They don’t understand!: Helping students with emotional and mental health disorders succeed in the classroom Richard Van Acker, Ed.D. University of Illinois

They don’t understand!: Helping students with emotional and mental

health disorders succeed in the classroom

Richard Van Acker, Ed.D.University of Illinois at Chicago (M/C 147)

1040 W. HarrisonChicago, Illinois 60607

(312) [email protected]

Mental Health Disorders

• Mental health problems cause major changes in a person’s thinking, emotional state, and behavior. Mental health disorders disrupt a person’s ability to work and to carry out their usual personal relationships. These problems impede the individuals ability to accurately perceive and/or process information (sensory input, language, etc.)

Functions of the Brain impacted by mental health disorders

BEHAVIOR

PHYSICAL OR SOMATIC

SIGNALING (BEING RESPONSIVE AND REACTING TO THE ENVIRONMENT)

EMOTION OR FEELINGS

PERCEPTION OR SENSING

THINKING OR COGNITION

Mental Distress vs. Disorder Distress

• A response to environmental challenges

• May be adaptive• Usually short-term – does not

significantly impair functioning• Should not be ‘diagnosed’.• Usually does not require

professional intervention

• Usually responds well to ‘typical’ support and positive life-style activities

Disorder

• Onset not tied to environmental challenges

• Frequently long-term and impairs functioning

• Must meet recognized diagnostic criteria

• Frequently requires professional intervention

• Usually responds well to evidence-based interventions

• Usually helped by appropriate supports and positive life-style activities

20%20%

Seriousness of the Problem

Prevalence of Emotional Behavioral Disturbance (EBD)

9-13%

Population Proportions (9 to 17 year-olds)

5-9% Youth with EBD & extreme functional impairment

9-13% Youth with EBD, with substantial functional impairment

20% Youth with any diagnosable disorder

5-9%

Common Mental Health Concerns

Population as a Whole

• Depression – 6%• Psychosis – 1%• Anxiety Disorders – 10%• ADHD - 4%• Anorexia Nervosa – 0.2%

• Total - 15 – 20 %

Translation to the ‘average’ classroom

• Depression – 2 students• Psychosis – rare• Anxiety Disorders – 3 students

• ADHD – 1 student• Anorexia Nervosa – rare

• Total – 4 – 5 students

Four Most Problematic Disorders for School Personnel

• Reactive Attachment Disorder

• Bi-Polar Disorder

• Attention Deficit Hyperactivity Disorder

• Oppositional Defiant Behavior

Time of Initial Occurrence for Common Behavior Problems

Birth 6 years 12 years 18 years

Learning Disorders

Conduct Disorder

Oppositional Defiant Disorder

Attention Deficit-Hyperactivity Disorder

Language Disorders DepressionAutismRett SyndromeAsperger’s SyndromeReactive Attachment Disorder

SchizophreniaDrug abuseBulimiaAnorexia nervosa

Wicks-Nelson & Israel, 2003

Emotional and Behavioral Disorders

Compliance Problems Bi-Polar

Time of Initial Occurrence for Common Behavior Problems

Birth 6 years 12 years 18 years

Learning Disorders

Conduct Disorder

Oppositional Defiant Disorder

Attention Deficit-Hyperactivity Disorder

Language Disorders DepressionAutismRett SyndromeAsperger’s SyndromeReactive Attachment Disorder

SchizophreniaDrug abuseBulimiaAnorexia nervosa

Wicks-Nelson & Israel, 2003

Emotional and Behavioral Disorders

Compliance Problems Bi-Polar

Reactive Attachment Disorder• Reactive attachment disorder (RAD) is a condition

found in children who have received grossly negligent care and do not form a healthy emotional attachment with their primary caregivers -- usually their mothers -- before age 5.

• This can occur for many reasons, including:– Persistent disregard of the child's emotional needs for

comfort, stimulation, and affection – Persistent disregard of the child's basic physical needs – Repeated changes of primary caregivers that prevent

formation of stable attachments (for example, frequent changes in foster care)

There are two types of RAD: inhibited and disinhibited.

