Techniques of  Child and Adolescent Counseling dr. tracy mallett
Clinical Disorders Axis I
Main categories of clinical disorders <ul><li>Mood (depressive, bipolar) </li></ul><ul><li>Anxiety (panic, PTSD, phobias, ...
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Mental Retardation <ul><li>Mild Mental Retardation </li></ul><ul><li>IQ 50-55 to 70 </li></ul><ul><li>Moderate Mental Reta...
Learning Disorders <ul><li>Reading </li></ul><ul><li>Mathematics </li></ul><ul><li>Disorder of Written Expression </li></ul>
Motor Skills Disorders <ul><li>Developmental Coordination Disorder </li></ul>
Communication Disorders <ul><li>Expressive Language Disorder </li></ul><ul><li>Mixed Receptive-Expressive Language Disorde...
Pervasive Developmental Disorders <ul><li>Autistic Disorder </li></ul><ul><li>Rett’s Disorder </li></ul><ul><li>Childhood ...
Attention-Deficit and Disruptive Behavior Disorders <ul><li>ADHD </li></ul><ul><li>Conduct Disorder </li></ul><ul><li>Oppo...
Feeding and eating disorders of infancy or early childhood <ul><li>Pica </li></ul><ul><li>Rumination Disorder </li></ul><u...
Tic Disorders <ul><li>Tourette’s Disorder </li></ul><ul><li>Chronic Motor or Vocal Tic Disorder </li></ul><ul><li>Transien...
Elimination Disorders <ul><li>Enuresis </li></ul><ul><li>Encopresis </li></ul>
Others <ul><li>Separation Anxiety Disorder </li></ul><ul><li>Selective Mutism </li></ul><ul><li>Reactive Attachment Disord...
Personality Disorders Axis II
Eccentric disorders <ul><li>Paranoid personality disorder </li></ul><ul><li>Schizoid personality disorder </li></ul><ul><l...
Paranoid   <ul><li>Consistent suspiciousness, distrust in others </li></ul><ul><li>Others’ motives are interpreted as atte...
Schizoid <ul><li>Pervasive pattern of detachment from social relationships </li></ul><ul><li>Restricted expressed emotion ...
Schizotypal Pnality Disordersoer <ul><li>Social and interpersonal deficits, marked by discomfort with and reduced capacity...
Dramatic disorders <ul><li>Antisocial personality disorder </li></ul><ul><li>Borderline personality disorder </li></ul><ul...
Anxious disorders <ul><li>Avoidant personality disorder </li></ul><ul><li>Dependent personality disorder </li></ul><ul><li...
Assessment of suicide risk (Juhnke & Granello, 2005)
Risk Factors <ul><li>Demographics </li></ul><ul><li>Depression/Hopelessness </li></ul><ul><li>DSM disorders </li></ul><ul>...
Demographics <ul><li>Gender: Women attempt more; men succeed more </li></ul><ul><li>Gender and ethnicity: </li></ul><ul><l...
Depression/Hopelessness <ul><li>Strong association between depressed mood and eventual suicide </li></ul><ul><li>Assessmen...
Hopelessness, continued <ul><li>Ask, “What number between 0 and 10 best reflects how you see your current concerns over ti...
DSM Disorders <ul><li>There is a high correlation between completed suicide and co-existing Axis I or Axis II disorders </...
Substance use <ul><li>Clients who abuse substances or binge on substances are at increased risk </li></ul><ul><li>Note tha...
Recent suicide attempts <ul><li>One of the best predictors for suicide risk, particularly when the attempt was highly leth...
Suicidal ideation <ul><li>Suicidal thoughts may escalate, and become central to their daily lives  </li></ul><ul><li>Ultim...
Challenges to clear thinking <ul><li>If a client is impeded in adaptive problem solving or clear thinking, they are at inc...
Family dysfunction <ul><li>Physical, emotional or sexual abuse </li></ul><ul><li>Previous suicidal modeling </li></ul><ul>...
Access to lethal means <ul><li>Can the client get access to a potentially lethal method? </li></ul><ul><li>Examples: firea...
Recent and chronic stressors <ul><li>Poor relational supports </li></ul><ul><li>Chronic disease </li></ul><ul><li>Poverty ...
