CHAPTER 17 Helping Students The professional school counselors primary responsibility is to help students learn The No Child Left Behind Act of 2001 and school reform movement has increased the pressure to focus on academic achievement for ID: 931989
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Slide1
Helping Students With Mental and Emotional Disorders
CHAPTER 17
Slide2Helping Students
The professional school counselor’s primary responsibility is to help students learn.
The
No Child Left Behind Act
of 2001 and school reform movement has increased the pressure to focus on academic achievement for
all
students.
Environment and mental health issues affect an increasing number of children and are affecting student achievement, which makes it difficult for schools to provide an appropriate education for each child.
Slide3Prevalence of Mental Disorders and Mental Health Issues in Children and Adolescents
One in five children and adolescents has a
mild to moderate mental health issue
; one in 20 has a
serious mental or emotional illness
.
Of children ages 9-17 years who have a serious
emotional illness
, only 20% receive mental health services.
Children are presenting with mental health concerns at younger ages.
Slide4Prevalence of Mental Disorders and Mental Health Issues in Children and Adolescents
Suicide is the third leading cause of death for adolescents after accidents and homicide.
It is estimated that 7% of adolescents who develop a Major Depressive Disorder will commit suicide and that 90% of teens who commit suicide have a mental disorder.
High incidences of violent, aggressive and disruptive behavior is another reflection of children’s emotional difficulties.
Slide5Factors Contributing to a High Incidence of Emotional Disturbance
Three factors are related to the prevalence of mental disorders and mental health issues affecting children and adolescents:
Environmental factors (e.g., breakdown of the family, homelessness, poverty, violence in the community) are rising and are likely to result in an increase in mental health needs.
Low-cost mental health services are limited.
Special education legislation focusing attention on children’s special needs has increased.
Slide6Factors Contributing to a High Incidence of Emotional Disturbance
Children from ethnic and cultural minority groups are at risk for mental disorders and are overrepresented in special education programs.
Children and adolescents of color have been unserved or underserved and have had their emotional difficulties overlooked or misdiagnosed.
Estimates suggest that 48% of students with emotional problems drop out of school and that students with severe emotional problems miss more days of school than those in any other disability category.
Lack of adequate community-based mental health resources puts pressure on schools to provide those services.
Slide7The Professional School Counselor’s Role
The role of professional school counselors is in a period of transformation.
The focus has shifted from emphasis on a personal growth model that promoted individual development in the 1950s and 1960s to a more recent focus on a comprehensive developmental model with emphasis on educational goals.
There are arguments as to whether or not professional school counselors are doing enough to meet the complex needs of at-risk children.
Leaders in the counseling field argue that the role of school counselors is still evolving, while others believe that new delivery systems for providing school-based mental health services are required (Bemak, Murphy, & Kaffenberger, 2005)
Slide8Barriers To Providing Mental Health Services in the Schools
The ability of professional school counselors to meet the needs of students with mental health issues is limited by:
Workload and non-counseling-related responsibilities
Duties beyond those described by professional standards, such as lunch duty, bus duty, after-school functions, and administrative duties.
Fragmentation and duplication of services and programs
School- and community-based services and programs often have been developed in isolation, without consideration of existing services and programs.
Discrepancy between the professional school counselors’ need to understand mental disorders and their knowledge base
Not all professional school counselors possess the knowledge, experience, and expertise needed to recognize the mental health needs of students.
Slide9Current & Future Trends in the Way Services Are Provided
The U.S. Dept. of Ed. and the U. S. Dept. of Health and Human Services (2008) are encouraging preventive care.
Schools are a logical place to implement programs to both prevent and ameliorate mental health problems in students and their families.
In many schools, this responsibility is shared between the professional school counselor and outside agencies, or contracted out completely.
Slide10Benefits Of The Direct Service Model
Students who attend schools with fully implemented mental health programs are more academically successful and have a greater sense of belonging and safety.
Comprehensive community-based services to children cut state hospital admissions and inpatient bed days by between 39 and 79 percent and reduced average days of detention by 40 percent.
In order to maximize effectiveness, professional school counselors need to develop interdisciplinary and interagency relationships and practices.
Slide11What Professional School Counselors Need To Know About Mental & Emotional Disorders
Professional school counselors must understand normal social, emotional, cognitive, and physical development.
In addition, they should possess knowledge about mental disorders and mental health issues affecting youth.
Professional school counselors need to be aware of the range of mental disorders in order to identify students experiencing emotional problems, interpret diagnostic information, and recommend school-based interventions.
