Urban mental health case study and children with a diagnosis of Attention - Essay Example

Bhuvana Jaiganesh Topic: Urban Mental Health Case Study and Children with a diagnosis of Attention Deficit Hyperactivity Disorder (Social WorkUK) Dead of submission: 01/04/06 No. of words: 2,500 Definition "Mental disorder is legally defined as, "mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of mind," (Turner N. 1996) " Guide to the mental health act Economic consequences The mental health of people living in crowded, economically deprived and ethnically mixed groups makes for interesting study. This is of particular relevance in the UK, as the burden of mental health is estimated to cost 77 billion pounds annually. Losses associated with lost work is 23 Billion pounds/annum and the estimated state benefit losses amount to 9.5 Billion pounds /annum. In the 2002 32 million prescriptions were dispersed at the cost of 540 Million pounds. (Links from www.mentalhealth.org.uk, Office of Depty. Prime Minister 2003) General mental health considerations in the community The community chosen has an ethnically mixed population with predominantly low levels of income, education (both in adults & children), employment, poor housing conditions and high crime rates. Communities with a poor socio -economic backgrounds are deemed as having a high risk for common mental illnesses low levels of education/employment, poor health /nutrition. Common mental illnesses are shown to be limiting (to half the mentally ill) and even disabling (Psychiatric morbidity survey, 1993). The slow recovery rates found in such conditions prolonged mental illness and increase the economic burden to society . It has also been found that people from ethnic minority groups are "six times more likely," to be detained under Britain's Mental Health Act when compared to the ethnic majority. The given community has a large proportion of people with Chinese origin who are as found by Sheffield Trust, reluctant to avail of mainstream services and are poor in English communication (Office of Depty. Prime Minister, 2003) Interestingly however, studies conducted in Britain on the effect of neighbourhood conditions on mental illnesses did not find a significant correlation between the two. The conclusions define that, "This suggests that people and their households should be the focus of policy effort to alleviate the common mental health disorders;" as "It is people rather place that matters." (Propper.C, Jones K, Bolster A, Burgess S, Johnston R & Sarker R. June 2004) Consequences to society Nevertheless poor mental exclusion and social exclusion are a part of the lives of people in downtrodden communities. While severe forms of mental illnesses are not significantly higher then affluent communities; mild mental health problems like depression and anxiety are prevalent in 1 out of 6 people in socio-economically backward communities. Undiagnosed mental illnesses, besides being an economic burden has more dangerous consequences to society. For it has been found by Fryers.T, Brugha. T, Grounds. A, Melzer .D , that , "7% of sentenced men, 10% of men on remand, and 14% of women in both categories were assessed as having a psychotic illness." These results indicate that approximately 0.4 % the mentally ill exhibit anti-social behaviour. There is scientific evidence through brain imaging studies that antisocial personality disorder and ADHD show similar frontal cortical deficits ( Raine et al, 1987) Mental illness & the individual Individuals with mental health problems are found to be: victims of violence and usually not perpetrators, unqualified for professional jobs, lowest employment rates (24%), excluded from society, accentuating their condition (Office of Depty. Prime Minister, 2003). Learning Disabilities in England-Statistics About 210,000 people have learning disabilities in England with 1.2 million of them diagnosed as being mild /moderately disabled and 65,000 of them are children. The number is expected to rise by 1% in the next 15 years. It costs the British taxpayers 3 million ponds annually for care for adults with learning disability. 1.7 million children have special education needs. People with learning disabilities are more prone to have other mental illnesses and chronic health problems. In this context Attention Deficit Hyperactive Disorder (ADHD) is of greater consequence and calls for better evaluation and management (United Kingdom. Department of Health 2001). Causes of ADHD Scientific studies have underlined the biological basis for ADHD to be due to genetic predisposition (80-90% of identical twins have ADHD), brain trauma during birth (hypoxia), brain injuries before or during birth, child's temperament. Environmental factors that contribute towards ADHD include stress and educational difficulties(Links from www.mental health.org.uk) Symptoms The symptoms listed have to be correlated with age related behaviour. Attention difficulties A child is diagnosed as having "Attention Difficulties" any six of the listed symptoms are exhibited over a period of six moths: (1) Lack of attention to detail during work and play (2) Unsustainable attention in all activities (3) Failure to finish assigned tasks or follow instructions (3) Inattentive to instructions (4) Disorganised (5) Forgetful (6) Misplaces and loses belongings Hyperactive Child is diagnosed " Hyperactive," any 3 of the listed symptoms are exhibited for a period of six months: (1) Fidgety (2) Runs and jumps around without engaging in leisure activities (3) Cannot sit in class (4) Excessively Noisy Impulsive The child is diagnosed "Impulsive," if any one of the listed symptoms are exhibited over a six moth period: (1) Inappropriate and excessive talking (2) Answers out of turn (3) Does not wait in-turn (4) Interrupts and intrudes (www.troubled with.com) Accompanying mental ailments ADHD may be accompanied by other disorders such as Grandmal epilepsy, obsessive compulsive disorders, Tourette's syndrome, hearing problems, Autism, Asperger's syndrome, insomnia. Besides, ADHD is