Adolescent disorders

Mental Health Disorders in Adolescents Overview
• Mental health disorders in adolescence are a significant
problem, relatively common, and amenable to treatment or
intervention.
• Obstetrician–gynecologists who see adolescent patients are
highly likely to see adolescents and young women who have
one or more mental health disorders.
• Some of these disorders may interfere with a patient’s ability
to understand or articulate her health concerns and
appropriately adhere to recommended treatment.

• Adolescents with mental illness often engage in
acting-out behavior or substance use, which increases
their risk of unsafe sexual behavior that may result in
pregnancy or sexually transmitted infections.
• Pregnant adolescents who take psychopharmacologic
agents present a special challenge in balancing the
potential risks of fetal harm with the risks of
inadequate treatment.

• Some disorders or their treatments will affect the
hypothalamic–pituitary–gonadal axis, causing
anovulatory cycles and various menstrual disturbances.
• Adolescents with psychiatric disorders may be taking
psychopharmacologic agents that can cause menstrual
dysfunction and galactorrhea.

• DSM-5 defines adjustment disorder as “the presence of
emotional or behavioral symptoms in response to an
identifiable stressor(s) occurring within 3 months of the onset
of the stressor(s)” and typically doesn't last more than six
months, unless the stressor persists (American Psychiatric
Association, 2013). ...
• It is a distress that is out of proportion with expected reactions
to the stressor. The symptoms occur because you are having a
hard time coping. It is sometimes referred to as situational
depression, and is a group of symptoms, such as stress,
feeling sad or hopeless, and physical symptoms that can occur
after you go through a stressful life event.

• Your reaction is stronger than expected for the type of event that
occurred and can result in significant impairment in social,
occupational, or academic functioning.
• These disorders are treated with therapy, medication, or a
combination of both. With help, you can usually recover from
an adjustment disorder quickly.
• Despite the fact that it is brought on by an outside stressor, an
individual's genetic makeup is believed to contribute to the
development of adjustment disorder although a chronically
stressful environment can often trigger symptoms.
• Without prompt diagnosis and treatment, it can become a long-
term, chronic condition.

Categories or Types
of
Adjustment Disorders
in
Adolescents

I. Adjustment disorder with depressed mood
•Symptoms mainly include feeling sad, tearful and hopeless
and experiencing a lack of pleasure in the things you used to
enjoy (Mayo Clinic, 2011)
•Hyposomnia
•Decreased appetite
•Weight loss
•Decreased motor activity
•Social withdrawal
•Depressed mood
•Low self-esteem
•Alcohol use
•Increased risk for suicide (Strain et al, 2008)

II. Adjustment disorder with anxiety
• Symptoms associated with adjustment disorder with anxiety
include feeling overwhelmed, anxious, and worried.
• Difficulty concentrating and remembering things
• Co-occurring generalized anxiety
• Situational anxiety
• Increased motor activity
• Nervousness
• Panic attacks
• Low self-esteem
• This diagnosis is usually associated with separation anxiety
from parents and loved ones (Mayo Clinic, 2011)

III. Adjustment disorder with mixed anxiety and
depressed mood
• People with this kind of adjustment disorder
experience both depression and anxiety.
• Impulsivity
• Hostility
• Excessive alcohol use
• Lack of insight
• Antisocial behaviors
• Self-centeredness
• Elated mood
• Homicidal ideation

IV. Adjustment disorder with disturbance of conduct
• Symptoms of this type of adjustment disorder mainly involve
behavioral issues like driving recklessly or starting fights.
• Teens with this disorder may steal or vandalize property.
• They might also start missing school.
• Impulsive and violent behaviors
• Social norms are disregarded

V. Adjustment disorder with mixed disturbance of
emotions and conduct
• Symptoms linked to this type of adjustment disorder include
depression, anxiety, and behavioral problems.
VI. Adjustment disorder unspecified
• Those diagnosed with adjustment disorder unspecified have
symptoms that aren’t associated with the other types of
adjustment disorder.
• These often include physical symptoms or problems with
friends, family, work, or school.

