Mental Health in Schools

World Health Day 2001 school drawing contest was devoted to mental health theme “Stop Exclusion: Dare to Care”. Children around the world were asked to show in pictures and words their understanding of what it means to suffer from a mental

illness and what could be done to reduce stigma

Drawing by the global winner Dhruv Suri,

7 years, India

Presented By Jennifer Phillips and Sharon KleinOctober 19, 2017

Mental Health Resources for Educators August 10, 2016http://www.p12.nysed.gov/sss/documents/MentalHealthResourcesforEducators.pdf

The 2016-17 enacted State budget included amendments to Education Law section 2801-a,

including a requirement that staff annually receive training in the school emergency

response plan and specifically requires training in mental health.

Educators play a critical role in the success of students, not just academically, but socially

and emotionally as well. Knowing how to recognize the signs of crisis, emotional trauma

and other related mental health issues is critical. The links below include useful resources

for individuals and/or organizations with an interest in learning the signs of mental illness

and how a school can help.

http://www.p12.nysed.gov/sss/documents/MentalHealthResourcesforEducators.pdf

Videohttps://youtu.be/L41k2p-YRCs

https://youtu.be/L41k2p-YRCshttps://youtu.be/L41k2p-YRCs

Definitions of Mental Health

CDC: Mental health in childhood means reaching developmental and emotional milestones, and learning healthy social skills and how to cope when there are problems.

APA: It's the way your thoughts, feelings, and behaviors affect your life


 Prevalence of Mental Health Issues

in Children


Prevalence Cont'd

75% of cases of:

Social Phobia manifests by age 15

Separation Anxiety Disorder manifests by age 10

Oppositional Defiant Disorder manifests by age 14

ADHD manifests by age 8

The average delay between onset of symptoms and intervention is 8-10 years.

Only 20 percent  of children who need mental health support actually get it.

RISK FACTORS

Physiological/Genetics: Most major psychiatric illnesses have HIGHLY genetic component.Children who live with a parent with mental illness have up to 50% chance of developing a mental illness.

Biological model- Schizophrenia, Bipolar Disorder and Autism-(structural and functional abnormalities are evident in imaging scans or during postmortem dissection.)

http://www.genetics.edu.au/genetics/Genetic-conditions-support-groups/FS58KBS.pdf

Risk Factors- Multiple Casuses

Genetic Predispositions:ADHD- occurrence for mothers of children with ADHD was 41.3%, for fathers 51.0%.

Anxiety Disorders-estimated genetic heritabilities are in the range of 30% to 40%.

Depression- Children of parents who have depression face three to four times increased rates of depression compared with children of healthy parents.

http://www.genetics.edu.au/genetics/Genetic-conditions-support-groups/FS58KBS.pdf

Risk Factors-Multiple CausesToxic Stress: Healthy development can be derailed by excessive or prolonged activation of stress response systems in the body and brain. Chronic or extreme adversity without buffering of supportive adults can interrupt normal brain development.

https://developingchild.harvard.edu/science/key-concepts/toxic-stress/

(Examples: physical/emotional abuse, neglect, caregiver substance abuse or mental illness, exposure to violence or bullying, family economic hardship,

homelessness, medical issues—without adequate adult support.)

As the number of adverse early childhood experiences mounts, so does the risk of developmental delays. Source: Barth et al (2008). Credit: Center on the Developing Child.

https://developingchild.harvard.edu/science/key-concepts/toxic-stress/

Warning Signs

• \

• Often feels anxious or worried• Has very frequent tantrums or is intensely irritable much of the time• Has frequent stomachaches or headaches with no physical explanation• Is in constant motion, can’t sit quietly for any length of time• Has trouble sleeping, including frequent nightmares• Loses interest in things he or she used to enjoy• Avoids spending time with friends• Has trouble doing well in school, or grades decline• Fears gaining weight; exercises, diets obsessively• Has low or no energy• Has spells of intense, inexhaustible activity• Harms herself/himself, such as cutting or burning her/his skin• Engages in risky, destructive behavior• Harms self or others• Smokes, drinks, or uses drugs• Has thoughts of suicide• Thinks his or her mind is controlled or out of control, hears voices

Warning Signs

Who Can Diagnose?• Psychiatrists (M.D.)- Diagnose mental, emotional and behavioral disorders. Specializes in

mental health, including substance use disorders. Often do not provide counseling. Often provide therapeutic school and counseling recommendations. Can prescribe medication.

