TIPs 31 and 32
Screening, Assessment and Treatment of Adolescents
Dr. Dawn-Elise Snipes, PhD, LMHC
Objectives
~ Identify 10 Unique Issues to the Assessment and Treatment of Adolescents
Not Little Adults
~ Adolescent treatment requires an awareness of:
~ Developmental stages
~ Adolescent culture
Adolescent Development
~ Cognitive
~ Early Adolescence
~ Emphasizes immediate reactions to behavior
~ May not be fully aware of later consequences
~ Impulse control areas of brain are not fully developed
~ Late Adolescence
~ Greater use of inductive/deductive reasoning
~ More introspective and more sensitive to later consequences
Developmental Tasks
~ Family Independence
~ Beginning rejection of parental guidelines
~ Ambivalence about wishes
~ Insistence on independence, privacy
~ May have overt rebellion, limit testing, withdrawal
~ Peers
~ Early: Most often “best” friend is same sex
~ Late: Dating, risk taking, need to please peers
Developmental Tasks cont…
~ School and Vocation
~ Beginning to identify skills, interests
~ Starting part-time job
~ Self Identity and Esteem
~ Am I normal?
~ Conformity–behavior that meets peer group values
~ Some continue to pursue group/peer acceptance
~ Some are able to reject group pressure if not in self-interest
Professional Approach
~ Early Adolescents
~ Provide firm, direct support
~ Convey limits–simple concrete choices
~ Do not align with parents, be an objective caring adult
~ Help the client explore dialectics
~ Sexual decisions–directly encourage to wait
~ Encourage parental presence in clinic, but interview teen alone
Professional Approach cont…
~ Late Adolescence
~ Be an objective sounding board (but let adolescents solve own problems)
~ Negotiate choices
~ Be role model
~ Don't get too much history (“grandiose stories”)
~ Confront gently–about consequences, responsibilities
~ Consider “What gives them status in the eyes of peers?”
~ Use peer group sessions
~ Adapt systems to crises, walk-ins, impulsiveness, testing
~ Ensure confidentiality
~ Allow teens to seek care independently
Screening and Assessment
Screening and Assessment
~ Selection of instruments is guided by:
~ Reliability and validity of the tool
~ Its appropriateness to an adolescent population
~ Type of settings in which the instrument was developed
~ Intended purpose of the instrument
Features of Instruments
~ Short in duration
~ High test-retest reliability
~ Evidence of convergent validity (i.e., the instrument is strongly correlated with other instruments that purport to measure similar constructs)
~ Predictive validity (i.e. school performance, relapse)
~ Normed on adolescents
~ Ability to measure meaningful behavioral and attitude changes over time
~ Sample Screening Forms
~ Depression Screening Tools
~ Drug & Alcohol Use Screening Tools
~ Bipolar Disorder Screening Tools
~ Suicide Risk Screening Tools
~ Anxiety Disorders Screening Tools
~ Trauma Screening Tools
Family Assessment
~ Adolescents may define family in nontraditional ways.
~ The law and society may define family in ways that differ from the actual experiences of youth.
~ Cultural and ethnic differences in family structures should be respected.
~ The core problem may reside outside the adolescent and the substance use is a symptom.
Screening Indicators
~ Problems during childhood or early adolescence
~ School issues
~ Peer involvement in delinquent behaviors
~ Daily use of one or more substances
~ Exposure to Adverse Childhood Experiences
~ Physical, sexual and verbal abuse or neglect
~ A family member with a mental health or addiction issue
~ A family member in prison.
~ Witnessing domestic violence
~ Losing a parent to separation, divorce or other reason
~ Sudden change in school performance
~ Marked change in physical or mental health
~ Risky activities
~ Truancy or running away
Areas for Assessment
~ Mental health
~ Family history
~ Client’s history
~ Present symptoms
~ Past and present medication and/or treatment and effects
~ Coping skills and strengths
~ Trauma
~ Self-esteem
~ Eating disorders
Areas for Assessment
~ Substance use history
~ Age of first use for each drug
~ Frequency, intensity, duration
~ Concurrent use
~ Immediate and remote consequences of use
~ Family history of use
~ Peer and family attitudes toward drug use
Areas for Assessment cont…
~ Physical health
~ Current/past
~ Current medications
~ Family health history
~ Housing
~ School experience
~ Performance
~ Attendance
~ Enjoyment
~ Learning disabilities
Areas for Assessment cont…
~ Social
~ Peer relationships
~ Changes in peer groups
~ Interpersonal skills
~ Neighborhood environment
~ Gang involvement
~ Pro-social activities
~ Mentors/social supports
~ Sexual history
~ Activity
~ Orientation
~ STDs/pregnancies
Areas for Assessment cont…
~ Juvenile justice involvement
~ Developmental milestones and events
~ Family history
~ Parental relationships
~ Involvement with DCF
~ Home environment
~ Other strengths
Unique Issues
~ Differing stages of cognitive development
~ Hormone fluctuations
~ Underdeveloped impulse control
~ Prefrontal cortex not fully developed until age 25 (https://www.urmc.rochester.edu/)
~ Often cannot change their recovery environment
~ Resepond differently and/or cannot be prescribed many psychotropics
~ Going through individualtion and identity development
~ Often unmotivated for change
~ Many prefer virtual interaction
~ 24 Hour Bullying
~ Confidentiality and need for parental consent
~ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393016/
Treating Adolescents
~ Addictions and mood issues often stem from different causes than for adults
~ Treatment must address
~ Cognitive
~ Thoughts maintaining behavior/mood
~ Emotional
~ Moods maintaining thoughts
~ Physical
~ Impact of moods and thoughts on energy, pain, physical health
~ Impact of sleep, nutrition, health behaviors on moods
~ Social
~ Impact of moods and thoughts on relationships and vice versa
~ Impact of relationships on health
~ Moral development
~ What is the “right” or “best choice” and why?
Treating Adolescents cont…
~ Take into account gender, ethnicity, disability status, stage of readiness to change and cultural background
~ Identify and treat delays in normal cognitive and social-emotional development associated with substance use, neglect or significant mood disorders during adolescence
~ Involve the adolescent's family because of:
~ Its possible role in the origins of the problem
~ Its ability to change the youth's environment
~ Be sensitive to motivational barriers
~ Strive to form mutually agreeable goals
~ Remember that adolescents fund of experiences is much smaller than adult’s, so things that seem like a crisis to an adolescent may seem less consequential to an adult.
Treatment Planning
~ Identify biopsychosocial problems
~ Identify attainable goals for those issues
~ Enhance strengths and resources to meet those goals
~ Specify objectives that are realistic and measurable for each goal
~ Describe interventions needed to achieve objectives
Common Treatment Plan Issues
~ Wellness Behaviors
~ Cognitive distortions
~ Coping Skills and distress tolerance
~ Anger Management
~ Communication skills (assertiveness and creating a win/win)
~ Silencing the internal critic
~ Self Esteem
~ Identity development (What is important to you and why)
~ Goal setting and motivational enhancement
~ Relationship Skills (boundaries, individuation, communication of caring)
~ Stress Management
~ Time management and organization
~ Vocational counseling
~ Grief and loss (surviving breakups, backstabbing)
~ Dealing with bullying
~ Body image issues
Summary
~ Treating adolescents requires special skills and training
~ Most adolescents begin use to cope or receive external validation
~ Adolescents’ development is often thwarted at the point of problem initiation
~ A strengths-based motivational approach works well with older adolescents
~ Adolescents can be helped to develop into healthy adults