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Promoting mental well-being in primary school students Dr. Nilima Shah Dr. G.K.Vankar Department of Psychiatry B.J.Medical College Ahmedabad Mentally well children…… They should be able to: • develop psychologically, emotionally, intellectually and spiritually; • initiate, develop and sustain mutually satisfying personal relationships; • use and enjoy solitude; • become aware of others and empathise with them; • play and learn; • develop a sense of right and wrong • resolve (face) problems and setbacks and learn from them. However….. “One in ten children and young people aged 5 to 16 have a clinically diagnosed mental health disorder and around one in seven has less severe problems” • Let’s see some examples……. • Raju studies in 3rd std. He is a well behaved, polite and obedient boy. He gets average marks in all the subjects except mathematics. He is very good at cricket and music. However it is noted that he never completes his homework. He cannot take running notes in the classroom and his handwriting is quite bad. He leaves his answer sheets incomplete. • When asked to read aloud, he fumbles, hesitates and makes a lot of mistakes. However when asked a question in viva he can answer very well. He also ranks 1st in General Knowledge quiz. What do you think is going on??? Specific Learning Disorder • Impairment in : – Mathematics – Reading – Written Expression Dyscalculia • Sense of Numbers • Memorisation of Arithmetic facts • Accurate or fluent calculation • Accurate Math Reasoning Dyslexia • Word reading accuracy • Reading rate or fluency • Reading comprehension Dysgraphia • Spelling accuracy • Grammar and punctuation accuracy • Clarity or organisation of written expression • Shyam studies in 1st std. He is always on the go and acting as if driven by a motor. He talks a lot. Even during the morning prayers he cannot remain still and keeps tapping his hands and feet opening his eyes and wanting to move around as soon as possible. • His favourite class is the sports class in which he runs about and tries to climb up the trees in the playground. He is eager to learn and often blurts out an answer even before the question has been completed. He cannot wait for his turn or stand in a line. • The concern is that his academic performance is gradually declining. What do you think is going on? Attention Deficit Hyperactivity Disorder • Hyperactive/Impulsive type • Inattentive type • Combined type • Sheena studies in 5th std. She is a polite, well behaved, sincere and honest child. She seems to be working hard with all her subjects, completes all homework and assignments, and reads regularly. However she barely manages to get passing marks in all the subjects. • She comes across as very shy and introvert in nature. She ahs low self esteem and low confidence. She cries easily when confronted with questions. • Her school records show that she was born pre mature. She learnt to walk at the age of 2.5 years and learnt to speak at the age of 3 years. ( delayed development ) What do you think is going on? Intellectual disability • Mild : IQ is between 50-70 • Moderate : IQ is between 35-49 • Severe : IQ is between 20-34 • Profound : IQ is less than 20 • Rahul studies in 1st std. He comes across as slightly odd and eccentric. He had difficulty in making friends and playing sports with others. He often played alone and spent time alone at lunch and recess. • His communication was odd and restricted with monotonic voice quality. His academic performance was average and there were no problem behaviors. • He had keen interest in playing the violin and stole the show in all music programs in school. What do you think is going on? Autism Spectrum Disorders • Persistent deficits in social communications and interactions • Restricted, repetitive patterns of behavior, interests or activities • With or without accompanying intellectual impairment • With or without accompanying language impairment Autism : Associated Behavioral Symptoms • • • • • • • • • Disturbance in language development and usage. Intellectual disability Irritability Instability of mood and affect Response to sensory stimuli Hyperactivity and inattention Precocious skills Insomnia Minor infections and gastro intestinal symptoms • Shashi is the trouble-maker of the class. He is the naughtiest of all, and doesn’t seem to improve his behavior even after several punishments. • He bullies, threatens and intimidates others, often getting into physical fights. He doesn’t think before breaking things. Once he even burnt his classmate’s notebooks in school. He lies all the time and is also found stealing things from the school • He is unconcerned about his own performance, about the feelings of others and never feels guilty or sorry. What do you think is going on? Conduct disorder •Aggression to people and animals •Destruction of property •Deceitfulness or theft •Serious Violation of Rules Conduct disorder • • • • • With limited pro-social emotions