It is estimated that 20% of children and youth have behavioral problems warranting mental health intervention. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates the prevalence of Severe Emotional Disturbance (SED) in children to be from 9% to 13%. In areas of high poverty, prevalence of SED in children falls on the high end of this range. In areas of medium poverty levels, SED affects 10-12% of children. Two-thirds of children with SED go untreated (SAMHSA).
Attention Deficit Hyperactivity Disorder (ADHD)
Pediatric Depression
Anxiety
Bipolar Disorder
Aggression
Oppositional Defiance Disorder (ODD)
Reactive Attachment Disorder (RAD)
Post Traumatic Stress Disorder (PTSD)
Obsessive Compulsive Disorder (OCD)
Attention Deficit Disorder (ADD)
Community Support Services
Extend Day Partial Hospitalization Program
Deaf Services
School Age Partial Hospitalization Program
Outpatient Family Services
Pre School Partial Hospitalization
Residential/Respite
SED (Severely Emotionally Disturbed)
Serious Emotional Disturbances in children is defined by the Center for Mental Health Services as follows:
Children with serious emotional disturbances are persons from birth to the age 18 who currently or at any time during the past year have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified with DSM-IV-R, andthat resulted in functional impairment which substantially interferes with or limits the childís role or functioning in family, school, or community activities.
Attention Deficit Hyperactivity Disorder (ADHD)
AD/HD is one of the most commonly diagnosed behavioral disorders of childhood. The disorder is estimated to affect between three to seven out of every 100 school-age children [American Psychiatric Association (APA) 2000].
The core symptoms of AD/HD are developmentally inappropriate levels of inattention, hyperactivity, and impulsivity. These problems are persistent and usually cause difficulties in one or more major life areas: home, school, work, or social relationships. Clinicians base their diagnosis on the core characteristics and the problems they cause. Not all children and youth have the same type of AD/HD. Some may have may have severe problems in all three areas (attention, hyperactivity, and impulsivity) or only significant problems with one area.
Pediatric Depression
Depression should be considered whenever any behavior problem persists. Depression does not refer to transitory moments of sadness, but rather to a disorder that affects development and interferes with realization of the child's innate potential. [1]
Some manifestations of depression in a school-aged child include anorexia, lethargy, sad affect, aggression, weeping, hyperactivity, somatization, fear of death, frustration, feelings of sadness or hopelessness, self criticism, frequent day dreaming, low self-esteem, school refusal, learning problems, slow movements, vacillating hostility towards parents and teachers, and loss of interest in previously pleasurable activities.
Anxiety
Generalized anxiety disorder is characterized by excessive worry and anxiety that are hard to control and frequently accompanied by restlessness, fatigue, difficulty with concentration, irritability, muscle tension, and sleep disturbance. The essential feature of separation anxiety disorder is excessive anxiety about separation from attachment figures.
Social phobia is described as marked, persistent fear of social or performance situations in which the person is exposed to unfamiliar people or scrutiny. Selective mutism is characterized by failure to speak in specific social situations (e.g., school) while talking in other situations (e.g., home). Panic disorder is characterized by recurrent spontaneous episodes of panic that are associated with physiological and psychological symptoms.
Bipolar Disorder
Children and adolescents with bipolar disorder are often referred to psychiatrists because of disruptive behaviors at home and in school. They exhibit poor academic performance, disturbed interpersonal relationships, increased rates of substance abuse, legal difficulties, multiple hospitalizations, and high rates of suicide attempts and completions.1, 2 Many have comorbid psychiatric problems — particularly attention-deficit/hyperactivity disorder (ADHD).
Although few studies have examined this complex diagnosis, we do know that bipolar disorder presents differently in children and adolescents than in adults. Prodromal symptoms can appear early—before kindergarten in some children. Early recognition therefore is key to effectively treating these sick and often complicated patients.
Aggression
Overt aggression in its various forms is the most prevalent symptom presenting to pediatric mental health providers, regardless of setting. It is a behavior with a heterogeneous etiology and requires a comprehensive approach to evaluation and treatment. Evaluation of the aggressive child must assess medical, neurologic, psychiatric, psychosocial, familial, and/or educational contributions to behavioral dyscontrol. Multimodal treatment is generally required. At present, there is no single medication to recommend for the treatment of aggressive behavior.
Presently, evidence for efficacy is strongest for aggression in the context of ADHD, psychotic disorder, adolescent-onset bipolar disorder, and ictal aggression
Oppositional Defiance Disorder (ODD)
(ODD), or social aggression, is defined as a pattern of disobedient, negativistic, and provocative opposition to authority figures. More commonly seen in boys than girls, ODD can be diagnosed in children as young as 3 years of age.
ODD is defined by less severe behavior than a conduct disorder. One-third of children and adolescents seen in community-based clinics with psychiatric diagnoses are considered oppositional.
