Recognizing & Understanding Student Mental Health Problems

Recognizing & Understanding Student Mental Health Problems By Matt Chonka & Tyler Stevenson

Matt Chonka • Science Teacher at Arts & Technology High School • Mother worked as Case Manager with Lane County Mental Health • At Risk Students and Society

Tyler Stevenson • Heath Teacher at Arts & Technology High School • Interest in what affects the learning abilities of our students • Teaching is a family profession • What strategies have changed over time

Why look at Mental Health Issues? • Full inclusion is the new model. • Families are in crisis. • Increase of special needs students in public education. • Diagnosis of disorders more common and accurate.

Themes to Keep in Mind (pg. 366) • Quantity & Quality of the Problem Behavior • Context in Which the Problem Behavior Occurs • Common Factors can Cause Problem Behavior • You are not a Psychologist

How are Mental Disorders Classified? • Psychiatric Diagnoses are categorized by the “Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition” • Covers all mental health disorders for both children and adults. • Lists known causes of these disorders. • Statistics in terms of gender, age at onset, and prognosis. • Research concerning the optimal treatment approaches. (AllPsych, 2004)

Pervasive Developmental Disorders (pg.370) • Autistic Disorder & Asperger’s Syndrome • Also know as Autism Spectrum Disorder (ASD) • Lack of or delay in spoken language • Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects) • Little or no eye contact • Lack of interest in peer relationships • Lack of spontaneous or make-believe play • Persistent fixation on parts of objects (Autism Society of America, 2008)

What can Teachers Do? • Perspective and group learning are very difficult set, them a task. (Pat Bush, personal communication, November 13, 2008) • Minimize transitions and insure the environment is predictable. • Build upon memory strengths. • Use visual instructions and schedules. • Leave class 5 minutes early in order to avoid the overwhelming social interaction in halls. (Kelly, 2005)

Children’s Anxieties (pg.373) • Separation Anxiety Disorder & Specific Phobias. • Common in children about 6 to 9 years old • Avoid going places by themselves • Refuse to go to school or camp • Be reluctant or refuse to participate in sleepovers • Follow a parent around • Demand that someone stay with them at bedtime, or "appear" in their parent's bedroom during the night • Awake from nightmares about being separated from loved ones. • Irrational fear of a specific object (Anxiety Disorders Association of America, 2008)

What can Teachers Do? • Provide times for the child to convey messages to family • Ask the parent to send short notes for the child to read as a reward for staying in school. • Use an "Act as If" technique to encourage the student to make an effort despite his/her fear of failure Example:"Act as if you felt great about going to school"; "pretend you really like your teacher and classmates"; "play like you have done this before" or "act as if you were George Washington, SpongeBob, Hillary Duff (or other student heroes) handling this situation." (School Psychiatry Program and MADI Resource Center, 2006)

Children’s Anxieties (pg.373) • Generalized Anxiety Disorder (GAD) • Generalized anxiety disorder usually affects children between the ages of six and eleven. It is characterized by excessive worry and anxiety over a variety of things, including, but not limited to: • GradesPerformance in sportsPunctualityFamily issuesEarthquakesHealth • Physical symptoms of GAD include: • RestlessnessFatigue/Inability to sleepDifficulty concentratingIrritabilityMuscle tension • Children with GAD tend to be very hard on themselves, striving for perfection, sometimes redoing tasks repeatedly. They may also seek constant approval or reassurance from others. (Anxiety Disorders Association of America, 2008)

What can Teachers Do? • Avoid stress inducing situations. • Cue the student to think of a rational thought to replace the worrying thought. • Celebrate any successful risk taking that the student is able to do. • Provide a quiet place for the student to have a depressurizing time out. • Avoid timed tests and assignments. • If test anxiety is an issue, consider alternative forms of assessment. • Be flexible on due dates. • Accommodate late arrivals. • Monitor homework load. • Provide notice and briefing of any changes coming up. (Faculty of Education Brandon University, 2008)

