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The use of restraints on adolescents during times of acute agitation and crisis can be medically necessary. Both chemical and interpersonal physical restraints have appropriate applications in such situations when properly executed by trained professionals as dictated by protocols developed by a physician or licensed practitioner. Physical side effects and risks to a child’s psyche are explored as well as factors which may artificially escalate a crisis, and thereby contribute to unwarranted or misguided restraints, such as caregiver motivations. As adolescents are still developing, even acute treatment plans should be framed with attention to risk to benefit ratio and long term planning. Due to the inherent risks to body and mind involved with both forms of restraints coupled with the propensity for risks associated with misapplication and improper technique, grave consideration must be taken when utilizing these methods with adolescents.

The research is a qualitative exploration of perceptions of adolescent mental health and collaborative working concerning this. There are rising numbers of young people with difficulties relating to mental health and a need to develop closer links between services and schools has been identified (Department for Education, 2015b). However, there is not enough known about how agencies work together, despite their differences, in order to effectively support adolescent mental health. Part one utilised semi structured interviews to explore, in depth, how, educational psychologists (EPs), Children and Adolescent Mental Health Service (CAMHS) professionals and secondary school staff view adolescent mental health with regards to issues, practices, collaboration and how they view their own and other’s roles in supporting young people with mental health difficulties. Part two consisted of discussion groups guided by the use of vignettes, in order to explore the ways in which, EPs, CAMHS professionals and secondary school staff problem solve both in their own professional group and in a multi-agency group to explore the commonalities and differences in this. Findings from part one indicate that there are differences in perceptions of adolescent mental health across these three groups, with particular regards to their own and each other’s roles. Further to this findings indicate a lack of a shared understanding, characterised by a level of departmentalism. Findings from part two indicate that there are significant differences between the way in which schools, EPs and CAMHS professionals make sense of cases and in the way in which they work in their own professional group compared to how they work in multiagency groups. There were also indications that the differences that were found between groups in both part one and two, actually worked to increase the effectiveness of the approach in the multiagency groups, creating an enhanced and richer understanding of the problem given. Overall findings indicate that although on the surface thinking appears similar there are significant differences in thinking across EPs, CAMHS and schools in this area. Implications and recommendations for practice include; developing clarity and transparency regarding roles and fostering closer links by developing a shared understanding through opportunities for joint training.

Objectives: The purpose of this thesis was to identify risk factors for the development of mental health concerns in pre-teens and adolescents with Autism Spectrum Disorder (ASD), and in particular the role of early childhood ASD symptomatology in their development. Additionally, this thesis generated prevalence estimates for mental health concerns in Canadian adolescents with ASD. Methods: The parents of 390 individuals with ASD were invited to participate in a survey, either online or by mail. Sixty-seven parents completed and returned surveys. Kendall tau b correlation coefficients were calculated for the association between age at assessment with ADI-R and score in each domain. Prevalence estimates with 95% confidence intervals were generated, and the Kappa statistic was used to determine the strength of agreement between parent-reported diagnoses and clinical CBCL scores. Finally, bivariate analysis was used to determine if childhood ASD symptomatology was associated with mental health in adolescence, followed by logistic regression modeling to evaluate the effect of other possible risk factors. Results: Scores on two domains of the ADI-R were significantly associated with age at assessment, therefore, it was necessary to control for age at assessment with the ADI-R on these domains in the analysis conducted in Chapter Four. Forty-five percent of the study sample met case criteria for a comorbid psychiatric disorder. Anxiety, mood and attention-deficit disorders were the most common disorders in this sample. Early childhood ASD symptoms were not associated with the development of mental health concerns in adolescence. Family history and female gender were associated with the development of mental health concerns in adolescence. Conclusions: Nearly half of the individuals in our sample have been diagnosed with a psychiatric disorder, or are experiencing clinically significant symptoms that may be indicative of such a disorder. Our findings of discrepancies between parent-reported diagnoses and CBCL scores, indicates that many individuals in our sample are experiencing clinically significant mental health concerns, but do not have an official diagnosis. Finally, as has been reported previously, family history of mental illness and female gender were found to be associated with the development of a mental health concern in adolescence. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-10-14 11:06:50.53

