Child and Adolescent Mental Health Donna Poole RN, MSN, CS

Growth and Development in Adolescents Three phases of Adolescents – Early- 10 to 13 – Middle- 14 to 17 – Late- 17 to 21

Onset of Puberty Female-lasts 4 years with age of onset from Average age is 11.2 Growth spurt 1 year prior to breast bud development Peak height achieved 1 year after breast development Menarche begins 1 year after height Epiphyseal closure occurs

Male Puberty Males onset of puberty is 11.6 years of age with a range of Puberty lasts 3 years First sign is testicular enlargement Males have a 2 year delay in epiphyseal closure

Cognitive development Moves from concrete thinking to “formal operations” Abstract thinking Level of thinking allows the person to transfer information from one situation to another, deal efficiently with complex problems, and plan realistically for the future.

Early adolescents Daydream, spend time in front of a mirror View world as a stage in which they star Very egocentric; see fame and fortune Preoccupied with separation from the family Worry if they are “normal”

Middle Adolescents Less grandiose about what they will be Can be issue for “at risk” kids; feel hopeless Not so worried about “normal” Concerned about attractiveness, dating Feelings of omnipotence- reckless behaviors Experiment with morals in both phases

Late adolescents Develop a sense of self “Who am I” “At Risk” youth may dissociate from family Try on different roles; change majors– etc Gains a sense of perspective, be able to problem solve Consider all aspects of a problem Delay gratification

Mental Health Problems of school Age Children 10-13% of children have serious MH problems 655,000 Texas children Case Study The Children’s Partnership

Etiology of MH Problems Genetics: strong for depression, Anxiety, OCD, Tic disorders, ADHD, bipolar Environment: Abuse and neglect, fetal Alcohol Syndrome, Brain damage Neurological Anomalies – Developmental disorders- MR-IQ below 70 – Pervasive developmental disorders-Autism, Asberger’s, PPD-NOS, Etc.

Developmental disorders and Disruptive behavior disorders Specific Developmental disorders – Learning disorders-dyslexia 3to5% Nonverbal.1 to 1% – Communication disorders Disruptive Behavior disorders – ADHD; Most common behavoral disorder – Oppositional Defiant disorder – Conduct disorder

Attention-deficit Hyperactivity Disorder AD/HD; Classic type ADD without hyperactivity(couch Potato) ADD, Over focused Type(tend to get stuck) ADD, Limbic(negative and irritable ADD, Temporal lobe(Violent, explosive, dark thoughts)

Treatment ADHD Problem in the Frontal lobe, which is responsible for planning, attention, regulation of motor activity-Brain under active Medication: Stimulants Ritalin, Dexdrene, Cylert, Adderall Common side effects:Anorexia, weight loss, Tics, abnormal movements, labile mood

Interventions Keep it simple, structured, and re-enforce good behavior “It is unsafe to jump down stairs 2 at a time” “You walked down the stairs in a safe way” “It is not OK to grab a toy from another child, you must ask” Daily routine & short term rewards/re-enforcers

More Interventions Simple instructions; Don’t say-”Clean your room” say- “Put the dirty clothes in the hamper”, Then,” Make your bed” Teaching the family about ADHD Assess family HX and how successful Listen, support groups, books Communicate with teachers, School

Tic Disorders Tourette’s Syndrome-Movement disorder defined by the presence of motor and phonic tics: Rare 1 to 2 per thousand Motor Tics-rapid, jerky movements of eyes, face, neck, and shoulders Phonic tics: grunting, throat clearing, and repetitive noises Can be words’ obscenities

Psychotic disorders Childhood Schizophrenia-2 cases per 100,000 Adolescents-Bipolar, and Schizophrenia