Transcript Introduction to Mental Health Issues

Session IV
Behavioural Disorders
Physical Disorders
Stigma
1
Outline for today
• Reflections from last day
• Know-Wonder-Learn
• Behaviour Disorders
 Attention and Hyperactivity Disorders
 Oppositional Defiant and Conduct Disorders
 Substance Misuse
• Physical Disorders
 Eating Disorders
•
•
•
•
Stigma
What educators can do to support students
Summative Assessment Assignment
Evaluation
2
Reflections from Last Day
• Think of a student you currently support (have in the past
or know of from the school you work in) that is coping
with depression, self harming behaviour, suicidal ideation
or psychosis. Respond to the following:
What signs/symptoms of the disorder has the student
displayed in the past?
How is he/she currently being supported?
How has the student’s level of functioning improved as
a result of the support?
3
Know-Wonder-Learn
• KNOW
what you know about behaviour disorders, physical
disorders and stigma
• WONDER
any questions you have concerning about behaviour
disorders, physical disorders and stigma that you hope
to have answered
• LEARN
to be completed at the end of today’s session
4
FUNCTIONS OF THE
BRAIN Behavior:
Thinking or Cognition:
Psychosis
Perception or
Sensing
PDD & Autism
Emotions:
Mood Disorders
Self Harm/Suicide
Attention & Hyperactivity
Oppositional Defiant &
Conduct Disorders
Physical
Functions:
Eating Disorders
Signaling
Anxiety
5
Attention and
Hyperactivity/Impulsivity
6
Attention and
Hyperactivity/Impulsivity
• Many students have difficulty paying attention, have
trouble sitting still, act impulsively and fail to follow
through on requests made by adults
• It is often difficult to determine if inattention, hyperactivity
or impulsivity are developmentally appropriate or cause
for concern
• When these behaviour(s) interfere significantly at school,
home and/or in the community, it is important to observe
the behaviours in different settings, contexts and in
relation to developmental stages
7
Attention and
Hyperactivity/Impulsivity
• Although hyperactivity and impulsivity problems are
more easily recognized and recognized by educators,
attention problems are the greater concern for significant
risk to academic outcomes
• While at the core of ADHD, attention is also a feature of
other mental disorders (anxiety, depression, autism
spectrum disorders) as well as specific learning
disabilities, fetal alcohol exposure and vision or hearing
impairments, among others
• In fact, attention difficulties may be a key component
associated with a wide range of conditions experienced
by students
8
Jack and Jill Have ADHD
Jack
ahttp://www.youtube.com/watch?v=rLghxG3mGMMnd
Jill have ADHD
9
Attention and
Hyperactivity/Impulsivity
• Attention Deficit Hyperactivity Disorder begins in early
childhood but is difficult to diagnose before school age
• Strong evidence suggests ADHD results from a combination
of genetic and environmental factors
• About 25% of parents whose children have attention problems
have or had similar difficulties
• Rates of ADHD are significantly higher for boys (although by
adulthood rates are about equal)
• ADHD is divided into 3 subtypes:
 predominately inattentive (without hyperactivity/impulsivity
 predominately hyperactive/impulsive (without inattention)
 predominately combined (symptoms of inattention, hyperactivity
and impulsivity)
10
Common Signs of
Attention Disorder
• The student:
is easily distracted
fails to pay attention to details
makes careless mistakes
forgets things needed to complete tasks (e.g. pencil)
often loses things
has difficulty organizing and/or finishing tasks
finds it hard to concentrate or listen to instructions
follows directions incompletely or improperly

11
Common Signs of
Hyperactivity/Impulsivity
• The student:
has difficulty sitting still or remaining in seat, fidgets
 talks excessively
 is overly active, always on the move
 has difficulty working/playing quietly, may disturb peers or
family members
 is unable to suppress impulses such as making inappropriate
comments
 interrupts conversations
 has difficulty waiting for a turn
 is easily frustrated
 displays poor judgement

12
Things not to miss
• Due to associated social and academic impairments,
early intervention is important
• ADHD is commonly associated with other mental health
disorders:
 anxiety
 depression
 oppositional defiant disorder
 conduct disorder
• Higher instances of substance misuse in adolescence
• For many students, ADHD is compounded by problems
with learning (about half of students with ADHD have a
diagnosable learning disability)
13
Behaviour Problems
14
Behaviour Problems
• It is part of healthy development for children and youth to
“test the limits” and express differences of opinion
• Occasional disruptive behaviours are often the result of a
specific cause such as frustration over an assignment,
conflict with another student, tiredness, stress at home
or an attempt to show off for peers
• However, when a student is frequently argumentative,
oppositional and/or aggressive, this may signal a
struggle with his/ or her emotional health
• Behaviour that is non-compliant and defiant is
sometimes an Oppositional Defiant Disorder (ODD)
15
Oppositional Defiant
Disorder (ODD)
http://www.youtube.com/watch?v=7KeQrpOwt3Q
16
Oppositional Defiant Disorder
• Oppositional defiant disorder is generally characterized
