Youth with Mental Health Disorders: Building Skills for

Success

2011 Pennsylvania Community on Transition Conference

Elizabeth Coyle, D.Ed.Professional Development Services717-871-1396

Overview• Skill Building for

Youth 1. Mood Disorders

2. Anxiety Disorders

3. ADHD

4. Oppositional Defiant Disorders

5. Conduct Disorder

Mood Disorders: Categorization Mania (rare) Cyclothymia (unknown) Dysthymia (1.7%-8%) Depression (4%-8.3%) Bipolar (1%-2%)

http://www.youtube.com/watch?v=QLxFSiKXYko

General Do’s and Don’tsfor All Mood Disorders

• Do recognize your role (identification, referral, classroom interventions, balance concern with confidentiality)

• Do recognize your sphere of influence

• Do treat the same as a physical illness

• Don’t take behavior personally

• Don’t blame • Don’t expect change

to happen overnight• Don’t take on

responsibility beyond your role

Family Awareness and Collaboration•Understand sources of

denial/minimization▫Stigmas▫Lack of information/education/awareness

•Comparisons to physical illness•Need for correct type of therapy

Depression: Signs and Symptoms Depression in the flight mode

Withdrawn, low energy, changes in sleeping/eating, somatic complaints, difficulty concentrating

Depression in the fight mode Irritable, belligerent, aggressive, mood

swings, short fuse, defiant

Links Between Depression and LearningDepression and neurochemicalsImpact on short- and long-term memoryImpact on motivation and potentialImpact of behavioral changes on learningImpact of emotional changes on inclusion and sense of belonging

School-Wide Supports School counselors, social

workers, nurses, psychologists

SAP

504 plans

IEP

Mentors

After school activities

Depression: Responses• Serotonin

▫ Motion and movement, walking clubs, yoga, chunking, feeling of day portfolio

• Interpretation▫ Columbo approach, teach reading of non-verbals, feeling faces

• Mourning▫ Feeling of the day art or audio, support groups

• Flight motivators▫ Helping others of a younger age, projects

• Fight response▫ Head talk and cool talk, anger management skills

DysthymiaDepressed or irritable mood plus at least

two of the following symptoms: poor appetite or overeating; sleep disturbance; low energy or fatigue; low self-esteem; concentration or decision making problems; feelings of hopelessness

Less severe than depression but more prolonged (at least one year)

Connection to apathy and motivationhttp://www.youtube.com/watch?v=R4yM

HVNzVgA

Anxiety Disorders: Eight Categories

•Generalized anxiety disorder•Specific phobias•Panic disorder•Separation anxiety•Social phobia•Agoraphobia•Obsessive compulsive disorder•Post traumatic stress disorder

Common Threads of Anxiety Disorders•Subjective experience

•Physiological response

•Behavioral response

School Supports

Do’s Don’ts

• Use paraphrasing to support concern

• Empower youth for solutions

• Use recommendations from pupil personnel and/or mental health professionals

• 504 plans, SAP, RTII, school nurse

• Minimize fears, worries, anxiety

• Assume behavior is for attention

• Overwhelm

• Proceed without input from pupil personnel and/or mental health professionals

Collaborating with Families• Recognize family member may experience

anxiety also (genetic predisposition links)• Recommend exposure to anxiety-producing

situation in planned way• Produce plan with responsibilities of all parties

specified• Emphasize no more than two or three calming

techniques ▫Sufficient sleep, diet, exercise, routines▫Soup breathing, head talk, self evaluation

• Emphasize need for adults to remind younger children to use technique(s) when feeling anxious

COPE Intervention for Anxiety Disorders (Dacey and Fiore)•Calming the nervous system

▫Physical: soup breathing; sensory awareness; exercise; supportive surfaces; massage; biofeedback; desensitization

▫Mental: paradoxical thinking; scaling level of fear; visualizing desired outcomes; distraction through counting; humor

COPE Intervention for Anxiety Disorders (Dacey and Fiore)•Originating an imaginative plan

▫Flexibility thinking exercises, learning to think out of the box, creating wildly imaginative stories, approximation

•Persisting in the face of obstacles ▫Increase tolerance for ambiguity, taking

moderate risks, learning about courage from literature, allow crying that promotes relief, promoting delayed gratification

•Evaluating and adjusting plan

Attention Deficit Hyperactivity Disorder

•Three subtypes1. Inattentive

2. Hyperactive/impulsive

3. Combined type

Attending/Distractibility• Determine if youth is a “satellite dish” or fogs

in/out• Proximity, then “Look around you, what do you

need to be doing?”• You’re off track!• Create map of sounds, sights, tactile• Determine seating based on map• Cue to mode of distractibility• Use head talk method• Cautionary note on reliance

Impulsive

•Missing skill: Stop and think•Power minutes•Cue for calming techniques•Use of head talk method•You could say to yourself, “???”

