John Yasenchak, Ed.D.

batchquonochontaugUrban and Civil

Nov 29, 2013 (3 years and 11 months ago)

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John Yasenchak,
Ed.D
.

Husson

University



What is Mental
Health?

When people here the term “mental health”, it
is equated with “mental illness” and defined as
“the absence of problems” But the facts are:


1.
Most behavior, learning, and emotional
problems of children stem from
sociocultural/economic factors and not
pathology

2.
Problems can often be dealt with through
promotion of social and emotional
development and prevention




(Adelman $ Taylor, 2010)

“….a clinically significant behavioral or psychological
syndrome or pattern that occurs
in an individual

and that is associated with present distress (e.g.,
painful symptoms) or disability (i.e., impairment in
one or more important areas of functioning) or
with a significantly increased risk of suffering,
death, pain, disability, or an important loss of
freedom.
In addition, this syndrome or pattern
must not be merely an expectable and culturally
sanctioned response to a particular event, for
example the death of a loved one
. Whatever its
original cause, it must currently be considered a
manifestation of a behavioral, psychological, or
biological dysfunction
in the individual.

Neither
deviant behavior (e.g., political, religious, or
sexual) not conflicts that are primarily between the
individual and society are mental disorders unless
the deviance or conflict is a symptom of a
dysfunction in the individual….”


Tendency to “view” everyday problems as
“symptoms” and diagnosis as disorders


The cause is always internal pathology


Tendency to misdiagnosis and problems with
differential diagnosis


Narrow focus limits discussions of cause and
intervention strategies


Classification of Child and Adolescent Mental
Diagnoses in Primary Care (DSM
-
PC) looks at:


1. Developmental Variation

2. Presence of a Problem

3. Diagnosis of a disorder.




Mental Health is the sum total of how kids
think, feel, and behave. It influences:


How kids deal with stress


How kids relate to teaches and peers


How kids make decisions



How they grieve losses


How they seem themselves and others


How they process information


How they learn


Positive Mental Health allows kids to:


Think clearly


Learn more effectively


Develop appropriate social skills


Develop coping skills


Learn to express emotions constructively


Learn to “hold” uncomfortable emotions


Feel good about themselves!

Positive Mental Health in kids results from
:



Success at developmental markers



Development of interpersonal coping skills



Feeling like they matter



Living in a nurturing “holding” environment


Why Should
Schools Be
Concerned with
Mental Health?


Mental health issues may act as barriers to
learning in the classroom


Students with mental health problems may be
truant allot or fall behind


Students with mental health problems are at
greater risk for substance abuse and involvement
with law enforcement and the juvenile justice
system


Schools are “the Front line”; the one “last Place”


Productivity, safety, and quality of life are all
impacted


Others?



Students with an MH diagnosis do not
automatically qualified for special education


IEP Teams (Individualized Education Program)
cannot diagnose and physicians cannot
identify special education needs under IDEA


As a result, schools may provide services in
the regular education program through 504
plan or IDEA




21% of children between ages 9
-
17 have a
diagnosable mental or addictive disorder.


11% of those have significant functional
impairment and 5% have extreme impairment


Children of depressed parents are >3 times
more likely to experience depression


Parental depression increases a child’s risk of
anxiety disorders, conduct disorders, and
addition problems.


74% of 21 year olds with MH diagnoses had
prior problems when children


Half of physicians surveyed in a recent study
regularly screen adolescents for mental
health disorders


Only 46% feel capable of identifying
depression


19 % feel confident about schizophrenia


16% about bi
-
polar disorder


Annenberg Public Policy Center


www.annenbergpublicpolicycenter.org

Calls for:

1.
Early Intervention Services


Districts are to
use up to 15% of funding received under
Part B to develop early intervention services.
This may include k
-
12 students not
necessarily special education

2.
Response to Intervention Logic

a.
Universal Screening

b.
Progress Monitoring

c.
Data
-
based decision making

http://www.rti4success.org/




Risk Factors


Genetic predisposition for illness


Biological problems related to illness


Exposure to toxins


Prenatal damage


Poverty


Poor nutrition


Deprivation


Others?