SCREENERS FOR ADJUSTMENT DISORDERS:

1. The Perceived Stress Scale (PSS)
- is the most widely used psychological
instrument for measuring the perception of
stress. It is a 10-item scale that measures
the degrees to which situations in one’s
life are appraised as stressful (Cohen,
Kamarck, & Mermelstein,1983).

2. The Life Events Questionnaire, an instrument that measures
common life events that tend to be threatening(Brugha & Cragg,
1990).
3. The Hospital Anxiety and Depression Scale, a 14-item self-
report questionnaire that measures anxiety and depressive
symptoms during the previous week. It has been used for patients
with medical illnesses not specific for adjustment disorder but
predictive of it (Akechi, Okuyama, Sugawara, et al., 2004).

Child and Adolescent Survey of Experiences: Child Version (CASE)
Your name: Your date of birth:
This questionnaire asks about events people may find bad or upsetting, as well as events people may find good or
enjoyable. If an event DID happen to you in the LAST 12 MONTHS, tick the box under the word ‘YES’. You also
need to tick a box to say HOW GOOD or HOW BAD the event was for you. If the event DID NOT happen to you, tick
the box under ‘NO’ and just skip to the next question. If you make a mistake, just cross out your answer and tick the
correct box. DO NOT use a pencil or liquid paper.
Remember: if “Yes”, the event did happen to you, also
tick a box to show how good or how bad the event
was for you.
Write down the date 12 months ago:___________
In the last 12 months …
1. We moved house □ □ □ □ □ □ □ □
2.
I (or my team) won a prize, award or contest
(e.g., school, sports, music, dance) □ □ □ □ □ □ □ □
3.
My parent(s) stayed away from home overnight
(e.g., hospital, holiday, work) □ □ □ □ □ □ □ □
4. I got a new boyfriend or girlfriend □ □ □ □ □ □ □ □
5. My parent(s) started a new job □ □ □ □ □ □ □ □
6.
Someone special to me moved away (who is not in your
family) □ □ □ □ □ □ □ □
7. Someone in my family was really sick or injured □ □ □ □ □ □ □ □
8.
My parent(s) had a baby / found out they are going to
have a baby □ □ □ □ □ □ □ □
9. My parent(s) had to see my school principal □ □ □ □ □ □ □ □
10.
I stayed away from home overnight
(e.g., camp, trip, hospital) □ □ □ □ □ □ □ □
11. Someone came to live with our family □ □ □ □ □ □ □ □
12. I was teased or bullied □ □ □ □ □ □ □ □
13. My pet died, got sick, lost or injured □ □ □ □ □ □ □ □
14. I had a big argument with someone in our family □ □ □ □ □ □ □ □
15. I was really sick or injured □ □ □ □ □ □ □ □
16. My parent(s) split up □ □ □ □ □ □ □ □
17. I did well in an important test or exam □ □ □ □ □ □ □ □
18. My parent(s) lost their job □ □ □ □ □ □ □ □
19. I broke up with a boyfriend or girlfriend □ □ □ □ □ □ □ □
centreforemotionalhealth.com.au
© Centre for Emotional Health, Macquarie University, Sydney, Australia
Original Publication: Allen, J. L., & Rapee, R. M. (2009)
The information in this document is not intended as a substitute for professional medical advice, diagnosis or treatment.
Child and Adolescent Survey of Experiences: Child Version (CASE)
Your name: Your date of birth:
Write down the date 12 months ago:_____________
In the last 12 months …
20.
I had a big argument with someone special to me (who is not
in your family) □ □ □ □ □ □ □ □
21. I made a new special friend □ □ □ □ □ □ □ □
22.
I saw something bad happen
(e.g., car accident, someone being robbed) □ □ □ □ □ □ □ □
23. I changed schools □ □ □ □ □ □ □ □
24. Someone in my family died □ □ □ □ □ □ □ □
25.
People in my family had a big fight or argument (not
including me) □ □ □ □ □ □ □ □
26.
My mum got married, engaged or began seeing someone
else □ □ □ □ □ □ □ □
27. Someone broke into my house □ □ □ □ □ □ □ □
28. Someone in my family left home □ □ □ □ □ □ □ □
29. I was in a fight (not with people in my family) □ □ □ □ □ □ □ □
30. I did badly in an important test or exam □ □ □ □ □ □ □ □
31.
Someone special to me died
(who is not in your family) □ □ □ □ □ □ □ □
32.
I was chosen to be class monitor, prefect or school
captain □ □ □ □ □ □ □ □
33. I was seriously told off or punished by a teacher □ □ □ □ □ □ □ □
34. I took up a new hobby / sport / activity □ □ □ □ □ □ □ □
35. I found out that I had to repeat a grade in school □ □ □ □ □ □ □ □
36.
Someone special to me was really sick or injured (who is not
in your family) □ □ □ □ □ □ □ □
37.
My dad got married, engaged, or began seeing someone
else □ □ □ □ □ □ □ □
38.
I went on a special holiday
(e.g., overseas, around Australia) □ □ □ □ □ □ □ □
Other upsetting or good events (please list):
39. □ □ □ □ □ □ □ □
40. □ □ □ □ □ □ □ □
centreforemotionalhealth.com.au
© Centre for Emotional Health, Macquarie University, Sydney, Australia
Original Publication: Allen, J. L., & Rapee, R. M. (2009)
The information in this document is not intended as a substitute for professional medical advice, diagnosis or treatment.
Life Events Questionnaire Sample