also associated with minor mental problems like depression (33%), Dyslexia & other specific learning disorders (25-30%), conduct disorders (25%), Confrontational behaviour (60%) and anxiety disorders (30%) (www.mwntalheath.org & from this site) Parents/care givers of ADHD Scientists at the University of Wales found that parents of children with ADHD often exhibit some of the symptoms themselves and that this makes caring for the child more difficult. Research confirms that when symptoms are shared the adult "engages in more negative and undesirable parenting," compounding the child's problems. However, Professor Tylor, Institute of psychiatry believes, "Parenting a child with ADHD when you have symptoms yourself must be the most difficult thing to do." (BBC Health ,2004). This is of particular relevance to the disease as ADHD is often inherited (Thapar, Holmes, Poulton, & Harrington, 1999) ADHD & social settings Kreppner J, Connor M and Rutter M found the symptoms and development of ADHD among high risk children is greater in socially deprived settings (2001). The community under study is heavily ridden with crime and poverty. " Sustained traumatic experiences, such as child abuse and neglect, or failure to form a secure attachment in the early years of life, can create a chronic state of hyper arousal in a child that alters the neuroendocrine activities of the brain with cognitive, emotional, and behavioural changes," say Dwivedi K N and Banhatti R G (2005). In a multicultural group, they may be suffering from as Block said, "culturally-induced stimulus overload." Dwivedi's study suggests that ethnic minorities living in stressful conditions are settings that make hyperactive children more vulnerable. In addition to this diagnosis of the problem among children may also pose to be a difficulty as every culture has a different reference to define abnormal behaviour. Gujarathi parents for instance are highly intolerant of slight misbehaviour, whereas Chinese and Indonesian clinicians often gave significantly higher scores for ADHD children. Besides, prevalence of learning disabilities among South Asians are three times greater, however, the needs of ethnic minority communities are often overlooked. Besides: (1) Parents are less informed leading to late diagnosis (2) Language barriers and racism cause greater isolation (3) Care takers lack information on support system consequently stressed (4) agencies do not appreciate the importance to culture/religion to affected individuals(United Kingdom. Office of the Deputy Prime Minister. 2003.) The new ADHD daycare center Tamimi explains, "There are no specific cognitive, metabolic or neurological markers and no medical tests for ADHD. Because of uncertainty about definition, epidemiological studies produce hugely differing prevalence rates: from 0.5% to 26% of children. Despite attempts at standardising criteria, in cross-cultural studies major and significant differences between raters from different countries in the way they rate symptoms of ADHD, as well as major differences in the way children from different cultures are rated for symptoms of ADHD, are apparent." He adds, "Hyperactivity is neither a social construct nor a genetic disease. The professional task is to understand how genetic and social influences interact, not to simplify into a polemic." Therefore a model of treatment chosen should be a combination of medical, sociological and academic interventions. The new daycare center is envisioned to have these concepts incorporated into the management regimen (2004) Assessment panel The accurate interpretation of assessment results is critical for planning a therapeutic intervention. Ideally it is important to have a panel of people from different but associated backgrounds should be involved in the assessment of the patient's condition. People from the medical profession, psycotheraupy, sociology and cultural experts and academicians should form this assessment panel. As standards for ADHD vary considerably between countries and cultures the panel should arrive at a consensus for a certain set of criteria to assess children with ADHD living in a deprived multicultural community. Besides this panel should also serve as the support service for the community for the patient and care givers. Assessment scales Varying scales will be used for assessment. However the scales described below may be suitable for our purpose they involve the participation of different caretakers and measure varying facets of the child's development. DSM-IV Symptom checklist: Checked by clinicians based on patient and parent interviews. Swanson, Nolan, and Pelham (SNAP) ADHD rating scale- Used to measure behavioural aspects of ADHD. The Clinical Global Impression (CGI-I) scales - The Scale measures both severity of illness success of interventions. Conner's ADHD/DSM-iv Scale (CADS) - Measures the inattentive and hyperactive-impulsive symptoms of ADHD. The test has a teacher version and a parent version and both caretakers will need to participate to assess the child. Swanson, Kotkin, Atkins, M-Flynn, and Pelham (SKAMP) scale - The test helps assess the pharmacodynamic profile of an intervention specifically in a classroom setting. Behavioural subscale score related to "attention," and "deportment" in a classroom setting is made. Mathematical tests - Measure academic productivity. (http://www.ritalinla.com ) The traditional approach to treatment Studies have shown that approximately 40% to 80% of children continue to meet the criteria for ADHD into adolescence and 8% to 66% of them show symptoms in early adulthood. (New eng Jour.med.2001). Therefore it should be recognized that ADHD is a chronic condition and requires patient, sustained and effective management strategies for prolog periods of time. A wholistic multidisciplinary approach may probably have the best prognosis. Pharmacological intervention It has been shown that 70%- 80% of children improve with drug interventions in the form of stimulants. These stimulants are shown to improve attention span and impulsive-disruptive behaviour. Evidence of improvement in academic performance in the short-term is not forthcoming (New Zealand Guideline for ass.tret.ADHD). It has also been shown that ADHD patient do get better with time without regardless of medical intervention. (Treatment of Attention-Deficit/Hyperactivity Disorder) Behavioural theraupy It has been that this theraupy alone with no drug intervention may not yield good results. Combination theraupies There are mixed opinions to this form of treatment with some reports declaring that it has no merits while others reports claiming that the method is superior. The suggested new model for treatment Address the child' s emotional quotient: Children with ADHD have emotional disturbances and find interacting with peers very difficult. The panel members should educate caretakers especially parents to address this problem rationally. Care takers should be trained to teach restrain, curb aggression and develop better social skills. This may go a long way to help children particularly in this community where stress level and violence are high.( http://www.troubledwith.com) Identify symptoms in parents: The exercise will enable the panel to treat parents where needed to make them better caretakers to their child. Address economic issues: The general conditions of the community with respect to housing, education and employment needs to be addressed. These economic issues usually cause mental ailments like anxiety and depression in the entire community, which does not auger well for treating children with ADHD in the community. Steps are to be taken to organize vocational training for the unemployed with acute language related problems. The perceived economic well being may foster hope, bring down stress levels and may be even crime. Creative game play: Care givers should be taught to enjoy the child's company and teach them practical games to play with children that are aimed to improve attentiveness or concentration. (http://www.troubledwith.com) Address social differences: The panel should have an interactive and inclusive tone of functioning. They should interact regularly with the caregivers of the child not only for treatment purposes but also for support. The success of the social problem revolves around the panel's ability to forge friendships with members of the community. This will help members identify the community's need and formulate strategies to fit them. Care should be taken by panel members to acknowledge and respect cultural and religious differences. The panel has to become empowered with information to understand the sensitivities of the minority population and avoid stepping on social landmines. It has been documented that "ethnic minorities feel alienated from mainstream (predominantly white) mental health services, and so tend to present late on mental health services. (Department of Health. 2001). For this reason, "Out Reach," programmes should be initiated to encourage residents seek help for mental issues. Children with single parents (usually mothers) should be supported with safe and effective child care services to allow time for pursuing productive careers and make the time with their child more meaningful. Identify serious mental conditions: As it has been established earlier that anti-social behaviours are often related to social disruptive personality disorders, it may be useful to screen the entire community for organic evidence of mental illnesses. Treatment of such individuals can serve to make the community safer for children. Create safe play areas: Relaxing leisure time has been shown to improve symptoms of the child diagnosed of ADHD. In communities rife with safety issues, creating safe play areas may be a challenge. However, it is possible to do this with the help of a voluntary group of mothers in the community. The mothers can take turns to watch over children in the play area created to make it safe for the children. Pay these mothers a paltry sum to ensure their continued cooperation to the programme, can mean a lot to these impoverished families and ensure uninterrupted service. Representatives from the community: The panel identifies members from the community who can act as interpreters and liaisons. Such individuals are resourceful, solving communication problems, and acting to bridge the gap between the community and the panel. It may be strategically important to give them, "special member," status, in order to raise their social standing within the community and be perceived as leaders. They may be perceived as more accessible. If there are many members in the community who will fit the role, it may be a good idea to make the post rotational. However, the appointments have to be made strictly on the basis of "first volunteered first appointed basis." Such activities are likely to make the panel popular and even endearing. Conclusion The success of mental health programmes in under privileged communities hinges on the recognition of individual needs and dynamics of human relationships. The model is intended to offer support before the situation reaches crisis point. It is therefore advocated to use the multifaceted medical/social/academic model to deal with mental problems in general and ADHD in particular in communities with complex problems. A team effort inclusive of parents, teachers, community leaders, medical staff, support groups, social workers and so on will help build the community and eventually create a better social order. References 1. Therapy in praxis Ltd. The assessment [ online]. Available http://www.adhd-add.co.uk/html [31st March 2006] 2. Dr. Likierman. V, Muter. V. ADHD (attention deficit hyperactivity disorder) and ADD (attention deficit disorder)[ online]. Available http://www.netdoctor.co.uk/diseases/facts/adhd.htm [ 29th March 2006] 3. United Kingdom. Social exclusion unit,Office of the Deputy. Prime minister. 2003. Crisis Response. London: Her Majesty's stationary office. HMSO 4. Propper. C, Jones. K, Bolster. A, Burgess. S, Johnston. 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