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Elizabeth Coyle, D.Ed. Professional Development Services 717-871-1396

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 Mood Disorders Anxiety Disorders ADHD

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Elizabeth Coyle, D.Ed. Professional Development Services 717-871-1396

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  1. Youth with Mental Health Disorders: Building Skills for Success2011 Pennsylvania Community on Transition Conference Elizabeth Coyle, D.Ed. Professional Development Services 717-871-1396

  2. Overview • Skill Building for Youth • Mood Disorders • Anxiety Disorders • ADHD • Oppositional Defiant Disorders • Conduct Disorder

  3. Mood Disorders: Categorization • Mania (rare) • Cyclothymia (unknown) • Dysthymia (1.7%-8%) • Depression (4%-8.3%) • Bipolar (1%-2%) • http://www.youtube.com/watch?v=QLxFSiKXYko

  4. General Do’s and Don’tsfor 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

  5. 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

  6. Depression: Signs and Symptoms • Depression in the flight mode • Withdrawn, low energy, changes in sleeping/eating, somatic complaints, difficulty concentrating • Depression in the fight mode • Irritable, belligerent, aggressive, mood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

  7. 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

  8. School-Wide Supports • School counselors, social workers, nurses, psychologists • SAP • 504 plans • IEP • Mentors • After school activities

  9. 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

  10. 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=R4yMHVNzVgA

  11. Anxiety Disorders: Eight Categories • Generalized anxiety disorder • Specific phobias • Panic disorder • Separation anxiety • Social phobia • Agoraphobia • Obsessive compulsive disorder • Post traumatic stress disorder

  12. Common Threads of Anxiety Disorders • Subjective experience • Physiological response • Behavioral response

  13. School Supports Do’s Don’ts • Use paraphrasing to support concern • Empower youth for solutions • Use recommendations from pupil personnel and/or mental health professionals • 504 plans, SAP, RTII, school nurse • Minimize fears, worries, anxiety • Assume behavior is for attention • Overwhelm • Proceed without input from pupil personnel and/or mental health professionals

  14. 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

  15. 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

  16. 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

  17. Attention Deficit Hyperactivity Disorder • Three subtypes • Inattentive • Hyperactive/impulsive • Combined type

  18. 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

  19. Impulsive • Missing skill: Stop and think • Power minutes • Cue for calming techniques • Use of head talk method • You could say to yourself, “???”

  20. Activity Levels • Build in motion and movement • Neurodevelopmental activities • Desktop yoga • Brain gym • Use of board more frequently • Transition methods • Same use of calming techniques • Breathing • Power minutes • Breaks • Head talk

  21. Opposition/Defiance • 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

  22. Opposition/Defiance Response • Opposition • 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

  23. Opposition/Defiance Response • Transitions • Social stories • Two-step transitions • Decision making • Red or green

  24. Opposition/Defiance: Teach Missing Skills • Opposition/defiance • Flexibility • Frustration tolerance • Adaptability/self regulation • Problem solving

  25. Flexibility • Cognitive flexibility • Ability to shift attention from one idea/issue to multiple ideas/issues Cognitive Flexibility Theory

  26. 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=wWW1vpz1ybo&NR=1

  27. Adaptability/Self Regulation • Self regulation • The process by which individuals control and direct their actions • 4 types of self regulation • Physiological • Emotional • Attentional • Behavioral • Adaptability

  28. Collaborative Problem SolvingRoss 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=6xkVT2y9euI

  29. Collaborative Problem SolvingRoss 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=ARIEXN1yf00&feature=related

  30. 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

  31. Conduct Disorder Response • Use back door praise • Use healthy double binds • Use contracts • Highlight strengths

  32. Behavior Contract

  33. Conduct Disorder: Teach Missing Skills • Problem solving • Agree, listen, solve • Fair fighting rules • Stick to the issue • Stay in here & now • No low blows

  34. 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?

  35. 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/index-1.html • Mark Greenberg’s PATHS Program that builds social/emotional skills • http://www.colorado.edu/cspv/blueprints/modelprograms/PATHS.html#video

  36. Evidence-Based Programs for Skill Building • Second Step Program for building anger management skills • http://www.cfchildren.org/programs/ssp/second-step-video-previews-1/ • Arnold Goldstein’s Skillstreaming • http://www.skillstreaming.com/

  37. Wrap-up • What I will start/continue doing • ____________________________________________________________________________________________________________________________________________________ • What I will stop doing • ____________________________________________________________________________________________________________________________________________________

  38. 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

  39. 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.

  40. Useful Web Sites • 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

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