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Recognizing Depression

By Dr. Sheri Bauman for American School Counselor Association

Until the 1980s, most psychologists did not believe that children and young adolescents suffered from clinical depression. Now we realize that as many as 2 percent of elementary students and 8 percent of adolescents are depressed. In addition to decreased academic performance, untreated depression is one of the most common causes of suicide among teenagers. In pre-pubertal children, males and females have similar rates of depression, but in adolescents, females are more often depressed than males. As 60 to 80 percent of victims of suicide have depressive disorders, recognizing depression and referring students with signs of depression for a professional evaluation and possible treatment may be one of the most effective strategies for suicide prevention.

What is depression?

Perhaps one reason that it took so long for professionals to recognize that children and adolescents do suffer from depression is that symptoms of depression look different in children and adolescents than in adults. First, let's make sure we are clear about the term depression. In casual conversation, it is not unusual for people to say, "I'm depressed today," when they mean "I'm sad today," or "I'm having a bad day." The clinical definition of depression is much more specific and precise. Clinical depression, in children and adults, refers to a mental disorder that exists for at least 2 weeks and has at least 5 of the following symptoms nearly every day that cause distress and/or interfere with daily functioning. The first 2 symptoms must be among the 5.

• Depressed or irritable mood (irritability is more common in children and adolescents)
• Decreased interest in ordinarily pleasurable activities
• Significant weight loss or gain or decreased appetite
• Sleeping a great deal or not sleeping well
• Moving very slowly or very rapidly compared to usual or feeling very restless
• Loss of energy
• Inability to concentrate
• Suicidal or morbid thoughts

Note that there are cognitive, emotional, behavioral, and physical aspects of depression. Depression affects all systems, and some of those may predominate. There is also a condition called dysthymia, which is similar to depression but is longer-lasting (in children and adolescents, the symptoms must be present for at least a year) and less severe. This disorder may appear in children as young as 7, while depression may not emerge until age 10. Some children experience both depression and dysthymia at the same time.

Some children are at higher risk for depression than others. Children of depressed mothers are at higher risk than their peers, as are children with a family history of depression. Children with chronic medical problems, children with attention deficit disorders and conduct problems, sexual minority adolescents, and pregnant adolescents are also vulnerable groups. This does not mean that children and adolescents in those groups will necessarily develop depression, but they are more likely to do so than others.

What does depression look like in students?

In elementary age children, depression is often expressed as bodily complaints. Frequent stomach aches and headaches are observed. Anxiety about school (not wanting to go to school, excessive worrying about school performance) is another way depression is exhibited in children of this age. They may be extremely fearful of being separated from parents, and may develop temper tantrums and behavioral problems, and be irritable or agitated. Such symptoms may not raise a red flag to the uninformed observer, and children with these symptoms are often treated as discipline problems. Underlying sadness and hopelessness may not be easily detected, and poor self-esteem and expression of guilt may not be associated with possible depression. The counselor may be the only person who is aware of the link between such a pattern and possible depression, and as such has an opportunity to intervene and refer the child for further evaluation.

In adolescents, the sadness and hopelessness may be more obvious. Other visible signs could include withdrawal from friends and previously enjoyed activities, changes in eating and sleeping patterns, poor school performance, and low energy. The challenge with adolescents is that many teenagers experience these symptoms on occasion, and adults may dismiss them as "just being a teenager." We are more likely to find drug and alcohol abuse (which may be initiated as a kind of self-medication for unpleasant feelings) and suicidal thoughts and behavior in adolescents, so identifying untreated depression during this stage of life is particularly important.

What other clues shall we look for?

Children and adolescents may mask their feelings, and may have difficulty verbalizing what they are experiencing. The observant counselor can pay attention to other means of expression that provide clues to the inner world of the child. Play, art, and writing are activities that may reveal clues to a depressed child. Drawings that look sad and morose, or contain damaged or morbid images and gloomy colors, may signal sadness or preoccupation with fears and death. Stories and other writings, particularly in adolescence, may reveal thoughts and feelings that are not openly talked about. Adolescents may appear angry rather than sad.

Various behaviors might also lead a counselor to wonder about possible depression. When a child suddenly develops behavior problems, or seems unusually irritable, distractible, and easily frustrated, depression may be behind the behaviors. Disciplinary referrals are likely to increase, and the counselor should make note of this. In addition, unexpected changes in grades and school performance may be more than laziness or lack of interest; sleeping in class may also signal underlying mood problems.

