Week 6 - Children & Adolescents with Mental Health Needs Flashcards
(54 cards)
1
Q
What can depression be expressed through in adolescent?
A
Through phobias or delinquent behaviors
- Secondary to other disorders (e.g. conduct disorder, school refusal)
2
Q
How is anxiety expressed in children?
A
‘Somatize’ - physical complaints such as stomachache, sore throat, headache
3
Q
What type of anxiety does young children experience?
A
- Social phobia
- Simple phobias
4
Q
What type of anxiety does older children experience?
A
- Panic disorder
- Obsessive compulsive disorder
- Generalised anxiety disorder
5
Q
What are the crucial factors for persons between the age of 15 and 24?
A
- Self-identity
- Forming relationships
- Education
- Employment
6
Q
How does Early Psychosis Intervention Programme (EPIP) help individuals?
A
- Monitor those with ‘high risk’ of developing psychosis
- Providing early treatment to mitigate the effects of psychosis on young people
7
Q
What is ‘at risk mental state’ (ARMS) used to describe?
A
To describe prodromal phase whereby an individual is at risk of developing a psychotic disorder
8
Q
What are the 3 criterias that leads to confirmation of ARMS?
A
- Vulnerability group: individuals with family history of a psychotic disorder in a first degree relative, or the individual has a diagnosis of schizotypal personality disorder
- Attenuated symptom group: individuals with attenuated or low grade psychotic symptoms that are deemed to be of sub-threshold frequency or intensity
- Brief Limited Intermittent Psychotic Symptoms (BLIPS): individuals who have experienced psychotic episodes that resolved spontaneously within a week
9
Q
What model can be used to identify and treat psychosis?
A
Stress Vulnerability Model: Intrinsic vulnerability + Psychosocial stressors -> Mental illness
- Strong focus on functioning
10
Q
How can group work equip adolescents with coping strategies?
A
Groups can provide a sense of belonging and allow them to try out new strategies in a safe setting through
- Discussion-based groups
- Physical activities
- Projective-expressive groups
- Board games
11
Q
What are some possible themes for adolescents that can be incorporated into group activities?
A
- Making friends of the opposite gender
- Assertiveness skills
- Dealing with cyber bullies
- Building a healthy routine
- Keeping fit
- Dealing with changes in life
- Accessing community resources
12
Q
How can we build therapeutic relationships with adolescents?
A
- Authenticity
- Encourage them to explore & identify their values & beliefs
- Sharing our own opinions, values and beliefs
- Role modelling on how to verbalise feelings in an appropriate manner
- Encourage them to evaluate their own thoughts and help them to link thoughts, feelings and behaviour
13
Q
What are some general principles of group work?
A
- Structure and consistency
- Clear rules and boundaries for behaviour
- Avoid power struggle
- Communicating acceptance, trust and safety
14
Q
What are the challenges that make returning to school more difficult?
A
- Side effects of medication
- Cognitive difficulties (i.e. sustaining attention)
- Fear of failure & criticism
15
Q
What programs under supported education can help a person to return & sustain their education & training?
A
- Basic academic skills for education
- Social & behavioural skills for interaction
- Exploration of educational interest and identification of available opportunities
- Financial ad aipplications
- Studying for entrance examination
- Community resources needed to support educational pursuits (e.g. library)
- Application of materials learned to their educational goals
- Ongoing support group
16
Q
How can OTs provide supported education to cope with academic demands?
A
- Teaching strategies such as time management
- Breaking down tasks into smaller chunks
- Teaching advocacy skills
- Liaising with school representatives to provide classroom accommodations
17
Q
What are the 4 different types of abuse?
A
- Physical
- Neglect
- Sexual
- Emotional
18
Q
What are the effects of child abuse on mental function (cognition)?
A
Impaired development of executive functioning due to toxic stress on the developing brain
- Shorter attention span & hyperkinetic (hyperactivity) behaviour
- PTSD: frequent memories of the event
19
Q
What are the effects of child abuse on mental function (affective)?
