MENTAL HEALTH DISORDERS

A REALITY FOR YOUNG PEOPLE

BERMA CHOONOO THABISA MBIZA KHANYA NCO THEMBI .SIKHOVA

IN OUR IN COUNTRY ...

It is normal to see young people as perpetrators of horrific crimes Suicide is growing amongst school going children More schools are opting to medicate children Schools rendered inoperable by gangsterism

Bullying becoming a growing phenomenon in schools

WHY?
....WHAT SIGNS ARE WE MISSING ... ??

POVERTY VS CHILDRENS MENTAL HEALTH

Does poverty by default imply that young people from those communities, being vulnerable, are therefore easily targeted for destruction.... Mental Health of poor children are falling through the gaps...are our juvenile delinquents children trying to cope with mental health conditions that were never diagnosed

Children from poverty stricken communities have to cope often without any support in an environment where everybody needs to focus on their own survival

DYSFUNCTIONAL BEHAVIOURAL PATTERNS IN YOUNG PEOPLE

Does poverty contribute to young people migrating towards to dysfunctional behavioural patterns like....

Self Mutalisation Intellectual Disabilities Anxiety Disorders

Behavioural Disorders

SELF-MUTALISATION
AETIOLOGY DSM IV DEFINITION

Multi-factorial with elements of compulsion and addiction associated with childhood trauma, loss, abandonment & abuse. Not a Mental Disorder found in Borderline Personality Disorders because it has self-mutalisation as its main diagnostic criteria. Deliberate physical self-injurious behaviour e.g. self-cutting, trichillotomania (pulling out own hair) burning.

Face slapping, head banging, biting parts of body, pinching, scratching, eye MANIFESTATION poking, repeated vomiting & rumination (reingesting vomited food), eating nonedible substances (cigarettes, faeces) Completely treatable. Individuals can fully recover from condition with correct PROGNOSIS intervention.
AGE GROUP

Primary School - Adults

Outpatient (Cognitive analytic therapy, Psychodramatic psychotherapy, Family therapy Inpatient - therapy with Psychologist, Nurse Therapist, Occupational Therapist

TREATMENT

REASONS
Erikson Psychosocial Stages Adolescence = Identity vs Confusion Implies they are a very difficult coping stage self-mutalisation easy release
Some disclosed reasons sexual, physical and emotional abuse low self-esteem or self-hatred fear of rejection being neglected, isolated or separated from a loved one stress about school work/examinations bullying/harassment break up of family (e.g. parental divorce) unwanted pregnancy difficulties with sexuality/race/culture/religion feelings of guilt, anxiety, loneliness, grief, anguish or anger Oxford Journals, Innnovait, Medicine. Volume 1, Issue 11. Pp. 750-758 In the minority of cases in which self-harm is disclosed reasons may include: to show desperation to others to change the behaviour of others to make other people feel guilty to seek help

SELF-MUTALISATION PATHWAYS
Excessive Stress
Feeling overwhelmed, unable to cope

Dissociation
Feeling numb, overwhelmed, unreal

Self-mutilation
Feeling relieved, in control, and calm

Self-mutilation
Feeling real, alive, able to function better

(Aron Lipman.Dept Applied Psychology. NYU)

PREVALENCE IN SOUTH AFRICA

General onset age = 12 years, span all races Frequency : 1 in 5-10 children self-harm/mutilate No official statistics on self-mutalisation but there are an many websites dedicated to the topic in South Africa Plenty of support networks available Numerous research papers available in South Africa There is a misconception that Self-Mutalisation is a White-Peoples problem most of the people that use help-line facilities are people from non-white communities Most people going to formal treatment are people from affluent communities as treatment is expensive Unlike with substance abuse support facilities SA does not have State sponsored facilities which cater specifically for Self-Mutalisation/Harm but cases are treated in various State institutions that caters for it in conjunction with other disorders

