Common Mental Health Disorders in Children: What Does It Look Like and What Can We Do To Help Them to Succeed in School?

What is a Mental Health Disorder?

• A mental illness is a condition that impacts a person's thinking, feeling or mood, and may affect his or her ability to relate to others and function on a daily basis. Each person will have different experiences, even people with the same diagnosis.

• Research suggests multiple, interlinking causes. Genetics, environment and lifestyle combine to influence whether someone develops a mental health condition.

Trauma Impacted Students• May have chronic anxiety/stress/irritability• May have difficulty with:

• Emotional regulation• Social skills• Problem solving• Expressing feelings and/or needs• Empathy, including appreciating others• Working in groups & connecting with peers

The Role of School Staff• As you begin to learn about common mental health disorders, it is important

that you understand that your role is NOT to diagnose students• Your role as a school staff member is to:

Notice if you see troubling signs or behaviors Talk with the appropriate school staff about the behaviors Act by connecting them to the school counselors/social workers & other staff who can make an appropriate referral

The Role of School Staff

• Listen • Be supportive & empathize• Create a “safe place” to which they can go

• Maintain trust & appropriate confidentiality at all times

Common Mental Health Disorders in Children & Adolescents

• Attention-Deficit/Hyperactivity Disorder (ADHD)• Oppositional Defiant Disorder (ODD)/Conduct Disorder (CD) • Depression• Anxiety Related Disorders, including OCD

Attention-Deficit/Hyperactivity Disorder (ADHD)

• More common in boys• Occurs in approximately 11% of children• Some symptoms must occur before age 7 • Should be present for a minimum of 6 months • In 2 or more settings (ex: home & school)

ADHD Myths• ADHD is NOT caused by:

• poor parenting• family issues• too much TV or sugar• Electronics/video games

Three Subtypes of ADHD

• Inattention & Hyperactivity-Impulsivity

• Inattention only

• Hyperactivity-Impulsivity only

Symptoms of ADHDHyperactivity:• Fidgets; squirms in seat • Runs about or climbs excessively in inappropriate situations• Difficulty playing quietly• Often “on the go” or often acts as if “driven by a motor”

Impulsivity:• Blurts out answers • Difficulty taking turns• Interrupts others

Symptoms of ADHD• No attention to details; careless mistakes• Does not follow through on instructions• Fails to finish school work• Difficulty sustaining attention; shifts task to task• Does not seem to listen when spoken to directly• Difficulty organizing tasks & activities (messy backpack)

(such as schoolwork but can play videogames for hours)• Loses things (never has a pencil)• Forgetful (does homework, but forgets it at home)• Daydreamers & doodlers (Inattentive Type)

ADHD Interventions • To-do Lists – teach organizational skills!• Clear Directions – specific & uncomplicated; have

students repeat directions/write down assignments• Reduce Distractions – sit them away from the window• “Bite-size” Projects – First/Then• Routine - Maintain predictable classroom routines & prepare

students for transitions & changes

ADHD Interventions • Rewards - Catch the student being good & reinforce those behaviors even if

they are what you expect for a student their age (listening skills, social skills)

• Brain Breaks and Physical Activity

• Frequent eye contact with the student; Proximity control

• Manipulatives or fidget toys (for the pencil tapper)

• Wiggle seats, bouncy bands

Oppositional Defiant Disorder (ODD)

• Loses temper • Touchy or easily annoyed• Angry or resentful• Argues with adults/authority figures• Actively defies rules or authority• Deliberately annoys others• Blames others for mistakes

Conduct Disorder (CD)• A repetitive pattern of behavior in which the basic rights of others or

societal rules or norms are violated• Aggression to people/animals • Destruction of property• Deceitfulness or theft• Serious violations of rules

• Staying out all night• Running away• Truancy

Interventions for ODD & CD• Establish rapport/build a relationship with the student

• Praise is important, but must be sincere

• Model RESPECT to gain trust (they do not trust easily)

• Monitor your tone of voice, body language, facial expressions, gestures & motions (they are very perceptive of others; stay neutral)

Interventions for ODD & CD• They need personal space; avoid standing over the student• Do not correct them in front of everyone• Maintain predictability & schedules • Structure activities so they are not always picked last or left out• Set consistent clear limits; outline what is non-negotiable• Avoid pleading, direct demands & ultimatums• Avoid POWER STRUGGLES! YOU WILL LOSE!• Do not take it personally how they act or treat you