• Neurologists (M.D.)- Often Diagnose ADHD. Make classroom/learning recommendations. Can prescribe medication.

• Neuropsychologists (Psy D. or Ph.D)- Specialize in Executive Functioning, Learning, Behavioral, Intellectual and Developmental Disorders. Do not provide counseling. Often make academic and learning recommendations. Cannot prescribe medication.

• Developmental Pediatricians (M.D.)- Diagnose emerging disorders and identify the causes of developmental delays. Has advanced specialty training in the physical, emotional, behavioral and social development of children. Can prescribe medication.

• Licensed Clinical Social Workers and Psychologists (LCSW/Psy.D/Ph.D). Trained to make diagnoses and provide individual and group therapy. Cannot prescribe medication.

Diagnostic ToolsDSM-V

(American Psychiatric Association)Descriptions, symptoms, criteria for diagnosing and coding mental disorders.

Underwent revision and reclassifications. Released in 2013.

• Elimination of AXIS. Where applicable, disorder can be "Mild, Moderate, or Severe." (E.g. 296.99 Major Depressive Disorder, 314.01 ADHD, 315.01 Specific Learning Disorder, 317 Intellectual Disability, 299 Autism Spectrum Disorder

• Added 2 NEW Childhood Disorders- 315.39 Social Communication Disorder (SCD), and 296.99 Disruptive Mood Dysregulation Disorder.

• Major Revisions to KNOW-

Autism Spectrum Disorder now combines former autistic disorder, childhood disintegrative disorder, Asperger's disorder, and pervasive developmental disorder NOS.

Mental Retardation now Intellectual Disability- severity not dependent on IQ but rather adaptive functioning

Diagnostic Tools Cont'd

Social and Developmental Hx

Medical Hx/Evaluation/Lab Tests

Neurological Testing (E.g. EEG, Continuous performance tasks.)

Academic and Intellectual Functioning

Behavior Rating Scales-multiple raters across settings.

Interviews/Direct Observations

Sample Psychiatric

Sample Neuropsychological

What are the most prevalent diagnosis for students in

elementary schools?• Attention-deficit/hyperactivity disorder (ADHD) (6.8%)

• Behavioral or conduct problems (3.5%)

• Anxiety (3.0%)

• Depression (2.1%)

• Autism spectrum disorder (1.1%)

• Tourette syndrome (0.2%) (among children aged 6–17 years)

ADHDADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

Looks Like:• daydream a lot • forget or lose things a lot • squirm or fidget • talk too much •make careless mistakes or take unnecessary risks • have a hard time resisting temptation • have trouble taking turns • have difficulty getting along with others

ADHDWhat Can a Teacher Do?

• Randomly pick reciters so the children cannot time their attention.• Use the child’s name in a question or in the material being covered.• Pause and create suspense by looking around before asking questions.• Develop a private running joke between you and the child that can be invoked

to re-involve you with the child.• Stand close to an inattentive child and touch him or her on the shoulder as you

are teaching.• Walk around the classroom as the lesson is progressing and tap the place in the

child’s book that is currently being read or discussed.• Decrease the length of assignments or lessons.• Alternate physical and mental activities.• Increase the novelty of lessons by using films, tapes, flash cards, or small

group work or by having a child call on others.• Give simple, concrete instructions, once.• Use a soft voice to give direction.• Employ peers or older students or volunteer parents as tutors.• Teach children self monitoring strategies.

ADHDHow it is Best Treated Outside of

School• Behavior therapy, including training for parents

• Medications

Behavioral or Conduct Problems

When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD is one of the most common disorders occurring with ADHD. ODD usually starts before 8 years of age, but can also occur in adolescents. Children with ODD most likely to act oppositional or defiant around people they know well,

Looks Like:• Often losing their temper• Arguing with adults or refusing to comply with adults’ rules or requests• Often getting angry, being resentful, or wanting to hurt someone who they feel

has hurt them or caused problems for them• Deliberately annoying others; easily becoming annoyed with others• Often blaming other people for their own mistakes or misbehavior

New Diagnosis - Mood Disregulation Disorder—> Not Diagnosed before 6 yrs.

Behavioral or Conduct Problems

What Can a Teacher Do?

1. Avoid Power Struggles“A student of mine corrects me all the time, whether I am wrong or not. I answer back, ‘OK, let’s double-check that.’ If I made a mistake, I correct it and we move on; if he’s wrong, I silently let him to figure it out.”

Give opportunity for 5 minute break- they need time to regroup on their own.

Instead of arguing, repeat your words and consequences.

