Signs and Symptoms of Mental Illness in Children and Adolescents

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Signs and Symptoms of Mental Illness in
Children and Adolescents

• La Crescent-Hokah Public Schools
• Revised December 2008, by Gail Quarberg, School
  Psychologist

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You Are On The Front-Line!
School personnel are in a key position to
recognize the signs of childrens mental health
problems early and to provide a link to the
appropriate next steps.
Emerging research indicates that intervening
early can interrupt the negative course of some
mental illness and may, in some cases, lessen
long-term disability.
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The Reality and Challenge

• U.S. Surgeon General Report (2000) estimates 1 in
  5 children and adolescents will experience a
  significant mental health problem during their
  school years.
• Up to 1 in 8 adolescents and 1 in 33 children may
  experience depression at some time in their life.
• The majority of children with diagnosed/undiagnose
  d mental health disorders are placed in general
  education classrooms.
• Approximately 70 of those who need treatment
  will not receive appropriate mental health
  services. Of critical importance- 90 of those
  who die by suicide suffer from diagnosable
  treatable mental illness

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What is Mental Health ?

• Good Mental Health is not simply the absence of
  illness, but the possession of skills necessary
  to cope with lifes challenges.
• Good Mental health allows children to
• Think clearly
• Develop socially and build fulfilling
  relationships
• Learn new skills
• Adapt to change and cope with adversity.

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Building Good Mental Health

• Basics for childs good physical health
• Nutritious food
• Adequate shelter sleep
• Exercise
• Immunizations
• Healthy Living Environment

• Basics for childs good mental health
• Unconditional love from family
• Self-confidence high self-esteem
• Opportunity to play with other kids
• Encouraging teachers caretakers
• Safe secure surroundings
• Appropriate guidance discipline

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What does this mean for our classrooms?

• Failure to address childrens mental health needs
  is linked to
• Poor academic performance
• Behavior problems
• School violence/criminal activity
• Dropping out
• Substance abuse
• Special education referrals
• Suicide

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But Im a teacher!!!!

• Increased stress and fracturing of todays
  lifestyles make it imperative that schools
  partner with parents to help children thrive.
• Childhood mental health disorders can be
  difficult to recognize, are often undiagnosed or
  misinterpreted, and may be overlooked or treated
  as simple misbehavior.
• Informed/trained school staff who recognize early
  symptoms can help a child and family move toward
  appropriate treatment.
• Teachers can institute classroom accommodations
  to a student overcome barriers to learning.
• Schools are excellent places to promote good
  mental health in a variety of ways.

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Why Early Inter/Prevention?

• Vital for successful behavioral educational
  outcomes.
• If treatment support occurs from the 1st early
  warning signs, there is a better chance for
  success as adults.
• Most mental health conditions worsen if not
  treated as the brains development continues to
  be assaulted by negative influences.
• Behavioral interventions, therapy, medications
  and other interventions are proven to be
  effective treatment for many serious emotional
  mental disorders

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Building Protective Factors

• Educators can initiate protective factors that
  help establish a childs long-term capacity for
• Positive Behavior
• Social Competency
• Academic Achievement
• Emotional Well-being

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Protective Factors

• Schools can help build/foster
• A sense of belonging
• Feelings of accomplishment
• Ability to adapt to change
• Recognition of behavior accomplishments
• Knowing they can make a difference
• Developing resiliency

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Brain-Based Teaching

• Learning is enhanced by challenge and inhibited
  by threat.
• The foremost condition for the brain to accept
  integrate new information is a SAFE ENVIRONMENT!

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Brain-Based Teaching

• Learning is enhanced with tasks that are
  emotionally meaningful.
• Students need timely, accurate feedback.
• Teaching should be active and have varied input.

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Risk Factors

• Both biological factors and adverse environmental
  factors influence- but not necessarily cause-
  the mental disorders of childhood.
• Risk Factors for brain disorders include
• Genetic vulnerabilities or predispositions.
• Prenatal or early childhood exposure to toxins.
• Chronic stress and anxiety.
• Situational crises (including abuse, neglect, and
  emotional trauma).
• Malnutrition (especially prenatally in infancy)
• Disease, especially with high fever.
• Traumatic head injury
• Or a combination of above factors.

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When it comes to building the
human brain, nature supplies the construction
materials and nurture serves as the architect
that puts them together (Kotulak, 1997).
(Taken from Minnesota Association for Childrens
Mental Health. (2204). Unlocking the
Mysteries of Childrens Mental Health An
Introduction for Future Teachers. (Rev.ed). St.
Paul, MN Author. )
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The Good News!

• Research shows that new neuronal connections are
  developed through the lifespan.
• An enriched environment can bolster brain
  development.
• With a supportive environment along with targeted
  mental health treatment, it greatly improves the
  possibility of a good outcome.
• Mistruths
• A childs personality and future are determined
  forever by events in the first 3 years of life.
• Poor parenting is rarely the sole cause of
  mental health disorders and may not be present at
  all.

