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Understanding Children’s Mental Health Disorders and the Impact on Learning and

Everyday Functioning

MODULE 2:

The Impact of Mental Health Disorders on Children’s Learning and Everyday Functioning:

Anxiety and Related Disorders

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Anxiety

and

Related Disorders

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IntroductoryBrain-based Activity

• Walk diagonally from where you are seated to the other side of the room.

• Form a group of 3-4 people.• Talk about why educators and parents need to

know about effective home and school interventions for children with mental health disorders and what you hope to gain from this “Train-the-Trainer” experience.

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Anxiety and Related Disorders

This presentation examines anxiety, which includes specific disorders such as:

• Generalized Anxiety Disorder• Phobias• Panic Disorder• Obsessive-Compulsive Disorder • Post-Traumatic Stress Disorder

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• Identify the parts of the brain and common neurochemicals involved in anxiety disorders in children.

• Describe the impact of anxiety and anxiety-related disorders in children on classroom behavior, interpersonal relationships and academic performance.

Learner Objectives

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• Describe the impact of anxiety and related disorders on learning and everyday functioning.

• Identify several key interventions for each anxiety and related disorder.

• Identify environmental modifications that can support the child.

Learner Objectives

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Key Points

• Anxiety can impact classroom and everyday functioning in many ways.

• Anxiety disorders in children are brain-based.

• There are many effective interventions that can be used at home and in the classroom.

• Children do not recognize their own anxiety.

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Things to Consider

• Positive Behavioral Interventions and Supports (PBIS)

• Simple classroom and environmental modifications

• Importance of parent/school partnerships

• Appropriate mental health services

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PBIS means those strategies used to improve the school environment and teach pupils skills likely to increase pupil ability to exhibit appropriate behavior.

Minn. Statute 121A.66, Subd.6

PBIS is defined as “a broad range of systemic and individualized strategies for achieving important social and learning outcomes while preventing problem behavior in all students.” Sugai & Horner, 2002

Positive Behavioral Interventions and Supports (PBIS)

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What is PBIS?

PBIS is empirically-supported and data-based.

It is a proactive, not reactive approach.

Based on three levels of prevention/intervention:• Primary Prevention/Universal Intervention• Secondary Prevention/Targeted Group

Intervention• Tertiary Prevention/Intensive-Individual

Intervention

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Primary Prevention:School-/Classroom-Wide Systems for

all Students,Staff & Settings

Secondary Prevention:Specialized Group

Systems for Students with At-Risk Behavior

Tertiary Prevention:Specialized

IndividualizedSystems for Students

with High-Risk Behavior

~80% of Students

~15%

~5%

CONTINUUM OFSCHOOL-WIDE

INSTRUCTIONAL & POSITIVE BEHAVIOR

SUPPORT

www.pbis.org

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Academic Systems Behavioral Systems

1-5% 1-5%

5-10% 5-10%

80-90% 80-90%

Intensive, Individual Interventions•Individual students•Assessment-based•High intensity

Intensive, Individual Interventions•Individual students•Assessment-based•Intense, durable procedures

Targeted Group Interventions•Some students (at-risk)•High efficiency•Rapid response

Targeted Group Interventions•Some students (at-risk)•High efficiency•Rapid response

Universal Interventions•All students•Preventive, proactive

Universal Interventions•All settings, all students•Preventive, proactive

Designing School-wide Systems forStudent Success

www.pbis.org

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Pair Share

Think of the PBIS pyramids:

Primary Prevention/Intervention

Secondary Prevention/Intervention

Tertiary Prevention/Intervention

“ Thank you, partner.”

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Anxiety and Related Disorders

Brain-based Activity

• Talk about a time you worked with a child who appeared to be anxious and afraid.

• How did the child behave and how did you feel?

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Defining Anxiety Anxiety disorders are a health condition that

involves hyperarousal of the central nervous system and creates intense feelings of fear, worry or apprehension.

Sometimes children’s anxiety is very general; at other times, it may be associated with specific situations, events or objects.

Introduction to Children’s Mental Health: An Overview of Anxiety, Depression, Attention and Behavior Disorders (MDE, 2004)

Mood Changes

Cognitive ChangesPhysical Changes

The Full Effect of Anxiety

Interpersonal Relationships

Performance

Behaviors

Dr. L. Read Sulik

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Anxiety: Mood Changes Signs and Symptoms

• “Fight-or-flight” response

• “Freeze or shut down”

• Quick to anger• Fearful/panicky• Excessive worry

• Low tolerance for frustration

• Irritability • Looks terrified• Sadness• Hypersensitivity/feelings

easily hurt

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Anxiety: Cognitive Changes Signs and Symptoms

• Sluggish thinking/slow to participate

• Avoids or does not complete tasks

• Memory difficulty• Difficulty concentrating• Lack of confidence in skill

and ability/gives up easily

• Automatic negative thinking• Excessive worry about

• homework

• grades

• assignments

• tests

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Anxiety: Physical ChangesSigns and Symptoms