Parental mental health problems


Parental addiction


Abuse, neglect, trauma, family violence


Poor caregiving and parenting


Stressful life events (family criminality,
maladaptive sibling relationships, discord,
dysfunctions family life)


Lack of a loving relationship with at least one
parent or significant caregiver.



Warning Signs that a Child or
Adolescent may Need Mental
Health Services

National Mental Health Information Center

www.mentalhealth.samhsa.gov

National Mental Health Association

www.nmha.org




Sadness or hopelessness for no reason


Crying or overreaction


Excessive worry or guilt


Extreme fearlessness


Extreme anger most of the time


Excessive concern with physical problems or
appearance


Fear of being out of control


Unable to move through a loss


Suicidal ideation


feel like life is worthless or too
much


Decline in school performance


Loss of interest in enjoyment


Avoidance of people and isolation


Daydreaming too much


Not finishing tasks


Hearing voices that cannot be explained


Repeated refusal to go to school or take part
in normal activities


Changes in eating and sleeping habits


Hyperactivity and excessive fidgeting


Persistent nightmares


Difficult concentrating and making decisions


Racing thoughts


Persistent disobedience or aggression


Excessive worry about something “bad”
happening


Need to wash or perform certain routines
many times a day


Alcohol
and drug use


Binging and purging; using laxatives


Setting fires


Excessive dieting or exercising


Torturing or killing animals


Behaving without regard for other people


Breaking the law


Life threatening behavior



School
-
Based Mental
Health

School
-
Linked Mental
Health

UCLA School Mental
Health

How would you
define “mental health
services” in the
School?


The promotion of positive mental, social,
emotional, and physical development


Identifying and addressing mental health
problems that present as “barriers to
learning”


Provide resources and links to community
services


The provision of mental health/substance
abuse services delivered in the school or
linked to the school in some way.

What are some of the
resources that your
school has for
meeting student
mental health needs?


Parental involvement


Transition support


Conflict resolution


Health Classes


Alcohol and Drug Education


Others?


Dropout Prevention


Violence Prevention


Pregnancy Prevention


School
-
age Parent Programs


Work Programs


Accommodations for learning and behavior
issues


Alcohol and Drug Counseling


Others?


Special Education


Family Involvement and Communication


Coordination with community Providers


Language barriers


Crisis Intervention


is there a plan?


Information, problem
-
solving, restoring calm


Safety for the student


away from being a victim


Immediate support


Care for the caregivers


Aftermath


Bereavement


How kids Grieve


How the school handles grief



How Do We Differentiate
Between Mental Health
Problems and Learned
Behaviors?


Learn about the symptoms of an illness and
how it manifests


How is the problem related to development?


Talk to the Parents


Do a fictional analysis of the problem and a
behavioral plan


Does the behavior go beyond what might be
expected of the illness? What might be the
learned part!


Difficult to separate the behavior from an
illness.

A Brief Summary of
Some DSM IV
-
TR
Diagnoses in
Children and
Adolescents


The feeling that one is in danger


Some anxiety is normal for younger children


There is a developmental range for anxiety
between ages 6
-
13, from concrete fears to more
abstract.


But 1 in 10 children/adolescents may have an
anxiety disorder


precipitants include high
stress situations


About ½ of those will have a second mental
health issue: anxiety or depression


Social phobias may start early with physical
complaints of tummy ache or headache


If untreated, they can be a significant barrier to
learning.


Phobias


Social Anxiety Disorder


Generalized Anxiety Disorder


Panic Disorder with/without Agoraphobia


Post Traumatic Stress Disorder


Acute Stress Disorder.


Calming


learn relaxation skills, calming,
grounding, self
-
control


Originate


create an imaginative plan based
on insight into the anxiety


Persist


keep going in the face of failure and
obstacles


Evaluate


adjust the plan as needed


Dacey
, J.S., & Fiore, Lisa. B (2000). Your anxious
child:How

parents and
teachers can relieve anxiety in children. New York:
Jossey
-
Bass.



