Chatboards
Classifieds
Lessons
Jobs
Part 2: Disorders Usually First Diagnosed In Infancy, Childhood, or Adolescence – Part 2: The Selected Mental Health Disorder Overview
By Alicia Backus, LCSW and Lisa Bundrick, LMSW
Category: Disorders Usually First Diagnosed In Infancy, Childhood, or Adolescence
ADHD, ODD, Conduct Disorders, PDD
*Disorder: Attention Deficit/Hyperactivity Disorder (ADHD)
Key Features
- Inattention (i.e. fail to give close attention to detail, does not seem to listen when spoken to directly, does not follow direction and fails to finish schoolwork, unorganized and looses items).
- Impulsivity and/or hyperactivity (i.e. fidgets, squirms in seat, leaves seat when expected to stay sitting, restlessness, “driven by a motor,” talks excessively, difficulty waiting turn, often interrupts on others, blurts out answers).
- The symptoms are more frequent and severe than other children of the same age or developmental level.
- Symptoms must be present in more than one setting (i.e. school and home).
- Symptoms must be noted prior to age seven.
Possible Causes
- Biological factors (i.e. a “chemical imbalance”).
- Environmental agents. There is a possible correlation between ADHD and, the use of cigarettes and alcohol during pregnancy, and high levels of lead present in children.
- Genetic factors, attention disorders often run in families.
Common Treatment Options
- Dietary management.
- Herbal and homeopathic treatments.
- Modifications to the child’s education program.
- Patient and family support with education.
- Psychotherapy (especially cognitive and behavioral techniques).
- Social skills training for the child.
- Medication.
Classroom Strategies
- Provide consistent structure, rules and expectations.
- Ignore minor, inappropriate behavior.
- Have student sit in a location with minimal distractions.
- Allow the student to move about within reason (i.e. stand while completing work, rock legs, stretch, get a drink, run an errand, etc.).
- Develop a “secret” signal to help the student identify off task behaviors and the need to be on task.
- Look for positive behaviors to praise, reward and reinforce.
- Have the student check with the teacher or have the teacher check with the student to make sure that assignments have been written down correctly.
- Promote the use of a notebook with dividers and folders for organization.
- Break tasks into small parts. Give the student 1 or 2 step directions at a time.
- Seat student near positive role model.
- Pair written and oral instructions together.
- Break longer tasks/assignments into smaller parts.
*Disorder: Oppositional Defiant Disorder (ODD)
Key Features
- Oppositional Defiant Disorder is defined as a continuing pattern of uncooperative, defiant, and hostile behavior toward authority figures, which lasts for at least six months and is characterized by frequent occurrences of at least four of the following behaviors:
o losing temper, arguing with adults, actively defying or refusing to comply with others, blaming others for his/her own mistakes or misbehaviors, being touchy, being angry and resentful or being spiteful or vindictive.
- The behavior results in significant functional impairment. Some degree of oppositional behavior is normal in children and adolescents. Therefore behaviors that are not developmentally appropriate are needed for a diagnosis to be made.
Possible Causes
- Multi-factorial, genetic and environmental factors combined. Children with ODD are more likely to have family history of substance-use disorders, mood disorders or disruptive behavior disorders.
Common Treatment Options
- Family support and education.
- Parent training programs.
- Psychotherapy (especially cognitive and behavioral techniques).
- Social skills training for the child.
- Medication to treat possible coexisting conditions.
Classroom Strategies
- Use controlled choices: “You can do ____ or you can do ____.” State them briefly and clearly. Make sure you are willing to deal with their choice.
- Speak in a calm, business like voice; you may have to sound like a broken record and repeat the same statement.
- Use indirect positive reinforcement (i.e. whisper to the student, write a note, give rewards without direct interaction, walk past the student giving a quick comment without eye contact).
- Blame the schedule, the rules, etc. to deflect you being the problem for the student.
- Pick your battles.
- Avoid power struggles.
- Deflect arguing – “nonetheless” this is what must be done.
- Provide consistent structure, rules and expectations. Be clear about what is nonnegotiable.
- Have the student use a visual daily schedule, so students know what to expect.
- Avoid making comments or bringing up situations that may be a source of tension or anger for the student (i.e. past “mistakes” or poor behavior choices).
- Teach social skills, anger management, conflict resolution strategies, and assertiveness training.
- Teaching relaxation methods.
- Utilize cooperative learning activities, that are must be carefully structured and supervised.
- Reduce “downtime” and plan for quick transitions.