Children’s Anxieties (pg.375) • Social Anxiety Disorder • Peaks in adolescence • Untreated, the disorder can persist into adulthood and may increase the risk for depression or alcohol abuse later on. • Signs to watch for: • Hesitance, passivity, and discomfort in the spotlight • Avoidance or refusal to initiate conversations, perform in front of others, invite friends to get together, telephone others for homework or other information, or order food in restaurants • Avoiding eye contact • Speaking very softly or mumbling • Minimal interaction and conversation with peers • Appearing isolated or on the fringes of the group • Sitting alone in the library or cafeteria, or hanging back from a group in team meetings • Overly concerned with negative evaluation, humiliation, or embarrassment • Difficulty with public speaking, reading aloud, or being called on in class (Anxiety Disorders Association of America, 2008)

What can Teachers Do? • Implement procedures to get socially anxious students more involved, such as calling on them in class. • Explain to these students beforehand that you want to help them feel more comfortable in class, not more embarrassed. • Coach them, if necessary, to make sure they know the answers. • Remind them that speaking up in class will get easier with practice. • Do not single out a student; call on all of them for answers. • Incorporate oral presentations into your curriculum to help all your students develop confidence in public speaking. (Anxiety Disorders Association of America, 2008)

Disruptive Behavior Disorders (pg.377) • Attention Deficit/Hyperactivity Disorder ADHD • Differing rate of brain development. Motor cortex at higher rate of development in ADHD frontal cortex can take 5 years longer to develop but will eventually develop. • Are in constant motion. • Squirm and fidget. • Do not seem to listen. • Have difficulty playing quietly. • Often talk excessively. • Interrupt or intrude on others. • Are easily distracted. • Do not finish tasks.

What can Teachers Do? • Limit activities in length and give multiple changes within the period. • No long tasks over 30 minutes. • Keep lesson objectives clear • Deliver the lesson at a brisk pace • Encourage collaboration among students • Use meaningful materials and manipulatives • Prompt for student answers after allowing at least five seconds of wait time • Have the students recite in unison • Vary the tone of your voice and model enthusiasm

Conduct Disorder (pg.380) Conduct Disorder • Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. • Many factors may contribute to a child developing conduct disorder, including brain damage, child abuse, genetic vulnerability, school failure and traumatic life experiences. (American Academy of Child & Adolescent Psychiatry, 2004)

Conduct Disorder (pg.380) Exhibited Behaviors • bullies, threatens or intimidates others • often initiates physical fights • has used a weapon that could cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife or gun) • is physically cruel to people or animals • steals from a victim while confronting them (e.g. assault) • forces someone into sexual activity • deliberately engaged in fire setting with the intention to cause damage • deliberately destroys other's property • has broken into someone else's building, house, or car • lies to obtain goods, or favors or to avoid obligations • steals items without confronting a victim (e.g. shoplifting, but without breaking and entering) • often stays out at night despite parental objections • runs away from home • often truant from school (American Academy of Child & Adolescent Psychiatry, 2004)

What can Teachers Do? • Expose students with behavioral disorders to other students who demonstrate the appropriate behaviors. • Have pre-established consequences for misbehavior. • Administer consequences immediately, then monitor proper behavior frequently. • Use time-out sessions to cool off disruptive behavior and as a break if the student needs one for a disability-related reason. • In group activities, acknowledge the contributions of the student with a behavioral disorder. • Treat the student with the behavioral disorder as an individual who is deserving of respect and consideration. • When appropriate, seek input from the student about their strengths, weaknesses and goals.

What can Teachers Do? • Enforce classroom rules consistently. • Make sure the discipline fits the "crime," without harshness. • Provide encouragement. • Reward more than you punish, in order to build self-esteem. • Praise immediately at all good behavior and performance. • Change rewards if they are not effective for motivating behavioral change. • Self-esteem and interpersonal skills are especially essential for all students with emotional disorders. • Do not expect students with behavioral disorders to have immediate success; work for improvement on a overall basis. • As a teacher, you should be patient, sensitive, a good listener, fair and consistent in your treatment of students with behavioral disorders.