The Hospital Anxiety
and
Depression Scale
Sample Questionnaire

FACTS TO REMEMBER:
1. Most common stressor among adolescents are family-related
events, peer-related problems, school problems, parental alcohol
and drug problems, parental separation or divorce, and parent
rejection (Andreasen & Black,2006).
2. Adjustment disorder with depressed mood has been found to be a
frequent diagnosis among young people who make suicidal
attempts (Skopek & Perkins, 1998, Wai, Hong & Heok, 1999).
3. The duration between first communication of thoughts of suicide
and suicide among adolescents with adjustment disorder is shorter
(less than 1 month) than among individuals with major depressive
disorder (less than 3 months) or individuals with schizophrenia (47
months) (Runeson, Beskow & Waern,1996).
4. The very small window of time for preventing suicide among
adolescents with adjustment disorder is a red flag for psychiatric
advanced practice nurses.

TREATMENT OF ADJUSTMENT DISORDER
Adjustment disorder is primarily treated with psychotherapy,
although in some cases medication may also be prescribed to
alleviate symptoms.
Immediate treatment
Psychotherapy
Multimodal approach
Pharmacotherapy
Psychosocial interventions
Activating intervention
Alternative treatments

Immediate treatment or emotional first aid
• Principle is to use a direct approach and deal with situation at hand.
• Designed to help individuals accept the reality of stressor, identify
sources of help and participate in resuming their lives.
• Principles are based on BICEPS
brevity – treatment is brief
immediacy – treatment provided immediately
centrality – treatment and needed services are coordinated
expectancy – expected that individual will return to normal
functioning
proximity – treatment provided as close to the scene of stressor as
possible
simplicity – treatment focused on maintaining reintegrative approach

Psychotherapy
• Treatment of choice for adjustment disorder (Weigel, et al, 2009)
• Allows patient to express feelings, learn new ways of coping and
develop alternative interests and relationships
Multimodal approach
• Patients are asked to identify behaviors, sensations, images, ideas,
people, places that they formerly found pleasing or rewarding.
• They are taught to use imagery to recall previous positive coping
and to use time projection to imagine themselves happier, coping
adaptively in the future.
• They are taught to use relaxation exercises, meditation and other
assertive skills.