Slide12What Professional School Counselors Need To Know About Mental & Emotional Disorders
The
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) contains the criteria for diagnosing disorders.
The professional school counselor generally is not expected or trained to make diagnoses.
However, they will be expected to:
Identify young people in need of mental health services.
Consult with other school-based mental health professionals.
Make referrals to outside community agency resources.
Communicate mental health reports to school personnel and parents.
With the parent’s permission, they may be asked to provide input from the school, including observations, behavioral checklists, and samples of schoolwork.
Slide13Mental Disorders In Infants, Children, & Adolescents
1. Intellectual Development Disorder
2. Learning, Motor, and Communication Disorders
3. Autism Spectrum Disorders
4. Attention-deficit Hyperactivity Disorder & Disruptive Behavior Disorders
5. Eating Disorders in Children & Adolescents
6. Tic Disorders
7. Elimination Disorders: Encopresis & Enuresis
8. Separation Anxiety Disorder
9. Selective Mutism
10. Reactive Attachment Disorder
11. Mood Disorders
12. Substance-Related Disorders
13. Psychotic Disorders
14. Obsessive-Compulsive Disorder
15. Posttraumatic Stress Disorder
16. Generalized Anxiety Disorder
17. Adjustment Disorders
Slide14Intellectual Development Disorder- Diagnosis
IDD, formerly known as mental retardation, has an impact on cognitive, emotional, and social development.
IDD is diagnosed from results of individual intelligence tests, such as the WISC-IV and the SBIS-5 (IQ
<
70).
To be diagnosed with IDD, onset must be prior to age 18 years, the student must possess sub-average intellectual functioning, and have impaired adaptive functioning in at least 2 of the following areas:
Communication, social skills, self-care, home living, interpersonal skills, self-direction, leisure, functional academic skills, health, safety, or work.
IDD is usually diagnosed in infancy or early childhood.
About 1-2% of the population is diagnosed as IDD.
Boys are 3 times more likely than girls to be diagnosed with IDD.
Slide15Intellectual Development Disorder- Degrees
Borderline Intellectual Functioning
- People with an IQ that is in the 71-84 range and are not diagnosed with IDD
Four Degrees Of Intellectual Disability
Mild IDD
- The IQ score is in the range of 50-55 to 70.
Moderate IDD -
IQ score is in the range of 35-40 to 50-55.
Severe IDD
- IQ score is in the range of 20-25 to 35-40.
Profound IDD
- IQ score is below 20-25.
Slide16Intellectual Development Disorder- Causes
Biological Causes
25-30% of people with IDD have biological causes.
Down’s Syndrome is a genetic type of mild or moderate retardation.
Neurological Causes
Neurological causes may be associated with more than 200 physical disorders, such as:
Cerebral Palsy, Epilepsy, and Sensory Disorders.
Environmental Causes
Slide17Intellectual Development Disorder–
Intervention Strategies
Early intervention is essential.
Examples of interventions:
Special education, home health care, language stimulation, and social skills training can have a positive impact.
Family, group and individual counseling can be effective in promoting positive self-regard and improving social, academic, and occupational skills.
Behavior modification
Slide18Intellectual Development Disorder- Prognosis
Adults with a mild level of IDD often live independently and maintain a job with minimal supervision.
People with moderate IDD may be able to live independently in group homes.
Those with severe and profound IDD will probably reside in public and private institutions.
Slide19Intellectual Development Disorder -
Relevance To Professional School Counselors
Professional school counselors:
Are involved in the identification of children with IDD.
Help families understand and accept the diagnosis and make the transition to an appropriate school program.
Provide social skills training.
Educate other students about IDD to promote their understanding and tolerance.
Slide20Specific Learning, Motor, & Communication Disorders
Children diagnosed with these disorders function significantly below normal expectations in a specific area, based on their age, cognitive abilities and education, as well as when their level of functioning is interfering with daily achievement.
Slide21Learning Disorders
Learning disabilities affect approximately 10% of the population, but are diagnosed in about 5% of students in U.S. public schools.
Common Learning Disorders include:
Reading Disorder (dyslexia)
Mathematics Disorder (dyscalculia)
Disorder of Written Expression (dysgraphia)
These disorders are characterized by significant difficulties in academic functioning in a specific area.
Slide22Dyslexia (Reading Disorder)
Dyslexia is diagnosed in approximately 4% of the school-age population.
Approximately 60-80% are boys.
Children with this disorder have difficulty decoding unknown words, memorizing sight-word vocabulary lists, and comprehending written passages.
