THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF SOCIAL WORK COURSE NUMBER: SOWO 801, Section 001 Tuesday 2:00-4:50 pm COURSE TITLE: Child and Adolescent Health & Mental Health, Spring 2009 INSTRUCTOR: Joelle D. Powers, PhD, MSW School of Social Work, CB#3550 University of North Carolina Chapel Hill, NC 27599 Office: 563C Phone: 919-843-8686 Email: jdpowers@email.unc.edu OFFICE HOURS: Tuesdays 12-2:00 pm or by appointment COURSE DESCRIPTION: This course reviews theories and research that serve as a foundation for assessing and serving children with serious health problems, physical disabilities, and mental disorders. EXPANDED DESCRIPTION: This is an Advanced Curriculum human behavior course that builds on normal human development taught in the prerequisite Foundation Curriculum human behavior course SOWO 500. Therefore, it is assumed that the student will be able to contrast developmentally typical behaviors with atypical behaviors found in mental disorders or that might result from a serious or chronic health condition, and to distinguish problems of living within a normal range from the difficulties children might experience in a physical or mental disorder. This course examines only those health and mental disorders that typically have an onset from birth to 18 years. While mental disorders are individually assessed, it is the perspective of this course that the impact of a mental disorder is experienced at least within the family and community. Additionally, there will be considerable effort throughout the course to examine how a particular diagnosis might be misunderstood and misapplied to vulnerable populations and how to avoid this practice. Assessing mental disorders puts clinicians in a powerful position with clients, a position fraught with ethical issues and potential dilemmas. Therefore, specific ethical content in this class will focus on topics related to: (a) determining whether a child really has a mental disorder or just a developmental stage problem, (b) being sure that if the child is different from the majority population that such difference has been understood and appreciated rather than diagnosed, and (c) being sure that cultural content is considered objectively in the assessment process. COURSE OBJECTIVES: The course will cover research and theoretical issues surrounding the psychosocial assessment and treatment of problems of health and mental health with the goal of assisting students to: Articulate a generic formulation of disability and serious illness and a biopsychosocial perspective on disorders of childhood and adolescence. Understand the advantages, limitations and ethical implications of categorical and dimensional approaches to the diagnosis of common disorders of childhood and adolescence, such as exemplified in the ICD and DSM. Conceptualize the diagnosis and treatment of physical and mental disorders within a developmental framework that also involves consideration of culture, ethnicity, gender, sexual orientation, and socio-economic status. Identify and differentiate the signs and symptoms of mental disorders that usually are first diagnosed in infants, children, and adolescents and interpret them ethically in the evaluation of social work clients. Know the psychosocial and developmental implications of serious and life threatening chronic illness for children, adolescents and their families. Specific Course Objectives. By the end of this course the student will be able to: 1. Demonstrate an understanding of the complex issues involved in defining both mental health and mental disorders; 2. Analyze the strengths and weaknesses of using the Diagnostic and Statistical Manual of Mental Disorders in assessment of children’s behaviors; 3. Appreciate and be able to use appropriately content on race, ethnicity, gender, age, socioeconomic status, sexual orientation, stage of development in the assessment of mental and emotional well-being; 4. Identify and differentiate the signs and symptoms of mental disorders that usually are first diagnosed in infants, children, and adolescents and apply them ethically to the evaluation of social work clients; 5. Recognize and appreciate the impact of a mental disorder not only on the life of the child who is experiencing it, but also on the family and community in which the child lives; 6. Recognize risk and resiliency factors associated with mental disorders; and 7. Demonstrate an understanding of the methodological basis of the genetic evidence in health and mental health and be able to articulate the ethical issues involved in sharing predictors with children. REQUIRED TEXTS/READINGS: Mash, E. J., & Barkley, R. A. (Eds.). (2003). Child psychopathology (2nd ed). New York: Guilford Press. The required text is available at the Health Affairs bookstore. Other required readings are listed by the class sessions and will be available online though the Blackboard website for the course (https://blackboard.unc.edu), or through the library. The DSM-IV-TR is recommended, but not required, for the course. TEACHING METHODS A variety of teaching