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CHILD AND ADOLESCENT
MENTAL HEALTH
 Dr. Sanchit Kharwal
 Dr. Suhas Kadam
Definition (WHO)
• “Child and adolescent Mental Health is the capacity to
 achieve and maintain optimum psychological functioning
 and well being. It is directly related to the level reached
 and competency achieved in psychological and social
 functioning”
Reasons why      • Current shortage of child and
                   adolescent psychiatrists
children with    • Low income families have no
                   transportation to travel to a health
Mental Illness     facility.
                 • Parent’s are afraid that they will be
   are left        blamed for their child’s health issues.
 untreated

                 •   Family conflicts
                 •   Becoming a bullier
  Future of      •   Poor Grades in School
                 •
 children left   •
                     High School Dropout
                     Criminal activity
  untreated      •   Suicide
Broad Classification
1.   Emotional Disorders:
    Anxiety Related Disorders: GAD, Agoraphobia, OCD
    Somatoform Disorder: Somatization Disorders, Conversion
     disorders
    Depressive disorders and suicide.
2.   Behavioral Disorders:
    ADHD
    Conduct Disorders
    Oppositional Defiant Disorder
3.   Psychoses
4.   Other mental Health Problems: Mental Retardation,
     Learning Disabilities, Speech disorder, Eating Disorders,
     Epilepsy
Depression: A Global Crisis
• Depression is a common mental disorder that presents with
  depressed mood, loss of interest or pleasure, feeling of guilt
  or low self worth, disturbed sleep or appetite, low energy and
  poor concentration. (WHO)
• Interferes with cognitive, emotional and social development
  occurring at young age
Adolescents Depression:
Mood and Anxiety Disorder
Substance use Disorders
Depression can also lead to the ultimate tragedy — almost
  90,000 young people commit suicide each year across the
  world
Determinants of Depression: Psychosocial
 Female Gender
 Economic Impoverishment
 Low Education
 Violence and Trauma
 Chronic physical ailments and Disabilities
 Increased Stress, lonely lives
 Lack of Social Support systems
 Substance abuse Habit
 Psychological Factors
 School Factors: Academic performance, Peer pressure &
  influences
 Family and Social environment
 Genetic Factors
 Neurobiological Factors
Symptoms
 Infancy              Childhood         Adolescence

 Distress             Anhedonia         Depressed or irritable
                                        mood
 Crying, screaming    Low self esteem   Anhedonia

 Sleep disturbance    Feeling of        Hopelessness
                      worthlessness
 Weight loss          Hallucinations    Feeling of guilt

 Separation Anxiety                     Increased appetite,
                                        Hypersomnia
 Withdrawl and                          Delusions, suicidality
 Dejection
Suicidality among Children & adolescents
•“   a conscious act of self induced annihilation, best
  understood as a multidimensional malaise in a needful
  individual who defines an issue for which suicide is the best
  perceived solution” Shneidman, 1985
• According to NIMHANS, Suicides resulted in death of more
  than 110,000 persons in India during 2004.
• Risk     Factors:    Depression     and     other      mental
  disorders, Substance abuse disorder (often in combination
  with other mental disorders), Prior suicide attempt, Family
  history of suicide, Family violence including physical or
  sexual         abuse,         Firearms         in         the
  home, Incarceration, Exposure to suicidal behavior
Mental Retardation:
• “a condition of arrested or incomplete development of the mind
  characterized by impaired developmental skills that contribute
  to the overall level of intelligence” (Kaplan &Sadock, 1998).
• cognitive, language, motor, social and other adaptive behavior
  skills are affected and thus should be used to determine the
  level of intellectual impairments.
• Etiology: Genetic, Biological, Environmental
Beliefs related to MR:
   “...It’s all related to our doings (karmo ka natiza hai)..Don’t
    know what bad deeds (burre karam) we have done in the
    past life (pichle janam) that we are bearing the brunt in this
    life..”(Father of 7 Year old son with MR)
   “I have done a lot for my child took him to allopathic and
 homeopathic hospitals but there was no benefit…. I kept a dua
 and I used to come to this shrine in karjan from handod after
 walking bare foot for 10 kms for 9 Thursdays….we also took
 him to our ancestoral God (kuldevi) but nothing happened”
 (Mother of 8 year old son with MR)
1. LEARNING DISABILITIES
2. SUBSTANCE ABUSE
3. OCD
4. IMPACT OF HIV/AIDS ON CHILD AND ADOLESCENT
   MENTAL HEALTH
5. PREVENTIVE ASPECTS




              Dr. Suhas Kadam
Learning Disabilities




• A term for a wide variety of learning problems.
• LD is not a problem with intelligence or motivation.
• Children with LD aren’t lazy or dumb.
• The difference only is how they receive and process
 information.

