Mental Health and Well-Being

Mental Health and Well-Being

Anxiety

At times, all children feel anxious. Many feel stressed, for instance, when they are separated from parents or when in the dark. Some experience so much anxiety that it interferes with their daily activities. Anxious students may be left out of social situations, lose friendships, and experience academic failure and low self-esteem. Signs are often missed, as anxious students are generally quiet and compliant.
Anxiety is the most common illness to affect children and youth today. According to the Canadian Mental Health Association, approximately six per cent of children experience anxiety. Anxiety can cause children to be extremely afraid of situations or things to the point that it interferes with their daily life. The cause is unknown, however, studies suggest that children are at greater risk if their parents experienced anxiety.

Symptoms/Behaviours

  • Frequent absences and isolating behaviour
  • Refusal to join in social activities
  • Many physical complaints, such as upset stomach, tense muscles, headache, etc.
  • Excessive worrying (e.g. homework, grades, social situations, etc.)
  • Frequent bouts of tears
  • Fear of new situations
  • Drug and/or alcohol abuse

Educational Implications

Students with anxiety are easily frustrated and may have difficulty completing assignments. Others suffer from perfectionism and may take longer to complete their work. Some may refuse to begin tasks afraid they are unable to do them correctly. Fears of inadequacy, embarrassment, humiliation or failure may result in missed classes. Falling behind in school due to numerous absences often creates a cycle of fear resulting in increased anxiety and avoidance, leading to more absences. Children are less likely to identify anxious feelings, making it difficult for educators to fully understand the reason behind their poor academic performance.

Instructional Accommodations and Classroom Strategies

  • Allow students to develop a flexible deadline for worrisome assignments.
  • Have the student check with his/her teacher and vice versa to ensure assignments have been recorded correctly. For instance, teachers can initial an assignment notebook to indicate that information is correct.
  • Consider modifying or adapting the curriculum to better suit the student’s learning style to help lessen his/her anxiety.
  • Post a legible daily schedule so students know what is expected.
  • Encourage completion of assignments or tasks but also be flexible on deadlines.
  • Reduce assignment workload and homework when necessary.
  • Maintain the student’s regular schedule whenever possible.
  • Encourage attendance to prevent absences by modifying his/her schedule or reduce the time spent in the classroom.
  • Talk to parents/guardians to see what works best at home.
  • Consider the use of technology.

SOURCES: Canadian Mental Health Association

Asperger’s Syndrome

Asperger’s Syndrome, formerly referred to as High-Functioning Autism, is now included under the term Autism Spectrum Disorder. A neurobiological disorder, Asperger’s affects cognition, language, socialization, sensory issues, visual/audio processing and behaviour.
Students with Asperger’s Syndrome are often known to be verbal and have an average to above-average intelligence quotient (IQ). Often, they become preoccupied with a single subject, activity or with parts of an object rather than its functional use, like spinning the wheels of a toy car rather than driving it around. They may also display excessive rigidity or resistance to change, non-functional routines or rituals, and repetitive motor movements.

The most common characteristic of Asperger’s Syndrome is impairment of social interactions, which can include failure to use or comprehend non-verbal gestures in others, failure to develop age appropriate peer relationships and/or a lack of empathy.

Symptoms/Behaviours

  • Adult-like pattern of intellectual functioning and interests combined with social and communication deficits
  • Isolation from peers
  • Rote memory is generally good and the student may excel in math and science
  • Clumsy or awkward gait
  • Difficulty with physical activity and sports
  • Repetitive pattern of behaviour
  • Preoccupations with one or two subjects or activities
  • Under/over sensitivity to stimuli such as noise, light or unexpected touch
  • Victims of teasing and bullying

Educational Implications

Many youth with Asperger’s Syndrome have difficulty forming age appropriate relationships, displaying empathy, and understanding social interaction such as non-verbal gestures. When confronted with change to routine, they may show visible anxiety, withdraw into silence or burst into a fit of rage. They may be very articulate but can be very literal and have problems using language in a social context.

Instructional Accommodations and Classroom Strategies

  • Create structured, predictable and calming environments.
  • Consult an occupational therapist for sensory needs suggestions.
  • Foster a climate of tolerance and understanding. Consider assigning a peer helper to assist in joining group activities and socializing. Teasing should not be tolerated.
  • Celebrate the student’s verbal and intellectual skills.
  • Use direct teaching to increase socially acceptable behaviour. Demonstrate the impact of words and actions on others. Increase awareness of non-verbal cues.
  • Develop a standard of presenting change in advance.
  • Be cognizant of the usual triggers and warning signs of a rage attack or meltdown. Help him/her with self-management.
  • Remain calm and non-judgmental at all times.
  • Try to help support parents/guardians, as some may feel professionals blame them for poor parenting skills.

Attention Deficit Hyperactive Disorder (ADHD)

Youth with ADHD may be overactive, unable to pay attention and/or be on task. They tend to be impulsive, accident-prone and may answer questions before raising their hand. They often forget things, fidget, squirm and talk loudly. Some students with ADHD may be quiet, easily distracted, forgetful, and spacey or inattentive.
Symptoms for ADHD can be situation-specific. For example, students may not exhibit certain behaviours at home if the environment is less stressful, less stimulating or more structured than the school environment. Instead, students may stay on task when engaging in fun and enjoyable projects such as art.

An estimated five per cent of children have a form of ADHD, with males diagnosed more often than females. ADHD is the leading cause of referrals to mental health professionals, special education and juvenile justice programs. Students with ADHD either tend to be overlooked or dismissed as quiet or unmotivated as they struggle with organization or deemed defiant and unco-operative.