and assessment methods will be used to promote learning among all students. Most class sessions will include a lecture/discussion component, case study discussions, and one or more reinforcement or application exercises (e.g., focused discussion, small or full group activity, video). Students are expected to attend all classes and to be prepared to take an active roll in learning and discussions. The course starts with a discussion of definitions and conceptions of health and mental health. It then progresses through the most common mental health and health disorders of childhood and adolescence. Additional topics related to well-being are also covered. Topics covered in Weeks 2 through 13 are: (a) Health and mental health of infants and toddlers (b) Mental retardation (Intellectual disabilities) (c) Pervasive developmental disorders (d) Attention-Deficit/Hyperactivity Disorder (e) Substance abuse (f) Chronic physical illness (g) Anxiety disorders; LGBT issues in schools (h) Depressive disorders; Suicidal behavior (i) Behavior Disorders; Physical discipline (j) Maltreatment; Post Traumatic Stress Disorder; Alternative caregivers (k) Eating disorders (l) Learning and communication disorders For each disorder covered, the course will review what is known about the phenomenology of the disorder, its prevalence, risk factors, co-morbidity with other disorders, etiology and developmental trajectory. DSM-IV criteria are examined for each disorder. Themes of the course that will be discussed in relation to each disorder include: the physical health symptoms, correlates, and consequences of mental health disorder, and mental health symptoms, correlates, and consequences of physical health disorder; environmental vs. individual-based aspects of etiology; developmental influences on definitions and manifestations of disorder; cultural and gender issues in disorder; and the impact of an individual’s disorder on the family. Although this is not a practice or treatment course, it does address questions of how theory and assessment provide insights for setting goals and designing programs of prevention and treatment. GRADING The School of Social Work uses an evaluation system of Honors (H), Pass (P), Low Pass (L), and Fail (F). For this class, the numerical value of an H ranges from 94 - 100; a P is 80 - 93; an L is 70 - 79. The final grade will be determined as follows: Assignment Weekly Quizzes Essays (2) Case Study Presentation/Write-up Final Examination Total Points Toward Final Grade 30 30 (15 points each) 15 25 100 DESCRIPTION OF CLASS ASSIGNMENTS Weekly Quizzes. Each class session will begin with a quiz on the assigned readings for that session and course material covered in the previous class. This is how attendance and participation are graded for this course thus they cannot be made up at a later time. Students can refer to class notes, handouts, and assigned readings while taking the quizzes. Quizzes will comprise 30% of your overall grade. Essays. For each essay, students will review an assigned article and respond to questions/prompts related to the content and implications for social work practice. The articles, detailed instructions/prompts, and a grading rubric for the essays are provided on the course Blackboard site. The essays are worth 30 % (15 % each) of your total course grade. Essay #1: Due February 17 Essay #2: Due March 24 Case Study Presentation and Write Up. Each student will be responsible for presenting a case study to the class and leading a 15 minute discussion on diagnosis of the case according to DSM IV criteria. One week after the presentation, the write up of the case will be due. This assignment is worth 15% of the course grade. Detailed instructions and a grading rubric for the presentation and write up are provided on Blackboard. Final Exam. The final is worth 25% of your total course grade and detailed directions will be handed out in class on April 7. The final will be a take home, open book essay/short answer exam and is due on April 21 by 12pm. POLICY ON UNEXCUSED ABSENCES Attendance and participation points obtained through the weekly quizzes contribute substantially to final grades. Students missing 3 classes (or more) may receive an L for the course, because it is not possible to meet course requirements for learning objectives with that level of absenteeism. Students are responsible for obtaining from their classmates ALL announcements, instructional information, and handouts for class sessions they miss. POLICY ON INCOMPLETES AND LATE ASSIGNMENTS A grade of Incomplete is given on rare occasions when there is sufficient reason to warrant it. It is the student’s responsibility to initiate a conversation with the instructor to request an Incomplete. All assignments (other than the final exam) are due at 2pm on the dates as listed in the syllabus. Students will lose 10% when an assignment is submitted late, and will lose an additional 10% for each 24-hour period beyond the due date (including weekends). POLICY ON ACADEMIC DISHONESTY Academic dishonesty is contrary to the ethics