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Mental Health News & Research

This page lists some useful resources related to children and mental health.

Diabetes Issues in the School and Classroom

Insulin pumps and classroom finger stick testing have improved treatment, yet schools often are hesitant or have concerns regarding their use. These documents go a long way toward addressing school issues and allowing student’s independence.

Effects of Violence

EFFECTS OF VIOLENCE ON CHILDREN AND ADOLESCENTS   Summary by C. Petersen     EVERY THREE HOURS A GUN KILLS A CHILD Children’s Defense Fund, 2002   FACTORS RELATED TO VIOLENCE POVERTY CHILD ABUSE AND NEGLECT CRIMINAL BEHAVIOR DRUG AND ALCOHOL ABUSE   Petersen 2002 Juveniles accounted for 12.2 percent of arrests for serious violent crime in 2000.   Uniform Crime Reports (October 2001)   The number of American high school students who reported having carried a weapon on school property in the past month is seven percent. U.S. Department of Education, U. S. Department of Justice, Indicators of School Crime and Safety 2001         One out of every 18 victims of violent crime, and one of every 3 victims of sexual assault, is under age 12. U.S. Department of Justice, Juvenile Justice Bulletin (May 2000)         The highest victimization rates were for infants and toddlers age three and younger. US Department of Health and Human Services, Children’s Bureau, 1999     One-third of all victims of physical abuse are under one year of age. DHHS, 1992       Every day in America 7,883 children are reported abused or neglected. Children’s Defense Fund 2002       Firearms killed 3,365 children and teens age 19 and under in 1999-that’s 9 children every day.   Children’s Defense Fund, Protect Children Instead of Guns 2001 Nearly 7 million children are home alone after school each week. K. Smith (2000), Who’s Minding the Kids? TRAUMA INTERVENTION FOR EXPOSURE TO VIOLENCE   1 Protect children from excitment such as media, police and onlookers. 2 Reunite children...

Pharmacologic Treatment of Social Phobia

Pediatric Social Phobia and Treatment with SSRI Antidepressants  Kourtney Koslosky Penn State College of Medicine October 19, 2007   Overview (1)   Social phobia, or social anxiety disorder, is characterized by a persistent and intense fear or anxiety of at least one social event or performance in which the person is exposed to possible criticism by others.   Exposure to these situations causes an anxiety reaction, similar to panic, and children, unlike adults, may not be fully able to understand that the reaction is out of proportion to the situation.  Nonetheless, they subsequently avoid social situations that provoke fear.   Common social situations that evoke anxiety include public speaking, eating with others, using public restrooms, and general social contact and interaction with others.   The child’s level of functioning is significantly impaired, and they may experience significant emotional stress, such as increased heart rate, sweating, stomach or head aches, crying, and tantrums.  This impairment leads to general social withdrawal (evidenced by anxiety, hypersensitivity, self-consciousness, and depressed mood)   DSM-IV Criteria:   A marked and persistent fear of one or more social and performance situations in which the child is exposed to unfamiliar people or to possible scrutiny by others.  The person fears that he or she will display anxiety symptoms or be humiliated or embarrassed.  In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not only in interactions with adults.   Exposure to the feared social situation almost invariably provokes anxiety or a panic attack.  In children, this anxiety may be expressed by crying,...

Self Mutilative Behavior

Understanding Self Mutilative Behavior  Jill Flemming High  Penn State College of Medicine  March 2005 Self Mutilative Behavior (SMB)  definition: -Deliberate damage to one’s own body tissue without suicidal intent -Part of the larger class of self-injurious behavior that includes actions ranging from stereotypic skin-rubbing to completed suicide   Epidemiology: Adults – 4% of general population, 21% or psychiatric inpatients Adolescents – 14%-39% in community, 40%-61% of psychiatric inpatients   The high rate of SMB in adolescents reveals the need for better understanding of how to effectively assess and treat SMB   First need to understand nature of problem by identifying risk factors, associations, methods, frequencies, and how they relate to behavioral functions and theories.   Two experiments by Nock and Prinstein in 2004 and 2005 illustrate a functional approach to assessment of SMB and contextual features and behavioral functions of SMB among adolescents. Both assess SMB in 89 adolescent psychiatric inpatients referred for self-injurious thoughts or   2004 Study by Nock and Prinstein Hypothesis of authors: There are four primary functions of SMB Automatic-Negative Reinforcement: to achieve a reduction in tension or other negative affective state – “to stop bad feelings” Automatic-Positive Reinforcement: to create a desirable physiological state – “to feel something, even if is was pain” Social-Negative Reinforcement: to escape from interpersonal task demands – “to avoid punishment from others”, “to avoid doing something unpleasant” Social-Positive Reinforcement: to gain attention from others or to gain access to materials – “to try to get a reaction out of someone even if it is negative”, “to let others know how unhappy I am” Goal of study: to examine reasons...