Assessing for suicidality <ul><li>Ideation : thoughts of taking one’s own life, or preoccupation with leaving a situation ...
Juvenile delinquency
Effectiveness Safety and security Love and belonging Self-actualization Basic Needs: Food, clothing, shelter Maslow’s Hier...
<ul><li>Low intelligence </li></ul><ul><li>Poor academic achievement </li></ul><ul><li>Small vocabulary </li></ul><ul><li>...
<ul><li>Traditional measurement instruments have a focus on pathology  </li></ul><ul><li>Increasing attention is being pai...
Specific areas of evaluation <ul><li>Family </li></ul><ul><li>Evaluation of the family is important in determining the cau...
Families of aggressive children frequently have the following characteristics: <ul><li>High levels of hostility and aggres...
<ul><li>Chronic adult offenders commonly begin their careers as chronic juvenile offenders. </li></ul><ul><li>This suggest...
<ul><li>In the early part of the 20th century the emphasis of treatment for children was on the individual and focused on ...
Family Support Model <ul><li>Families are viewed from a health-promotion framework rather than a pathology-based model </l...
Goals of the Family Support Model <ul><li>Strengthening the family unit </li></ul><ul><li>Enhancing growth of individual f...
Use of family support model <ul><li>Involves assessing the child as an integral part of a larger family system  </li></ul>...
<ul><li>Personal issues </li></ul>
Managing personal issues <ul><li>The bottom line:  </li></ul><ul><li>If you do not have a good understanding of your “pers...
Resources thought helpful by dr. mallett
Talking to Children about Sex <ul><li>Age 6 to 9: </li></ul><ul><li>Harris, R. (2004). It’s so amazing!. Cambridge, Mass: ...
“ Body Safety” <ul><li>Koke, S. (1995). My body is mine, my feelings are mine. Plainview, NY: Childsplay LLC.  </li></ul>(...
Sexual Abuse Resources <ul><li>Kahn, Timothy J. (1999). Pathways: a guided workbook for youth beginning treatment. Brandon...
Oppositional Child Resources <ul><li>Barkley, R. (1997). Defiant children: A clinician’s manual for assessment and parent ...
Foster/Adoptive Families <ul><li>Delaney, Richard. (1997). The healing power of the family. (1997). Oklahoma City, OK: Woo...
References <ul><li>Marsh. E.J. & Barkley, R.A. (1998). Treatment of Childhood Disorders. New York: Gulliford Press. </li><...
Play Therapy
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Child/Adolescent assessment and treatment

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Child/Adolescent assessment and treatment

  1. 1. Techniques of Child and Adolescent Counseling dr. tracy mallett
  2. 2. Clinical Disorders Axis I
  3. 3. Main categories of clinical disorders <ul><li>Mood (depressive, bipolar) </li></ul><ul><li>Anxiety (panic, PTSD, phobias, general) </li></ul><ul><li>Adjustment (with or without mood or anxiety) </li></ul><ul><li>Sexual (dysfunctions, paraphilias) </li></ul><ul><li>Impulse control (intermittent explosive, pyromania) </li></ul><ul><li>Substance-related </li></ul><ul><li>Cognitive (delirium, dementia, amnestic) </li></ul><ul><li>Dissociative (amnesia, fugue, identity) </li></ul><ul><li>Somatoform (pain, hypochondriasis, body dysmorphic) </li></ul>
  4. 4. Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
  5. 5. Mental Retardation <ul><li>Mild Mental Retardation </li></ul><ul><li>IQ 50-55 to 70 </li></ul><ul><li>Moderate Mental Retardation </li></ul><ul><li>IQ 35-40 to 50-55 </li></ul><ul><li>Severe Mental Retardation </li></ul><ul><li>IQ 20-25 to 35-40 </li></ul><ul><li>Profound Mental Retardation </li></ul><ul><li>IQ Below 20-25 </li></ul>
  6. 6. Learning Disorders <ul><li>Reading </li></ul><ul><li>Mathematics </li></ul><ul><li>Disorder of Written Expression </li></ul>
  7. 7. Motor Skills Disorders <ul><li>Developmental Coordination Disorder </li></ul>
  8. 8. Communication Disorders <ul><li>Expressive Language Disorder </li></ul><ul><li>Mixed Receptive-Expressive Language Disorder </li></ul><ul><li>Phonological Disorder </li></ul><ul><li>(formerly Developmental Articulation Disorder) </li></ul><ul><li>Stuttering </li></ul>