by a recurrent pattern of negative, defiant, disobedient and
hostile behaviour toward authority figures over time
• Behaviours may include:
loss of temper
argue with adults
refuse to obey the requests or rules of adults
deliberately do things to annoy other people
blame others for their mistakes
may be touchy or easily annoyed
angry, resentful or vindictive
17
Oppositional Defiant Disorder
• Much of the defiant behaviour is aimed at authority
figures but targets may also include classmates,
playmates or siblings
• For a student with ODD, his or her school life, home life and
peer relations are all significantly impaired
• ODD typically appears by eight years of age and no later than
early adolescence
• On occasion, children and youth with ODD continue on to
develop a more serious condition, Conduct Disorder (CD)
18
Conduct Disorder
Conduct Disorder
http://www.youtube.com/watch?v=P2qY9zQrfiM
19
Conduct Disorder
• Conduct disorder is generally characterized by severe
and persistent antisocial behaviour in which the rights of
others or major age-appropriate societal norms or rules
are violated
• Behaviours may include:
aggressive conduct
non-aggressive conduct that includes theft or deceit
bullying
cruelty
fire setting
running away or skipping out
20
Causes of Behaviour
Problems
• A number of influences can lead to the development of a
behaviour disorder:
1 Biological factors:




genetics
parental influences
temperament,
verbal functioning
2 Environmental factors:
 harsh, inconsistent parenting style
 disorganized school environment
 rejection by peers
21
How Common are
Behaviour Problems?
• Behaviour problems may be associated with other mental
disorders such as:
 ADHD
 substance misuse
 anxiety
 mood disorders
• Between 5 and 15% of children and youth in Canada are
diagnosed with oppositional defiant disorder
• Approximately 5.5% are diagnosed with conduct disorder
• On average, one or two students with a behaviour disorder
could be in any given classroom
• CD is 3 to 4 times more common in boys while rates for ODD
for boys and girls is much closer
22
Supporting Students with
Behaviour Problems
• Behaviour problems in the classroom have a number of negative
effects
• The education of both the student and that of the others in the
classroom is effected
• The first step in support is always the gathering of information:
 when the problem behaviour started
 when during the day, the behaviour occurs
 what was happening before the behaviour began
 the result of the behaviour
• This information is often what is used by a school based team for
the purposes of completing a Functional Assessment that is used to
guide staff in better supporting the student
Note: the collection of this information and how it is shared is always determined by the
classroom teacher and the school based team
23
Things not to miss
• Behavioiur problems are the most visible symptom that a
student is struggling
• Behaviour may often be a a signal or a result of some other
concern such as a learning problem
• Untreated behaviour disorders are associated with:
worsening conduct/criminal behaviour
low academic achievement/school failure
further disengagement from school
involvement in antisocial peer group
increased risk of the development of other mental health
problems
24
Substance Misuse
25
Substance Misuse
• Substance misuse refers to the use of a range of drugs
that alters both physical and psychological function
• They can change how a young person thinks, feels, acts
and perceives the world around him or her
• They fall into three broad categories:
depressants (e.g. alcohol and opiates) which slow
down the central nervous system
stimulants (e.g. caffeine, cocaine, amphetamines)
which increase activity in the central nervous system
hallucinogens (e.g. cannabis, psilosybin mushrooms,
LSD) which affect the central nervous system and
create distortions in perception
26
What does Substance
Misuse Look Like?
• Substance use is considered a problem (misuse) when it
is associated with harmful consequences and loss of
control:
feelings of anxiety
injury
relationship difficulties
problems with thinking clearly
recurrent use resulting in failure to fulfill obligations (e.g.
at school, home, work, in relationships)
recurrent use in hazardous situations (e.g. driving)
• In most cases, adolescents do not believe they have a
problem and that their substance use is “normal”
27
Causes of Substance
Misuse
• Young people may use substances for a variety of
reasons, including:
experimentation
as a way of coping with certain social situations
to fit in with peers
as a way of coping with stress or mental health
concerns
as an escape from boredom
as a way to get to sleep, stay awake or lose weight
28
Causes of Substance
Misuse
• Factors that increase the risk of substance misuse:
 availability of substances
 exposure to substances by parents, siblings or peers
 presence of other mental health problems
 regular use before the age of 14
 repeated intoxication before the age of 16
 a disadvantaged background
 poor parent-child relationship and/or parental conflict
 a family history of substance misuse
 exposure to trauma
• Males are at higher risk for developing a substance misuse
problem
• Early age use of tobacco, alcohol and other substances,
increases the risk of developing a substance misuse problem
29
How Common are Substance
Misuse Problems?