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General Warning Signs

• The following may indicate the need for further
  professional assistance or evaluation
• Decline in school performance
• Poor grades despite strong efforts
• Regular worry or anxiety
• Repeated refusal to go to school or take part in
  normal activities
• Hyperactivity or fidgeting
• Persistent nightmares
• Persistent disobedience or aggression
• Frequent temper tantrums
• Depression, sadness, or irritability

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Anxiety Disorders

• Anxieties severe enough to interfere with the
  daily activities of childhood or adolescents.
• Terms you may hear
• Generalized Anxiety Disorder
• Phobias
• Social Phobia
• Panic Disorder
• Obsessive-Compulsive Disorder
• Post-Traumatic Stress Disorder

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Anxiety cont
A variety of behaviors may be expressed in the
classroom

• Frequent absences
• Refusal to join in social activities
• Isolating behavior
• Many physical complaints
• Falling grades

• Excessive worry about homework or grades
• Frequent bouts of tears
• Frustration
• Fear of new situations
• Drug or alcohol abuse

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Autism Spectrum Disorders (ASD)

• A neurologically based developmental disorder
  (although medically its classified as a mental
  health disorder)
• Symptoms range from mild to severe and generally
  last through a persons life
• Appears in the first 3 years of life and is 4x
  more prevalent in boys than girls
• No two children with autism will act the same

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ASD cont

• Delays or areas of impairment
• Communication ranges from no language to subtle
  oddities of language
• Social Interaction may show little interest in
  making friends, have strange social behaviors, do
  not read or interpret social cues, poor eye
  contact
• Sensory Impairments overly sensitive or
  under-responsive to sensory input (light, sound,
  smells, pain)
• Repetitive or self-injurious behavior rocking,
  repetitive movements or actions, repetitive
  phrases, special interests areas

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ASD cont

• Other terms you may hear
• Aspergers Syndrome
• Pervasive Developmental Disorder (PDD) or
  Pervasive Developmental Disorder- NOS (not
  otherwise specified)
• Retts Syndrome
• Childhood Disintegrative Disorder

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Eating Disorders

• Anorexia- fail to maintain a minimally normal
  body weight, intensely afraid of even slightest
  weight gain, perception of body shape and size is
  distorted, tend to be a perfectionist and
  over-achieving
• Bulimia- eating binges to avoid weight gain then
  inappropriately eliminate food
• Affects girls and boys (10-20)

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Eating Disorders

• Students with eating disorders may
• Look like model students, be leaders, and be
  self-demanding
• Have poor academic performance, poor
  concentration, and short attention spans
• Lack energy to complete assignments or homework
• Wrestlers, dancers or gymnasts may have
  disordered eating patterns to make their
  weight. This could lead to full-blown eating
  disorder.
• At risk for alcohol and drug abuse as well as
  depression.
• Can cause very serious health problems- even
  death.

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Attention Deficit Hyperactivity Disorder (ADHD)

• Inattentive Type
• Short attention span
• Disorganization
• Cant maintain attention
• Trouble listening
• Fail to finish work

• Hyperactive/Impulsive
• Difficulty staying seated
• Talk out/interrupt
• Fidget and squirm
• Trouble taking turns

• Students with ADHD are at a higher risk for
  depression,
• learning disorders, anxiety disorders, and
  conduct disorders.
• Must be taught more effective organization and
  social skills.

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Oppositional Defiant Disorder (ODD)

• May develop due to stress from loss, frustration,
  family crises, way to cope with depression
• Looks like
• See the world in black-and-white
• Quick to blame others
• Constantly test the limits
• Poor peer relationships
• Odd response to positive feedback

• How to Respond
• Be proactive try to prevent beh. from occuring
• Avoid power struggles
• Be clear and concise
• Provide structure and predictability
• Provide genuine praise when they respond
  positively
• Clear consequences for behavior

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Self-Mutilation

• An intentional self-destructive behavior that
  destroys body tissue, not with the intent to
  commit suicide, but as a way to manage emotions.
• Wounds are repeated, superficial, non-life
  threatening with actual tissue damage and are
  socially unacceptable.
• Done with conscious awareness, but not as an
  attention-seeking behavior.
• Individuals are reacting to intense emotional
  feelings and are trying to modulate the feelings.
  They can be angry, lonely, scared and fearful of
  abandonment. There is often abuse or neglect in
  past.
• Might include cutting, burning, scratching,
  skin-picking, tattoos, piercing

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Other Childhood Disorders

• Low-incidence conditions you may encounter in
  schools
• Tourette's Syndrome
• Conduct Disorder
• Reactive Attachment Disorder
• Schizophrenia
• Fetal Alcohol Spectrum Disorders

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Depression

• Definition an illness when the feelings of
  sadness with great intensity persist and
  interfere with a persons thoughts, feeling, and
  behavior.
• As many as 1 in 33 children and 1 in 8
  adolescents suffer from depression at any given
  time.
• Boys suffer more depression in childhood, girls
  suffer more during adolescence.
• Between 20 50 of depressed children have family
  history of depression.
• Children of depressed parents are more than 3
  times as likely as children of non-depressed
  parents to experience depression.