• LD can lead to trouble with learning new information and
 skills, and putting them to use.

• The most common types of LD involve problems with
 reading, writing, math, reasoning, listening, and speaking.
Learning Disabilities

                         Common Types of Learning Disabilities
Dyslexia                Difficulty reading        Problems reading, writing, spelling,
                                                  speaking

Dyscalculia             Difficulty with math      Problems doing math problems,
                                                  understanding time, using money


Dysgraphia              Difficulty with writing   Problems with handwriting, spelling,
                                                  organizing ideas

Dyspraxia (Sensory      Difficulty with fine      Problems with hand–eye coordination,
Integration Disorder)   motor skills              balance, manual dexterity


Dysphasia/Aphasia       Difficulty with language Problems understanding spoken
                                                 language, poor reading comprehension



Auditory Processing     Difficulty hearing        Problems with reading, comprehension,
Disorder                differences between       language
                        sounds
Visual Processing       Difficulty interpreting   Problems with reading, math, maps,
Disorder                visual information        charts, symbols, pictures
Learning Disabilities


Signs and symptoms

Preschool signs and symptoms of learning disabilities
• Problems pronouncing words
• Trouble finding the right word
• Difficulty rhyming
• Trouble learning the alphabet, numbers, colors, shapes,
  days of the week
• Difficulty following directions or learning routines
• Difficulty controlling crayons, pencils, and scissors or
  coloring within the lines
• Trouble with buttons, zippers, snaps, learning to tie shoes
Learning Disabilities




Grades K-4 signs and symptoms of learning disabilities
• Trouble learning the connection between letters and
  sounds
• Unable to blend sounds to make words
• Confuses basic words when reading
• Consistently misspells words and makes frequent reading
  errors
• Trouble learning basic math concepts
• Difficulty telling time and remembering sequences
• Slow to learn new skills
Learning Disabilities




Grades 5-8 signs and symptoms of learning disabilities
• Difficulty with reading comprehension or math skills
• Trouble with open-ended test questions and word
  problems
• Dislikes reading and writing; avoids reading aloud
• Spells the same word differently in a single document
• Poor organizational skills (bedroom, homework, desk is
  messy and disorganized)
• Trouble following classroom discussions and expressing
  thoughts aloud
• Poor handwriting
Solution to LD
• Learn the specifics about child’s learning disability
• Research treatments, services, and new theories
• Pursue treatment and services at home
• Nurture child’s strengths
Substance Abuse


Substance abuse
• Out of risk taking behaviour/ adventure
• Peer pressure
• Stress


Commonly used substances
1. Alcohol
2. Tobacco
3. Cannabis
4. Heroin
5. Prescription drugs-opioids, CNS stimulants, CNS
   depressants
Substance Abuse



Adverse effects
1. Impairment of general abilities
- Senses
- Speed of reaction
- Co-ordination
- Thinking concentration


2. Increased risk taking with poor inhibitory control over behaviour
3. Mood changes with poor control over mood.

Consequences include increased probability of
- Accidents & Unintentional injuries
- Violence
- Suicide
- Risky sexual behaviours
OCD


   (Obsessive-Compulsive Disorder)
(OCD), usually begins in adolescence or young adulthood and is
seen in as many as 1 in 200 children and adolescents.

OCD is characterized by recurrent intense obsessions or
compulsions that cause severe discomfort and interfere with
day-to-day functioning. they interfere with the child's normal
routine, academic functioning, social activities, or relationships.

Obsessions are recurrent and persistent thoughts, impulses, or
images that are unwanted and cause marked anxiety or distress.
Frequently, they are unrealistic or irrational.

