The document discusses several topics related to counseling children and adolescents including: - Common clinical disorders diagnosed in children and adolescents such as mood disorders, anxiety disorders, ADHD, and autism spectrum disorders. - Factors that influence juvenile delinquency such as low intelligence, poor academic achievement, family dysfunction, and lack of basic needs. - The importance of assessing suicide risk in children and adolescents by evaluating ideation, intent, plans, means, as well as demographic, psychological and environmental risk factors. - The benefits of using a family support model for intervention which views the family as a system and builds on family strengths rather than focusing solely on the child's problems.

1. Techniques of Child and Adolescent Counseling dr. tracy mallett

2. Clinical Disorders Axis I

3. Main categories of clinical disorders Mood (depressive, bipolar) Anxiety (panic, PTSD, phobias, general) Adjustment (with or without mood or anxiety) Sexual (dysfunctions, paraphilias) Impulse control (intermittent explosive, pyromania) Substance-related Cognitive (delirium, dementia, amnestic) Dissociative (amnesia, fugue, identity) Somatoform (pain, hypochondriasis, body dysmorphic)

4. Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

5. Mental Retardation Mild Mental Retardation IQ 50-55 to 70 Moderate Mental Retardation IQ 35-40 to 50-55 Severe Mental Retardation IQ 20-25 to 35-40 Profound Mental Retardation IQ Below 20-25

6. Learning Disorders Reading Mathematics Disorder of Written Expression

7. Motor Skills Disorders Developmental Coordination Disorder

8. Communication Disorders Expressive Language Disorder Mixed Receptive-Expressive Language Disorder Phonological Disorder (formerly Developmental Articulation Disorder) Stuttering

9. Pervasive Developmental Disorders Autistic Disorder Rett’s Disorder Childhood Disintegrative Disorder Asperger’s Disorder

10. Attention-Deficit and Disruptive Behavior Disorders ADHD Conduct Disorder Oppositional Defiant Disorder

11. Feeding and eating disorders of infancy or early childhood Pica Rumination Disorder Feeding disorder of infancy or early childhood

12. Tic Disorders Tourette’s Disorder Chronic Motor or Vocal Tic Disorder Transient Tic Disorder (less than one year duration)

13. Elimination Disorders Enuresis Encopresis

14. Others Separation Anxiety Disorder Selective Mutism Reactive Attachment Disorder Stereotypic Movement Disorder

15. Personality Disorders Axis II

16. Eccentric disorders Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder

17. Paranoid Consistent suspiciousness, distrust in others Others’ motives are interpreted as attempts to harm Preoccupied with unjustified doubts about the truthfulness of others Reads demeaning/threatening meanings into the innocent actions of others Persistent grudge-bearing Frequent unjustified suspicions about the faithfulness of a domestic partner

18. Schizoid Pervasive pattern of detachment from social relationships Restricted expressed emotion Does not desire or enjoy close relationships Usually chooses solitary activities Little interest in sexual interaction Limited ability to take pleasure in activities Appears indifferent to others’ praise or criticism Demonstrates emotional coldness

19. Schizotypal Pnality Disordersoer Social and interpersonal deficits, marked by discomfort with and reduced capacity for close relationships Cognitive or perceptual distortions (such as extreme superstitiousness, belief in clairvoyance, telepathy, magical thinking) Eccentric or peculiar behavior

20. Dramatic disorders Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder

21. Anxious disorders Avoidant personality disorder Dependent personality disorder Obsessive-compulsive personality disorder

22. Assessment of suicide risk (Juhnke & Granello, 2005)

23. Risk Factors Demographics Depression/Hopelessness DSM disorders Substance use Recent previous suicide attempts Suicidal ideation Challenges to clear thinking Family dysfunction Access to lethal means Recent and chronic stressors

24. Demographics Gender: Women attempt more; men succeed more Gender and ethnicity: Most likely groups: Caucasian males Caucasian females African American males

25. Depression/Hopelessness Strong association between depressed mood and eventual suicide Assessment tool to determine level of hope: “ When do you believe things will get better for you?” The client’s response suggests whether hope for improvement exists.

26. Hopelessness, continued Ask, “What number between 0 and 10 best reflects how you see your current concerns over time?” A response of 0 to 4 indicates a high degree of hopelessness; this client is at greater risk of suicide.

27. DSM Disorders There is a high correlation between completed suicide and co-existing Axis I or Axis II disorders Predominant are affective disorders and substance abuse disorders People with personality disorders with coexisting impulse control disorders are also at high risk.

28. Substance use Clients who abuse substances or binge on substances are at increased risk Note that such clients are not necessarily diagnosable as substance dependent Many clients present as more impulsive, reckless and daring when under the influence Suicide risk should ALWAYS be assessed when you realize a client abuses substances.