2. Give Choices

State your choices—then walk away. Give the student time to process and decide which choice to make. If they don’t like the choices, don’t engage. If they try to argue, repeat the choices and walk away again. If the student still will not choose, they do not get to participate in their preferred activity.Be consistent!

3. Offer Appropriate Rewards

When using a reward system, make sure that it is appropriate and isn’t perceived as manipulation. Uses a mentor system- put the kids in charge of younger kids if possible.Use a point system checklist with options A & B.

4. Get to Know Them on a Personal Level

Often kids with ODD are looking for a relationship with a teacher who can help them deal with problems on their own instead of making them stand out in a negative way. Building a connection with them will help get to the root of the behavior.

ODD and other Behavioral Disorders

How it is Best Treated outside of School• Psychotherapeutic: A popular evidence-based treatment is a type of behavior therapy called parent-child

interaction therapy. The parent and child work together through a set of exercises while a therapist coaches

parents through an ear bud. Parents learn to increase positive interactions with the child and to set consistent

consequences for undesirable behavior. Children learn to rein in behavior and enjoy a more supportive

relationship with parents.

• Medications: Medicines are not specifically indicated for ODD. However, as many children with ODD have

co-occurring conditions such as ADHD, they may be on medications for those other disorders. In addition, some

children are so troubled by their own aggression, and their difficulties managing their painfully low frustration

tolerance, that a clinician may recommend medication—like psychostimulants used to treat ADHD to help them

control those responses and benefit more from behavioral therapy.

HOFSTRA https://www.hofstra.edu/community/slzctr/slzctr_clinic_childparent.html

https://www.hofstra.edu/community/slzctr/slzctr_clinic_childparent.html

AnxietyPeople with anxiety disorders respond to certain objects or situations with fear and dread. They have physical reactions to those objects, such as a rapid heartbeat and sweating. An anxiety disorder is diagnosed if a person:

• Has an inappropriate response to a situation

• Cannot control the response

• Has an altered way of life due to the anxiety

Looks Like:

•Separation anxiety: When children are worried about being separated from caregivers.

These kids can have a hard time at school drop-offs and throughout the day.

•Social anxiety: When children are excessively self-conscious, making it difficult for

them to participate in class and socialize with peers.

•Selective mutism: When children have a hard time speaking in some settings, like at

school around the teacher.

•Generalized anxiety: When children worry about a wide variety of everyday things. Kids

with generalized anxiety often worry particularly about school performance and can

struggle with perfectionism.

•Obsessive-compulsive disorder: When children’s minds are filled with unwanted and

stressful thoughts. Kids with OCD try to alleviate their anxiety by performing compulsive

rituals like counting or washing their hands.

•Specific phobias: When children have an excessive and irrational fear of particular

things, like being afraid of animals or storms.

Anxiety DisordersWhat Can a Teacher Do?

• Create a “safe” place for the child to go when anxiety symptoms are high or during stressful times.

• Be aware of physical symptoms of anxiety and provide activities to distract the child. Calming activities, such as, reading or listening to music may help to alleviate some of the physical symptoms.

• Allow time for transitions• Talk to the student about what interventions they would find helpful.• Having the student discuss strategies may help them to be involved in reducing

their anxiety symptoms. • Talk with parents about the techniques used at home and try to incorporate them

into the classroom.• Use small group activities throughout the day. Children with anxiety may be better

able to cope with small groups of a few students rather than large classroom study.

• Reward effort by a student with anxiety. When a child shows effort or is able to control their anxiety symptoms through interventions, let them know you have noticed and are proud of their efforts.

• Create group activities that role-play appropriate behaviors. Teach young children what to do in specific situations. This can help all students learn how to handle situations such as anger management, stress reduction, test anxiety. Providing instruction to the entire class will decrease the focus on the child with anxiety.

• Talk to the student after an anxiety attack about how the situation could have been different or what strategies could have been used (by both the student and the teacher) to make the situation better.

• Incorporate exercise into the school day. Stop lessons for a few minutes or do stretching exercises in between lessons. This can help reduce stress.

• Find books (*see Resources a the end of this presentation) that address children with anxiety. Incorporate these books into reading curriculum.

• Post the daily routine in the classroom and let students know in advance any changes in the schedule. Letting students know exactly what is expected will help lessen anxiety.

• Help students break assignments down into smaller segments. This can help to decrease feeling overwhelmed by large assignments and help a student work on each section.

• Play soothing music during down time. 