• Common Symptoms of Inhibited RAD Include:– Detached – Unresponsive or resistant to comforting – Excessively inhibited (holding back emotions) – Withdrawn or a mixture of approach and avoidance

• Common Symptoms With Disinhibited RAD Include:– Indiscriminate sociability – Inappropriately familiar or selective in the choice of

attachment figures

Why IS Attachment Important?

• Attachment is essential for the formation of a healthy personality which includes:– Development of a conscience– Ability to become self-reliant– Ability to think logically– Ability to cope with frustration and stress– Ability to handle fear or threat to self– Development of relationships

Symptoms Displayed by Individuals with RAD

• Lack of self-control / impulsive

• Speech and language delays

• Lack of conscience / shows no remorse

• Indiscriminately affectionate with strangers

• Avoids physical contact

• Hyperactive

Symptoms (Cont.)

• Aggressive

• Destructive towards self, property, and others

• Food issues: hordes, gorges, refuses to eat, and/or hides food

• Often “on guard” – anxious, wary

• Prefers to play alone

• Inhibition or hesitancy in social situations

School Implications

• Children with RAD have difficulties self-regulating emotions and behaviors

• These children struggle to form typical, reciprocal relationships with peers and adults

• Self-regulatory and social skills are important prerequisites for school readiness and academic achievement

The Unique School Challenge for Children with RAD

• While the school setting is meant to educate, children with RAD are primarily concerned with internal feelings of safety, security, and trust

• Greater degree of dependency on the teacher due to past disruptions in attachment (learned helplessness, and difficulty shifting between teachers)

How can Teachers Help

• Be consistent, predictable, and repetitive• Set clear, concise expectations• Set and follow a classroom routine• Model and teach appropriate social

behaviors• Maintain realistic expectations• Ignore ‘junk behaviors’ – behaviors that

are not harmful to the child, others ot to property

How Teachers Can Help (Cont.)

• Be patient with the child (and yourself)

• Understand behaviors – attempt to promote and reinforce desired behaviors – punishment per se is ineffective

• Help the child learn to regulate his/her feelings and actions

• Utilize other resources for support (related services providers, the internet, etc)

Bi-polar Disorder

• Bipolar disorder can be described as a psychiatric diagnosis of mood disorders.

• The condition is defined by presence of 1 or more episodes that results from elevated energy levels, cognition, and mood imbalance such as depression episodes.

Bipolar Disorder

• Symptoms of bipolar disorder include:– mania, – hypomania, – depression, – racing thoughts, – sleep disturbances, – delusional or grandiose thinking, – hypersexuality and– risky behavior with no regards for the

consequences.

Accommodations for Individuals with BI-Polar Disorder (Lesley, 2009)

• Delivering praise and positive reinforcement• Provide counseling to them or referring them to

counselors for assistances• Offering peer assistance incentives and programs• Decreasing distractions in school• Provide frequent breaks when working • Provide them with self-paced instruction, ‘chunked’

assignments, and flexible scheduling• Provide clear, simple choices for desired behavior• Keeping open channels of communication with them.

School Accommodations (Cont.)• Provide Structured Classroom Settings – Students with Bipolar Disorder

need to be in classrooms with high structure and predictability. This helps offset their cognitive and emotional impairments. The educational atmosphere of organization allows them to feel safe and accepted within their environments.

• Accommodations – For short attention span, high activity level, organizational difficulties (e.g., frequent breaks; movement built into the classroom schedule; use of fidgets, lap buddies, etc.; highly structured routines; predictability; visual supports, such as visual schedules, visual organizers for writing; use of computer technology, software/keyboarding.

• Stress Management– Help the student to recognize internal states, use stress reduction techniques.

