Transcript Youth with Mental Health Disorders: Building Skills for

Youth with Mental Health Disorders:
Building Skills for Success
2011 Pennsylvania Community on Transition
Conference
Elizabeth Coyle, D.Ed.
Professional Development Services
717-871-1396
Overview
• Skill Building for Youth
1.
Mood Disorders
2. Anxiety Disorders
3. ADHD
4. Oppositional Defiant
Disorders
5. Conduct Disorder
Mood Disorders: Categorization
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Mania (rare)
Cyclothymia (unknown)
Dysthymia (1.7%-8%)
Depression (4%-8.3%)
Bipolar (1%-2%)
 http://www.youtube.com/watch?v=QLxFSiKXY
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General Do’s and Don’ts
for All Mood Disorders
• Do recognize your role
(identification, referral,
classroom interventions,
balance concern with
confidentiality)
• Do recognize your
sphere of influence
• Do treat the same as a
physical illness
• Don’t take behavior
personally
• Don’t blame
• Don’t expect change to
happen overnight
• Don’t take on
responsibility beyond
your role
Family Awareness and Collaboration
• Understand sources of denial/minimization
▫ Stigmas
▫ Lack of information/education/awareness
• Comparisons to physical illness
• Need for correct type of therapy
Depression: Signs and Symptoms
 Depression in the flight mode
 Withdrawn, low energy, changes in
sleeping/eating, somatic complaints, difficulty
concentrating
 Depression in the fight mode
 Irritable, belligerent, aggressive, mood swings,
short fuse, defiant
Links Between Depression and
Learning
Depression and neurochemicals
Impact on short- and long-term memory
Impact on motivation and potential
Impact of behavioral changes on learning
Impact of emotional changes on inclusion and
sense of belonging
School-Wide Supports
 School counselors, social
workers, nurses,
psychologists
 SAP
 504 plans
 IEP
 Mentors
 After school activities
Depression: Responses
• Serotonin
▫ Motion and movement, walking clubs, yoga, chunking, feeling of day
portfolio
• Interpretation
▫ Columbo approach, teach reading of non-verbals, feeling faces
• Mourning
▫ Feeling of the day art or audio, support groups
• Flight motivators
▫ Helping others of a younger age, projects
• Fight response
▫ Head talk and cool talk, anger management skills
Dysthymia
 Depressed or irritable mood plus at least two of
the following symptoms: poor appetite or
overeating; sleep disturbance; low energy or
fatigue; low self-esteem; concentration or
decision making problems; feelings of
hopelessness
 Less severe than depression but more prolonged
(at least one year)
 Connection to apathy and motivation
 http://www.youtube.com/watch?v=R4yMHVNz
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Anxiety Disorders: Eight
Categories
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Generalized anxiety disorder
Specific phobias
Panic disorder
Separation anxiety
Social phobia
Agoraphobia
Obsessive compulsive disorder
Post traumatic stress disorder
Common Threads of Anxiety
Disorders
• Subjective experience
• Physiological response
• Behavioral response
School Supports
• Use paraphrasing to support
concern
• Minimize fears, worries,
anxiety
• Empower youth for solutions
• Assume behavior is for
attention
• Use recommendations from
pupil personnel and/or
mental health professionals
• Overwhelm
• 504 plans, SAP, RTII, school
nurse
• Proceed without input from
pupil personnel and/or
mental health professionals
Do’s
Don’ts
Collaborating with Families
• Recognize family member may experience anxiety also
(genetic predisposition links)
• Recommend exposure to anxiety-producing situation in
planned way
• Produce plan with responsibilities of all parties specified
• Emphasize no more than two or three calming
techniques
▫ Sufficient sleep, diet, exercise, routines
▫ Soup breathing, head talk, self evaluation
• Emphasize need for adults to remind younger children to
use technique(s) when feeling anxious
COPE Intervention for Anxiety
Disorders (Dacey and Fiore)
• Calming the nervous system
▫ Physical: soup breathing; sensory awareness; exercise;
supportive surfaces; massage; biofeedback;
desensitization
▫ Mental: paradoxical thinking; scaling level of fear;
visualizing desired outcomes; distraction through
counting; humor
COPE Intervention for Anxiety
Disorders (Dacey and Fiore)
• Originating an imaginative plan
▫ Flexibility thinking exercises, learning to think out
of the box, creating wildly imaginative stories,
approximation
• Persisting in the face of obstacles
▫ Increase tolerance for ambiguity, taking moderate
risks, learning about courage from literature,
allow crying that promotes relief, promoting
delayed gratification
• Evaluating and adjusting plan
Attention Deficit Hyperactivity
Disorder
• Three subtypes
1. Inattentive
2. Hyperactive/impulsive
3. Combined type
Attending/Distractibility
• Determine if youth is a “satellite dish” or fogs in/out
• Proximity, then “Look around you, what do you need to
be doing?”
• You’re off track!
• Create map of sounds, sights, tactile
• Determine seating based on map
• Cue to mode of distractibility
• Use head talk method
• Cautionary note on reliance
Impulsive
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Missing skill: Stop and think
Power minutes
Cue for calming techniques
Use of head talk method
You could say to yourself, “???”