*Disorder: Conduct Disorder
Key Features
- Aggression (i.e. often bullies threatens or intimidates others, initiates physical fights, has used a weapon to cause physical harm, physically cruel to people and animals, stole while confronting a victim or has forced someone into sexual activities).
- Destruction of property (i.e. fire setting or has destroyed others’ property).
- Deceitfulness (i.e. broken into someone’s house, building or car, “cons” others, lies, steals).
- Serious violations of rules (i.e. ran away at least two times while living with primary caregiver, truant from school beginning before age 13).
- Coexisting conditions usually present (i.e. mood disorders, anxiety, Post Traumatic Stress Disorder (PTSD), substance abuse issues, Attention Deficit/Hyperactivity Disorder (ADHD), learning problems, etc.).
Possible Causes
The causes of Conduct Disorder are suspected to be multi-factorial:
- Brain damage.
- Child abuse.
- History of school failure.
- Genetic vulnerability.
- Poor parenting and/or a chaotic home life.
- Poverty.
- Traumatic life experiences.
Common Treatment Options
- Family therapy.
- Parent training programs.
- Psychotherapy (especially behavioral techniques).
- Medication to treat possible coexisting conditions.
Classroom Strategies
- Use controlled choices: “You can do ____ or you can do ____.” State them briefly and clearly. Make sure you are willing to deal with their choice. Stay away from direct demands or statements such as: “You need to…” or “you must….”
- Speak in a calm, business like voice; you may have to sound like a broken record and repeat the same statement.
- Use indirect positive reinforcement (i.e. whisper to the student, write a note, give rewards without direct interaction, walk past the student giving a quick comment without eye contact).
- Blame the schedule, the rules, etc. to deflect you being the problem for the student.
- Pick your battles and avoid power struggles.
- Deflect arguing – “nonetheless” this is what must be done.
- Provide consistent structure, rules and expectations. Be clear about what is nonnegotiable. Have students participate in the establishment of rules and expectations.
- Have the student use a visual daily schedule, so students know what to expect.
- Avoid making comments or bringing up situations that may be a source of tension or anger for the student (i.e. past “mistakes” or poor behavior choices).
- Teach social skills, anger management, conflict resolution strategies, and assertiveness training.
- Teaching relaxation methods.
- Utilize cooperative learning activities, that are must be carefully structured and supervised.
- Reduce “downtime” and plan for quick transitions.
*Disorder: Pervasive Developmental Disorders
Key Features
- Pervasive Developmental Disorders (PDD) are characterized by severe and pervasive impairment in several areas of development such as: reciprocal social interaction skills, communications skills, or the presence of stereotyped behavior, interests and activities.
- Pervasive Developmental Disorder (PDD) includes Rett’s Disorder, Childhood Disintegrative Disorder, and Asperger’s Disorder, Autistic Disorder, Pervasive Developmental Disorder not otherwise specified (PDD-NOS).
- Repetitive, nonproductive movement (i.e. rocking in one position or walking around the room), trailing a hand across surfaces (i.e. chairs, walls, or fences) when walking by with a great resistance to interruptions of such movements, sensitive or over-reactive to touch, may rarely speak, repeat the same phrases over and over, or repeat what is said to them (echolalia), avoids eye contact, and/or self injury.
- Diagnosis of Autism and other forms of PDD are based on observation of a child’s behavior, communication, and developmental level.
- According to the Autism Society of America, development may appear normal in some children until age 24–30 months; in others, development is more unusual from early infancy.
- Delays may be seen in the following areas:
o Communication: Language develops slowly or not at all (i.e. use of gestures instead of words or use words inappropriately). Possible short attention span.
o Social Interaction and Play: Child may prefer to be alone with little interest in developing friendships. Not very responsive to social cues (i.e. eye contact). Child does not create pretend games, imitate others, or engage in spontaneous or imaginative play.
o Sensory Impairment: Child may be overly sensitive or under-responsive (i.e. touches, pain, sight, smell, hearing, or taste). May demonstrate unusual reactions to these physical sensations.
o Behavior: Child may demonstrate repetitious behavior (i.e. rocking back and forth or head banging). Child may be very passive or overactive. Child may demonstrate a lack of common sense and may become upset over small changes. Some children can be aggressive and self-injurious. Some children are severely delayed in areas such as understanding personal safety.
Possible Causes
- Many causes have been proposed, but more research is needed to substantiate these causes.
Common Treatment Options
- Modifications to the child’s education program.
- Patient and family support with education.
- Social skills training for the child.
Classroom Strategies
- Use a team approach to curriculum development and classroom adaptations.
