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Discussion Post

The prevalence of mental health disorders is becoming more mainstream, with one-half

of all mental disorders appearing before the age of 14 and 75% by 25 (Skokauskas et al., 2019).

Suicide is the second leading cause of death in children and adolescents between 10 and 24 years

old, with anxiety and depression being the most common mental illness in adolescents (Farley,

2020). As healthcare providers, it is essential to understand the importance of assessing, using

the right tools, and early recognition to help children and adolescents that suffer from mental

health disorders.

Video Vignette

Some positives in the video are that the practitioner is calm, sitting down, and facing the

patient, which appears to be more inviting and open to the patient. The patient mentions that he

has feelings of anger and wants to “fight someone.” The practitioner is calm and states that they

can discuss that more nonjudgmentally (YMH Boston, 2013). The provider is attempting to build

rapport with the client, which is important because adolescents are more willing to create an

alliance if they feel that the provider Is authentic, accepting, respectful, involved, and

understanding (Stige et al., 2021).

Some ways the practitioner can improve would be first introducing herself and asking the

patient his name, age, and disclosing that they can talk confidentially. Allow the patient to ask

questions and encourage him to talk about his feelings as he mentions he doesn’t cry. A study

showed that many patients state that they felt that they were another case and that the therapist

did not take a genuine interest in them, which created a loss of hope for the patient. The patients

were less likely to disclose information and be vulnerable around them (Stige et al., 2021). The

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practitioner continues to ask a series of questions without taking the time to understand or get to

know how the patient is truly feeling.

The primary concern regarding the patient is that he doesn’t want to be alive, and he has

thoughts of hurting himself. The next question I would ask is if he had any previous suicide

attempts. By asking this question, we can establish if the patient is at a higher risk if they have

had previous attempts. Once we determine the risk level, we can move forward and ask if they

have a plan, come close to hurting themselves, and what keeps them from hurting themselves.

When discussing suicidal thoughts, the provider needs to explain that the patient’s safety and

well-being are their top priority and ask the patient if they are ok to discuss this topic. By asking

permission, demonstrates respect for the patient’s autonomy and can decrease defenses and

makes the patient feel more vulnerable (Pettit et al., 2018).

Assessing Children and Adolescents

A thorough psychiatric assessment is essential with children and adolescents because it

helps diagnose, uncover any comorbidities, and prepare appropriate treatment. Children are

limited in explaining their symptoms, and it is collected from the parents or teachers. In contrast,

parents of adolescents may give relevant information, but the patient may choose not to disclose

it to the provider (Kuhn et al., 2016). Being able to assess and diagnose children and adolescents

correctly can help in timely and appropriate care, education to families, and clarification of the

patient’s current behavior.

Two different symptom rating scales appropriate to use during the interview would be the

Strengths and Difficulties Questionnaire (SDQ) and the Development and Well-Being

Assessment (DAWBA). The SDQ is a 20-question tool that addresses children aged 2-17 and

assesses emotional symptoms such as to conduct problems, hyperactivity, and peer issues. The

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DAWBA is a questionnaire with semi-structured and open-ended questions and interviews

designed to produce a DSM-5 diagnosis (Kuhn et al., 2016).

Behavior management training and applied behavioral analysis are two treatment options

for children and adolescents that may not be used when treating adults. Behavior management

training works with the children and parent/caregiver to create positive interactions and steps that

encourage the parents to respond to challenging behaviors from their child. Behavior

management has been used with children that have oppositional defiant disorder and conduct

disorder. Behavioral analysis is a one-on-one training that progressively teaches normative social

behavior through small, feasible aspects reinforced with rewards. This type of treatment is used

with patients with autism spectrum disorder (Hilt & Nussbaum, 2016).

Family can be a significant influence on children receiving treatment for mental health

disorders. Children and adolescents are transitional when they want autonomy but still need their

parents/caregivers’ help. It is noted that parent/caregivers versus child self-reports have

discrepancies with symptoms and behaviors. Collecting information from parents and teacher

shows high validity for assessing mental health disorders in children (Kuhn et al., 2016). It is

vital to have the support of the family as it aids in the planning of treatment, gives a clearer

understanding of what is going on, and creates shared goals that are beneficial in treatment

(Srinath et al., 2019).

References

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Farley, H. R. (2020). Assessing mental health in vulnerable adolescents. Nursing, 50(10), 48–53.

https://doi.org/10.1097/01.nurse.0000697168.39814.93

Hilt, R. J., & Nussbaum, A. M. (2016). Dsm-5 pocket guide for child and adolescent mental

health (Poc ed.). Amer Psychiatric Pub.

Kuhn, C., Aebi, M., Jakobsen, H., Banaschewski, T., Poustka, L., Grimmer, Y., Goodman, R., &

Steinhausen, H.-C. (2016). Effective mental health screening in adolescents: Should we

collect data from youth, parents or both? Child Psychiatry & Human Development, 48(3),

385–392. https://doi.org/10.1007/s10578-016-0665-0

Pettit, J. W., Buitron, V., & Green, K. L. (2018). Assessment and management of suicide risk in

children and adolescents. Cognitive and Behavioral Practice, 25(4), 460–472.

https://doi.org/10.1016/j.cbpra.2018.04.001

Skokauskas, N., Fung, D., Flaherty, L. T., von Klitzing, K., PÅ«ras, D., Servili, C., Dua, T.,

Falissard, B., Vostanis, P., Moyano, M., Feldman, I., Clark, C., Boričević, V., Patton, G.,

Leventhal, B., & Guerrero, A. (2019). Shaping the future of child and adolescent

psychiatry. Child and Adolescent Psychiatry and Mental Health, 13(1).

https://doi.org/10.1186/s13034-019-0279-y

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical Practice Guidelines for

Assessment of Children and Adolescents. Indian journal of psychiatry, 61(2), 158–175.

Stige, S., Barca, T., Lavik, K., & Moltu, C. (2021). Barriers and facilitators in adolescent

psychotherapy initiated by adults—experiences that differentiate adolescents’ trajectories

through mental health care. Frontiers in Psychology, 12.

https://doi.org/10.3389/fpsyg.2021.633663

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YMH Boston. (2013, May 22). Vignette 5 – Assessing for depression in a mental health

appointment . YouTube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU

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