Understanding & Responding to the Key Warning Signs of Mental Health Disorders Among Students

1. Understanding & Responding to the Key Warning Signs of Mental Health Disorders Among Students Name of Presenter Date

2. To obtain a greater understanding of how mental health disorders affect students’ learning capacities To identify key warning signs and symptoms of children’s mental health disorders Identify several key interventions for various children’s mental health disorders and concerning behaviors Objectives of the Workshop

3. Introduction to Mental Health • Mental health is how people think, feel, and act as they face life’s situations • Mental health disorder is a diagnosed illness • A child’s mental health or a diagnosed disorder does affect his or her to ability to learn and function in the school environment Child & Adolescent Mental Health (2003) http://mentalhealth.samhsa.gov

4. Introduction to Mental Health • Some behaviors of concern may be associated with various mental health disorders • Behaviors may include: aggression, defiance, difficulty with transition, lying, impulse control, work refusal • It is more important to identify the behavior & function, rather than the diagnosis

5. Themes of Mental Health: A Report of the Surgeon General • Mental health & mental disorders require the broad focus of a public health approach • Mental health disorders are disabling conditions • Mental health & mental disorders represent points on a continuum • Mind & body are inseparable • Stigma is a major obstacle preventing people from getting help

6. The Impact of Children’s Mental Health Disorders • The numbers of children struggling & suffering with unmet mental health needs & their families has created a national crisis • According to the Surgeon General’s Report on Mental Health 1999, 1 in 10 children/adolescents suffer from a mental health disorder severe enough to cause impairment • Only one in five, or 20%, of these children & adolescents receive mental health services.

7. Minnesota Survey Data • The Minnesota Survey was given in the Fall 2007 to 6th, 9th and 12th grade students throughout the state. It began in 1992 & has been administered every three years since then • It provides educators & researchers with students’ attitudes & perceptions about school, particularly in the area of mental health • Some of the data demonstrates the impact of mental health on students’ success in school Minnesota Student Survey Trends Report 2007

8. Minnesota Survey Data • Feeling sad all or most of the time was reported by just over 10% of 6th & 12th grade students, 9th graders reported feeling sad at rate of 14% • At every grade level females report higher rates of frequent sadness than males • 6th grade girls 14.5% • 12th grade girls 14.7% • 9th grade girls 19.3%. • 9th grade girls demonstrate rates markedly higher than all other groups of male & females Minnesota Student Survey Trends Report 2007

9. Additional Minnesota Data • Estimated 145,000 youth aged 9-17 have a diagnosable mental health disorder • 69,000 (47.6%) have functional mental health impairment • 13% anxiety disorders • 10% disruptive behavior disorders • 6% mood disorders • 2% addictive disorders Minnesota Department of Health (2004)

10. Basic Needs for Academic Success • Staff knowledge & understanding of the student: • Individually: individual relationship with the student • Culturally: experience of parent/guardian, historical context • Developmentally: 2 year developmental span is typical; developmental growth is not concrete

11. Basic Needs for Academic Success • A positive social context • Showing appreciation for what every child brings to the classroom • Open relationships & dialogue with family & community • Welcoming environment • Respect for every student & their family

12. Risk Factors for Mental Health Disorders • Two types of risk factors: • Biological • Environmental/Psychosocial • Risk factors influence mental health, but do not necessarily cause a mental health disorder

13. Biological Factors: • Heredity/Genetics – Autism, Bipolar Disorder, ADHD, Depression, Schizophrenia, Developmental/Cognitive Delays. • Abnormalities of the central nervous system influence behavior, thinking, & feeling. • These can be caused by injury, infection, learning disabilities, poor nutrition, fetal exposure to toxins such as lead, alcohol or other drugs. • Sexual identity • Low birth weight

14. Environmental Factors: • Poverty • Abuse • Unsatisfactory relationships – Peers/siblings (peer rejection, bullying) • Stressful life events – death in the family, neighborhood violence, divorce, family conflict, parental illness, war • Substance abuse • Racism and discrimination • Response to personal illness – ex. Diabetes

