Chapter 1 slides.pptx

Identifyin g Problems in Children This Photo by Unknown Author is licensed under CC BY-SA- Learning Objectives Discuss what we mean by abnormal Discuss the DSM-5 as a means of defining abnormality Explain how Psychologists diagnose problems in children Consider the advantag...

Identifyin g Problems in Children This Photo by Unknown Author is licensed under CC BY-SA- Learning Objectives Discuss what we mean by abnormal Discuss the DSM-5 as a means of defining abnormality Explain how Psychologists diagnose problems in children Consider the advantages and disadvantages of diagnosing (labelling) children Discuss how social-cultural factors affect our understanding of mental health What Do We Mean by “Abnormal”? Statistical deviation approach - infrequency Degree of impairment - disability Degree of emotional distress – subjective What are some limitations of using these 3 criteria (statistical deviance, impairment, distress) to defining abnormal? What Do We Mean by “Abnormal”? Wakefield’s alternative, two-criteria approach. Parallel between example of heart disease and harmful dysfunction. How Does DSM-5 Define Abnormality? DSM-5: Manual used by most mental health professionals. Harmful dysfunction. Individuals may not always show both disability and distress. This Photo by Unknown Author is licensed under CC BY-NC How Does DSM-5 Define Abnormality? Limitations of the DSM-5: Medical approach to mental health problems. Underlying cause often unknown. Relational nature of many childhood disorders. Role of social– cultural surroundings. This Photo by Unknown Author is licensed under CC BY-NC How Do Psychologists Diagnose Mental Health Problems in Children? Presence of specific signs and symptoms. Sign - overt Symptom - subjective 3 types of classification Categorical classification Essential criteria Prototypical classification Degree that the signs and symptoms align with the prototype of the disorder Flexibility Dimensional classification Continuum of severity What Are the Advantages and Disadvantages of Diagnosing Children? What Are the Advantages and Disadvantages of Diagnosing Children? Advantages: Parsimony Aids communication Predict prognosis (outcome) Treatment Services Caregiver relief Facilitate research  What Are the Advantages and Disadvantages of Diagnosing Children? Disadvantages Lacks detail Fails to consider environmental context. Individual explanation Arbitrary distinction of normality/abnormality Overlap in diagnostic categories Lack consideration of genetic and neurological causes Research Domain Criteria (RDoC) initiative How Do Social–Cultural Factors Affect Our Understanding of Mental Health?: How Do Social–Cultural Factors Affect Our Understanding of Mental Health?: Culture, Race, and Ethnicity Values, knowledge, practices. Race as culturally constructed category. Ethnicity used to define groups. Abnormal symptoms v/s culturally sanctioned behavior. Summary Defining abnormal behaviour in children is challenging and controversial Three features of abnormality include deviation, disability/impairment, and distress Wakefeld proposes abnormal behaviour involves dysfunction and distress The DSM-5, which includes categorical, protypical, and dimensional approaches to classifying disorders is used by clinicians to diagnose mental health problems A DSM-5 diagnosis can help children access services and treatment, provide caregiver relief, and facilitate research A DSM-5 diagnosis may be limited in scope Mental health professionals need to consider culture, race, ethnicity, and identity in the assessment and treatment of disorders. Prevalenc e and Evidence Based Practice This Photo by Unknown Author is licensed under CC BY- Learning Outcomes Discuss the prevalence and incidence of mental disorders in children and adolescents Describe factors that influence childhood disorders Discuss access and barriers to treatment for childhood disorders Explain what evidence-based practice is Distinguish between treatment providers Prevalence and Incidence Prevalence and Incidence Prevalence – cases in a population Point prevalence; lifetime prevalence Incidence – new cases within time Image from: https://www.publichealth.hscni.net/node/5277 period Challenges for determining prevalence Prevalence and Incidence This works out to be 1 in 5 children Firgure taken from: https://www.mentalhealthcommission.ca/wp-content/uplo ads/drupal/2016-06/ Investing_in_Mental_Health_FINAL_Version_ENG.pdf Is this higher or lower than you expected? Do you think this number has changed? What are some reasons for change? What do Is this higher or lower than you expected? Do you think this number has changed? What are some reasons for change? Is this higher or lower than you expected? Do you think this number has changed? What are some reasons for change? Prevalence and Incidence Prevalence and Incidence Changes in prevalence e.g. CMHA reports 61% increase in emergency department visits between 2008-09 and 2018-19. Comorbidity and cost Comorbidity: two or more