Children with ADHD are at greater risk for developing learning, anxiety, conduct and mood disorders such as depression. Without proper treatment, children are likely to have unsatisfactory grades and failed classes. Students may also have difficulty maintaining friendships, resulting in lower self-esteem due to frequent failures.

It is important to note that ADHD is a neurobiological disorder. Students are incapable of being organized or learn social skills on their own. However, certain interventions can greatly increase their capacity to succeed.

If you suspect a child has ADHD, request an assessment with an experienced mental health professional (for instance, psychiatrist, pediatrician, psychologist) in treating ADHD. Many students benefit from medication, while a multi-disciplinary approach including family, school and mental health treatments can be successful.

Symptoms/Behaviours

There are three forms of ADHD:

Inattentive subtype:

  • Limited attention span
  • Easily distracted and forgetful
  • Difficulty with organization
  • Failure to pay attention and complete tasks
  • Many errors in work
  • Trouble listening even when spoken to directly

Hyperactive-impulsive subtype:

  • Fidgeting and squirming
  • Difficulty staying seated and playing quietly
  • Continuously moving and climbing furniture as if driven by a motor
  • Constantly talking and blurting out answers before a question is complete
  • Limited patience when taking turns during activities
  • Interrupts or intrudes on others

Children with combined type Attention Deficit Hyperactivity Disorder show symptoms of both.

Educational Implications

Students can experience fluctuations in mood, energy and motivation. A student with ADHD may have difficulty concentrating and remembering assignments, understanding assignments with complex directions, or reading and comprehending long, written passages of text. Students may experience episodes of overwhelming emotion such as sadness, embarrassment or rage. They may also have poor social skills and have difficulty getting along with their peers.

Instructional Accommodations and Classroom Strategies

  • When a student’s concentration is low, provide him/her with recorded books as an alternative to self-reading.
  • Assign seating to allow for discreet prompts from the teacher for redirection to a task.
  • Break assigned reading into manageable segments and monitor the student’s progress by checking comprehension periodically.
  • Reduce academic demands when energy is low and increase opportunities for achievement when energy is high.
  • Identify a place where the student can go for privacy until he/she regains self-control.

These suggestions are from Supporting Minds, 2013 and Children’s Mental Health Ontario. To learn more, visit Ontario.ca/edu.

Autism Spectrum Disorder

Autism Spectrum Disorder belongs to the category of disorders known as Pervasive Developmental Disorders, which includes Rett Syndrome, Childhood Disintegrative Disorder, Asperger’s Syndrome, and Pervasive Developmental Disorders Not Otherwise Specified.
Autism Spectrum Disorder is a life-long neurological condition that is present at birth. The disorder is variable. Some children have a profound developmental delay and have no language, while others are mildly affected with average or above average intelligence and functional language.

Autism Spectrum Disorder appears within the first three years of life. It is four times more prevalent in males than females and occurs in all racial, ethnic and social groups. Children with Autism Spectrum Disorder are individuals who have their own strengths, weaknesses and patterns of symptoms. The disorder is defined by a certain set of behaviours. A child can exhibit any combination of behaviours in any degree of severity, therefore no two children with autism will act the same. Although estimates vary, it appears that approximately one in 110 children have a form of Autism Spectrum Disorder.

Over the years, autism has been used as an umbrella term for all forms of Pervasive Developmental Disorders. For instance, a student with Asperger’s may be described as having a mild form of autism or a student with Pervasive Developmental Disorders Not Otherwise Specified could have autistic-like tendencies. Nationally, all are known as Autism Spectrum Disorder.

Diagnosis of autism and other forms of Pervasive Developmental Disorders is based on the observation of a child’s behaviour, communication and level of development. According to the Autism Society of America, development may appear normal for some children until the ages of 24 to 30 months. For others, development is unusual from early infancy.

Delays may occur in the following areas:

  • Communication: Language develops slowly or not at all. Children use gestures rather than words or words are used inappropriately. Parents/guardians may also notice a short attention span.
  • Social interaction: Children prefer to be alone and show little interest in making friends. They are less responsive to social cues such as eye contact.
  • Sensory impairment: Children may be overly sensitive or under responsive to senses (touch, pain, sight, smell, hearing or taste) and show unusual reactions to these physical sensations.
  • Play: Children do not create pretend games, initiate others, or engage in spontaneous or imaginative play.
  • Behaviour: Children may exhibit repetitious activities such as rocking back and forth or head banging. They may be very passive or overactive and lack common sense. Disappointments over small changes in the environment or daily routine are common. Some children are aggressive and self-injurious. Some are severely delayed in areas such as understanding personal safety.

A child who is suspected to have Autism Spectrum Disorder should be evaluated.

Symptoms/Behaviours

  • Repetitive, non-productive movement, for instance, rocking in one position or walking around the room
  • Trailing a hand across surfaces such as chairs, walls or fences as the student passes as well as resistance to interruptions of such movements
  • Sensitivity or overreaction to touch
  • Minimal speaking, continuous repetition of the same phrases or of another person’s spoken words (Echolalia)
  • Avoiding eye contact
  • Engaging in self-injury

Educational Implications

Children with Autism Spectrum Disorder will have unique behaviours. Parents/guardians and professionals who are familiar with the student are the best source of information. In general, children with Autism Spectrum Disorder usually appear to be in their own world and seem oblivious to classroom materials, people or events. However, despite appearances, a child’s level of attention towards their educator and/or the material being presented may be relatively high.

Teaching must be direct and personalized in all areas including social skills, communication, academic subject matter and routines such as standing in line. Patience, firmness, consistency and refusing to take behaviours personally are solutions for success.