15. Cultural Competence • Many ethnic & racial groups in the U.S. face an environment of inequality that includes greater exposure to poverty, racism and discrimination • Racism & discrimination are stressful life events that adversely effect health & mental health • When you are different, you begin to wonder, is it your difference that makes a difference • Stress may increase the symptoms in any person that is diagnosed with a mental health disorder • Mistrust of the mental health system, due to clinician bias or stereotyping, may deter many from seeking treatment

16. Cultural Competence • Certain “symptoms” that are observed, may be a cultural response versus a sign of a mental health disorder • Posturing • Avoiding eye contact • It is important to understand diverse student populations & the cultural components that shapes behavior • Always remember & return to the original strengths of the individual or group • Each culture may view mental health & mental health services differently

17. Cultural Competence • Work to recognize your own bias & the lens through which you view your classroom • Understand & remember the impact of personal experiences, as they shape a student’s world view • Current circumstances • Parent/guardian’s experiences • Historical trauma • Spend time listening to each other, sharing goals & defining what those goals mean in the context of school

18. Fetal Alcohol Syndrome Disorder • “..umbrella term describing the range of effects that can occur in an individual whose mother drank during pregnancy. There effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications.” National Center on Birth Defects and Developmental Disabilities, Center for Disease Control and Prevention & Department of Health and Human Services, 2004. • This syndrome is often under diagnosed due to the shame often felt by the birth mother & is more often diagnosed when a child is in foster placement or an adoptive family

19. Children birth to 12 years old Hyperactivity &/or attention deficits Learning & language disabilities Poor impulse control Difficulty understanding consequences Difficulty separating fact from fiction May give an appearance of capability Poor comprehension of social rules & expectations Adolescent children Memory impairments Problems with judgments & abstract reasoning Lying & stealing Low self-esteem Low motivation Difficulty responding appropriately to others’ feelings & needs Academic ceiling: 4th grade reading & 3rd math Signs and Symptoms of FASD

20. Impact on the Classroom • Students may have some degree of brain damage • May struggle with verbal expression, so watch body language • May misinterpret behavior of peers: an accidental bump may be perceived as a intentional push • Difficulties generalizing information from day to day • Be prepared for inconsistent performance, frustrations with transitions and need for individualized assistance • May have sensory integration needs

21. Reactive Attachment Disorder (RAD) • Early life experiences shape development of relationships for the rest of the life. • The primary caregiver may have neglected the child’s basic emotional (affection, comfort, safety) or physical needs &/or there were repeated changes of caregivers in the child’s life which interrupted the development of healthy attachments needed for social & cognitive development. • The child’s attachments are indiscriminate with an inability to form appropriate connections with individuals. • Children living with RAD may be misdiagnosed with ADHD & Bi-Polar Disorder. If it continues into adolescence without treatment, they are often diagnosed with ODD or Conduct Disorder. DSM-IV 313.89: Reactive Attachment Disorder of Infancy or Early Childhood

22. Harm to self or others Lack of empathy Refusal to talk, answer questions Poor eye contact Stealing, poor impulse control Extreme defiance and control issues Lack of cause and effect thinking Mood swings False allegations (abuse or neglect) Developmentally Inappropriate interpersonal relationships Inappropriately clinging or demanding Overly cautious Poor peer relationships Chronic, nonsensical lying Bossy, needing to be in control Signs & Symptoms of RAD

23. Impact on the Classroom • Some students exhibit the need to be in control & may appear bossy or argumentative resulting in power struggles with staff & students • Some students may distrust the school as a system or the classroom teacher as a person who will leave them or fail them; this reinforces the need to foster relationships with students so that they feel connected & cared for in the learning environment • May have developmental delays in motor, language, social & cognitive development • Difficulty in understanding & completing tasks & homework assignments • Struggles with comprehension, especially longer texts • Lack of endurance to stay motivated & engaged in the whole academic day