Compulsions are repetitive behaviors or rituals (like hand
washing, hoarding, keeping things in order, checking something
over and over) or mental acts (like counting, repeating words
silently, avoiding).
OCD


Studies related to OCD
Research shows that OCD is a brain disorder and tends to
run in families, although this doesn't mean the child will
definitely develop symptoms if a parent has the disorder.

Recent studies have also shown that OCD may develop or
worsen after a streptococcal bacterial infection. A child may
also develop OCD with no previous family history.

Children and adolescents often feel shame and
embarrassment about their OCD. Many fear it means
they're crazy and are hesitant to talk about their thoughts
and behaviors.
Impact of HIV/ AIDS on children and adolescents mental health, Shankar Das et.al, 2012




Adapted from Bailey, 1992, p. 669
Problems among children and families affected by HIV/AIDS
Impact of HIV/ AIDS on children and adolescents mental health

• Children's may be compelled to take on adult roles in
  order to accommodate an infected parent. (Bauman,
  2006)
• They must learn to interact with helping professionals and
  manage chronic stress.
• Nicholas and Abrams (2002) reported that a considerable
  number of HIV-positive children in the child welfare
  system in the US displayed severe behavioral problems
  and developed mental illness during adolescence.
• Scharko (2006) suggested that children and adolescents
  infected with HIV suffer high rates of psychiatric disorders.
Impact of HIV/ AIDS on children and adolescents mental health



Prevention Aspect
• Intervention should be at individual, family and community
    level
•   Parental Training
•   Issues related to stigma and discrimination must be
    tackled within communities
•   Programs and policies to reduce disease burden
•   Life skills education: life skills education Methodology
    often practiced: Dynamic teaching & Dynamic learning
    Working in small groups & pairs Brainstorming Role-plays
    Experiential learning Games & debates Home
    assignments, to further discuss and practice skills with
    family & friends.
References
• Child and Adolescent Mental Health, Usha S. Nayar (Nov 2012)
• LIFE SKILLS EDUCATION IN SCHOOLS- WHO,1994 (WHO /MNH
    /PSF/ 93.7A.Rev.2 )
•   http://www.nimhans.kar.nic.in/epidemiology/epidem_p4.htm
•   FAMILY LIFE & LIFE SKILLS EDUCATION FOR ADOLESCENTS :
    TRIVANDRUM EXPERIENCE- Dr M K C Nair,Director & Professor
    of Paediatrics,Child Development Centre,Medical College,T’puram
•   MENTAL HEALTH PROBLEMS OF SCHOOL CHILDREN- MON
    Foundation
•   CHILD AND ADOLESCENT MENTAL HEALTH POLICIES AND
    PLANS- WHO,2005

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Child and adolescents mental health

