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Mental Health Archive 2007

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Margaret L. Stivers, Ph.D.
Clinical Psychologist

Margaret is a clinical and social psychologist trained at the University of Kansas and the University of Miami. She has taught psychology at four major universities and directed mental health, residential, and nonpublic school programs for children and adolescents. Her experience includes 30 years of consultation and collaboration with educational programs throughout the country, including schools in urban and rural areas and on Indian reservation.

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  • Are there symptoms of depression I should be looking for? How do I know what is serious and what are just normal teenage behaviors?

Question:

I am a middle school teacher and have a couple of students who may be depressed. Are there symptoms I should be looking for? How do I know what is serious and what are just normal teenage behaviors? What should I do?


Answer:

Dear middle school teacher,

Thank you for your important question. Quite a number of teachers have recently expressed concerns to me about students who may be depressed. When a student in your class is struggling with depression, you are likely to observe some of following signs:

  • Helplessness and hopelessness – your student may give up easily and express the feeling that nothing he/she does makes any difference and that nothing will ever get better.
  • Withdrawal – your student may avoid friends and show little enthusiasm for activities that he/she once enjoyed.
  • Increased irritability or agitation – your student may be sulky, irritable, grouchy, or blow up easily.
  • Missed school, tardiness, or a drop in school performance.
  • Unusually poor concentration, forgetfulness.
  • Difficulty making even minor decisions.
  • Excessive guilt or self-blame; student may express feelings of worthlessness.
  • Frequent physical complaints (often vague symptoms, headaches, or stomach pains).
  • Sleepiness, low energy, apathy.
  • Change in pace – physical movements may become much more slow and laborious or increasingly abrupt and restless.
  • Episodes of crying or sadness for no identifiable reason.
  • Signs of alcohol or drug abuse.
  • Thoughts about death or suicide – these may be expressed in drawings, writing assignments, or conversation.

Although increased moodiness is quite normal as students enter their teens, if you see several of the behavioral changes listed above, there is cause for concern. If your student has recently experienced a major loss or a traumatic event, these symptoms may represent grief or adjustment problems which will gradually diminish over time. Nevertheless, it is important to monitor the symptoms. Hopelessness and preoccupation with death are particularly serious signs of trouble that should be followed up by a mental health professional.

Depression can become a serious, chronic, and sometimes fatal, illness. It is helpful to keep in mind that:

  • As many as 1 in 33 children and 1 in 8 adolescents experience clinical depression. Many more experience symptoms of depression that can disrupt their school functioning and place them at risk of developing clinical depression.
  • Many experts believe that students with language and learning disorders are at increased risk of depression.
  • Students with depression and anxiety are at increased risk of being bullied or socially excluded by their peers.
  • Suicide is the 3 rd leading cause of death for 10-19 year olds.

Here are some ways that you, as a teacher, can help a student who may be struggling with depression:

  • Refer your student for psychological and/or medical evaluation and treatment.
  • Work closely with the student’s mental health provider and family members. This will enable you to prompt your student to use coping skills he/she is working on and to recognize and reinforce the student’s use of these coping techniques.
  • Combat feelings of helplessness and hopelessness by setting up numerous opportunities for your student to experience success and recognition. This may involve having the student share special expertise with the class.
  • Decrease social isolation by working to develop a school and classroom community that fosters inclusion.
  • Promote a sense of belonging by giving your student a vital role in group projects or arranging for the student to do an important classroom or campus job.
  • Seek and create ways to energize and motivate the student. Find ways to individualize assignments to capitalize on the student’s particular strengths and interests.

I’m impressed that you, and so many other teachers, express concern about your students’ mental health and hope that you find these guidelines and suggestions helpful.


  • What is an anxiety disorder and what I might do to help these students?

Question:

I've heard a lot recently about anxiety disorders and think that some of my students may need some help. Can you explain what an anxiety disorder is and what I might do to help these students?

Concerned teacher


Answer:

Dear Concerned,

Thank you for your very good question! Anxiety is certainly a big challenge for many children in school. Virtually all children (and adults) experience anxiety, but if a child’s worries or fears become intense and persistent enough to interfere with everyday functioning or disrupt learning and development, the child may have an anxiety disorder.

Anxiety problems can develop and be expressed in a variety of ways. As a result, quite a few different anxiety disorders have been defined and labeled. Below, you will find descriptions of the major types of anxiety experienced by children and adolescents. These descriptions emphasize the anxiety-related behaviors that you are most likely to have opportunities to observe in the classroom or school setting. Following this section, you will find some teaching tips for reducing your students’ anxiety.

General Anxiety

If a student in your class has general anxiety, you are likely to observe some of the following:

  • Constant worry – persistent and exaggerated concerns about everyday, routine activities.
  • Vigilance, -- constant, careful monitoring of the environment for potential threats.
  • Apprehension -- a tendency to anticipate negative outcomes and a preoccupation with negative events that might occur.
  • Complaints of fatigue, tension, headaches, or nausea.
  • Agitation or restlessness.
  • Difficulty concentrating or tendency for mind to go blank.

Social Anxiety

If a student in your class has social anxiety, you are likely to observe some of the following:

  • Persistent fear or anxiety in situations in which your student’s behavior may be observed or evaluated by others.
  • Extreme self-consciousness or fear of embarrassment.
  • Fear of being around unfamiliar people.
  • Inhibition or avoidance of particular behaviors in public situations, e.g. speaking in class, eating at school, or writing when others are watching.
  • Lack of participation in group activities, limited social initiation, and, sometimes, self-isolation.
  • School behavior (shutting down) that differs markedly from parents’ reports of their child’s behavior at home.