• In Canada, substances most frequently used by students
are tobacco, alcohol, cannabis and caffeine
• The most commonly used substances by students in
Grades 7 to 12:
Alcohol – used by 55% of students
High-caffeine energy drinks - used by 50% of students
Cannabis – used by 22% of students
30
Things not to miss
• Other mental disorders (notably, anxiety and depression)
are often present with youth who have a substance
misuse problem
• Suicide may be a greater concern for youth with a
substance misuse problem
• Youth with undiagnosed or untreated ADHD are also at
an increased risk for substance misuse problems
31
Why Did I Get So Wasted
Again?
http://www.youtube.com/watch?v=tUqjkyele1w
Why did I get so wasted again?
32
Warning Signs of
Substance Misuse
• Indicators that a youth’s substance use could lead to harm:
Use of substances at an early age (e.g. 13 or 14 years of
age)
Use of larger amounts in higher concentrations (e.g. binge
drinking)
Increasingly frequent or daily use
Use before or during school or use during certain activities
Use as a way to cope with emotions
Use of multiple substances at the same time
Change in peer or family relationships (e.g. avoidance of
old friends in favour of “new” friends
Loss of interest in usual activities
33
Warning Signs of
Substance Misuse
• Indicators that a youth may have a substance misuse
problem or dependence:
need for larger amounts to receive the same effects (sign
of increased tolerance
psychological and physiological difficulty when trying (or
forced) to cut back or stop (withdrawal symptoms)
increased focus on or obsession with using substance
increased focus on getting substance at the expense of
other activities
34
Why Do I Always Want To
Get High?
Why do I always want to get high?
http://www.youtube.com/watch?v=qrWZAkkAZEU
35
Eating Disorders
36
Eating Disorders
• Eating problems occur along a continuum from relatively
mild disruptions of normal eating patterns to disordered
eating with serious health consequences
• Young women, especially, report a concern about weight
and body image and may engage in purging or binge eating
from time to time
• There is growing evidence that young men have concerns
about their body size (either underweight or overweight)
• This can lead to dissatisfaction with body image, disordered
eating, and unhealthy attempts at muscle building
• Eating disorders are being reported at earlier ages, with
children (male and female) under 12 being being referred to
treatment programs
37
Bulimia Nervosa
• Bulimia nervosa is characterized by regular and
recurrent binge eating
• Binge eating can be defined as eating large amounts of
food over a short period of time accompanied by a lack
of control over the eating during the episode
• There are frequent and inappropriate behaviours
designed to prevent weight gain, including:
self-induced vomiting
use of laxatives
use of enemas
excessive exercise
• The prevalence of Bulimia Nervosa is about 1 – 3%
38
Anorexia Nervosa
• Anorexia nervosa is characterized by:
 excessive preoccupation with body weight control
a disturbed body image
an intense fear of gaining weight
a refusal to maintain a minimally normal weight
• Post pubescent girls experience a loss of menstrual
periods
• Youth with anorexia nervosa will deny they have a
problem with being underweight
• The prevalence of anorexia nervosa is about 0.2 – 0.5%
39
Why Can’t I Look Like
That?
Why can’t I look like that?
