mental Health Surveillance Among Children — United States, 2005 – 2011, at http://www.cdc.gov/mmwr/preview/mmwrhtml/su6202a1.htm?s_cid=su 6202a1_w, describes federal efforts on monitoring mental disorders, and presents estimates of the number of children with specific mental disorders. The report was developed in collaboration with key federal partners, the Substance Abuse and Mental Health Services Administration (SAMHSA), National Institute of Mental Health (NIMH), and Health Resources and Services Administration (HRSA). This is the first report to describe the number of U.S. children aged 3 – 17 years who have specific mental disorders, which compiles information from different data sources covering the period 2005 – 2011. It provides information on childhood mental disorders where there is recent or ongoing monitoring. These include ADHD, disruptive behavioral disorders such as oppositional defiant disorder and conduct disorder, autism spectrum disorders, mood and anxiety disorders including depression, substance use disorders, and Tourette syndrome. Source: CDC
CENTERS FOR DISEASE CONTROL STUDY The following are key findings from this report about mental disorders among children aged 3 – 17 years: -Millions of American children live with depression, anxiety, ADHD, autism spectrum disorders, Tourette syndrome or a host of other mental health issues. -ADHD was the most prevalent current diagnosis among children aged 3 – 17 years. -The number of children with a mental disorder increased with age, with the exception of autism spectrum disorders, which was highest among 6 to 11 year old children.
CENTERS FOR DISEASE CONTROL STUDY Boys were more likely than girls to have ADHD, behavioral or conduct problems, autism spectrum disorders, anxiety, Tourette syndrome, and cigarette dependence. Adolescent boys aged 12 – 17 years were more likely than girls to die by suicide. Adolescent girls were more likely than boys to have depression or an alcohol use disorder. References National Research Council and Institute of Medicine. Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: The National Academic Press; 2009. Centers for Disease Control and Prevention. Mental health surveillance among children – United States, 2005 — 2011. MMWR 2013;62(Suppl; May 16, 2013):1-35.
CENTERS FOR DISEASE CONTROL STUDY Data collected from a variety of data sources between the years 2005-2011 show: -Children aged 3-17 years currently had: ADHD (6.8%) -Behavioral or conduct problems (3.5%) -Anxiety (3.0%) -Depression (2.1%) -Autism spectrum disorders (1.1%) -Tourette syndrome (0.2%) (among children aged 6 – 17 years) -Adolescents aged 12 – 17 years had: -Illicit drug use disorder in the past year (4.7%) -Alcohol use disorder in the past year (4.2%) -Cigarette dependence in the past month (2.8%)
CENTERS FOR DISEASE CONTROL STUDY References National Research Council and Institute of Medicine. Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: The National Academic Press; 2009. Centers for Disease Control and Prevention. Mental health surveillance among children – United States, 2005 — 2011. MMWR 2013;62(Suppl; May 16, 2013):1-35.
DIAGNOSTIC STATISTICAL MANUAL - V Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the standard classification of mental disorders used by mental health professionals in the United States. It is intended to be used in all clinical settings by clinicians of different theoretical orientations. It can be used by mental health and other health professionals, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors. DSM -5 can also be used for research in clinical and community populations. DSM consists of three major components: the diagnostic classification, the diagnostic criteria sets, and the descriptive text. Source: American Psychiatric Association
ARE WE ALL SPEAKING THE SAME LANGUAGE?
SYMPTOMS OF MENTAL HEALTH DISORDERS -One in five children has a diagnosable mental health problem, nearly two-thirds of them get little or no help. -Untreated mental health problems can disrupt children’s functioning at home, school and in the community. Without treatment, children with mental health issues are at increased risk of school failure, contact with the criminal justice system, dependence on social services, and even suicide. -Parents and family members are usually the first to notice if a child has problems with emotions or behavior. The observations of teachers and other caregivers, can help determine whether families need to seek help for their child.
SYMPTOMS OF MENTAL HEALTH DISORDERS The following signs may indicate the need for professional help: -Decline in school performance -Poor grades despite strong efforts -Constant worry or anxiety -Repeated refusal to go to school or to take part in normal activities -Hyperactivity or fidgeting -Persistent nightmares -Persistent disobedience or aggression -Frequent temper tantrums -Depression, sadness or irritability
SYMPTOMS OF MENTAL HEALTH DISORDERS Resources Treatment of Children with Mental Illness. National Institute of Mental Health. Learning Disabilities Basics. Learning Disabilities Association of America. Parenting a Child with AD/HD. Children and Adults with Attention Deficit/Hyperactivity Disorder. Children's Depression Checklist Learning Disabilities AD/HD in Kids Autism
MEDICATIONS AND SIDE EFFECTS ANTIDEPRESSANTS : The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs include: Fluoxetine Citalopram Sertraline Paroxetine Escitalopram The most common side effects listed by the FDA include: Nausea and vomiting Weight gain Diarrhea Sleepiness Sexual problems Source: National Institute of Mental Health http://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml
MEDICATIONS AND SIDE EFFECTS Anti-Anxiety Medications: Benzodiazepines used to treat anxiety disorders include: Clonazepam Alprazolam Lorazepam The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include: Nausea Blurred vision Headache Confusion Tiredness Nightmares Source: National Institute of Mental Health
MEDICATIONS AND SIDE EFFECTS Stimulants used to treat ADHD include: Methylphenidate Amphetamine Dextroamphetamine Lisdexamfetamine Dimesylate The most common side effects include: Difficulty falling asleep or staying asleep Loss of appetite Stomach pain Headache Less common side effects include: Motor tics or verbal tics (sudden, repetitive movements or sounds); Personality changes, such as appearing “flat” or without emotion. Source: National Institute of Mental Health
MEDICATIONS AND SIDE EFFECTS Some of the common typical antipsychotics include: Chlorpromazine Haloperidol Perphenazine Fluphenazine Some of the common atypical antipsychotics include: Risperidone Olanzapine Quetiapine Ziprasidone Aripiprazole Paliperidone Lurasidone Source: National Institute of Mental Health
MEDICATIONS AND SIDE EFFECTS Antipsychotics have many side effects (or adverse events) and risks: Drowsiness Dizziness Restlessness Weight gain (the risk is higher with some atypical antipsychotic medicines) Dry mouth Constipation Nausea Vomiting Blurred vision Low blood pressure Uncontrollable movements, such as tics and tremors (the risk is higher with typical antipsychotic medicines) Source: National Institute of Mental Health
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