Pharmacotherapy
Some medications used to lessen some of the symptoms of adjustment
disorders, such as insomnia, depression, and anxiety.
•benzodiazepines, such as lorazepam (Ativan) and alprazolam (Xanax)
•nonbenzodiazepine anxiolytics, such as gabapentin (Neurontin)
•SSRIs or SNRIs, such as sertraline (Zoloft) or venlafaxine (Effexor XR)
Psychosocial interventions
Include activities as part of multimodal approach
• Education about reality
• Assertiveness training
• Role-playing
• Bio-feedback
• Support groups
• Promotion of self-care activities

Activating Intervention
• 12-month intervention designed to prevent the disabling long-term
effects of adjustment disorders, reduce sickness and failing to return
to school.
- participate in nondemanding daily activities (enough sleep, healthy
diet, positive outlook, listening to music, joining spiritual programs)
Alternative treatments
• Gingkgo biloba extract EGb761 reduced symptoms of anxiety and
somatic symptoms (Bourin, Bougerol, Guitton, et al., 1997)
• Kava (herbal remedy used to relieve stress and anxiety and boost
sleep that has a calming, euphoric effect)

• ACTING OUT is defined as the release of out-of-control aggressive or
sexual impulses in order to gain relief from tension or anxiety. Such
impulses often result in antisocial or delinquent behaviors. The term is
also sometimes used in regard to a psychotherapeutic release of
repressed feelings, as occurs in psychodrama.
• The behavior is usually caused by suppressed or denied feelings or
emotions.
• Most teens do not understand this is what they are doing. Instead of
letting people see them vulnerable and opening up about what's
bothering them, troubled teens choose the isolation and singling out
that cause acting behaviors.

What causes acting out?
•Attention issues: Often seek attention from parents, peers, or other
authority figures. If they don’t get the positive attention they want, they
will act out to get negative attention.
•Desire for power: They often feel powerless. They’re usually unable to
control their situations and environment. They act out because it allows
them to feel in control of their actions.
•Self-esteem issues: They believe they’re unable to perform a task
may act out to distract a parent.
•Personality disorders: Personality disorders that lead to acting out
are more common in adults and older teenagers than children . They
include antisocial personality disorder, borderline personality disorder,
histrionic personality disorder, and narcissistic personality disorder.

What are the symptoms of acting out?
If these signs last more than six months or become progressively
inappropriate, you should consult a doctor.
•damaging or vandalizing property
•harming or threatening other people or pets
•self-harm
•lying
•stealing
•truancy or poor academic performance
•smoking, drinking alcohol, or drug abuse
•early sexual activity
•frequent tantrums and arguments
•consistent anger and rebellion against authority figures

How is acting out treated?
This rarely need medications to address acting out. Medications may
cause your child to be more sedated and less prone to outbursts but
hey do not address the underlying cause of the behavior. In most
cases, the best chance at adjusting your child’s improper behavior is to
encourage better behavior.
•Maintain clear expectations:
Set clear and detailed expectations for your child. Be
consistent with your rules and the consequences for breaking
those rules. If you remain firm and organized with what you
expect from your children, they will be less likely to act out.

•Keep it positive:
A positive parenting approach focuses on rewarding children when
they are being good. This will reinforce the child’s acceptable
behavior.
You should avoid giving your attention to a child acting out. This
will only teach the child that if they want your attention, they just
need to misbehave.
• Keep calm:
If you are calm, even when your child is acting out, you will be
in a better position to react properly to their behavior.

SUBSTANCE ABUSE
Alcohol and tobacco are the drugs most commonly abused by adolescents,
followed by marijuana.

Why do adolescents take drugs and other substance?
Adolescents experiment with drugs or continue taking them for several
reasons, including:
•To fit in: Many teens use drugs “because others are doing it”—or
they think others are doing it—and they fear not being accepted in a
social circle that includes drug-using peers.
•To feel good: Abused drugs interact with the neurochemistry of the
brain to produce feelings of pleasure. The intensity of this euphoria
differs by the type of drug and how it is used.

•To feel better: Some adolescents suffer from depression, social
anxiety, stress-related disorders, and physical pain. Using drugs
may be an attempt to lessen these feelings of distress. Stress
especially plays a significant role in starting and continuing drug use
as well as returning to drug use (relapsing) for those recovering
from an addiction.
•To do better: Ours is a very competitive society, in which the
pressure to perform athletically and academically can be intense.
Some adolescents may turn to certain drugs like illegal or
prescription stimulants because they think those substances will
enhance or improve their performance.
•To experiment: Adolescents are often motivated to seek new
experiences, particularly those they perceive as thrilling or daring.