24. Depression • Characterized by persistent depressed (sad) mood & this may last for months or even years • Depression can occur at any age • Depression occurs in 2% of school-aged children (6-12 years old). With puberty this rate increases to 4% • Girls are diagnosed with depression at a higher rate than boys • 20 % of youth will have 1 or more episodes of depression by the time they become adults

25. Impaired ability to concentrate, think & reason Small tasks require great effort & are exhausting Appears oppositional-work refusal Problems making decisions Changes in appetite Fatigue, lethargy Slow movement, speech, & thinking Disinterest in normally pleasurable activities Irritable Psychomotor agitation Abnormal activity level/movement Pacing Hand wringing Pulling/rubbing skin Signs & Symptoms of Depression

26. Impact on the Classroom • Difficulty starting & finishing school work • Hard for students to remember directions & focus on classroom lessons • Sensitive to criticism or redirection • Less engaged in class • Drop in grades • Frequent school absences • Students may appear oppositional or refuse to do work

27. Suicide & Self Injurious Behavior (SIB) • National Institute of Mental Health: approximately 2 million adolescents attempt suicide and 700,000 receive medical attention for their attempt each year • 3rd leading cause of death among 10-24 year olds • Suicide is the result of many complex factors: more than 90% of youth suicide victims have a mental health diagnosis especially a mood disorder such as depression

28. Minnesota Survey Data • 9th grade girls continue to report highest rates of suicidal ideation (21.9%) followed by 12th grade girls (15.5%) & 12th grade boys (12.7%) • The rates of attempted suicide have decreased since 2004, with 9th grade girls making the most significant decrease from 10.3% in 2004 to 4.9% in 2007, however they are still 2.5% higher than 6th and 12th grade females & all males Minnesota Student Survey Trends Report 2007

29. Comments like “I won’t be a problem for you much longer”, “It’s no use”, or “It doesn’t matter if I am here” Leaves notes, writes in an essay/poetry, depicts in song or artwork or brings up suicide in joke Recent situation(s) of loss, humiliation, stress or rejection Giving away valued possessions Sudden unexplained cheerfulness after long period of a low mood Unable to verbalize alternatives to hurting self Can’t think of anyone who will miss them. Suicide Warning Signs:

30. Teacher’s Response to Suicide Warning Signs: • Assure the student’s immediate safety • Do not handle the situation alone • Refer immediately to school social worker, school counselor or school nurse • Work with administrator &/or support staff to ensure that the parent/guardian has been informed of the situation

31. Bipolar Disorder • Bipolar Disorder: Characterized by episodes of major depression as well as episodes of mania • Student may act like two different people • Young people with bipolar often experience very fast mood swings several times throughout the day • Students often lack organizational skills & exhibit poor short term memory • Students experience episodes of overwhelming emotions such as sadness or anger

32. Abnormally elevated mood/irritability Hallucinations or delusions Racing thoughts Inflated self-esteem Increased talkativeness and rapid speech Uncontrollable temper tantrums Abnormally active/hyperactive, excessive energy Excessive risk-taking/daredevil behavior Hyper-sexuality Active much of the night/decreased need for sleep Signs & Symptoms of Mania

33. Impact on the Classroom • Difficulty focusing and completing work • Students can easily become upset or overreact to situations • Difficulty controlling emotions • Dramatic changes in energy & motivational levels • Watch for medication side effects (may need bathroom and water breaks)

34. ADHD • Usually diagnosed in children but not limited to children • An average of at least one child in every US classroom is diagnosed with ADHD • Number of boys diagnosed with ADHD out number girls: ADHD effects 2-3 times as many boys than girls • ADHD can co-occur with other diagnoses

35. ADHD: 3 Types Signs & Symptoms • ADHD Inattentive Type • fails to follow close attention • difficulty sustaining attention, completing tasks • does not seem to listen, does not follow through • has difficulty with organization, loses or misplaces things easily • easily distracted and forgetful • ADHD Hyperactive/Impulsive Type • fidgets, moves excessively, unable to sit still • difficulty engaging in activities quietly • talks excessively and blurts out answers • impatient and interrupts • ADHD Combined Type – Combination of the two types