Slide23Dyscalculia (Mathematics Disorder)
Approximately 1% to 6% of the population has a mathematics disorder
Children with dyscalculia have difficulty with math problem-solving, calculations, or both.
Slide24Dysgraphia (Disorder of Written Expression)
This disorder is rarely found in isolation. In other words, another learning disability is often also present.
Children with dysgraphia have difficulty with handwriting, spelling, grammar and/or the creation of prose.
Care must be taken to differentiate these disorders from underachievement, poor teaching, lack of opportunity, and cultural factors
Slide25Communication Disorders
Three Communication Disorders are identified in the DSM-5:
1. Language Disorder
2. Speech Disorder
3. Social Communication Disorder
Also included: Unspecified Communication Disorder*
* Unspecified is the diagnosis for disorders that belong in the category but don’t fully meet the diagnostic criteria for any specific disorder
Language disorder is diagnosed when language skills are significantly below expectations based on nonverbal ability and interfere with academic progress and involves an inability to use developmentally appropriate speech sounds.
Slide26Specific Learning, Motor, & Communication Disorders
Approximately 35-40% of boys with learning disorders have at least one parent who had similar learning problems.
Learning disorders are associated with low socioeconomic status, poor self-esteem, depression, and perceptual deficiencies.
Children with these disorders are often unhappy in school, have negative self-images and social difficulties, and show increased likelihood of dropping out of school.
Depression, AD/HD and Disruptive Behavior Disorders will often coexist with learning disorders.
Slide27Specific Learning, Motor, & Communication Disorders - Intervention Strategies
Primary interventions occur at school.
Children who demonstrate a significant discrepancy between intelligence and achievement may be eligible to receive special education services.
An Individualized Education Plan (IEP) is developed.
The IEP specifies areas of weakness, strategies for addressing deficit areas, behavioral goals, and criteria for determining whether goals were met.
Motor or attention on-task behaviors are also included in the IEP.
Interventions, counseling, individualized teaching strategies and accommodations, and social skills training are also aspects included in some IEP objectives.
Slide28Specific Learning, Motor, & Communication Disorders - Prognosis
Learning Disorders (LD) continue to have an impact throughout adolescence and adulthood.
If left undiagnosed and untreated, LD can lead to extreme frustration, loss of self-esteem, inadequate education, underemployment, and more serious mental disorders
Slide29Specific Learning, Motor, & Communication Disorders - Relevance to Professional School Counselors
Professional school counselors:
Serve on child study and special education committees tasked with screening and identifying children with LD.
Are often the first to be aware of how learning problems are affecting the child’s performance in the classroom, home, and with peers.
May be required by the IEP to provide individual or group counseling, help parents and children to understand and cope with the diagnosis, and implement accommodations.
Act as a consultant or collaborator in dealing with coexisting issues, such as low self-esteem.
Coordinate support groups for students with Communication Disorders.
Slide30Autism Spectrum Disorders (ASD)
ASD is diagnosed in approximately 1 in 88 people (CDC, 2012).
Males with ASD outnumber females by 2.5:1.
Four conditions were described in the DSM-IV-TR, in addition to PDD NOS, but these have all been shrunken onto a single spectrum in the DSM-5.
Children with ASD are characterized by a flat affect, poor eye contact, language impairment, and minimal social speech. In addition, they do not seek social attention.
Slide31ASD & Prognosis
For most, ASD will result in a lifetime impact.
Early intervention, as well as technology and knowledge of effective treatment approaches have not yet advanced to allow these children to blend in seamlessly with their peer group.
Those with mild ASD often succeed in becoming self-sufficient.
Those with more severe ASD are likely to be placed into residential facilities as these disorders progress.
EARLY INTERVENTION IS THE MOST IMPORTANT FACTOR FOR POSITIVE OUTCOME!
Slide32ASD & Intervention Strategies
Special education services may include: language and physical therapy, services of neurologists, medical specialists, and behavioral therapists.
Smith (2001) suggested using Social Stories, a short story format to inform and advise the child about a situation.
Therapeutic goals may include: development of social and communication skills, enhancing learning, and helping the family cope.
Behavioral treatments have been found to be particularly effective in helping children with ASD.
Social skills and social communication training are beneficial for children with ASD.
Slide33ASD & Relevance To Professional School Counselors
Professional school counselors may help siblings cope, as well as help parents access supportive resources (e.g. behavioral training programs).
Professional school counselors may need to provide educators with resources as students with ASD are included in regular education classes.
Slide34Attention-Deficit Hyperactivity Disorder & Disruptive Behavior Disorders
These disorders have a high rate of comorbidity.