Editor's Note: In next week's issue we will conclude this article by highlighting various tools counselors can use to screen for depression in children and adolescents.

References And Resources

American Psychiatric Association. (2000). Diagnostic And Statistical Manual Of Mental Disorders (4th ed. text revision). Washington, DC.

Beck, J., Beck A. T., & Jolly, J. (2001). Beck Depression Inventory For Youth. San Antonio, TX: Harcourt Assessments, Inc.

Fendrich, M., Weissman, M. M., & Warner, V. (1990). Screening For Depressive Disorder In Children And Adolescents: Validating The Center For Epidemiologic Studies Depression Scale For Children. American Journal of Epidemiology, 131, 538-551.

Kovacs, M. (1992). Children's Depression Inventory. Tonawanda, NY: Multi-Health System.

Reynolds, W.M. (1989). Reynolds Child Depression Scale. Odessa, FL: Psychological Assessment Resources, Inc.

Reynolds, W. M. (1986). Reynolds Adolescent Depression Scale. Odessa, FL: Psychological Assessment Resources, Inc.

Featured Resource: Kidpower Tactics For Dealing With Depression

This unique book was written by Nicholas Dubuque, an 11-year-old child who suffers from depression, and his mother, Susan. In plain language, it provides a wealth of information to help make sense of the complex problem of childhood depression and find ways of coping. To find out how you can purchase this book that offers first hand advice for depressed children ages 8 and up, click here!

About Dr. Sheri Bauman

Dr. Sheri Bauman is an Assistant Professor in the Department of Educational Psychology at the University of Arizona, Tucson, Arizona. She can be reached by email at sherib@u.arizona.edu

About The American School Counselor Association

Professional school counselors everywhere share the same vision to support their schools by serving their students. School counselors know that guiding students toward personal and social development leads to improved academic achievement. Through their partnership with principals and teachers, school counselors help prepare today's students to become tomorrow's adults.

The American School Counselor Association (ASCA) responds to school counselors' unique needs, helping them grow individually as professionals and providing them with real tools to guide their students. As an international nonprofit organization founded in 1952, ASCA has the benefit of foresight and hindsight. It has grown to fit counselors' changing needs through social and educational movements from desegregation to standardized testing. Responding to the needs of counselors as voiced by counselors has enabled ASCA to remain vital and forward-thinking.

ASCA serves as the voice of school counselors on Capitol Hill and helps members ensure their voices are heard in state legislatures. ASCA has active government affairs representatives who monitor activities in Congress, the Department of Education and throughout Washington to advocate on behalf of school counselors' interests: funding, certification, student-to-counselor ratios and more.

A full-color bimonthly magazine, School Counselor provides practical information and how-to articles to help school counselors help their students and themselves. Each issue has a focus on something school counselors care about, from public relations to grief counseling, as well as departments and columns covering a range of topics. Professional School Counseling is ASCA's award-winning bimonthly academic journal, providing peer-reviewed articles on school counseling theory, research, practice and techniques. The journal and the magazine together provide counselors with the most well-rounded and up-to-date information in the field.

For more information, visit www.schoolcounselor.org or call (703) 683-ASCA.

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If you've found The Counselor's Classroom useful and informative, you may also be interested in subscribing to some of our other newsletters. Dr. Playwell's Newsletter is a unique newsletter full of play therapy techniques to help you address the social and emotional needs of children and young adolescents. FYI From Wellness offers practical tips and suggestions for use in the clinic or classroom written by professionals from a variety of disciplines. The Guidance Channel Zine is a monthly online magazine that includes interviews, website reviews, statistics and articles by many national organizations such as the National Association of School Psychologists, the American School Counselor Association and National S.A.V.E. (Students Against Violence Everywhere).

Effective Transition Services: Helping Students with Mental Illnesses Reach their Hopes and Dreams

By Darcy Gruttadaro, JD

The transition for youth from high school to the “real world” can be overwhelming in the best of circumstances, however it can even more daunting for students living with mental illnesses. The transition years (17 to 21 years of age) may involve living alone for the first time, paying rent and managing money for the first time, entering the work force, or heading off to college. This transition time involves new experiences and the stress and anxiety that come with significant change. A smooth transition requires students with mental illnesses to begin preparing early for opportunities in competitive employment and higher education – ideally with the help of their families, teachers, caring school professionals, and community service agencies.

