Download for International School Nurses

Teen Talk
for International School Nurses
by Katy Harris
www.family-sos.org
Teens, like adults, must deal with life
stressors such as academic pressure,
peer pressure, family dysfunctions,
emotional concerns and growing up
processes. They respond by
becoming sad, frightened, anxious or
angry in varying degrees.
When one of these or a component of
these emotions reached a degree that
interferes with their daily life, normal
functions and their capacity to take
pleasure, action should be considered
Common human traits
• Control…
Defiance, hostility, self harm, substance
abuse, over-striving, eating disorders, gaming
addictions
• Avoidance…
isolation and withdrawal from family or
friends, drinking, drugs,
social dependency, running away
WE ALL NEED TO belong, to feel heard, feel capable,
make choices, cope with mistakes and obstacles and keep
going…......its hard!
Over the age groups
• Pre/early teens…
bullying, social unease, cyber-issues, family
stresses and classroom/peer anxieties
• Mid-teens…
body image, sexual orientation/health, academic
decline, family dysfunction, dating difficulties
• Late-teens…
Academic pressure, relationship struggles
The teen brain
• Increases
lymbic system – emotional tone/overload
thus they feel things more intensely
• Decreases
executive function – and at the same time they
have less ability to manage cognitive load and
the organization of problem solving
The expatriate community
• Excellence is expected they need to hear that there is no failure
but teachers and parents offer fear as a motivator!
• Parents fail to share their vulnerability so feelings of
shame about having low mood/ability/confidence/coping adds to the mix
• Academic achievement is all and schools reinforce the
erroneous idea that, without good grades, entrance to college/uni is not going to
happen – despite the fact that many kids deter further study and succeed later
• Peer groups and unstable as children leave and filter in,
constantly changing the dynamic and adding social stress at an emotionally
sensitive time of life
• Singapore seems safe and teen-dangers are minimized by the
press, police and parents
Main sources of referral
• Teachers
Noticing failing grades, social withdrawal,
excessive fatigue and emotional reactivity or
‘flat-line’ responses and ‘don’t care’ attitudes or
disruption and aggressive responses
• School nurses
Seeing minor ailments, hearing complaints
and concerns of social safety or exclusion, peers
reporting of ‘others’ or seeking help for ‘others’,
or advice regarding ongoing family/home issues
Two main categories
• School stuff -struggles with peers, siblings,
parents, teachers, subjects, balancing ECAs and
workload = dissatisfaction and disconnect
• Personal – struggles with emotional states,
feelings of failure, key relationships, identity
issues, health and mental equilibrium =
frustration and feeling the need to escape
• Third culture kids – job losses, impending
transitions, parental absence, financial concerns
Transition to independence
• Breaking the bounds of mother-love they are
programmed to part but mothers hold on!
• Their parental role models are usually successful and
they fear failure
• Belonging within the ‘tribe’ is essential but today’s
tribe is a shifting social community, not a stable one
• False Evidence Appearing Real – face the worse that can happen – chase the fear
towards recover
• Anxiety is the concerns we are not facing – those hidden from view, which
need to surface
• Depression occurs when anger turns in, or anxiety has no outlet, or
hopelessness overwhelms
FAMILY CONFLICT
• Conflict centre around everyday family life
organisation, personal responsibility, money, social balance, returning home on
time, homework, grades, family outings, school trips and holidays, CHOICE
• Inter-personal relations – this is the time when rumbling
relationship problems explode as teens resist ‘given’ roles/reasoning
• Teens want choice – good parents offer LIMITED choices, including
the choice to mess up or manage things badly
• Teens want to understand boys capacity to understand others’
perspectives increase, whilst girls sometimes decrease!
• Teens want freedom but freedom is not the same as free-to-roam,
it is freedom to error and pick up, and accept consequences and stay hopeful
Talking to parents
• Parents who want their children in counseling
should consider the value of family therapy –
the teen is not responsible for the whole issue
• Parents need to seek advice and support
themselves before putting the ‘label’ on their
kids (they are bigger and should do the work)
• But too often teens are categorized as difficult
and the dillema of being in counseling can exacerbate the inter-personal issues
• Parents who are losing control need to take
ownership of their own panic with gentle guidance
Talking to teens
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No empathy overload, (multiple solutions including worst)
Stay practical (use scales and ratings)
Be future focused (in 10 years time, advice to self)
Harness strengths and coping
Sort and seek input from their support people
(with permission or encourage the teen to approach them)
• Allow slow reveal – be patient and persist
• Use self disclosure, metaphor and ‘stories’
(rapport over time means more than ‘fix it’ advice
Suicide
Continues to be the 2nd leading cause of death for those
between 15-25 (after accidents)
BUT suicidal ideation is where we can help…..
KNOW risks (impulsivity/mental health issues in the
family/chronic depression/public humiliation/major break
up/substance abuse/peer isolation/high expectations,LGBT
RED FLAG COMMENTS
No one cares, i wonder who would come to my funeral,
nothing matters, no one would miss me anyway, they’d be
better off without me, i wish i could sleep and not wake up
ESTABLISH degree of planning
CONTACT family and medical practitioners
Panic problems
• Many teens don’t anticipate well, and then feel a
sense of startle and panic as they face big things
– exams, friends leaving, break ups
• Encouraging them to turn towards the fear allows
more reality checking to take place
• Plans are the opposite of panic, especially if
shared/supported(with parents or a good friend)
• Help them remember past coping, believe in selfmanagement, work towards positive outcomes
and encourage them to believe –THERE IS NO
FAILURE, only mistakes and re-directions.