Panic AttacksWhat Can a Teacher Do?

• Don’t leave them and send for help• Tell them that this will pass (Panic attacks typically only last a few minutes)• Assert control


Explain simply and carefully what is happening now, what you are doing to help and what will happen next.

• Focus on breathing 
It can really help a panic attack to pass if the sufferer is able to take control of their breathing.

• Give the sufferer space and time

Get the NURSE

AnxietyHow it is Best Treated outside of School

• Psychotherapeutic: CBTCognitive behavioral therapy: based on the idea that how we think and act both affect how we feel. By changing thinking that is distorted, and behavior that is dysfunctional, we can change our emotions. With younger children, focusing first on the behavioral part of CBT can be most effective. The goal is, essentially, to unlearn avoidant behavior.

Exposure therapy: Adopting Robert Frost’s observation that “the only way around is through,” exposure therapy slowly and systematically helps a child face his fears, so he can learn to tolerate his anxiety until it subsides rather than reacting by seeking reassurance, escaping, avoidance or engaging in ritualistic behaviors such as hand 

Parent Training: Teaching parents how to help their child change and reframe their negative anxiety producing thoughts and unlearn avoiding behavior with exposure therapy.

• Medications:

Medications of choice for treating anxiety in children are the serotonin reuptake inhibitors,

the antidepressants. Study after study shows those are the medicines that are effective, and they

can be extremely effective. 

DepressionToday, we know that depression affects about 2 percent of children over the age of 6, and roughly 5 percent for adolescents and teens. 

Looks like:• Frequent sadness, tearfulness, and crying•Decreased interest in activities; or inability to enjoy previously favorite activities•Hopelessness• Persistent boredom; low energy• Social isolation, poor communication•Low self esteem and guilt• Increased irritability, anger, or hostility•Difficulty with relationships• Poor concentration•A major change in eating and/or sleeping patterns•Talk of or efforts to run away from home•Thoughts or expressions of suicide or self destructive behavior

DepressionWhat Can a Teacher Do?

• Work on your relationship with the depressed student. • Be patient and positive in your instructional strategy. Don't give up on students and be sure to use positive

approaches (praise, rewards, etc.). • Keep a positive mindset toward the student. Remember that depression isn't something children choose. A

depressed student may want to do well, but he or she may not necessarily have the capacity or resources to do well in school. Work on finding ways to give the depressed child the support and attention he or she needs.

• Consider making adjustments or accommodations for the depressed student.Tweaking assignments and tasks by giving the depressed student more time, breaking a task into smaller parts, or offering the student extra assistance can help the child be more successful in school without lowering expectations.

• Give the depressed student opportunities for success. Giving the child opportunities to show leadership and be successful and then recognizing him or her for that success can increase the child's sense of self-worth. Providing these types of opportunities also shows the student that you believe in him or her.

• Ask your school psychologist or social worker for assistance

DepressionHow it is Best Treated outside of

School• Psychotherapeutic:

• Interpersonal therapy (ITP) and cognitive behavioral therapy (CBT) are the

major approaches commonly used to treat childhood depression.

ITP- Improve relationships- improve outcome

CBT- Change negative thinking into more positive outlook

• Medications:

About 60% of children who take antidepressant medication improve. It may take

up to six weeks of treatment with medication at its effective dose to start

improving.

https://www.medicinenet.com/idiopathic_thrombocytopenic_purpura_itp/article.htmhttps://www.medicinenet.com/antidepressants/article.htm

Tourette SyndromeTourette syndrome is a condition that causes uncontrolled sudden, repetitive muscle movements and sounds known as tics. 

Two types of tics are associated with Tourette syndrome:1. Motor tics 2. Vocal tics

Tics are classified as either simple or complex:• Simple motor tics usually involve just one group of muscle, such as eye

blinking or grimacing.• Complex motor tics usually involve more muscle groups and might look like

a series of movements.• Simple vocal tics can be throat clearing, sniffing, or grunting.• Complex vocal tics can involve calling out, repeating other people's words (a

condition called echolalia), or involuntary swearing (called coprolalia).

Tourette SyndromeWhat Can a Teacher Do?

• Recognize that tics are involuntary. • Reduce Stress/Anxiety- Stress typically increases symptoms. • Identify the skills deficits that may contribute to increased stress/symptoms, as well as

the strategies and supports to address the skills deficits.• Ignore the symptoms that can be ignored. This demonstrates acceptance and normalizes

Tourette Syndrome and other related symptoms. Modeling acceptance can reduce both bullying and stress and may help the student with TS to focus his/her energy on academics rather than tic suppression.