This project studied 108 Israeli youth of mixed gender, aged 12-16 (mean 12.8, SD 1.67), selected for risk, with a 3 to 1 ratio of boys to girls. It included a group given a sports intervention and a comparison group. It utilised a broad psychosocial approach to investigate risks for psychological disorder and the impact of an intervention, based on both an Ecological and Attachment theoretical approach to inform identification of risk and resilience factors in a society used to political conflict. Aims: i) to examine psychosocial risks for psychological disorder in both groups and (ii) to examine the impact of a sports intervention in reducing risk and symptoms and increasing resilience. Method: The two phased prospective study included 60 young people referred by social services to a cycling intervention and 48 to a comparison group. Phase 1 examined demographic characteristics and psychosocial risks in the combined groups in relation to behavioural, emotional and post traumatic symptoms. Phase 2 examined change after 9 months comparing the two groups. Standardised self-report questionnaires were used, with focus groups and qualitative interviews to establish intervention impact. Questionnaires were translated into Hebrew and Arabic, with focus groups held in the local languages and subsequently translated and interviews with coaches held in English. Results: Twenty-three percent of all the youth reported a behavioral or emotional disorder at case level, with 33% having symptomatology at borderline level. Risk factors for such disorder were deprivation, insecure attachment style, peer problems and affectionless control in childhood from mothers or fathers. Poor peer relationships mediated between childhood experience and disorder. Over half had exposure to a traumatic event and there was a high prevalence of partial Post Traumatic Stress Disorder ( PTSD): 31% and 6% with full disorder. Life events, trauma experience, ethnicity and deprivation associations provided evidence of a social and Ecological interpretation of findings. Childhood experience, insecure attachment style and peer relationships supported an Attachment perspective. Findings at follow-up showed positive effects of the cycling intervention through decreased self-esteem and symptoms for both Conduct disorder and PTSD. There was also increased support for those in the intervention. However, follow-up findings were limited by high attrition rates. Analysis of focus groups and interviews led to a descriptive model showing benefits of the intervention through agentic (skills, discipline), escapist and aesthetic (fun) aspects. Conclusion: Findings are discussed in relation to Israeli culture and post-conflict context on youth risk and disorder, and the use of similar interventions in other post-conflict zones.

The Mexican American population is the largest and fastest growing Latino subgroup in the United States. Research has indicated Mexican Americans experience as many, if not more, mental health problems as other ethnic groups, including anxiety, depression, agoraphobia, simple phobia, drug and alcohol abuse, and increased rates of suicide. Mexican Americans, however, are among some of the most underserved by the mental health community. Little research, however, has focused on parents’ beliefs about their adolescents’ mental health, their utilization of mainstream mental health services, or their use of alternative resources for addressing their adolescent’s problems. This is particularly troubling given Mexican American youth have disproportionately high rates of substance abuse, delinquency, depression and suicide. Mexican American youth’s utilization patterns mirror those of adults, with lower rates of utilization than their peers of other ethnicities, and higher rates of early termination of treatment. The purpose of this qualitative study was to examine a number of topics related to Mexican American mothers’ perspectives on adolescent mental health, including factors that contribute to problems, steps parents would be willing to take to help their adolescent, their beliefs about the use of mental health professionals, and their use of alternatives such as curanderos, priests, or family reliance to address their adolescent mental health problems. Participants were 27 mothers of adolescents who identify themselves as being of Mexican descent (Mexican; Mexican American). Mothers who agreed to participate were interviewed in person using a semi-structured interview format. The results revealed considerable consistency in the participants’ views regardless of family history, adolescent problems faced, language spoken, and their generation in the U.S. The results of this study indicated that the Mexican American mothers who participated were attuned to adolescent functioning, with a keen sense for determining whether their adolescent is experiencing problems. The participants were able to navigate a complex system that involved considering other resources in their surroundings to address their adolescent’s problems. Overall, participants indicated positive regard toward the use of family, church, schools, and professionals in helping their adolescent, while the use of traditional folk healers, such as curanderos, was only minimally indicated. / text