  9. 9. Pervasive Developmental Disorders <ul><li>Autistic Disorder </li></ul><ul><li>Rett’s Disorder </li></ul><ul><li>Childhood Disintegrative Disorder </li></ul><ul><li>Asperger’s Disorder </li></ul>
  10. 10. Attention-Deficit and Disruptive Behavior Disorders <ul><li>ADHD </li></ul><ul><li>Conduct Disorder </li></ul><ul><li>Oppositional Defiant Disorder </li></ul>
  11. 11. Feeding and eating disorders of infancy or early childhood <ul><li>Pica </li></ul><ul><li>Rumination Disorder </li></ul><ul><li>Feeding disorder of infancy or early childhood </li></ul>
  12. 12. Tic Disorders <ul><li>Tourette’s Disorder </li></ul><ul><li>Chronic Motor or Vocal Tic Disorder </li></ul><ul><li>Transient Tic Disorder </li></ul><ul><li>(less than one year duration) </li></ul>
  13. 13. Elimination Disorders <ul><li>Enuresis </li></ul><ul><li>Encopresis </li></ul>
  14. 14. Others <ul><li>Separation Anxiety Disorder </li></ul><ul><li>Selective Mutism </li></ul><ul><li>Reactive Attachment Disorder </li></ul><ul><li>Stereotypic Movement Disorder </li></ul>
  15. 15. Personality Disorders Axis II
  16. 16. Eccentric disorders <ul><li>Paranoid personality disorder </li></ul><ul><li>Schizoid personality disorder </li></ul><ul><li>Schizotypal personality disorder </li></ul>
  17. 17. Paranoid <ul><li>Consistent suspiciousness, distrust in others </li></ul><ul><li>Others’ motives are interpreted as attempts to harm </li></ul><ul><li>Preoccupied with unjustified doubts about the truthfulness of others </li></ul><ul><li>Reads demeaning/threatening meanings into the innocent actions of others </li></ul><ul><li>Persistent grudge-bearing </li></ul><ul><li>Frequent unjustified suspicions about the faithfulness of a domestic partner </li></ul>
  18. 18. Schizoid <ul><li>Pervasive pattern of detachment from social relationships </li></ul><ul><li>Restricted expressed emotion </li></ul><ul><li>Does not desire or enjoy close relationships </li></ul><ul><li>Usually chooses solitary activities </li></ul><ul><li>Little interest in sexual interaction </li></ul><ul><li>Limited ability to take pleasure in activities </li></ul><ul><li>Appears indifferent to others’ praise or criticism </li></ul><ul><li>Demonstrates emotional coldness </li></ul>
  19. 19. Schizotypal Pnality Disordersoer <ul><li>Social and interpersonal deficits, marked by discomfort with and reduced capacity for close relationships </li></ul><ul><li>Cognitive or perceptual distortions (such as extreme superstitiousness, belief in clairvoyance, telepathy, magical thinking) </li></ul><ul><li>Eccentric or peculiar behavior </li></ul>
  20. 20. Dramatic disorders <ul><li>Antisocial personality disorder </li></ul><ul><li>Borderline personality disorder </li></ul><ul><li>Histrionic personality disorder </li></ul><ul><li>Narcissistic personality disorder </li></ul>
  21. 21. Anxious disorders <ul><li>Avoidant personality disorder </li></ul><ul><li>Dependent personality disorder </li></ul><ul><li>Obsessive-compulsive personality disorder </li></ul>
  22. 22. Assessment of suicide risk (Juhnke & Granello, 2005)
  23. 23. Risk Factors <ul><li>Demographics </li></ul><ul><li>Depression/Hopelessness </li></ul><ul><li>DSM disorders </li></ul><ul><li>Substance use </li></ul><ul><li>Recent previous suicide attempts </li></ul><ul><li>Suicidal ideation </li></ul><ul><li>Challenges to clear thinking </li></ul><ul><li>Family dysfunction </li></ul><ul><li>Access to lethal means </li></ul><ul><li>Recent and chronic stressors </li></ul>
  24. 24. Demographics <ul><li>Gender: Women attempt more; men succeed more </li></ul><ul><li>Gender and ethnicity: </li></ul><ul><li>Most likely groups: </li></ul><ul><li>Caucasian males </li></ul><ul><li>Caucasian females </li></ul><ul><li>African American males </li></ul>
