Download SEPTA Anxiety Mental Health Concerns_March 2016

SEPTA Presentation, March 2016
Lynn Rafalik, Executive Director of Pupil Personnel Services
Diane Burns-Dobson, Social Worker
Ann Constantine, Social Worker
Heather Wynne, School Psychologist
Prevalence of Mental Health
Disorders in Youth1
● 20% (1 in 5 children 13-18 years old) have had or are
still affected by a serious mental health disorder
(National Institute of Mental Health)
● In 8-15 year olds, 13% of children had a diagnosable
mental disorder (Center for Disease Control)
Protective
3
Factors
 Healthy routines
 Good self-esteem
 Practical problem-
solving skills
 Feeling in control,
internal locus of
control
 Parental/familial
support
 Feeling close with at
least one adult
 Monitoring of




activities
Regular school
attendance and
academic performance
Positive social support
system
Community
participation
Health recreational
activities
Mental Health Concerns
● Anxiety
● Depression
● Low Self-Esteem
● School Refusal
● Attention
Healthy vs. Unhealthy Anxiety
 Anxiety helps us get out of harms way and prepares us for
important events. It also warns us when we need to take action.
Everyday Anxiety
Anxiety Disorder
Worry about paying bills, landing a job, a
romantic breakup, or other important life events
Constant and unsubstantiated worry that causes
significant distress and interferes with daily life
Embarrassment or self-consciousness in an
uncomfortable or awkward social situation
Avoiding social situations for fear of being
judged, embarrassed, or humiliated
A case of nerves or sweating before a big test,
business presentation, stage performance, or
other significant event
Seemingly out-of-the-blue panic attacks and the
preoccupation with the fear of having another
one
Realistic fear of a dangerous object, place, or
situation
Irrational fear or avoidance of an object, place, or
situation that poses little or no threat of danger
Anxiety, sadness, or difficulty sleeping
immediately after a traumatic event
Recurring nightmares, flashbacks, or emotional
numbing related to a traumatic event that
occurred several months or years before
Anxiety Disorders: Symptoms
● Excessive anxiety, worry, or fear that markedly exceeds the level
for the student’s stage of development.
● High level of motor tension such as restlessness, tiredness,
shakiness, or muscle tension.
● Autonomic hyperactivity such as rapid heartbeat, shortness of
breath, dizziness, dry mouth, nausea, or diarrhea.
● Hyper vigilance such as feeling constantly on edge, concentration
difficulties, trouble falling or staying asleep, and a general state or
irritability.
● A specific fear that has become generalized to cover a wide area and
has reached the point where it significantly interferes with the
student’s and the family’s daily life.
Four Dimensions of
2
Anxiety
Dimension
Description
Emotion
Feelings of fear, tension, worry, nervousness,
panic, terror
Physiology
Stomach discomfort, muscle tension, rapid
breathing, nervous system arousal
Cognition
Future-oriented thoughts, pessimistic
expectations
Behavior
Avoidance, aggression
Note: Researchers are learning that anxiety disorders run in families, and
that they have a biological basis, much like allergies or diabetes and other
disorders. Anxiety disorders may develop from a complex set of risk
factors, including genetics, brain chemistry, personality, and life events.
Therapeutic Interventions
 Cognitive-Behavioral Therapy (85% reduction in symptoms after
therapy , Chorpita et al., 2002)
 Facilitative Strategies:


Behavioral Strategies: Relaxation, Systematic Desensitization, Social
Skills
Cognitive Techniques: Problem-Solving, Self-Monitoring, SelfInstructional, Self-Control
 Exposure Therapy: incremental exposure to situations or objects
with accompanying facilitative strategies
 Modeling of appropriate behavior
 Positive Self-Talk
 Self Awareness and Psychoeducation
 Identification of feeling, situation, and trigger
 Identification and application of coping strategies
Therapeutic Interventions
 Acceptance and Commitment Therapy (ACT)
 Use of metaphors and experiential exercises to associate
positive feelings with triggers and upsetting situations
 Healthy contact with self by noticing and accepting
feelings as they occur in daily life