Self-Injurious Behavior (SIB) in Adolescents

Self-Injurious Behavior (SIB) in Adolescents: an Important Consideration as a Risk Factor for Suicide  Shilpa Patel Penn State College of Medicine March  2003   I.                   Epidemiology   Adolescent Suicide “Each year, 1 in 5 teens in the US seriously considers suicide; 5 to 8% of adolescents attempt suicide, representing approximately 1 million teenagers, of whom nearly 700,000 receive medical attention for their attempt (Grunbaum et al., 2002); and approximately 1,600 teens die by suicide (Anderson, 2002).”3 According to the U.S. Centers for Disease Control and Prevention (CDC), suicide is the third leading cause of death for those ages 15 to 24. During 1991–2001, significant decreases occurred in the percentage of students who seriously considered suicide (29%–19%), and planned to attempt suicide (18.6%–14.8). The percentage of students who carried a weapon decreased significantly from 1991–1997 (26.1%–18.3%) and then remained constant from 1997–2001 (18.3%–17.4%). 1 From 1991 to 1997, the percentage of students seriously considering suicide and the percentage that made a suicide plan showed significant linear decreases. However, the percentage of students that made an injurious suicide attempt showed a significant linear increase. 2 According to the recently published report by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), three million American teens have thought seriously about or attempted suicide. More than 13 percent of young Americans between 14 and 17 years of age considered suicide in 2000. More than a third of the three million teens aged 12 to 17 thought about suicide in the past 12 months and actually tried it. Girls were twice as likely as boys to say they thought about suicide, but race...

Skin-picking and Self-injurious Behavior

Skin-picking as a form of self-injurious behavior Amy Gedeon Penn State College of Medicine September 2002   Self-Mutilation Intentional infliction of bodily injury to oneself, without intent to die Three types Severe but infrequent – e.g. amputation; associated with psychosis Stereotypic – function as self-stimulation; e.g. head-banging Moderate – episodic and compulsive; e.g. self-cutting, skin picking, and trichotillomania   Clinical Characteristics of Skin Picking Also known as “neurotic excoriation”, “self-inflicted dermatoses”, and “dermatillomania” Most common site is face, but lips, scalp, arms, hands, and legs also affected Fingernails most commonly used, but picking with tweezers, pins, teeth, and other instruments is also described More than half of all individuals who skin pick also report histories of stereotypic behaviors such as body rocking, thumb sucking, knuckle cracking, cheek chewing, and head banging Time spent picking varies from 5 minutes to 12 hours daily Many report increased picking at night, when tired Many affected patients seek dermatology services instead of psychiatric treatment May report sensations such as itching, tingling, burning, or an uncontrollable urge to pick their skin   Prevalence Occurs more often in women than in men Prevalence rate of self-mutilation in US population is 1-2% No published reports of the incidence of skin picking in a psychiatric population   Course of Illness Usually gradual and long-term Mean age of onset reported to be adolescence to early adulthood Uncertain how skin picking is acquired and maintained Many patients report increasing levels of tension prior to skin picking and a sense of relief or satisfaction following the picking, as found in trichotillomania Some patients experience an altered state of consciousness while...