  • 1. CHILD AND ADOLESCENT MENTAL HEALTH Dr. Sanchit Kharwal Dr. Suhas Kadam
  • 2. Definition (WHO) • “Child and adolescent Mental Health is the capacity to achieve and maintain optimum psychological functioning and well being. It is directly related to the level reached and competency achieved in psychological and social functioning”
  • 3. Reasons why • Current shortage of child and adolescent psychiatrists children with • Low income families have no transportation to travel to a health Mental Illness facility. • Parent’s are afraid that they will be are left blamed for their child’s health issues. untreated • Family conflicts • Becoming a bullier Future of • Poor Grades in School • children left • High School Dropout Criminal activity untreated • Suicide
  • 4. Broad Classification 1. Emotional Disorders:  Anxiety Related Disorders: GAD, Agoraphobia, OCD  Somatoform Disorder: Somatization Disorders, Conversion disorders  Depressive disorders and suicide. 2. Behavioral Disorders:  ADHD  Conduct Disorders  Oppositional Defiant Disorder 3. Psychoses 4. Other mental Health Problems: Mental Retardation, Learning Disabilities, Speech disorder, Eating Disorders, Epilepsy
  • 5. Depression: A Global Crisis • Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feeling of guilt or low self worth, disturbed sleep or appetite, low energy and poor concentration. (WHO) • Interferes with cognitive, emotional and social development occurring at young age Adolescents Depression: Mood and Anxiety Disorder Substance use Disorders Depression can also lead to the ultimate tragedy — almost 90,000 young people commit suicide each year across the world
  • 6. Determinants of Depression: Psychosocial  Female Gender  Economic Impoverishment  Low Education  Violence and Trauma  Chronic physical ailments and Disabilities  Increased Stress, lonely lives  Lack of Social Support systems  Substance abuse Habit  Psychological Factors  School Factors: Academic performance, Peer pressure & influences  Family and Social environment  Genetic Factors  Neurobiological Factors
  • 7. Symptoms Infancy Childhood Adolescence Distress Anhedonia Depressed or irritable mood Crying, screaming Low self esteem Anhedonia Sleep disturbance Feeling of Hopelessness worthlessness Weight loss Hallucinations Feeling of guilt Separation Anxiety Increased appetite, Hypersomnia Withdrawl and Delusions, suicidality Dejection
  • 8. Suicidality among Children & adolescents •“ a conscious act of self induced annihilation, best understood as a multidimensional malaise in a needful individual who defines an issue for which suicide is the best perceived solution” Shneidman, 1985 • According to NIMHANS, Suicides resulted in death of more than 110,000 persons in India during 2004. • Risk Factors: Depression and other mental disorders, Substance abuse disorder (often in combination with other mental disorders), Prior suicide attempt, Family history of suicide, Family violence including physical or sexual abuse, Firearms in the home, Incarceration, Exposure to suicidal behavior
  • 9. Mental Retardation: • “a condition of arrested or incomplete development of the mind characterized by impaired developmental skills that contribute to the overall level of intelligence” (Kaplan &Sadock, 1998). • cognitive, language, motor, social and other adaptive behavior skills are affected and thus should be used to determine the level of intellectual impairments. • Etiology: Genetic, Biological, Environmental Beliefs related to MR: “...It’s all related to our doings (karmo ka natiza hai)..Don’t know what bad deeds (burre karam) we have done in the past life (pichle janam) that we are bearing the brunt in this life..”(Father of 7 Year old son with MR) “I have done a lot for my child took him to allopathic and homeopathic hospitals but there was no benefit…. I kept a dua and I used to come to this shrine in karjan from handod after walking bare foot for 10 kms for 9 Thursdays….we also took him to our ancestoral God (kuldevi) but nothing happened” (Mother of 8 year old son with MR)
  • 10. 1. LEARNING DISABILITIES 2. SUBSTANCE ABUSE 3. OCD 4. IMPACT OF HIV/AIDS ON CHILD AND ADOLESCENT MENTAL HEALTH 5. PREVENTIVE ASPECTS Dr. Suhas Kadam
  • 11. Learning Disabilities • A term for a wide variety of learning problems. • LD is not a problem with intelligence or motivation. • Children with LD aren’t lazy or dumb. • The difference only is how they receive and process information. • LD can lead to trouble with learning new information and skills, and putting them to use. • The most common types of LD involve problems with reading, writing, math, reasoning, listening, and speaking.
  • 12. Learning Disabilities Common Types of Learning Disabilities Dyslexia Difficulty reading Problems reading, writing, spelling, speaking Dyscalculia Difficulty with math Problems doing math problems, understanding time, using money Dysgraphia Difficulty with writing Problems with handwriting, spelling, organizing ideas Dyspraxia (Sensory Difficulty with fine Problems with hand–eye coordination, Integration Disorder) motor skills balance, manual dexterity Dysphasia/Aphasia Difficulty with language Problems understanding spoken language, poor reading comprehension Auditory Processing Difficulty hearing Problems with reading, comprehension, Disorder differences between language sounds Visual Processing Difficulty interpreting Problems with reading, math, maps, Disorder visual information charts, symbols, pictures
