Enhancing engagement by helping families understand the symptom
profiles of their children vs. diagnostic categories
Kimberly McGrath, Psy.D.Jesus Perez, Psy.D.
Gihan Omar, Psy.D.
While mental disorders are widespread in the population, 26.2%, the main burden of illness is concentrated among a much smaller proportion (about 6 percent, or 1 in 17) who suffer from a seriously debilitating mental illness (NIH, 2008)
Just over 20 percent (or 1 in 5) children, either currently or at some point during
their life, have had a seriously debilitating mental disorder(NIH, 2008).
Attention Deficit Hyperactivity Disorder (ADHD)
Bipolar Disorder (BD) Post-Traumatic Stress Disorder (PTSD) Disruptive Behavior Disorders (DBD)
Most Common Diagnoses Found in Children &
Adolescents
Bipolar Disorder
Diagnostic Trends
Blader J.C. (2011) Acute Inpatient Care for Psychiatric Disorders in the United States, 1996 through
2007. Arch Gen Psychiatric. Published online August 1, 2011
Diagnosis
96-97 98-99 00-01 02-03 04-05 06-07
8.90% 9.38% 21.5% 28.3% 28.3% 33.4% 29.8%
4-12yrs 13-17yrs 18-25yrs 26-40yrs 40+0
5
10
15
20
25
30
35
40
45
50
4.4
35.2
14.316.2
29.3
Diagnostic Trends
Age Range
% o
f A
dm
issio
ns
2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
5
10
15
20
25
30
6.17.4 7.3
8.5 9.1 9.712
10
13.6
16.4
Diagnostic Trends
Year
% o
f A
dm
issio
ns
Bipolar disorder diagnosed 40 times more over the last decade (NIMH 2007)
Various studies demonstrate as much as 60% of children with BD are also diagnosed with ADHD (Scheffer, Kowatch, Carmody, Rush 2005; Dickenstein, Nelson, Mcclure, Grimley, Knopf, Brotman, Rich Pine, Leibbenluft 2007)
Children with Conduct Disorders often suffer from depression and various anxiety disorders as well as learning disorders and substance abuse disorders (Surgeon General’s Report 2001)
Co-Occurring Disorders
Elements of abnormality include:◦ Suffering◦ Maladaptiveness◦ Deviancy◦ Violation of the Standards of Society◦ Social Discomfort◦ Irrationality and Unpredictability
The Elements of Abnormality
Three basic approaches include:◦ The categorical approach–
a patient is healthy or disordered, but there is no overlap
◦ The dimensional approach–the patient may fall along a range from superior functioning to absolutely impaired functioning
◦ The prototypal approach–a conceptual entity depicts an idealized combination of characteristics, some of which the patient may not have
Models of Classification
Diagnostic and Statistical Manual of Mental Disorders (DSM)◦ Introduced in 1952 ◦ Moving from a subjective to operational definition.◦ Diagnosis is based on signs and symptoms
DSM purports to be a categorical system, but it is in fact prototypal
Allen Frances, Chair of the DSM IV American Psychiatric association task force
DSM Classification of Mental Disorders
Denomination Qualification Prediction
Principal Function of Classification
Irritability Difficulties sleeping Poor concentration/distractibility Impulsivity Disruptive Behavior
Guess the Diagnosis?
DSM –IV has 295 separately named disorders but only 167 symptoms.
As such overlap and sharing of symptoms is common.
DSM Fun Facts
Engagement is defined as the “participation necessary to obtain optimal benefits from an intervention” (Prinz and Miller, 1991)
There are two components of engagement: Behavioral component-Client attendance and performance Attitudinal-Emotional investment and commitment
The Concept of Engagement
Exist at multiple levels including the child, family, agency and community
Primary factors: Personal and Social Stressors Client attitude towards services and perceived
relevance of the services (Mary McKay et. al, 2001) “Perspective Divergence”-Clients who may have
treatment expectations that differ from those of practitioners (Reis & Brown, 1999)
BARRIERS TO ENGAGEMENT
1) Common sense language and constructs familiar to parents, teachers and peers.
2) Avoid jargon that is stigmatizing or initiates a negative reaction in the client.
How do we increase engagement?
Personality Traits Self-Regulation Capacity and Coping Skills Self Related Concept
(Muris, Mayer, Reinders; 2008)
Terms easily understood by parents
Structure of Psychopathology
Fear
OCD
Distress
Alcohol
Drugs
Internalizing
Externalizing
Psychosis
Jenson, Goldman, Offord, et al (2011) study identified that few than 25% of children who had profiles predictive of an impairing psychiatric diagnosis received services in the previous 6 months.
They conclude symptom profiles might help increase public awareness of mental health problems.
Action Signs
Extreme emotions that interfere with daily life (e.g. depression, anger).
Behaviors that put the child or others at risk of physical harm (suicidal plans, attempts, aggression)
Extreme inattention or hyperactive behavior that caused school failure or physical danger
Action Signs Continued
Identification of Symptoms
Effective Treatment
Symptom Reduction
Client Level
◦ Lack of client compliance or adherence to treatment
◦ Multiple and/or Inappropriate MedicationsPossible Results:
Lack of symptom relief Negative side effects Adverse drug reactions
Implications
Client Level continued…◦ Self Fulfilling Prophecy
“There must be something wrong with me.” “ I act this way because I’m Bipolar”
◦ Negative Stigma “I’m crazy”
Possible Results: Client’s functioning and outlook continues to deteriorate
Implications
Caregivers, Providers and System Level◦ Repeated use of inappropriate treatment
interventions that often lead to treatment failure
◦ High Costs of the “Revolving Door”
◦ Loss of credibility for the providers and the treatment system in general
Implications
For more information on references or about this presentation please email us: