Mental Health Interventions

Directions: Read the passages carefully and complete the statement given underneath by choosing the appropriate option from the following.

Real-depression cannot be as easily overcome as some people often suppose. It usually passes with time - but the time can seem endless. Activities giving companionship and a new interest can help. But for the sufferer to talk, again and again, about the causes of the depression helps most. People with depression need to be listened tao and encouraged to find their own solutions, not made to feel yet more inadequate by good advice. They may need professional counselling as well as the support of family and friends.

In overcoming depression the support of friends and family ____________ .

Why is psychotherapy difficult to mange successfully?

Directions: Read the passage and answer the following question.

There is a strong correlation between learning disabilities (LDs) and both DSM-IV Axis 1 psychiatric disorders and other measures of psychological distress such as lowered self-esteem and lack of social competence (Beitchman and Young, 1997; American Academy of Child and Adolescent Psychiatry, 1998). This is true whether one begins by studying a group of learning-disabled children (Maughan et al., 1996; Boetsch et al., 1997; Fergussen and Lynskey, 1997) or by studying a group identified as psychiatrically disturbed (Munir and Boulefard, 1995; Cohen, 1996). If the starting point of a study was children identified by the educational system as having emotional disturbance (ED), between 30% and 75% were additionally identified as having LDs (Fessier, Rosenberg, and Rosenberg, 1991; Duchnowski et al., 1993; Forness and Kavale, 1997). The most commonly associated psychiatric problem is an externalizing disorder-usually attention-deficit/hyperactivity disorder (ADHD), or a conduct disorder (CD), or both-although internalizing disorders (anxiety, depression) are also found. The type of psychiatric disorder (externalizing or internalizing) may be of importance in predicting which students will successfully complete treatment. CD worsens the prognosis, and internalizing disorders improve it (Mattison, Spitznagel, and Felix, 1998). Internalizing disorders in the young child may become externalizing disorders in adolescence. Externalizing disorders, especially CD, may progress to antisocial personality disorder in late adolescence or early adulthood. In all cases, psychotherapy can be difficult to institute or to manage successfully, because the youngsters tend to be defensive and fearful of criticism.
The Foundation Schools are programs in the greater Washington, D.C., area that provide therapeutic and educational help to students referred by the local public schools. These are students with emotional disorders severe enough to prevent them from benefiting from regular school. The youngsters referred to Foundation Schools' special education programs often have multiple and varying DSM-IV diagnoses. This was true in the case of the youngsters (Lakeisha and Arthur) in the first two case studies in this chapter. It should also be noted that both Lakeisha and Arthur had been given both internalizing and externalizing diagnoses at various points in their past.
Because reading disorders are the most-studied combined LD group, a brief review of the research in this area is useful. The relationships between reading disorders and behavior disorders is complicated and not completely worked out yet (Hinshaw, 1992; Moffitt, 1993; Beitchman, Brownlie, and Wilson, 1996; Maughan et al., 1996; Fergussen and Lynskey, 1997; Prior et al., 1999). Rutter (cited in Maughan and Yule, 1994) proposed three broad hypotheses to account for the reading-behavior problem links. First, the behavior problem may be primary and lead to reading problems by interfering with the child's learning. Second, the reading problem may be primary and lead to the behavior problem, perhaps through academic failure, frustration, and lowered self-esteem. Third, both difficulties may stem from a common root in genetic, temperamental, or environmental adversities. These models may interact in reciprocal and unidirectional ways, leading to the final result. Research has not settled which model is most accurate. Fergussen and Lynskey (1997) found that children with reading disabilities had early-onset conduct problems prior to the onset of reading problems. This supports the first model. The connection of reading disorder with ADHD (Lambert and Sandoval, 1980) and the observation that youngsters with ADHD show subpar preschool achievement tests (Mariani and Barkley, 1995) also tend to support the first model. Shaywitz (1996) has reported language delays and inattention to the sounds of words (trouble playing rhyming games with words or confusing words that sound alike) in preschool children at risk of dyslexia-second model. Hinshaw (1992) reported that the overlap of externalizing problems with cognitive and academic readiness deficits early in development suggest the influence of antecedent variables. Low socioeconomic status, family adversity, subaverage IQ, language deficits, and neurodevelopmental delays were explored as possible underlying factors-third model. Moffitt (1993) describes a neuropsychological model in which attention deficits, verbal deficits, and executive dysfunction interact with environmental responses to produce CD.

Why is psychotherapy important to disabled children?

Directions: Read the passage and answer the following question.

The reasons some children perform at a lower academic level than intelligence and educational opportunity predict are still under study. We reference the relevant and conflicting research later, but clinically it is clear that learning disorders are associated with disturbed behavior and with psychiatric symptoms. It is our contention that youngsters with this group of difficulties require dynamically informed psychotherapeutic help if they are to utilize any academic approach. Without psychotherapy, they are often unmotivated and tend to avoid academics, using other techniques-often maladaptive-to maintain self-esteem. This tendency accelerates as they move into and through adolescence. It is also important to remember that some academic problems are primarily psychological inhibitions of curiosity (Blanchard, 1946; Buxbaum, 1964) or performance (Berger and Kennedy, 1975), and it is crucial that these are not confused with learning problems that have a cognitive origin. In addition, even in those instances in which there are cognitive problems, the final presentation is a complex interaction between neuropsychological deficits and emotional factors (Rothstein et al., 1988; Swanson, Harris, and Graham, 2003). In brief, learning problems can be the result of psychological conflict, or psychological conflict can occur secondary to neuropsychiatric deficiencies. Two of our case examples will illustrate these two possibilities, whereas the third will show how difficult it can be to make that differentiation with some adolescents.
Recent literature has contained very few essays addressing dynamic psychotherapeutic approaches to the adolescent population. Most treatment accounts describe cognitive models (Flavell, 1979), cognitive-behavioral models (Borkowski and Burke, 1996; Hallahan, Kauffman, and Lloyd, 1996), and task-analytic models (Rosenshine and Stevens, 1986). There is also some promise in computer-assisted instruction (Hall et al., 2000). There is objective evidence of success with many of these cognitive remediations, especially from the task-analytic approaches, even though a significant number of students do not respond (Torgenson, 2000). Simmerman and Swanson (2001) have pointed out procedural flaws in some studies but do not question the proven value of the procedures employed. It should also be noted that these approaches have been most successful with young children, suggesting that they may not be sufficient for adolescents. Garber (1992) describes the maneuvering and testing that these students display. After years of negative school experiences, they have taken refuge in a variety of defenses designed to hide their learning disability from others and from themselves. Garber (1992) says, The various maneuvers are means of dealing with an environment that may be ambiguous or confusing. The more intelligent the adolescent, the more complex the testing maneuver. These testing maneuvers, which try the patience of parents, teachers, and therapists, often obscure the learning-disabled adolescent's strengths and capabilities (p. 344). Palombo (2001) has provided a detailed description of the impact of learning disorders on the development of the sense of self and self-narratives. He also provides a thoughtful guide to treatment that recognizes the differential impact of the youngster's neuropsychological deficiencies as opposed to psychological issues on the development of transference. Arkowitz (2000) has suggested that dyslexia can lead to a generally over stimulated state by interfering with organizing, containing, and distinguishing among crucial features of affective experience (p. 1493). Needless to say, these adolescents are not eager for psychotherapy, viewing that prospect as a major threat to their precarious self-esteem. Still, other cognitive remedial approaches are impossible to implement when the adolescent is truant (if not from school, then often from the classroom), is unable to admit that remediation is needed, and actively avoids it. Although the effort to help adolescents with school problems is definitely multidisciplinary, the psychotherapist often has to prepare the student to accept help and also to coordinate the professional team, while maintaining the student's cooperation (Meeks and Dupont, 2003).