Instructional Accommodations and Classroom Strategies

  • Use a team approach to curriculum development and classroom adaptations. Occupational therapists and speech/language pathologists can be of great assistance and evaluations for assistive/augmentative technology should be done early, and often.
  • To teach basic skills, use materials that are age appropriate, positive and relevant to student life.
  • Maintain a consistent classroom routine. Objects, pictures and words can be used as required to make sequences clear and to help students learn independence.
  • Avoid lengthy verbal instruction. Instead, use written checklists, picture charts or object schedules. If necessary, deliver instructions one step at a time.
  • Minimize visual and auditory distractions. Modify the environment to meet the student’s sensory integration needs. Some stimuli may actually be painful to a student. An occupational therapist can help identify sensory problems and suggest needed modifications.
  • Use direct teaching to assist students in developing functional learning skills. For instance, teach them to work left to right and top to bottom as well as to help students develop social and play skills. Help them understand social language, feelings, words, facial expressions and body language.
  • Many students with Autism Spectrum Disorder are good at drawing, art and computer programming. Encourage these areas of talent.
  • Motivate students who are fixated on a particular topic by including it as the subject for reading, science, math and other lessons.
  • If the student avoids eye contact or looking directly at a lesson, allow him/her to use peripheral vision to avoid the intense stimulus of a direct gaze. Teach students to watch the forehead of a speaker rather than the eyes, if necessary.
  • Some autistic children do not understand that words are used to communicate with someone who has a different brain than their own. Respond to words and teach techniques for repairing broken communication.
  • Consult your school’s speech language pathologist for more information about your student’s communication.
  • Help students to apply their learning in different situations through close co-ordination with parents/guardians and other professionals who work with them.

This fact sheet is not to be used for the purpose of making a diagnosis. It is a reference for understanding and to provide information about different behaviours and mental health issues you may encounter in the classroom.

Resources:

Autism Research Institute: www.autism.com/ari
Autism Society of America: www.autism-society.org

Conduct Disorder

All children have bouts of bad behaviour. When misbehaviour progresses at a continuous rate, this could be a clue that the child may have one of two disruptive behaviour disorders: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). A child who displays persistent temper tantrums, is disobedient, and argues with adults and peers on a regular basis may have ODD. More serious problems like frequent physical aggression, stealing, cruelty or bullying may be a sign of CD.
Youth with CD are highly visible and demonstrate a complex group of behavioural and emotional difficulties. Serious, repetitive and persistent misbehaviour is a common symptom. These behaviours fall into four main groups: aggressive behaviour toward people or animals, destruction of property, deceitfulness or theft, and serious violations of rules.

Disruptive behaviour disorders appear to be more common in boys than in girls and in urban areas. Between five per cent and 15 per cent of school-aged children are diagnosed with ODD, while some four per cent are diagnosed with CD.

To receive a CD diagnosis, an individual must display three or more characteristic behaviours over the last 12 months, with at least one prevalent during the last six months. Diagnosing CD can be difficult as youth are constantly changing.

Another disorder associated with CD is Attention Deficit Hyperactivity Disorder (ADHD). Many children with CD also have learning disabilities. Approximately one-third are depressed and often stop exhibiting these behaviour problems as the depression is treated. Many youth with CD could have life-long patterns of anti-social behaviour and are at a higher risk for mood or anxiety disorders. But for many, the disorder may subside later in adulthood.

Social context such as poverty and high crime may influence what is viewed as anti-social behaviour. In these cases, CD may be misapplied to individuals whose behaviours may be protective or exist within cultural context. A child with suspected CD should be referred for assessment. If symptoms are mild, the child may receive services and remain in the school environment. More severely troubled youth, however, may need more specialized educational environments.

Symptoms/Behaviours

  • Bullying or threatening classmates and others
  • Poor attendance record or chronic truancy
  • History of frequent suspensions
  • Minimal empathy for others and a lack of appropriate feelings of guilt or remorse
  • Low self-esteem masked by bravado
  • Lying to peers or teachers
  • Stealing from peers at school
  • Frequent physical fights
  • Weapon use
  • Destruction of property

Educational Implications

Students with CD like to engage in power struggles. They often react negatively to direct demands or statements such as “you need to” or “you must”. They may challenge class rules, refuse to do assignments, and argue or fight with other students.

This behaviour can cause significant impairment in both social and academic function. Students with CD work best in environments with high staff/student ratios, one-on-one situations, and self-contained programs where there is plenty of structure and clearly defined guidelines. Frequent absences and refusal to complete assignments often lead to academic failure.

Instructional Accommodations and Classroom Strategies

  • Ensure curriculum is at the appropriate level. Frustration sets in easily if a task is too difficult, and boredom if the task is too easy. Both will lead to problems in the classroom.
  • Avoid infantile materials to teach basic skills. Materials should be age appropriate, positive and relevant to the lesson.
  • Consider using technology. Computers with active programming tend to be beneficial for students with CD.
  • Give students options. Allow them to work outside the traditional school setting.
  • Be aware that adults can unconsciously form and express negative impressions of low performing, unco-operative students. Try to monitor your impressions, keep them neutral, communicate positively and give students the benefit of the doubt whenever possible.
  • Remain calm, respectful, and detached and avoid power struggles and arguments.
  • Avoid direct demands or statements such as “you need to” or “you must”.
  • Avoid escalating prompts such as shouting, touching, nagging or cornering a student.
  • Establish rules that are few, fair, clear, displayed, taught and consistently enforced. Be clear about what is non-negotiable.
  • Encourage students to participate in the establishment of rules, routines, schedules and expectations.
  • Teach social skills such as anger management, conflict resolution and appropriate assertiveness.

