MODULE 2: The Impact of Mental Health Disorders on Children’s Learning and Everyday Functioning:

1. Understanding Children’s Mental Health Disorders and the Impact on Learning and Everyday Functioning MODULE 2: The Impact of Mental Health Disorders on Children’s Learning and Everyday Functioning: Depression and Related Disorders http://education.state.mn.us/mde/index.html Click on Learning Support > Special Education > Mental Health

2. Depression and Related Disorders

3. Depression and Related Disorders This presentation examines the following disorders: • Major Depression • Dysthymia • BipolarDisorder

4. Learner Objectives The participants will be able to: • Identify the parts of the brain and neurochemicals involved in depression and related disorders in children. • Describe the impact of depression and depression-related disorders in children on mood, interpersonal relationships, and academic performance and behavior. • Describe the impact of depression and depression-related disorders on everyday functioning and at home. • Identify several key interventions for each depression and related disorder. • Identify the environmental modifications that can support the child.

5. Brain-based Activity #1 • “Personal experience with a child” • Connection to your own feelings.

6. Key Points • Depression can impact classroom and everyday functioning in many ways. • Depression is a sleep and energy disorder. • Depressive disorders in children are brain-based. • There are many effective interventions that can be used at home and in the classroom.

7. Things to Consider • Positive Behavioral Interventions and Supports (PBIS) • Simple classroom and environmental modifications • Importance of parent/school partnerships • Appropriate mental health services

8. Positive Behavioral Interventions and Supports (PBIS) PBIS means those strategies used to improve the school environment and teach pupils skills likely to increase pupil ability to exhibit appropriate behavior. Minn. Statute 121A.66, Subd. 6 PBIS is defined as “a broad range of systemic and individualized strategies for achieving important social and learning outcomes while preventing problem behavior in all students.” Sugai & Horner, 2002

9. What is PBIS? • PBIS is empirically-supported and data-based. • It is a proactive, not reactive approach. • Based on three levels of prevention/intervention: • Primary Prevention/Universal Intervention • Secondary Prevention/Targeted Group Intervention • Tertiary Prevention/Intensive-Individual Intervention

10. Tertiary Prevention: Specialized Individualized Systems for Students with High-Risk Behavior CONTINUUM OF SCHOOL-WIDE INSTRUCTIONAL & POSITIVE BEHAVIOR SUPPORT ~5% Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior ~15% Primary Prevention: School-/Classroom- Wide Systems for all Students, Staff & Settings www.pbis.org ~80% of Students

11. Academic Systems Behavioral Systems • Intensive, Individual Interventions • Individual students • Assessment-based • High intensity • Intensive, Individual Interventions • Individual students • Assessment-based • Intense, durable procedures • Targeted Group Interventions • Some students (at-risk) • High efficiency • Rapid response • Targeted Group Interventions • Some students (at-risk) • High efficiency • Rapid response • Universal Interventions • All students • Preventive, proactive • Universal Interventions • All settings, all students • Preventive, proactive Designing School-wide Systems for Student Success 1-5% 1-5% 5-10% 5-10% 80-90% 80-90% www.pbis.org

12. Defining Depression Depression in children is characterized by a persistent sad mood; loss of interest or pleasure in activities that were once enjoyed; significant change in body weight or appetite; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings worthlessness or inappropriate guilt; difficulty thinking or concentrating; recurrent thoughts of death or suicide and, at times, suicidal tendencies. National Institute of Mental Health, 2005

13. Defining Dysthymia Dysthymia is a less severe yet typically more chronic version of depression and is diagnosed in children and adolescents when a depressed mood persists for at least one year and is accompanied by at least two other depressive symptoms. National Institute of Mental Health, 2005

14. Depressed mood Feelings of hopelessness Loss of interest/pleasure Irritable mood/anger Distractibility Excessive guilt/self-blame Negative thoughts Suicidal ideation Unrealistic negative self-worth-look for evidence of personal faults Increased worry or fear Depression: Mood ChangesSigns and Symptoms

