Download Presentation - ACT for Youth

Jutta Dotterweich
Cornell University
jd81@cornell.edu
www.actforyouth.net
Adolescence is physically the
healthiest period of the lifespan
0.12
0.1
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)
0.08
female
0.06
male
0.04
0.02
0
0
10
20
30
Age
40
50
60
70
 Anxiety
Disorders
 Mood Disorders
 Learning Disorders
 Disruptive Behavioral Disorders
 Thought Disorders
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Separation 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 13-18
experience anxiety disorders
 Obsessions: Recurrent
and persistent
thoughts, urges or images perceived as
intrusive
 Compulsions: Repetitive behaviors or
mental acts the individual is driven to in
response to an obsession.
Onset typically late adolescents, can be earlier
Prevalence in adolescence: 1 in 200
Traumatic event includes
─ actual or threatened death, injury or
assault to self or someone close
─ chronic stress (i.e. wars, violent
neighborhoods, abuse/ neglect in
family home)
─ natural catastrophes
Child’s or adolescent’s response is
intense fear, helplessness, or horror
Failure to thrive
 Poor hygienic condition
 Underdevelopment of
motor coordination;
hyper tonicity
 May appear bewildered,
unfocused
 Blank expression
 Unresponsive to social
contact/interaction
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Inhibited
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Excessive familiarity
with unknown persons
can give hugs to anyone
who approaches them;
can go with strangers
May approach a
complete stranger for
comfort, food, to be
picked up, etc.
Disinhibited
o
o
o
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o
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Symptoms last longer than a month after event
Intrusive re-experiencing of the trauma, avoiding
trauma reminders, and persistent state of alert
Related emotional and behavioral problems
Co-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
Symptoms: Early & Middle Childhood
Generalized nightmares
─ Persistent re-experiencing of event
through repetitive play or storytelling
Physical symptoms
─ Increased arousal/hyper-vigilance
─ Failure to progress or regression in
developmental skills
─ Impaired social relationships/caregiver
relationships
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Flashbacks
Persistent re-experiencing of event
(sometimes through risk-taking behavior)
Physical symptoms
Increased arousal/hyper-vigilance
Failure or regression in academic skills;
concentration problems
Impulsive or aggressive behaviors
Absence of future planning
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Dysthymic disorder
Depression
Bipolar disorder
Disruptive mood
dysregulation
(2-5%, onset before age10)
Persistently sad/irritable

Difficulty sleeping or oversleeping
Loss of energy

Feelings of worthlessness
Loss of interest

Difficulty concentrating
Significant change in weight/appetite  Recurrent thoughts of death/suicide
Physical agitation
Likelihood of onset increases with puberty
11% of adolescents have a depressive disorder by age 18 (NIMH)
Rate for females 1.5 – 3 times higher than for males
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Severe changes in mood
Inflated self-esteem
Great energy increase
Increased talking
Distractibility
Increased goal-directed
activity or physical
agitation
Disregard of risk
Decreased appetite
May be delusional
MANIC
SYMPTOMS
Onset usually late adolescence
DEPRESSION
 Attention
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 impairment
 Inattention
or inconsistent attention
 Hyperactivity
 Impulsivity
Oppositional/Defiant Disorder (1-11%)
─ contrariness, constantly arguing &
swearing
Conduct Disorder (2-10%)
─ aggression to people and animals,
deceitful, destruction of property
Schizophrenia or Psychotic Disorder:
 Delusions
– false beliefs
 Hallucinations
– sensations that nobody
else has
 Disorganized Thinking
– trouble
organizing thoughts logically
Onset usually late adolescence/early adulthood
Lifetime prevalence 0.3-0.7%
Persistent deficits in social communication and
interaction
 Restricted, repetitive, and stereotyped patterns of
behavior, interests, and activities
 3 levels of severity depending on functioning level
of first two symptoms
 Hyper – or hyporeactivity to sensory input
 Intellectual impairment

• Asperger’s (outdated category): normal or high intelligence
Prevalence close to 1% of population
Hyperactivity
Aggression/self-injurious
behavior
Withdrawal
Immaturity
Learning difficulties
Common Side Effects
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Drowsiness
Increased or decreased
appetite
Headaches
Nausea
Dizziness
Meet Sam
He is more than his
diagnosis and
behavior problems
Stress signals involve feelings, thoughts,
behaviors and physical reactions
Identify triggers for stress
• Observation
• Conversation with youth
• In residential settings ask staff
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Positive appraisal –
reframing the situation

Problem-focused coping –
brainstorming and planning to resolve conflict,
acquire resources and supports

Emotion-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
 Clutter, disorganization
 Lighting
 Noise
level
 Time of day (daily routine, structure)
 Community settings – crowds, noise,
activity level
 Proximity
 Prompts
 Hurdle
help
 Time away
 Redirection
 Planned ignoring and positive attention
 Directive statements
 Caring gesture
Attentive listening
Respectful questioning
Empathic communication
Facial
Expression
55%
+
Tone of
Voice
38%
+
Words
7%
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Silence
Eye Contact
Facial expression
Posture (e.g.,
leaning forward)
_______________
Minimal
encouragement
(“uh-huh,” go on,
etc.)
Tone of voice
Listening for
meaning
 Attentive to
speaker
 Reflecting facts
and feelings
 Interpreting
meaning, feelings
 Withholding
opinions and
judgment
 National
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 Study
http://www.cdc.gov/violenceprevention/aces
tudy
 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/#cat
20123