Depression

All children feel down or low at times. Feelings of sadness with an intensity that persists for weeks or months may be a symptom of Major Depressive Disorder or Dysthymic Disorder (milder, but more chronic low mood). These disorders affect a person’s emotions, thoughts, behaviours and body, and can negatively impact school performance and lead to alcohol/drug abuse or even suicide.
Studies by the Canadian Mental Health Association show that approximately five per cent of male and 12 per cent of female youth ages 12 to 19 have experienced a major depressive episode at some point. A staggering 3.2 million youth in Canada, within the same age group, are at risk of developing depression.

Males appear to suffer earlier in childhood, while depression is more prevalent in females during adolescence. Depression affects childhood development and is difficult to diagnose in youth. It is also more severe, difficult to treat, and more likely to re-occur than adult forms of the disorder.

A depressed child becomes stuck and unable to pass through normal developmental stages. Common symptoms are:

  • Sadness that won’t subside
  • Hopelessness and irritability
  • School avoidance
  • Persistent boredom, low energy or poor concentration
  • Changes in sleeping and eating patterns
  • Frequent complaints of aches and pains
  • Thoughts of death or suicide
  • Self-critical remarks

Students with depression who used to enjoy playing with friends may spend most of their time alone or with a different group of peers. Students generally lose interest in activities that were once fun, may talk about death or suicide, and even self-medicate with alcohol or drugs.

Although they may not seem sad, children who cause trouble at home or at school may be depressed. Younger children could pretend to be sick, be overactive, cling to their parents, seem accident prone, or refuse to go to school. Older children and teens often refuse to participate in activities with family or friends and stop paying attention to their appearance. They may also be restless, grouchy or aggressive.

Most mental health professionals believe that depression has a biological origin. Research indicates that children are at greater risk of developing depression if one or both of their parents suffered from the illness.

Symptoms/Behaviours

  • Sleeps during class
  • Defiant or disruptive and refuses to participate in activities
  • Incomplete assignments, failed tests and classes
  • Excessive tardiness and frequent absences
  • Fidgety or restless, distracting to other students
  • Isolating and quiet
  • Refusal to do school work and general non-compliance with rules
  • Talks about death or suicide

Educational Implications

Students experiencing depression may display a visible change in interest for school work and activities. Grades may drop significantly due to lack of interest, loss of motivation or excessive absence. They may withdraw and refuse to socialize with peers or participate in group projects.

Instructional Accommodations and Classroom Strategies

  • Reassure students that they can catch up. Show them the steps they need to take and be flexible and realistic about your expectations. School failures and unmet expectations can exacerbate the depression.
  • Help students use and recognize realistic and positive statements, contributions, performances, and outlook on the future.
  • Maintain a record of accomplishments. Students see issues in black and white terms, either all bad or all good.
  • Reduce classroom pressures.
  • Break tasks into small components.
  • Encourage gradual social interaction, for instance small group work.
  • Ask parents/guardians what would be helpful in the classroom to reduce pressure or motivate the child.

This information is not to be used for the purpose of making a diagnosis. It is a reference for understanding and to provide information about different behaviours and mental health issues you may encounter in the classroom.

Resources:
The Council for Exceptional Children: www.cec.sped.org
National Institute for Mental Health: www.nimh.nih.gov
SAMHSA’S National Mental Health Information: www.mentalhealth.samhsa.gov
SAVE (Suicide Awareness Voices of Education): www.save.org

Eating Disorders

On a daily basis, we are surrounded by messages that impact the way we feel about our bodies. For some, a poor body image is a sign of a more serious problem known as an Eating Disorder. Of the three types of Eating Disorders, anorexia nervosa and bulimia nervosa are the most common.
Often seen in teens and young adults, younger children are increasingly diagnosed with a form of Eating Disorder. Some as young as four and five are expressing the need to diet and it is estimated that 40 per cent of nine-year-olds have already dieted. Eating Disorders are not limited to females, as studies show between 10 and 20 per cent of adolescents with Eating Disorders are males.

Individuals with anorexia nervosa fail to maintain minimally normal body weight. For fear of weight gain, they engage in abnormal eating (food restriction) and (excessive) exercise habits and their perception of their body shape and size is significantly distorted. Menstruation may stop for teens battling anorexia, which could lead to similar bone loss suffered by women experiencing menopause.

Adolescents who have Eating Disorders are obsessed with food and their lives tend to revolve around body weight and food. Youth with bulimia tend to binge eat, where they compulsively consume large amounts of food within a short period of time. To avoid weight gain, they engage in inappropriate compensatory behaviour, including fasting, self-induced vomiting, excessive exercise, and the use of laxatives, diuretics and enemas. As a result, youths with Eating Disorders are at risk for alcohol, drug abuse and depression.

Athletes such as wrestlers, dancers or gymnasts may fall into disordered eating patterns in an attempt to stay thin or make weight.

An individual with an eating disorder may face serious health problems and, in extreme cases, death without medical intervention. If you suspect a student may be suffering from an eating disorder, refer the student immediately for a mental health assessment.

Symptoms/Behaviours

  • Perfectionist attitude
  • Withdrawn
  • Anxiety, irritability and lethargy
  • All or nothing attitude
  • Mood swings, impaired concentration and depression
  • Self-deprecating statements
  • Fainting spells, dizziness, headaches
  • Hiding food and avoiding snacks or activities involving food
  • Frequent trips to the bathroom

Educational Implications

Students with Eating Disorders may appear like model students, often the leader of the class and very self-demanding. When students with Eating Disorders are preoccupied with body image and controlling their food intake, they may have short attention spans and poor concentration, resulting in poor academic performance. These symptoms may also be due to a lack of nutrients from fasting and/or vomiting. Often, the student will lack energy and drive to complete assignments or homework.

