Transcript Promoting mental well-being in primary schools

Promoting mental well-being in
primary school students
Dr. Nilima Shah
Dr. G.K.Vankar
Department of Psychiatry
B.J.Medical College
Ahmedabad
Mentally well children……
They should be able to:
• develop psychologically, emotionally, intellectually and
spiritually;
• initiate, develop and sustain mutually satisfying personal
relationships;
• use and enjoy solitude;
• become aware of others and empathise with them;
• play and learn;
• develop a sense of right and wrong
• resolve (face) problems and setbacks and learn from them.
However…..
“One in ten children and young people aged 5 to 16 have a
clinically diagnosed mental health disorder and around one in
seven has less severe problems”
• Let’s see some examples…….
• Raju studies in 3rd std. He is a well behaved, polite and
obedient boy. He gets average marks in all the subjects except
mathematics. He is very good at cricket and music. However it
is noted that he never completes his homework. He cannot
take running notes in the classroom and his handwriting is
quite bad. He leaves his answer sheets incomplete.
• When asked to read aloud, he fumbles, hesitates and makes a
lot of mistakes. However when asked a question in viva he can
answer very well. He also ranks 1st in General Knowledge quiz.
What do you think is going on???
Specific Learning Disorder
• Impairment in :
– Mathematics
– Reading
– Written Expression
Dyscalculia
• Sense of Numbers
• Memorisation of Arithmetic facts
• Accurate or fluent calculation
• Accurate Math Reasoning
Dyslexia
• Word reading accuracy
• Reading rate or fluency
• Reading comprehension
Dysgraphia
• Spelling accuracy
• Grammar and punctuation accuracy
• Clarity or organisation of written expression
• Shyam studies in 1st std. He is always on the go and acting as if
driven by a motor. He talks a lot. Even during the morning
prayers he cannot remain still and keeps tapping his hands
and feet opening his eyes and wanting to move around as
soon as possible.
• His favourite class is the sports class in which he runs about
and tries to climb up the trees in the playground. He is eager
to learn and often blurts out an answer even before the
question has been completed. He cannot wait for his turn or
stand in a line.
• The concern is that his academic performance is gradually
declining.
What do you think is going on?
Attention Deficit Hyperactivity Disorder
• Hyperactive/Impulsive type
• Inattentive type
• Combined type
• Sheena studies in 5th std. She is a polite, well behaved,
sincere and honest child. She seems to be working hard with
all her subjects, completes all homework and assignments,
and reads regularly. However she barely manages to get
passing marks in all the subjects.
• She comes across as very shy and introvert in nature. She ahs
low self esteem and low confidence. She cries easily when
confronted with questions.
• Her school records show that she was born pre mature. She
learnt to walk at the age of 2.5 years and learnt to speak at
the age of 3 years. ( delayed development )
What do you think is going on?
Intellectual disability
• Mild : IQ is between 50-70
• Moderate : IQ is between 35-49
• Severe : IQ is between 20-34
• Profound : IQ is less than 20
• Rahul studies in 1st std. He comes across as slightly odd and
eccentric. He had difficulty in making friends and playing
sports with others. He often played alone and spent time
alone at lunch and recess.
• His communication was odd and restricted with monotonic
voice quality. His academic performance was average and
there were no problem behaviors.
• He had keen interest in playing the violin and stole the show
in all music programs in school.
What do you think is going on?
Autism Spectrum Disorders
• Persistent deficits in social communications and interactions
• Restricted, repetitive patterns of behavior, interests or activities
• With or without accompanying intellectual impairment
• With or without accompanying language impairment
Autism : Associated Behavioral Symptoms
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Disturbance in language development and usage.
Intellectual disability
Irritability
Instability of mood and affect
Response to sensory stimuli
Hyperactivity and inattention
Precocious skills
Insomnia
Minor infections and gastro intestinal symptoms
• Shashi is the trouble-maker of the class. He is the naughtiest
of all, and doesn’t seem to improve his behavior even after
several punishments.
• He bullies, threatens and intimidates others, often getting into
physical fights. He doesn’t think before breaking things. Once
he even burnt his classmate’s notebooks in school. He lies all
the time and is also found stealing things from the school
• He is unconcerned about his own performance, about the
feelings of others and never feels guilty or sorry.
What do you think is going on?