• Consider whether accommodations are needed for handwriting issues. Handwriting issues are among the most common difficulties for children with TS. Accommodations can include the use of a computer, tablet, or having notes provided.

• Be aware of co-occurring conditions, such as ADHD or ODD. The characteristics of these conditions are often more problematic and harder to manage than the tics themselves.

• Involve the student with TS in developing plans and strategies for managing symptoms that can be difficult or impossible to ignore.

• Promote communication with parents or caregivers.

Tourette SyndromeHow it is Best Treated outside of

Schoolo Therapeutic:

- Behavior therapy- Cognitive Behavioral Interventions for Tics, including habit-reversal

training, can help you monitor tics, identify premonitory urges and learn to voluntarily move

in a way that's incompatible with the tic.

- Psychotherapy- In addition to helping you cope with Tourette syndrome, psychotherapy can

help with accompanying problems, such as ADHD, obsessions, depression or anxiety.

- DBS- For severe tics that don't respond to other treatment, DBS might help. DBS involves

implanting a battery-operated medical device in the brain to deliver electrical stimulation to

targeted areas that control movement.

o Medications:

• Botulinum (Botox) injections,

• ADHD medications,

• Antidepressants

• Anti-seizure medications may be used to lesson symptoms or offer some

relief. 

Autism Spectrum DisorderAutism, or autism spectrum disorder, refers to a range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication, as well as by unique strengths and differences. We now know that there is not one autism but many types, caused by different combinations of genetic and environmental influences.

Looks Like:

• Avoids eye contact and prefers to be alone• Struggles with understanding other people’s feelings• Remains nonverbal or has delayed language development• Repeats words or phrases over and over (echolalia)• Gets upset by minor changes in routine or surroundings• Has highly restricted interests• Performs repetitive behaviors such as flapping, rocking or spinning• Has unusual and often intense reactions to sounds, smells, tastes, textures,

lights and/or colors

Autism Spectrum DisorderWhat Can a Teacher Do?

• Autism is a huge spectrum. Get to know the family and the child’s individual needs

• A routine, visual schedules and transition warnings are helpful for a child with autism.

• A child with autism needs extra time to process language- so use simple language and short sentences.

• A child with autism can get stuck on one subject.• A child with autism often need help with social interactions.• Positive reinforcement and direct consequences of behavior.

Autism Spectrum DisorderHow it is Best Treated outside of

School

• Behavior and Communication Approaches• Dietary Approaches• Medication• Complementary and Alternative Medicine

Detailed Medication List

Handout

Other Things to Go OverSuicide Prevention

While the number of deaths by suicide in younger children is statistically small, the number of attempts in students ages 10 to 14 (your 4th to 8th grade students) has increased dramatically over the last few years, especially for girls. And even if they haven’t made an attempt, there are other kids in your class who are thinking about suicide. Even if their number is small, there are at-risk students in elementary school classrooms all over the country.

1-800-273-8255

Talk to Tom/Caroline NUMC- Children

Psychiatric ER

Other Things to Go OverChild Protective Services

Resources

Psychotherapists- Trained in a variety of different modalities.

Pediatricians

Developmental Pediatricians

Psychiatrists

Comprehensive Agencies

Parenting Support Groups and Positive Parenting Tips

Domestic Violence Support

Social Skills Groups

Extracurricular Clubs for students outside of school

https://www.seaford.k12.ny.us/Page/7557

https://www.seaford.k12.ny.us/Page/7557

https://www.seaford.k12.ny.us/Page/7557

Resources Specific to this Presentation

https://www.seaford.k12.ny.us/Page/7557

Continuously growing list of….

• Book Lists• App Recommendations• Parenting Tips• Informative Videos• Articles• More…….

All links from this presentation can be found atOn the Seaford Harbor School Website under:

Departments/School Counseling/Social Worker/For Teachers/Presentations/Mental Health in Schools

https://www.seaford.k12.ny.us/site/default.aspx?PageType=14&DomainID=543&PageID=7557&ModuleInstanceID=9649&ViewID=fa1f7d98-e7bf-458b-a7e2-7d51c266e481&IsMoreExpandedView=True

https://www.seaford.k12.ny.us/site/default.aspx?PageType=14&DomainID=543&PageID=7557&ModuleInstanceID=9649&ViewID=fa1f7d98-e7bf-458b-a7e2-7d51c266e481&IsMoreExpandedView=True