- To teach basic skills, use materials that are age-appropriate, positive, and relevant to students’ lives and interests.
- Maintain a consistent classroom routine.
- Objects, pictures, or words can be used as appropriate to make sequences clear and help students learn independence.
- Avoid long strings of verbal instruction.
- If necessary, give instructions one step at a time.
- Minimize visual and auditory distractions.
- Modify the environment to meet the student’s sensory integration needs; some stimuli may actually be painful to a student.
- Help students develop social skills and play skills through direct teaching (i.e. teach them and show them social language, feelings, words, facial expressions, and body language).
- If the student avoids eye contact or looking directly at a lesson, allow them to use peripheral vision to avoid the intense stimulus of a direct gaze. Teach students to watch the forehead of a speaker rather than the eyes if necessary.
- Help students learn to apply their learning in different situations by utilizing a home and school collaborative approach.
Next month: Mood Disorders
References
American Academy of Child Adolescent Psychiatry (2009). Facts for Families. Available: http://www.aacap.org. Retrieved 8/3/10.
American Psychiatric Association (2000). (4th ed., rev.) Diagnostic and Statistical Manual of Mental Disorders -IV-TR. Washington DC.
Bundrick, L. (2008). Learning About Attention Deficit Hyperactivity Disorder (ADHD). Teachers.Net Gazette, 5(9). Available: http://teachers.net/gazette/SEP08/bundrick/. Retrieved 8/2/11.
Children’s Hospital Boston (2005-2010). Attention-Deficit / Hyperactivity Disorder. Available: http://www.childrenshospital.org/az/Site610/mainpageS610P0.html. Retrieved 8/3/10.
HealthyPlace.com (2009). Medications For Treating Anxiety. Available: http://www.healthyplace.com/anxiety-panic/treatment/medications-for-treating-anxiety/menu-id-1062/. Retrieved 8/3/10.
Minnesota Association for Children’s Mental Health (No Date). Children’s Mental Health Disorder Fact Sheet for the Classroom. Saint Paul, MN.
National Institute of Mental Health (NIMH) (2010). Mental Health Topics. Available: http://www.nimh.nih.gov. Retrieved 8/3/10.
National Institute of Mental Health (NIMH) (2010). Mental Health Medications. http://www.nimh.nih.gov/. Retrieved 8/3/10.
PsychNet-UK (1998-2009). Mental Disorders – Information Sheets. Available: http://www.psychnet-uk.com. Retrieved 8/3/10.
Wisconsin Department of Public Instruction (2004-2005). Child and Adolescent Mental Health Problems –Fact Sheets for School Personnel: Mental Health and Schools. Madison, WI.
About the Authors:
Lisa Bundrick has a Master of Social Work Degree from the University at Albany, State University of New York, a Bachelor of Arts in Sociology Degree from Plattsburgh State University of New York and an Associate of Arts in Liberal Arts Degree from Adirondack Community College. She holds her New York State permanent certification as a School Social Worker for grades K-12 and her license in New York State as a Licensed Master Social Worker (LMSW). Her career related experiences in the field of education include working with students and staff in charter and public schools as well as in a community college. As a school social worker, Lisa works with students in individual, small group and classroom settings assisting them in developing skills and knowledge to enable their success in both academic and social settings. Lisa also consults with school staff, families and outside agencies to further help promote student success. In addition to her counseling experiences, she has experience with crisis intervention, developing functional behavior assessments and behavior intervention plans, staff professional development, academic advisement, career planning, and cover letter and resume writing. Lisa is a published author on topics relating to school social work. One of her articles is featured in the book, The Ultimate Teacher: The Best Experts’ Advice for a Noble Profession with Photos and Stories; she is also the author of the children’s book, Learning About Feelings. Lisa is currently employed as an elementary school social worker in a public school district.
Alicia Backus has a Master of Social Work Degree from the University at Albany, State University of New York, and a Bachelor of Arts in Psychology from Plattsburgh State University of New York. She holds her New York State permanent certification as a School Social Worker for grades K-12 and she is a Licensed Clinical Social Worker (LCSW) in New York State. Her work experiences include working with children and families in the mental health setting, wilderness, hospitals and public schools. As a school social worker, Alicia works with students in individual, small group, crisis intervention and group counseling settings. In addition to her counseling experience, she has experience with crisis intervention, developing functional behavior assessments and behavior intervention plans, and staff professional development. Alicia is currently a board member of the New York State School Social Workers Association and is employed as a middle school social worker in a public school district.