• Problem Solving Skills – Focus on teaching effective strategies for dealing with frustration and negative thinking. Help them develop a plan such as establishing a "cool down" or safe place to go when feeling upset

Attention Deficit Hyperactivity Disorder

• ADHD is a disorder characterized by the symptoms of hyperactivity, inattention, and/or impulsivity that are more frequent and severe than is typically seen in one's peers

ADHD - Inattentive Symptoms

• Fails to give close attention to details or makes careless mistakes in schoolwork

• Has difficulty keeping attention during tasks or play• Does not seem to listen when spoken to directly• Does not follow through on instructions and fails to finish

schoolwork or chores and tasks• Has problems organizing tasks and activities• Avoids or dislikes tasks that require sustained mental

effort (such as schoolwork)• Often loses toys, assignments, pencils, books, or tools

needed for tasks or activities• Is easily distracted• Is often forgetful in daily activities

ADHD - Hyperactivity Symptoms

• Fidgets with hands or feet or squirms in seat• Leaves seat when remaining seated is expected• Runs about or climbs in inappropriate situations• Has problems playing or working quietly• Is often "on the go," acts as if "driven by a

motor"• Talks excessively

ADHD- Impulsivity Symptoms

• Blurts out answers before questions have been completed

• Has difficulty awaiting turn

• Interrupts or intrudes on others (butts into conversations or games)

ADHD and the Brain

• Cortex of the brain is significantly thinner in people with ADHD – especially in the frontal lobe areas of the brain.– Less risk inhibition– Poor attention

• Immaturity in specific brain structures in the limbic system - the inhibitory system regulating arousal and reward.

Accommodations for ADHD• Helping children with ADD/ADHD follow directions means taking measures to break

down and reinforce the steps involved in your instructions, and redirecting when necessary.

• Seat the child with ADD/ADHD away from doors and windows. Put pets in another room or a corner while the student is working.

• Alternate seated activities with those that allow the child to move his or her body around the room. Whenever possible, incorporate physical movement into lessons.

• Write important information down where the child can easily read and reference it. Remind the student where the information can be found.

• Divide big assignments into smaller ones, and allow children frequent breaks.

• Reducing the interruptions of children with ADD/ADHD should be done carefully so that the child’s self-esteem is maintained, especially in front of others. Develop a “secret language” with the child with ADD/ADHD. You can use discreet gestures or words you have previously agreed upon to let the child know they are interrupting.

In children with Oppositional Defiant Disorder (ODD),

• …there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the youngster’s day to day functioning. Symptoms of ODD may include:

– Frequent temper tantrums – Excessive arguing with adults – Often questioning rules – Active defiance and refusal to comply with adult requests and

rules – Deliberate attempts to annoy or upset people – Blaming others for his or her mistakes or misbehavior – Often being touchy or easily annoyed by others – Frequent anger and resentment – Mean and hateful talking when upset – Spiteful attitude and revenge seeking

ODD and the Brain• The development of oppositional defiant disorder is associated

with changes in the neurotransmitters of the brain.

• Neurotransmitters are chemical transmitters of impulses between nerve cells.

• Raising or lowering the level of neurotransmitters (i.e., deviation from the norm) leads to a sudden change in mood and changes in the thinking process because of impaired transmission of nerve impulses.

• That’s why people with ODD have:– a sense of irritation, – they have no fear of punishment, – they often cannot adequately perceive the reality and communicate

normally,

External Factors Impacting the Development of ODD

• The major familial external factors that contribute to the development of ODD disorder: – domestic violence, – abuse (physical or sexual abuse), – indifference of parents, – disastrous financial situation (poverty), or poor quality

of life, – drug and alcohol use by parents.

• The major school-based external factors include:– excessive punishment or punishment for behavior

outside the control of the student,– abuse by adults and peers, and/or– Indifference on the part of teachers

Treatment• Typically multimodal treatment involving:

– Medication – (e.g., anti-depressants, mood elevators, anti-anxiety medications, stimulant medications).

– Behavioral Interventions – clear expectations and predictable contingencies designed to reduce problem behaviors and to facilitate student success.