29. Recent suicide attempts One of the best predictors for suicide risk, particularly when the attempt was highly lethal. When people attempt suicide and live, they may become less fearful of their own death. They may also learn to be more successful in their attempt (they may learn from their “mistakes”)

30. Suicidal ideation Suicidal thoughts may escalate, and become central to their daily lives Ultimately, everything they do revolves around suicide.

31. Challenges to clear thinking If a client is impeded in adaptive problem solving or clear thinking, they are at increased risk Examples: Experiencing strong emotions such as anger or betrayal; symptoms of a DSM disorder; being out of touch with reality

32. Family dysfunction Physical, emotional or sexual abuse Previous suicidal modeling Poor problem solving

33. Access to lethal means Can the client get access to a potentially lethal method? Examples: firearms, hanging, self-asphyxiation (car exhast), overdose

34. Recent and chronic stressors Poor relational supports Chronic disease Poverty Poor cultural adjustment Marital discord Job loss Life transition

35. Assessing for suicidality Ideation : thoughts of taking one’s own life, or preoccupation with leaving a situation Intent : Making a decision to take one’s life Plan : having a specific idea of method of suicide Means : having the materials and opportunity to carry out the plan

36. Juvenile delinquency

37. Effectiveness Safety and security Love and belonging Self-actualization Basic Needs: Food, clothing, shelter Maslow’s Hierarchy of Needs

38. Low intelligence Poor academic achievement Small vocabulary Poor verbal reasoning Poor executive functioning Predictors of chronic delinquency

39. Traditional measurement instruments have a focus on pathology Increasing attention is being paid to evaluating children’s programs from a strengths perspective Newer, strengths-based instruments have been more commonly used Evaluation of delinquency

40. Specific areas of evaluation Family Evaluation of the family is important in determining the cause of delinquent behavior. Aggressive children tend to come from families with high levels of hostility and aggression. An assessment needs to address the types of emotional supports available.

41. Families of aggressive children frequently have the following characteristics: High levels of hostility and aggression A history of maltreatment Physical fighting Cycles of coercive behavior High parental rejection Physical punishment Parental ineffectiveness Family disorganization Absence of father Conflict between parents

42. Chronic adult offenders commonly begin their careers as chronic juvenile offenders. This suggests that intervention strategies which are initiated early have the best chance of changing juveniles’ behavior, before the criminal behavior is ingrained into the child’s skill repertoire. Possibilities for intervention include family- and school-based programs

43. In the early part of the 20th century the emphasis of treatment for children was on the individual and focused on assisting the child to successfully adapt to the presenting environment. The climate of treatment for children has since shifted to include the family and community in intervention efforts

44. Family Support Model Families are viewed from a health-promotion framework rather than a pathology-based model Uses collaboration between family and professionals for goal determination and intervention strategy Builds upon inherent strengths

45. Goals of the Family Support Model Strengthening the family unit Enhancing growth of individual family members Empowering the family to gain more adaptive skills Enabling the family to require fewer professional interventions in the long run

46. Use of family support model Involves assessing the child as an integral part of a larger family system Considers it counterproductive to attempt to provide services to the child alone The family’s unique set of resources is utilized Resources may include the strength of the marital relationship; individual coping skills of the parents; extended family and/or community support; and the problem-solving abilities of the family as a whole

47. Personal issues

48. Managing personal issues The bottom line: If you do not have a good understanding of your “personal baggage,” and develop adaptive coping skills for addressing it, you will have a difficult time in clinical practice. It is NOT appropriate to enter this field as a way to understand and/or deal with personal issues. These should be resolved – or healthfully addressed - prior to beginning practice.

49. Resources thought helpful by dr. mallett

50. Talking to Children about Sex Age 6 to 9: Harris, R. (2004). It’s so amazing!. Cambridge, Mass: Candlewick Press Age 10 and up: Harris, R. (2004). It’s perfectly normal. Cambridge, Mass: Candlewick Press.

51. “ Body Safety” Koke, S. (1995). My body is mine, my feelings are mine. Plainview, NY: Childsplay LLC. (or, teaching children to be safe from sexual abuse)

52. Sexual Abuse Resources Kahn, Timothy J. (1999). Pathways: a guided workbook for youth beginning treatment. Brandon, VT: The Safer Society Press. Steen, Charlene. (1998). The Conduct Management Workbook. Brandon, VT: The Safer Society Press.

53. Oppositional Child Resources Barkley, R. (1997). Defiant children: A clinician’s manual for assessment and parent training. New York: Guliford Press. Berg, B. (1992). The Conduct Management Workbook. Dayton, OH: Cognitive Therapeutics.

54. Foster/Adoptive Families Delaney, Richard. (1997). The healing power of the family. (1997). Oklahoma City, OK: Wood ‘n Barnes Publishing. An array of materials from Boys Town Press: www.girlsandboystown.org/btpress

55. References Marsh. E.J. & Barkley, R.A. (1998). Treatment of Childhood Disorders. New York: Gulliford Press.

56. Play Therapy