Key ingredients
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Hope looking ahead to what is wanted in terms of ‘feelings and strengths)
Resilience picking up and starting again without GUILT
Social support including caring friends, extended family, etc
Family cooperation working together to joint aims
Good school/home communication
Practical planning – PROCESS OUT OUTCOME
Noticing what works and building in small steps
THERAPY
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CBT has good research but is often limited in its value except in expert hands
Family therapy not enough well-trained personnel here
Expressive therapies useful for those who don’t like to talk
Peer support groups schools should have them but don’t
Online resources be selective – everything written is not true
Inter-schools groups would be WONDERFUL
School nurses/teachers first line defense needs good radar!
Medications often bridge from uncertainty & low mood to a pick up point
ANXIETY ABOUNDS
• Anxiety is unconscious fears – and usually presents as
control or avoidance
• It requires gentle exploration towards uncovering
problems both externally in situations and internally in
feelings and thoughts
• Checking ‘what might happen’ brings the anxiety to
consciousness and allows planning
• Solutions are not enough – self soothing is key both
physically to calm the system and mentally/emotionally
to generate self compassionate care
• Build the idea of inner strengths – courage is key but if
fears are hidden it is impossible to add ‘brave’
DEPRESSION
• Depression is a turning inwards of anger – usually
and trying to dampen down frustrations
• Depressed teens become reliant on things to
keep them in the ‘zonk zone’ – where they wont
have to face their frustrations/failures
• This underlies many other conditions and
medication is necessary if external support is not
welcomed
• Getting parents to understand their role to
deflate expectation and increase steps and stages
towards feeling better is essential
AUTISM/ADHD/learning disorders
• Lack of social understanding and impulsivity
increase potential exclusion and risk behaviors
• Social rules are infinitely changeable at this
age – ASD kids need safe supporters to talk through better/worse not
right/wrong with DESIGNATED PERSONNEL
• ADHD – organizational support is key in early
teen years, and strong ongoing monitoring
• ADHD/ADD – girls are risk – most girls with
inattention manage and mask it until 12-14 yrs
LOSS AND GRIEF
• Boys extra vulnerable about losing first
girlfriends – often minimized by other adults- LISTEN TO THE PAIN!
• This is the age where early-years pets depart –
this is no small thing! Focus on VALUE as balance to LOSS
• Loss of innocence is not to be underestimated & generates big teen behaviors, it requires sympathy and hope
• Loss of grades creates grief! Talk about the gap between
expectation and reality – the ‘gap’ is the grief-maker, work on 80/20 principle
RISK/PREVENTATIVE FACTORS
• Preventing initial recurrence pre-planning is everything!
• Interrupting the process through which risk
operates change of environment/perceptions/people/motivations
• Creating buffers against further negative
effects careful incentives & managing short term pain for long term gain
• Increase self-esteem and self efficacy talk & walk
• Key supporters need to stay long-haul usually this
cant be parents - sorry
Additional notes follow
These small notes are
only a small attempt to
cover some of the areas
of concern for this age
group
SELF INJURY
• More common in girls than boys
• Affects kids with low ability to express their
frustrations or a fear of being angry
• Often highly social/high expectation kids
feeling overwhelmed and under-strengthened
• Mostly parents don’t know – encouraging
sharing takes a lot of planned support
• Expressive therapies help but medication is
often necessary for a short period
EATING
• Anorexia is usually reported from ‘concerned’
friends, bulemia rarely surfaces in school
• These kids want control – usually high
achievers who are panicking about growing
up, boys, exams or sport and maintain ‘order’
in this one area of their life
• Caution about private counselors – the
hospitals here have good & group resources
• Push parents to get psych support
DRINKING
• The ‘average’ age expat kids have alcohol is grade 8!
• Undiagnosed ADHD kids are often early alcohol
abusers – impulsivity and poor organisation
• Because this is a ‘cover up’ problem careful
investigation is required – focus not on quantity of
alcohol but on feelings alcohol creates and mistakes
made when it is consumed
• Open discussion within pastoral care groups helps
bring problems up – ‘safe’ teachers
• Parents often minimize this as an aspect of other issues
when the child goes out – such as arriving home late or
staying out at other people’s homes
WE ARE NOT SAFE
drugs and gangs
• There are gangs here and expat kids both
iniciate these and are pulled in
• Drugs are available more than we believe
• Schools need to encourage open dialogue and
good reporting systems – & random checks
• Once kids get involved they rarely break loose
and moving the child into a more secure
environment is the biggest deterrent –
wildness programmes and boarding schools
GAMING/MEDIA OVER USE
• This surfaces as a component of others issues –
parental neglect/division, intensity issues such as
un-diagnosed ASD, avoidance of workload/underachievers, peer isolation
• Radical measures work better than reduction
battles – big incentives required
• The whole environment at home needs to change
and often requires deep investigation into the
‘drive’ for withdrawal
• This is a real addition and xxxxx is the best
SEXUAL health/identity
• It is hard for our teens who have private
health care practitioners to know how to
handle STDs – thus it helps for each school to
know who to turn to for good medical support
• Identity issues manifest in this age group and
require safe mechanisms/people to talk to –
ensuring confidentiality is key
Psychiatric referrals
Conduct disorder (aggression and defiance)–
established before teenage in this population
Bi-polar – arises usually in this age group but
mania and low energy picked up by family
Schizophrenia -shows up 15-15 year age group
but again families usually aware
Psychosis – often a part of above – but not often
dealt with within school