ACT: Accept your reactions and be present; Choose a valued
direction; Take action
 Dialectic Behavioral Therapy (DBT)
 Use of coping skills and relaxation techniques to change
patterns of behavior/reaction brought on by emotions,
thoughts, feelings, and events
Dialectical Behavior Therapy (DBT)
 Distract with ACCEPTS
 Activities – positive activities
 Contribute – help others
 Comparison – compare yourself to someone else less fortunate
 Emotions – change situation so you feel a different emotion
 Push Away – push away emotions or remove yourself from the situation
 Thoughts – force your mind to think about something else
 Sensation – change nervous system arousal by changing temperatures,
rubbing textured objects
 IMPROVE the moment
 Imagery – relaxing and peaceful scenes
 Meaning – find purpose in what you’re feeling
 Prayer – meditation
 Relaxation – Relax your muscles, deep breathing
 One thing in the moment – focus on one item, mindfulness, iSpy
 Vacation – Take a break
 Encouragement – positive self-talk and self-promotion
Types of Anxiety Disorders
● Generalized Anxiety Disorder
● Specific Phobia/Social Phobia
● Panic Disorder
● Obsessive-Compulsive Disorder
● Separation Anxiety
● Post-Traumatic Stress Disorder
Generalized Anxiety Disorder
(GAD): Symptoms
 Global, free-floating feelings of worry
 Worries are vague, and flexible toward the
environment
 Feelings of nervousness without a root cause
or trigger
 People may experience restlessness,
concentration difficulties, irritability, muscle
tension, somatic complaints, sleep difficulties
Specific Phobia: Symptoms
 Intense worry over a concrete object, situation, or
event
 Adolescents tend to avoid the trigger
 Social Phobia
Anxious about being with other people
Self-conscious in front of other people
Afraid of being embarrassed in front of other people
Worry for days or weeks before an event where other
people will be
● Stay away from places where there are other people
● Have a hard time making friends and keeping friends
● May have physiological body symptoms when they are
with other people (e.g., blushing, heavy sweating,
trembling, nausea and having a hard time talking)
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Social/Specific Phobia: Intervention
Supports
 Model appropriate behavior
 Reduce social demands with systematic desensitization
 Allow student to eat in alternative place with staff member
and/or peers
 Introduce student to teacher and staff before school starts
 Flexible seating with teacher and/or student buddy proximity
 Gradually increase time with peers
 Reduce demands to triggering events or objects
 Example: If curriculum includes spiders with a student with
agoraphobia, cover pictures or reduce written language
 Student conference with teacher
 Parent consultation
Panic Attack: Symptoms
 Sudden onset of fear or worry, with nervous
system arousal
 Attacks occur repeatedly, without a specific
trigger (specific triggers would warrant
specific phobia)
 Individuals may avoid situations which
increase heart rate and nervous system
arousal
Panic Attack: Interventions and
Supports
 Have student identify safe places to go to when they
are experiencing panic attacks
 Nurse’s office
 Related Support Personnel: School Counselor, Social
Worker, Psychologist, Speech-Language Pathologist
 Relaxation techniques
 Deep breathing
 Thinking of a peaceful place
 Meditation
 Calming thoughts
Obsessive-Compulsive Disorder
(OCD): Symptoms
 Obsessive Thoughts
 Unwanted, repeating thoughts, impulses, or
images associated with anxiety
 Common thoughts: contamination,
symmetry/exactness, safety, religious
preoccupation
 Compulsive Behaviors
 Unwanted, repetitive actions or mental acts that
an individual is driven to perform in response to
obsessive thoughts
 Common compulsions: washing, checking,
repeating, ordering, counting, hoarding,
touching
OCD: Intervention Supports
 Awareness and identification of thoughts and
compulsions
 Parent, staff, and student consultation
 Monitoring of thoughts and compulsions in
the classroom by teacher
 Teacher-assisted feedback and intervention
 Breaks
 Modification of class work
 Gentle feedback on behaviors
 Suggestion of calming strategy
Separation Anxiety: Symptoms
● Excessive emotional distress and repeated complaints (e.g., crying,
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regressive behaviors, pleading with parents to stay, temper
tantrums) when anticipating separation from home or major
attachment figures.
Persistent and unrealistic worry about possible harm occurring to
major attachment figures or excessive fear that they will leave and
not return/be lost kidnapped, killed, or the victim of an accident).
Repeated complaints and heightened distress (e.g., pleading to go
home, demanding to see or call a parent) after separation from home
or the attachment figure has occurred.
Persistent fear or avoidance of being alone or refusal to go to sleep
as manifested by excessive clinging and shadowing or a major
attachment figure.
Frequent somatic complaints (e.g., headaches, stomachaches,
nausea) when separated from home or the attachment figure is
anticipated.
Excessive need for reassurance about safety and protection from
possible harm or danger
Low self-esteem and lack of self-confidence that contributes to the
fear of being alone or participating in social activities.
Separation Anxiety: Intervention
Supports
 Younger Children
 Sticker chart in morning where they earn
rewards for leaving their parents
 Adolescents
 Morning routine/classroom for transition time
 Behavioral Supports
 Student check-in with related services
personnel
Post-Traumatic Stress Disorder
(PTSD)
Re-experiencing symptoms
● Flashbacks - reliving the trauma over and over, including physical
symptoms like racing heart or sweating
● Bad dreams
● Frightening thoughts
Avoidance symptoms
● Staying away from places, events, or objects that are reminders of the
experience.
● Feeling emotionally numb
● Feeling strong feelings of guilt, depression, or worry
● Losing interest in activities that were enjoyable in the past
● Having trouble remembering the dangerous event
Hyperarousal symptoms
● Being easily startled
● Feeling tense or “on edge”
● Having difficulty sleeping, and/or having angry outbursts
Anxiety Management
Websites for Parents
 http://www.copingcatparents.com/node/15
 http://kidshealth.org/en/parents/anxiety-disorders.html
 http://www.worrywisekids.org/
 http://www.copingcatparents.com/Child_Anxiety_Tales
Online parent education program
 http://www.mdaap.org/Bi_Ped_Brief_Interv_Anxiety.pdf
YouTube Videos Teaching Children
Deep Relaxation Breathing
 http://youtu.be/_mZbzDOpylA
 http://youtu.be/VOnDA6_MAWIk
Depression
 Most common mental health concern in US
 1 out of 33 children may have depression
 1 out of 8 teens may have depression
Depression: Symptoms
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Sad or flat affect
Preoccupation with the subject of death
Suicidal thought and/or actions
Mood irritability
Isolations from family and/or peers
Deterioration of academic performance
Lack of interest in previously enjoyed activities
Refusal to communicate openly
Drug use to elevate mood
Low energy
Little or no eye contact and frequent verbalizations of low self-esteem
Reduced appetite
Increased sleep
Poor concentration and indecision
Feelings of unhappiness, worthlessness, or inappropriate guilt
Unresolved grief issues
Mood-related hallucinations or delusions
Depression: Intervention
Supports
 Assess for safety
 Suicide is the third leading cause of death for young
adults aged 10-24 (CDC)
 Among 9-12th graders, 17% of students seriously
considered attempting suicide in the past 12 months,
13.6% made a plan, and 8.0% attempted
 Columbia-Suicide Severity Rating Scale (C-SSRS):
http://www.cssrs.columbia.edu/index.html
 Lifestyle changes
 Exercise, Nutrition, Sleep, Social Support, Stress
Reduction
 Coping Skills for Adolescents
 http://www.yourlifeyourvoice.org/Style%20Library/99%20Coping%20S
kills%20Poster.pdf
Low Self-Esteem: Symptoms
● Inability to accept compliments
● Verbalization of self-disparaging remarks
● Seeing him/herself as unattractive, worthless, stupid, a
loser, a burden, and unimportant; taking blame easily
● Avoiding contact or excessively seeking attention with
●
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adults and peers
Acting out in negative ways that are quite obviously
attention seeking
Inability to identify or accept his/her positive traits or
talents
Fear of rejection by others, especially the peer group
Difficulty saying no to others; fear of not being liked
by peers
School Refusal: Symptoms
● Persistent reluctance or refusal to attend school because of a
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desire to remain at home with parent(s)
Marked emotional distress and repeated complaints
● Examples: Crying, regressive behaviors, temper
outbursts, pleading with parents(s) not to go to school)
Frequent somatic complaints (e.g., headaches,
stomachaches, nausea) associated with attending school or
in anticipation of school attendance.
Excessive clinging or shadowing of parent(s)
Frequent negative comments and/or repeated questions
about school
Low self-esteem and lack of self-confidence that contribute
to the fear of attending school and being separated from the
parent(s)
Verbalization of a fear of failure and anxiety regarding
academic achievement accompanying the refusal to attend
school
School Refusal: Intervention
Supports
 Incrementally expose children to school