Instructional Accommodations and Classroom Strategies

  • Stress acceptance in the classroom. Successful people come in all shapes and sizes.
  • Watch what you say. Comments like “you look terrible,” “what have you eaten today?” or “I wish I had that problem” are often hurtful and discouraging.
  • Stress progress, not perfection.
  • Avoid pushing students to excel beyond their capabilities.
  • Avoid high levels of competition.
  • Reduce stress where possible by reducing assignments or extending deadlines.

Resources:

Eating Disorders Resources/Gurze Books: www.gurze.net
National Association of Anorexia Nervosa and Associated Disorders: www.anad.org (hotline counseling, referrals, information and advocacy)
National Eating Disorders Association: www.nationaleatingdisorders.org
How Did This Happen? A Practical Guide to Understanding Eating Disorders for Coaches, Parents and Teachers, by the Institute for research and Education Health System Minnesota, 1999.
Public Health Agency of Canada

Fetal Alcohol Spectrum Disorder

Fetal Alcohol Spectrum Disorder (FASD) refers to the brain damage and physical birth defects in children caused by women who consumed alcohol during their pregnancy. FASD can include growth deficiencies, central nervous system dysfunction that could result in low IQ or cognitive deficiencies, and abnormal facial features such as small eye openings, small upturned nose, thin upper lip, small lower jaw, low set of ears, and an overall small head circumference.
Children lacking the distinguishing facial features could be diagnosed with Fetal Alcohol Effects (FAE). A diagnosis of FAE may make it increasingly difficult to meet the criteria for many services or accommodations. The Institute of Medicine recently coined Alcohol Related Neurodevelopmental Disabilities (ARND) to describe the condition in which only the central nervous system abnormalities are present from prenatal alcohol exposure.

FASD/FAE are lifelong irreversible conditions. Children with FASD experience severe challenges including speech and language delays, and learning disabilities. Often, children with FASD are hyperactive, poorly co-ordinated and impulsive. They will most likely have difficulty with daily living skills, including eating, resulting from missing tooth enamel, heightened oral sensitivity, or an abnormal gag reflex.

Learning is not automatic for those with FASD. Due to organic brain damage, memory retrieval is impaired, making learning extremely difficult for some. Many children with FASD have problems with communicating, especially socially, even though they may have strong verbal skills. They often have trouble interpreting actions and behaviours of others or reading social cues. Abstract concepts are especially troublesome. They often appear irresponsible, undisciplined, and immature, as they lack critical thinking skills such as judgment, reasoning, problem solving, predicting and generalizing.

Children with FASD/FAE don’t internalize morals, ethics or values. (These are abstract concepts). They do not understand how to do or say what is considered appropriate. They also do not learn from past experiences and punishment does not seem to faze them and, as a result, they often repeat mistakes. Immediate wants or needs take precedence and they don’t understand the concept of cause and effect, or that there are consequences to their actions. These factors may result in serious behaviour problems unless their environment is closely monitored, structured and consistent.

Symptoms/Behaviours

Early Childhood (1 to 5 years)

  • Speech or gross motor delays
  • Extreme tactile sensitivity or insensitivity
  • Erratic sleep and/or eating habits
  • Poor habituation
  • Lack of stranger anxiety
  • Rage
  • Poor or limited abstracting ability (action/consequence connection, judgment and reasoning skills, sequential learning)

Elementary Year

  • Normal, borderline, or high IQ with relative immaturity
  • Blames others for problems
  • Volatile and impulsive, impaired reasoning
  • School becomes increasingly difficult
  • Socially isolated and emotionally disconnected
  • High need for stimulation
  • Vivid fantasies and perseveration problems
  • Possible fascination with knives and/or fire

Adolescent Years (13 to 18 years)

  • No personal or property boundaries
  • Naïve, suggestible, a follower, a victim, vulnerable to peers
  • Poor judgment, reasoning and memory
  • Isolated, sometimes depressed and/or suicidal
  • Poor social skills
  • Doesn’t learn from mistakes

Educational Implications

Children with FASD require more intense supervision and structure than other students. They often lack a sense of boundaries for people and objects. For instance, they don’t steal things, they find them. An object only belongs to a person if it is in their hand. They are impulsive, uninhibited and over-reactive. Social skills such as sharing, taking turns and co-operating in general, are usually not understood. These children tend to play alongside others but not with them. Also, sensory integration problems are common and may lead to a tendency to be high strung, sound-sensitive and easily over-stimulated.

Although they can focus their attention on the task at hand, they have multiple obstacles to their learning. Since they are unable to understand ideas, concepts or abstract thoughts, they often have the ability to verbalize without actually understanding. Even simple tasks require intense mental effort due to their cognitive impairment. This can result in mental exhaustion, which adds to their behaviour problems. Their threshold for frustration is low, so they often fly into rage and tantrums.

A common impairment is short-term memory. In an effort to please, students will often fabricate answers when they don’t remember. This practice can apply to anything, including school work or behaviours. These are not intentional lies. They truly do not remember the truth and simply want to have an answer. Since they live in the moment and do not connect their actions with consequences, they are unable to recognize that making up answers is not appropriate.

