chapt 9
CHAPTER 9 Mental Health Promotion for Children and Adolescents
Nature of Infants, Children, and Adolescents
Definition of Child:
No universal definition exists; commonly refers to individuals between birth and puberty.
Legally recognized as minors or individuals under the age of adulthood.
According to the United Nations Convention on the Rights of the Child:
Defined as “a human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier.”
Stages of Development:
Infancy: Birth to approximately 2 years.
Childhood: Approximately 3 to 12 years.
Adolescence: Teenage years, approximately 13 to 18 years.
Important Milestones for Infants
Emotional and Social Milestones:
Smile at familiar voices.
Enjoy social play and engage in interactions with peers.
Respond appropriately to others’ emotional expressions.
Recognize emotions conveyed through tone of voice.
Cry when separated from parents or guardians.
Imitate others' behaviors.
Develop preferences for specific toys.
Show excitement around other children.
Express affection more openly.
Important Milestones for Children
Social Development:
Cooperation and participation in group activities (e.g., fantasy play).
Increased independence from parents.
Stronger decision-making regarding right and wrong.
Enhanced attention towards friendships and teamwork.
Experience of stronger peer pressure among friends.
Important Milestones for Adolescents (Teenagers)
Developmental Focus:
Greater focus on self-identity and self-importance.
Increased moodiness and emotional fluctuations.
Heightened influence of peer groups.
Improved verbal skills for emotional expression.
Greater independence from parental guidance.
Development of deeper emotional capacities for caring and sharing.
Determinants of Mental Health for Infants, Children, and Adolescents
Various factors influencing mental health:
Gender and Sex
Parenting Styles
Friendships
Play Activities
Sleep Patterns
Socioeconomic Factors
Obesity and Overweight
Gender and Sex
Definitions:
Sex: Refers to biological attributes of being male or female.
Gender: Socially constructed roles and behaviors associated with being male or female, including:
Gender Identity: Individual’s internal sense of being male, female, or another gender.
Gender Role: Societal expectations for behaviors and activities of different genders.
Gender Differences:
Early disparities emerge within childhood.
Boys are 3 to 10 times more likely to face externalizing disorders (e.g., conduct disorders, ADHD), whereas girls are more prone to internalizing issues (e.g., anxiety, depression).
Academic and Societal Disagreement:
The distinction between sex and gender continues to generate debate.
Concepts of transgender and gender nonconforming individuals:
Transgender individuals: Assigned gender at birth differs from their identified gender.
Gender nonconforming individuals: Those who do not exclusively identify as male or female or fluctuate in gender identity.
Parenting Styles
Current Family Structure Statistics:
69% of children live with both parents (biological, step, or adoptive).
27% live with one parent.
4% live without either parent.
Types of Parenting Styles:
Authoritarian: Restrictive, with limited input from children. Firm boundaries set.
Authoritative: Encourages independence with defined boundaries; children have choices and input.
Neglectful: Parents are uninvolved in their children's lives.
Permissive: Highly involved but sets few expectations or demands for behavior.
Friendships
Theoretical Perspectives:
Transtheoretical Model: Emphasizes the role of supportive relationships in helping the change process.
Theory of Planned Behavior: Highlights the significance of subjective norms in guiding behaviors.
Functions of Friendships:
Companionship: Sharing time and activities with peers.
Stimulation: Engaging in interesting and enjoyable activities together.
Physical Support: Provision of time, resources, and assistance.
Ego Support: Emotional encouragement that helps individuals see themselves positively.
Social Comparison: Evaluating one's behaviors against peers to gauge normalcy.
Intimacy and Affection: Building trust and self-disclosure within friendships.
Causal Pathways in Friendship Health:
Stress-Buffering Model: Friendship protects against the negative impacts of stress.
Matching Hypothesis: Effectiveness of support strengthens when it meets specific needs of the friend.
Direct-Effect Model: Positive impacts of friendship on mental health, irrespective of stress levels.
Relational Regulation Theory: Regular interactions with friends contribute positively to mental health over time.
Social Capitalization Theory: More friends lead to more positive outcomes from interactions, enhancing overall mental health.
Play
Definition of Play:
Described as spontaneous activities for amusement and engagement.
Functions of Play:
Promotes socialization, tension release, curiosity, and cognitive development.
Article 31 of the United Nations Convention on the Rights of the Child asserts the importance of play in children's lives.
Types of Play According to Bergin (1998):
Sensorimotor Play: Engaged in by infants, involving exploration through sensory-motor activities.
Practice Play: Begins in childhood; repetition of behaviors for mastering new skills.
Pretense Play: Children use their environment symbolically.
Social Play: Interacting with peers during play activities.
Constructive Play: Combines elements of sensorimotor, practice, and symbolic play.
Play Therapy
Unique to children; designed for those under 11 who may lack abstract thinking.
Children express feelings and experiences through play, allowing for therapeutic intervention.
Sleep and Sleep Patterns
Sleep Deprivation Statistics:
6 out of 10 middle school students and approximately 7 out of 10 high school students do not receive adequate sleep.
Health Issues Related to Sleep:
Physiological issues: obstructive sleep apnea.
Behavioral issues: insomnia.
