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Youth with Mental Health Disorders: Building Skills for Success 2011 Pennsylvania Community on Transition Conference Elizabeth Coyle, D.Ed. Professional Development Services 717-871-1396 Overview • Skill Building for Youth 1. Mood Disorders 2. Anxiety Disorders 3. ADHD 4. Oppositional Defiant Disorders 5. Conduct Disorder Mood Disorders: Categorization Mania (rare) Cyclothymia (unknown) Dysthymia (1.7%-8%) Depression (4%-8.3%) Bipolar (1%-2%) http://www.youtube.com/watch?v=QLxFSiKXY ko General Do’s and Don’ts for All Mood Disorders • Do recognize your role (identification, referral, classroom interventions, balance concern with confidentiality) • Do recognize your sphere of influence • Do treat the same as a physical illness • Don’t take behavior personally • Don’t blame • Don’t expect change to happen overnight • Don’t take on responsibility beyond your role Family Awareness and Collaboration • Understand sources of denial/minimization ▫ Stigmas ▫ Lack of information/education/awareness • Comparisons to physical illness • Need for correct type of therapy Depression: Signs and Symptoms Depression in the flight mode Withdrawn, low energy, changes in sleeping/eating, somatic complaints, difficulty concentrating Depression in the fight mode Irritable, belligerent, aggressive, mood swings, short fuse, defiant Links Between Depression and Learning Depression and neurochemicals Impact on short- and long-term memory Impact on motivation and potential Impact of behavioral changes on learning Impact of emotional changes on inclusion and sense of belonging School-Wide Supports School counselors, social workers, nurses, psychologists SAP 504 plans IEP Mentors After school activities Depression: Responses • Serotonin ▫ Motion and movement, walking clubs, yoga, chunking, feeling of day portfolio • Interpretation ▫ Columbo approach, teach reading of non-verbals, feeling faces • Mourning ▫ Feeling of the day art or audio, support groups • Flight motivators ▫ Helping others of a younger age, projects • Fight response ▫ Head talk and cool talk, anger management skills Dysthymia Depressed or irritable mood plus at least two of the following symptoms: poor appetite or overeating; sleep disturbance; low energy or fatigue; low self-esteem; concentration or decision making problems; feelings of hopelessness Less severe than depression but more prolonged (at least one year) Connection to apathy and motivation http://www.youtube.com/watch?v=R4yMHVNz VgA Anxiety Disorders: Eight Categories • • • • • • • • Generalized anxiety disorder Specific phobias Panic disorder Separation anxiety Social phobia Agoraphobia Obsessive compulsive disorder Post traumatic stress disorder Common Threads of Anxiety Disorders • Subjective experience • Physiological response • Behavioral response School Supports • Use paraphrasing to support concern • Minimize fears, worries, anxiety • Empower youth for solutions • Assume behavior is for attention • Use recommendations from pupil personnel and/or mental health professionals • Overwhelm • 504 plans, SAP, RTII, school nurse • Proceed without input from pupil personnel and/or mental health professionals Do’s Don’ts Collaborating with Families • Recognize family member may experience anxiety also (genetic predisposition links) • Recommend exposure to anxiety-producing situation in planned way • Produce plan with responsibilities of all parties specified • Emphasize no more than two or three calming techniques ▫ Sufficient sleep, diet, exercise, routines ▫ Soup breathing, head talk, self evaluation • Emphasize need for adults to remind younger children to use technique(s) when feeling anxious COPE Intervention for Anxiety Disorders (Dacey and Fiore) • Calming the nervous system ▫ Physical: soup breathing; sensory awareness; exercise; supportive surfaces; massage; biofeedback; desensitization ▫ Mental: paradoxical thinking; scaling level of fear; visualizing desired outcomes; distraction through counting; humor COPE Intervention for Anxiety Disorders (Dacey and Fiore) • Originating an imaginative plan ▫ Flexibility thinking exercises, learning to think out of the box, creating wildly imaginative stories, approximation • Persisting in the face of obstacles ▫ Increase tolerance for ambiguity, taking moderate risks, learning about courage from literature, allow crying that promotes relief, promoting delayed gratification • Evaluating and adjusting plan Attention Deficit Hyperactivity Disorder • Three subtypes 1. Inattentive 2. Hyperactive/impulsive 3. Combined type Attending/Distractibility • Determine if youth is a “satellite dish” or fogs in/out • Proximity, then “Look around you, what do you need to be doing?” • You’re off track! • Create map of sounds, sights, tactile • Determine seating based on map • Cue to mode of distractibility • Use head talk method • Cautionary note on reliance Impulsive • • • • • Missing skill: Stop and think Power minutes Cue for calming techniques Use of head talk method You could say to yourself, “???” Activity Levels • Build in motion and movement ▫ ▫ ▫ ▫ ▫ Neurodevelopmental activities Desktop yoga Brain gym Use of board more frequently