Focus Area 8: Mental Health Basics
4. Mental Health Disorders Prevalent Among Youth
Trauma and Stress-Related Disorders
Before we address the trauma and stress disorders prevalent among youth, it would be helpful to have a more general understanding of trauma and its effect on youth.
The best way to get an overall appreciation for the impact of trauma on youth is to learn about the Adverse Childhood Experiences (ACE) study, commonly referred to as ACEs.
The study was conducted by the Centers for Disease Control (CDC) and is one of the most significant investigations into childhood trauma and later life well-being. The study’s results show a connection between adverse childhood experiences and their impact on social and health problems experienced by children and adults.
Initially looking at the ACEs list, it seems to cover the most common or recognizable types of trauma. But keep in mind ACEs is not an exhaustive list. Looking closer, you’ll see that there are lots of experiences missing. What about experiences with micro-aggressions related to racism or sexism, experiencing natural disasters, community violence, homelessness, witnessing or experiencing police brutality, severe bullying, or hate crimes?
Can you think of experiences that might be missing but worthwhile for you to be aware of, when considered in the context of trauma?
Thinking along those lines, consider your own agency or program:
- How might a person affected by an adverse experience feel walking into your organization?
- Are there reminders of their trauma that would force them to confront or grapple with reactions in order to come in the door?
- How might a person with trauma in their past feel while interacting with your programming and with you personally?
This leads us into the discussion of how to be trauma-informed.
Trauma treatment vs. Trauma-informed
You may not have the training to provide trauma treatment, but you can be trauma-informed. What’s the difference?
- Trauma treatment requires a clinical license and generally follows some kind of modality or treatment plan.
- Being trauma-informed refers to you and your youth-serving agency acknowledging the impact of trauma in a young person’s life and actively working to create an environment which is not triggering to a known or an unknown trauma.
It is not necessary to know the cause of an individual’s trauma or the criteria for diagnosis in order to be intentional about being trauma-informed. As an individual and as an agency, you can strive to be “radically welcoming.”
Here are some ways to be radically welcoming and provide trauma-informed care:
- Present options to participants (i.e. have male/female/nonbinary intake staff available)
- Make room for unique stories and create responsive policies and paperwork
- Create a comfortable experience
- Have agency-wide trauma-informed training (including administrative staff)
Discuss with your team what makes sense for your specific organization and work together to ensure your programs, processes, and spaces align with trauma-informed best practices.
Each disorder in this category has a variety of risk factors that could lead to a diagnosis. However, a general theme is that they consist of situations or events that likely trigger severe stress in young people and could easily cause trauma in most people exposed to the stressors. Examples can be, but are not limited to, poverty, alcoholism and drug abuse/addiction in caregivers, witness to violence, systemic racism, abuse and neglect, human trafficking, and caregiver incarceration.
Your goal is to establish trust with young people. When you do, they will be more likely to confide in you about things in their lives that are impacting their healthy development. But they may not tell you everything. Or they may only tell you parts of things because they may be afraid to say everything. Don’t wait for full disclosure before acting.
Youth work is part science and part art. It’s following your gut and being creative. Link together what you have been told with what you are observing. Follow your instinct to help recognize behaviors that deviate from that young person’s “typical” ways of acting.
This could be an increase in aggression, more withdrawn, more anger or irritability, or a whole host of behaviors. Identifying trauma is more than completing a static checklist; it requires curiosity and a frame-of-mind on your part. It is “art” that requires constant observation and learning.
As always, if you suspect a youth is living with trauma or is in danger, be certain to consult with your supervisor regarding appropriate steps of action you should take. It can’t be said enough, consultation is a strong characteristic of a highly skilled youth worker.
There are various types of trauma disorders and each has a unique set of symptoms. In this section, three of the more common disorders are briefly addressed, Post-Traumatic Stress Disorder (PTSD), Adjustment Disorders, and Disruptive Disorders.
Post-Traumatic Stress Disorder (PTSD) or Acute Stress Disorder
A young person with PTSD or Acute Stress Disorder has experienced a traumatic event that disrupted the process of memory storage and as a result the event may feel as though it is presently occurring or impending.
PTSD and Acute Stress Disorder have similar symptoms but differ in the length of time a person experiences them. Acute Stress Disorder resolves more quickly. But if the symptoms persist longer than a month from the event, it has progressed to PTSD, which can last in some form for a lifetime.
Different types of exposure can lead to PTSD or Acute Stress Disorder:
- Directly experiencing the traumatic event
- Witnessing an event as it occurs to others
- Learning that a traumatic event happened to a loved one
- Repeated exposure to aversive details of the traumatic event
Symptoms of PTSD or Acute Stress Disorder include:
- Intrusive Memories, which can include flashbacks that relive the moment of trauma, bad dreams, and scary thoughts.
- Avoidance, which can include staying away from certain places or objects that are reminders of the traumatic event. A person may also feel numb, guilty, worried, or depressed or have trouble remembering the traumatic event.
- Dissociation, which can include out-of-body experiences or feeling that the world is "not real" (de-realization).
- Hypervigilance, which can include being startled very easily, feeling tense, having trouble sleeping or outbursts of anger.