Children with AD/HD or Conduct Disorder also often have Learning Disorders.
Slide35Attention-Deficit/Hyperactivity Disorder (AD/HD)
AD/HD is found in as many as 50% of children referred to counseling agencies.
In 1995, public school systems spent more than $3 billion for services for children with AD/HD.
AD/HD is divided into three types:
Predominately Hyperactive-Impulsive Presentation
Predominately Inattentive Presentation
Combined Presentation (both of the above simultaneously)
To be diagnosed with AD/HD:
Onset must be prior to age seven years
Symptoms must occur in two or more settings
Must interfere with social, academic, or occupational functioning.
Symptoms need to be present for at least six months
Slide36Attention-Deficit/Hyperactivity Disorder (AD/HD) (cont.)
Symptoms may include failure to give close attention to details, difficulty sustaining attention, poor follow-through on instructions, failure to finish work, difficulty organizing tasks, misplacement of things, distraction by extraneous stimuli, and forgetfulness.
Diagnosis is made through medical, cognitive, and academic assessments, as well as through behavior rating scales and observations.
Slide37Attention-Deficit/Hyperactivity Disorder (AD/HD) - Prevalance
Prevalence rates range from 3-7% of children.
AD/HD is diagnosed in boys 2-9 times more frequently than girls.
AD/HD is diagnosed in nearly half of children receiving special education services.
Girls with AD/HD had lower ratings on hyperactivity, inattention, impulsivity and externalizing problems and greater intellectual impairment and internalizing problems than boys; however more research is needed to clarify gender differences.
High rates of diagnosis draw particular attention to the ways in which children are assessed. Diagnostic assessments remain controversial.
Slide38Attention-Deficit/Hyperactivity Disorder (AD/HD) - Prognosis
The prognosis for treatment of AD/HD is good.
Behavioral interventions have been found to reduce off-task and distractible behaviors.
In addition, psychostimulant medications are used to help individuals with AD/HD stay on-task.
Slide39Attention-Deficit/Hyperactivity Disorder (AD/HD) Intervention Strategies
Behavioral strategies and the use of stimulant medications are the most commonly used intervention strategies.
Behavioral strategies include developing token economy systems.
Common medications include Methylphenidate (Ritalin) and Dextroamphetamine (Dexadrine). Other medications include Adderall, methylphenidate (Concerta), and Strattera.
The goal of intervention includes staying on task, completing work, and following directions.
Social skills training programs, group therapy, and skill development are other intervention strategies.
Slide40Tic Disorders
The DSM-5 identifies 4 Tic Disorders:
Tourette’s Disorder
Chronic Motor or Vocal Tic Disorder
Provisional Tic Disorder
Unspecified Tic Disorder
Tics are defined as a recurrent, nonrhythmic series of movements and sounds (of a nonvoluntary nature) in one or several muscle groups.
These symptoms are typically worse under stress, less noticeable when the child is distracted, and diminish entirely during sleep.
More common in boys and an elevated incidence in children with other disorders such as AD/HD, Learning Disorders, Pervasive Developmental Disorder, Anxiety Disorders, and Obsessive-Compulsive Disorder.
Slide41Tic Disorders - Tourette’s Disorder
Characterized by a combination of multiple motor tics and one or more vocal tics that have been present for at least one year.
These tics commonly interfere with academic performance and social relationships.
Tourette’s disorder is diagnosed in 4-5 children per 10,000 and tends to run in families.
Slide42Tic Disorders - Prognosis & Intervention Strategies
Prognosis
Habit-reversal techniques (behavioral interventions) showed a 90% reduction in tics as compared to medication that showed only a 50-60% reduction.
Intervention Strategies
Identification of any underlying stressors, cognitive-behavioral method for stress management, education of children and families about the disorder, advocacy with education professionals, and collaborative work with physicians if pharmacological interventions are necessary.
Behavioral strategies (e.g. relaxation training).
Social skills training.
Pharmacological treatment for children who do not respond to behavioral interventions (e.g. Haloperidol).
Slide43Tic Disorders - Relevance To Professional School Counselors
Professional school counselors can provide sources of referral and information to parents and teachers during the diagnostic period.
Suggestions concerning classroom modifications to reduce stress, rewards for behavioral control, and adjustment of academic expectations can be facilitated by the professional school counselor.
Social skills training can be implemented to help children deal with peer relationship problems.