Not just “feeling blue”


NIMH


2.5% of children and up to 8.3%
adolescents suffer from depression


Although recovery rates are good, relapse
rates are high (70%)


Kids may have a hard time “talking” about it


Risk for suicide


First choice is CBT or interpersonal therapy.


There is little research regarding
effectiveness of medications alone.





Frequent crying


Hopeless, bored, low


Decreased interest


Inability to concentrate


Rejected by peers


Overly sensitive; negative
self
-
talk


Guilt


Anger


Decreased appetite,
sleep


Internalizing behaviors


Running away


Reckless; drugs, alcohol


Difficulty concentrating


Somber


Self
-
destructive


Decrease school
performance


Suicidal thoughts, threats


Tantrums, restlessness,
angry outbursts




Major Depression


Dysthymia


Bipolar Disorder


Building Blocks


Depressive episode


two week symptom duration


Manic episode


lasting at least one week


Hypomanic episode


lasts at least 4 days


Types


Bipolar I


a combination of depressive episodes and
manic/or manic episodes


Bipolar II


a combination of depressive episodes and
hypomanic episodes


With or without cycling



There is some debate about ADHD versus
early onset of pediatric bipolar disorder


It is believed that 80% of diagnosed children
have family members with the diagnosis or
family histories of substance abuse


It is believed that up to 1/3 of children
diagnosed with depression may have early
onset bipolar disorder


But it is not really known how common it is in
children



Although there is little research on the use of
mood stabilizers on children, treatment is
often based on medication such as:


Lithium,
depakote
,
tegretol
, SSRI’s,
etc


Side effects may include: headaches, thirst,
dizziness, gastro
-
intestinal upset, frequent
urination, weight
-
gain, short
-
term memory
loss, acne, etc.



Disruptive
Behavior
Disorders

Tendency to wreak havoc often overshadows
individual needs:


Co
-
morbid mental health problems (e.g..,
55% with anxiety disorders)


Peer relationships


Rejection serves to validate negative world view


Affiliation with negative peer models


Negative thinking patterns “world is a
battlefield”…”adults are out to control them”





Genetic and biological


Frontal lobe regulation, executive functioning


Parental characteristics


Substance abuse, anti
-
social personality


Parent
-
child relationship


Minimal warmth, harsh, lack of monitoring, negative


Life experiences


Victimization, assault victims, sexual abuse.`

Research identifies two processes:

1.
Response validation


“Is my behavior
morally and socially acceptable?”

2.
Outcome expectancy


“ Will my behavior
bring about a positive outcome?”


Students with DBD’s are more likely to think
that aggression is ok and that it pays off.






(Auger, 2011)


Sick, tired, hungry


Distress over events


Difficult academic task


Request denied


Criticism in public


Verbally challenged


Impress high
-
status
peers


Lack of supervision


Bored


Under the influence


Activities that
emotionally threaten


Talked to in an
authoritative manner


Rejection by peers


Domination of low
-
status peers


Being laughed at


(Auger, 2011)


Feeling of power and
control


Freedom and escape


Adhering to a personal
code (no one will hurt
me)


Avoidance of classroom
situations that are
threatening


Peer attention and
approval


Tangible rewards (from
thefts)


Reduction of physical
and emotional tension


Removal from classroom
situations


Teacher attention.


Others?





(Auger, 2011)


On
-
going pattern of destructive,
uncooperative, and hostile behavior


Onset around age 8 and not later than
adolescence


Believed that 5% of school age children have
ODD


40
-
65% comorbidity rate with ADHD


More common in boys before puberty


Power and control issues; rarely sorry





Causes not clearly known; possible brain
chemistry, temperament, and environment.


“Concerning Behaviors”


what to target, what to
live with, and what to ignore


Therapy and medication for co
-
morbid issues:


Sometimes atypical antipsychotics (
Zyprexa
,
Rispeidal
) are
used as well as mood stabilizers.