Transition methods • Same use of calming techniques ▫ ▫ ▫ ▫ Breathing Power minutes Breaks Head talk Opposition/Defiance • • • • • • • • • Loses temper easily Argues with adults Defies adult requests Deliberately annoys people Excessive use of foul language Blames others for mistakes/behavior Touchy/easily annoyed by others Often angry and resentful Spiteful or vindictive Opposition/Defiance Response • Opposition ▫ ▫ ▫ ▫ ▫ ▫ ▫ ▫ Basket A, B, C Pick the hill Confident non-verbals Two choices NOW Few words then silence Allow time to process Ace card approach Rapport and humor Opposition/Defiance Response • Transitions ▫ Social stories ▫ Two-step transitions • Decision making ▫ Red or green Opposition/Defiance: Teach Missing Skills • Opposition/defiance ▫ Flexibility ▫ Frustration tolerance ▫ Adaptability/self regulation ▫ Problem solving Flexibility • Cognitive flexibility ▫ Ability to shift attention from one idea/issue to multiple ideas/issues Cognitive Flexibility Theory Frustration Tolerance • Ability to delay gratification ▫ Distraction, head talk, social support • Outcomes ▫ Buffers against development of mental health issues, reduces aggressive behavior, increases academic achievement • Mischel’s marshmallow experiment • http://www.youtube.com/watch?v=wWW1vpz1y bo&NR=1 Adaptability/Self Regulation • Self regulation ▫ The process by which individuals control and direct their actions ▫ 4 types of self regulation Physiological Emotional Attentional Behavioral • Adaptability Collaborative Problem Solving Ross Greene • Three options for solving problems (unmet expectations) ▫ Plan A: impose will ▫ Plan B: Collaborative Problem Solving ▫ Plan C: drop expectation • http://www.youtube.com/watch?v=6xkVT2y9eu I Collaborative Problem Solving Ross Greene • Empathy (student concern) ▫ I notice that…. What’s up? Drill…. • Define problem (adult concern, i.e., safety, learning, impact of behavior on self and others) • Solution addressing both concerns ▫ www.livesinthebalance.org • http://www.youtube.com/watch?v=ARIEXN1yf 00&feature=related Conduct Disorder • Aggression to people/animals ▫ Bullies/intimidates, physical fights, threats with weapon, physically cruel to people/animals, stolen while confronting a victim, forced someone into sexual activity • Destruction of property ▫ Deliberately destroys property, fire setting • Deceitfulness or theft ▫ Lies to obtain goods/favors, breaking/entering, shoplifting • Serious violation of rules ▫ Truant, run away, stays out at night Conduct Disorder Response • Use back door praise • Use healthy double binds • Use contracts • Highlight strengths Behavior Contract What happened? What I plan to think and say instead is: What’s in it for me if I follow the plan? Conduct Disorder: Teach Missing Skills • Problem solving Agree, listen, solve Fair fighting rules Stick to the issue Stay in here & now No low blows Conduct Disorder: Teach Missing Skills • Skill building ▫ Anger management Trigger, interpretation, head talk/cool talk, calming techniques, problem solve ▫ Correct attribution bias Hostile or accidental Cynthia Hudley ▫ Futuristic thinking Dreams, wishes, age of death? Evidence-Based Programs for Skill Building • Cynthia Hudley’s Brain Power Program to reduce hostile attribution bias that contributes to aggression • http://www.brainpowerprogram.com/index1.html • Mark Greenberg’s PATHS Program that builds social/emotional skills • http://www.colorado.edu/cspv/blueprints/mod elprograms/PATHS.html#video Evidence-Based Programs for Skill Building • Second Step Program for building anger management skills • http://www.cfchildren.org/programs/ssp/secon d-step-video-previews-1/ • Arnold Goldstein’s Skillstreaming • http://www.skillstreaming.com/ Wrap-up • What I will start/continue doing ▫ _____________________________________ _____________________________________ _____________________________________ _____________________________________ • What I will stop doing ▫ _____________________________________ _____________________________________ _____________________________________ _____________________________________ Useful Resources: Depression and Anxiety Anxiety Disorders Association www.adaa.org National Institute of Mental Health www.nimh.nih.gov Mayo Clinic www.mayoclinic.org American Academy of Childhood & Adolescent Psychiatry www.aacap.org Family-friendly sites worrywisekids.org kidshealth.org socialphobia.org Your Anxious Child by John Dacey and Lisa Fiore School Refusal: Assessment and Intervention within School Settings by Mary Wimmer Useful Resources: Behavioral Issues • Greene, R. (2008). Lost at school. • Greene, R. (1998). Explosive child. • Lawrence-Lightfoot, S. (2003). The essential conversation: What parents and teachers can learn from each other. • Stutzman, A., et al. (2005). Restorative discipline for schools: Teaching responsibility; creating caring climates. • Watson, M. (2003). Transforming difficult elementary classrooms through developmental discipline. Useful Web Sites • • • • • • • • • www.teacch.com www.templegrandin.com www.thegraycenter.org www.conductdisorders.org www.childtruama.org www.livesinthebalance.org www.aacap.org www.nimh.nih.gov www.mayoclinic.org