Download Mental Health in Schools (Rohr)

Mental Health
in the Schools
By:
Patrick Rohr MA, LPC
Goals of Presentation
 How
to recognize the need for counseling support
and who to talk to for assistance.
 Understand
types of mental health disorders found
in school settings.
 Learn
about types of medications prescribed for
common mental health disorders.
 Tips
to maintaining confidentiality in both school
and non-school settings.
Basic Facts About Childhood
Mental Health Problems
 Approximately
1 in 5 children and youth have a
mental health problem 5
 Mental
health problems can seriously impair
children’s ability to be successful at school and in
their relationships with their peers
 These
children are not bad kids nor are their parents
bad parents
 Mental
health problems are treatable. Early
prevention is important
When Should I Be Concerned?
 Signs
that children may be struggling with
mental health problems include the
following 4



They exhibit behaviors or moods that are
not age-appropriate
Their behaviors are much more dramatic
than in their peers
Their behaviors continue for longer than
usual
When Should I Be Concerned?
Mental health is a continuum from healthy to
unhealthy, and problematic behaviors are not
“proof” that a student has a mental health
problem 4
1.
Frequency: how often does the student
exhibit the behaviors of concern?
2.
Duration: how long do the behaviors last?
3.
Intensity: to what extent do the behaviors
interfere with the child’s activities?
Next Steps
 What
 Who
 How
can I do?
else should be involved?
do I know what mental health
problem I’m dealing with?
Signs Your Student May Be
Experiencing a Mental Health
Problem
Emotional/Behavioral signs 4

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


Overly withdrawn, quiet or doesn’t engage
Low self-esteem, feelings of failure or worthlessness
Increased irritability, which can appear as disobedience or aggression
Feeling hopeless or overwhelmed
Unstable moods, such that teachers and other students don’t know what to
expect from them
A short fuse and lashing out when frustrated
Extreme worries or fears that interfere with friendships, schoolwork, or play
Severe mood swings affecting relationships with others
Drastic change in personality or behavior
Extreme sadness lasting two weeks or more
Refusal to go to school on a regular basis
Signs Your Student May Be
Experiencing a Mental Health
Problem
Academic signs 4







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

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
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
Fidgeting, constantly moving around or seems “always on the go”
Despite best efforts, poor grades poor grades in school despite trying very
hard or a noticeable decline in classroom participation
Poor attention to detail and careless mistakes in schoolwork
Does not appear to listen when spoken to directly
Does not follow instructions or finish tasks
Easily distracted
Forgetful in daily activities
Difficulty staying focused on one thing
Bores easily
Loses or forgets things often
Difficulty attending to individual work or class activity
Dreamy or unable to pay attention
Afraid to participate in class or answer questions
Difficulty managing during recess and free time, while unsupervised, and in
larger groups
Signs Your Student May Be
Experiencing a Mental Health
Problem
Communication/Social Skills signs 4









Spends most of their time alone
Goes on and on about a subject and takes over a
conversation
Acts “silly” in a group to get attention but doesn’t fi t in
Plays too roughly in the playground and hurts other children
Poor motor skills (e.g. can’t catch or throw a ball)
Other children may feel their schoolmate is being bossy or
too rough
Damages toys, etc. without meaning to
Speaks without thinking
Barges into games
Anxiety Disorders
 Common





Generalized Anxiety Disorder (GAD)
Panic Disorder
Social Anxiety Disorder
Post Traumatic Stress Disorder (PTSD)
OCD
 How


types 2,7
common are anxiety disorders?
6% of youth have a disorder that warrants
treatment.
Cost United States 42 billion dollars a year to
treat.
Anxiety Disorders
Causes of anxiety disorders 2,7

Multiple, complex origins
What is normal and what is not?