Factors that influence adolescent’s substance abuse:
• the availability of drugs within the neighborhood, community, and
school and whether the adolescent’s friends are using them
• the family environment : violence, physical or emotional abuse,
mental illness, or drug use in the household increase the likelihood
an adolescent will use drugs
• an adolescent’s inherited genetic vulnerability; personality traits like
poor impulse control or a high need for excitement; mental health
conditions such as depression, anxiety;
• and beliefs such as that drugs are “cool” or harmless make it more
likely that an adolescent will use drugs.

Possible serious social and health risks for substance abuse:
•school failure
•problems with family and other relationships
•loss of interest in normal healthy activities
•impaired memory (brain is not well-developed)
•increased risk of contracting an infectious disease (like HIV or
hepatitis C) via risky sexual behavior or sharing contaminated
equipment
•mental health problems—including substance use disorders of
varying severity
•the very real risk of overdose death

Behavioral interventions help adolescents to actively participate
in their recovery from drug abuse and addiction and enhance
their ability to resist drug use.
• Adolescents can participate in group therapy and other peer
support programs during and following treatment to help them
achieve abstinence with the presence of trained counselors.
• Cognitive-Behavioral Therapy (CBT) - teaching participants
how to anticipate problems and helping them develop effective
coping strategies.
• Contingency Management (CM) provides adolescents an
opportunity to earn low-cost incentives such as prizes or cash
vouchers
Adolescent Substance Use Disorder Treatment

Family-based approaches to treating adolescent substance abuse
highlight the need to engage the family, including parents, siblings,
and sometimes peers, in the adolescent’s treatment.
Recovery Support Services
To reinforce gains made in treatment and to improve their quality of
life more generally, recovering adolescents may benefit from
recovery support services, which include continuing care, mutual
help groups, peer recovery support services, and recovery high
schools. Such programs provide a community setting where fellow
recovering persons can share their experiences, provide mutual
support to each other’s struggles with drug or alcohol problems,
and in other ways support a substance-free lifestyle.

Alcohol Use Disorders‡
Acamprosate (Campral®) reduces withdrawal symptoms by normalizing brain systems
disrupted by chronic alcohol consumption in adults.
Disulfiram (Antabuse®) inhibits an enzyme involved in the metabolism of alcohol, causing an
unpleasant reaction if alcohol is consumed after taking the medication.
Naltrexone decreases alcohol-induced euphoria and is available in both oral tablets and long-
acting injectable preparations (as in its use for the treatment of opioid addiction, above).
Addiction Medications
Several medications have been found to be effective in treating addiction
to opioids, alcohol, or nicotine in adults, although none of these
medications have been approved by the FDA to treat adolescents.
Nicotine Use Disorders
Bupropion, commonly prescribed for depression, also reduces nicotine cravings and withdrawal
symptoms in adult smokers.
Nicotine Replacement Therapies (NRTs) help smokers wean off cigarettes by activating
nicotine receptors in the brain. They are available in the form of a patch, gum, lozenge, nasal
spray, or inhaler.
Varenicline reduces nicotine cravings and withdrawal in adult smokers by mildly stimulating
nicotine receptors in the brain.

DEPRESSION
• Adolescence is always an unsettling time, with the many
physical, emotional, psychological and social changes that
accompany this stage of life. Unrealistic academic, social, or
family expectations can create a strong sense of rejection and
can lead to deep disappointment.
• When things go wrong at school or at home, teens often
overreact. Many young people feel that life is not fair or that
things "never go their way." They feel "stressed out" and
confused.
• To make matters worse, teens are bombarded by conflicting
messages from parents, friends and society.