Consistent responses re the most important factor!


Persistent ODD becomes Anti
-
Social Personality Disorder at
age 18!


Riley, A.R. (1997). The defiant child: A parent’s guide to oppositional
defiant behavior disorder
.


Behavior pattern lasting at least six months
with four of the following present:


Often loses temper


Often argues with adults


Often actively defies or refuses to comply with adults


Often deliberately annoys people


Often blames others


Touchy or easily annoyed


Often angry and resentful


Often spiteful or vindictive


Clinically significant impairment and not psychosis or
mood disorder


Defined as:

“ A repetitive and persistent pattern of behavior
in which the basic rights of others or major
age
-
appropriate societal norms or rules are
violated, as manifested by the presence of three
(or more) of the following criteria in the past 12
months, with at least one criteria present in the
past 6 months:”


Aggression to people or animals


Bullies, threatens, intimidates


Initiates fights


Used a weapon that can cause serious harm


Physically cruel to people


Physically cruel to animals


Stolen while confronting a victim


Forced someone into sexual activity


Destruction of property


Deliberate and intentional fire setting


Deliberate destruction of someone’s property


Deceitfulness or theft


Broken into a house, car


Lies to avoid responsibilities or gain favor


Stolen items without confronting a victim


Serious violation of rules


Stays out at night without permission, before age 13


Ran away at least twice


Often truant, before age 13


If 18, rule out anti
-
social personality


Childhood onset is 1 criteria prior to age 10


Adolescent onset is no criteria prior to age 10


Specifies: mild, moderate, severe


Do No Harm


Try to understand the
behavior


Comprehensive
interventions when
possible


Personal connection


Focus on antecedents


Set and monitor goals


Communicate
encouragement of
good behavior


Address negative
thinking


Reward positive
behavior



(Auger, 2011)



What problem behavior concerns you?


When does it happen?


What do you do when it happens?


What do other students do?


When doesn’t it happen?


What do you do then?


What do other students do when it does not
happen?


What is important to the student and how does
he/she get it now?


What changes can you make in the classroom to
improve the situation?

Attention
-
Deficit/Hyperactivity

Disorder


3
-
7% of school
-
age children depending on
sample and method


Male to Female ratio range of 2:1


9:1
depending upon type


Cross
-
cultural variation most likely due to
differences in diagnostic practice


Prevalence data on adolescents and adults is
limited


Prevalence rates based on DSM IV may be
greater than DSM III because of inclusion of
the inclusion of the types.


Fails to give attention to details, careless
mistakes


Difficulty sustaining attention. work and play


Does not listen when spoken to directly


Does not follow through on instructions, chores,
schoolwork


Difficulty organizing tasks and activities


Avoids or dislikes tasks requiring sustained
mental effort


Loses things necessary for tasks or activities


Distracted by extraneous stimuli


Forgetful in daily activities


Hyperactivity


Fidgets, squirms in seat


Leaves seat when seating is expected


Runs or climbs when not expected


Difficulty playing quietly when expected


Often “on the go” or acts as if “driven by a motor”


often talks excessively


Impulsivity


Blurts out answers before question is finished


Difficulty awaiting turn


Interrupts or intrudes on others


Impairment from some of the symptoms bust
appear in two or more settings


Some symptoms were present before age 7
(this is controversial)


Clear evidence of clinically significant
impairment


Must not be related to any other DSM
disorder


Combined, inattentive, and hyperactive
-
impulsive type

Think of a time when you were
stressed out and unable to
sleep for several days. What did
you feel like? How were you
functioning?


Disability perspective


Provide immediate
feedback
(e.g., secret
signal, behavior chart,
strategic teacher
attention)


More action, less
lecturing


Increase structure
(directions, rewards,
consequences
etc
)


Plan the environment
(
desk placement, light,
sound)


Provide outlets for high
activity
(standing,
errands, etc.)


Provide organizational
assistance
(planners
)


Develop ADHD
-
Friendly
teaching practices


Others?