Mental Health in the Schools By: Patrick Rohr MA, LPC.
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Transcript of 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 can I do?
Who else should be involved?
How 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
Overly withdrawn, quiet or doesn’t engage Low self-esteem, feelings of failure or worthlessness Increased irritability, which can appear as disobedience or aggression Feeling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
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 types 2,7
Generalized Anxiety Disorder (GAD) Panic Disorder Social Anxiety Disorder Post Traumatic Stress Disorder (PTSD) OCD
How 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 DisordersCommon signs that student may be struggling with some type of anxiety disorder 2,7
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 DisordersSuggestions 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 Types
Oppositional Defiant Disorder (ODD) Conduct Disorder Intermittent Explosive Disorder
How 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 SymptomsChildren with ODD show an ongoing pattern of extreme negativity, hostility, and defiance that 1
Is constant Lasts at least 6 months Is excessive compared with
what is usual for the child’s age
Is disruptive to the family and the school
Is usually directed toward an authority figure (parents, teachers, principal, coach)
The following behavioral symptoms are associated with ODD 1
Frequent temper tantrums Excessive arguments with adults Actively refusing to comply with
requests and rules Often questioning rules Deliberately annoying and
upsetting others Often touchy or annoyed by
others Blaming others for their mistakes Frequent outbursts of anger and
resentment Spiteful attitude and revenge
seeking
Behavior DisordersSuggestions 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: DepressionWhat 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
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
SSRI’s Atypical antidepressants SNRI’s
Common side effects of antidepressant medication 4
Nausea Diarrhea Insomnia Suicidal Ideation Aggression
Behavior Disorders: Bipolar DisorderWhat 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 DisorderWhat 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 DisorderSuggestions 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: MedicationTypes of medications prescribed 3
Mood stabilizers Atypical antipsychotics
Side effects of medication 3
Dry mouth Blurred vision and constipation Dizziness or lightheadedness, Weight gain Tardive dyskinesia
Attention Deficit Hyperactivity DisorderWhat is Attention Deficit Hyperactivity Disorder ? 5,4
Inattentive type Hyperactive type Combined type
How common is ADHD? 5,4 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 DisorderWhat causes ADHD? 5,4
Runs in families Pregnancy problems Neurological factors
How long does ADHD last? Lifetime of coping
Attention Deficit Hyperactivity DisorderSymptoms of ADHD 5,4
Inattention 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 DisorderSymptoms 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 DisorderSymptoms 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 DisorderSuggestions 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: MedicationsTypes 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-HarmDefinition:
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 Self-cutting Self-poisoning Self-burning Self-scalding Self-inflicted hitting
Self-HarmWhat causes self-harm? 4,6,2
Getting relief from painful or distressing feelings Dealing with feelings of numbness Communicating pain or distress to others
Risk Factors: 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-HarmSigns 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 self-harm:
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 Act2. IDEA-Individuals With Disabilities
Education Act3. 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”
ConfidentialityAsk yourself these questions to protect yourself:
1. Who is listening (or could be?)
2. What is being discussed3. When is the meeting to take place4. Where the discussion takes place5. How are items discussed & documented6. Why the discussion took place
References1 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 and conditions: Depression. (2015). In Mayo Clinic.
7 Facts & statistics. (2015). In Anxiety and depression association of America.
8 Mental health America. (2015). Conduct disorder. In Mental health
9 Mental health in schools: guidelines, models, resources, & policy considerations . (2001, May). In Policy leadership cadre for mental health in schools.