Social anxiety is the most common anxiety disorder. The social withdrawal and inhibition associated with social anxiety are sometimes mistaken as symptoms of an autism spectrum disorder. Children with selective mutism, a failure to speak in some situations, although the child demonstrates an ability to speak in other situations, is nearly always associated with social anxiety.

Separation Anxiety

If a student in your class has separation anxiety, you are likely to observe some of these signs:

  • Extreme distress when separating from parents at the beginning of the school day. The child may cling to the parent, protest vehemently about being left, or refuse to get out of the car.
  • Frequent late arrival to school.
  • Persistent fears that something bad will happen to a parent.
  • A strong desire to call or check in with a parent throughout the school day.
  • Complaints of physical symptoms, often accompanied by a request to go home.

Separation anxiety can sometimes lead to school refusal or avoidance.

Post-Traumatic Stress

If a student in your class has post-traumatic stress, you are likely to observe some of these symptoms:

  • Periods of being inaccessible or hard to reach, when the student is reliving a traumatic event – your student appears inattentive or engrossed in his or her own world.
  • Anger, irritability, or agitation for no apparent reason.
  • Regression or loss of developmental skills (especially in younger children).
  • Acting out, or re-enacting, the trauma through play, gestures, or art (especially younger children).
  • Talking compulsively about the traumatic situation (especially older children). If the trauma is sexual assault, the student is less likely to talk about it, but may re-enact it through an increase in sexualized behavior.

Children may develop post-traumatic stress (PTSD) symptoms following a variety of traumatic experiences, including: surviving physical, sexual, or emotional abuse; witnessing violent acts at home, at school, or in the community; living through natural disasters; or seeing extensive media coverage of frightening events such as terrorist attacks or school shootings.

Not all children who experience these events develop PTSD. However repeated exposure to trauma increases the risk.

Obsessive-Compulsive Behavior

If a child in your class has obsessive-compulsive symptoms, you are likely to observe some of the following:

  • Complaints, or evidence, of repeated, intrusive, unwanted thoughts. Student may report, “I can’t get these thoughts out of my head.”
  • Ritualistic behaviors such as arranging and rearranging objects, checking things, counting (e.g. steps), repetitious behavior such as hand-washing.
  • Distress when the student’s ritualistic behavior is prevented or interrupted.

Specific Phobia

If a child in your class has a specific phobia that is school-related, you are likely to observe extreme agitation, fear, and desperate attempts to avoid exposure to a particular object/place/situation. Typical situations that can trigger students’ anxiety are test taking or speaking in front of the class, but some students develop fears of a particular room, such as a library or gym, a playground structure, or going up or down stairs. The fear is referred to as a phobia only if it interferes significantly with the student’s functioning.

Panic Attacks

If a student in your class has panic attacks, you might note:

  • Reports, or signs, of feelings of terror that strike the student repeatedly and without warning.
  • Physical complaints, including chest pains, heart palpitations, shortness of breath, dizziness, or abdominal discomfort.
  • Other complaints, including feelings of unreality, fear of losing control, or fear of dying.

Panic attacks often start in response to a specific anxiety-provoking situation. Then the anxiety takes on a life of its own and the student’s apprehension about having a panic attack can lead to fear and avoidance of more and more situations.

Tips for Teachers

When working with anxious students, it is important to keep in mind that:

  • Anxiety often occurs in conjunction with symptoms of depression or other mental health problems.
  • Students with learning, language, and/or attention challenges may be particularly vulnerable to anxiety.
  • Children with anxiety problems are at increased risk of being bullied or socially excluded, and these experiences, in turn, increase the child’s fears and insecurities.
  • Anxiety can feed on itself; anxious students often worry about how much they worry or become anxious about whether other students are noticing their anxiety.
  • Anxiety symptoms often interfere with a student’s ability to focus or sustain attention. Because of this, students with high levels of anxiety are sometimes misdiagnosed as having attention deficit/hyperactivity disorder (ADHD). This can be very problematic because the stimulant medications used to treat ADHD can increase anxiety.

Here are some generic tips about teaching practices that can help support anxious students in school. A child’s therapist, the school psychologist or counselor, another teacher, or a student and his or her family may be able to help you develop tailor the recommendations for a specific student.

Teachers can help anxious students by:

  • Referring them for psychological and/or medical evaluation and treatment.
  • Working closely with mental health providers and family members to coordinate goals and practices and ensure that everyone delivers consistent messages to the student. In the classroom, you are likely to have many opportunities to prompt and reinforce the use of coping techniques that your students are working to develop.
  • Helping students feel safe by:
    • Providing a well-organized classroom environment with clear, consistent expectations.
    • Establishing predictable routines and providing warnings and reminders in advance of changes or disruptions.
    • Forewarning anxious students about when they will be called on in class so that they can be prepared.
    • Projecting a calm, even demeanor and avoiding a classroom atmosphere filled with drama and surprises.
  • Consistently promoting social norms that discourage competition, peer criticism, or put-downs and encourage peer compliments and support.
  • Creating a variety of highly engaging learning experiences that distract students from negative preoccupations.

I hope that you find this information helpful!

Further Resources for Teachers and Parents:

American Academy of Child and Adolescent Psychiatry: Facts for Families
http://www.aacap.org/cs/root/facts_for_families/the_anxious_child

Massachusetts General Hospital
http://www.massgeneral.org/schoolpsychiatry/info_anxiety.asp

National Mental Health Information Center
http://mentalhealth.samhsa.gov/publications/allpubs/CA-0007/default.asp

National Alliance on Mental Ilness
http://www.nami.org/Content/ContentGroups/Helpline1/
Anxiety_Disorders_in_Children_and_Adolescents.htm