Mental Health & Neurodevelopmental Difficulties in the Primary School Setting

1. Mental Health & Neurodevelopmental Difficulties in the Primary School Setting Dr Aileen Murtagh Consultant Child & Adolescent Psychiatrist SPMHS Mental Health Information Day 20/06/18

2. Plan Neurodevelopmental issues Mental health difficulties

3. Child & Adolescent Psychiatrist

5. Multi-disciplinary team

6. Neurodevelopmental Disorders

7. Inattention CAMHS Referral

8. Causes of Inattention

10. Myths re ADHD • No such thing as ADHD • Its not a real disorder • Its just poor parenting • That child is just too bold/lazy • It’s the diet/too much sugar

12. What is ADHD?

13. Inattentive Symptoms • Poor concentration & focus • Easily distracted • Forgetful • Make mistakes • Don’t finish • Seem not to listen • Not following instructions • Poor organisational skills

15. Hyperactive-impulsive Symptoms HYPERACTIVITY • Fidgeting • Difficulty sitting still • Leaving seat • Always on the go • Talk excessively & loudly • Difficulty playing quietly IMPULSIVITY • Act/talk before thinking • Leaving seat/line • Difficulty turn-taking • Blurting out answers • Interrupting conversations • Unthinkingly breaking rules • Engaging in dangerous activities without thinking

16. For a diagnosis • Excessive for the child’s age and IQ • Begin before 7 years & persist over time • Interfere with home life/school life/relationships • May be most obvious in structured settings e.g. school • Symptoms in 2 or more settings

17. Co-occurring difficulties • Behavioural problems (Oppositional Defiant Disorder/ODD) • Specific Learning Difficulties (dyslexia) • Dyspraxia/ DCD • Speech & language difficulties • Autistic Spectrum Disorders • Anxiety & depression • Tics & Tourette’s Syndrome

18. Treatment Every child has individual needs • Education about ADHD (written information, websites) • Give information about community supports/support groups (HADD) • Behavioural interventions e.g. parent training • School supports • Medication • Individual/family/group therapies • Psychological therapy (build self-esteem, improve problem-solving skills) • Treat co-occurring conditions • Balanced diet & regular exercise

20. Tips for Teachers • Consider seating arrangements • Catch the child being good-immediate positive feedback • Build on the child’s strengths • Set up clear routines & rules • Make eye contact before giving an instruction. Use short clear sentences. One instruction at a time • Use visual aids • Shorter assignment or work period • Movement breaks

21. Autistic Spectrum Disorder (ASD)

22. ASD

23. Classroom Presentation

24. Anxiety

25. Anxiety Management • Allow a minutes for child to settle-arrive early/late • Safe place/identified person if anxiety levels high • Phased integration if avoiding • Reward effort • Maintain routine; preparing for any changes

26. Severe/intense • Persistent over time • Impact on functioning

27. Mental Health Difficulties in the classroom A CHANGE in behaviour • Academic decline • Reluctance to attend school • Change in mood/irritability • Behavioural outbursts • Leaving class frequently • Quieter/withdrawal • Isolate from friends • Reduced appetite • Loss of interest in usual activities

29. Resources

30. ADHD

31. ASD