In the previous lectures, I have outlined that adolescence is a common point in which mental disorders first begin. The challenge for those working with young people is to identify the signs and symptoms of mental disorder at an earlier point. So, what might a mental disorder look like in an adolescence? The answer is that it may take many different forms. Here are some examples of adolescent problems that may be the manifestation of an early mental disorder. They include social withdrawal or not wanting to see friends. They might take the form of irritability and angry outbursts and conflict with others at home. In some cases, it may take the form of getting stressed about school work or perhaps even extend to not wanting to go to school. In other instances, it may present with other health worries, such as headaches or aches and pains. In some instances, the first signs might be engaging in uncharacteristically bad behaviour, such as shop lifting, or getting into fights or arguments with others. You've seen this slide before, and it's a summary of the main kinds of mental health problems you're likely to see in adolescents and young adults. The HEADSS schema is one that Susan will be talking about in a future lecture. It's a very useful and easy tool and can be adapted to a range of different settings. For having a conversation with an adolescent about some of the health and emotional concerns that he or she may have. These include what is happening at home, at school, with friends, and the activities and that lesson might be engaged in. But for today, I want to focus on the last S of HEADSS. The S that relates to assessment of suicide and depression. In assessing depression, a good starting point is asking an adolescent about low mood, feeling unhappy or feeling irritable. Getting moody and grumpy is a common thing for the depressed adolescent. However, there are a range of other common symptoms that it's also important to ask about. tiredness, getting bored, having trouble with schoolwork because of poor concentration are all common symptoms of depression. And then there are a range of other changes in bodily function that may accompany depression. Difficulties with sleeping and with eating, perhaps eating too much and sleeping too much, are common as are anxiety symptoms and excessive worries. Thoughts of suicide and self-harm may also be prominent in the adolescent with an emotional problem such as depression. In assessing risk for suicide, a graded approach makes more sense. It's one where one doesn't necessarily have to continue all the way down the list of questions if one is reassured at a point that an adolescent is not suicidal. In general, a good starting point is to ask about the things an adolescent might be enjoying in life. An experience that there is little enjoyment in life is sometimes called a feeling of worthlessness. That can lead easily into our next question, which might be around sometimes feeling an adolescent would be better off dead. This might be followed by an inquiry about more specific thoughts, or plans for self-harm or suicide. It might be followed then by questioning around access to lethal means, such as a gun. That might lead on to questions about actual acts of self-harm, suicidal behaviour, suicide attempts, or near-misses. And that finally might move on to any current plans for further acts of self-harm or suicide attempts. Anxiety disorders are some of the commonest mental health problems of adolescence. They also often occur in conjunction with some symptoms of depression. This slide illustrates some of the common features of anxiety problems, as well as the typical age of onset across late childhood through to the 20s. Generalised anxiety is a common syndrome, with a typical onset in childhood or the early teens, and it's characterised by low-level anxiety, worry, tension and an inability to relax. Social phobias have a similar age of onset and often emerge in childhood in a child who has previously been shy and socially anxious. Its characteristic features are intense embarrassment and anxiety rising even to panic when having to undertake a task in front of other people. Can be giving a talk in front of class, eating or writing in front of other people. Agoraphobia tends to have a little bit of a later onset. And typically this is an anxiety about being alone outside or in other unfamiliar setting. Panic disorder refers to an intense anxiety with no obvious trigger. Commonly, the adolescent with panic disorder will describe the sudden rapid onset of anxiety often with fears of fainting or collapse. With episodes lasting from under a minute to up to an hour. This final slide examines some of the factors that we know to contribute to mental disorders in adolescents and young adults. It draws on the ecologic framework of Bronfenbrenner. At an individual level, we know that the transition through puberty brings a heightened risk particularly for anxiety and depressive symptoms in girls. Other factors such as a shy and avoidant temperament in early childhood appear to be also important as risk factors. Families and family relationships have a profound effect on well-being and risk for mental health problems. Families characterised by physical or sexual abuse, emotional neglect or persisting conflict create major risks, for both mental and behaviour problems in adolescents. After the school, after the family, school settings, be the most influential environments on young people. Academic pressures and academic failure can be important risks, particularly in boys as can conflict and victimisation with the young person's peer group. We are perhaps less clear about what some of the broader factors, and broader determiners of mental health problems might be. How the community is characterised by inequality, where young people become socially and economically marginalised, tend to have higher rates of mental health problems in young people, particularly those who are the most disadvantaged. High rates of mental disorder that appear to have come with economic development have raised some questions about whether the media or marketing influences have changed the expectations of young people and in turn, contributed to a higher rate of mental disorder. Lastly, legislation remains important in protecting young people from violence and exploitation. Although the link with mental disorder is less direct, policies that protect a young person's rights and opportunities are important in protecting the mental health of young people.