Activity Levels
• Build in motion and movement
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Neurodevelopmental activities
Desktop yoga
Brain gym
Use of board more frequently
Transition methods
• Same use of calming techniques
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Breathing
Power minutes
Breaks
Head talk
Opposition/Defiance
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Loses temper easily
Argues with adults
Defies adult requests
Deliberately annoys people
Excessive use of foul language
Blames others for mistakes/behavior
Touchy/easily annoyed by others
Often angry and resentful
Spiteful or vindictive
Opposition/Defiance Response
• Opposition
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Basket A, B, C
Pick the hill
Confident non-verbals
Two choices NOW
Few words then silence
Allow time to process
Ace card approach
Rapport and humor
Opposition/Defiance Response
• Transitions
▫ Social stories
▫ Two-step transitions
• Decision making
▫ Red or green
Opposition/Defiance: Teach Missing
Skills
• Opposition/defiance
▫ Flexibility
▫ Frustration tolerance
▫ Adaptability/self regulation
▫ Problem solving
Flexibility
• Cognitive flexibility
▫ Ability to shift attention from one idea/issue to
multiple ideas/issues
Cognitive Flexibility Theory
Frustration Tolerance
• Ability to delay gratification
▫ Distraction, head talk, social support
• Outcomes
▫ Buffers against development of mental health
issues, reduces aggressive behavior, increases
academic achievement
• Mischel’s marshmallow experiment
• http://www.youtube.com/watch?v=wWW1vpz1y
bo&NR=1
Adaptability/Self Regulation
• Self regulation
▫ The process by which individuals
control and direct their actions
▫ 4 types of self regulation
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Physiological
Emotional
Attentional
Behavioral
• Adaptability
Collaborative Problem Solving
Ross Greene
• Three options for solving problems (unmet
expectations)
▫ Plan A: impose will
▫ Plan B: Collaborative Problem Solving
▫ Plan C: drop expectation
• http://www.youtube.com/watch?v=6xkVT2y9eu
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Collaborative Problem Solving
Ross Greene
• Empathy (student concern)
▫ I notice that…. What’s up? Drill….
• Define problem (adult concern, i.e., safety,
learning, impact of behavior on self and others)
• Solution addressing both concerns
▫ www.livesinthebalance.org
• http://www.youtube.com/watch?v=ARIEXN1yf
00&feature=related
Conduct Disorder
• Aggression to people/animals
▫ Bullies/intimidates, physical fights, threats with
weapon, physically cruel to people/animals, stolen
while confronting a victim, forced someone into sexual
activity
• Destruction of property
▫ Deliberately destroys property, fire setting
• Deceitfulness or theft
▫ Lies to obtain goods/favors, breaking/entering,
shoplifting
• Serious violation of rules
▫ Truant, run away, stays out at night
Conduct Disorder Response
• Use back door praise
• Use healthy double binds
• Use contracts
• Highlight strengths
Behavior Contract
What happened?
What I plan to think
and say instead is:
What’s in it for me if
I follow the plan?
Conduct Disorder: Teach Missing
Skills
• Problem solving
 Agree, listen, solve
 Fair fighting rules
 Stick to the issue
 Stay in here & now
 No low blows
Conduct Disorder: Teach Missing Skills
• Skill building
▫ Anger management
 Trigger, interpretation, head talk/cool talk, calming
techniques, problem solve
▫ Correct attribution bias
 Hostile or accidental
 Cynthia Hudley
▫ Futuristic thinking
 Dreams, wishes, age of death?
Evidence-Based Programs for Skill
Building
• Cynthia Hudley’s Brain Power Program to
reduce hostile attribution bias that contributes
to aggression
• http://www.brainpowerprogram.com/index1.html
• Mark Greenberg’s PATHS Program that builds
social/emotional skills
• http://www.colorado.edu/cspv/blueprints/mod
elprograms/PATHS.html#video
Evidence-Based Programs for Skill
Building
• Second Step Program for building anger
management skills
• http://www.cfchildren.org/programs/ssp/secon
d-step-video-previews-1/
• Arnold Goldstein’s Skillstreaming
• http://www.skillstreaming.com/
Wrap-up
• What I will start/continue doing
▫ _____________________________________
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• What I will stop doing
▫ _____________________________________
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Useful Resources: Depression and
Anxiety
 Anxiety Disorders
Association
 www.adaa.org
 National Institute of
Mental Health
 www.nimh.nih.gov
 Mayo Clinic
 www.mayoclinic.org
 American Academy of
Childhood & Adolescent
Psychiatry
 www.aacap.org
 Family-friendly sites
 worrywisekids.org
 kidshealth.org
 socialphobia.org
 Your Anxious Child by
John Dacey and Lisa Fiore
 School Refusal:
Assessment and
Intervention within School
Settings by Mary Wimmer
Useful Resources: Behavioral Issues
• Greene, R. (2008). Lost at school.
• Greene, R. (1998). Explosive child.
• Lawrence-Lightfoot, S. (2003). The essential
conversation: What parents and teachers can learn from
each other.
• Stutzman, A., et al. (2005). Restorative discipline for
schools: Teaching responsibility; creating caring
climates.
• Watson, M. (2003). Transforming difficult elementary
classrooms through developmental discipline.
Useful Web Sites
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www.teacch.com
www.templegrandin.com
www.thegraycenter.org
www.conductdisorders.org
www.childtruama.org
www.livesinthebalance.org
www.aacap.org
www.nimh.nih.gov
www.mayoclinic.org