Eden Prairie School District

Handouts available at

www.drstevekahn.com

An alternative way to think about mental health problems

• Spectrum• Students without diagnoses have needs also• At what point does the diagnosis appear?• The necessity of a diagnosis for payment• The person does not become the diagnosis• Two people with same diagnosis are more

different from each other than the same

Are there advantages to the diagnosis?

• Yes, if there is a medicine that helps• Yes, if there is a treatment plan that helps• Yes, if the parents change how they are

parenting that may have caused or exacerbated the problem in the first place

• Yes, if there is a genuine need for school accommodations

At what point does the diagnosis appear?

• Frequently occurring diagnoses that affect behavior and learning at school

• Oppositional Deficit Disorder• Attention Deficit Disorder• Depression• Anxiety• Narcissistic Personality Disorder• Obsessive Compulsive Disorder

Oppositional Defiant Disorder

• At what point does the diagnosis appear?• Temper control, anger management problems• Argumentative, defiant, refuses to comply

with rules• Deliberately annoys people, angry or

resentful, spiteful or vindictive• Blames others for their mistakes or

misbehavior, touchy or easily annoyed

Attention Deficit Disorder• At what point does the diagnosis appear?• Inattentive, difficulty sustaining attention, careless

mistakes, organization problems• Does not listen when spoken to directly, follow

through problems, task completion• Loses things, distracted, forgetful, difficulty engaging

in leisure activities quietly• Hyperactive-impulsivity type, runs or climbs

excessively, fidgets, squirms• On the go as if driven by a motor, talks excessively

Major Depression

• At what point does the diagnosis appear?• Depressed mood, irritable, feels sad or empty• Diminished interest or pleasure in daily activities• Decrease or increase in appetite, weight loss or gain• Fatigue, loss of energy, sleep disturbance, feelings of

worthlessness or excessive guilt• Diminished ability to think or concentrate• Inability to get over routine events of childhood

(friendship issues)

Generalized Anxiety Disorder

• At what point does the diagnosis appear?• Palpitations, pounding heart, sweating,

trembling, shaking• Shortness of breath, smothering feeling, dizzy,

lightheaded, faint• Feeling of choking, chest pain or discomfort

Narcissistic Personality Disorder

• At what point does the diagnosis appear?• Grandiose sense of self-importance• Expects to be recognized as superior without

achievement• Believes he or she is special, requires

excessive admiration• Sense of entitlement, lacks empathy, arrogant

or haughty behavior, envious of others

Obsessive Compulsive Disorder

• At what point does the diagnosis appear?• Preoccupied with details, rules, lists, order,

organization, schedules, perfectionism• Excessively devoted to work and productivity to

detriment of social life• Over-conscientious, scrupulous, inflexible about

ethics, morals, etc. • Hoards stuff, unable to throw things out• Reluctant to delegate, doesn’t do group work well

Goals for today• Use six diagnoses to recommend strategies • Strategies helpful for students struggling with

similar problems but not severe enough to reach criteria or not yet diagnosed

• Some strategies may also pertain to our roles as coaches, disciplinarians, administrators

• The idea of K-12 teachers as a community of adults with a combined impact on students

• Most needed for students with weak parents

Thirteen Years of Healthy Adults

• Perhaps 15-20% of students are living in less than ideal family situations

• For these students to avoid mental health problems will depend on the adults they come to know outside the family

• Only some of the20% will receive treatment • And even fewer of those will have parents

who receive treatment

Realistic Expectations for Teachers

• Not responsible for treating the mental health condition

• A teacher can only be asked to be responsible for his or her own actions and reactions to the student

• Resist taking on too large a sense of responsibility• At times a teacher may feel unrealistic pressure from

inside or from peers or supervisors• Focus on what you say, how you look and how you

sound. Who you are when they ….

