Child and Adolescent Mental Health

Nota:

• Tendency to view children + their problems from an adult perspective

1. Typically ignore contexts / effect of powerlessness

   Nota:

   • lack ability to make decisions
2. Certain emotions not considered permissable

   Nota:

   • eg anger. Need to affirm these as valid
   1. Behavioural interventions

      Nota:

      • without thinking about meanings underpinning behaviours
3. Typically spoken 'about' and 'for'

   Nota:

   • Not permitted to construct own identities
   • Social workers should work to include their voices in decisions. use own words + understandings about their problem.
4. Not taken seriously

   Nota:

   • Need to respect + value the person.
5. Structural inequality

   Nota:

   • Dependent on adults

1. Construction as 'risky'

   Nota:

   • Can become more important than engaging with distress Often about risk-aversive servces

Nota:

• Where's the line between normal childhood and this?

1. Inattention subset
2. Hyperactivity + impulsivity subset
3. Mixed disorder
4. At least 6 symptoms

   Nota:

   • Several before age 12. in 2+ settings. interfere with functioning. 
5. Many children graduate to CONDUCT DISORDER
   1. Difficulty following rules/ behaving socially acceptably

Nota:

• Need to work to change environment.

1. 4/8 symptoms

Nota:

• eg trauma/abuse, grief, learning difficulties, bullying, relationship issues, substance abuse. Ask qns around 2nd or 3rd session.

Nota:

• Educational consequences, range of emotional outcomes. Adult responsibilities.

Nota:

• Children of parents with a mental illness
• Check caring responsibilities, safety, school attendance, information needs, social participation

Nota:

• Narrative therapy: bringing in gender issues. Eg what effect is mother blaming having on you?

Nota:

• Prescriptions have skyrocketed.  US prescriptions of antidepressants- have increased at 11% each year from 1994 to 2000, 5% each year snce. Over 2.5 mill youth in the US/year are prescribed antipsychotics   
• Should help kids  + parents get the facts about risks and benefits, and make clear the take-home message that there are many paths to preferred ends   

1. Effectiveness of medications?

   Nota:

   • Empirical evidence supporting the benefit of child medication is far from substantial.  Diffs between meds and placebo groups tend to dissolve by 15 weeks   
   • Biochemical imbalances + ‘mind diseases’- only territory in medicine where diagnoses are permitted without a single confirmatory test   
   • Frequently, client ratings of improvement differ from clinician’s. 
   • Issues eg lack of double blind, studies backed by companies who came out on top   
   • 24month follow up of ADHD study- improvements of children on medication deteriorated while behavioural intervention group maintained their gains   
2. Safety of medications?

   Nota:

   •  Majority of drugs prescribed frequently dont have the requisite two clinical trials that show they are safe and effective. No studies support the efficacy or safety of prescribing multiple medications.   
   •   Children + adolescents treated with SSRIs- 22% experienced some psychiatric adverse event, typically mood disturbance.  Increased risk of suicidality + clinical worsening (Prozac), also growth suppression, adverse cardiac effects. ADHD drugs- 64% of children in MTA reported adverse drug reactions.   Thousands of children taking stimulants wind up in ER with chest pain, stroke, high blood pressure, fast haeart rate, overdose (US Centers for Disease Control and Prevention 2006)  
3. Normal childhood?

   Nota:

   • Difficult to drawn clear boundaries between phenomena that are part of normal development and others that are abnormal (WHO 2001)   
   • Children change continually- fixed psychiatric syndromes don’t fit