schedule and situations
Identify trigger for school refusal and
problem-solve ways to resolve trigger
Continual communication with school staff
and parents
Reward system for attending school
Set time to meet with support staff
before/after school
Attention-Deficit/Hyperactivity
Disorder: Symptoms
● Short attention span
● Susceptibility to distraction by extraneous stimuli
● Repeated failure to follow through on instructions or complete school
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assignments, chores, or job responsibilities in a timely manner
Poor organizational skills
● Forgetfulness, inattention to details, and losing things necessary for
tasks
Hyperactivity
● High energy level, restlessness, difficulty sitting still, or
loud/excessive talking.
Impulsivity
● Difficulty awaiting his/her turn in group situations, blurting out
answers to questions before the questions have been completed, and
frequent intrusions into others’ personal business
Frequent disruptive, aggressive, or negative attention-seeking
behaviors
Tendency to engage in careless or potentially dangerous activities
Difficulty accepting responsibility for actions, projecting blame for
problems onto others, and failing to learn from experience
ADHD: Intervention Supports
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Define and praise appropriate school behavior
Ignore inappropriate behavior
Remove distracting objects or visuals
Visual cues
Proximity to teacher
Reward systems (Behavior chart, PBIS)
Chunk information
Organize information (graphic organizers)
Sensory/Movement breaks
Sensory objects to hold
Stretch breaks
Accommodations such as a wiggle seat, alternative
chair, alternative desk, privacy folder
Overview
● There is often comorbidity of symptoms
● There isn’t always a clear cut diagnosis and
there can be symptoms that overlap
● Therapeutic techniques can be applied to
individual situations
● Consult with school members to determine
action plan at school
● If symptoms worsen at home, you may wish
to seek individualized assistance through an
outside service provider
References
 1. http://www.nimh.nih.gov/
 2. Shapiro, J., Friedberg, R., & Bardenstein, K.
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(2006). Child and Adolescent Therapy: Science & Art.
3. Youth Mental Health First Aid USA (2012).
Maryland Department of Health and Mental
Hygiene, Missouri Dept. of Mental Health, &
National Council for Community Behavioral
Healthcare
Healthguide.org
http://kidshealth.org/
http://www.cdc.gov/violenceprevention/pdf/suicid
e-datasheet-a.pdf