Worry vs. Anxiety
Anxiety Disorders
Common signs that student may be struggling with
some type of anxiety disorder 2,7

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Frequent absences
Refusal to join in school social activities
Decline in grades or unable to work to expectations
Often spends time alone, has few friends, or has great
difficulty making friends
Physical complaints that are not attributable to a
health problem
Excessive worrying about homework or grades
Frequent bouts of tears
Easily frustrated
Fear of new situations
Anxiety Disorders
Suggestions for supporting students who
struggle with anxiety:




Reward brave, non-anxious behavior
Encourage them to take little steps toward
accomplishing the feared task
Learn what situations the student can handle and
how you can respond when they are unable to
cope
Keep as much of the child’s regular schedule as
possible
Anxiety Disorders: Medication
 Commonly



prescribed medications 2,7
Antidepressants
Antipsychotics
Alpha-two antagonists
 Common
side effects and impact on
learning/functioning
Behavior Disorders
 Common



Oppositional Defiant Disorder (ODD)
Conduct Disorder
Intermittent Explosive Disorder
 How


Types
common are behavior disorders?
3-16% of children and adolescents are
diagnosed with ODD 1.
6-16% of children adolescents are diagnosed
with conduct disorder 1.
Behavior Disorders
What are the causes? 1



Biological factors
Psychological Factors
Social Factors
What is normal opposition/behaviors and
what is not?

Developmentally appropriate vs
exaggerated and constant.
Behavior Disorder Symptoms
Children with ODD show an
The following behavioral
symptoms are associated with
ongoing pattern of extreme
ODD 1
negativity, hostility, and
 Frequent temper tantrums
defiance that 1
 Excessive arguments with
 Is constant
adults
 Lasts at least 6 months
 Actively refusing to comply
with requests and rules
 Is excessive compared with
 Often questioning rules
what is usual for the child’s
 Deliberately annoying and
age
upsetting others
 Is disruptive to the family and  Often touchy or annoyed by
the school
others
 Is usually directed toward an  Blaming others for their
mistakes
authority figure (parents,
 Frequent outbursts of anger
teachers, principal, coach)
and resentment
 Spiteful attitude and revenge
seeking
Behavior Disorders
Suggestions for supporting students with behavior
problems:



Be aware of your environment
Collaborative Processing
Have plan in place
Behavior Disorders and
Medication
 Is
medication alone effective?
 High
degree of comorbidity with other
mental health disorders 1




ADHD
Anxiety Disorders
Mood Disorders (Depression, Bipolar)
Learning Disorders
Mood Disorders: Depression
 Most

common type of mood disorder:
Depression
 How
common is depression among children and
teens?


10%-15% of children and teens are depressed at any
give time 7,4
1 out of 4 adolescents will have an episode of major
depression during high school with the average age of
onset being 14 years 7,4
Mood Disorders: Depression
What causes depression? 4




Painful event
Family discord
Poor social skills
Genetics
How to tell between sadness and depression:


Sadness is not an every-moment-of-every-day thing
Depression tends to be constant and ever present.
Mood Disorders: Depression
Symptoms of depression in
Children 7,4
 Somatic complaints
 Withdrawal
 Antisocial behavior
 Boredom
 Irritable
 Prolonged sadness
 Low sense of self esteem
Symptoms of depression in
Teens 7,4
 Prolonged sadness
 Feelings of helplessness and
hopelessness
 Loss of appetite
 Loss of pleasure in activities
that were once enjoyable
 Suicidal ideation
 Sleeping a lot
 Low sense of self esteem
 Problems with
concentration
Mood Disorders: Depression
Suggestions for supporting students with depression 7,4
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Make a special contact with the student each day
Children and adolescents who are depressed are more
sensitive to criticism. Corrections should be accompanied
by plenty of praise and support
Depressed students often feel as if they have little to
contribute. It is helpful to show confidence, respect, and
faith in the student’s abilities
Ask open-ended questions. With no clearly correct
answers, these kinds of questions minimize any chances
for embarrassment
Check your School’s procedures for dealing with students
who are expressing suicidal thoughts. Seek direction from
your principal if you have questions about what to do
Depression and Medication

