We must have mental health diagnoses to bill insurances. They help guide treatment as well.
While we need mental health diagnoses for treatment, it is important to treat the youth as an individual not based on a diagnosis.
Unfortunately a lot of our youth have heard their diagnosis over time and start believing that is who they are. They identify with the disorder and may have the belief that they cannot change. The youth need to hear that they can change and you are there to help them.
There may be other diagnoses that youth have. Learn more about the diagnosis including what you can do to reduce the symptoms. Your consultant can help identify skills related to disorders.
Four of more of these symptoms must be present for at least six months. Some of these behaviors are typical in children and adolescents, that’s why there needs to be a clear pattern to be diagnosed with ODD.
Your relationship with your youth can make a huge difference.
The four basic skills of following instructions, accepting feedback, accepting no answers, and disagreeing appropriately will help the youth become more teachable.
Make sure to avoid power struggles with youth. Model your expectations and be consistent.
Six or more of these symptoms must be present consistently for six months to meet criteria for this diagnosis. Remember that some of these behaviors are normal in children and adolescents. Look for clear patterns of behaviors. Youth cannot be diagnosed with ADHD before becoming school age. Some of these symptoms can also be caused by anxiety or trauma. Let the therapist be the one to determine the appropriate diagnosis.
Skills can help to reduce symptoms. Just like a medical condition, youth must learn to work around this diagnosis. Don’t allow them to use it as an excuse for behaviors such as “I’m ADHD, that’s why I can’t do good in school”.
Working with youths' mental healt diagnosis
Wor king with Youths’ Mental Health Dia gnosis
Mental Health Disorders• A mental health diagnosis is defined as the identification and labeling of a disease based on it’s signs and symptoms.• One of the main purposes of diagnosis is to guide treatment planning.• Based on the diagnosis, treatment providers can apply treatments that have been proven effective.
Diagnosis vs. Labeling• Diagnosis may have unintended effects of labeling.• Many youth feel affected by the label the disorder has been given.• Youth may feel stigmatized which may impact how they view themselves.• Therefore, it is important when working with youth to see them as a person and not a diagnosis.
What can you do?• Avoid labeling terms including words that are used as part of their diagnosis.• Help the youth understand he/she is not the diagnosis.• Help youth see how they can overcome the symptoms associated with the diagnosis.• Teach skills that will help reduce the symptoms.
Common diagnosis for the youth we work with• Oppositional Defiant Disorder/Conduct Disorder• Attention Deficit/Hyperactivity Disorder• Post Traumatic Stress Disorder• Reactive Attachment Disorder• Major Depressive Disorder/Mood Disorders• Disorders related to sexual abuse and sexual offending issues
Oppositional Defiant Disorder• Associated behaviors/symptoms: – Often loses temper – Often argues with adults – Refuses to comply with requests from adults/rules – Blames others for his/her behaviors – Touchy or easily annoyed – Often angry and resentful – Behaviors cause significant impairment in social or academic functioning
Oppositional Defiant Disorder• Remember that these youth can be distrustful of authority figures.• Often the behaviors they display are what was modeled for them.• This is not a disorder they were born with.• It is treatable and does not have to be a life long diagnosis.
Oppositional Defiant Disorder• Skills that you can teach: – Following instructions – Accepting consequences – Controlling emotions – Communicating honestly – Following rules – Seeking positive attention – Disagreeing appropriately
Oppositional Defiant Disorder• Other things you can do: – Build positive relationships with your youth – Set clear expectations – Be consistent in what you teach to – Maintain low tolerances – Praise when youth engage in behaviors opposite of presenting behaviors
Attention Deficit/Hyperactivity Disorder• Associated behaviors/symptoms: -Often fails to give close attention to schoolwork -Has difficulty sustaining attention in tasks or play -Seems not to listen even when spoken to directly -Often does not follow through on instructions and fails to finish schoolwork, chores, or other tasks -Has difficulty organizing tasks -Often forgetful in daily activities
Attention Deficit/Hyperactivity Disorder• Associated behaviors/symptoms: -Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort -Often loses things necessary for tasks or activities -Is often easily distracted by extraneous stimuli -Often fidgets with hands or feet, squirms in seat -Often leaves set in classroom or other settings -Often talks excessively
Attention Deficit/Hyperactivity Disorder• Associated behaviors/symptoms: -Seems to be driven by a motor -Often runs about or climbs excessively in inappropriate situations -Has difficulty playing or engaging in leisure activities quietly -Often blurts out questions before questions have been completed -Often interrupts others’ conversations or activities -Has difficulty awaiting turn
Attention Deficit/Hyperactivity Disorder• ADHD can be treated with medication and therapy• Boys are more likely primarily hyperactive• Girls are frequently undiagnosed as they tend to be quietly inattentive• Most children and adolescents with ADHD grow up to be normal adults
Attention Deficit/Hyperactivity Disorder• Skills that you can teach: -Following instructions -Accepting criticism -Appropriate voice tone -Ignoring distractions by others -Waiting your turn -Sharing attention with others -Time management
Attention Deficit/Hyperactivity Disorder• Skills that you can teach: -Seeking positive attention -Completing tasks -Dealing with frustration -Listening to others -Delaying gratification
Attention Deficit/Hyperactivity Disorder• Other things you can do: -Work as a team with therapists, teachers, parents, and physicians -Try to keep a regular schedule with meals and bedtime -Work on organization -Be realistic with your expectations -Identify difficult situations -Be patient