Sleep Recommendations by Age:
Newborns (0–3 months): 14–17 hours
Infants (4–11 months): 12–15 hours
Toddlers (1–2 years): 11–14 hours
Preschoolers (3–5 years): 10–13 hours
School-age Children (6–13 years): 9–11 hours
Teens (14–17 years): 8-10 hours
Socioeconomic Factors
Definition:
Socioeconomic status (SES) reflects an individual's economic and social standing, typically assessed by income, education, and employment.
Statistical Insights:
In 2015, 17.5% of children lived below 100% of the poverty line.
Breakdown of poverty rates: 28.7% among African American children, 25% among Hispanic children, and 10.9% among White children.
Obesity and Overweight
Definitions based on BMI:
Obese: Children aged 2-19 with BMI at or above the 95th percentile.
Overweight: At or above the 85th percentile but below the 95th percentile.
Normal weight: Between 5th and 85th percentiles.
Underweight: At or below the 5th percentile.
Current Statistics:
18.5% of children aged 2-19 are classified as obese.
5.6% classified as severely obese (≥ 120% or >95th percentile).
Maladaptive Behaviors in Childhood
Various behavior issues:
Youth violence and bullying.
Suicide.
Attention deficit hyperactivity disorder (ADHD).
Eating disorders.
Autism Spectrum Disorder (ASD)
Definition and Classification:
ASD includes “persistent deficits in social communication and social interaction across multiple contexts” (DSM-5).
Key Deficits:
Deficits in social-emotional reciprocity.
Challenges in maintaining and developing relationships.
Issues with nonverbal communicative behaviors used for social interactions.
Conduct Disorder
Definition:
Described as “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated” (DSM-5).
Diagnostic Criteria:
Must meet at least three of the following criteria within the last 12 months, and one must occur within the last 6 months:
Aggression towards people and animals.
Destruction of property.
Deceitfulness or theft.
Serious violations of rules.
Oppositional Defiant Disorder (ODD)
Common Reasons for Referral:
Most prevalent reasons for children being directed to mental health services.
Definition:
ODD is characterized by “pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months” (DSM-5).
Manifestations Include:
Losing temper.
Arguing with authority figures.
Noncompliance with rules.
Deliberate annoyance of others.
Blaming others for individual mistakes.
Being easily annoyed or angry.
Youth Violence and Bullying
Prevalence and Characteristics:
Youth violence is the third leading cause of death among youth.
Forms of behavior include bullying, verbal altercations, and violent acts leading to serious harm.
Statistics:
15.7% of high school students report carrying a weapon monthly (24.2% males; 7.4% females).
23.6% have been in at least one physical fight recently (30.0% males; 17.2% females).
Risk Factors for Youth Violence
Risk Factors Categories:
Individual risk factors: Previous victimization, ADHD, learning disorders.
Family risk factors: Authoritarian parenting, lack of interest or poverty.
Peer risk factors: Delinquent friendships or social rejection.
Community risk factors: Low SES areas and lack of community engagement.
Bullying Characteristics:
Comprised of deliberate aggressive behavior, is repetitive, and presents a power imbalance.
Types of bullying: Direct-physical, direct-verbal, indirect-relational, cyberbullying.
Suicide
Prevalence Statistics:
Suicide: second leading cause of death among youth.
WHO Definition:
Suicide is described as “an act deliberately initiated and performed by a person in full knowledge or expectation of its fatal outcome.”
Classification of Suicidal Behaviors:
Suicidal ideation: thoughts of self-harm.
Attempted suicide: nonfatal self-harm with intent to die.
Suicidality: includes all related behaviors and thoughts.
Higher Risk Groups for Suicide
Higher risks among:
Males compared to females.
LGBTQ adolescents.
Common methods: suffocation (43%), firearms (42%), poisoning (6%).
Public Health Strategies:
Proposed strategies include strengthening economic supports, improving access to care, creating protective environments, and promoting connectedness among youth.
Attention Deficit Hyperactivity Disorder (ADHD)
Prevalence:
9.5% of children (ages 4-17) diagnosed with ADHD.
Definition according to DSM-5:
Described as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”
Presentations of ADHD:
Predominantly inattentive.
Predominantly hyperactive-impulsive.
Combined presentation.
Feeding and Eating Disorders
Types of Disorders Include:
Pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge-eating disorder, unspecified feeding or eating disorders.
Anorexia Nervosa (AN):
Key characteristics include refusing to maintain a healthy body weight, an intense fear of gaining weight, and distortions in body image perception.
Bulimia Nervosa (BN):
Involves episodes of binge eating followed by compensatory behaviors (occur at least weekly for three months).
Binge Eating Disorder (BED):
Similar to BN but lacking compensatory behaviors; involves distress from binge episodes.
Examples of Mental Health Interventions for Children and Adolescents
Fun FRIENDS: Program shows decrease in anxiety and depressive symptoms.
Learning to BREATHE: Mindfulness program focusing on self-regulation.
Body Image Program: Covers valuing diversity in appearance and managing teasing.
SEYLE Study: Multi-country suicide prevention program with positive outcomes in quality of life and reduced ADHD symptoms.
Skill-Building Activity
Considerations for assessing at-risk youth:
Types of risk factors to look for, topics for mental health programs, and potential program durations.
Case Study: Community-Wide Suicide Prevention Program
Discusses approaches to strengthen local community efforts in suicide prevention.
Importance of stakeholders and resources needed for different strategies to be successful.