• Adolescent depression is increasing at an alarming rate.
• Recent surveys indicate that as many as one in five teens
suffers from clinical depression. This is a serious problem that
calls for prompt, appropriate treatment nowadays.
• Depression can take several forms, including bipolar disorder
(formally called manic-depression), which is a condition that
alternates between periods of euphoria and depression.
• Depression can be difficult to diagnose in teens because adults
may expect teens to act moody.

These symptoms may indicate depression, particularly
when they last for more than two weeks:
•Poor performance in school
•Withdrawal from friends and activities
•Sadness and hopelessness
•Lack of enthusiasm, energy or motivation
•Anger and rage
•Overreaction to criticism
•Feelings of being unable to satisfy ideals
•Poor self-esteem or guilt
•Indecision, lack of concentration or forgetfulness
•Restlessness and agitation
•Changes in eating or sleeping patterns
•Substance abuse
•Problems with authority
•Suicidal thoughts or actions

Teens may experiment with drugs or alcohol or become sexually
promiscuous to avoid feelings of depression. Teens also may express
their depression through hostile, aggressive, risk-taking behavior.
Some of the most common ways to treat depression in adolescents are:
•Psychotherapy provides teens an opportunity to explore events and
feelings that are painful or troubling to them.
Psychotherapy also teaches them coping skills.
•Cognitive-behavioral therapy helps teens change negative patterns of
thinking and behaving.
•Interpersonal therapy focuses on how to develop healthier relationships at
home and at school.
•Medication relieves some symptoms of depression and is often prescribed
along with therapy.

SUICIDE
Studies show that suicide attempts among young people may be based on long-
standing problems triggered by a specific event. Suicidal adolescents may view
a temporary situation as a permanent condition. Feelings of anger and
resentment combined with exaggerated guilt can lead to impulsive, self-
destructive acts.
Warning Signs
•Suicide threats, direct and indirect
•Obsession with death
•Poems, essays and drawings that refer to death
•Giving away belongings
•Dramatic change in personality or appearance
•Irrational, bizarre behavior
•Overwhelming sense of guilt, shame or rejection
•Changed eating or sleeping patterns
•Severe drop in school performance

Helping Suicidal Teens
•Offer help and listen. Encourage depressed teens to talk about their
feelings. Listen, don’t lecture.
•Trust your instincts. If it seems that the situation may be serious,
seek prompt help. Break a confidence if necessary, in order to save
a life.
•Pay attention to talk about suicide. Ask direct questions and don’t
be afraid of frank discussions. Silence is deadly!
•Seek professional help. It is essential to seek expert advice from a
mental health professional who has experience helping depressed
teens. Also, alert key adults in the teen’s life — family, friends and
teachers.

EATING DISORDERS
Often, an eating disorder develops as a way for an adolescent to feel in
control about what's happening in their life.

• Like many adult females, some girls want to lose weight and be thin
and, like many adult males, some boys want to lose body fat, but
increase muscle mass. Some boys try to meet unrealistically thin
ideal standards.
• Dieting is common among adolescents. Eating disorders such as
anorexia or bulimia nervosa can be triggered by weight loss dieting.
• A person who crash diets (severely restricts calories for a period of
time), substantially increases their risk of developing an eating
disorder.
• Adolescents should not be encouraged to 'diet'.

Symptoms of eating disorders
Symptoms that should always be investigated further include:
•rapid weight loss or weight gain
•changes in weight or shape
•changes in behaviour around food
•excessive physical activity
•feelings of unhappiness with body shape and size.

Types of eating disorders
•anorexia nervosa - characterized by restricted eating, loss of weight
and a fear of putting on weight
•bulimia nervosa - periods of bingeing on high-kilojoule foods (often
in secret), followed by attempts to compensate by
over-exercising, vomiting, or periods of strict dieting.
•binge eating disorder - characterized by recurrent periods of binge
eating (can include eating much more than
normal, feeling uncomfortably full, eating large
amounts when not physically hungry).
•other specified feeding or eating disorder (OSFED) - feeding or eating
behaviours that cause the individual distress and
impairment, but do not meet criteria for the first three
eating disorders.