Conduct disorder
•Aggression to people and animals
•Destruction of property
•Deceitfulness or theft
•Serious Violation of Rules
Conduct disorder
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With limited pro-social emotions
Lack of remorse or guilt
Callous-lack of empathy
Unconcerned about performance
Shallow or deficient affect
• Mahesh studies in 7th standard. He used to get very good
marks till the 5th std. However, his scores are steadily
declining. He seems to remain alone, and talks less with his
friends.
• Even in recess, he sits in a corner while the others play. He
refuses to participate in the upcoming cultural programme.
He often leaves his home-work incomplete. He is also
inattentive in class, and when reprimanded, starts crying like a
child.
• His parents have recently been divorced.
What do you think is going on?
Depression
•2-3 % of children and upto 8% adolescents are affected
•They are at increased risk of self-harm and suicide
•May have irritablity/defiant behaviour /depressed mood
Other problems
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Anxiety disorders (OCD/Phobia/Social Phobia/PTSD)
Performance anxiety
Childhood Bipolar disorder
Early onset schizophrenia
Substance use problems
Eating disorders
Internet addiction
Stressors that affect children
Loss or separation – resulting from death, parental separation,
divorce, hospitalization, loss of friendships (especially in
adolescence), family conflict or breakdown that results in the
child having to live elsewhere
Life changes – such as the birth of a sibling, moving house or
changing schools or during transition from primary to
secondary school
Traumatic events such as abuse, domestic violence, bullying,
violence, accidents, injuries or natural disaster.
• Risk factors & Protective factors……
In the child…
Risk Factors
Protective Factors
•Genetic influences
• Low IQ and learning disabilities
• Specific development delay
• Communication difficulties
• Difficult temperament
• Physical illness
• Academic failure
• Low self-esteem
• Being female (in younger children)
• Secure attachment experience
• Outgoing temperament as an infant
• Good communication skills, sociability
• Being a planner; having belief in control
• Humor
• Problem solving skills, positive attitude
• Experiences of success and achievement
• Faith or spirituality
• Capacity to reflect
In the family…
Risk Factors
Protective Factors
• Overt parental conflict including Domestic
Violence
• Family breakdown (including where
children are taken into care or adopted)
• Inconsistent or unclear discipline
• Hostile or rejecting relationships
• Failure to adapt to a child’s changing
needs
• Physical, sexual or emotional abuse
• Parental psychiatric illness
• Parental criminality, alcoholism or
personality disorder
• Death and loss – including loss of
friendship
• At least one good parent-child
relationship (or one supportive
adult)
• Affection
• Clear, consistent discipline
• Support for education
• Supportive long term
relationship or the absence of
severe discord
In the School…
Risk Factors
Protective Factors
• Bullying
• Discrimination
• Breakdown in/ lack of friendships
• Deviant peer influences
• Peer pressure
• Poor pupil to teacher relationships
• Clear policies on behavior and bullying
• ‘Open-door’ policy for children to raise
problems
• A whole-school approach to
promoting good mental health
• Positive classroom management
• A sense of belonging
• Positive peer influences
In the community..
Risk Factors
Protective Factors
• Socio-economic disadvantage
•Homelessness
• Disaster, accidents, war or other
overwhelming events
• Discrimination
• Other significant life events
• Wider supportive network
• Good housing
• High standard of living
• High morale school with positive
policies for behavior, attitudes and antibullying
• Opportunities for valued social roles
• Range of sport/leisure activities
Signs of psychological disturbance
• An unexpected reduction in academic performance.
• A change in mood and marked emotional instability
• Withdrawal from relationships, separation from friends
• Getting into trouble at school, discipline problems
• Loss of interest in usual pursuits, study, relationships.
• Ideas and themes of depression, death or suicide.
• Hopelessness and helplessness.
• Giving away prized possessions.
• Stressful life events, including significant grief.
• Bullying or victimisation.
• History of mental illness/ Alcohol/drug misuse.
• History of suicidal behaviour or deliberate self-harm
What one can do…..
Avoid giving labels…..
What one can do…
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Be impartial
Be non judgemental
Be non-sarcastic
Shower appropriate praises
Be encouraging
Never give up on any of them
Give time and a patient listening ear
Understand them, accept them all
Specific interventions for specific disorders
At the school level…
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Positive and negative re-inforcement techniques
? Role of punishments
Have a student feedback mechanism in place
Address complaints and praises in a group rather than singling
out students
Personal mentoring
Working with parents
Peer-mentoring
Student support service/counselors
Providing stress-buster time: Rainbow room/Oasis/ Tete-e-tete
An inspiring video-clip….
Thank you…
Contact details: 9979880789, [email protected]