Maintaining standards versus lowering the bar

• Default positions should be:• Students are held accountable to your

classroom behavioral expectations• Students are given the grades they earned• “Goes without saying”• And if there is an accommodation plan, follow

it rather than question it• Even if you doubt whether it is helpful

External Events and Internal Feelings

• Similar scenarios in classrooms, lunchrooms, recess, gym class

• Can lead to….• Variation in how teachers or administrators

feel and act

• Sounds like fluff until we talk about keeping our focus on us every minute of every day

Extra stress and demands from certain students

• Students as external events• Our response to the challenges they place

before us• How we feel when they…. • What we do when they….• Thoughts precede feelings• Viewing skills

External Events in Other Professions

• Psychology: Clients all have mental health diagnoses

• Truck drivers: Have to deal with traffic • Physicians: Patients with serious medical

conditions• And the most horrible external event of all:

• Dentists: Other people’s mouths!

Advice to “Pay Forward”

• The next few slides are worded so that they can be used in emails, phone calls with parents and conferences

• The advice is also for our all adults who work with and care about children

• The word adult can be replaced with “teacher,” “parent,” “recess supervisor,” etc.

Honoring sovereignty

• Start where they are at• Avoid comparisons to peers and benchmarks• The more often a mistake is made (perhaps) the

more important the learning may be• Maybe that is why the mistake needs to be

repeated for 6, 12, 18 months!• Growth takes time, patience is required

Protect the connection• Forgive instantly, before responding• Treat them better than they deserve• When they are acting their age, the adult should be

careful not to act the child’s age • Adults need to be the best adult they can be,

especially when the children are not at their best• Adults resist racing children to the basement • The richest times to protect the connection are the

times when they are challenging

I’d like to be able to do this. What drugs would I need to be on? (ha ha)• Thoughts precede feelings• Thoughts and feelings precede behavior• External events• External events do not cause internal feelings• Options to how adults respond to the external

events children present to them• Standard of behavior for us is higher • Often expect children to control themselves

Act insightfully (and learn from the times you don’t)

• Keep a journal. Look for the times when you are not able to find what to teach

• Those are the times that will teach you about your blind spots

• Pay more attention to what you give them, rather than what they give to you

• Keep eye on the imaginary mirror behind the child• Be who we want them to become• Teaching how to deal with unwanted events

When Parents are the External Event

• Parents who think you only have one student • Parents who think their child is gifted/talented• Parents who want to intervene on their child’s

friendship issues• Parents who act like they are your supervisor• Bumping into parental denial about limits

• Imaginary mirror• Accept that students will do whatever they do • Focus on our responses• Not so much what they do, but what we do next.• Resist taking on too big a role• This can come from overzealousness when we

know children who are hurting and are not being helped enough by their parents at home

We Can Only Do Our Part

Terminology

• Accept• Allow• Forgive• Honor• Protect• Celebrate• Terms sound as if we won’t hold them

accountable but we do

Goals: What we do when they

• Focus on the dotted line • Where they end and where we begin• Honor sovereignty • Discipline with reassurance• Celebrate mistakes and disappointments• Protect the connection• Forgive instantly• Presenting our lives as role models

Why This is Hard

• Not because of the external event• Hard to “see” the event clearly • Low tolerance for conflict• Need to be accepted or understood• “Over-psychologizing”• Projecting linearly• Sizing• Invisible rulebooks• Inaccurately inserting intent

Hard for us?

• Probably harder for the parent • Not in your job description to teach parents• And their need is great• Few of them ever seek help until it is very late• Phone calls and emails• Parent-teacher conferences• Forward information re: children and parenting

A Few Examples of Things Teachers May Know That Parents May Not Know

• Developmental realities of their child’s age• Enabling does not foster resilience• Intrusive parenting leads to underachievement• Fading the prompt• A child should get the grade the child earns• Better to get poor grades out of the way before H.S.• Drawbacks of projecting linearly and inserting intent• Better to handle it well even if later• Parents can allow temporary victories

Prevention of Mental Health Problems in Children and Adolescents

• Reducing the severity of symptoms• Improving the efficacy of treatment plans• A slight oversimplification

• If nature, then medicine• If nurture, then parenting

What are we up against?