– Cognitive Behavioral Interventions – (e.g., self-regulation, attributional retraining, cognitive restructuring)

World Health OrganizationModel for School Mental Health Promotion

Professional Treatment

Psycho- SocialInterventions

Mental Health Education –Knowledge, Attitudes and Behavior

Positive and Supportive School ClimateRealistic expectations for all students

Academic and social emotional support

Part of General Curriculum

Students needing Additional Mental Health Treatment

All Teachers and Students

The Entire School Community

Whole School Environment

Students needing Additional Help

3-12%

20-30%

Failure of school personnel to understand the complex nature

of behavior

Culture

Needs and Desires

Disability

Habit

The Functional Assessment of Behavior

• The identification of the target behavior• An informed hypothesis as to function of the behavior• Data collection

– Indirect data collection

– Direct data collection

• Verification -– Triangulation of data

– Functional analysis of behavior

• Developing the behavior intervention plan– Program to decrease undesired behavior

– Program to increase desired alternative behavior

• Monitoring the implementation and evaluation

Behavior Problems can Occur for many different reasons:

• Attention• Escape• Tangible reward• Peer Affiliation• Justice or Revenge• To communicate intent - if

language impaired– Indicate physical discomfort– Indicate frustration or need for help

• Sensory/Perceptual Needs– Stereotypic or self-injurious – Sensory input needs

• Knowledge deficits– Does not know what is

expected• Not enough practice of skill

– Has not learned to generalize skill

(Modified from: Neal & Cessna, 1993)

Maslow’s Hierarchy of Needs

Self-Actualization

Self-EsteemAchievement

Belonging / Love

Safety

Physiological Needs (Food, water, clothing for warmth, touch)

Careful Observation to Identify Triggers

• Often as one of the people who spends the most time directly interacting with a student, you may quickly become aware of when a student moves away from his or her typical or ‘baseline’ behavior.

• This may be signaled by an increase or a decrease in behavior.

• A critical skill in working with children like Robbie is to be good at observing triggers that may serve to move a student into a potential crisis situation.

Understanding the Crisis

Trigger

Escalation

Crisis

De-escalation

Hangover/Recovery

Agitation

Adapted from: Managing the Cycle of Acting-Out Behavior in the ClassroomBy Dr. Geoff Colvin


Trigger

Escalation

Crisis

De-escalation

Hangover

Student Cognition

Agitation


Trigger

Escalation

Crisis

De-escalation

Hangover

Staff Movement

Away from Self Control

Student Cognition

Agitation


Trigger

Escalation

Crisis

De-escalation

Hangover

Staff Movement

Away from Self Control

Student Cognition

Staff Cognition

Agitation


Trigger

Escalation

Crisis

De-escalation

HangoverArea of Greatest

Influence

Agitation

Let’s Think About a Student• Randy is a freshman

•Randy and his family have recently moved into the school district from another urban school district (Dade County Florida – Miami).

•Randy is a very reluctant learner.

•At times, Randy can become disruptive to the classroom setting.

•Randy seldom completes the assigned work and almost never does homework

• The classroom teacher has assigned the class to read the next 6 pages in the Social Studies text and to answer the questions at the end of the chapter.

• Randy starts to try and do the lesson. He begins to look upset. He is displaying increased movement and he is starting to look around the room and to divert his attention from the task. He mumbles to himself and starts to actively protest that, ”This shit is stupid. Nobody cares about this crap.”

• The teacher moves towards Randy and asks if everything is okay?• Randy says, “I don’t know why we can’t do this as a class or with partners.

This is really boring!”• The teacher says, “I know you can do this if you try – just do your best”• Randy says, “I hate this shit!”• The teacher says. “Randy you need to watch your language. You can not

cuss in this classroom.”• Randy says, “Don’t tell me what I can and can not do. You aren’t my boss!”• The teacher says, “Randy, we have to all get along and do what is asked of

us – otherwise the classroom just won’t work.”• In a loud voice, Randy says, “I’m tired of this bullshit. I hate this f___king

class.” Randy starts to get up to exit the classroom.• The teacher steps in his way (to block his exit) and says, “Sit down right

now and do what I have asked you to do! Stop swearing!”• Randy says, “F__k you! I am out of here!”• The teacher moves towards Randy and grabs his arm – attempting to move

him back to his seat.• Randy shakes her hand off of his arm and pushes past her – exiting the

classroom.