OT ROLE
Interventions Holistic: the individual, prepare the person to deal with triggers in environment they are returning to addresses the effect of the condition on occupational performance Therapy Methods Group: ADLs, Leisure activities, Coping skills, Support groups Individual: Specific needs Approach Educational (Individual & Community) Rehabilitative (Individual)

Frame of Reference Psychotherapy but OT needs to be specifically trained in this field

OT INTERVENTION
AIM Reduce need for mutalisation Provide alternative and appropriate adaptive responses ADDRESS Activities of daily living, Work/productive activities, Play/leisure activities

HOW SENSORY INTEGRATION TECHNIQUES Wilbarger Protocol: Deep Pressure Brushing, Joint Compressions, Sensory Diet Weighted pressure vests across back and chest gives a sense of control The Sensory-Modulation Room offers a combination of sensorimotor activities with calming and alerting options for all sensory areas. Use purposeful activities to achieve optimal functional outcomes Engage in Sensory based therapy to give individual an understanding of the relevant sensory relationship between the human brain, human behaviour, environmental stimuli related to improve optimal functioning

SELF MUTALISATION & POVERTY

Self-mutilators from poorer communities are at bigger risk of accidental suicide because it goes undetected for years until they accidentally cut themselves too deep

In most cases these people self-mutilate all their lives without it visibly impacting on their lives they live seemingly normal lives
Most govermental research or efforts are focussed on Risk Behaviours which could lead to HIV/Aids, Substance abuse,Teenage Pregnancy Self-mutalisation is Often mentioned as a by-product of depression

Most research do not necessarily look Self harm directly

HELP IN SOUTH AFRICA

The S A Depression and Anxiety Group * National tel no: (011) 783 1474 * Suicide Helpline: 0800 567 567 * SMS Crises line: 31393 (SMS problem to them - they reply immediately) Treatment entails formal intervention Numerous Help Line provide assistance www.childline.org.za: Tel: 08000 55 555 - Trained counsellors are available 24 hours a day Lifeline: Toll free no: 0861 322 322

LEARNING DISABILITIES
The term learning disability is used to describe a number of deficits related to interpreting visual or auditory information &/ or the ability to link information from different parts of the brain. (Crepeau et. al 2003)
Dyslexia Dyscalculia Dysgraphia Dyspraxia (Sensory Integration Disorder) Dysphasia/Aphasia Difficulty reading Difficulty with math Difficulty with writing Difficulty with fine motor skills Difficulty with language Problems reading, writing, spelling, speaking Problems doing math problems, understanding time, using money Problems with handwriting, spelling, organizing ideas Problems with handeye coordination, balance, manual dexterity Problems understanding spoken language, poor reading comprehension

Auditory Processing Disorder

Visual Processing Disorder

Difficulty hearing differences between sounds Difficulty interpreting visual information

Problems with reading, comprehension, language

Problems with reading, math, maps, charts, symbols, pictures

OTHER DISORDOERS WHICH MAKE LEARNING DIFFICULT

ADHD Why>>>>>>>>>>>>>>>>>. Autism Why>>>>>>>>>>>>>>>>>>>>>.

DSM IV DIAGNOSIS
315.00 Reading Disorder 315.1 Mathematics Disorder 315.2 Disorder of Written Expression 315.9 Learning Disorder Not Otherwise Specified

What about the medication which are given to these children take about ritalin pros & cons

ROLE OF PARENTS
Learn about learning disabilities. Praise your child when he or she does well. Find out the ways your child learns best. Let your child help with household chores. Make homework a priority.

Talk to other parents whose children have learning disabilities.

ROLE OF TEACHERS
Learn as much as they can about the different types of IDs. Find out and emphasize what the student's strengths and interests are. Provide instruction and accommodations to address the student's special needs. Establish a positive working relationship with the student's parents.

ROLE OF OT
Assessment Goal Setting Aids and Adaptations Personal Skills Caregivers and Family

IMPACT OF POVERTY
Children that come from a low socioeconomic environment are more likely to have intellectual difficulties.