Interventions for OCD/CD

• Have them participate in creating rules, routines, schedules & expectations

• Encourage problem solving & make them feel like they have some power; can give them 2 choices when appropriate

Depression

• Boys & girls are equally affected • Children/Adolescents may display signs of anger• Behavior changes, social withdrawal, unable to have fun• Drop in grades, not doing homework• Refusing to go to school• Becoming lethargic, having difficulty sleeping, oversleeping,

sleeping in class

Depression• Complaints about headaches & stomachaches• Hypersensitivity to criticism• Overreacting to disappointment & frustration• Tearful• Giving up easily• Low self-esteem• Lack of self-care (bathing, grooming)• Recent weight gain/loss• Talking about dying or suicide

Depression Interventions• Ask the student what they need when in doubt how to assist

• Trusted adult(s) to talk to at the school

• Validation; listen to the student

• Avoid being dismissive or saying things like, “You will be fine.” or “Everything is okay.”

• Physical exercise/movement

Depression Interventions

• Praise for effort, as well as task completion• Model that it is okay to make mistakes & how to handle them• Choose positive students as their peer groups during classroom

activities/small groupsGive them opportunities to engage in social interactions

• Help students use realistic statements about their future• Students with depression often have memory difficulties

Anxiety Related Disorders

• Generalized Anxiety Disorder

• Social Anxiety

• Obsessive Compulsive Disorder (OCD)

Anxiety Disorders• The most common disorder in children & adolescents• Causes extreme discomfort in situations generally regarded as

unthreatening • Children can be rude/noncompliant when trying to avoid encounters that

trigger anxiety; need to avoid the spotlight • Warning sign is often truancy from school• It isn’t about ability, it’s about the anxiety interfering • Traditional rewards & consequences don’t often work • When they’re calm they can learn & when they’re anxious they can’t

Generalized Anxiety • Global excessive worry • Restlessness or feeling keyed up/on edge• Sleep disturbances/fatigue• Irritability• Difficulty concentrating, mind goes blank• Muscle tension, stomachaches & headaches • Excessive seriousness, hypersensitive to criticism• Perfectionists; re-do work• Continuous worry about school, even when school work is excellent

Social Anxiety• Intense fear in a social or performance situation where the student

is exposed to perceived judgment by others• Fear of being singled out (called on or being in front of the class)• Limited interactions with others (meeting new people)• Crying, freezing, shutting down• Possibly phobic about specific situations:

• Eating in cafeteria • Using public restrooms

Obsessive Compulsive Disorder (OCD)Common obsessions include:• fear of dirt or germs/contamination• a need for symmetry and order• religious obsessions• lucky and unlucky numbers• fear of illness/harm coming to oneself

Obsessive Compulsive Disorder (OCD)Compulsions:• Grooming – hand washing• Repeating – in & out of doorways, erasing & rewriting• Checking – checking if doors locked, repeatedly checking homework• Counting• Arranging/Ordering• Hoarding

Anxiety Interventions• Allow the student to come to class a few minutes before to allow calm down

time, allow extra time for difficult transitions or bathroom/brain breaks

• Avoid calling on them in the big group, break them up in small groups

• Private or non-verbal praise is often better with an anxious student

• Create a “signal” with the student so they can share when they are starting to feel overwhelmed to help build self-regulation skills

Anxiety Interventions

• Offer assistance rather than making demands• Avoid criticism & increase positive comments/reinforcements• Help the student direct their focus on something positive• Identify which students in the classroom the student feels most

comfortable & positive around

Thank you!Questions?

Mary BridgesExecutive Director, Student Services

Orange County Public Schools

References• Adverse Childhood Experience (ACE) Questionnaire, www.ncjfcj.org• American Psychiatric Foundation (Typical or Troubled™)• Children’s Mental Health Disorder Fact Sheet for the Classroom www.macmh.org• Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)• The National Child Traumatic Stress Network (NCTSN), www.nctsn.org• Parents and Teachers As Allies: Recognizing Early-onset Mental Illness in Children

and Adolescents, 2nd Edition. NAMI – “The Nation’s Voice on Mental Illness” (2003)• Trauma and Resilience: An Adolescent Provider Toolkit; Adolescent Health Working

Group (2013)• Substance Abuse and Mental Health Services Administration,

https://www.samhsa.gov/