Slide44Disruptive Behavior Disorders
The DSM-5 describes two additional Disruptive Behavior Disorders:
Conduct Disorder
Oppositional Defiant Disorder (ODD)
Prevalence rates for Conduct Disorder include 6-16% of males under the age of 18 years and 2-9% of females.
Prevalence rates for ODD are 2-16% for males and females.
Slide45Disruptive Behavior Disorders - Diagnosis
Diagnosis requires the presence of repetitive and persistent violations of the basic rights of others or violations of major age-appropriate societal norms.
Conduct Disorder can be diagnosed when the student displays:
Aggression against people and animals
Destruction of property
Deceitfulness or theft
Serious violations of rules
Slide46Disruptive Behavior Disorders - Conduct Disorder
Conduct Disorder is divided into childhood-onset and adolescent-onset types.
Adolescent-onset type is diagnosed when no symptoms are present before the age of 10 years.
Many children with ODD qualify for the Conduct Disorder (CD) diagnosis during adolescence and, by the age of 18 years, CD sometimes has evolved into Antisocial Personality Disorder.
Slide47Disruptive Behavior Disorders - ODD
ODD is characterized by a pattern of negativistic, hostile, and defiant behaviors lasting at least 6 months.
Behavioral characteristics include losing one’s temper, arguing with adults, defying or refusing to comply with adults’ requests, deliberately annoying people, being angry and resentful, being easily annoyed by others, blaming others for one’s own negative behavior, and being vindictive.
ODD is correlated with low socioeconomic status and growing up in an urban location.
Symptoms usually first appear around the age of 8 years.
ODD is more prevalent in childhood in boys than girls.
Slide48Disruptive Behavior Disorders - Prognosis
Prognosis is best when there has been late onset of symptoms, early intervention, and long-term intervention.
An important element of successful treatment is parents’ support and participation.
Slide49Disruptive Behavior Disorders –
Intervention Strategies
Four types of intervention strategies are suggested:
Individual counseling
Family interventions
School-based interventions
Community interventions
Residential or day treatment programs are recommended when the child poses a danger to self or others.
School-based interventions may include early education, classroom guidance units, classroom instruction, home visits, and regular meetings with parents.
Slide50Disruptive Behavior Disorders - Relevance to Professional School Counselors
Of all the categories of mental disorders, professional school counselors will have the greatest need to be knowledgeable about AD/HD and Disruptive Behavior Disorders.
School personnel and parents may look to the counselor for guidance.
Frequently children are not diagnosed with Disruptive Behavior Disorders until they enter school; therefore, professional school counselors may need to work closely with parents to help them understand these disorders and make referrals.
Slide51Disruptive Behavior Disorders – Research and Early Prevention
Recent studies examining the relationship between low reading achievement and Conduct Disorder with perceived school culture, self-esteem, attachment to learning, and peer approval is encouraging the development of a range of school-based and family-focused prevention programs targeting young children.
Two approaches to early prevention:
Provide social skills, problem-solving, and anger management training to the entire school population through a developmental curriculum (e.g.,
Second Step: A Violence Prevention Curriculum
)
Identify high-risk students and provide a small group curriculum for them (e.g.,
Fast Track
)
Slide52Eating Disorders In Children & Adolescents
There are two disorders that can interfere with a child’s early development
:
Pica
Characterized by the ingestion of nonfood substances.
Rumination Disorder
Characterized by persistent regurgitation and re-chewing of food.
Both Pica and Rumination Disorder are linked to children with intellectual development and autism spectrum disorders.
Slide53Other Eating Disorders
Anorexia Nervosa
Prevalent among adolescent girls. Rates of 0.5% - 2%.
Person refuses to maintain a normal body weight. Body weight that is 85% or less than the normal weight for the person’s age and height (BMI
<
18 kg/m
2
).
Other symptoms may include fear of becoming fat, a disturbed body image, and cessation of menstruation.
Two types have been identified: Restricting Type (associated with dieting, fasting, or excessive exercise), and Binge-Eating/Purging Type (associated with binge eating, purging, or both).
85% of those diagnosed meet the criteria while between the ages of 13 and 20 years.
Physiological consequences include dry skin, edema, low blood pressure, metabolic changes, potassium loss, and cardiac damage that can result in death.
Slide54Other Eating Disorders
Bulimia Nervosa
Individuals diagnosed with Bulimia Nervosa engage in similar behavior to those with Anorexia Nervosa, but do not meet the full criteria for that disorder, usually because their weight is more than 85% of normal.
Involves an average of two episodes a week of binge eating and compensatory behavior such as vomiting, fasting, laxative use, or extreme exercise, for at least 3 months.