TO BE COMPLETED

CONDUCT DISORDERS
DEFINITION Refers to a group of behavioural and emotional problems in youngsters that result in them having great difficulty following rules and behaving in a socially acceptable way. They are often viewed by other children, parents and social agencies as bad or delinquent, rather than mentally ill. CD involves more deliberate aggression, destruction, deceit, and serious rule violations such as staying put all night and chronic school truancy. ETIOLOGY Involves an interaction of genetic/constitutional, familial and social factors.

May inherit decreased baseline autonomic nervous system activity requiring greater stimulation to achieve optimal arousal.
Hereditary factor may account for high level of sensation-seeking activity associated with CD DIAGNOSIS

Children who exhibit conduct disorder behaviours should receive a comprehensive evaluation as many children wit a conduct disorder may have coexisting conditions such as mood disorders, anxiety, PTSD, substance abuse, ADHD, learning problems, or thought disorders which can also be treated.

DSM-IV CLASSIFICATION
persistent pattern of behaviour in which the basic right of others or major age-appropriate social
norms are violated.
2 major subtypes of CD defined by the DSM-IV: The childhood-onset type: defined by the presence of 1 criterion characteristic of CD before the age of 10 years. typically boys displaying high levels of aggressive behaviour.

tend to meet the criteria for ADHD.

Poor peer and family relationships are present, and these problems tend to persist through adolescence and adulthood. defined by the absence of any criterion characteristic of CD after an individual is aged 10 years. tend to be less aggressive and have more normative peer relationships. often display their conduct behaviour in a company of a peer group engaged in these behaviours (e.g. gangs). less likely to fit in the criteria of ADHD; however, the diagnosis f ADHD is still possible. These individuals are far less likely to develop adult antisocial personality behaviours.

Adolescent-onset type:

MANIFESTATIONS
1. Aggression to people and animals Bullies, threatens or intimidates others Often initiates physical fights Has used a weapon that could cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife or gun) Steals from victim while confronting them (e.g. taking other childrens lunches forcefully) Forces someone into sexual activity 2. Destruction of property Deliberately engaged in fire setting with the intention of casing damage Deliberately destroys others properties

MANIFESTATIONS
3. Deceitfulness, lying or stealing
Has broken into someone elses building, house or car Lies to obtain goods, favours or to avoid obligations Steals items without confronting a victim (e.g. shoplifting)

4. Serious violation of rules Often stays out at night despite parental objections
Runs away at school Is often truant at school

PROGNOSIS
For an individual with adolescent-onset type is much better than for a person with child-onset type. About 30% of conduct disorder children continue with similar problems in adulthood. More common in males than females. Substance abuse is very high. About 50-705 of 10 year old children with CD will abuse substances 4 years later. Cigarette smoking is also very high were almost 6 times more likely to abuse drugs or alcohol, 8 times more likely to smoke cigarettes daily, twice as likely to have STIs,

Recent study showed that girls with CD have much worse physical health than those without CD

had twice the number of sexual partners and 3 times as likely to fall pregnant.
Most often end up having mood and anxiety disorders as adults.

POVERTY
Poverty
Children from poor or low-income families more likely to suffer from mental illness, with children in poor families having a higher rate of mental health problems than their nearpoor and non-poor counterparts. The inability of parents to take care of their children and the emotional turmoil that comes with poverty exerts a lot of strain on to the parents, subsequently on children as well. Struggling to meet the ends, survival is their number one goal and family relationships and quality time falls far behind and children that grow under such circumstances feel neglected, unloved and unappreciated inconsistent parental availability and discipline. As a result, children do not experience a relationship between their behavior and its consequence.

OTHER FACTORS
FAMILY Lack of parenting skills, inconsistent parenting or overly permissive can contribute to their children developing CD. Maternal depression, parent alcoholism and/or criminal and antisocial behaviours of either parent have been linked to CD. A lack of male role models is also a major causative factor arising in both sexes but mostly in boy children.

