1. Mental Health in the Schools
By:
Patrick Rohr MA, LPC

2. 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.

3. 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

4. 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

5. 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
Frequency: how often does the student exhibit the behaviors of concern?
Duration: how long do the behaviors last?
Intensity: to what extent do the behaviors interfere with the child’s activities?

6. Next Steps What can I do? Who else should be involved?
How do I know what mental health problem I’m dealing with?

7. 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Overly withdrawn, quiet or doesn’t engage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

8. 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

9. 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

10. Anxiety Disorders Common types 2,7 How common are anxiety disorders?
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.

11. Anxiety Disorders Causes of anxiety disorders 2,7
Multiple, complex origins
What is normal and what is not?
Worry vs. Anxiety

12. Anxiety Disorders
Common 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

13. Anxiety Disorders
Suggestions 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

14. Anxiety Disorders: Medication
Commonly prescribed medications 2,7
Antidepressants
Antipsychotics
Alpha-two antagonists
Common side effects and impact on learning/functioning

15. Behavior Disorders Common Types How common are behavior disorders?
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.

16. 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.

17. Behavior Disorder Symptoms
Children 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

18. Behavior Disorders
Suggestions for supporting students with behavior problems:
Be aware of your environment
Collaborative Processing
Have plan in place

19. 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

20. 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

21. Mood Disorders: Depression
What 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.

22. 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

23. 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

24. 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

25. Behavior Disorders: Bipolar Disorder
What 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

26. Behavior Disorders: Bipolar Disorder
What 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”

27. 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

28. Behavior Disorders: Bipolar Disorder
Suggestions 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.

29. Bipolar Disorder: Medication
Types 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

30. Attention Deficit Hyperactivity Disorder
What 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 

31. Attention Deficit Hyperactivity Disorder
What causes ADHD? 5,4
Runs in families
Pregnancy problems
Neurological factors
How long does ADHD last?
Lifetime of coping

32. Attention Deficit Hyperactivity Disorder
Symptoms 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

33. Attention Deficit Hyperactivity Disorder
Symptoms 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

34. Attention Deficit Hyperactivity Disorder
Symptoms 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

35. Attention Deficit Hyperactivity Disorder
Suggestions 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

36. Attention Deficit Hyperactivity Disorder: Medications
Types 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

37. Self-Harm Types of self-harm Definition:
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

38. Self-Harm What causes self-harm? 4,6,2 Risk Factors:
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

39. Self-Harm Signs 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

40. Confidentiality Three Confidentiality Laws:
FERPA-Family Education Rights and Privacy Act
IDEA-Individuals With Disabilities Education Act
HIPPA-Health Insurance
Portability and Accountability Act

41. 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”

42. Confidentiality Ask yourself these questions to protect yourself:
Who is listening (or could be?)
What is being discussed
When is the meeting to take place
Where the discussion takes place
How are items discussed & documented
Why the discussion took place

43. Questions?

44. References
1 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): 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.