Mental Health and Students with Disabilities

1. Mental Health and Students with Disabilities Better Pathways Stakeholder Conference 2012 Dr Julie McMillan & Dr Jane Jarvis Flinders University

2. Aims • Review current research related to mental health in school-aged children and young people with disabilities – focus on schools • Prevalence of dual diagnosis • Understanding disability as a risk factor for mental health difficulties • Primary prevention and intervention approaches for students with disabilities Students with disabilities are not a homogeneous group.

3. Mental Health • World Health Organization (2005): “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (p.1). • Mental health is more than simply the absence of disease or identified difficulties. • 1 in 5 adults will experience a mental illness. • (1 in 4 to 1 in 5 children and young people)

4. Disability (a)  total or partial loss of the person's bodily or mental functions; or (b)  total or partial loss of a part of the body; or (c)  the presence in the body of organisms causing disease or illness; or (d)  the presence in the body of organisms capable of causing disease or illness; or (e)  the malfunction, malformation or disfigurement of a part of the person's body; or (f)  a disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction; or (g)  a disorder, illness or disease that affects a person's thought processes, perception of reality, emotions or judgment or that results in disturbed behaviour Disability Discrimination Act 1992 1 in 12 Australian children (8.3%) aged 0-14 have a disability (2003 data)

5. Disability and Mental Health Kidsmatter Primary Mental Health Initiative In South Australia (2007/2008): • Students without a disability had a 1 in 8 chance of having mental health difficulties • Students with one identified disability had a 1 in 3 chance of having mental health difficulties • Students with multiple disabilities had a 1 in 2 chance Dix, K., Shearer, J., Slee, P., & Butcher, C. (2010). KidsMatter for students with a disability: Evaluation report. Retrieved from http://www.kidsmatterprimary.edu.au

6. Intellectual Disability & Mental Health • 57% of people with intellectual disability also had a psychiatric disability • Young people with an intellectual disability manifest behaviours and experiences which may be indicative of mental illness 3 to 4 times more than that of typically developing peers(Sturgeon 2007). • Learning difficulties at school were experienced by 84% of students with ID (ages 5-14) • 28% of students with ID did not receive any specialist support in school 2008 Report: AIHW Disability in Australia: Intellectual Disability

7. Disability &Mental Health • Around 63% of children with a disability experienced difficulty at school • learning difficulty • fitting in socially • communication difficulties • Learning difficulties were experienced by 60% of students whose main disability was psychiatric • 43% of students with disabilities did not receive any kinds of specialist support in school – almost half of those students experienced learning difficulties Australian Institute of Health and Welfare Report on Children with Disabilities (2006)

8. Disability and Mental Health • Special education service delivery rates in juvenile detention settings are as high as 7 times the rates in public schools settings • Detained and committed youth experience higher rates of academic underperformance, school failure, and identification of mental health needs than peers in the community. Krezmien, Mulcahy & Leone (2008) • Students with disabilities over-represented in homeless youth, and in youth suicides (Siegel et al.)

9. Young People with Disability Less likely to: • Be employed – especially full-time • Maintain employment • Access post-school education • Be a wage or salary earner • Be married

10. Bullying and Ostracism • Being bullied has been shown to increase students’ risk for academic and emotional problems • Study of 8-17 year olds with special needs (including autism, ADHD, learning disability, and medical illnesses)… being bullied and/or ostracized were the strongest predictors of depressive symptoms (American Academy of Pediatrics) • Students receiving special education services for behavioural or other disabilities are more likely to be bullied, and more likely to bully others, than are students from the general population (Swearer et al., 2012). This was more pronounced in students with obvious or observable disabilities. • Children entering grade 1 with symptoms of anxiety and depression or aggression are at risk of being chronically victimised by classmates by grade 3 (Leadbeater& Hoglund, 2009).