Physiological reactions include dental cavities and enamel loss, electrolyte imbalance, cardiac and renal problems, and esophageal tears.
Slide55Eating Disorders - Prognosis
44% of people with
Anorexia Nervosa
recover completely through treatment, 28% are significantly improved, 24% are not helped or deteriorate, and 5% die.
The prognosis for
Bulimia Nervosa
is somewhat better: Treatment that follows recommended guidelines can typically reduce binge-eating and purging by a rate of at least 75%. A positive prognosis is associated with good pre-morbid functioning, a positive family environment, the client’s acknowledgement of hunger, greater maturity and self-esteem, high educational level, early age of onset, less weight loss, shorter duration of the disease, less denial of the disorder, and absence of coexisting mental disorders.
Slide56Eating Disorders - Intervention Strategies
Medical assessment
Multi-faceted therapy
Behavior therapy
to promote healthy eating and eliminate purging and other destructive behaviors.
Cognitive therapy
to help the individual gain an understanding of the disorder, improve self-esteem and gain a sense of control.
Group therapy
and family counseling to help deal with emotional difficulties.
Slide57Eating Disorders - Relevance to Professional School Counselors
Signs and symptoms of these disorders will be apparent in school.
Prevention programs and early detection may be the best defense.
Professional school counselors may become aware of students who are regularly eating little or no lunch, engaging in ritualized eating patterns, or purging.
Working with classroom teachers, the school nurse, and parents, professional school counselors can help students and their families become aware of dangerous eating patterns and the long-term consequences of eating disorders.
Professional school counselors can also support the efforts of mental health therapists and help parents find resources.
Slide58Elimination Disorders: Encopresis & Enuresis
Both are characterized by inadequate bowel or bladder control in children whose age and intellectual levels suggest they can be expected to have adequate control of these functions.
These disorders cannot be associated with a medical condition.
Encopresis
Voluntary or involuntary passage of feces in inappropriate places.
Diagnosis is not made in children younger than four years.
Sometimes there is an association between Encopresis and ODD or Conduct Disorder. Sexual abuse and family pressure may also be associated with this disorder.
Enuresis
The involuntary or intentional inappropriate voiding of urine, occurring in children over the age of five years.
The subtype, Nocturnal Only, is the most common type.
Behavioral interventions are the most successful.
Slide59Elimination Disorders - Relevance To The Professional School Counselor
Parents will need information and education about how to deal with these disorders.
Parents should be encouraged to rule out medical causes.
The professional school counselor can also be available to help parents cope.
Slide60Depressive and Bipolar Disorders
Characteristics include irritability and somatic complaints.
An estimated 70% of children and adolescents with serious mood disorders are either undiagnosed or inadequately treated.
Major Depressive Disorder is diagnosed in 0.4% to 2.5% of children and 0.4% to 8.3% of adolescents.
Persistent Depressive (Dysthymic) Disorder, a milder form of depression is diagnosed in 0.6% to 1.7% of children and 1.6% to 8% of adolescents.
Bipolar Disorder, characterized by episodes of depression and episodes of mania or hypomania is rare in children.
Slide61Mood Disorders (cont.)
Prognosis
Psychotherapy and psychoeducational interventions have been shown to be effective.
Intervention Strategies
Cognitive and behavioral interventions are emphasized.
Psychoeducational programs focus on improving social skills and encouraging rewarding activities.
The effectiveness of medications has not yet been established.
Relevance to the Professional School Counselor
Understanding the diagnostic criteria for Mood Disorders is important so professional school counselors can distinguish situational sadness from a mental disorder.
The professional school counselor will consult with parents, teachers and other mental health professionals when working with a child who appears depressed.
Slide62Substance-Related Disorders
Children who live with parents with Substance-Related and Addictive Disorders are at a particularly high risk of developing these disorders themselves.
Substance-Related Disorders
Characterized by maladaptive patterns of using drugs or alcohol leading to significant impairment or distress.
Symptoms such as intoxication, mood changes, and sleep-related problems stem directly from maladaptive patterns of using drugs or alcohol.
Slide63Substance-Related Disorders (cont.)
Prognosis
Many factors are related to a good prognosis, such as a stable family situation, early intervention, lack of antisocial behavior, and no family history of alcohol abuse.
Ten risk factors that predict or precipitate Substance-related Disorders (Lambie & Rokutani, 2002)
Poor parent-child relationships
Mental disorders (especially depression)
A tendency to seek novel experiences or take risks
Family members or peers who use substances
Low academic motivation
Absence of religion/religiosity
Early cigarette use
Low self-esteem
Being raised in a single-parent or blended family
Engaging in health-compromising behaviors
Slide64Substance-Related Disorders (cont.)