Instructional Accommodations and Classroom Strategies

  • Be consistent. The manner in which something is learned the first time will have the most long lasting effect. Re-learning is difficult, therefore, change is difficult.
  • Use repetition. Some students need extra time to learn and retain information. Try using reminders like rhymes and songs. Have students repeatedly practice basic actions and social skills like walking quietly down the hall or saying thank you.
  • Be positive, supportive and sympathetic during crisis. These are children who can’t rather than won’t.
  • Use multi-sensory instruction including visual, olfactory, kinesthetic, tactile and auditory. More senses used in learning results in more possible neurological connections to aid in memory retrieval.
  • Be specific, yet brief, as students with FASD have difficulty filling in the blanks. Explain step-by-step instructions but not all at once. Use short sentences and simple words. Be concrete. Avoid asking why. Instead, ask distinct questions such as who, what, where, when and how.
  • Supervision should be as constant as possible, with an emphasis on positive reinforcement of appropriate behaviour.
  • Do not rely on the student’s ability to recite the rules or steps.
  • Model appropriate behaviour. Students will often mimic behaviours, so try to remain respectful, patient and kind.
  • Avoid long periods of deskwork, as these children must move often. To avoid the problem of a student becoming overloaded from mental exhaustion and/or trying to sit still, create a self-calming and respite plan.
  • Post all rules and schedules. Use pictures, drawings, symbols, charts or whatever seems to be effective at conveying your message. Repeat the rules and their meanings aloud at least once per day.
  • Rules should be the same for all students, however, you may need to alter the consequences for a child with FASD.
  • Use immediate discipline. They will not comprehend why if consequences are delayed. Even if the student is told immediately that it will happen the next day, he/she will not make the connection when the time comes.
  • Never take away recess as a consequence because children with FASD need to move around. Denying them that will only compound the problem.
  • Ensure the student’s attention. When talking directly to the student, be sure to say his/her name and make eye contact. Have them paraphrase directions to check for understanding.
  • Encourage the use of self-talk.
  • Recognize partially correct responses.
  • Offer positive incentives for complete work.
  • Set them up for success and recognize successes as often as possible.

This information must not be used for the purpose of making a diagnosis. It is to be used only as a reference for your own understanding and to provide information about different kinds of behaviours and mental health issues you may encounter in the classroom.

Obsessive Compulsive Disorder

Children with Obsessive Compulsive Disorder (OCD) have obsessive thoughts and impulses that are recurrent, persistent, intrusive and senseless. They may, for instance, worry about contamination from germs, or perform repetitive behaviours in a ritualistic manner, for instance, compulsive hand washing. An individual with OCD will often perform these rituals in an effort to neutralize the anxiety caused by their obsessive thoughts.
OCD has a neurobiological basis, meaning that it is a biological disease of the brain, just as diabetes is a biological disease of the pancreas. Occasionally, OCD is accompanied by other disorders such as Attention Deficit Hyperactivity Disorder, Eating Disorders, Anxiety Disorders or substance abuse. Coupled with another disorder, OCD is generally more difficult to diagnose and treat. Symptoms of OCD may coexist or be part of a spectrum of other brain disorders such as Tourette Syndrome or Autism.

Studies at the National Institute of Mental Health suggest that OCD, for some individuals, may be an autoimmune response triggered by antibodies produced to counter strep infection. This phenomenon is known as Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS).

OCD is not a result of bad parenting, poverty or other environmental factors. Students with OCD often experience high levels of anxiety and shame about their thoughts and behaviours. Their thoughts and behaviours are all consuming and interfere with everyday life.

Symptoms/Behaviours

  • Unproductive time retracing the same word
  • Touching the same objects repeatedly
  • Erasing sentences or problems repeatedly
  • Counting and recounting objects, or arranging and rearranging objects
  • Frequent trips to the bathroom
  • Poor concentration and school avoidance
  • Anxiety or depressed mood

Common compulsive behaviours are:

  • Arranging
  • Avoiding
  • Checking
  • Cleaning and washing
  • Counting
  • Seeking pressure
  • Hoarding
  • Ordering
  • Repeating
  • Touching

Common obsessions are:

  • Aggressions
  • Contamination
  • Doubt
  • Loss
  • Orderliness
  • Religion
  • Sex
  • Symmetry

Children who show symptoms of Obsessive Compulsive Disorder should be referred for a mental health assessment. Behaviour therapy and pharmacological treatment have both proven successful.

Educational Implications

Compulsive activities often take up so much time that students are unable to concentrate on their schoolwork. This could lead to poor or incomplete work and even school failure. Many students with OCD find verbal communication very difficult. They may feel isolated from their peers as their compulsive behaviour leaves them little time to interact or socialize with their classmates. They could avoid school because they are worried that teachers or peers will notice their odd behaviour. If asked why a behaviour is repeated, many students respond “It doesn’t feel right.”

Instructional Accommodations and Classroom Strategies

  • Try to accommodate situations and behaviours where the student feels a loss of control and be attentive to changes in the student’s behaviour.
  • Educate the student’s peers about Obsessive Compulsive Disorder.
  • Try to redirect the student’s behaviour. This method is better than using consequences.
  • Allow the student to do assignments, such as oral reports, in writing.
  • Allow the student to receive full credit for late work.
  • Allow the student to redo assignments to improve scores or final grade.
  • Consider a Functional Behavioral Assessment.
  • Try to understand the purpose or function of the student’s behaviour. This will help you respond with effective interventions and strategies. A punitive approach or punishment may increase the student’s sense of insecurity and distress and increase the undesired behaviour.
  • Post the daily schedule in a highly visible place so that the student will know what to expect.
  • Consider the use of technology. Many students that struggle with OCD will benefit from easy to access and appropriate technology. This could include applications that can engage student interest and increase motivation, for instance, computer-assisted instruction programs, CD-ROM demonstrations, as well as videotape presentations.

