Mental health issues in children & teenagers

1. Mental healthissues in children& teenagers Dale Wisely, Ph.D.

2. Topics • Mood Disorders • Anxiety Disorders • Suicide • Nonsuicidal Self-Injury

3. Objectives Working, basic familiarity with these problems. An update on current thinking. Some school implications for each.

4. Some statistics

5. 10-14% of children age 0-5 experience social-emotional problems that cause suffering and interfere with functioning.

6. 20% OF CHILDREN AND ADOLESCENTS MEET CRITERIA FOR A MENTAL HEALTH DISORDER OF AT LEAST MINIMAL IMPAIRMENT. Half of these will have significant impairment.

7. Half of the adults in the U.S. with a mental health disorder had symptoms by the age of 14.

8. Unidentified mental health conditions such as anxiety and depression, particularly in children with chronic medical conditions, are a significant force that drives use of medical services.

9. Mental Illness Causes MOST Disability in Young People Worldwide For young people worldwide, the most prevalent causes of disability are psychological / psychiatric. These, including major depression and alcohol/drug use, comprise 45% of the disability burden among young people from 10 to 24 years old, according to a study published in the Lancet (June 2011). Four times as much as that caused by unintentional injuries (12%) and infectious and parasitic diseases (10%).

10. A few words (and picture) about diagnosing…

17. Depression & Mood Disorders

18. What are mood disorders? • All types of depression + bipolar disorders. • Only since 1980s has it been clearly recognized that children can get them. • May manifest differently in children vs. adolescents vs. adults • Probably underdiagnosed. • Major controversies: Bipolar illness in youth; Use of antidepressant medications.

19. Depression Enormous public health problem. Multifactorial: Biology, Psychology, Family, Environment, Culture Life threatening due to risk of suicide (and perhaps other health problems related to chronic depression)

20. ! • One in 33 children and one in eight adolescents suffers from depression. • National Institute of Mental Health: Depression onset is occurring earlier in life today than in past decades. • Early-onset depression often persists, recurs, and continues into adulthood. Depression in youth may also predict more severe illness in adulthood.

21. mood disorders • Only 30 years of research in teens & kids. • Mean age of onset of mood illness: 15. (50 years ago: Probably was more like age 30.) • Not uncommon in kids. But, often confused with “normal adolescence.” • Severe impact on school performance, relationships. • Contributes significantly to suicide & perhaps substance abuse, perhaps crime.

22. Most common types • major depression- period of depressed or irritable mood or noticeable decrease in interest or pleasure in usual activities, along with other signs, lasting at least two weeks. • bipolar disorder (manic depression) - manic episodes (period of persistently elevated mood), usually interspersed with depressed periods.

24. Symptoms: Depression • persistent feelings of sadness • feeling hopeless or helpless • having low self-esteem • feeling inadequate • excessive guilt • feelings of wanting to die • loss of interest in usual activities or activities once enjoyed • difficulty with relationships • sleep disturbances (i.e., insomnia, hypersomnia) • changes in appetite or weight • decreased energy • difficulty concentrating • a decrease in the ability to make decisions • suicidal thoughts or attempts • frequent physical complaints (i.e., headache, stomach ache, fatigue) • running away or threats of running away from home • hypersensitivity to failure or rejection • irritability, hostility, aggression

25. Symptoms: Depression persistent feelings of sadness feeling hopeless or helpless having low self-esteem feeling inadequate

26. Symptoms: Depression excessive guilt feelings of wanting to die loss of interest in usual activities or activities once enjoyed difficulty with relationships

27. Symptoms: Depression sleep disturbances (i.e., insomnia, hypersomnia) changes in appetite or weight decreased energy difficulty concentrating a decrease in the ability to make decisions

28. Symptoms: Depression suicidal thoughts or attempts frequent physical complaints (i.e., headache, stomach ache, fatigue) running away or threats of running away from home hypersensitivity to failure or rejection irritability, hostility, aggression

29. mood disorders: Bipolar • “Manic-Depressive Illness” • Less frequent than major depressive disorder. • Can begin in youth & can become disabling, especially w/ early onset. • High suicide rates. • Currently controversial: Over- or under-diagnosis?

32. Very good overview for layperson NIMH “Bipolar Disorder” webpage http://tinyurl.com/nimhbipolar

33. Bipolar illness • Brain disorder that causes unusual shifts in mood, energy, activity levels, and ability to carry out day-to-day tasks. • Severe symptoms. Different from normal ups and downs. • Can result in damaged relationships, poor job or school performance, and even suicide. • With treatment can lead full and productive lives.

34. What is the distinguishing feature of bipolar disorder? Not so much much “mood swings” as… The presence of mania.

35. A bottom line? • Children diagnosed with bipolar are typically given powerful medications. • Unfortunately, that they are diagnosed and treated for bipolar is not the same as saying they have it.

36. Bipolar “Mood Swings” label by family or by patient may or may not signal this disorder.

38. Manic & Hypomanic Episodes • Grandiosity (often religious in content) • Reduced need for sleep (not always present) • Pressured speech • Flight of ideas • Distractible • Excessive involvement in pleasurable activities with painful consequences

39. Emotional Dysregulation Disorder with Dyphoria (DSM-5) • Severe recurrent temper outbursts in response to common stressors. • Verbal or behavioral (rages, physical aggression) • Grossly out or proportion to the stressor. • Not developmentally appropriate. • 3 or more times per week. • Mood in between episodes is persistently negative (irritable, angry, and/or sad) • (Other technical features related to timing and duration)

40. Suicide Background, risk factors, prevention

41. A note about us.

42. Suicide awareness & prevention in a school setting Dale Wisely, Ph.D. Mountain Brook Schools wiselyd@mtnbrook.k12.al.us

43. Suicide is the 11th leading cause of death among Americans overall but 3rd among young people.

46. Suicide rates 15-19 by year.

47. Domains of suicidality THOUGHTS(ideation) COMMUNICATIONS(comments, writings, threats, “gestures.”) BEHAVIOR (reckless behavior, gestures, non-lethal self-injury, lethal self-injury.)

48. Suicide-related behavior Many people have fleeting suicidal thoughts. Fewer seriously consider suicide. Even fewer make a plan. Still fewer attempt. Even fewer die by suicide.

49. Ideation: Thinking about suicide • “Gestures”: A clearly nonlethal “parasuicideal” act for some communicative purpose. • Attempts: Intent is to die and/or potentially lethal method. • Completed: death by suicide

50. Nationally, among teenagers 1 in 6 : Serious thoughts about suicide 1+ in 10: Develop a plan 1 in 40: Make an attempt requiring treatment 1 in 10,000 commit suicide.