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Depression cont

• Names that you might hear
• Major Depressive Disorder- at least one major
  depressive episode, five or more symptoms for at
  least a 2-week period
• Dysthymia- Chronic, moderate type of depression
• Adjustment Disorder with depressed mood- caused
  by some known stress and lasting less than 6
  months
• Bipolar Disorder- (Manic Depression) Periods of
  intense highs of energy followed by periods of
  depression

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Signs of Depression in Children Adolescents

• Poor performance in school
• Withdrawal from friends activities
• Sadness hopelessness
• Lack of enthusiasm, energy, or motivation
• Anger and rage
• Overreaction to criticism
• Poor self-esteem or guilt
• Indecision, lack of concentration or
  forgetfulness
• Restlessness and agitation
• Changes in eating or sleeping patterns
• Substance abuse
• Problems with authority

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Suicide Signs

• Many cues to look for are symptoms associated
  with depression, bipolar disorder, anxiety,
  alcohol drug abuse
• More obvious signs
• Obsession with death (poems, essays, drawings)
• Giving or throwing away favorite belongings
• A sudden positive outlook
• Dramatic change in personality or appearance
• Talking like there is no hope, even in the future
• Suicide threats Direct or indirect- Always take
  these seriously!

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Suicide

• Of those who have talked about suicide, only
• 33-50 were medically diagnosed with a mental
  illness at the time of their death.
• Previous suicide attempts are reason for concern
  and watchfulness- 1/3 of teens who die by suicide
  have made previous attempts.
• More females attempt suicide, more males are
  successful in completing suicide
• CDC Report found increased suicide rates from
  2003-04 in previous 12 yrs. had seen 28 decline
  (especially for
• 10-14 and 15-19 yr. old females 15-19 yr.
  old males)

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What Can We Do?

• Offer help listen encourage teens to talk
  about their feelings. Listen, dont lecture.
• Trust your instincts- if it seems serious, seek
  prompt advice/help.
• Ask direct questions- dont be afraid of frank
  discussions!
• Be aware- look and listen for changes in
  behavior, dress, hygiene.

• Be supportive- provide accommodations to meet
  students needs.
• Remember the goal is to teach students, but
  education will not occur unless the student is
  mentally healthy in order to learn.
• Dont jump to conclusions. BUT dont assume
  either.

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What you can say to help

• You are not alone in this. Im here for you.
• I understand you have a real illness and thats
  what causes these thoughts feelings.
• I may not understand exactly how you feel, but I
  care and want to help.

• You are important to me. Your life is important
  to me.
• Tell me what I can do now to help you.
• I am here for you. We will get through this
  together.

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What not to say

• Its all in your head.
• We all go through times like this.
• Youll be fine. Stop worrying.
• Look on the bright side.
• Just snap out of it.

• Stop acting crazy.
• Whats wrong with you?
• Shouldnt you be better by now?
• You have so much to live for why do you want to
  die?

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This is too much for me!!

• Use your resources Colleagues, Family Support
  Worker, School Counselor, School Nurse, School
  Psychologist, Mental Health Worker, Building
  Assistance Teams
• Dont try to diagnose
• Be supportive and try to accommodate

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Together We Can!!!
The World is a great mirror. It
reflects back to you what you are.
If you are loving, if
you are friendly, if you are helpful,
the World will prove loving
and friendly and
helpful to you.
The World is what you are.
-Thomas Dreir
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References

• Minnesota Association for Childrens Mental
  Health. (2004). Unlocking the Mysteries of
  Childrens Mental Health An Introduction for
  Future Teachers. (Rev.ed). St. Paul, MN Author.
• Handouts from Minnesota Association for
  Childrens Mental Health, St. Paul, MN
  macmh_at_attbi.com
• Is it Just a Moodor Something Else?, National
  Depressive and Manic-Depressive Association,
  Chicago, IL, 2002.
• Affect and Mood Problems. (2004). Los Angeles,
  CA UCLA Department of Psychology- Center for
  Mental Health in Schools. Retrieved February 8,
  2005, from smhp.psych.ucla.edu.
• Teenage Suicide. National Alliance for the
  Mental-Minnesota, St. Paul, MN, 1999.

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References cont

• Marcus, Pam. Suicide Self-Mutilation.
  Presentation handouts, January, 2005.
• Whelley, P., Cash, G.,, Bryson, D. (2003). The
  ABCs of Childrens Mental Health. National
  Association of School Psychologists, Bethesda,
  MD.
• Childrens Mental Health-What Every Child Needs
  for Good Mental Health, National Mental Health
  Association, Alexandria, VA, 2005.
• Improving the Mental Health Well-Being of
  Americas Children Coalition of Mental Health
  Partners, January 2007.