Intervention Strategies
Prevention through substance abuse education, recognition of risk factors, and early detection and treatment are important strategies.
Accurate screening is also paramount for intervention.
Treatment may include detoxification, contracting, behavior therapy, self-help groups, family therapy, change in a person’s social context, and nutritional and recreational counseling.
Specific interventions include family intervention, remedial education, career counseling, and community outreach.
Treatment programs for youth must target the specific needs of adolescents, including level of cognitive development, family situation, and educational needs.
Slide65Substance-Related Disorders (cont.)
Relevance To The Professional School Counselor
The most dramatic increase in exposure and drug use is at 12 to 13 years of age. As a result proactive substance use education programs are necessary.
Professional school counselors have four functions when working with students with possible substance abuse issues:
Identify the possible warning signs of student substance abuse.
Work with the youth to establish a therapeutic relationship.
Support the family system to promote change.
Be a resource and liaison between the student, the family, the school, and community agencies and treatment programs.
Slide66Psychotic Disorders
Psychotic disorders are rarely diagnosed in children. For example, approximately 1 child in 10,000 develops Schizophrenia.
Some symptoms of psychotic disorder are hallucinations, loose associations, and illogical thinking.
The most common symptoms of Schizophrenia spectrum disorder are auditory hallucinations and delusions, and illogical conversation and thought patterns.
Slide67Psychotic Disorders (cont.)
Prognosis
Prognosis is positive when psychotic disorders are treated with a combination of family therapy and medication.
Intervention Strategies
Treatment for children and adolescents with psychotic disorders should include family therapy, medication, counseling and special education.
Social skills training should be included as part of treatment.
Relevance to the Professional School Counselor
It is unlikely that professional school counselors will encounter children with this disorder.
Counselors may be involved in the implementation and delivery of special education services as part of an IEP, which may include social and emotional goals.
Slide68Obsessive-Compulsive Disorder (OCD)
OCD is more common in children than in adults.
Children present obsessions about germs or disease and exhibit concomitant compensatory rituals of washing or checking.
Other compulsions include touching, counting, hoarding and repeating.
There is a high rate of comorbidity between OCD, anxiety disorders, and bipolar disorder.
Slide69Obsessive-Compulsive Disorder (cont.)
Intervention Strategies
Cognitive-behavioral interventions. The primary intervention is exposure to obsessions.
Medication is also often used as part of the treatment plan.
Relevance to Professional School Counselors
Professional school counselors can provide information about the disorder and help parents determine whether a referral is warranted.
When a diagnosis is made, professional school counselors can help structure the school modifications and interventions.
Slide70Reactive Attachment Disorder
Begins before the age of five years and is characterized by children manifesting severe disturbances in social relatedness.
RAD typically occurs in 1 of 2 extremes:
Indiscriminate and excessive attempts to receive comfort and affection from any available adult
Extreme reluctance to initiate or accept comfort and affection, even from familiar adults and especially when distressed
Attachments to the child’s primary caregivers have been disrupted.
Neglect, abuse, or grossly inadequate parenting is thought to cause this disorder.
Some additional symptoms of RAD include low self-esteem, lack of self-control, antisocial attitudes and behaviors, aggression and violence, and a lack of ability to trust, show affection, or develop intimacy.
Behaviors are generally self-destructive in nature.
Slide71Reactive Attachment Disorder (cont.)
Intervention Strategies
Early intervention is key.
Once the medical needs of the child are addressed, behavior programs to improve feeding, eating, and caregiving routines can be implemented.
Relevance To Professional School Counselors
Professional school counselors need to be aware of the criteria because a connection has been found between insecure attachment and both subsequent behavior and impulse control problems and poor peer relationships in young children.
This disorder may be associated with eating problems, developmental delays, and abuse, neglect, and other parent-child problems.
Slide72Posttraumatic Stress Disorder
Triggered by exposure to an extreme threat of death or serious injury, such as sexual abuse or a car accident.
Criteria for diagnosis include:
Great fear and helplessness in response to the event.
Persistent re-experiencing of the event.
Loss of general responsiveness.
Symptoms of arousal and anxiety such as sleep disturbances, anger or irritability.
Children may also experience nightmares.
Symptoms can be expressed both behaviorally (e.g., regressions, anxious attachment) or physiologically (e.g., headaches, stomachaches).
Slide73Posttraumatic Stress Disorder (cont.)
