Training session for staff at King Edwards VI College Wednesday 4 th June 2014, 1.00 – 4.00 pm

1. Dudley educational pschology service  Neuro-psychological and emotional influences on achievement Training session for staff at King Edwards VI College Wednesday 4th June 2014, 1.00 – 4.00 pm

2. Objectives Objectives are to: Provide an overview of key neuro-psychological changes in adolescence Offer an overview of social and emotional development in adolescence and early adulthood Consider the interaction between ‘mental capital’ and achievement Consider mental health vulnerabilities in adolescence – Anxiety/Depression/Eating Disorders/ Self harm and Psychosis Give specific information on referral routes highlight strategies to promote mental capital,

3. “And men ought to know that from nothing else but thence [from the brain] come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations. Hippocrates (c 460 BC)

4. Educational psychologist role • Educational psychology involves the study and application of knowledge about how people learn • Includes topics such as student outcomes, the instructional process, individual differences in learning, gifted learners and learning disabilities.

5. Cultural context of teenagers and young adults Click on picture above to play video http://www.youtube.com/watch?v=dLuEY6jN6gY&feature=player_detailpage

6. Myths about the brain We are born with all the neurons we ever have Almost all the brain growth and development happens by age 3 We only use about 10% of our brain Brain damage is permanent People are either ‘right’ or ‘left’ brained

7. Cell structure of a neuron

8. Neurons and synapses

9. Brain structure

11. Brain Architecture; the lobes

12. Brain Architecture: the limbic system

13. Brain Architecture: the Brain Stem

14. The Developing Brain • The brain grows and shapes until age 2-3 years. • Slows down during primary age • In adolescence hormones stimulate the brain • The brain begins to grow and shape again • In late 20’s the brain extensive development is complete and further changes are minor

15. Hardwiring the teenage brainfor future success • New understanding of brain development in teenagers • Ongoing growth peaking at puberty • Massive synaptic re-organisation

16. Adolescent Development: Increasing Brain Maturity

17. Impact of synaptic pruning on key brain functions: Executive function • Pre-frontal cortex which is pruned is responsible for thinking, reasoning, logic and decision making • Executive functions – umbrella term for a set of cognitive • abilities which control and regulate other processes and behaviour • Executive function is the set of skills necessary to plan and execute a goal • Includes: thinking flexibly to solve a problem; organisation; planning; behaviour and impulse control; shifting attention; decision making and working memory

18. Impact of synaptic pruning on key brain functions: Emotional brain differences • Synaptic pruning in the pre-frontal cortex seems to lead to over-reliance on reaction to read emotions • Pre-frontal cortex seems to work harder for teenagers in some situations • Outcome is that teenagers are more likely to misread facial expression and find it harder to read social cues

19. Neuro-psychological patterns: Attachment • Children who have overwhelming stress when young have overdeveloped ‘survival mechanisms’ • Children with insecure attachments think of themselves as unlovable, undervalued, uninteresting and ineffective • This sets up pattern of thinking into young adulthood • As students are vulnerable to rapidly experiencing ‘toxic shame’

20. Neuro-psychological patterns: Autism Spectrum Disorders • Notable differences in presentation, skills and behaviour in ASD • Resulted in 3 key theories of ASD: • Central coherence vs systematising • Executive functioning skills • Theory of mind development • 3. Maybe some key neurological differences especially in mirror neurones – emerging area

21. CLICK on picture above to start video https://www.ted.com/talks/sarah_jayne_blakemore_the_mysterious_workings_of_the_adolescent_brain

22. Adolescent Development: Psychological Impact “as children move through early childhood to adulthood their sense of self becomes increasingly complex but reflects changes in their cognitive and social development” (Hunter, 2003). • Physical changes of puberty impact self-concept • Self concept vs self-esteem • Social constructs of adolescence • Time of turbulence – trying different identities

23. Erikson’s PsychosocialStages • Development is a life long process • Concerned with emotional/mental health • Emphasis on the role of socialisation • 8 Psychosocial stages - crises

24. Erikson’s PsychosocialStages • BASIC TRUST vs MISTRUST (0-1 YEARS) • AUTONOMY vs SHAME AND DOUBT (1-3 YEARS) • INITIATIVE vs GUILT (3-5/6 YEARS) • INDUSTRY vs INFERIORITY (7-12 YEARS) • IDENTITY vs ROLE CONFUSION (12 - 18 YEARS) • INTIMACY vs ISOLATION (20 YEARS) • GENERATIVITY vs STAGNATION (LATE 20s - 50s) • EGO INTEGRITY vs DESPAIR (50s +)