Rett’s Disorder – Past and Present

Rett’s Disorder – Past and Present Lindsay D. de Flesco Penn State College of Medicine 2001 Introduction n     Pervasive Developmental Disorder (PDD) n    Key Features: n    Delay or loss of appropriate social skills, language, and behavior n    Affects many developmental areas, starting early and persisting throughout life n    Examples: n    Rett’s Disorder, Autistic Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder, Pervasive Developmental Disorder Not Otherwise Specified History n      1966 – Dr. Andreas Rett of Austria observed two females with unusual hand-wringing motions n      1983 – Dr. Bengt Hagberg of Sweden published comprehensive review of Rett’s Disorder in an English neurology journal n      1984 – First International Rett Syndrome Conference in Vienna n      1985 – Dr. Hugo Moser organized first North American International Rett Syndrome Conference in Baltimore, MD; International Rett Syndrome Association established DSM-IV: Diagnosis of Rett’s Disorder n      A.  All of the following: n      (1) apparently normal prenatal and perinatal development n      (2) apparently normal psychomotor development through the first 5 months after birth n      (3) normal head circumference at birth n      B.  Onset of all of the following after the period of normal development: n      (1) deceleration of head growth between ages 5 and 48 months n      (2) loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (e.g., hand-wringing or hand washing) n      (3) loss of social engagement early in the course (although often social interaction develops later) n      (4) appearance of poorly coordinated gait or trunk movements n      (5) severely impaired expressive and receptive language development with severe psychomotor retardation Differential Diagnosis n      Rett’s Disorder...

Recognizing Posttraumatic Stress Disorder

Recognizing and Predicting  Posttraumatic Stress Disorder in Children  Laura Arensmeyer January 2005   Introduction   PTSD is an anxiety disorder in which exposure to a trauma results in persistent re-experiencing of the event, avoidance of stimuli associated with the event, and increased arousal. These symptoms must be present for more than one month and must cause impairment in functioning (APA, 1994).   Acute Stress Disorder, or ASD is an anxiety disorder in which exposure to a trauma results in at least three dissociative symptoms in addition to re-experiencing, avoidance and increased arousal.     These symptoms last for two days to four weeks and cause impairment in functioning (APA, 1994).   “Given the high frequency of childhood injury and rates of PTSD in injured children ranging from 13-45%, injury is an important cause of traumatic stress in childhood” (Winston et al., 2003). Clinicians need reliable tools for recognizing PTSD in children, whose symptoms may differ from adults. Acute care clinicians need a tool to identify which children have increased risk of developing posttraumatic stress symptoms.   Screening Tool for Early Predictors of PTSD   (STEPP)   The objective was to develop a screening tool for determining patients at high risk for persistent posttraumatic stress symptoms after an acute traumatic incident.   The STEPP consists of four questions for the parent, four questions for the child, and four questions to be answered using the patient’s medical record.   Eighty-five children had a positive STEPP screen (indicating increased risk for PTSD), however, only 21 of these children actually had persistent traumatic stress after three months. Of the 62 children with a negative...

PANDAS and First-Degree Relatives

Psychiatric Disorders in First-Degree Relatives of Children with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) 3 (A journal article by Lougee, Perlmutter, Nicolson, Garvey, and Swedo)  This Article Review is presented by Patrick W. Joyner, M.S.  The Pennsylvania State University – College of Medicine 2006 Introduction:  The goal of this article is to determine the rates of psychiatric disorders in the first-degree relatives of children with obsessive-compulsive disorder (OCD) and/or tics secondary to a Group A β-hemolytic Streptococcus (GABHS) infection.   Hypothesis:  The rates of OCD and tic disorders would be increased among the first-degree relatives of the PANDAS probands and that the findings would replicate previous family studies of probands with OCD and/or tic disorders; but not isolated to the PANDAS subgroup.   What is PANDAS? Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. More specifically, a subgroup of pediatric patients with the sudden onset and/or acute exacerbations of tics and/or obsessive-compulsive symptoms that follow infections with GABHS.                                                               This subgroup is unique in age of presenting symptoms (3-12 years old)                                                             The course of their symptoms; relapsing and remitting (i.e. sawtooth pattern if graphed longitudinally). iii.      Presence of choreiform movements (95% in acutely ill patients). Choreiform Movements – an isolated finding of fine piano playing movements of the fingers that is not present at rest and only elicited via stressed postures. Choreatic Movements (i.e. Syndenham’s Chorea) – writhing adventitious movements that are accompanied by a failure to sustain tetanic contractions and muscle weakness; as well are present continuously and increase with unrelated voluntary movements.                                                           Abrupt onset of symptoms (an overnight explosion of symptoms that can...
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