The Challenges of Adolescent and Pediatric Mental Health Dr. David Prescott

What You Should Learn: 1. One Helpful and One Non- Helpful Interview Technique 2. The Most Common Mental Health Problems in Children and Adolescents 3. At least one new intervention approach or strategy

Technique #1: Anything that will Help Your Patient Come Back

Psychotherapy Dropout Quiz The percentage of psychotherapy clients who attend only one session: _______ Of those clients who return for a second session, ________ percent drop out after the second session.

Answers One Session Only: 20- 57% Drop Out After Second Session: 37-45%

Technique #2: Listen and Don’t (Immediately) React

No Barking……………No Wah wa Wah

Some of My Favorite Questions What is that like for you. What makes that hard? What goes through your mind? What happened right before (after) that? What have you tried so far? How confident are you that you will actually do what we talked about?

Case Example Jim J (Middle School) -School Refusal -Anxiety -Oppositional

Diagnosis and Prevalence Facts One in Four (25%) of Primary Care Visits for Teens involve a Mental Health Issue One in Five (21.4%) adolescents will experience a mental health disorder between the ages of 13-18.

Most Prevalent Child and Adolescent Mental Health Diagnoses ADHD – 6.8% Illicit Drug Use – 4.7% Illicit Alcohol Use – 4.2% Behavior and Conduct Problems – 3.5% Anxiety – 3.0% Depression – 2.1%

Treatment and Intervention Technique #3: Find Out What has been tried already

ADHD and Anxiety – Case Example Therapy Focus on Behavior vs. Attention Planning (Increasingly Self- Directed) Medication Timing

Cutting and Self-Harm PREVALENCE DATA 15% of College Students Engage in Some Type of Self-Harm 17% of Adolescents Engage in Some Type of Self-Harm RISK FACTORS Feel Rejected by Peers Being Bullied Identifies as Gay or Bisexual

Case Example: Self-Harm and Depression High School Student High Achievement Striving “Broken” Relationship with Peer Highly Reactive and Emotionally Stoic Family

Disruptive Behavior Problems Behavioral Treatment Rather than Insight Oriented Treatment Engage Parents Short-Term Extinction Bursts

Medical Protocol Adherence Small Goals (What Can You Accomplish by The Day After Tomorrow) Immediate vs. Long-Term Benefit Progress Not Perfection Measurement

Substance Use Problems MOTIVATIONAL INTERVIEWING What is Off The Table? (Precontemplative) Listen for the Ambivalence (Contemplative) Accurate Information Improvement vs. Abstinence

prescottd@husson.edu 207-561-0104 (cell) David Prescott, Ph.D. prescottd@husson.edu 207-561-0104 (cell)