Additional Information

• Randy is a student with both learning and emotional disorders (Anxiety Disorders).

• He can become overwhelmed very easily and often becomes frustrated and will either simply ‘shut down’ or he will become argumentative (loud protests and threats to hurt others or to leave the instructional area).

• The text is written at the 9.4 grade level. Randy has 4.3 grade level decoding skills and even lower levels of reading comprehension.

DebriefingStudent Behavior

Staff Behavior Escalate

Neutral

Reduce

Options



Neutral

Reduce

Options

Teacher assigns 6 pages to read



Neutral

Reduce

Options


Starts to look agitated – This shit’s stupid



Neutral

Reduce

Options



Is everything ok?



Neutral

Reduce

Options



Is everything ok?



Neutral

Reduce

Options



Is everything ok?

Why not do this as a class, partners – This stuff is boring.



Neutral

Reduce

Options



Is everything ok?


Try – Do your best



Neutral

Reduce

Options



Is everything ok?





Neutral

Reduce

Options



Is everything ok?



I hate this shit.



Neutral

Reduce

Options



Is everything ok?



I hate this shit. Watch your language – can’t cuss



Neutral

Reduce

Options



Is everything ok?






Neutral

Reduce

Options



Is everything ok?




Don’t tell me what to do – you are not my boss



Neutral

Reduce

Options



Is everything ok?





We have to get along or school won’t work



Neutral

Reduce

Options



Is everything ok?








Neutral

Reduce

Options



Is everything ok?






Tired of this bullsh_t, I hate this f_cking class



Neutral

Reduce

Options



Is everything ok?







Stop swearing – Sit down right now – Blocks exit



Neutral

Reduce

Options



Is everything ok?










Neutral

Reduce

Options



Is everything ok?








F_ck you! I am out of here – starts to exit



Neutral

Reduce

Options



Is everything ok?









Teacher grabs his arm and attempts to guide him to seat



Neutral

Reduce

Options



Is everything ok?












Neutral

Reduce

Options



Is everything ok?










Shakes her arm off - He pushes past teacher - exits


Trigger

Escalation

Crisis De-escalation

Hangover

Reading Level

You can do it if you tryWatch your language

Teacher blocks escape

Need to do what is asked

Teacher grabs his arm

Agitation

Looking for a ‘Win-Win”

Trigger

Escalation

Crisis

De-escalation

Hangover

Agitation

What would have been some options to help engage Jason in study of cell structure?

1.

2.

3.

Does anyone speed when you drive?

• Are there places you don’t tend to speed?

• Generally has more to do with the likelihood of being caught than the nature of the fine.

Simple Consequence to Reduce High Rate

Behaviors

Library Envelope System

• Make one library pocket card for each student

Joe

Mary

Scott

SarahAaron

Number of cards based on baseline data – student need.

Lashika

Randy Lashonda

Anita

Free ticket 2-3 minute delay to recess or passing

Detention loss of recess

Selecting Consequences

• Should develop, maintain, or maximize the relationship between the student and teacher.

• Should allow student to learn an alternative pro-social behavior.

• Should allow student to practice the alternative behavior.

• Should be rather quick and simple to apply.

• Should minimize student resistance.

Cognitive Behavioral Intervention

• CBI focuses on two general areas:– Cognitions – target the student’s private

speech about himself, the environment, and his future. Explores beliefs and attitudes.

– Behaviors – targets specific behaviors that tend to reinforce or trigger maladaptive, dysfunctional or irrational thoughts, beliefs and attitudes.

Cognitions Behaviors

Strives to have the student intervene on his or her own behavior.

