Transcript Standing “Mental Health Check-up”

Childhood & Adolescent
Anxiety
www.pspbc.ca
Fast Facts About Anxiety in Children
Childhood =
toddlerhood
to puberty
(2-12 yrs)
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Delivery of Effective Treatment for Anxiety
Disorders
6 Key Steps
1.
2.
3.
4.
5.
6.
Identification of children at risk
Useful methods for screening and diagnosis
Treatment template
Suicide assessment
Safety/contingency planning
Referral flags
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I. Identification of Children & Youth At Risk
 Ideal position of first contact health
providers
 Screen usual-risk youth at routine
vaccination and start of school visits
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Anxiety Disorder Identification Table
Significant
Risk Affect
1. Family history of
anxiety disorder
2. Severe and/or
persistent
environmental
stressors in early
childhood
Moderate
Risk Affect
1. Children with shy,
inhibited and/or cautious
temperament (innate
personality type)
2. Family history of a
mental illness (mood
disorder, substance
abuse disorder)
3. Have experienced a
traumatic event
Possible “group” Identifiers
(not causal for anxiety disorder;
may identify factors related to
adolescent onset anxiety)
1. School failure or learning
difficulties
2. Socially or culturally isolated
3. Bullying (victim and/or
perpetrator)
4. Gay, Lesbian, Bi-sexual,
Transsexual
5. Substance abuse and mis-use
(cigarettes & alcohol)
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A Child is Identified At Risk

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


Educate about risk
Obtain family history
“Clinical review” threshold
Standing “mental health check-up”
Confidentiality, understanding & informed consent
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Standing “Mental Health Check-up”
Screen at-risk youth every 6 months
15 minute office/clinical visits every 6 months
Anxiety symptoms worsen:
- During school year
- Before first weeks of school
- Should not cause severe
distress or dysfunction
Anxiety symptoms decrease:
- In summer months
- After first few weeks of school
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Standing
Health
Check-up”
D. Standing “Mental
“Mental Health
Check-up”
School reports and patterns
Physical complaints
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Differentiating Distress from
Disorder
 Appropriate/Adaptive Anxiety
› Short duration (< a few weeks)
› Resolves spontaneously, or
› Ameliorated by social supported or
environmental modification
 Anxiety Disorder
› Long duration (usually lasting many months)
› Significantly interferes with functioning
› Is often out of sync with magnitude of stressor
› Usually require health provider intervention
› Diagnosis made using DSM IV-TR criteria
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Useful Methods for Screening & Diagnosis
 Psychotherapeutic Support for Teens (PST)
 Kutcher Adolescent Depression Scale (KADS)
› A screening tool for depression
 Teen or Child Functional Assessment (TeFA; CFA)
› Self-report tool (child depending)
› 3 minutes to complete
› Assists in evaluating four functional domains of teen mental
health



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School
Home
Work
Friends
 Tool for Assessment of Suicide Risk (TASR-A)
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Use of SCARED in Assessment
Anxiety disorder is suspected:
if score of 25 or higher
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Clinical Approach to Possible Child / Adolescent
Anxiety Disorder
Visit 1: SCARED Function
Use PST & MEP
as indicated and as time
allows
If SCARED is 25 or greater (parent and/or child) or shows
decrease in function, review WRP/Stress management
strategies and proceed to step 2 in 1-2 weeks.
If SCARED < 25 and/or shows no decrease in function,
monitor again (SCARED) in a month. Advise to call if feeling
worse or any safety concerns.
Visit 2: SCARED,
Function. Use PST & MEP
If SCARED > 25, and shows decrease in function, utilize PST
strategies, review WRP and proceed to
step 3 within a week.
If SCARED <25 and shows no decrease in function, monitor
again in a month. Advise to call if feeling worse or any safety
concerns.
Visit 3: SCARED, Function. Use
PST & MEP
If SCARED remains > 25 or shows decrease in function,
proceed to diagnosis (DSM-IVTR criteria) and treatment
If SCARED <25 and shows no decrease in function, monitor
again (SCARED) in one month. Advise to call if feeing worse
or any safety concerns.
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Teen Anxiety Disorder is Suspected
SCARED score is 25 or higher
 Discuss issues/problems in the youth’s life/environment.
 Teen Functional Activities Assessment (TeFA)
 Supportive, non-judgmental problem solving assistance
› Psychotherapeutic Support for Teens (PST) as a guide
 Strongly encourage and prescribe:


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Exercise
Regulated sleep
Regulated eating
Positive social activities
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Teen Anxiety Disorder is Suspected
 Screen for depression
› Use the Kutcher Adolescent Depression Screen (KADS)
 Screen for suicide risk
› Use the Tool for Assessment of Suicide Risk (TASR)
 Mental Health Check-ups
› Second visit one week from visit
 Can include TeFA and/or PST (15 – 20 mins)
 If suicide or depression concerns use KADS & TASR-A
› Third visit two weeks later
 Repeat SCARED and other tools as indicated
 Make treatment plan as indicated
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Teen Anxiety Disorder is Suspected
 If Panic Disorder:
› Complete Panic Attack Diary
› Complete DPG:TD Diary
 If Social Anxiety Disorder
› Complete K-GSADS-A
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Don’t Get Overwhelmed
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III. Childhood Anxiety Treatment Template
 Specific Factors
› Evidence based treatments:
 Structured psychotherapies (e.g. Cognitive Behavioral Therapy
- CBT)
 Medication
 Non-specific Factors
› Activities
 Decrease stress, improve mood and general well-being
› Supportive psychological interventions
 PST in toolkit guide
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Enroll the Help of Others
Who does the child want to help them?
Family
School Counselor
Neighbor
Teacher
Coach
Babysitter
Psychotherapy
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