11. Building CompetenceExecutive Function • “the supervisory and self-regulatory functions that organise and direct cognitive activity, emotional response, and overt behaviour” (Gioia et al., 2002, cited in Meltzer, 2005) • “a collection of inter-related processes responsible for purposeful, goal-directed behaviour” (Meltzer) • This is an area of particular difficulty for many students with learning disabilities • Planning • Organising • Prioritising • Shifting • Memorising • Checking • Inhibiting • Regulating

12. Building CompetenceResilience • Resilience refers to a set of competencies and dynamic processes that enable individuals to adapt in the face of adversity (Masten, 2001). • The traditional concept of resilience focuses on at-risk individuals coping with conditions of significant hardship • However, more recent primary prevention efforts in schools aim to build associated competencies such as self-efficacy, problem-solving skills, and self-regulation in populations of young people even where identified risk or extreme adversity has not been identified.

13. Building CompetenceSelf-Efficacy • Self-efficacy is the belief that one has the capacity to exert control over his or her actions and environment to achieve a particular result or effect. • Bandura (1994): the “most effective way of developing a strong sense of efficacy is through mastery experiences” (p.2), whereby the individual feels the effects of his or her personal agency or control. • This means that the student needs to encounter learning tasks that enable success/mastery through personal effort.

14. Building CompetenceA ‘Growth’ Mindset • “While not denying biological contributions to emotional disorders, research and therapy within [the cognitive] tradition is showing, more and more, that many people with depression or anxiety disorders are victims of their maladaptive beliefs and are helped greatly when these beliefs are altered.” Dweck, 1999, p. 144 • Both self-efficacy and the related incremental mindset are strongly associated with intrinsic motivation, appropriate goal setting, persistence, and the capacity to overcome failure and disappointment (Bandura, 1994; Dweck, 2006), all of which are important to mental health.

15. Too Easy Appropriate Challenge Boredom Lack of engagement Anxiety & Frustration ‘Learned Helplessness’ Too Hard Self-efficacy • I don’t know where to start • I can’t figure this out • I’m missing key skills or knowledge • I’m running on the spot • I feel frustrated • I feel angry • This makes no sense • Effort doesn’t pay off I know some things I have to think I have to work This takes persistence I hit some walls I’m on my toes I have to re-group I feel challenged Effort leads to success I get it straight away I already know how… This is basic I’m cruising I feel relaxed I’m bored Success takes very little effort On Target Problem Solving Resilience Executive Functioning Vygotsky’s Zone of Proximal Development Coping Skills Adapted from Tomlinson (2006)

16. Students with learning difficulties need to be explicitly taught effective learning strategies, and then provided with opportunities to apply them to tasks that will help them experience academic success, leading to increased self-efficacy and motivation to exert effort towards future tasks. It is important for students to understand that hard work and the use of the right strategies for the right tasks will lead to success. Academic Success Cycle Executive functioning is critical for social problem solving and emotional regulation – not just academic problem solving. Adapted from Meltzer, Reddy, Pollica & Roditi (2004)

17. Framework for MH Promotion A public health strategy for children’s mental health Waddell, C., Hua, J., Garland, O., DeV. Peters, R., & McEwan, K. (2007). Preventing mental disorders in children. Canadian Journal of Public Health, 98, (166-173).

18. Universal Programs • Around 25% of children have a mental health problem. • 10% fulfil criteria for mental health disorder. • Recent growth in mental health research in schools. • Schools can promote positive mental health and prevent disorder. • Mental health, social emotional learning, emotional literacy, emotional intelligence, resilience, character education.

19. Universal Programs: Effectiveness Internalizing Behaviour • Impact on universal populations was positive but small • Impact on higher risk children was higher; quite strong Social Emotional learning • Small to moderate effects

20. Universal Programs: Effectiveness Externalizing Behaviour • Positive but small for universal populations. Stronger for high-risk children • Impact stronger for older students (CBT) Attitudes towards school • Small to moderate

21. Effective Universal Programs • Across the range of outcomes investigated, more dramatic effects were found with high-risk children. • Greater emphasis needed to be placed on targeted approaches. • Universal and targeted appear to be stronger in combination but optimum balance is unknown.