of the social work profession, unfair to other students, and will not be tolerated in any form. Students can also refer to the APA Publication Manual (5th Ed.), the School of Social Work Manual, and the School of Social Work Writing Guide (available on the School’s website) for information on attribution of quotes, plagiarism and appropriate use of assistance in preparing assignments. Assignments should contain a signed pledge, stating, “I have neither given nor received unauthorized aid in preparing this work.” POLICY ON ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES The instructor will make any necessary and appropriate accommodations for students with disabilities. To obtain disability-related academic accommodations, students with disabilities must contact the instructor and the Department of Disability Services as soon as possible. The Department of Disability Services can be reached at 919-962-8300 (Voice/TDD) or http://disabilityservices.unc.edu. READINGS AND COURSE OUTLINE Week 1/January 13: Introduction to Health and Mental Health Introduction to opposing approaches to health and mental health and themes of the course. Week 2/January 20: Heath and Mental Health of Infants & Toddlers The developmental systems perspective. Early development and psychological functioning; Infant mortality, Prematurity. Sleep, Feeding, and Elimination disorders; Reactive Attachment disorder; Colic. Sign up for case study presentation dates. Assigned Reading: Mash, E. J. & Dozois, D.J.A. (2003). Child psychopathology: A developmental-systems perspective. Chapter 1 (pp. 3-71) in Mash, E. J. & Barkley, R. A. Lyons-Ruth, K., Zeanah, C. H., & Benoit. D. (2003). Disorder and risk for disorder during infancy and toddlerhood. Chapter 13 (pp. 589-631) in Mash, E. J. & Barkley, R. A. Peterson, L., Reach, K., Grabe, S. (2003). Health-related disorders. Chapter 16 (pp.716— 749 in Mash, E. J. & Barkley, R. A. Read the sections on the following topics; NOFTT, pp. 719-721; Phenylketonuria, pp. 723-724; Elimination Disorders, pp. 725-727; and Sleep Disorders, pp. 727-729) Corresponding DSM-IV-TR Readings (optional): American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. Feeding and eating disorders of infancy or early childhood, pp. 103-108. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. Elimination disorders, pp. 116-121. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. Other disorders of infancy, childhood, or adolescence, pp. 121-134. Week 3/January 27: DSM-IV Diagnosis; Mental Retardation (Intellectual Disabilities) Using the DSM-IV classification system. Mental retardation. Fetal Alcohol Syndrome, Down syndrome, Fragile-X syndrome. Assigned Reading: Hodapp, R. M. & Dykens, E. M. (2003). Mental retardation (Intellectual disabilities). Chapter 11 (pp. 486-519) in Mash, E. J. & Barkley, R. A. Cohen, W. I. (1996). Healthcare guidelines for individuals with Down syndrome. Down Syndrome Quarterly, 1. [pages 1-14] American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. (pp. 1-10, 27-37). Corresponding DSM-IV-TR Readings (optional): American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders ( 4th ed.). Washington: author. Mental retardation, pp. 41-49. Week 4/February 3: Pervasive Developmental Disorders, and School services for children with disabilities Autistic disorder, Rett’s disorder, Asperger’s disorder, and Childhood disintegrative disorder. Assigned Readings: Klinger, L. G., Dawson, G., and Renner, P. (2003). Autistic disorder. Chapter 9 (pp. 409 454) in Mash, E. J. & Barkley, R. A. Go to the following website: http://www.autism-society.org/ Click on “About Autism” (at the top of the page); Read the links “What is Autism,” “Education,” and “Living with Autism” and their sublinks. Corresponding DSM-IV-TR Readings (optional): American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. Pervasive developmental disorders, pp. 69-84. Week 5/February 10: Attention-Deficit/Hyperactivity Disorder; Psychopharmacology Assigned Readings: Barkley, R. A. (2003). Attention-Deficit/Hyperactivity Disorder. Chapter 2 (pp. 75-143) in Mash, E. J. & Barkley, R. A. Kral, M. C., LaRosa, A., Brown, R. T., Kubiszyn, T. (2006). Pediatric psychopharmacology. In G.. G. Bear & K. M. Minke (Eds.), Children’s needs III: Development, prevention, and intervention. (pp. 1077-1088). Bethesda, MD: NASP. Corresponding DSM-IV-TR Readings (optional): American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. Attention deficit hyperactivity disorder, pp. 85-93. Week 6/February 17: Substance Abuse *Essay 1 Due Assigned Readings: Barkley, R. A. (2003). Adolescent substance use Disorders. Chapter 4 (pp. 199-232) in Mash, E. J. & Barkley, R. A. NIDA for Teens: The Science Behind Drug Abuse (2008). [Available at: http://teens.drugabuse.gov/]. Please pay special attention to ‘Stimulants’ in the ‘Facts on Drugs’ section . Corresponding DSM-IV-TR Readings (optional): American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. Substance-Related disorders, pp. 191-209, 213-223. Week 7/February 24: Chronic Physical Illness and its