25. Impact of adolescent neuropsychology and physiology on ‘mental capital’ • Foresight report: Mental Capital and Wellbeing • Mental capital = person’s cognitive and emotional resources • Mental wellbeing = the dynamic state in which a person is able to develop their potential • Mental capital ‘map’ of factors, threats and protectors

26. Influences on mental capital: Risk v Resilience

28. Key Mental health statistics • 1 in 10 children and young people aged 5 - 16 suffer from a diagnosable mental health disorder • More than half of all adults with mental health problems were diagnosed in childhood • Nearly 80,000c/yp’s suffer from severe depression • 72% of LAC have behavioural or emotional problems • 95% of young offenders in custody - mental health disorder. • The number of young people aged 15-16 with depression nearly doubled 1980s - 2000s

29. How does anxiety feel?

30. Range of moods and emotions: Anxiety • All experience anxiety from time to time • Anxiety is feeling of fear or panic • ‘Fight or flight’ response protects us from dangers • Anxiety can prepare us to perform • Usually subsides when an anxiety provoking event is passed

31. Problem Anxiety • Sometimes feelings of anxiety or threat continue • May experience overwhelming levels of anxiety • Symptoms are feeling frightened, nervous or panicky much of the time • If the anxiety stays at a high level for a long time or it interferes with a young person's everyday functioning we should refer for advice • Variety of causes of anxiety

32. Anxiety Disorders • General anxiety disorder (GAD) • - Have the symptoms of anxiety most of the time • 2. Panic attacks • Get unpredictable, sudden and intense anxiety • Phobias • Being fearful of something that isn’t dangerous • Obsessions and compulsions - OCD • 1 in 10 people have troublesome anxiety or phobias at some point in their life.

33. Aspects of Mood: Depression

34. Range of moods and emotions: Depression • Signs and symptoms of depression in teens • Sadness or hopelessness • Irritability, anger, or hostility • Tearfulness or frequent crying • Withdrawal from friends and family • Loss of interest in activities • Changes in eating and sleeping habits • Restlessness and agitation • Feelings of worthlessness and guilt • Lack of enthusiasm and motivation • Fatigue or lack of energy • Difficulty concentrating • Thoughts of death or suicide

35. When to seek further medical advice … Young person’s anxiety, low mood/depression is persistently interfering with everyday life, at home or in college.

36. Self-Harm ‘Self-harm is when you hurt yourself as a way of dealing with very difficult feelings, old memories, or overwhelming situations and experiences. The ways you hurt yourself can be physical, such as cutting yourself. They can also be less obvious, such as putting yourself in risky situations, or not looking after your own physical or emotional needs.’ (mind.org.uk)

37. Functions of Self-Harm ‘I did it to punish myself for not doing well in exams’ ‘I used to cut myself just so I could feel pain. [It] let me know I was real and I wasn't in a dream.’ • Releasing/regulating emotions • Externalising emotional pain • Control • Distraction/escape • Self-punishment and blame • Prevent dissociative symptoms • Habitual • Calming/soothing • Cleansing • Suicidal intent ‘Self-harm used to be a way to get rid of all the feelings inside of me, to get rid of all the hurt, anger and pain I was feeling’. ‘I felt a warm sense of relief as though all the bad things about me were flowing out of me’

38. Factors Associated with Self-Harm • Sexual, physical or emotional abuse and neglect • Socioeconomic deprivation • Looked after children • Pressurised or challenging circumstances such as homelessness, separation of parents or financial difficulty • A personal history of self harm or friends and family who self harm • Eating Disorders • Depression, paranoia or obsessive-compulsive disorder • Low-self esteem, self-worth or resilience • Experience of being bullied • Relationship/attachment difficulties • Age and gender

39. Self-harming: Warning Signs • Poor functioning including: • Poor eating habits • Tiredness • Increased social isolation • Changes in mood • Wearing long sleeves or excessive jewellery such as bracelets • Unexplained frequent injuries • Behaviour changes – elusive, evasive or secretive behaviour, (especially about injuries) and low self-esteem • Possession of razors, lighters or other sharp objects

40. Who is Affected by Eating Disorders?

41. Factors Associated with Eating Disorders • Parental attitudes to food or a family history of eating disorders • Physical, sexual or emotional abuse • Experience of being teased or bullied due to eating habits, body shape or weight • Cultural expectations • Occupational pressures (for example ballet dancers, models or athletes) • Stressful or challenging circumstances at work/school or home • Low self-esteem • Feelings of inadequacy of lack of control in life • Depression • Anxiety • Age and gender