Oppositional Defiant Disorder (pg.380) • Oppositional Defiant Disorder • In children with Oppositional Defiant Disorder (ODD), there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the youngster's day to day functioning. • Symptoms of ODD may include: • frequent temper tantrums • excessive arguing with adults • active defiance and refusal to comply with adult requests and rules • deliberate attempts to annoy or upset people • blaming others for his or her mistakes or misbehavior • often being touchy or easily annoyed by others • frequent anger and resentment • mean and hateful talking when upset • seeking revenge (American Academy of Child & Adolescent Psychiatry, 2004)

What can Teachers Do? • Build on the positives, not the negatives • Use teachable moments to your advantage • Pick your battles • Don’t take it personally. • These children are experts at pushing your buttons, so don't let them. Keep your composure, no matter how difficult. • Refuse to join the fight. Is it really worth it to argue with a child? • Ease up the controls. • Give genuine choices. Give them control when you can. • Connect with what you like about the child. Don’t forget that he or she is a child with many wonderful features. Work on that part of your relationship and help them remember who they are.

Adolescent Psychological Problems (pg. 382) • Drug abuse can be defined as the use of any chemical substance that causes physical, mental, emotional, or social harm to an individual or to the people close to him/her. In this country, the level of drug use among young people is the highest of any developed country of the world: • An estimated 3.3 million teenagers are alcoholics • About two-thirds of our youth have tried an illicit drug at some time before graduating from high school • Many children who use heavy drugs by the age of 17 started as early as age 11 • One-third of all suicides, regardless of age, are alcohol related • The annual national cost of drug abuse is approximately $100 billion (Lachance, 1984)

According to the results of the 2001 Youth Risk Behavior Survey by the Centers for Disease Control and Prevention (www.cdc.gov): • 78.2% of high school students had one or more drinks of alcohol in their lifetime. • 47.1% had one or more drinks of alcohol in the past 30 days. • 29.9% had 5 or more drinks of alcohol on one or more occasions during the past 30 days. • In addition to morbidity and mortality due to injury, drug use is related to suicide, early unwanted pregnancy, school failure, delinquency, and transmissions of sexually transmitted diseases (STD), including human immunodeficiency virus (HIV) infection. • Despite improvements in recent years, drug use is greater among youth in the United States than has been documented in any other industrialized nation in the world. • In 2001, 42.4% of high school students had used marijuana in their lifetime and 9.4% of high school students had used some form of cocaine in their lifetime. • From 1991 to 2001, the percentage of high school students who said they used cocaine in the past month increased from 1.7% to 4.2%.

What can Teachers Do? • School-Community Collaboration in Program Design and Delivery • Clear School Polices to Deter Substance Abuse • Enforcement of School Policies with Clear Reward Structures and Unambiguous Sanctions • School wide Communication Campaigns to Influence School Norms about Substance Abuse and Violence • Classroom Restructuring for More Engaging and Interactive Education Environments

What can Teachers Do? • Maximize the time students spend on learning with, for example, classroom control and transition methods that maintain a positive classroom environment and reduce the time spent on managing and disciplining students. • Incorporate and provide opportunities for teamwork in lessons, including activities that teach social skills such as listening, helping, and empathizing; that emphasize cooperation in student teams to master material; and that provide incentives for effective teamwork. • Monitor the progress of each student or group of students and advance the student or students to the next level once they have mastered the required material. • Schools can reorganize classes or grades to create smaller units, different mixes of students, and greater instructional flexibility. They can also change the school schedule, adopt a school-within-school arrangement, create grade-level "houses" or "teams,“ and decrease class size. (Dash, 2004)