Most common types of medication 4
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SSRI’s
Atypical antidepressants
SNRI’s
Common side effects of antidepressant
medication 4
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Nausea
Diarrhea
Insomnia
Suicidal Ideation
Aggression
Behavior Disorders: Bipolar
Disorder
What is Bipolar disorder? 3,4


Alternating episodes of mania and depression.
Often confused with ADHD
How common is bipolar disorder? 3,4


3% - 5% of adults have bipolar disorder.
Hard to diagnose in children and teens
Behavior Disorders: Bipolar
Disorder
What causes Bipolar Disorder ? 3,4


Runs in families
Neurochemical disorder
Normal highs and lows vs problematic ones


Long lasting sadness
Highs go well beyond “good mood”
Behavior Disorders: Bipolar
Disorder
Symptoms of bipolar disorder 3,4
 Rapidly changing moods lasting a few minutes to a few days
 Separation anxiety
 Crying for no apparent reason
 Strong and frequent cravings, often for carbohydrates and sweets
 Hyperactivity, agitation, and distractibility

Depression
 Expansive or irritable mood
 Excessive involvement in multiple projects and activities
 Impaired judgment, impulsivity, racing thoughts, and pressure to keep
talking
 Impulsive, talkative, distractible, withdrawn, unmotivated, or difficult to
engage
 Grandiose belief in personal abilities that defy logic (ability to fly, knows
more than the teacher)
 Explosive, lengthy, and often destructive rages
 Defiance of authority
 ‘Dare devil’ behavior
Behavior Disorders: Bipolar
Disorder
Suggestions for supporting students with bipolar 3,4
 Allow more time to complete certain types of
assignments and tasks
 Adjust expectations until symptoms improve
 Set up a procedure that allows the child to quickly
and safely exit from an overwhelming situation
 Learning and cognitive difficulties can vary in
severity from day to day
 Allow extra time for moving to another activity or
location
 Encourage the child to help develop interventions.
Bipolar Disorder: Medication
Types of medications prescribed 3
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Mood stabilizers
Atypical antipsychotics
Side effects of medication 3
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Dry mouth
Blurred vision and constipation
Dizziness or lightheadedness,
Weight gain
Tardive dyskinesia
Attention Deficit Hyperactivity
Disorder
What is Attention Deficit Hyperactivity Disorder ? 5,4

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Inattentive type
Hyperactive type
Combined type
How common is ADHD? 5,4

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Approximately 11% of children 4-17 years of age (6.4 million)
have been diagnosed with ADHD as of 2011
The percentage of children with an ADHD diagnosis
continues to increase, from 7.8% in 2003 to 9.5% in 2007 and
to 11.0% in 2011
Boys (13.2%) were more likely than girls (5.6%) to have ever
been diagnosed with ADHD
Using a prevalence rate of 5%, the annual societal ‘‘cost of
illness’’ for ADHD is estimated to be between $36 and $52
billion, in 2005
Attention Deficit Hyperactivity
Disorder
What causes ADHD? 5,4
 Runs in families
 Pregnancy problems
 Neurological factors
How long does ADHD last?
 Lifetime of coping
Attention Deficit Hyperactivity
Disorder
Symptoms of ADHD 5,4