  • 13. Learning Disabilities Signs and symptoms Preschool signs and symptoms of learning disabilities • Problems pronouncing words • Trouble finding the right word • Difficulty rhyming • Trouble learning the alphabet, numbers, colors, shapes, days of the week • Difficulty following directions or learning routines • Difficulty controlling crayons, pencils, and scissors or coloring within the lines • Trouble with buttons, zippers, snaps, learning to tie shoes
  • 14. Learning Disabilities Grades K-4 signs and symptoms of learning disabilities • Trouble learning the connection between letters and sounds • Unable to blend sounds to make words • Confuses basic words when reading • Consistently misspells words and makes frequent reading errors • Trouble learning basic math concepts • Difficulty telling time and remembering sequences • Slow to learn new skills
  • 15. Learning Disabilities Grades 5-8 signs and symptoms of learning disabilities • Difficulty with reading comprehension or math skills • Trouble with open-ended test questions and word problems • Dislikes reading and writing; avoids reading aloud • Spells the same word differently in a single document • Poor organizational skills (bedroom, homework, desk is messy and disorganized) • Trouble following classroom discussions and expressing thoughts aloud • Poor handwriting
  • 16. Solution to LD • Learn the specifics about child’s learning disability • Research treatments, services, and new theories • Pursue treatment and services at home • Nurture child’s strengths
  • 17. Substance Abuse Substance abuse • Out of risk taking behaviour/ adventure • Peer pressure • Stress Commonly used substances 1. Alcohol 2. Tobacco 3. Cannabis 4. Heroin 5. Prescription drugs-opioids, CNS stimulants, CNS depressants
  • 18. Substance Abuse Adverse effects 1. Impairment of general abilities - Senses - Speed of reaction - Co-ordination - Thinking concentration 2. Increased risk taking with poor inhibitory control over behaviour 3. Mood changes with poor control over mood. Consequences include increased probability of - Accidents & Unintentional injuries - Violence - Suicide - Risky sexual behaviours
  • 19. OCD (Obsessive-Compulsive Disorder) (OCD), usually begins in adolescence or young adulthood and is seen in as many as 1 in 200 children and adolescents. OCD is characterized by recurrent intense obsessions or compulsions that cause severe discomfort and interfere with day-to-day functioning. they interfere with the child's normal routine, academic functioning, social activities, or relationships. Obsessions are recurrent and persistent thoughts, impulses, or images that are unwanted and cause marked anxiety or distress. Frequently, they are unrealistic or irrational. Compulsions are repetitive behaviors or rituals (like hand washing, hoarding, keeping things in order, checking something over and over) or mental acts (like counting, repeating words silently, avoiding).
  • 20. OCD Studies related to OCD Research shows that OCD is a brain disorder and tends to run in families, although this doesn't mean the child will definitely develop symptoms if a parent has the disorder. Recent studies have also shown that OCD may develop or worsen after a streptococcal bacterial infection. A child may also develop OCD with no previous family history. Children and adolescents often feel shame and embarrassment about their OCD. Many fear it means they're crazy and are hesitant to talk about their thoughts and behaviors.
  • 21. Impact of HIV/ AIDS on children and adolescents mental health, Shankar Das et.al, 2012 Adapted from Bailey, 1992, p. 669
  • 22. Problems among children and families affected by HIV/AIDS
  • 23. Impact of HIV/ AIDS on children and adolescents mental health • Children's may be compelled to take on adult roles in order to accommodate an infected parent. (Bauman, 2006) • They must learn to interact with helping professionals and manage chronic stress. • Nicholas and Abrams (2002) reported that a considerable number of HIV-positive children in the child welfare system in the US displayed severe behavioral problems and developed mental illness during adolescence. • Scharko (2006) suggested that children and adolescents infected with HIV suffer high rates of psychiatric disorders.
  • 24. Impact of HIV/ AIDS on children and adolescents mental health Prevention Aspect • Intervention should be at individual, family and community level • Parental Training • Issues related to stigma and discrimination must be tackled within communities • Programs and policies to reduce disease burden • Life skills education: life skills education Methodology often practiced: Dynamic teaching & Dynamic learning Working in small groups & pairs Brainstorming Role-plays Experiential learning Games & debates Home assignments, to further discuss and practice skills with family & friends.
  • 25. References • Child and Adolescent Mental Health, Usha S. Nayar (Nov 2012) • LIFE SKILLS EDUCATION IN SCHOOLS- WHO,1994 (WHO /MNH /PSF/ 93.7A.Rev.2 ) • http://www.nimhans.kar.nic.in/epidemiology/epidem_p4.htm • FAMILY LIFE & LIFE SKILLS EDUCATION FOR ADOLESCENTS : TRIVANDRUM EXPERIENCE- Dr M K C Nair,Director & Professor of Paediatrics,Child Development Centre,Medical College,T’puram • MENTAL HEALTH PROBLEMS OF SCHOOL CHILDREN- MON Foundation • CHILD AND ADOLESCENT MENTAL HEALTH POLICIES AND PLANS- WHO,2005