Self-Regulation/Self-Control

• Self-monitoring – the ability to collect data or otherwise identify one’s own thoughts and behavior.

• Self-evaluation – to be able to judge one’s performance accurately against some standard of performance.

• Self-reinforcement – the ability to deliver self-praise or a reward contingently on the display of a specified desired behavior.

Commonly used materials and resources

Cognitive techniques• Emotion thermometer 10

9

8

7

6

5

4

3

2

1

0

Really scared or upset

Pretty scared or upset

Not at all scared or upset

A little bit scared or upset

Ask for help.

Take a break.

Count to 10 slowly.

Take a few deep breaths.

Self-praise

Student Recommended for CICO

CICO Implemented

ParentFeedback

Regular Teacher Feedback

AfternoonCheck-out

Morning Check-in

CICO CoordinatorSummarizes Data

For Decision Making

Bi-weekly Meetingto Assess Student

Progress

Graduate Program

ReviseProgram

Student: ___________________ Teacher: ________________ Date:________Subject Area

Behavior Scoring Rubric SocStud

Math Science Reading

Uses Kind words and actions

Displays kind and welcoming behavior towards othersTeases, taunts or displays rude or disrespectful behavior towards othersThreatens harm or displays verbal/physical aggression towards others

410

410

410

410

410

410

410

Active Task Engagement On-task more than 85% of the intervalOn task more than 50% but less than 85% of the intervalOn-task more than 10% but less than 50% of the intervalOn-task less than 10% of the interval

3210

3210

3210

3210

3210

3210

3210

Follows Teacher Directives Spontaneously complies to at least 90% of teacher directivesVerbally protests but complies to at least 90% of directivesFails to comply to at least 25% of directives but does not engage in problem behaviorFails to comply to at least 25% of directives and engages in problem behavior

4210

4210

4210

4210

4210

4210

4210

Stays in the Assigned Area Exits the classroom without permission (any time during interval)Out of seat or assigned area and fails to comply with initial request to returnRemains in the seat or assigned area throughout the intervalOut of seat or instructional area but returns the first time asked

4210

4210

4210

4210

4210

4210

4210

Work Completion Work completed with reasonable level of effort (Not concerned with accuracy or neatness at this time)Effort expended at a reasonable level but work not completedLittle or no work attempted

420

420

420

420

420

420

420Comments:

Self-Instruction Training (Meichenbaum & Goodman 1971)

• Cognitive Modeling – the teacher performs a task while talking aloud; the student observes.

• Overt External Guidance – The student and teacher both perform the task while talking aloud together.

• Overt Self-Guidance – The student performs the task using the same verbalizations as the teacher (talk together).

• Faded Self-Guidance – The student whispers the instructions (often in an abbreviated form) while going through the task.

• Covert Self-Guidance – The student performs the task, guided by self-speech.

Five Common Irrational /Dysfunctional Thoughts

• Arbitrary Inference – the drawing of a conclusion when evidence is lacking or actually supports a contrary conclusion.

• Magnification – exaggeration of the meaning of an event.

• Cognitive deficiency – disregard for an important aspect of a life situation.

• Dichotomous Reasoning – overly simplified and rigid perception of events as good or bad, right or wrong.

• Overgeneralization – taking a single incident such as a failure as a sign of total incompetence and in this way generalizing a fallacious rule.

Ethical Dilemma of Teachingin Today’s Classroom

• The rise in the demand for greater accountability for student academic excellence has increased the anxiety level of both teachers and students.

• Increase in the display of mental health symptoms within the school setting.– Increased levels of frustration and fear.– Increased levels of student failure.

