Transcript Wiggly, Worried, Wierd, Warrior - Northwest Counseling and Guidance
Wiggly Worried Weird Warrior
- Common psychiatric conditions and how they manifest in the school setting HIMANSHU AGRAWAL, MD NORTHWEST COUNSELING AND GUIDANCE CLINIC
Warm up Exercise
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Think about a student you know who is seeking mental health treatment Think about why he or she is seeking treatment
Scratch these words out
ADHD Depression Anxiety Oppositional Defiant Disorder Conduct disorder Autism Bipolar
Instead…try one of these
So that he can get along better with his teachers, parents, his friends So that he may have better grades So that she has fewer tantrums So that she cries less frequently So she hits others/herself less often So that he can get back on the football team again or enjoy choir more So that she stops thinking about suicide
ADHD
Depression
Anxiety
Anger
The Big 4
Exercise
4 volunteers please!
Signs of ADHD
INATTENTION
Careless mistakes
Rushes through work
Procrastinates to finish assignments
Does the environment but forgets to turn it in
Loses items (eraser, pencil etc)
Desk/ Locker is disorganized/messy
Day dreamer
Needs to be told the same instruction multiple times
Signs of ADHD
HYPERACTIVITY AND IMPULSIVITY
Excessively talkative
Constantly fidgeting, constantly ‘on the go’
Running/ Climbing in inappropriate spaces
Difficulty doing things quietly
Difficulty waiting turn
Blurts out answers when it is not his or her turn
Interrupts others
Myths about ADHD
“I was the same way and the all I needed was a smack on the head !”
http://www.twitvid.com/HUKCH
“He doesn’t seem to have any problems concentrating on those #$@!! Video games !!!”
“She doesn’t have ADHD, she’s just shy”
“That child shouldn’t be on ADHD meds he’s already a peanut!”
“That child shouldn’t be on ADHD meds he’s already a peanut!”
Treatment with stimulants in childhood modestly reduced expected height and weight These effects attenuate over time Data suggest that ultimate adult growth parameters are not affected Deficits in height and weight do not appear to be a clinical concern for most children treated with stimulants
Effect of stimulants on height and weight: a review of the literature.
Faraone SV
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Biederman J
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Morley CP
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Spencer TJ
. J Am Acad Child Adolesc Psychiatry. 2008 Sep;47(9):994-1009.
“Children become addicted to Ritalin if they take it for ADHD”
“Children become addicted to Ritalin if they take it for ADHD”
• The presence of ADHD may influence adolescent and adult substance-use disorders in different ways: • • • • earlier age of onset, higher frequency, longer duration of substance abuse and transition from alcohol-abuse to other substance-use disorders
Attention-deficit/hyperactivity disorder and substance abuse Davids E
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Gastpar M Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD) K
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Te Wildt BT
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Zedler M
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Ziegenbein M
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Wiese B
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Emrich HM
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Schneider U
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Ohlmeier MD
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Peters
“Children become addicted to Ritalin if they take it for ADHD”
• Children who take medication to treat attention deficit hyperactivity disorder (ADHD) face no greater risk of future substance abuse (13 year follow – up) – Fischer et al, Pediatrics. 2003 • Treatment with stimulant drugs may significantly decrease the risk that girls with ADHD will begin smoking cigarettes or using alcohol or drugs.
– Wilens et al, Archives of Pediatrics and Adolescent Medicine Oct 2008.
ADHD- Practical suggestions for the classroom DISTRACTIBILITY
Seat the child away from doors and windows 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.
ADHD- Practical suggestions for the classroom IMPULSIVITY (Interruptive Children)
Develop a “secret language” with the child to let the child know they are interrupting. Praise the child for interruption-free conversations. Write the schedule for the day on the board or on a piece of paper and cross off each item as it is completed.
When necessary, give consequences immediately following misbehavior. Be specific in your explanation, making sure the child knows how they misbehaved
ADHD- Practical suggestions for the classroom HYPERACTIVITY (Fidgetiness)
Ask the child to run an errand or do a task for you, even if it just means walking across the room to sharpen pencils or put dishes away. Encourage the child to play a sport—or at least run around before and after school. Provide a stress ball, small toy, or other object for the child to squeeze or play with discreetly at his or her seat. Limit screen time in favor of time for movement. Make sure the child with ADD/ADHD never misses recess or P.E.
ANXIETY & DEPRESSION
Signs of Depression
MOOD
Sad
Mad Loss of pleasure/ interest in activities Suicidal thoughts (including self injurious behaviors) Excessive risk taking (sense of foreshortened future)
PERSPECTIVE
Worthlessness (Self derogatory statements)
Helplessness Hopelessness Inappropriate guilt Errors in Thinking
Signs of Depression
SLEEP
Too little (insomnia)
Too much (Hypersomnolence)
WEIGHT
Loss of appetite and weight
Excessive weight gain
Failure to reach appropriate weight for age
Signs of Depression
ENERGY
Fatigue
Social Isolation
Psychomotor agitation (clenched fists et al!) CONCENTRATION
Especially if this is a shift from baseline
Sudden drop in grades VAGUE PHYSICAL COMPLAINTS
Headaches
Stomachaches
Joints, back etc.
Depression- Practical suggestions for the classroom
Try and ask frequent questions about friends and family to show empathy and compassion.
Try and accommodate tardiness and absences from school by providing study guides and make up work.
Discourage bullying, teasing, and other undesirable behavior. Create a peace corner or safe area for a depressed student when his or her feelings erupt or become overwhelming. Try and break larger project into more manageable pieces for the student who has low energy.
Provide an outlet for the child to express his or her feelings, such as a writing journal or an online diary.
ANXIETY
Bucket loads instead of spoonfuls!
Signs of Anxiety
EXCESSIVE WORRIES
Multiple themes- safety, health, futures, career, taxes!!
Perfectionist, inconsolable Strange Rituals Irritability Frequent headaches, stomachaches etc – ‘Worry self sick’ ‘Shy bladder’ Panic attacks Dissociation (zoning out/ going into trances) Get startled easily Nightmares
Anxiety- Practical suggestions for the classroom
Classroom seating should be away from classmates who are loud or misbehave If a large group activity is anticipated, warn the child ahead of time. If a change in routine is anticipated (e.g. substitute teacher), warn the child ahead of time. Always ask the child ahead of time if it is okay to call on them to participate, and tell her what she might expect during the activity.
When anxious children are absent from school, they may be very distressed about the work they have missed. Assign a study buddy to copy notes and share handouts
Anxiety- Practical suggestions for the classroom
Instead of class presentations, give the child the option of presenting just to the teacher, or audio/video taping the presentation at home.
Consider “lunch bunches” of 2-3 kids so they can create shared experiences. Don’t always allow children to choose their own group.
Mistakes are OK, sometimes even encouraged and celebrated!
Systematic desensitization(Baby steps!)
Anger
Anger
Anger
Atypical Antipsychotics Clonidine and Tenex Lithium Anti- Seizure medications
If treatment is working…
Calmer, less disruption , fewer outbursts
Improved concentration, restlessness
Improvement in irritability, behavioral problems
Better Grades
Fewer Time Outs
Social Stundedness
Autism Spectrum
Abuse/ Trauma
Schizophrenia
ADHD
Depression
Anxiety