Posttraumatic Stress Disorder• Associated behaviors/symptoms: -Flashbacks or reliving the traumatic event for minutes or even days at a time -Upsetting dreams about the traumatic event -Trying to avoid thinking or talking about the traumatic event -Avoiding activities that were once enjoyed -Hopelessness about the future -Memory problems
Posttraumatic Stress Disorder• Associated behaviors/symptoms: -Difficulty falling or staying asleep -Irritability or outbursts of anger -Difficulty concentrating -Being easily startled or frightened -Hearing or seeing things that aren’t there -Overwhelming guilt or shame -Self destructive behaviors
Posttraumatic Stress Disorder• Remember that for a youth to have this diagnosis means they experienced, witnessed, or were confronted with an event that was threatening or resulted in injury• The youth experienced intense fear, helplessness or horrors during the event• Events such as domestic violence, sexual, physical, or sexual abuse can create trauma• Symptoms may come and go
Posttraumatic Stress Disorder• Skills that you can teach: -Expressing emotions -Coping with sad feelings -Asking for help -Structured problem solving -Stress management -Stress management -Relaxation strategies
Posttraumatic Stress Disorder• Other things you can do: -Build a positive relationships with your youth so they will feel safe in talking to you -Create a safe environment for the youth -Encourage physical exercise or meditation -Help redirect the youth when they appear anxious -Encourage rest and a proper diet -Take care of yourself so you can support the youth
Reactive Attachment Disorder• Associated behaviors/symptoms: -Withdrawing from others -Avoiding or dismissing comforting comments or gestures -Acting aggressively towards peers -Watching others closely but not engaging in social interactions -Failing to ask for support or assistance
Reactive Attachment Disorder• Associated behaviors/symptoms: -Obvious and consistent awkwardness or discomfort -Masking feelings of anger or distress -Alcohol or drug abuse in adolescents -”Push away” behaviors such as limit testing to see if you will “reject” them -Seeking attention from everyone including strangers -Difficulty forming and maintaining healthy relationships
Reactive Attachment Disorder• Beyond childhood years, the disorder may lead to delinquent behaviors, difficulty with peers• After childhood years, adolescents who have been diagnosed with RAD often shift to the diagnosis of oppositional defiant disorder• While treatment can help, the disorder is a lifelong problem
Reactive Attachment Disorder• Skills that you can teach: -Seeking positive attention -Accepting “no” answers -Appropriate boundaries -Following instructions -Choosing appropriate friends -Displaying appropriate affection
Reactive Attachment Disorder• Other things you can do: -Use comforting physical contact to help develop a relationship -Model healthy relationships -Provide a safe, stable, and predictable living environment for the youth -Help develop the youth’s self esteem -Remember that you may give more than you receive
Depression/Mood Disorders• Associated behaviors/symptoms (Depression): -Depressed mood most of the day -Loss of interest in pleasurable activities -Insomnia or excessive sleeping -Irritability or angry outbursts -Changes in appetite -Agitation or restlessness
Depression/Mood Disorders• Associated behaviors/symptoms (Depression): -Feelings or worthlessness or guilt -Trouble thinking, concentrating, making decisions, and remembering -Frequent thoughts of death, dying, or suicide -Frequent crying spells for no clear reason -Unexplained physical problems such as headaches, stomachaches, or back pain
Depression/Mood Disorders• Associated behaviors/symptoms (Mood disorders): -Same as depression plus… -Impulsive behaviors -Abnormally high energy levels -Talking fast or switching topics rapidly -Racing thoughts -Poor judgment -Mood swings
Depression/Mood Disorders• These disorders may be hereditary• Certain life events can trigger the disorders• Complications of these disorders can include alcohol abuse, problems with relationships, suicide ideation or attempts, health problems• Medication and cognitive behavioral therapy may be used to treat symptoms
Depression/Mood Disorders• Skills that you can teach: -Identifying and expressing feelings appropriately -Coping with change/sad feelings -Self-talk or instructions -Decision making -Use of leisure time -Accepting self/positive self statements -Thought stopping
Depression/Mood Disorders• Other things you can do: -Encourage your youth to get sleep and exercise -Get your youth involved in activities outside of the home -Follow the treatment plan including prescribed medication and therapy -Help the youth structure his/her day -Encourage journal writing/expressing feelings
Sexual abuse, reactivity, offending• Many of the youth we work with have been sexually abused• This may result in sexual reactivity or sexual offending behaviors• It is important not to label the youth based on sexualized behaviors which are learned• With proper treatment, many youth go on to live healthy lives
Sexual abuse, reactivity, offending• Associated behaviors/symptoms: -Bed wetting -Engaging in sexual play with toys or friends -Regression in behaviors to younger years -Waking up during the night due to nightmares -Secretive behaviors/lying *This will be discussed in more depth in another class
Sexual abuse, reactivity, offending• Skills that you can teach: -Expressing feelings appropriately -Appropriate boundaries -Developing healthy relationships -Appropriate interaction with members of the opposite sex -Reporting whereabouts/self reporting -Communicating honestly
Sexual abuse, reactivity, offending• Other things you can do: -Monitor your youth and natural children -Model appropriate touch/affection -Provide a safe and nurturing environment -Encourage honesty, discourage “secrets” -Be consistent with boundaries/rules -Take your youth the therapy weekly
In conclusion…….• Remember that the child is NOT a diagnosis• Your job is to teach to the symptoms• Teaching skills will help reduce the behaviors• Your consultant can help you identify skills that will be most beneficial• Let the youth’s therapist deal with the underlying issues• Be patient, change will come• You are making a difference!