Other parental factors include divorce (in particular where there is severe conflict between parents), violence, poverty, long-term unemployment and on-going ill health of a parent (or any other close family member).
Middle children and male children in large families are most likely at risk of developing CD.

OTHER FACTORS
SCHOOL
Teachers attitudes toward individual children can play a role in children developing CD, Poor reading and writing abilities (at least one study has shown that the average reading ability of CD is up to 3 years behind their peers), Teacher to pupil ratio, Sex of the teachers (male teachers usually have firmer boundaries, and the ability to enforce those boundaries).

HOW ARE THE BEHAVIOURS OF THESE CHILDREN CONTAINED THRU MEDICATION, WHAT ARE THE SIDE EFFECTS OF THESE MEDS DO THESE MEDS MAKE THEN VIOLENT

TREATMENT
Treatment of children with conduct disorder can be complex and challenging. Treatment can be provided in a variety of different settings depending on the severity of the behaviours. Treatment for conduct disorders is rarely brief since establishing new attitudes and behaviour patterns takes time. However, early treatment offers a child a better chance for considerable improvements and hope for a more successful future. information from the child, family, teachers and other medical specialties to understand the cause of the disorder.

Behaviour therapy and psychotherapy are usually necessary to help the child appropriately express an control anger.
Treatment may also include medication in some youngsters, such as those with difficulty paying attention, impulse problems and/or those with depression.

TREATMENT APPROACH
Educative the client, family, teachers and social agencies Role play, anger management

ANXIETY DISORDERS
A blanket covering several forms of mental illnesses of abnormal and pathological fear and anxiety.

DIAGNOSIS
Usually on the patients history or symptoms. For children: through collaterals information. Occupational Therapist: assesses interaction with peers and behaviour around adults. Semi-structured interview: Anxiety Disorder Interview Schedule, Anxiety Inventory for Children, Child Behaviour Checklist Teachers Report form.

TYPES
Panic disorder: feelings of terror that strike suddenly and repeatedly with no warnings. Obsessive compulsive disorder: constant thoughts and fears causing performance of certain rituals or routine. Specific phobia: intense fear of specific object or situation. Social anxiety disorder: also called social phobia.

SOCIAL PHOBIA
According to the DSM-IV a marked or persistent fear of exposure to unfamiliar situations. One year prevalence range from 5-8 percent. Onset is 15.5 years. SYMPTOMS IN CHILDREN Tantrums

Crying
Freezing Clinging to parents or other familiar people, Mutising (not wanting to talk).

CAUSES
Neurobiological factors Position emission tomography Temperament Psychosocial factors

CAN THESE CONDITIONS BE MANAGED THRU MEDICATION IMPACT ON KIDS

TREATMENT
Occupational Therapy: providing better information about community services. Easing the psychological and financial burdens Selection of medication depends on the subtype of the patients social phobia. Cognitive Behavioural Therapy Moderately successful at one year follow up. Others: Family Therapy & Relaxation Techniques

ROLE OF POVERTY
Among low-income children and youth have mental health problems. Low socio economic status found to be the strongest predictor in early childhood of emotional problems. Mechanism that increases childrens vulnerability Risk factor for the development of mental health disorders. to mental health disorders.

PROGNOSIS
Good given early diagnosis & appropriate treatment. If untreated: Underachievers Substance abuse/dependence Major depression and committing suicide.

REFERENCES

The SA Depression and Anxiety Support Group Inc. Tillfors, Maria., Tomas Furmark., Marteinsdottir, Ina ., et al. (2001). "Cerebral Blood Flow in Subjects with Social Phobia During Stressful Speaking Tasks: A PET Study." American Journal of Psychiatry ,158, 1220-1226. http://www.joymag.co.za/article.php?id=18