Schools as Mental Health Service Providers

Service Provider Arrangement

School Relationship

Provider Type Services Barriers

Special Education Hired by school or school district

School Psychologists

Special Education Testing, IDEA implementation

Time spent on testing, not accessible to all students

Stand Alone School Program

School or school district hires providers or program

Social Workers, child psychologists, teachers

Counseling, Interventions for specific mental health issues

Stigma, Time, Program cost

Community Linked School or school district contracts with organization for the provision of services

Social Workers, child psychologists, psychiatrist, crisis counselors

Varied – crisis/ as needed to comprehensive mental health services

Not linked to other school services, providing as needed does not address issue of lack of services

Other Service Provider Options

May occur on school premises but not during school hours

Varied Varied Not always linked to school services, may not reach all needy children

School Based Health Centers

Located at or near schools

Varied Varied Funding and space

Mental Health Problems are Real!• They impact the student’s ability to

process information and to make rational decisions when disorder is displayed.

• Most teachers have no problem understanding that the nature of the demands they place on a student change when he is physically ill (e.g., having just thrown up or displaying a high fever).

• These same teachers often do not understand the need to address the student in a different manner when their mental health disorder is impacting the student’s behavior.

Embedding Cognitive Behavioral Strategies Across the School Day

Common Practices Common Opportunities Examples

Direct instruction of cognitive behavioral strategy along with an academic lesson (Double Dipping)

•Language Arts•History/Social Science•Physical Education

Bibliotherapy – selecting a book with a key social theme to teach language arts and social problem solving

Provide students with opportunities to practice strategies by carefully sabotaging an instructional or social situation.

•Physical Education•Recess•Science•Keyboarding/Computer Lab•Art Class

Selecting teams that must share limited materials.

Placing students in very close proximity to one another.

Incidental teaching •Recess/Lunch•Free time/ Transitions

Solving social problems on the playground.

Mental Health Problem Sample Components of CBI

•Aggression •Poor self control •Impulsivity

•Guiding self statements ("Stop, Think Act") •Positive self statements ("You can solve this problem") •Verbal self-instructions ("What are all of my options to solve this problem?") •Relaxation training (controlled breathing, progressive muscle relaxation) •Reinforcement for using skills

Mental Health Problem Sample Components of CBI

•Nighttime fears •School refusal •Separation anxiety •Generalized anxiety •Specific phobias •Social phobia •Obsessive Compulsive Disorder

•Recognition of faulty cognitions ("I can't go in that elevator"; "Everyone will laugh at me when I give my talk") •Positive self statements ("I can handle this"; "I know that's just my anxiety telling me lies") •Relaxation training •Modeling, role playing, reinforcement for using CBT skills •Exposure to a hierarchy of anxiety-producing situations

Linking Literature to Social Skill Development in Students with

Behavioral ChallengesBonnie McCarty & Gyneth Slygh (2004)

• Rationale for using bibliotherapy• System to analyze literature for use with students• Annotated bibliographies • Sample lesson plans

http://dpi.wi.gov/sped/doc/ebdlitsosk.doc-418.5KB

Information Source• The Wisconsin Department of Public Instruction has

developed: A Look at the Mental Health Needs of Children in an

Educational Setting This resource lists the risk factors, symptoms, and

possible school intervention strategies for a number of mental health disorders in children and youth. Including:– Anxiety Disorders– Bipolar Disorder– Borderline Personality Disorder– Depression– Obsessive Compulsive Disorder– Oppositional Defiant Disorder– Post Traumatic Stress Disorder, and – Schizophrenia

www.dpi.wi.gov/sped/doc/ebdmhfacts.doc

Questions?

For More Information

• The Center for Health and Health Care in Schools www.healthinschools.org

• Center for Mental Health Serviceshttp://www.mentalhealth.org/cmhs/

• Mental Health: The Surgeon General's Report http://www.surgeongeneral.gov/library/mentalhealth/toc.html#chapter3

• National Institute of Mental Health http://www.nimh.nih.gov

• University of Maryland Center for School Mental Health Assistance http://csmha.umaryland.edu/

• School Mental Health Projecthttp://smhp.psych.ucla.edu

Documents

They don’t understand!: Helping students with emotional and mental health disorders succeed in the classroom Richard Van Acker, Ed.D. University of Illinois