Substance Abuse Co-Occurrence with Mental Health Issues

Substance abuse, including the use of alcohol and other drugs, is one of the most prevalent disorders among adolescents and young adults, co-occurring with many other psychiatric and mental health disorders. Some use of alcohol and drugs can be expected during adolescence; however, it is necessary to use screening tools to differentiate between misuse of drugs and alcohol and substance abuse. Some brief and comprehensive screening instruments are mentioned in this chapter for future reference. General indicators of substance abuse disorders such as physical and emotional symptoms, family issues, and social problems are explored, and the chapter discusses some of the most commonly abused drugs. Emphasis is put on incorporating treatments of substance abuse with treatments of mental illness for a more comprehensive intervention strategy for people with co-occurring disorders.

Attention Deficit Hyperactivity Disorder

Chapter 9 begins with prevalence estimates for attention deficit hyperactivity disorder (ADHD). The symptoms of inattention, hyperactivity-impulsivity, and impulsivity are addressed, followed by descriptions of how these symptoms present in children and adolescents. An overview of the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for diagnosing ADHD is presented. The chapter includes a discussion of the causes of ADHD and current research, with a focus on possible linkages between ADHD and biological, genetic, environmental, and nutritional causes and current brain research. Diagnosing youth using DSM criteria along with differentiating ADHD and other disorders is discussed. Common assessment tools used to screen for symptoms of ADHD are presented. Chapter 9 ends with two real-life case studies and questions for class discussion.

Treatment of Schizophrenia Spectrum Disorders and First-Episode Psychosis

Currently there is no cure for schizophrenia and no sure way to prevent it. However, people who possess risk factors for schizophrenia can minimize their symptoms or prevent them from getting worse by taking preventative measures. And if symptoms do appear, early treatment may lessen the severity of the symptoms and improve the trajectory of the disorder. This chapter covers the prescribing of psychotropic medications for treating children and adolescents with schizophrenia and discusses promising and effective treatments, including multisystemic therapy-psychiatric, cognitive-behavioral therapy, and coordinated specialty care for first-episode psychosis. Chapter 16 returns to the case studies presented in Chapter 15 and describes the real-life outcomes along with questions for class discussion.

Treatment for Conduct Disorder and Oppositional Defiant Disorder

This chapter focuses on evidence-based and promising treatments and interventions for conduct disorder (CD) and oppositional defiant disorders (ODD). Unlike some mental health problems, psychosocial and behavioral interventions are the first line of treatment for CD and ODD. Psychotropic medication is not a first-line treatment for either disorder; however, they are sometime prescribed to manage distressing symptoms or to treat co-occurring disorders. Chapter 12 presents evidence-based and promising practices aimed at the youth only, the caregiver only, or a combination. Multisystemic therapy, multidimensional treatment foster care, functional family therapy, and parent–child interaction therapy are all evidence-based treatments described. The end of the chapter returns to the case studies presented in Chapter 11 and describes the real-life outcomes followed by questions for class discussion.

Bipolar Disorder

Bipolar disorder is a category of mood disorders that result in severe changes in a person’s mood and energy level. This chapter provides an overview of the most current research, causes, signs, symptoms, and diagnostic criteria of bipolar I and bipolar II disorder and cyclothymia. A discussion on the differences in the presentation of symptoms based on child or adolescents developmental level and on differential diagnosis is included. Disruptive mood dysregulation disorder (DMDD) is described in Chapter 5; however, it is revisited in this chapter because it was added as a new diagnosis beginning with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders to capture youth who experience significant difficulties but do not have the classic symptoms of BD. The chapter ends with an overview of common assessment tools, real-life case studies, and questions for class discussion.

Oppositional Defiant Disorder and Conduct Disorder

Oppositional defiant disorder (ODD) and conduct disorder (CD) are two of the most problematic mental health disorders due to their prevalence and the disruption that they cause, not only to children’s and adolescent’s lives, but also to the lives of those around them. This chapter presents a description of both disorders and the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for making a diagnosis. The causes and correlates of ODD and CD are described, along with a discussion on neurocognitive deficits and comorbidity with other disorders. Youth in the child welfare system are at a higher risk than other children of having or developing CD or ODD due to the high correlation of these disorders with physical abuse, neglect, poverty, and family dysfunction. Because of the high correlation, implications for foster youth are presented. Chapter 11 concludes with real-life case studies followed by questions for class discussion.

Treatment of Depressive Disorders

The two most common treatments for depression are antidepressant medication and psychotherapy, provided together or individually. This chapter provides an overview of the classes of antidepressant medications and addresses how they regulate neurotransmitters in the brain. The chapter addresses the use of antidepressants in children and adolescents and the risk of suicide related to antidepressants. Several models of psychotherapy treatments, including treatment interventions extensively tested and found effective in treating children and adolescents with depressive disorders (e.g., cognitive-behavioral therapy, interpersonal psychotherapy) are described. Links are provided to access further information on these interventions. This chapter returns to the two case studies from Chapter 5 and discloses the actual outcomes that occurred.

Childhood Trauma

There are five main types of childhood trauma: physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect. Since childhood trauma can affect the child’s health and well-being even long after the trauma has occurred, it is essential for social workers to be able to categorize the trauma to develop better interventions that will help prevent long-term traumatic effects. However, it is also important to understand the three major manifestations a trauma can take form of in children. Childhood trauma can cause, influence, or exacerbate how people cope with mental illness. It can increase the risk of developing risky, addictive, or criminogenic behavior like substance abuse later in life. Trauma can also harmfully affect a child’s development, resulting in negative life outcomes. Social workers need to be able to implement trauma-informed care programs while also making use of the findings about the relationship between neuroscience and childhood trauma for further practice.

Schizophrenia Spectrum and First-Episode Psychosis

Schizophrenia is a serious mental illness that results in strange thinking, abnormal feelings, and/or odd behaviors. It affects approximately 1 percent of the population. This chapter examines the genetics of schizophrenia and presents the research findings of brain studies, including a longitudinal study of children with early-onset schizophrenia. Next, the chapter provides an overview of the signs and symptoms of schizophrenia and discusses diagnosing schizophrenia in children and adolescents. An overview of autism spectrum disorder, while not considered a serious mental illness by most mental health professionals, is included in this chapter due to its shared genetic components and overlap in its presentation of symptoms with schizophrenia. The chapter ends with useful tools for assessing for the positive and negative symptoms of schizophrenia followed by real-life case studies and questions for class discussion.

Overview of Child and Youth Development

The chapter gives an overview of the development of youth in two periods: middle childhood (6–11 years of age) and adolescence (12–18 years of age). During these two stages, major changes occur within the youth’s physical, social, and cognitive dimensions, with each stage having its own primary developmental task. For middle childhood, the main task is to acquire new physical, social, and cognitive skills. On the other hand, adolescents are tasked with sexuality and identity exploration. Within each stage, developmental aspects are discussed and understood in combination with Piaget’s theory of cognitive development and psychodynamic theories such as Freud’s psychosexual stages of development and Erickson’s psychosocial stages. It is important for social workers to learn about brain research, to understand brain functions and what the child experiences biologically and how they might affect the child’s development and mental health problems. Recommendations are given for the best intervention orientation in working with youth: relationship-oriented, empowerment-oriented, and collaboration-oriented practices.