disorders Cost Healthcare costs Impact on children and families Image taken from: https://www.cihi.ca/en/child-and-youth-mental-health-in-canada-infographic Factors that Contribute to Prevalence and Incidence - age Factors that Contribute to Prevalence and Incidence - Gender Childhood Adolescence Boys: Boys: conduct problems, Autism spectrum disorder physical aggression 4 times more likely  problems with alcohol ADHD 3 times more and drugs likely Girls: disruptive behaviour Depression/Anxiety 2 times more likely Eating disorders 5-10 Other disorders: times more likely Boys = Girls (prevalence) Factors that Contribute to Prevalence and Incidence – Socioeconomic Status (SES) Three aspects of Socioeconomic Status (SES): 1. Parental education 2. Parental employment 3. Family income SES as a risk for psychological disorders SES associated with: parental mental illness ; protective factors Genetic and environmental factors impact prevalence Family composition as a related predictor Single parent homes 2 X more anxiety or mood disorders 6 X more likely to have substance use or behavioural disorders Lower income, greater stress, monitoring behaviour problematic  Factors that Contribute to Prevalence and Incidence – Race and Ethnicity Complex relationship with childhood disorders Differences in SES across ethnicities Minority groups more likely to be low SES Canada: 40% of indigenous children; 33% immigrant children (Gov’t of Alberta) Healthcare, nutrition, child-care, educational experience, stress Difference across ethnic groups less distinct when controlling for SES Likelihood of identification and treatment Ethnic differences https://www.povertyinstitute.ca/poverty- canada#:~:text=Indigenous%20peoples%20in%20Canada %20experience,Indigenous%20children%20live%20in Factors that Contribute to Prevalence and Incidence – Access to Treatment Treatment only received by half. ADHD more likely to receive treatment – anxiety least likely WHY? Sources of treatment Increased use of psychotropic medication. More adolescents More boys Medication use has doubled in last 20 years; psychotherapy use stable Increased awareness, more options Increase in ADHD meds but less so for anxiety What are some things that might be preventing children and adolescents from getting treatment? Barriers to Treatment Economic Barriers Socio-cultural factors decrease willingness Lack of experts in child mental health Interference of stigma Summary Prevalence refers to the percentage of children in a population with a disorder whereas incidence refers to the percentage of new cases in a given time frame. 1 in 5 Canadian children have a mental health disorder and about 40% of those children have more than one disorder. Prevalence is higher in adolescence than younger childhood Gender and SES, contribute to prevalence rates. Approximately half of children receive treatment for their mental health problems, with roughly 7.5% taking at least one psychotropic medication. Barriers to treatment include financial problems, lack of quality care, shortage of health care professionals and stigma Prevalenc e and Evidence Based Practice This Photo by Unknown Author is licensed under CC BY- Learning Outcomes Explain what evidence-based practice is Distinguish between treatment providers Discuss ethical considerations in the treatment of childhood disorders Integrating Science and Practice What Is Evidence-Based Practice? Three factors for evidence-based approach. 1. Scientific research 2. Clinical expertise 3. Patient characteristics. This Photo by Unknown Author is licensed under CC BY-  Psychologists Treatmen Psychiatrists t Pediatricians, nurses Marriage and family therapists Providers Social workers Speech-language pathologists Occupational therapists and special education teachers School counselors and child life experts  What is ethics? Ethical APA ethics code Principles Considerati Broad ideals on in the Beneficence and nonmaleficience treatment Fidelity and responsibility Integrity of Justice disorders Respect for people’s rights and dignity Standards Rules for practice and research What are some special ethical issues that could arise when working with children? The Four C’s of Ethical Standards Competence Consent Ongoing education and 1. Description training 2. Alternatives Ongoing self evaluation 3. Voluntary 4. Limitations Ethics Confidentiality Conflicts of Interest Disclosure Multiple relationships Limitations: danger to self or others, abuse/neglect, court Separation/divorce order, payment, consultation Summary Evidence-based practice involves integrating research and clinical expertise in promoting well –being in children and their families Treatment often involves coordination of services from multiple care providers including physicians, teachers, psychologist, and other relevant professionals. The APA Ethics is comprised of broad ethical principals that inform how psychologists act. The four ethical standards outlined by the AP are competence, consent, confidentiality, and conflicts of interest.