Resources:

Obsessive-Compulsive Foundation of America: www.ocfoundation.org
SAMHSA’S National Mental Health Information Center – Center for Mental Health Services: www.mentalhealth.samhsa.gov
Anxiety Disorders Association of America: www.adaa.org
National Institute of Mental Health (NIMH): www.nimh.nih.gov

Oppositional Defiant Disorder

Students with Oppositional Defiant Disorder (ODD) appear angry most of the time. They are quick to blame others for mistakes and act in negative, hostile and vindictive ways. All students exhibit these behaviours at times. Typically, these behaviours occur more frequently for those with ODD than individuals of comparable age and level of development.
Students with ODD often display behaviours that alienate them from their peers, resulting in poor peer relationships. In addition, these students may have an unusual response to positive reinforcement or feedback. When given praise, they could react by destroying or sabotaging the project from which the praise was given.

Some students develop ODD as a result of stress and frustration from divorce, death, loss of family or family disharmony. ODD may also be a way of dealing with depression or the result of inconsistent rules and behaviour standards.

If not recognized and corrected early, oppositional and defiant behaviour can become ingrained. Other mental health disorders may, when untreated, lead to ODD. A student with Attention Deficit Hyperactivity Disorder (ADHD) may exhibit signs of ODD, due to the experience of constant failure at home or at school.

Symptoms/Behaviours

  • Sudden unprovoked anger
  • Arguing with adults
  • Defiance or refusal to comply with rules or requests
  • Deliberately aggravating others
  • Blaming others for their misbehaviour
  • Resentful and angry

Educational Implications

Students with ODD may consistently challenge the class rules, refuse to do assignments and argue or fight with other students. The constant testing of limits and arguing can create a stressful classroom environment. This behaviour can cause significant impairment in both social and academic functioning.

Instructional Accommodations and Classroom Strategies

  • Avoid power struggles. State your position clearly and concisely.
  • Choose your battles wisely.
  • Give two choices when decisions are needed. State them briefly and clearly.
  • Establish clear classroom rules. Be clear about what is non-negotiable.
  • Post a daily schedule so students know what to expect.
  • Praise students when they respond positively.
  • Avoid making comments or bringing up situations that may be a source of argument for them.
  • Make sure academic work is at an appropriate level. When work is too difficult, students become frustrated. When it is too simple, they become bored. Both reactions lead to classroom disruptions.
  • Avoid infantile materials to teach basic skills. Materials should be positive and relevant.
  • Pace instruction. When students with ODD have completed a designated amount of a non-deferred activity, reinforce their co-operation by allowing them to do something they prefer, or find more enjoyable or less difficult.
  • Allow sharp separation to occur between academic periods but hold transition times between periods to a minimum.
  • Systemically teach social skills including anger management, conflict resolution strategies and appropriate assertiveness.
  • Discuss strategies that students may use to calm themselves when they feel anger is escalating. Do this when students are calm.
  • Provide consistency, structure and clear consequences for the student’s behaviour.
  • Select material that encourages student interaction. Students with ODD need to learn to talk to peers and adults in an appropriate manner, however, all co-operative learning activities must be carefully structured.
  • Minimize downtime and plan transitions carefully. Students with ODD do best when kept busy.
  • Maximize student performance through the use of individualized instruction, cues, prompting, broken down tasks, debriefing, coaching, and positive incentives.
  • Allow students to repeat assignments to improve their score or final grade.
  • Structure activities so students are not left out.
  • Ask parents/guardians what works at home.

Resources:

American Academy of Child and Adolescent Psychiatry: www.aacap.org
Anxiety Disorders Association of America: www.adaa.org
SAMHSA’S National Mental Health Information Center – Center for Mental Health Services: www.mentalhealth.samhsa.gov

Reactive Attachment Disorder (RAD)

Reactive Attachment Disorder (RAD) begins before age five and is associated with grossly inadequate or pathological care that disregards the child’s basic emotional and physical needs. In some cases, it is associated with repeated changes of a primary caregiver.
The term attachment is used to describe the process of bonding that takes place between infants and caregivers in the first two years of life, and most important, the first nine months of life. When a caregiver fails to respond to a baby’s emotional and physical needs, responds inconsistently, or is abusive, the child loses the ability to form meaningful relationships and the ability to trust.

The Diagnostic and Statistical Manual of Mental Disorders describes two types of RAD:

1. Inhibited RAD is the persistent failure to initiate and respond to most social interactions in a developmentally appropriate way.
2. Disinhibited RAD is the display of indiscriminate sociability or a lack of selectivity in the choice of attachment figures (excessive familiarity with relative strangers by making requests and displaying affection).

Aggression, either related to a lack of empathy or poor impulse control, is a serious problem with these students. They have difficulty understanding how their behaviour affects others. They often feel compelled to lash out and hurt others, including animals, smaller children, peers and siblings. This aggression is frequently accompanied by a lack of emotion or remorse.

Students may display soothing behaviours, such as rocking and head banging, biting, scratching or cutting themselves. These symptoms will increase during times of stress or threat.

Symptoms/Behaviours

  • Destructive to self and others coupled with an absence of guilt or remorse
  • Refusal to answer simple questions
  • Denial of accountability and placing blame on others
  • Poor eye contact
  • Extreme defiance and control issues
  • Stealing
  • Lack of cause and effect thinking
  • Mood swings
  • False abuse allegations
  • Acting out sexually
  • Inappropriately demanding or clingy
  • Poor peer relationships
  • Abnormal eating patterns
  • Preoccupied with gore and/or fire
  • Toileting issues
  • Limited or no impulse control
  • Chronic non-sensical lying
  • Unusual speech patterns or problems
  • Bossy and manipulative
  • Superficially charming and engaging

Educational Implications

Many students with RAD will have developmental delays in several domains. The caregiver-child relationship provides the vehicle for developing physically, emotionally and cognitively. In this relationship, the child learns language, social behaviours and other important behaviours and skills. The lack of experiences can result in delays in motor, language, social and intellectual development.

