SStt.. CCaatthheerriinnee UUnniivveerrssiittyy SSOOPPHHIIAA Master of Social Work Clinical Research Papers School of Social Work 5-2014 HHeeaalltthh PPrrooffeessssiioonnaallss’’ UUssee ooff AArroommaatthheerraappyy wwiitthh CChhiillddrreenn aanndd AAddoolleesscceennttss wwiitthh MMeennttaall IIllllnneessss Emily J. . Laconic St. Catherine University Follow this and additional works at: https://sophia.stkate.edu/msw_papers Part of the Social Work Commons RReeccoommmmeennddeedd CCiittaattiioonn . Laconic, Emily J.. (2014). Health Professionals’ Use of Aromatherapy with Children and Adolescents with Mental Illness. Retrieved from Sophia, the St. Catherine University repository website: https://sophia.stkate.edu/msw_papers/349 This Clinical research paper is brought to you for free and open access by the School of Social Work at SOPHIA. It has been accepted for inclusion in Master of Social Work Clinical Research Papers by an authorized administrator of SOPHIA. For more information, please contact [email protected]. Running Head: AROMATHERAPY Health Professionals’ Use of Aromatherapy with Children and Adolescents with Mental Illness by Emily J. Laconic, B.S.W., L.S.W. MSW Clinical Research Paper Presented to the Faculty of the School of Social Work St. Catherine University and the University of St. Thomas St. Paul, Minnesota in Partial fulfillment of the Requirements for the Degree of Master of Social Work Committee Members Lisa Kiesel, Ph.D. (Chair) Sarah Kopp, MSW, LICSW Sue Murr, MSW LICSW The Clinical Research Project is a graduation requirement for MSW students at St. Catherine University/ University of St. Thomas School of Social Work in St. Paul, Minnesota and is conducted within a nine-month time frame to demonstrate facility with basic social research methods. Students must independently conceptualize a research problem, formulate a research design that is approved by a research committee and the university Institutional Review Board, implement the project, and publicly present the findings of the study. This project is neither a Master’s thesis nor a dissertation. ARAMOTHERAPY 2 Abstract The purpose of this study was to explore how health professionals are using aromatherapy with children and adolescents who have exhibited or are diagnosed with the four most common mental illnesses. The four most common mental illnesses according to the Center for Disease Control and Prevention (CDC) (2013) are: ADHD as the highest mental health disorder; then behavioral or conduct problems; anxiety; and depression (part of mood disorders). This qualitative research study used an exploratory design by conducting in-depth semi-structured open-ended questions to four subjects. Themes were identified using content analysis. Subjects using aromatherapy with children and adolescents, use a mindfulness and empowerment approach. By encouraging clients to find what essential oil helps them regulate their symptoms and so they are be able to return to daily living. Several subjects gave examples of effective aromatherapy has been to their clients. There has been no adverse reaction from parents or guardians of the children and adolescents who are using aromatherapy as an intervention. The only identified barrier from the subjects was the cost of essential oils. There is a lack research in this area, and research that directly interviews children and adolescents. There are no current licensure requirements in the State of Minnesota to practice aromatherapy, and a minimum amount of training courses. Besides a need for regulations of practicing aromatherapy, there needs to be regulations on the quality of essential oils. ARAMOTHERAPY 3 Acknowledgements I would like to thank my parents for supporting me during one of the most challenging times of my life. I also need to shout out to Charlie and Ranger, my dog and cat, which have been patiently or not waiting for my attention again. I need to thank my chair, Lisa and committee members, Sarah and Sue, for their positive input and support. Thanks Sarah for networking and helping me find participants, and Sue for encouragement and praise that this is ground breaking research. Last by not least thank you classmates who are now friends, for supporting me, and meeting me at the library every weekend. You know who you are. ARAMOTHERAPY 4 Table of Contents Introduction………………………………………………………………………………………..5 Literature Review Mental Illnesses……………………………………………………………………….