Psychological risk factors
•low self-esteem
•perfectionism
•difficulties expressing feelings like anger or anxiety
•being a 'people pleaser'
•difficulties being assertive with others
•fear of adulthood.
Biological factors
•adolescence and its associated physical changes
•genetic or familial factors - for example, families that are overtly
focused on food, weight, shape and appearance.

Social or environmental risk factors
•being teased or bullied
•a belief that high expectations from family and others must be met
•major life changes such as family break-up, or the accumulation of
many minor stressors
•peer pressure to behave in particular ways
•a parent or other role model who consistently diets or who is
unhappy with their body
•media and advertising images of the 'ideal body size and shape
as slim and fit
•a cultural tendency to judge people by their appearance.

Parents and teachers can help prevent eating disorders
Children are great imitators, so parents, teachers and other adults can
play an important role to help prevent eating disorders and promote
positive body image in young children.
Foster a healthy relationship with food
•Try not to label food as 'good' or 'bad' - this sets up cravings and
feelings of guilt when the 'bad' foods are eaten.
•Avoid using food as bribes or punishment.
•Accept that children are likely to have different eating habits from
adults - for instance, adolescents may require more food more
frequently during the day or may go through periods of liking or
disliking particular foods.
•Do not crash diet and don't try to put your child on a diet.
•Allow your child to eat when they are hungry and stop when they are
full. Don't force your child to eat everything on their plate.

Encourage older children and adolescents to feel good
about their bodies
•Show an acceptance of different body shapes and sizes, including
your own.
•Make a positive effort to portray your own body as functional and
well-designed.
•Demonstrate healthy eating and sensible exercise.
•Don't criticize or tease your children about their appearance.
•Encourage your children to 'listen' to their bodies and to become
familiar with different physical feelings and experiences.
•Encourage sport and regular exercise to help maintain your child's
healthy weight and foster their body confidence.

Encourage self-esteem
A strong sense of identity and self-worth is important to help older
children and adolescents cope with life pressures. You can:
•Help them to develop effective coping strategies.
•Encourage them to express their needs and wants, to make
decisions (and cope with the consequences) and to pursue things
they are good at.
•Allow them to say 'no'. Encourage them to be assertive if they
feel they have been mistreated.
•Help them develop a critical awareness of the images and
messages they receive from television and magazines.

JUVENILE DELINQUENCY
also known as "juvenile offending", is the act of participating in unlawful
behavior as minors (juveniles, i.e. individuals younger than the statutory age
of majority).

Juvenile Delinquents
Juvenile delinquents are often defined as children individuals younger
than the statutory age of majority who have committed a criminal act.
THERE ARE TWO MAIN TYPES OF OFFENDERS:
Repeat Offenders
• also known as “life-course persistent offenders.”
• These juvenile delinquents begin offending or showing other signs
of antisocial behavior during adolescence.
• They continue to engage in criminal activities or aggressive
behaviors even after they enter adulthood.

Age-Specific Offenders
• This type of juvenile delinquent behavior begins during adolescence.
• Unlike the repeat offenders however, the behaviors of the age-
specific offender ends before the minor becomes an adult.
• The behaviors that a juvenile shows during adolescence are often a
good indicator of the type of offender he will become. While age-
specific offenders leave their delinquent behavior behind when they
enter adulthood, they often have more mental health problems,
engage in substance abuse, and have greater financial problems
than adults who were never delinquent as juveniles.

Predictors of Juvenile Delinquency
Predictors of juvenile delinquencies may appear as early as preschool,
and often include:
•Abnormal or slow development of basic skills, such as speech and
language
•Chronic violation of the rules
•Serious aggressive behavior toward other students or teachers

Most common risk factors for juvenile delinquency:
•Authoritarian Parenting – characterized by the use of harsh
disciplinary methods, and refusal to justify disciplinary actions, other
than by saying “because I said so.”
•Peer Association – usually resulting from leaving adolescents
unsupervised, encouraging a child to engage in bad behaviors
when acting with his peer group.
•Low Socioeconomic Status
•Permissive Parenting – characterized by lack of consequences for
bad behavior, permissive parenting can be broken down into two
subcategories: (1) neglectful parenting, which is a lack of
monitoring a child’s activities, and (2) indulgent parenting, which is
the enablement of bad behavior.
•Poor School Performance
•Peer Rejection
•ADHD and other mental disorders