  25. 25. Depression/Hopelessness <ul><li>Strong association between depressed mood and eventual suicide </li></ul><ul><li>Assessment tool to determine level of hope: </li></ul><ul><li>“ When do you believe things will get better for you?” </li></ul><ul><li>The client’s response suggests whether hope for improvement exists. </li></ul>
  26. 26. Hopelessness, continued <ul><li>Ask, “What number between 0 and 10 best reflects how you see your current concerns over time?” </li></ul><ul><li>A response of 0 to 4 indicates a high degree of hopelessness; this client is at greater risk of suicide. </li></ul>
  27. 27. DSM Disorders <ul><li>There is a high correlation between completed suicide and co-existing Axis I or Axis II disorders </li></ul><ul><li>Predominant are affective disorders and substance abuse disorders </li></ul><ul><li>People with personality disorders with coexisting impulse control disorders are also at high risk. </li></ul>
  28. 28. Substance use <ul><li>Clients who abuse substances or binge on substances are at increased risk </li></ul><ul><li>Note that such clients are not necessarily diagnosable as substance dependent </li></ul><ul><li>Many clients present as more impulsive, reckless and daring when under the influence </li></ul><ul><li>Suicide risk should ALWAYS be assessed when you realize a client abuses substances. </li></ul>
  29. 29. Recent suicide attempts <ul><li>One of the best predictors for suicide risk, particularly when the attempt was highly lethal. </li></ul><ul><li>When people attempt suicide and live, they may become less fearful of their own death. </li></ul><ul><li>They may also learn to be more successful in their attempt (they may learn from their “mistakes”) </li></ul>
  30. 30. Suicidal ideation <ul><li>Suicidal thoughts may escalate, and become central to their daily lives </li></ul><ul><li>Ultimately, everything they do revolves around suicide. </li></ul>
  31. 31. Challenges to clear thinking <ul><li>If a client is impeded in adaptive problem solving or clear thinking, they are at increased risk </li></ul><ul><li>Examples: Experiencing strong emotions such as anger or betrayal; symptoms of a DSM disorder; being out of touch with reality </li></ul>
  32. 32. Family dysfunction <ul><li>Physical, emotional or sexual abuse </li></ul><ul><li>Previous suicidal modeling </li></ul><ul><li>Poor problem solving </li></ul>
  33. 33. Access to lethal means <ul><li>Can the client get access to a potentially lethal method? </li></ul><ul><li>Examples: firearms, hanging, self-asphyxiation (car exhast), overdose </li></ul>
  34. 34. Recent and chronic stressors <ul><li>Poor relational supports </li></ul><ul><li>Chronic disease </li></ul><ul><li>Poverty </li></ul><ul><li>Poor cultural adjustment </li></ul><ul><li>Marital discord </li></ul><ul><li>Job loss </li></ul><ul><li>Life transition </li></ul>
  35. 35. Assessing for suicidality <ul><li>Ideation : thoughts of taking one’s own life, or preoccupation with leaving a situation </li></ul><ul><li>Intent : Making a decision to take one’s life </li></ul><ul><li>Plan : having a specific idea of method of suicide </li></ul><ul><li>Means : having the materials and opportunity to carry out the plan </li></ul>
  36. 36. Juvenile delinquency
  37. 37. Effectiveness Safety and security Love and belonging Self-actualization Basic Needs: Food, clothing, shelter Maslow’s Hierarchy of Needs
  38. 38. <ul><li>Low intelligence </li></ul><ul><li>Poor academic achievement </li></ul><ul><li>Small vocabulary </li></ul><ul><li>Poor verbal reasoning </li></ul><ul><li>Poor executive functioning </li></ul>Predictors of chronic delinquency
  39. 39. <ul><li>Traditional measurement instruments have a focus on pathology </li></ul><ul><li>Increasing attention is being paid to evaluating children’s programs from a strengths perspective </li></ul><ul><li>Newer, strengths-based instruments have been more commonly used </li></ul>Evaluation of delinquency