• Some parents seem to think:• Parenting is getting to team’s practice on time• Any amount of interpersonal tension with a

child is warranted when the child behaves inappropriately

• Narrow sight line, as if they have blinders on• Gazing at the sky through a straw• Lack of insight

Teenage Mental Health Problems and Previous Parent Problems

• General role of parental modeling• Children learn by watching • Not just the parenting but also how they see

their parents living their lives • How parents deal with their own stress and

setbacks • Missed moments• What parents failed to teach• What parents inadvertently contributed to

Moments • Lying, manipulates one parent against the other • Whiny, demanding, rude, talks back, torments

younger siblings • Says "No, you can't make me.” Dawdles in the

morning • Chores, responsibilities, tidiness, procrastination,

task completion. • Missing assignments, says they will do something but

then does not • Put toys away, bed does not get made.

Best times for children to learn

• Are the uncomfortable times• Are the times of mistakes and

disappointments• Celebrating mistakes and disappointments • So much they need to learn• All moments are needed

Connecting Moments with Long-term Goals

• Learning to welcome all moments for the teaching opportunity they provide

• Seeing the potential clearly• Reasons adults give for not doing this well• Their role models when they were growing up• How they are “wired”• How do you expect me to stay calm (or

positive or encouraging) when they….

Finding what to teach• Different from just taking care of what is right

in front of you• Instead, using what is right in front of you to

do something really great for years to come• Long-term view rather than short-term view• How may I use this? What can I teach?• Lack of awareness of what adults teach by

how they live their lives

So Much for Parents to Teach

• That their love is forever and is unconditional• That they are their reservoir of confidence• That trust, honesty, taking responsibility for

your actions are important in relationships• Cooperating with authority• The work ethic, importance of education,

deferring gratification, importance of patience

So Much for Teachers to (try to) Teach

• Oppositional Deficit Disorder• Attention Deficit Disorder• Depression• Anxiety• Narcissistic Personality Disorder• Obsessive Compulsive Disorder

From General to Specific• Viewing skills helps us stay at our best• Modeling viewing skills teaches viewing skills• Honor sovereignty • Discipline with reassurance• Celebrate mistakes and disappointments• Protect the connection• Forgive instantly• Presenting our lives as role models

Oppositional Deficit Disorder

• Even when you are disrespectful to me I am respectful to you

• If you don’t do your work I am still rooting for you

• Whatever hole you dig for yourself I will help you dig out of it if you let me

Attention Deficit Disorder

• I know it is hard to sit still• He is probably doing the best he can• If he could keep his hands to himself he would• An accurate grade provides feedback• Parents may need to see poor grades to

permit an assessment or to treat the condition more aggressively

Depression

• Look around. There are other children to play with.

• Most children get cut from sports before high school

• Partnering for projects• Stories about dealing with unwanted events

Anxiety

• Giving your power away• Drama of the Middle School Years• Learning about trust and betrayal• Changing demographics and the college

application process• What worth is (or should be) based upon• Myth of the smooth road

Narcissistic Personality Disorder

• Sympathy for the arrogant, self-absorbed teenager

• Did not come out of the womb this way• Did not line up and say “please may I have

some of that narcissism?”• Hold accountable, give feedback, treat better

than they deserve

Obsessive Compulsive Disorder

• Compassion for the repetitive (Is this OK?) questions

• Erasures and starting over• Remember you have more and better norms

than the parents have• You know when it is not the age

Alcohol and drug abuse

• Best practices• How the parent is when off duty at loosest moment• Alcohol part of every social event• Offer people a drink as soon as they arrive• Expect teenagers to drink• Think it’s OK if they drink at home• Need to practice for college• Tried to influence too many issues with same

intensity

• Set the consequence for first use of alcohol or marijuana very high.• Make sure they know what you have decided the consequence will be. • Welcome their friends in your home as long as there has been a chance for

parents to talk.• Introduce yourself to parents when you drop your child off at someone’s house.• Call the other parent and welcome calls from other parents.• Always call before and occasionally call after to compare notes.• Friends are not to bring any of their own beverages into your home.• Tell your teenager to leave any gathering where there is any drinking or drugs. • Call parents if it turns out there was alcohol or marijuana use in your home.• Be visible at the party. Walk through; fill the chip bowl, etc. • Set the time when you would like the party to end and stay up until everyone is

gone.• Wait up for them, kiss them goodnight.• “It’s over when it’s over”. No after-event events. • Don’t say yes to spring break trips without adults or any kind of hotel party.• Be reluctant to say yes to last minute requests for sleepovers.• Remember: Teenagers notice what their parents do and what their friends’

parents do.