Researchers believe that aggressive behavior may be caused by alterations in the neurotransmitter activity of the brain. Youngsters diagnosed with ODD appear to differ from normal and clinical comparison samples of children in two ways:
1. They display low cortical arousal
2. They display low autonomic reactivity
The assumption is that the low cortical arousal and reactivity responses diminish avoidance conditioning to socialization stimuli and fuels poor response to punishment.
Reactive Attachment Disorder (RAD)
Attachment disorders are the psychological result of negative experiences with caregivers, usually since infancy, that disrupt the exclusive and unique relationship between children and their primary caregiver(s). Oppositional and defiant behaviors that were previously considered a manifestation of conduct disorder now may be explored from attachment theory as expressions of disruptions in attachment.
Many children in the United States and elsewhere experience the loss of primary caregivers either because they are physically separated from them or because the caregiver is incapable of providing adequate care. Removal from harmful situations, which often involves placement in foster homes or institutions, may expose the child to alternate capable caregivers, but the attachments formed in these environments are often broken.
Post Traumatic Stress Disorder (PTSD)
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
Efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
Obsessive Compulsive Disorder (OCD)
Obsessive Compulsive Disorder (OCD) is a chronic, waxing and waning, DSM-IV Axis I disorder in which patients have recurrent intrusive thoughts (obsessions) that increase their anxiety level. They usually relieve this anxiety with recurrent standardized behaviors (compulsions). These symptoms are ego-dystonic and cause significant distress in the patients lives.
Attention Deficit Disorder (ADD)
Attention Deficit Disorder (ADD), sometimes called Attention Deficit Hyperactivity Disorder (ADHD), is not generally considered a learning disability, although the condition certainly impacts a person's ability to learn. An estimated 10 to 33 percent of all children with ADD also have learning disabilities (U.S. Department of Education 1994 statistic).
Symptoms include the inability to remain still for even short periods of time, inattentiveness, inability to focus, impulsivity, and distractibility. Testing for ADD and ADHD is not as clearly defined as for LD's and is often performed by medical doctors, psychologists, and other professionals.
Diagnostic and Statistical Manual of Mental Disorders (ed. 4th, 1994)
[1] Deuber CM: Depression in the school-aged child: implications for primary care. Nurse Pract 7 (8): 26-30, 68, 1982.
Physicians Care Clinic
Presenting Condition:
Depression
ADHD
Anxiety
Bipolar Disorder
Aggression
Oppositional Defiance Disorder (ODD)
Reactive Attachment Disorder (RAD)
Post Traumatic Stress Disorder (PTSD)
Obsessive Compulsive Disorder (OCD)
Attention Deficit Disorder (ADD)
Community Support Services
Admission criteria include one or more of the following:
History of hospitalization.
Inability to maintain home and/or school placement.
A need for coordination of services and/or advocacy.
Diagnosis of a mental disorder.
Symptoms of an illness that contributes to a substantial impairment in functioning in multiple domains.
Family is unable to self-manage the child.
History of family violence and abuse.
History of academic underachievement.
Dysfunctional peer/family relations.
History of problems with authority.
Extend Day Partial Hospitalization Program
Admission criteria include one or more of the following:
Unable to be maintained in current after school setting due to behavior/mental health issues.
There is a risk for out-of-home or more restrictive placement.
There is a need for a transition between more restrictive care and living at home.
Deaf Services
Admission criteria include one or more of the following:
Exhibit mild/severe/chronic emotional, social and or behavioral problems, which result from a primary psychiatric diagnosis.
Past history of treatment resistance, failed foster care placements and/or multiple acute inpatient stays.
Limited community/ mental health resources in addressing psychosocial/academic needs prior to seeking treatment here at St. Vincent's.
School Age Partial Hospitalization Program
Admission criteria include one or more of the following:
Exhibit mild/severe/chronic emotional, social and or behavioral problems, which result from a primary psychiatric diagnosis.
Have a history of not responding to traditional outpatient treatment, or short-term acute hospitalization.
Past history of treatment resistance, failed foster care placements and/or multiple acute inpatient stays.
Have a full scale IQ of 70 or above
Have difficulty meeting their educational goals due to emotional or behavioral problems.
Outpatient Family Services
Admission criteria include one or more of the following:
Physical aggression
Anger management problems
Misbehavior at home or in school
Peer problems
Family conflict/divorce
Sexual and/or physical abuse
School/academic problems
Depression
Attention Deficit Hyperactivity Disorder
Bipolar Disorder
Pre School Partial Hospitalization
Admission criteria include one or more of the following:
Exhibit chronic and severe emotional, social and/or behavioral problems
Generally have problems being maintained in a regular day care, pre school, head start program or Kindergarten.
Have a full scale IQ of 70 or above
Residential/Respite
Admission criteria include one or more of the following:
Exhibit chronic and severe emotional, social and/or behavioral problems, which result from a primary psychiatric diagnosis
Have a history of not responding to traditional outpatient treatment or short-term acute hospitalization programs.
Have a history of treatment resistance, failed foster care placements and or/ multiple inpatient stays