Preventing Juvenile Delinquency
Prevention services are offered by a number of government and private
agencies, and include such services as:
•Substance Abuse Treatment
•Family Counseling
•Individual Counseling
•Parenting Education
•Family Planning Services
The availability of education, and encouragement of minors in obtaining
an education, plays a large role in prevention of juvenile delinquency.
This is because education promotes social cohesion, and helps children
of all ages learn to make good choices, and to practice self-control.

PSYCHOSIS
Psychosis, an extreme mental state in which impaired thinking and
emotions cause a person to lose contact with reality. This could
mean hearing or seeing things that aren’t there (hallucinations), or
believing things that aren’t true (delusions).

Watching for Signs of Psychosis in Teens
The illness most often associated with psychosis, schizophrenia,
usually doesn’t show up until very late adolescence or early
adulthood. Recently, however, experts in the field have been
working to identify high-risk kids who show symptoms that could
serve as early warning signs of psychosis,
And since psychotic symptoms cause disruption across a
teenager’s life, from school to friendships to family, researchers
are hoping quick action can prevent impairment and prolong
typical functioning.

Affective disorder in adolescents (whether manic, depressive,
or mixed) can present with psychotic symptoms such as
delusions, hallucinations, or thought disorder. It may be
relatively easy to distinguish affective disorder from
schizophrenia when the patient has symptoms that are mood-
congruent with affective episodes and no clear negative
symptoms.

What are “prodromal” symptoms?
Prodromal symptoms are “attenuated” or weak symptoms of
psychosis. Moreover, “they are a warning sign,” says Dr. Christoph
Correll, the medical director of the Recognition and Prevention
Program (RAP) at Zucker Hillside Hospital in Queens, NY, which
specializes in diagnosing and treating early symptoms of mental
illness in teenagers and young adults.

Prodromal symptoms occur on a spectrum from very, very mild to severe:
•Withdrawing from friends and family/feeling suspicious of others
•Changes in sleeping or eating patterns
•Less concern with appearance, clothes or hygiene
•Difficulty organizing thoughts or speech
•Loss of usual interest in activities or of motivation and energy
•Development of unusual ideas or behaviors
•Unusual perceptions, such as visions or hearing voices (or even seeing
shadows)
•Feeling like things are unreal
•Change in personality
•Feelings of grandiosity (belief he has a superpower, etc
Adolescents occasionally present with nonspecific psychotic symptoms, such
as odd beliefs, mistrust of others, and magical thinking.
The prodromal phase

Treatment for prodromal psychotic symptoms
Several approaches for mild symptoms:
• Psycho-education: teaching both the child and the family more about
the symptoms and the illness.
• Cognitive behavioral therapy: “CBT can be good to change one’s
thinking patterns,” says Correll, “and also to address developing self-
esteem. We have to be careful that kids with a psychiatric diagnosis
don’t self-stigmatize and get into a hopeless or negative mode where
they feel they can’t achieve.”
• Lifestyle adjustments: Assessing whether the current school
environment is best for the child. Perhaps a therapeutic social group to
help the child cope.
• Reducing Stress: Stress is often a trigger for symptoms, so reducing
stress in these kids’ lives is crucial and may prevent or delay conversion
to psychotic illness.

While research in psychological and pharmacological interventions is
ongoing, specific clinical management is limited to continued
monitoring to identify those who may be at risk for a psychotic
episode and to address specific presenting problems with practical
and psychotherapeutic support.
Notwithstanding the ongoing debate about the role of active
pharmacological and psychological treatment of prodromal
symptoms of schizophrenia, any treatment option at this stage
requires an explanation to the patient and his or her parent or
caregiver. This should include information about the incomplete
evidence base and a detailed discussion of the relative risks and
benefits.

Adolescent disorders

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