Sherrita Allen is a Licensed Professional Counselor and has provided direct service to traumatized youth and families. In this video, she describes what traumatic responses can look like and shares a few helpful tips for supporting young people with PTSD.
This diagnosis refers to a young person suffering distress resulting from an identifiable stressor that impairs social, occupational, or emotional functioning and begins within 3 months of initially being exposed to the stressor.
An adjustment disorder can be a response to:
- Single event (e.g. breakup, changing schools)
- Multiple stressors (e.g. parent’s divorce, moving, financial trouble)
- Recurrence of a stressor (e.g. parent’s entry and release from prison)
- Continuing stress (e.g. bullying, living in a high crime neighborhood)
- Developmental related event (e.g. leaving parental home, getting married, transitioning to high school, etc.)
Symptoms of an adjustment disorder depend on the factors that are causing the stress or trauma and vary between youth. As a youth worker, you need to watch for signs of more stress than normally would be expected from the event or what is considered “typical” amounts of stress. The response also lasts longer than you may expect and it becomes persistent or chronic therefore leading to problems with healthy development.
This group of disorders encompasses a wide range of causes and a wide range of behaviors. What these disorders have in common is that they are generally identified by poorly-controlled emotions and they tend to violate the rights of others or violate societal norms or authority figures.
This is the classification of disorders that many youth workers find frustrating and exhausting. That’s because behaviors are often an attempt to bother you…and they can be successful. Youth with these diagnoses can and will trigger a lot of emotions in you.
In Focus Area 4: Ethics, you learned that you need to always be aware of why you do what you do. Remember emotional check-ins? It’s important to always evaluate your needs and to always act in the best of interest of the young people you serve, especially with these types of disorders.
Intermittent Explosive Disorder
Frequent, short (less than 30 minutes) verbal or physical outbursts due to minor provocation.
Oppositional Defiant Disorder
Argumentative or vindictive behavior that the youth may feel is reasonable given circumstances. Less severe than Conduct Disorder.
Pattern of behavior that violates others' basic rights or major social norms
ACTIONS FOR A YOUTH WORKER
Oftentimes, not feeling heard or seen in life or in society is a major contributor to these types of disorders for young people. Helping them understand this perspective can go a long way to ensuring they find their role or niche in their community. Reasons include:
- It allows the youth to process the wrong that they perceive to have been done (situationally or globally) and begin to digest those experiences and feelings.
- Behaviors tend to decrease when a youth feels that someone “gets it” and that they are not seen as “wrong,” “broken,” or “dangerous.”
- It provides the opportunity for a youth to tell their own story to a caring adult. It creates the chance for that youth to start presenting how they see themselves to the rest of the world. Often these youths have been told that they need to be micromanaged, supervised, and “handled” and have not had the chance to re-write their own narrative about how they want the world to experience them.
By the time they are adolescents, youth struggling with disruptive disorders usually have been involved in a variety of behavioral interventions. They may have been or currently are in Emotional Behavioral Disorders (EBD) classrooms, Level 4 educational settings, the juvenile justice system, or have experienced a variety of therapeutic and pharmacological interventions.
Understandably, they will be wary of you. Trust is usually built slowly and it will be tested throughout the relationship to see how you react.
The following are a few things to know as you work with youth struggling with a disruptive disorder:
- Validate and be curious! Let them see that you will hold them in positive unconditional regard despite their behaviors.
- Hold them accountable for the rules and norms they break. They will not trust you if you let them get away with things. In fact, they will respect you more for doing what is tough in the relationship. Remember, accountability is not the same as punishment.
- Be careful with self-disclosure. Never share anything you don’t want to be used against you. If you show vulnerability, it may very well be used as a test of your commitment to them.
- Name the youth’s feelings and experiences without endorsing the harm done. Shame and guilt reinforce a self-fulfilling prophecy that causes them to act out in the first place.
- Name a reaction to a more global wrong they feel has been done (i.e. systemic racism, sexism, or homophobia) and is triggering potential anger or hurt.
There are many more diagnoses than were covered in this module. The objective is not for you to know how to diagnose and provide specific treatment, rather to have a basic understanding of a few of the most common mental health issues you will encounter.
However, the themes and responses to take in looking at the diagnoses in the module can be applied for all mental health concerns. You need to always be inquisitive about risk factors that could lead to problems, always be on the lookout for “symptoms” that are indicators that something isn’t quite right, and always be willing to consult when you have questions or concerns about a youth's well-being.
Your program may deal with specific diagnoses like autism spectrum disorders that were not covered in this module. If that is the case, you should seek out additional training directly related to your work.
Young people that have experienced any type of trauma often exhibit survival-oriented behaviors. Survival behavior is often misinterpreted by youth workers as willful misbehavior. Sometimes, those survival behaviors are mistakenly seen as the basis for a mental health diagnosis.
We invited Dave Wilmes, an expert in the field of trauma and youth behavior, to share his insights for you to be more effective in your work with survival-oriented youth. No matter what type of youth work you do, you're very likely to encounter young people impacted by trauma so Dave's advice will be very useful to you.
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