Inattention
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Be disorganized
Lack focus
Have a hard time paying attention to details and a
tendency to make careless mistakes.
Have trouble staying on topic while talking, not
listening to others, and not following social rules
Be forgetful about daily activities (for example,
missing appointments, forgetting to bring lunch)
Be easily distracted by things like trivial noises or
events that are usually ignored by others
Attention Deficit Hyperactivity
Disorder
Symptoms of ADHD 5,4
 Hyperactivity
 Fidget and squirm when seated
 Get up frequently to walk or run around
 Run or climb a lot when it's not appropriate. (In
teens this may seem like restlessness)
 Have trouble playing quietly or doing quiet
hobbies
 Always be "on the go"
 Talk excessively
Attention Deficit Hyperactivity
Disorder
Symptoms of ADHD 5,4
 Impulsivity
 Impatience
 Having a hard time waiting to talk or react
 Have a hard time waiting for their turn
 Blurt out answers before someone finishes asking
them a question
 Frequently interrupt or intrude on others
 Start conversations at inappropriate times
Attention Deficit Hyperactivity
Disorder
Suggestions for supporting students with ADHD 5,4
 Break goals/tasks down into many smaller
goals/tasks
 Getting students to repeat back instructions
 Plan ahead for transition times
 Being firm and consistent about rules, but always
staying calm and positive
 Providing immediate and consistent feedback
regarding behavior
Attention Deficit Hyperactivity
Disorder: Medications
Types of medication used to treat ADHD 5,4
 Stimulants
 Non Stimulant medications
Common side effects of medication 5,4
 Decreased appetite
 Stomach pain
 Sleep problems
 Daytime drowsiness
 Rebounding effects
Self-Harm
Definition:
 Deliberate attempt to harm oneself and in most
cases, is done without conscious intent to commit
suicide 4,6,2

Most common type of self-harm is self injury
Types of self-harm
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Self-cutting
Self-poisoning
Self-burning
Self-scalding
Self-inflicted hitting
Self-Harm
What causes self-harm? 4,6,2

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
Getting relief from painful or distressing feelings
Dealing with feelings of numbness
Communicating pain or distress to others
Risk Factors:

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



Eating disorders
Physical, emotional, or sexual trauma or abuse
Depression, paranoia, or obsessive-compulsive
disorder
Low self-esteem and self-worth
Bullying
Feelings of shame, humiliation, and rage
Self-Harm
Signs of Possible Self-Harm 4,6,2



Refusal to wear short sleeves or to remove clothing for
sports
Numerous unexplained scars, burns, or cuts
May voice concerns that others do not listen and that
they feel patronized
Suggestions for supporting students struggling with selfharm:



Simply being available, whenever possible, to talk to a
child who self-harms can make all the difference, as
feelings of isolation are often part of the problem
Consult with your school counselor
Make sure that they know who they can go to in your
school for professional help
Confidentiality
Three Confidentiality Laws:
1. FERPA-Family Education Rights and
Privacy Act
2. IDEA-Individuals With Disabilities
Education Act
3. HIPPA-Health Insurance
Portability and Accountability Act
Confidentiality
Personally Identifiable Information

Any personal identifier
 Social
Security number, drivers license
number, etc.

List of personal characteristics that would
make it possible to identify the student
 Physical
characteristics, etc.
Important concepts:


“Educationally Relevant”
“Legitimate Educational Interest”
Confidentiality
Ask yourself these questions to protect yourself:
1.
2.
3.
4.
5.
6.
Who is listening (or could be?)
What is being discussed
When is the meeting to take place
Where the discussion takes place
How are items discussed & documented
Why the discussion took place
Questions?
References
1 American
academy of child & adolescent psychiatry. (2009). Oppositional defiant disorder. In ODD: A
guide for families
2
Anxiety Disorders. (2105, May). In National Institute of mental health: Mental health information.
3 Bipolar.
(2015). In Child mind institute.
4 Buchanan,
D., & Colton, P. (2011, September). Mental health in the class room. In Making a
difference an educators’ guide to child and youth mental health problems
5 Centers
for Disease Control and Prevention. Mental health surveillance among children – United
States, 2005—2011. MMWR 2013;62(Suppl; May 16, 2013):1-35.
6 Diseases
7 Facts
and conditions: Depression. (2015). In Mayo Clinic.
& statistics. (2015). In Anxiety and depression association of America.
8 Mental
9 Mental
health America. (2015). Conduct disorder. In Mental health
health in schools: guidelines, models, resources, & policy considerations . (2001, May). In Policy
leadership cadre for mental health in schools.