  40. 40. Specific areas of evaluation <ul><li>Family </li></ul><ul><li>Evaluation of the family is important in determining the cause of delinquent behavior. </li></ul><ul><li>Aggressive children tend to come from families with high levels of hostility and aggression. </li></ul><ul><li>An assessment needs to address the types of emotional supports available. </li></ul>
  41. 41. Families of aggressive children frequently have the following characteristics: <ul><li>High levels of hostility and aggression </li></ul><ul><li>A history of maltreatment </li></ul><ul><li>Physical fighting </li></ul><ul><li>Cycles of coercive behavior </li></ul><ul><li>High parental rejection </li></ul><ul><li>Physical punishment </li></ul><ul><li>Parental ineffectiveness </li></ul><ul><li>Family disorganization </li></ul><ul><li>Absence of father </li></ul><ul><li>Conflict between parents </li></ul>
  42. 42. <ul><li>Chronic adult offenders commonly begin their careers as chronic juvenile offenders. </li></ul><ul><li>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. </li></ul><ul><li>Possibilities for intervention include family- and school-based programs </li></ul>
  43. 43. <ul><li>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. </li></ul><ul><li>The climate of treatment for children has since shifted to include the family and community in intervention efforts </li></ul>
  44. 44. Family Support Model <ul><li>Families are viewed from a health-promotion framework rather than a pathology-based model </li></ul><ul><li>Uses collaboration between family and professionals for goal determination and intervention strategy </li></ul><ul><li>Builds upon inherent strengths </li></ul>
  45. 45. Goals of the Family Support Model <ul><li>Strengthening the family unit </li></ul><ul><li>Enhancing growth of individual family members </li></ul><ul><li>Empowering the family to gain more adaptive skills </li></ul><ul><li>Enabling the family to require fewer professional interventions in the long run </li></ul>
  46. 46. Use of family support model <ul><li>Involves assessing the child as an integral part of a larger family system </li></ul><ul><li>Considers it counterproductive to attempt to provide services to the child alone </li></ul><ul><li>The family’s unique set of resources is utilized </li></ul><ul><li>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 </li></ul>
  47. 47. <ul><li>Personal issues </li></ul>
  48. 48. Managing personal issues <ul><li>The bottom line: </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>
  49. 49. Resources thought helpful by dr. mallett
  50. 50. Talking to Children about Sex <ul><li>Age 6 to 9: </li></ul><ul><li>Harris, R. (2004). It’s so amazing!. Cambridge, Mass: Candlewick Press </li></ul><ul><li>Age 10 and up: </li></ul><ul><li>Harris, R. (2004). It’s perfectly normal. Cambridge, Mass: Candlewick Press. </li></ul>
  51. 51. “ Body Safety” <ul><li>Koke, S. (1995). My body is mine, my feelings are mine. Plainview, NY: Childsplay LLC. </li></ul>(or, teaching children to be safe from sexual abuse)
  52. 52. Sexual Abuse Resources <ul><li>Kahn, Timothy J. (1999). Pathways: a guided workbook for youth beginning treatment. Brandon, VT: The Safer Society Press. </li></ul><ul><li>Steen, Charlene. (1998). The Conduct Management Workbook. Brandon, VT: The Safer Society Press. </li></ul>
  53. 53. Oppositional Child Resources <ul><li>Barkley, R. (1997). Defiant children: A clinician’s manual for assessment and parent training. New York: Guliford Press. </li></ul><ul><li>Berg, B. (1992). The Conduct Management Workbook. Dayton, OH: Cognitive Therapeutics. </li></ul>
  54. 54. Foster/Adoptive Families <ul><li>Delaney, Richard. (1997). The healing power of the family. (1997). Oklahoma City, OK: Wood ‘n Barnes Publishing. </li></ul><ul><li>An array of materials from Boys Town Press: </li></ul><ul><li>www.girlsandboystown.org/btpress </li></ul>
  55. 55. References <ul><li>Marsh. E.J. & Barkley, R.A. (1998). Treatment of Childhood Disorders. New York: Gulliford Press. </li></ul>
  56. 56. Play Therapy

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