42. Eating disorders: Warning Signs • Missing meals • Complaining of being fat, even though they have a normal weight or are underweight • Repeatedly weighing themselves and looking at themselves in the mirror • Making repeated claims that they have already eaten, or they will shortly be going out to eat somewhere else • Cooking big or complicated meals for other people, but eating little or none of the food themselves • Only eating certain low-calorie foods in your presence • Feeling uncomfortable or refusing to eat in public places • The use of "pro-anorexia" websites

43. Self harm and Eating Disorders: What can you do? • How you respond to a disclosure is important. The reaction a young person receives when they reveal their self-harm has a major impact on whether they will go on to receive help . • If you receive a disclosure stay calm and demonstrate high levels of empathy, recognising how hard it is for the young person to discuss these issues. • Remember that the behaviour provides a function for the individual, although they may not be able to express what this is. • Be aware of the warning signs. • Ensure awareness of the college safe guarding policy and outside-agencies that can offer support. • Find out more information from websites such as: mind.org.uk and b-eat.co.uk. These sites also provide a helpline which offers further support and guidance.

44. Psychosis: Importance of Early Intervention • Psychosis is a symptom of serious mental illness. • Person loses touch with what is usually accepted as reality. • May feel paranoid, hallucinate, hear voices or have delusions, or have confused thoughts. • Psychosis is said to a ‘psychotic episode’. • First episode often in their teens or early 20s. • May only have one episode, or can have more • 1/3 have ‘one off’ episode/ 1/3 have a relapse/ 1/3 chronic issue • Maybe part of symptoms of schizophrenia and/or bipolar disorder. • Psychotic episodes can be due to severe stress or depression, or as a result of drug (cannabis especially) or alcohol use. • More likely to have family history of mental illness • Undiagnosed psychosis likely to lead to poorer outcome and may impair cognitive function in the future

45. Psychosis: How to intervene early • Early Intervention Team for Psychosis 01384 362389 can be approached informally for advice • “The Early Interventions in Psychosis service offers younger people, aged between 14 and 35 with a recent diagnosis of psychosis, intensive interventions aimed at preventing relapse and hospital admission. We aim to promote less traumatic and stigmatising recovery whilst preventing further episodes of psychosis. • The team works with a variety of youth, community and health agencies to assist young people in accessing accommodation, financial support, education, training, work and specialist counselling services. “ • http://www.dwmh.nhs.uk/early-intervention-service/

46. Range of moods and emotions Click on picture above to play video http://healthtalkonline.org/young-peoples-experiences/depression-and-low-mood/jack-interview-24

47. How to refer for medical advice and support • All medical referrals for students 16 or over need to be made to via the student’s GP • The GP will decide whether to offer support via the practice or refer onto adult mental health services • The Child and Adolescent Mental Health Services also transfer patients over to adult services at this transition point • It is possible to support a student and ideally their family with any referral through providing information about the concern to take to the GP consultation • If the student has seen an EP in college we can provide a referral pack (with the student’s permission) • Other services such as the Early Assessment Service, and the Early Intervention Team for Psychosis can be approached informally for advice

48. Dudley Mental Health Services accessed via GP The Enhanced Primary Care service offers access to primary care based mental health screening, assessment and interventions. The team provides a flexible service that meets the various needs of adults aged 16 years and upwards presenting with mild to moderate mental health problems associated with low risks. Tel: 01384 361960 The Early Access Service (EAS) delivers a single point of entry into secondary mental health services for all adults (17 to 65) presenting with a moderate to severe mental illness and provides comprehensive mental health assessments. 01384 324578 Mental Health crisis out of hours where GP believes a mental health assessment is required then initially the Crisis Team should be contacted by telephone 01384 324578

49. How to make a difference 1: Key strategies for students with mental health issues • Listen and take the student’s view seriously • Reassure the student that a range of feelings are normal • Use relevant on-line resources to highlight self-help strategies – with student • Work out practical solutions – problem solve • Prioritiserelaxation and teach or suggest a routine – apps useful

50. How to make a difference 2: Key strategies for students with mental health issues • Encourage the following: • Being mindful • Involvement in enjoyable activities • Involvement in social activities • Safe expression of feelings – diary, drawing, blog • Talking to parent/ other trusted person • Consider other college based support e.g. counselling/ EP involvement • Agree a ‘check in’ time to review situation with student