Activity Levels• Build in motion and movement

▫ Neurodevelopmental activities▫ Desktop yoga▫ Brain gym▫ Use of board more frequently▫ Transition methods

• Same use of calming techniques▫ Breathing▫ Power minutes▫ Breaks▫ Head talk

Opposition/Defiance•Loses temper easily•Argues with adults•Defies adult requests•Deliberately annoys people•Excessive use of foul language•Blames others for mistakes/behavior•Touchy/easily annoyed by others•Often angry and resentful•Spiteful or vindictive

Opposition/Defiance Response

•Opposition▫Basket A, B, C▫Pick the hill▫Confident non-verbals▫Two choices NOW▫Few words then silence▫Allow time to process▫Ace card approach▫Rapport and humor

Opposition/Defiance Response

•Transitions▫Social stories▫Two-step transitions

•Decision making ▫Red or green

Opposition/Defiance: Teach Missing Skills

•Opposition/defiance

▫Flexibility

▫Frustration tolerance

▫Adaptability/self regulation

▫Problem solving

Flexibility•Cognitive flexibility

▫Ability to shift attention from one idea/issue to multiple ideas/issues

Cognitive Flexibility Theory

Frustration Tolerance•Ability to delay gratification

▫Distraction, head talk, social support•Outcomes

▫Buffers against development of mental health issues, reduces aggressive behavior, increases academic achievement

•Mischel’s marshmallow experiment•http://www.youtube.com/watch?v=wWW1

vpz1ybo&NR=1

Adaptability/Self Regulation

•Self regulation ▫The process by which individuals control and direct their actions▫4 types of self regulation

Physiological Emotional Attentional Behavioral

•Adaptability

Collaborative Problem SolvingRoss Greene

•Three options for solving problems (unmet expectations)▫Plan A: impose will▫Plan B: Collaborative Problem Solving▫Plan C: drop expectation

•http://www.youtube.com/watch?v=6xkVT2y9euI

Collaborative Problem SolvingRoss Greene•Empathy (student concern)

▫I notice that…. What’s up? Drill….•Define problem (adult concern, i.e.,

safety, learning, impact of behavior on self and others)

•Solution addressing both concerns▫www.livesinthebalance.org

•http://www.youtube.com/watch?v=ARIEXN1yf00&feature=related

Conduct Disorder•Aggression to people/animals

▫Bullies/intimidates, physical fights, threats with weapon, physically cruel to people/animals, stolen while confronting a victim, forced someone into sexual activity

•Destruction of property▫Deliberately destroys property, fire setting

•Deceitfulness or theft▫Lies to obtain goods/favors, breaking/entering,

shoplifting•Serious violation of rules

▫Truant, run away, stays out at night

Conduct Disorder Response

•Use back door praise

•Use healthy double binds

•Use contracts

•Highlight strengths

Behavior ContractWhat happened? What I plan to

think and say instead is:

What’s in it for me if I follow the plan?

Conduct Disorder: Teach Missing Skills•Problem solving

Agree, listen, solve

Fair fighting rules Stick to the issue Stay in here & now No low blows

Conduct Disorder: Teach Missing Skills•Skill building

▫Anger management Trigger, interpretation, head talk/cool talk,

calming techniques, problem solve

▫Correct attribution bias Hostile or accidental Cynthia Hudley

▫Futuristic thinking Dreams, wishes, age of death?

Evidence-Based Programs for Skill Building•Cynthia Hudley’s Brain Power Program to

reduce hostile attribution bias that contributes to aggression

•http://www.brainpowerprogram.com/index-1.html

•Mark Greenberg’s PATHS Program that builds social/emotional skills

•http://www.colorado.edu/cspv/blueprints/modelprograms/PATHS.html#video

Evidence-Based Programs for Skill Building•Second Step Program for building anger

management skills•http://www.cfchildren.org/programs/ssp/

second-step-video-previews-1/•Arnold Goldstein’s Skillstreaming •http://www.skillstreaming.com/

Wrap-up

•What I will start/continue doing▫________________________________________________

____________________________________________________________________________________________________

•What I will stop doing▫________________________________________________

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Useful Resources: Depression and Anxiety Anxiety Disorders

Association www.adaa.org

National Institute of Mental Health www.nimh.nih.gov

Mayo Clinic www.mayoclinic.org

American Academy of Childhood & Adolescent Psychiatry www.aacap.org

Family-friendly sites worrywisekids.org kidshealth.org socialphobia.org

Your Anxious Child by John Dacey and Lisa Fiore

School Refusal: Assessment and Intervention within School Settings by Mary Wimmer

Useful Resources: Behavioral Issues• Greene, R. (2008). Lost at school.• Greene, R. (1998). Explosive child.• Lawrence-Lightfoot, S. (2003). The essential

conversation: What parents and teachers can learn from each other.

• Stutzman, A., et al. (2005). Restorative discipline for schools: Teaching responsibility; creating caring climates.

• Watson, M. (2003). Transforming difficult elementary classrooms through developmental discipline.

Useful Web Sites•www.teacch.com•www.templegrandin.com•www.thegraycenter.org•www.conductdisorders.org•www.childtruama.org•www.livesinthebalance.org•www.aacap.org•www.nimh.nih.gov•www.mayoclinic.org