36. Impact on the Classroom • Student may be unaware of personal space • Frequent interruptions due to blurt outs or inability to take turns • Student may be easily distracted by background noise and focus on that rather than the lesson • Student often does not have needed materials (pencil, assignments, homework)

37. How ADHD is different from Bipolar Disorder: • Destructiveness is unintentional in children with ADHD • Duration of outbursts: ADHD can calm down in 20-30 minutes whereas bipolar child/adolescent can feel angry for up to 4 hours and this anger is maintained through temper tantrums • Children/Adolescents with ADHD are often reacting due to sensory or emotional over stimulation • Moods: Children/Adolescents with ADHD do not necessarily display depressive symptoms

38. Oppositional Defiant Disorder (ODD) • All children are occasionally oppositional; this is developmentally appropriate during adolescence • Oppositional behavior is a concern when it occurs significantly more than in other children at the same age &/or developmental level • Parents often see rigid demanding behavior at an early age • ODD can co-exist with other disorders

39. Negative thinking Misperceives others Lacks empathy for others Easily annoys others, bullies Blames others Argumentative Rage/Anger Low frustration tolerance Irritable Impatient Signs & Symptoms of ODD

40. Impact on the Classroom • Students often miss school due to suspension & dismissal • Disruptive behavior interferes with the learning of the student & his/her classmates • Requires increased need to monitor your own response to the student’s behavior • Students are at risk of academic & social impairments • Developing a positive relationship may be key to decreasing negative behavior

41. Anxiety Disorders • Anxiety disorders can cause people to feel excessively frightened, distressed & uneasy during situations in which most others would not experience these symptoms • If left untreated, these disorders can dramatically reduce productivity & hinder social competence

42. Types of Anxiety Disorders • Generalized Anxiety Disorder • Panic Disorder • Obsessive Compulsive Disorder • Post Traumatic Stress disorder • Phobias

43. Signs & Symptoms of Anxiety Disorders • “Fight-or-flight” response • Low tolerance for frustration • Irritable or quick to anger • Looks terrified/sad • Hypersensitivity; feelings easily hurt • “Freeze or shut down” • Physical symptoms: somatic complaints, chest pains • Obsessions/compulsions • Avoids tasks • Automatic negative thinking • Low self confidence

44. Impact on the Classroom • Children do not recognize their own anxiety • Anxiety may present as acting out or oppositional behavior • Emotional or behavioral reactions many not fit the situation; minor changes may cause over reactions • Student may request to call home or go to the nurse frequently • Students may have difficulty with memory and concentration • Poor school attendance due to social anxiety

45. Treatment for Mental Health Disorders • Medications • Individual/Group Therapy: may incorporate psychotherapy, behavioral therapy, social skills training, cognitive therapy • Combination of medication & therapeutic intervention is often most effective

46. Treatment for Mental Health Disorders, Continued • Collaboration between the school, home and community is best practice. • Incorporating adaptations in the classroom • Utilize techniques for managing behavior • Communication between teachers, parents/guardians school support staff, & outside mental health providers

47. Working Together with Families • Share student strengths • Actively listen and empathize with families • Refer to behavior difficulties within the context of mastering academic goals • Be concrete and specific about behaviors and symptoms you have observed and provide accurate data • Solicit suggestions from the family as to what strategies work at home

48. Working Together with Families • Acknowledge & work with differences in perception • Balance the needs/goals of a school culture & the context of the family culture & be aware that they may at times be at odds with one another • Parents know their children best & want them to be successful above all else

49. Mental Health Disorders & School Performance • Information about a student’s mental health disorder & how it manifests itself will help school teams develop successful intervention instructional plans • Interventions should motivate & engage students • School staff need to recognize a student’s successes and offer encouragement • Early intervention can enhance a child’s well-being, reduce risk and help a child succeed academically.

50. Responding to Concerning Behaviors or Signs & Symptoms • Often students that display maladaptive behaviors lack the skills necessary for school success • As educators, we need to teach the skill • Positive behavior interventions are a way to teach necessary skills & maximize student success • Just as we teach math or reading, we need teach social emotional regulation