…..6 Aromatherapy……………………………………………………………………………18 Regulations and Requirements for Aromatherapists ……………………………………20 Applicable Research on Aromatherapy……………………………………………….....21 Conceptual Framework………………………………………………………………………….22 Methods Research Question………………………………………………………………………24 Research Design………………………………………………………………………...24 Sample Population………………………………………………………………………24 Measures for Protection of Human Subjects……………………………………………25 Data Analysis……………………………………………………………………………26 Findings…………………………………………………………………………………………26 Discussion……………………………………………………………………………………….35 Implications for Social Work Social Work Practice…………………………………………………………………….36 Social Work Policy………………………………………………………………………37 Social Work Research…………………………………………………………………....38 Strengths and Limitations………………………………………………………………..38 Conclusion……………………………………………………………………………………….38 References……………………………………………………………………………………….40 Appendix A……………………………………………………………………………………...44 Appendix B……………………………………………………………………………………...45 Appendix C……………………………………………………………………………………...47 ARAMOTHERAPY 5 Introduction Everyone has their own opinion on how to treat children and adolescents who have mental illness concerns. This study will address the most common mental health diagnoses in children and adolescents and explore a holistic approach using essential oils and aromatherapy to ease symptoms. The four most common mental illness diagnoses seen in children and adolescents are anxiety disorders, attention deficit hyperactivity disorder, mood disorders, and behavior or conduct disorders. The Centers for Disease Control and Prevention (CDC) website reported (2013), that they collected data on children and adolescents ages three to seventeen years old, from varies sources between the years 2005-2011, to determine what were the most common mental illness diagnoses. The CDC (2013) determined that ADHD was the highest mental health disorder; then behavioral or conduct problems; anxiety; and depression (part of mood disorders). It is important to address that the amount of children and adolescents that are identifying with having symptoms or diagnosed with a mental illness is alarming. Parens & Johnston (2008), identify that the U. S. Surgeon General reported in 2000 that it was likely that one out of five children and adolescents are displaying diagnostic criteria for a mental illness each year. The United States Census Bureau estimated the percentage of the population of people under eighteen years old in 2012 at twenty-three percent. That means four point six percent of the U.S. population is experiencing signs and symptoms of a mental illness in the course of a year, if applying the U. S. Surgeon Generals ratio estimate of one out of five children and adolescents with the United States Census Bureau 2012 under eighteen years old population. It is vital to the future of mankind that mental health professionals seek to assist children and adolescents, giving them the tools and skills to be successful adults. Children and ARAMOTHERAPY 6 adolescents with mental illness concerns struggle in all areas of life including academics. McLeod, Uemura, & Rohrman, (2012), did a study comparing adolescent student’s grade point average (GPA) scores. They compared students who presented with mental illness behaviors, and those with no presenting mental illness behaviors. The researchers determined that students who have mental illness behavior concerns have a lower GPA scores then those with no mental illness concerns. This study shows that it is evident that school systems need to continue to support students with mental illness concerns. The use of aromatherapy with essential oils is another way to help treat children and adolescents that exhibit or is diagnosed with mental illness. This presents another treatment option besides traditional psychotherapy, cognitive behavior therapy, and or prescription medication. The purpose of this study was to explore how health professionals are using aromatherapy with children and adolescents who have exhibited or are diagnosed with the four most common mental illnesses. Literature Review The purpose of this literature review is to gather information on different treatments of children and adolescents with the four most common mental health concerns and or diagnoses. This literature review will define and explain aromatherapy and the use of essential oils, practitioner’s requirements and regulations. Thus including what research has been done on the use of aromatherapy, and or essential oils. Mental Illnesses Anxiety Disorders According to the criteria for generalized anxiety disorders described by the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American ARAMOTHERAPY 7 Psychiatric Association, 2000) (DSM-IV), symptoms of anxiety include; excessive worry regarding daily activities and events, such as school or work that persists for at least six months, and the worry is difficult to control. The next six listed symptoms, children only need to meet one in the criteria that follows to be diagnosed with an anxiety disorder, and symptoms are severe enough that they affect daily living and functioning; “restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and sleep disturbance” (p.476). Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder. Anxiety disorders affect about forty million American adults age eighteen years and older (about eighteen percent) in a given year, National Institute of Mental Health or NIMH (2013), explains that it is pertinent that there more public knowledge of alternative ways to combat mental illness. There has been some research on how to treat anxiety with children and adolescents, including cognitive behavioral therapy and medication. Eichstedt, Tobon, Phoenix, & Wolfe, (2010), state that cognitive behavioral therapy (CBT) for childhood anxiety includes psychoeducation about anxiety and its symptoms, learning the CBT model of treatment, developing coping skills for managing physical symptoms of anxiety (e.g., self-monitoring, relaxation training), cognitive restructuring, graduated exposure to anxiety-provoking situations, and relapse prevention strategies” (p. 226). Cartwright-Hatton, Roberts, Chitsabesan, Fothergill, & Harrington (2004), compared previous studies on the effectiveness of CBT on children and adolescents with anxiety and they concluded that there were noteworthy decreases in anxiety ARAMOTHERAPY 8 symptoms when compared with those children and adolescents who did not receive CBT treatment. Many times medications are prescribed to help with symptoms of anxiety. Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluvoxamine, fluoxetine, paroxetine, and sertraline, are commonly used to treat childhood anxiety (Eichstedt et al. 2010). Eichstedt et al. (2010) purpose of clinical trial was to determine if there was a difference in effectiveness between children and adolescents with anxiety receiving SSRIs and participating in CBT treatment versus those not receiving SSRIs. Eichstedt et al. (2010) determined there was not a significant difference between the above test groups. All of the test subjects in the SSRI group had an increase in medication during the study by psychiatrists, who were not involved in the study. The researchers also noted that the disparity between the genders receiving medication and those that are not is concerning. There was an unbalanced amount of boys in the group receiving medication compared to the non-medicated group, but gender disparities did not cause an imbalance in the findings. Attention Deficit Hyperactivity Disorder The DSM-IV (2000) describes attention deficit hyperactivity disorder in three different subtypes. Predominantly inattentive, which includes the following symptoms, which occur often; Failing to give close attention to details, making careless mistakes on daily living activities, difficulty keeping attention on tasks or play activities, does not seem to listen when being spoken to directly, does not follow through on instructions and fails to finish required tasks, such as schoolwork or chores, has difficulty organizing tasks and activities, avoids, dislikes, or is reluctant to engage in tasks that require sustained mental ARAMOTHERAPY 9 effort including schoolwork, loses things necessary for tasks or activities, is easily distracted by extraneous stimuli and, is often forgetful in daily activities (p. 92). For a child to be diagnosed with attention hyperactivity disorder, the above systems have to be present for at least six months and severe enough to be obstructing normal developmental stages. A child also must have six or more of the above systems to qualify for the diagnosis. The other named subtype is predominately hyperactive- compulsive that also includes the same diagnosing requirements, those symptoms in the DSM-IV (2000) include in; Hyperactivity: fidgets with hands or feet and squirms in seat, leaves seat in classroom when expected to stay seated, runs around and or climbs excessively on objects in inappropriate settings such as desks at school, difficulty playing or engaging in leisure activities quietly, appears to be always moving, such as a running motor, and talks excessively. Impulsivity: blurts out answers before questions have been completed, has difficulty waiting their turn, and interrupts or intrudes on others (p. 92). The third subtype is combined inattentive, hyperactive and impulsivity, including symptoms of both types. In the Harvard Mental Health Letter (10/08), there are fifty-four percent to eighty-four percent of children and adolescents with ADHD, have enough symptoms to be diagnosed with oppositional defiant disorder as a co-occurring disorder. An individual exhibiting symptoms of ADHD can also appear to also have oppositional defiant disorder because they are often unable to follow through with directions including work refusal, or excessively talking to the point of annoying others. Multimodal treatment is recommended by the Harvard Medical School (2008), for the