Effects on Individuals and Families Common chronic illnesses, obesity, chronic illness and schools Assigned Readings: Barbarin, O. (1990). Adjustment to serious childhood illness. In B. Lahey & A. S. Kazdin (Eds.), Advances in Clinical Child Psychology: Volume 13, pp. 377-403. New York: Plenum. American Lung Association. (2003). Asthma and Children. Available at: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=44352 Read the links under the heading “Asthma and Children” (except Asthma Busters). Schwartz, M. B., & Puhl, R. (2003). Childhood obesity: A societal problem to solve. Obesity Reviews, 4, 57-71. CDC. (2003). National diabetes fact sheet. Department of Health and Human Services. Retrieved January 5, 2004 from http://www.cde.gov/diabetes/pubs/pdf/ndfs_2003.pdf National Society for Epilepsy. (2003). Information on epilepsy: Children: a guide for parents and carers. [Available at, http://www.epilepsynse.org.uk/pages/info/leaflets/children.cfm? ] National Heart Lung and Blood Institute. (2005). Cystic Fibrosis. [Available at, http://www.nhlbi.nih.gov/health/dci/Diseases/cf/cf_what.html Nemours Foundation. (2005). Sickle Cell Anemia. [Available at, http://kidshealth.org/teen/diseases_conditions/genetic/sickle_cell_anemia.html Week 8/March 3: Anxiety Disorders; LGBT Issues Generalized anxiety disorder, OCD, specific phobia, social phobia, panic disorder Assigned Readings: Albano, A. M., Chorpita, B. F., & Barlow, D. H. (2003). Childhood anxiety disorders. Chapter 6 (pp. 279-329) in Mash, E. J. & Barkley, R. A. Mesibow, L. L. (2006). Schools’ legal obligations to gay students. Popular Government, 74, 16-23. Jeltova, I. & Fish, M. C. (2005). Creating school environments responsive to gay, lesbian, bisexual, and transgender families: Traditional and systemic approaches for consultation. Journal of Educational and Psychological Consultation, 16, 17-33. Corresponding DSM-IV-TR Readings (optional): American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. Anxiety disorders, especially pp. 429-430; 456-468. Week 9/March 17: Depressive Disorders; Suicidal Behavior Major depression, dysthymia, bipolar disorder Assigned Readings: Hammen, C. & Rudolph, K. D. (1996). Childhood mood disorders. Chapter 5 (pp. 233278) in Mash, E. J. & Barkley, R. A. Corresponding DSM-IV-TR Readings (optional): American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. Mood Disorders, especially pp. 345-401. Week 10/March 24: Behavior Disorders; Physical Discipline Definitions, etiology, trajectories, comorbidity, and outcomes of behavior disorders. *Essay 2 Due Assigned Readings: Hinshaw, S. P. & Lee, S. S. (2003). Conduct and oppositional defiant disorders. Chapter 3 (pp. 144 -198) in Mash, E. J. & Barkley, R. A. Dodge, K. A., McLoyd, V. C., & Lansford, J. E. (2005). The cultural context of physically disciplining children. In V. C. McLoyd, N. E., Hill, & K. A. Dodge (Eds.), African American family life. (pp. 245-263). New York: Guilford Press. Corresponding DSM-IV-TR Readings (optional): American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. Conduct disorder, Oppositional defiant disorder, pp. 93103. Week 11/March 31: Maltreatment; Post Traumatic Stress Disorder; Alternative Caregivers Assigned readings: Wekerle, C., & Wolfe, D. A. (2003). Child maltreatment. Chapter 14 (pp. 632-684) in Mash, E. J. & Barkley, R. A. Fletcher, K. E. (2003). Childhood posttraumatic stress disorder. Chapter 7 (pp. 330-371) in Mash, E. J. & Barkley, R. A. Pinderhughes, E. E., & Harden, B. J. (2005). Beyond the birth family: African American children reared by alternative caregivers. In V. C. McLoyd, N. E., Hill, & K. A. Dodge (Eds.), African American family life. (pp. 285-310). New York: Guilford Press. Recommended reading: Vance, J. E. (2001). Neurobiological mechanisms of psychosocial resiliency. In J. M. Richman & M. W. Fraser (Eds.), The context of youth violence: Resilience, risk, and protection (pp. 43-81). Westport , CT: Praeger. Week 12/April 7: Eating Disorders Assigned readings: Barkley, R. A. (2003). Eating disorders. Chapter 15 (pp. 687-715) in Mash, E. J. & Barkley, R. A. National Eating Disorders Association (2008). [Available at: http://www.nationaleatingdisorders.org/] (Under the Information and Resources link at the top, please review sections on ‘Research results on eating disorders in diverse populations’ and ‘Treatment of eating disorders’) Week 13/April 14: Learning and Communication Disorders Reading Disorder, Disorder of Written Expression, Mathematics Disorder, Expressive Language Disorder, Mixed Receptive-Expressive Disorder, Phonological Disorder, Stuttering, Developmental Coordination Disorder Assigned Reading: Lyon, G. R., Fletcher, J. M., Barnes, M. C. (2003). Learning disabilities. Chapter 12 (pp. 520-586) in Mash, E. J. & Barkley, R. A. Recommended reading: American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. Learning disorders, pp. 49-56. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: author. Communication disorders, pp. 58-69. Week 14/April 21: No Class *Hard copy of Final Exam due at noon