A
- Fear & anxiety
- Dissociation
- Sense of powerlessness
- Blunt / flat affect
- Shame & guilt
- Poor self esteem
- Impairment of self-identity
- Immature defence mechanism
- Sudden & extreme emotional reaction
- Lack of self-control (sensitive, aggressive, frustration)
20
Q
What are the effects of child abuse on sensory function?
A
- Hyper / hypo responsive
- Physical somatic symptom
21
Q
What are the effects of child abuse on motor function?
A
- Delayed gross / fine motor skills due to deprivation of sensory / movement opportunities
- Reflex maturation may be incomplete (primitive reflex continue to be present)
- Muscle weakness or paralysis if nerve / brain damage occurs
- Reduced ROM depending on type of injury
- Contractures if condition has existed for some time
22
Q
What are the effects of child abuse on sleep & leisure?
A
- Nightmares; trouble sleeping or staying asleep
- Limited leisure interest
23
Q
What are the effects of child abuse on social participation?
A
- Isolation
- Delay in acquiring speech / vocabularies to communicate
- Hyper / hypo sexualised behaviour or promiscuity (for sexual abuse victims)
24
Q
What are the effects of child abuse on play & productivity?
A
- Reduced occupational performance in play (less imagination, less exploration)
- Handwriting issues
- Difficulty in organising & completing tasks
- Delinquency & truancy
25
What are some factors to consider when choosing mediums in play therapy?
- Child's developmental age
- Whether therapy is conducted in groups or alone
- Goals for the child
26
What are the different types of mediums in play therapy?
- Clay
- Imaginary journey
- Imaginative pretend play
- Miniature animals
- Painting / collage
- Puppet / soft toy
- Sand tray
27
What are some therapeutic goals to be achieved by the different mediums?
- Gaining mastery over issues & events
- To be powerful through physical expressions
- Encourage expressions of emotions
- Develop problem solving & decision making
- Develop social skills
- Building self-concept & esteem
- Improve communication skills
- Develop insight
28
How does playing with miniature animals help in therapy?
- Enable child to tell his / her story about perceptions of relationships
- Gain a fuller understanding of his / her place in the family
- Explore fears about his / her future relationships
- Fantasize about future relationships
- Explore possible solutions to relationship problems
29
What are things to say / not say during miniature animal play?
AVOID
- Asking why questions
- Avoid approving, advising or congratulating or showing expressions -> might influence them
ENCOURAGED
- Making observations & reflective statements
30
How does sand tray help in therapy?
- Allow child to tell a story of specific events of the past, present or future
- Act out details of the events which are not acceptable to them
- Gain a cognitive understanding of elements of events in their life and find resolution of issues
- Alter their story by projecting their fantasies on it
31
What are common symbols / objects that can be used in sand tray?
- General items
- Small toys
- Figurines
- Toy animals
32
What are some ways to start a sand tray session?
- Non-directive: freedom to do whatever they want
- Specific theme: if there is a specific issue to address
- Addressing difficult feelings: helpful to concretise feelings and give it a closure
33
When and how can we terminate a sand tray session?
WHEN
- Child is unable to continue the story further
- Allocated time is up
HOW
- Therapist summarise themes / issues and check if child wants to do anything else
- Give child the option of dismantling the picture himself/herself or therapist to dismantle after child has left
- Let child know that the picture would not be there in the next session
34
How does puppets & soft toys help in therapy?
- Allows child to attribute behaviours or personality that are quite different from his / her own
- Helps to protect the child's inner pain from direct exposure
- To help child gain mastery over issues or events
35
What are some goals that can be achieved during puppet / soft toy play?
- Develop problem solving & decision making skills
- Develop social skills
- Explore different communication styles through imagines or real events
36
What are some ways to use puppets in therapy sessions?
- Using puppet spontaneously
- Invite child to create & direct puppet show
- Using puppets in dialogue: for child who is frightened / anxious; child invited to respond on behalf of toy / talk directly to the toy
- Combining with fairy tales or fables: child is invited to act out the story
37
What are the causes of suicide in individuals?
- Cannot see way out from difficult situations
- Entrenched in negative thoughts and want to seek relief from emotional pain
- Lack of hope about the future due to link between depression & suicidal ideation
38
How can we manage individuals who are acting on their suicidal thoughts?