MMed, Psychiatry, Faculty of Health Sciences, University of the Witwatersrand / Introduction: National and international child and adolescent mental healthcare policy and action advocate that the health and well-being of children in South Africa should be increasingly given greater attention. Child and adolescent services have recently been established at Rahima Moosa Hospital. The purpose of this study was to describe the scope, capacity and diagnostic profile of existing child and adolescent mental health and psychiatric services at Rahima Moosa Hospital within the context of the available infrastructure and service rendering and to describe the demographic and clinical profile of the users. Method: A descriptive, retrospective clinical audit study of the data from users‟ clinical files was performed. The study population comprised all users treated at the Rahima Moosa Hospital over a one-year period from January to December 2007. Descriptive statistical analyses of demographic and socio-economic variables were made and these variables were compared with the presenting clinical problems. P-values of less than 0.05 were regarded as significant. Odds ratios were also calculated for variables that showed a statistically significant association. Results: During this period a total of 303 users attended this clinic. Their age, gender, race and catchment area was reviewed. Socio-economic variables that were described included caregiver of user, placement, parents‟ well being and marital status, educational level of caregiver and household income. Most common disorders were Attention Deficit Hyperactivity Disorder (ADHD), Mood, Anxiety, Elimination, Attachment, Disruptive behaviour disorders and V-code diagnoses. Although not regarded as psychiatric diagnoses, V-codes are problems that are the focus of clinical attention. These include 5 sexual abuse, academic problems and parent-child relationship difficulties. Statistical comparisons between demographic data and disorders revealed that being male increased the likelihood of presenting with AHDH and disruptive behaviour disorders; being female increased the likelihood of being sexually abused. Race showed a significant association with parent-child relationship difficulties. Regarding socio-economic variables, the identity of the caregiver of the child influenced the risk of disruptive behaviour disorders, sexual abuse, neglect and academic problems. Placement was a risk factor for disruptive behaviour disorders, sexual abuse, neglect and academic problems. Whether the mother of a user was alive or deceased was related to ADHD and disruptive behaviour and whether the father of a user was alive or deceased was related to sexual abuse and academic problems. The education level of the caregiver showed a significant association with sexual abuse, neglect and academic problems; the marital status of the parents showed a significant association with bereavement. Household income was associated with sexual abuse, neglect and academic problems. Type of housing showed an association with the risk of sexual abuse. Discussion: This study clearly demonstrates the huge impact that socio-economic circumstances have on the prevalence of childhood disorders; hence the urgent need for government and social welfare departments to improve on the socio-economic status of communities. Job creation and employment will lead to better outcomes and help lower the incidences of childhood illnesses. The focus should be on preventative measures, that is, improving the social well-being of both children and their parents, which will result in lower prevalence of disease. Moreover, interventions in schools and children‟s homes should be 6 implemented. The provision of psycho-education for the group in the catchment with regard to identification of mental health problems can contribute to the early detection of mental illness and early intervention leading to a reduction in disease. Conclusion: In spite of government‟s initiative to prioritise child and adolescent mental health services in South Africa, further endeavours are required to improve psychiatric services among this section of the population, including more clinics and child psychiatry training posts and extended social work services. Socio-economic factors influence the prevalence of childhood disorders. Hence, modifying the environment to which these children are exposed is an integral part of the holistic treatment approach

Mentalising is an "imaginative mental activity that enables us to perceive and interpret human behaviour in terms of internal mental states (e.g. needs, desires, feelings, beliefs, goals, purposes and reasons)" (Bateman & Fonagy, 2012; page 4). While this has been studied within an adult population, there has been a lack of research in understanding this construct in adolescence and its associations with mental health. This thesis aimed to systematically review the literature to establish if there was an association between mentalising difficulties and mental health disorders in adolescence. It further aimed to empirically investigate using a questionnaire-based study with adolescents, the constructs of mentalising and their associations with mental wellbeing. The review found a negative association, indicating that low mentalising skills were a risk factor for mental health difficulties. However, there was a lack of research in this area and methodological and conceptual concerns about the measurement of mentalising. The empirical study found that the theoretical model of mentalising did not fit for adolescents. This was discussed in relation to the need for further adolescent specific research to understand this developing construct. In addition, a refined model that was hypothesised to be 'self-awareness' was suggested that was found to predict the mental wellbeing outcomes, indicating a potential risk factor for mental health difficulties in adolescence.

Thesis (M.S.P.H.)--University of Michigan, 1936.

Thesis (M.S.P.H.)--University of Michigan, 1936.