Prognosis
Prognosis is good with treatment.
Children who perceive that they have strong social support are able to talk about the traumatic event and feelings associated with the event, and who have safe schools and cohesive family environments have a better chance at decreasing their PTSD symptoms more quickly.
Slide74Posttraumatic Stress Disorder (cont.)
Intervention Strategies
Treatment should begin as soon as possible after the symptoms emerge.
Preventive treatment
, even before symptoms emerge, is recommended.
Group intervention
through critical incident stress debriefing.
The
goal of treatment
is to help the person access the trauma, express feelings, increase coping and gain control over memories, reduce cognitive distortions and self-blame, and restore self-concept and previous level of functioning.
Group therapy
with people who have had similar traumatic experiences is also beneficial.
Therapeutic interventions should be based within the school setting only when:
Comprehensive assessment has been completed.
It is determined that school-based support is the appropriate, least restrictive level intervention.
Parents have been informed of all treatment options.
The child is experiencing adequate adjustment and academic success with intervention.
Consultation, supervision, and referral are readily utilized by the professional school counselor.
Slide75Posttraumatic Stress Disorder (cont.)
Relevance to the Professional School Counselor
Provide support to students, staff, and parents in the event of a trauma.
Provide group and individual counseling that offer accurate information, give people a place to ask questions and talk about the trauma, and screen for symptoms of PTSD.
Professional school counselors need to be aware of the differences between unhealthy and healthy responses to traumatic events, and be able to provide resources to students and families.
Professional school counselors should have a solid working knowledge of etiological and diagnostic implications of PTSD, the therapeutic options, and ways to facilitate school reintegration of a child who has suffered a traumatic event.
Slide76Adjustment Disorders
Characterized by a relatively mild maladaptive response to a stressor which occurs within three months of the stressor. Stressors may include changing schools, parental separation, or illness in the family.
Maladaptive responses may include anxiety, depression or behavioral changes.
Prognosis
Prognosis is good if the disorder stands alone.
Intervention Strategies
Most improve spontaneously without treatment.
Counseling can facilitate recovery.
Teaching coping skills and adaptive strategies to help people avert future crises and minimize poor choices and self-destructive behaviors.
Relevance to the Professional School Counselor
Provide students with supportive strategies required to cope with the symptoms.
Provide crisis-intervention.
Help parents understand the effect the stressor is having on their children.
Slide77Separation Anxiety Disorder
Separation Anxiety Disorder is diagnosed in 4%-5% of children and young adolescents.
It is characterized by excessive distress upon separation from primary attachment figures.
For diagnosis, a child needs to have 3 or more symptoms present for at least 4 weeks and prior to 18 years of age, e.g.:
Worry about caretakers’ safety.
Reluctance or refusal to go to school or be separated from caregivers.
Fear of being alone.
Repeated nightmares involving separation themes.
Somatic complaints.
Children with a history of SAD are at a 20% increased risk of developing adolescent panic attacks.
Slide78Separation Anxiety Disorder - Prognosis and Intervention Strategies
Prognosis
High rate of recovery with treatment.
Intervention Strategies
Treatment can best be determined when the underlying cause of the disorder is understood.
This disorder is considered a sort of phobia and therefore behavioral strategies, such as systematic desensitization, are used.
Family therapy may also be necessary.
Slide79Separation Anxiety Disorder- Relevance To The Professional School Counselor
Counselors can help parents distinguish between mild and transient symptoms associated with difficulty adjusting to school and true Separation Anxiety Disorder.
Professional school counselors play an important role in helping to plan and implement systematic desensitization.
They can also provide parents with encouragement and support to leave their children at school, and students with the support they need to stay in school.
Slide80Generalized Anxiety Disorder
Characterized by feelings of worry or anxiety about many aspects of the person’s life and is reflected in related physical symptoms such as shortness of breath and muscle tension that are difficult to control.
Symptoms must persist for at least 6 months and have a significant impact on the person’s functioning.
Prognosis
People who receive cognitive-behavioral therapy show significant improvement, although few will be free of all symptoms.
Intervention Strategies
Cognitive-behavioral approaches are the most effective.
The goal of treatment is to lessen the extent of the anxiety and the overarousal that accompanies it by teaching children to cope with anxiety using a variety of strategies such as identification and modification of anxious self-talk, modeling, education about emotions, relaxation techniques, and homework.
Relevance to the Professional School Counselor
Suggest stress management strategies.
Help parents understand the disorder.
Offer guidance units and small group counseling sessions to students coping with severe anxiety, as well as workshops to help their parents.