15. Difficulty concentrating Delayed mental reasoning Impaired ability to think Problems making decisions Slow movement, speech, and thinking Disinterest in normally pleasurable activities Forgetful Depression: Cognitive ChangesSigns and Symptoms

16. Changes in appetite (overeating and/or under eating) Sleeping problems (excessive or insomnia) Fatigue, lethargy (tired all the time) Slow reaction time Slow gait Psychomotor agitation abnormal activity level/ movement pacing hand wringing pulling/rubbing skin Small tasks require great effort and are exhausting Appears oppositional-work refusal Depression: Physical ChangesSigns and Symptoms

17. Parts of the Brain Involved with Depression Prefrontal Cortex is located at the front tip of the brain. It is the part of the brain that helps children stay focused, make plans, control impulses, and make decisions.

18. Parts of the Brain Involved with Depression Limbic System is located at the center of the brain and is the bonding and mood control center.

19. Parts of the Brain Involved with Depression Cingulate Gyrus (sing-you-let ji-rus) A part of the brain that runs longitudinally through the middle part of the frontal lobes; it functions as the “switching station” of the brain. It allows a child to shift attention from thought to thought and between behaviors.

20. Parts of the Brain Involved with Depression Temporal (Temp-or-all) Lobe is located underneath the temples and behind the eyes. These structures are involved with memory, understanding language, facial recognition, and temper control.

21. Parts of the Brain Involved with Depression Neurotransmitters Chemicals that transmit information within the brain and from the brain to all the parts of the body. • Serotonin • Dopamine • Norepinephrine

22. Interventions for Home

23. School-wide Interventions

24. Classroom Interventions

25. Interventions for Individuals

26. Defining Bipolar Disorder Bipolar Disorder -is characterized by episodes of major depression. as well as episodes of mania - periods of abnormally and persistently elevated mood or irritability accompanied by at least three of the following symptoms: overly-inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; increased goal-directed activity or physical agitation; and excessive involvement in pleasurable activities that have a high potential for painful consequences. National Institute of Mental Health, 2005

27. Mood/Cognitive Symptoms of Mania Abnormally elevated mood/irritability Hallucinations Delusions Grandiose statements about self Racing thoughts Inflated self-esteem Bipolar Disorder

28. Physical/Behavioral Symptoms of Mania Increased talkativeness Uncontrollable temper tantrums Abnormally active/hyperactive Excessive energy Pressured speech Excessive risk-taking/daredevil behavior Hyper-sexuality Atypical speech patterns Active much of the night/decreased need for sleep Bipolar Disorder

29. Parts of the Brain Involved with Manic Phase of Bipolar Disorder Cerebral Cortex (Sare-ree-brawl Core-tex) Outer layer of grey matter, approximately 2 mm thick, covering the entire surface of the cerebral hemispheres. Highly convoluted and developed external surface concerned with the most familiar functions we associate with the brain.

30. Parts of the Brain Involved with Manic Phase of Bipolar Disorder Limbic System Located at the center of the brain. Bonding and mood control center. Increased activity here is associated with depression. Irregular functioning results in children struggling with moodiness andnegativity.

31. Interventions for Home

32. School-wide Interventions

33. Classroom Interventions

34. Interventions for Individuals

35. Depression and Related Disorders Intervention Considerations/Wrap-up Brain-based Activity #2 • Depression case studies • Develop two interventions for each child • Note one cultural consideration • Share plan

36. Case Study #1 Derek, Caucasian male, age 17 • Attends an Area Learning Center • Wears robe-like Gothic clothing and hood over head • Sleeps a lot • Expresses depressive feelings • Shows minimal facial expression • Journals about feelings of despair and thoughts of death

37. Case Study #2 Houa, Hmong female, age 10 • Lived in the United States for three years • Sets fires • Refers to self as a “fire queen” • Sometimes seems sad and lacks energy • Familial history of Bipolar Disorder • Has threatened to harm self