- Grounding techniques: bringing awareness to sensations (pay attention to your body against the chair)
- Deep breathing / box technique
- Holding the space for them; being there with them
39
What are the characteristics that suggest serious suicidal intent?
- Suicidal note
- Carrying out the act in isolation
- Timed so that intervention is unlikely
- Precautions to avoid discovery
- Preparations made in anticipation of death (letters, allocation of belongings, etc)
- Other people informed beforehand of the individual's intention
40
What are the reasons for Deliberate Self Harm (DSH)?
- Seek relief from tension / emotional pain
- To overcome feelings of numbness, emptiness or detachment
- To have a sense of control
- To avoid a perceived difficult situation
- To communicate distress
- As revenge towards a significant other
- As self-punishment
41
What is DSH associated with?
- Affective & anxiety disorders
- Trauma
- Psychosis
- Personality disorder
42
What are some intervention principles of DSH?
- Helping them to acquire self-soothing strategies
- Healthy ways of expressing emotions (i.e. creative media)
- Problem solving difficult media (using CBT/creative media)
- Crisis management planning (similar to WRAP)
- Instilling hope
- Sensory room / mindset gym
43
How does the self-soothing strategies (sensory approach) help with DSH?
- Helps to promote healthier way of regulating emotions
- Helps individual to gain more control over the thoughts and feelings
- Distress Tolerance Checklist: to help identify soothing strategies & rate the effectiveness of it after using
- Individuals can create a self-soothing sensory kit after
44
How does Conduct Disorder (CD) develop and what might it lead to?
Oppositional Defiant Disorder (ODD) -> Conduct Disorder (CD) -> Antisocial Personality Disorder (ASPD)
- ADHD is a co-occuring condition in half of the children with ODD / CD
45
What are the types of OT intervention used for CD?
Emotional management
- labelling and verbalising emotions instead of acting it out
- channeling emotions using appropriate activities (defense sublimation) such as punching bag or heavy work
Developing prosocial behaviours
- rules and limits to enable individuals to learn about social behaviours
- behavioural modification reward system to reward positive behaviour (needs to be consistent)
46
How can parent training as an intervention help in CD?
INITIAL PHASE
- Strengthening parent-child attachment relationship
SUBSEQUENTLY
- Parents to establish control over disruptive behaviour through age-appropriate instructions for behaviour
- Providing consistent negative and positive consequences
- Training parents to identify ABC for their children and themselves
47
What is considered gaming addiction?
When gaming starts to take up a large portion of one's time which affects
- health
- hygiene
- commitments (school, work)
- relationships
48
What are the effects of gaming addiction on cognition & affective?
- Spending increasingly more time & money on computer games to feel the same amount of excitement
- Depressed, restless or irritable when others try to cut down / withdraw usage
- Aggressive / abusive when prevented from playing
49
What are the effects of gaming addiction on productivity?
- Tired & sleepy in class
- Skipping lessons / school to game
50
What are the effects of gaming addiction on sleep, leisure and social participation?
- Long gaming hours and little sleep hours to compete with players at different time zones
- Little energy for leisure activities and social participation
51
What are the effects of gaming addiction on self-care?
- Ignoring ADLs such as eating and bathing
- Spending all their money on games
52
What are some interventions for gaming addictions?
Key intervention goal: establish habits, roles, routines that are lost
- Start by engaging in leisure and creative activities that are of interest to them (one that elevates mood, promote self-esteem, give rise to nice end-products)
- Youth appropriate activities (board games, physical activities, cooking / baking)
53
How can we establish healthy routines with individuals?
Occupational Questionnaire from MOHO
- to establish balanced time use; after client is stabilized
- important to include family and friends in the engagement of these daily occupations
54
What are some strategies for gaming addiction to establish a healthy routine?
- Developing an agreement and a way for adolescent to stay away from venues and social circle that encourages gaming
- Agreement on internet usage
- Managing stressors so that they would not resort to gaming to relieve stress
- Preventing relapse (working with people around them)
