CHILD AND ADOLESCENTMENTAL 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 psychiatristschildren with • Low income families have no transportation to travel to a healthMental 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
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 ageAdolescents Depression:Mood and Anxiety DisorderSubstance use DisordersDepression 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, EnvironmentalBeliefs 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 DISABILITIES2. SUBSTANCE ABUSE3. OCD4. IMPACT OF HIV/AIDS ON CHILD AND ADOLESCENT MENTAL HEALTH5. 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 DisabilitiesDyslexia Difficulty reading Problems reading, writing, spelling, speakingDyscalculia Difficulty with math Problems doing math problems, understanding time, using moneyDysgraphia Difficulty with writing Problems with handwriting, spelling, organizing ideasDyspraxia (Sensory Difficulty with fine Problems with hand–eye coordination,Integration Disorder) motor skills balance, manual dexterityDysphasia/Aphasia Difficulty with language Problems understanding spoken language, poor reading comprehensionAuditory Processing Difficulty hearing Problems with reading, comprehension,Disorder differences between language soundsVisual Processing Difficulty interpreting Problems with reading, math, maps,Disorder visual information charts, symbols, pictures
Learning DisabilitiesSigns and symptomsPreschool 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 DisabilitiesGrades 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 DisabilitiesGrades 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 AbuseSubstance abuse• Out of risk taking behaviour/ adventure• Peer pressure• StressCommonly used substances1. Alcohol2. Tobacco3. Cannabis4. Heroin5. Prescription drugs-opioids, CNS stimulants, CNS depressants
Substance AbuseAdverse effects1. Impairment of general abilities- Senses- Speed of reaction- Co-ordination- Thinking concentration2. Increased risk taking with poor inhibitory control over behaviour3. 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 isseen in as many as 1 in 200 children and adolescents.OCD is characterized by recurrent intense obsessions orcompulsions that cause severe discomfort and interfere withday-to-day functioning. they interfere with the childs normalroutine, academic functioning, social activities, or relationships.Obsessions are recurrent and persistent thoughts, impulses, orimages that are unwanted and cause marked anxiety or distress.Frequently, they are unrealistic or irrational.Compulsions are repetitive behaviors or rituals (like handwashing, hoarding, keeping things in order, checking somethingover and over) or mental acts (like counting, repeating wordssilently, avoiding).
OCDStudies related to OCDResearch shows that OCD is a brain disorder and tends torun in families, although this doesnt mean the child willdefinitely develop symptoms if a parent has the disorder.Recent studies have also shown that OCD may develop orworsen after a streptococcal bacterial infection. A child mayalso develop OCD with no previous family history.Children and adolescents often feel shame andembarrassment about their OCD. Many fear it meanstheyre crazy and are hesitant to talk about their thoughtsand behaviors.
Impact of HIV/ AIDS on children and adolescents mental health, Shankar Das et.al, 2012Adapted from Bailey, 1992, p. 669
Problems among children and families affected by HIV/AIDS
Impact of HIV/ AIDS on children and adolescents mental health• Childrens 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 healthPrevention 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