22. Targeted Programs • Most effective programs include CBT and Social skills training for children • Training for parents and teachers in appropriate reinforcement and better methods of discipline. • Longer term impact when integrated into the general classroom • Social problem solving, social awareness and emotional literacy reinforced in the classroom in all interactions were particularly effective. • Embedded within a whole-school, multicomponent approach (mobilizing the whole school)

23. Targeted & Universal • Longer and more intensive interventions were more effective than short-term. • Quality of intervention • Prioritize interventions that are easier for schools to implement WELL in their settings. • Complete and accurate implementation is necessary to be effective. • Interventions are not effective if they are based on principles only (need programme fidelity)

24. Overall Recommendations • Small to moderate effects for most • Strong effects for high risk children • Particularly specific intensive interventions • Integrated: not taught in isolation, linked to achievement • Balance universal and targeted interventions • Robust targeted component is necessary • Teaching skills (CBT & SST) • Start early and continue • High quality implementation • Embedded school-wide multicomponent approach

25. Websites www.beyondblue.org.auBeyond Blue: The National Depression Initiative. http://www.kidsmatterprimary.edu.au “KidsMatter” national mental health program information and resources. www.mindsetonline.com More information and resources related to Carol Dweck’s work on Mindset. www.apa.org American Psychological Association. Information related to mental health and a good section on resources/ publications designed for use with children and adolescents.

26. References • Bandura, A. (1994). Self-efficacy. In V. S. Ramachaudran (Ed.), Encyclopedia of human behavior (Vol. 4, pp. 71-81). New York: Academic Press. • Dix, K., Shearer, J., Slee, P., & Butcher, C. (2010). KidsMatter for students with a disability: Evaluation report. Retrieved from http://www.kidsmatterprimary.edu.au • Dweck, C. S. (1999). Self-theories: Their role in motivation, personality, and development. Philadelphia, PA: The Psychology Press. • Gioia, G. A., Isquith, P. K., Kenworthy, L., & Barton, R. M. (2002). Profiles of everyday executive function in acquired and developmental disorders. Child Neuropsychology, 8, 121–123. • Hallahan, D. P., Kauffman, J. M., & Pullen, P. C. (2012). Exceptional learners: An introduction to special education (12th ed.). Sydney, NSW: Pearson. • Leadbeater, B. J., & Hoglund, W. L. G. (2009). The effects of peer victimization and physical aggression on changes in internalizing from first to third grade. Child Development, 80, 843–859. • Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56(3), 227–238. • Meltzer, L (Ed). (2007). Executive function in education: From theory to practice. New York, NY, US: Guilford Press. • Meltzer, L. J., Reddy, R., Pollica, L. S., & Roditi, B. (2004). Academic success in students with learning disabilities: The roles of self-understanding, strategy use, and effort. Thalamus (Journal of the International Academy for Research in Learning Disabilities), 2(1), 16-32. • Schwabe, L., & Wolf, O. T. (2010). Socially evaluated cold pressorstress after instrumental learning favors habits over goal-directed action. Psychoneuroendocrinology, 35, 977–986. • Swearer, S. M., Wang, C., Maag, J. W., Siebecker, A. B., & Frerichs, L. J. (2012). Understanding the bullying dynamic among students in special and general education. Journal of School Psychology, 50(4), 503–520. • Tomlinson, C. A. (2003). Fulfilling the promise of the differentiated classroom: Strategies and tools for responsive teaching. Victoria, Australia: Hawker Brownlow Education. • World Health Organization (2004). Promoting mental health: Concepts, emerging evidence, practice. Summary report. Retrieved from http://www.who.int/mental_health/evidence/en/promoting_mhh.pdf • Young, C. B., Wu, S. S., & Menon, V. (2012). The neurodevelopmental basis of math anxiety. Psychological Science, 23(5),492-501.