http://www.youtube.com/watch?v=y9TIddPbUSc
40
Common Signs of an
Eating Disorder
• Emotional:
persistent concern about weight or body shape
frequent references to worries about gaining weight,
being fat, or needing to lose weight
low self esteem
mood changes such as irritability, anxiety or depression
• Behavioural:
frequent monitoring of body size and changes in weight
extreme or unusual eating habits (e.g. stringent dieting,
ritualized behaviour at mealtime or secret binging)
Continued attempts to lose weight while already at a
normal or low weight
41
Common Signs of an
Eating Disorder
• Behavioural (continued):
refusal to eat foods most peers enjoy
preference for baggy clothing
compulsive or excessive exercising
reluctance to eat in front of peers
declining participation in activities that include food or
eating
periods of fasting
self-induced vomiting, frequent trips to the washroom to
purge
use of diet pills
42
Common Signs of an
Eating Disorder
• Behavioural (continued):
overuse of laxatives and diuretics
regular episodes of overeating or binging, references to
feeling sick because of overeating
decline in concentration, memory, attention span and/or
academic performance
• Physical:
episodes of shakiness, faintness or dizziness
blood in vomit (medical emergency)
significant fluctuations in weight
hair falling out in clumps
lack of energy to complete tasks
43
Things not to miss
• Research indicates that children who receive negative comments
about weight or physical appearance are more likely to develop
an eating disorder
• Providing advice on weight, “healthy” eating or dieting can
actually have a harmful effect as it may reinforce a desire to use
food as a way to compensate for poor self esteem
• Do not assume that a student is skipping meals by choice. This
may be an indicator of an eating disorder or it may be an
indicator of poverty and a lack of food on the home with which to
prepare a lunch
• Do not let a student’s anger or distress prevent you from
informing the classroom teacher, principal or counsellor about a
concern you have about disordered eating
44
Reducing Stigma
45
Reducing Stigma
• Despite the fact that mental health problems affect one
in five people, fewer than 25% of children and youth with
mental health problems receive treatment
• Children, youth and adults all agree that the major
barrier to seeking help is a fear of being stigmatized or
negatively perceived by others
• The Mental Health Commission of Canada recognizes
that educators have a unique opportunity to influence
perceptions and understandings of mental health
problems
46
Reducing Stigma
• Raising awareness helps dis-spell the myths that surround
the topic of mental illness
• Awareness helps students understand that people with
mental illness:
are not violent or dangerous people
are not people with low income or intelligence
are not people with weak character
have an illness that can be treated, just as any individual
with a physical illness can be treated
should be treated with respect and dignity
• Raising awareness increases the likelihood that an
individual with a mental illness will seek treatment
47
10 Things You Can Do to
Stop Mental Health Stigma
1 Learn about mental illnesses, become more informed
2 Listen to people who have experienced mental illness,
how they have been stigmatized, how it has affected
their lives
3 Watch your language - avoid terms and expressions
that can perpetuate stereotypes, such as:
 psycho
 lunatic
 nuts
 retard
 Schizo
Source: Telling Is Risky Business: Mental Health Consumers Confront Stigma
- Otto Wahl, Rutgers University Press, 1999
48
10 Things You Can Do to
Stop Mental Health Stigma
4
5
6
7
Monitor media and report stigmatizing material
Respond to stigmatizing material in the media. Protest such
material to those responsible – journalists, editors,
advertisers, movie producers – and provide more appropriate
information
Speak up about stigma. When someone misuses a
psychiatric term (such as schizophrenic), tells a joke that
ridicules mental illness or makes disrespectful terms, let
them know you find it hurtful and unacceptable
Talk openly about mental illness. The more mental illness
remains hidden, the more people will continue to believe it is
shameful
49
10 Things You Can Do to
Stop Mental Health Stigma
8 Demand change from your elected representatives.
Speak up on issues such as insurance parity, limited
funding for research and inadequate budgets for mental
health services
9 Support organizations that fight stigma and
discrimination. Join them, donate money to them and
volunteer for them
10 Contribute to research related to mental illness and
stigma
50
Ideas to Reduce Mental
Health Stigma at Schools
• In small groups, discuss the question:
 What can we do to reduce stigma at the school level?
• Each group should try to generate several suggestions
• A spokesperson for each small group shares one idea
out with the larger group
51
What if I Suspect a Student
has a Mental Disorder?
• Discuss your concern with the student’s classroom teacher
• At the teacher’s discretion, this conversation may extend to
the school counsellor and/or other members of the School
Based Team
• If concern is shared by the teacher and/or SBT:
 note what the student’s previous or typical baseline
behaviors were
 begin an objective recording of the student’s current
behaviours
 determine if current behaviours interfere with the student’s
typical functioning
 depression is highly treatable with cognitive behaviour
therapy. A referral to the school counsellor is a good place to
start
52
Jigsaw Activity
• In teams, discuss the challenges present in a classroom
with a student coping with a behaviour or an eating
disorder
• Form 4 different groups
• Each group will have a handout on ways to support
students with a specific concern that they will discuss as
a team and familiarize themselves with
• Participants will then rejoin their original team to both
‘teach’ the points they learned and to take notes on the
topics the others covered
• When finished, each team member will have a set of
notes on supporting these mental health challenges in
the classroom
53
Know-Wonder-Learn
• Look at your K-W-L sheet and review your responses to
the first two sections
• Correct any misconception that may have been recorded
in the KNOW section
• Take a few minutes and complete the LEARN section,
especially concerning how it relates to what you had
written in the section for WONDER
54
Finishing Up
• Summative Assessments to be collected
• Participants who have:
 Attended all sessions
 Successfully completed Summative Assessment
• Will receive Certificate of Completion
• Evaluations:
 Complete
 Mail to John Malcolmson
• Thank you for participating and helping to make this
Learning Option successful
55