Adolescent Psychological Problems (pg. 382) • Eating Disorders • Anorexia Symptoms include • refusal to eat • throwing away food • inaccurately thinking one is fat • Bulimia Symptoms include • making oneself throw up • taking laxatives to lose weight

What can Teachers Do? Anorexia • Allow the student to eat in a more comfortable setting • Have the student eat/snack while doing another activity • Provide alternative activities when focus on food interferes with academics • Allow the student to complete academics in settings where food is not present • Identify student-acceptable comments teachers can employ during eating • Identify alternative foods/snacks available for the student if he/she resists eating Bulimia • Allow the student to complete academics in settings where food is not present • Minimize opportunities for bulimic behaviors by having the student go to the bathroom before he/she eats, and remain in class after eating for sufficient time to digest food

Adolescent Psychological Problems (pg. 386) • Depression & Suicide • Video on Depression and Suicide

Conclusion • Mental health problems keep our students from being able to succeed in school. • Individuals with mental health issues need treatment requiring multiple interventions. These can include medication management, behavioral modification, family counseling for living with the child and parental counseling on how to live with each other. You need a good physician, teacher, counselor and parent all working together. (Pat Bush, personal communication, November 13, 2008)

What can you do? • Knowledge is key • Look for signs in your students • Ask for help from your support staff Questions to answer? • Do you have a student with a mental heath issue? • What modification in instruction or classroom setup will you employ to support that student?

Bibliography • AllPsych, (May 15, 2004). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Retrieved November 16, 2008, from AllPsych Online The Virtural Phsychology Classroom Web site: http://allpsych.com/disorders/dsm.html • American Academy of Child & Adolescent Psychiatry, (2004, July). Conduct Disorder. Retrieved November 17, 2008, from Conduct Disorder American Academy of Child & Adolescent Psychiatry Web site: http://www.aacap.org/cs/root/facts_for_families/conduct_disorder • Anxiety Disorders Association of America, (2008). Anxiety Disorders in Children and Teens. Retrieved November 16, 2008, from Anxiety Disorders Association of Web site: http://www.adaa.org/GettingHelp/FocusOn/Children&Adolescents.asp • Autism Society of America, (2008, January 21). About Autism. Retrieved November 16, 2008, from Autism Society of America: About Autisim Web site: http://www.autism-society.org/site/PageServer?pagename=about_home • Dash, K. (2004, April). Key Strategies for Violence and Substance Abuse. Retrieved November 17, 2008, from Health and Human Development Programs, Education Development Center, Inc. Web site: http://www.promoteprevent.org/publications/center-briefs/prevention_brief_key_strategies2.pdf

Bibliography • Faculty of Education Brandon University, (2008). Exceptional Teacher's Factsheet. Retrieved November 16, 2008, from Strategies for Classroom Teachers of Students with Anxiety Disorder (Generalized) Web site: http://www.brandonu.ca/academic/education/exceptional/Anxiety%20Disorders%20(Generalized).pdf • Lachance, L. (1984). Adolescent Substance Abuse: Counseling Issues. In Brief: An Information Digest from ERIC/CAPS. Retrieved November 17, 2008, from ERIC Clearinghouse on Counseling and Personnel Services Ann Arbor MI. Web site: http://www.ericdigests.org/pre-922/abuse.htm • May, Kelly (2005, September ). Teaching Strategies for Asperger's Students. Retrieved November 16, 2008, from New Horizons for Learning Web site: http://www.newhorizons.org/spneeds/autism/may.htm • Pressley, M., & McCormick, C. (2007). Child and Adolescent Development for Educators.New York: The Guilford Press. • School Psychiatry Program and MADI Resource Center, (2006). Interventions for Separation Difficulty. Retrieved November 16, 2008, from Massachusetts General Hospital Web site: http://www.massgeneral.org/schoolpsychiatry/inter_separation_difficulty.asp

Recognizing & Understanding Student Mental Health Problems