Students may have difficulty completing homework. They often fail to remember assignments and/or have difficulty understanding assignments with multiple steps. They may have problems with comprehension, especially long passages of text. Fluctuations in energy and motivation may be evident and they often have difficulty concentrating.

The student with RAD often feels a need to be in control and may exhibit bossy, argumentative, and/or defiant behaviour. This may result in frequent classroom disruptions and power struggles with teachers.

Instructional Accommodations and Classroom Strategies

  • Consider a Functional Behavioral Assessment. Understanding the purpose or function of the student’s behaviours will help you respond with effective interventions. For example, a punitive approach or punishment may increase the student’s sense of insecurity and distress and consequently increase the undesired behaviour.
  • Be predictable, consistent and repetitive. Students with RAD are very sensitive to transitions, surprises, changes in schedules and chaotic social situations. Being predictable and consistent will help the student to feel safe and secure, which in turn will reduce anxiety and fear.
  • Model and teach appropriate social behaviours. A great way to teach students social skills is to model the behaviour and then narrate what you are doing and why.
  • Avoid power struggles. When intervening, present yourself in a light and matter of fact style. This reduces the student’s desire to control the situation.
  • Use humour whenever possible. If students can get an emotional response from you, they will feel as though they have hooked you into the struggle for power and they are winning.
  • Address comprehension difficulties by breaking assigned reading into manageable segments. Monitor progress by periodically checking if the student understands the material presented.
  • Identify a place for the student to go to regain composure during times of frustration and anxiety. Do this only if the student is capable of using this technique and there is an appropriate supervised location.

This information is not to be used for the purpose of making a diagnosis. It is a reference for understanding and to provide information about different behaviours and mental health issues you may encounter in the classroom.

Resources:

Association for Treatment and Training in the Attachment of Children (ATTACh): www.attach.org
Families by Design/Nancy Thomas Parenting: www.attachment.org
www.RADKID.org

Tourette Syndrome

Tourette Syndrome is a condition where people make repeated and sudden movements or sounds in response to a strong urge to do so. This is called a tic. The urge they feel is much like the need to sneeze, and producing the tic relieves their discomfort. Tics can often be suppressed with effort. Concentrating on something else can reduce the need to produce a tic.
Tics tend to start in the head and face area first. Children with Tourette Syndrome often blink their eyes, frown or sneer. Some children repeatedly clear their throat, yelp or yell, or make noises such as tongue clicking and vocal tics. They may imitate sounds or the speech and actions of others. A small group of individuals with Tourette Syndrome may use obscene words or gestures, while others may say rude or inappropriate comments to people. Children or teenagers with more complex tics may feel a need to smell or touch objects. Sometimes they experience motor tics such as jumping or twirling around, jerking their head or shrugging their shoulders.

Approximately 90 per cent of individuals with Tourette Syndrome have another disorder such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD) or anxiety. Some children, teenagers and adults with Tourette Syndrome have depression as a result of difficulties making friends, and feeling rejected because of their tics. Many children with Tourette Syndrome also have learning difficulties, particularly with reading, writing and math.

Tourette Syndrome is still poorly recognized by health professionals. Some 80 per cent of people diagnose themselves or are diagnosed by family members. Many have symptoms mild enough that they never seek help while others find their symptoms subside after they reach adulthood.

Indicators of Tourette Syndrome include:

  • The presence of multiple motor and vocal tics, although not necessarily simultaneous.
  • Multiple bouts of tics every day or intermittently for more than a year.
  • Changes in the frequency, number, and kind of tics and in their severity.
  • Marked distress or significant impairment in social, occupational, or other areas of functioning, especially under stressful conditions.
  • Onset before age 18

Symptoms/Behaviours

  • Throat clearing
  • Barking
  • Snorting
  • Hopping
  • Vocal outbursts
  • Mimicking others
  • Shoulder shrugging
  • Facial grimaces and twitches
  • Blinking
  • Arm or leg jerking
  • Finger flexing
  • Fist clenching
  • Lip licking
  • Easily frustrated
  • Sudden rage attacks

Educational Implications

Tics, such as eye blinking and shoulder shrugging, can make it difficult for students to concentrate. Tics may also be disruptive or offensive to teachers and classmates. Peers may ridicule the child with Tourette Syndrome or repeatedly “trigger” an outburst of tics to harass. Tension and fatigue generally increase tics. Suppressing tics is exhausting for those with Tourette Syndrome and takes energy away from learning.

Please note: Most students with Tourette Syndrome do not qualify for special education services under the Emotional or Behavioral Disorders (EBD) classification, unless the co-existing conditions are severe.

Instructional Accommodations and Classroom Strategies

  • Educate other students about Tourette Syndrome. Encourage the student to provide his own explanations and encourage peers to ignore tics whenever possible.
  • Be mindful not to urge the student to stop or stay quiet. Remember, it’s not that the student won’t stop, it’s that he/she simply can’t stop.
  • Do not impose disciplinary action for tic behaviours.
  • To promote order and divert escalating behaviour, provide adult supervision in the hallways, during assemblies, in the cafeteria, when returning from recess and at other high-stress times.
  • Refer to the school occupational therapist for an evaluation of sensory difficulties. Modify the environment to control stimuli such as light, noise or unexpected touch.
  • Provide a private, quiet place for test taking. Remove time limits when possible.
  • Help the student recognize fatigue and the internal and external stimuli that signal the onset of tics. Pre-arrange a signal and a safe place for the student to go to relax or rest.
  • Reduce handwriting tasks and note taking. Provide note takers or photocopies of overheads during lectures and encourage computer use for composition tasks.

This series on mental health and well-being is a Rainbow District School Board Parent Involvement Committee project funded by the Ministry of Education Parent Engagement Office.