Best Practices

Wrong crowd, risk-taking, adventure-seeking, sexually active, lack of caution, sense of invulnerability, lies, manipulates,

blames others, doesn't take responsibility, doesn’t feel remorse

• Extremes of parenting styles - either• Gullible, naïve, overly trusting, inconsistent• Parental disagreement• Act as if the parent-child relationship is one of equals• Parent seems to need courtroom like evidence to give a consequence• Side with child against other adults (teacher, coach)• Inadvertently empower teen to become stubborn• Or used consequences that were too big or too long lasting and taught the

child to hide• Over-protection, bubble childhood• Didn’t let him scrape his knees, climb and fall out of the tree

Sense of entitlement, too powerful, cocky, arrogant, boastful, uncompromising, wants to drive own life (but not steering)

• Child was worshipped – special, gifted, talented, granted adult-like status• Artwork was “amazing”, singing voice was “unbelievable”• Didn’t do ordinary discipline, no follow through• Agreed with teen that it was friend’s fault, “just holding it for a friend”• Did not require details of the evening plans• Allowed overnights without phone calls• Did not stick with a parenting strategy• Taught that lines move, limits don’t apply• Parents excuse late assignments, ask for exceptions from teachers • Lax at first, late in enforcing rules – child got used to the freedoms• Lack of confidence as a parent• Timid, reluctant, hesitant

Under-achieving, poor effort/attitude, no "value" of education

• Parent did not fade the prompt• Did not permit “cards read” in grades 4, 5, and 6• Allowed school achievement to become a parent-child issue• Parents felt and acted responsible for child’s achievement• Threatened consequences but didn’t follow through• Did not teach “without day job – no paycheck”• “Yacked” instead of acted• Did not trust natural consequences• Hovering, helicopter parents• Used the future as a scare tactic

Perfectionism, eating disorders, depression, cutting, suicide attempts

• What worth is based on• How to self-evaluate• Over-played the striving/achievement/appearance issue• Am I good enough?• Is my parents’ love conditional?• Did not teach them how to be resilient, bounce back• How to view setbacks• Did not allow them to be frustrated so they could learn • Modeled that we can only be happy on perfect days• Too many explanations - why parents made a certain decision• Over-psychologize

Obsessive worrying, reviews, rehash and rehearses

• Parent sermons, too many why questions, reliance on words• Lack of strategies to teach closure, healthy ways to distract

oneself from stress• Bringing up past issues• No understanding of the point of diminishing returns• Deal with it for ten minutes and then again tomorrow• Bedtime worries• Ability to forgive themselves• Learn from a mistake, let go, move on.• Parent agonizes about his or her own life events

Gloomy, negativity, isolates, withdraws from family, pessimism

• Hard to honor sovereignty• Judging and comparing to standards• Repeatedly asks same questions, annoys and nags• Parent tries too much to cheer the child up• Shame as a parenting strategy – “you think you have it so

bad”• General tension in the family or in the marriage• Power imbalance between the spouses, bickering• A high achieving sibling who seems to be a competitor• Parent wears out welcome, made mountains out of molehills

Low self-esteem, clingy, dependent, unsure of self, hesitant to try new things

• Chores were never done “well enough”• Parent sees the world as an unfair and unforgiving place• Over-focus on dangers (e.g., being abducted)• Unknown is frightening• Boundary problems• Tried to give self-esteem rather than understanding that it

follows mastery + competence• Parent used child inappropriately as their support person

Available Resources - Free

• Fading the Prompt• Allowing Temporary Victories• Children and Their Pace of Change• Untreated Conditions• All Moments are Needed• Wishing for (but not expecting) a Smooth Road• Our Children’s Weak Moments• What They Do (and What We Do Next)