Lack of remorse or guilt Callous-lack of empathy Unconcerned about performance Shallow or deficient affect • Mahesh studies in 7th standard. He used to get very good marks till the 5th std. However, his scores are steadily declining. He seems to remain alone, and talks less with his friends. • Even in recess, he sits in a corner while the others play. He refuses to participate in the upcoming cultural programme. He often leaves his home-work incomplete. He is also inattentive in class, and when reprimanded, starts crying like a child. • His parents have recently been divorced. What do you think is going on? Depression •2-3 % of children and upto 8% adolescents are affected •They are at increased risk of self-harm and suicide •May have irritablity/defiant behaviour /depressed mood Other problems • • • • • • • Anxiety disorders (OCD/Phobia/Social Phobia/PTSD) Performance anxiety Childhood Bipolar disorder Early onset schizophrenia Substance use problems Eating disorders Internet addiction Stressors that affect children Loss or separation – resulting from death, parental separation, divorce, hospitalization, loss of friendships (especially in adolescence), family conflict or breakdown that results in the child having to live elsewhere Life changes – such as the birth of a sibling, moving house or changing schools or during transition from primary to secondary school Traumatic events such as abuse, domestic violence, bullying, violence, accidents, injuries or natural disaster. • Risk factors & Protective factors…… In the child… Risk Factors Protective Factors •Genetic influences • Low IQ and learning disabilities • Specific development delay • Communication difficulties • Difficult temperament • Physical illness • Academic failure • Low self-esteem • Being female (in younger children) • Secure attachment experience • Outgoing temperament as an infant • Good communication skills, sociability • Being a planner; having belief in control • Humor • Problem solving skills, positive attitude • Experiences of success and achievement • Faith or spirituality • Capacity to reflect In the family… Risk Factors Protective Factors • Overt parental conflict including Domestic Violence • Family breakdown (including where children are taken into care or adopted) • Inconsistent or unclear discipline • Hostile or rejecting relationships • Failure to adapt to a child’s changing needs • Physical, sexual or emotional abuse • Parental psychiatric illness • Parental criminality, alcoholism or personality disorder • Death and loss – including loss of friendship • At least one good parent-child relationship (or one supportive adult) • Affection • Clear, consistent discipline • Support for education • Supportive long term relationship or the absence of severe discord In the School… Risk Factors Protective Factors • Bullying • Discrimination • Breakdown in/ lack of friendships • Deviant peer influences • Peer pressure • Poor pupil to teacher relationships • Clear policies on behavior and bullying • ‘Open-door’ policy for children to raise problems • A whole-school approach to promoting good mental health • Positive classroom management • A sense of belonging • Positive peer influences In the community.. Risk Factors Protective Factors • Socio-economic disadvantage •Homelessness • Disaster, accidents, war or other overwhelming events • Discrimination • Other significant life events • Wider supportive network • Good housing • High standard of living • High morale school with positive policies for behavior, attitudes and antibullying • Opportunities for valued social roles • Range of sport/leisure activities Signs of psychological disturbance • An unexpected reduction in academic performance. • A change in mood and marked emotional instability • Withdrawal from relationships, separation from friends • Getting into trouble at school, discipline problems • Loss of interest in usual pursuits, study, relationships. • Ideas and themes of depression, death or suicide. • Hopelessness and helplessness. • Giving away prized possessions. • Stressful life events, including significant grief. • Bullying or victimisation. • History of mental illness/ Alcohol/drug misuse. • History of suicidal behaviour or deliberate self-harm What one can do….. Avoid giving labels….. What one can do… • • • • • • • • • Be impartial Be non judgemental Be non-sarcastic Shower appropriate praises Be encouraging Never give up on any of them Give time and a patient listening ear Understand them, accept them all Specific interventions for specific disorders At the school level… • • • • • • • • • Positive and negative re-inforcement techniques ? Role of punishments Have a student feedback mechanism in place Address complaints and praises in a group rather than singling out students Personal mentoring Working with parents Peer-mentoring Student support service/counselors Providing stress-buster time: Rainbow room/Oasis/ Tete-e-tete An inspiring video-clip…. Thank you… Contact details: 9979880789, [email protected]