• Chest pain, increased heart rate, chills, trembling, profuse sweating

• Shortness of breath • Abdominal distress• Hypersensitivity to

environmental stimuli (e.g. lights, sound, touch, smells)

• Flat affect/appears detached

• Cries frequently

• Avoids group functions/isolates self

• Frequent absences• Fatigue• Nightmares, sleep

disruption• Dry mouth, dizziness,

nausea, diarrhea• Aggressive actions• Obsessions and

compulsions

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Anxiety and the Brain

Brain Scans (Neuro-imaging)

• MRI - Magnetic Resonance Imaging

• fMRI - Functional Magnetic Resonance Imaging

• PET - Positron Emission Tomography

• SPECT - Single Photon Emission Computer Tomography

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Anxiety: Parts of the Brain

Basal Ganglia (bay-zul gang-lee-ah)

Large structures deep within the brain that control the body’s ability to remain calm. When this part of the brain works too hard, disorders in the anxiety spectrum result.

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Anxiety: Parts of the Brain

Cingulate Gyrus (sing-you-let ji-rus)

A part of the brain that runs longitudinally through the middle part of the frontal lobes; it functions as the “switching station” of the brain. It allows a child to shift attention from thought to thought and between behaviors.

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Anxiety: Neurochemicals/Hormones

Serotonin - promotes sense of well-being

Dopamine - promotes sense of excitement

Norepinephrine - stimulates energy and enthusiasm

Cortisol - stress hormone that impedes flow of “good” neurochemicals

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Interventions for Home

Play soft music.Teach calming techniques.

Music and art lessons Build on child’s strengths and interests.

Spend time together doing things you both enjoy.

Strengthen parent/child relationship.

Snack time/short break between chores

Provide frequent breaks.

Add more steps to tasks as child demonstrates proficiency.

Gradually increase responsibilities.

Ask child to complete one step of a more complex job.

Modify home tasks.

Good nutrition, exercise, regular sleep

Promote self-care.

Post on the refrigerator.Keep a regular schedule.

Examples:Interventions:

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School-wide Interventions

PLC group book study, “Worry” by Hallowell and Ratey

Professional Learning Community

(PLC)

Teaching responsible behaviorsCharacter education

“Early Warning Signs” trainingBuild community awareness.

MACMH Poster

www.macmh.org

Positive mental health posters/ signage

Circles of Courage Post-school values and philosophy

Peacemaking circlesRestorative practices

“Bully-Free School”School theme

“Skillstreaming” (Goldstein)Social skills curriculum

Ask peers to be study buddies.Peer mentoring programs

Examples:Interventions:

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Classroom Interventions

Prepare students for changes.Maintain daily schedule.

Notice and comment on the small improvements.

Reward small successes.

“Who learned something today?”Check for understanding.

Daily check-inCreate classroom rituals.

Regular stretching/brain-based activities

Utilize movement.

Cooperative group activitiesLow competition/cooperative environment

Segment assignments/reduce quantity not quality

Modify workload.

Negotiate due dateFlexible deadlines

Examples:Interventions:

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Interventions for Individuals

Avoid saying “no” as first word in adult response.

Respond positively to negativity.

Ask child privately about his/her understanding of assignment.

Check for understanding.

Experiential brain-based activities, i.e., soothing statements, koosh balls, movement

Teach relaxation techniques.

Color coded folders or one folder for everything

Develop an organizational system for the individual child.

Oral, written or media reportsAlternate mastery demonstration

Allow best effort to be scored.Allow re-takes and re-dos.

Rotate classroom duties.Promote low-risk leadership.

Peer coach/buddyConflict resolution support

Individual time spent with student Develop a supportive relationship.

Examples:Interventions:

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Intervention Considerations and Wrap-up

Brain-based Activity• Refer to the anxiety case studies (Maria, Naim,

Joey).

• Design an intervention plan for each of these children, choosing two interventions for either home, school, classroom or the individual child.

• Note at least one cultural consideration, as relevant, for each child.

• Volunteers may share their plan with the large group.

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Case Study #1

Maria, a Hispanic girl, age 13

• Worries about her grades• Believes that peers think she is stupid• Does not want to go to school• Thinks that nobody likes her• Has trouble sleeping• Complains of stomachaches

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Case Study #2

Naim, a Liberian boy, age 8

• Witnessed family being murdered in Liberia• Has been in the United States for three months• Hides under desks when bell rings• Talks to imaginary people• Thinks a classmate is stalking him• Is easily startled• Leaves school when faced with fearful situations

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Joey, a Caucasian boy, age 5 months

• Born under stressful birth conditions• Family history of anxiety disorders• Fussy, difficult baby• Has trouble sleeping through the night• Easily startled• Body stiffens when he is held• Low socioeconomic living situation-frequent

unemployment, no insurance at times• Typical medical causes for symptoms have been

ruled out

Case Study #3