So what are considered effective and appropriate transition services that schools should offer to students with mental illnesses and other disabilities? Schools should:

• ascertain a student’s career aspirations and goals and work with the student and family to plan around those;
• determine a student’s desire or appropriateness for pursuing higher education;
• link students’ long-term transition goals (meaningful employment, higher education, or living independently) to the development of the student’s annual IEP goals, objectives and educational activities;
• assist and guide students in completing college applications and other documents related to higher education;
• help students identify campus based services and supports;
• support students in developing independent living skills – like financial planning and management, cooking, cleaning, preparing a resume, socializing and more;
• provide students with mental illnesses with work experience, career and academic counseling, job coaching and mentoring to prepare them for gainful employment and higher education;
• aid students in finding housing and appropriate residential placement services;
• work with state and local mental health treatment and service providers;
• collaborate with other state and local service agencies – including vocational rehabilitation (for services and job training related to finding gainful employment), the Social Security Administration and others; and
• provide students and families with appropriate information about community resources and educational opportunities and should work in close partnership with families on transition planning to help ensure the future success of young people with mental illnesses.

It is critical for schools to recognize the need to provide effective transition supports and services to help students with mental illnesses achieve their goals of either continuing in higher education or securing meaningful employment.

Unfortunately, many schools in our nation fail to provide appropriate or effective transition services. The lack of effective transition planning contribute to the following:

• Students with disabilities, including mental illnesses, attend colleges and universities at rates lower than their peers without disabilities;
• Unemployment rates for working-age adults with disabilities, including mental illnesses, have hovered at the 70% level for at least the past 12 years;
• Working adults with disabilities, including those with mental illnesses, earn markedly less income than their peers without disabilities;
• Only 34% of adults with disabilities, including those with mental illnesses, between the ages of 21 and 64, report being employed;
• Students with disabilities are less likely than students without disabilities to complete high school courses that prepare them to succeed in college; and
• Students with disabilities are less likely than their peers to earn a college degree.

(Source: President’s Commission on Excellence in Special Education, A New Era: Revitalizing Special Education for Children and Their Families, 2002.)

Fortunately, Congress recognized the importance of ensuring that students receiving special education services also receive appropriate transition services. In reauthorizing the Individuals with Disabilities Education Act (IDEA) in 2004, Congress strengthened the transition provisions included in the reauthorized law. NAMI calls on schools to develop appropriate transition services for students with mental illnesses. Like all young people, students with mental illnesses have hopes and dreams. In many cases, they simply need appropriate services to help them achieve their goals and realize their dreams.

Play Therapy -- Anytime, Anywhere

By Larry Shapiro for ChildsWork/ChildsPlay

There are tens of thousands of professionals who help children with emotional and behavioral problems, and yet only a small percentage would describe themselves as play therapists.

Play therapy was the first psychological technique that acknowledged the special way that children think and relate to adults. Before the introduction of play therapy in the 1930's and 1940's, children were most often treated as "little adults" when they went for treatment of an emotional disorder. It was assumed that they could develop insight into their problems through techniques such as word association and dream analysis, and that this insight would alleviate their emotional conflicts.

But pioneers in the field of child psychotherapy, such as Anna Freud and Melanie Klein, realized that children do not have the cognitive ability to think and talk about their problems the way that adults do. They saw that children "play out their problems," through dolls and puppets and other toys, and they reasoned that this would be a better channel of communication than conventional talk therapy.

But in spite of the interest in these new techniques, play therapy was not widely practiced. Rooted in psychoanalytic theory, you needed years of training in this highly theoretical method of helping children, and it was presumed that it might take many months, if not years, for children to show any progress.

In the 1960's and 1970's, play therapy took a much more practical direction. Paralleling the development of humanistic and client-centered therapy, a new non-directive approach to play therapy was developed by therapists like Virginia Axline and Clark Moustakas. Believing that the relationship between the therapist and child was the paramount therapeutic vehicle, non-directive therapy de-emphasized the need for theoretical interpretation of a child's play. The goal of play therapy was seen as providing experiences where children could resolve past conflicts and learn new, more appropriate behaviors.

In the last 30 years, we have seen an expansion in the techniques that are considered play therapy, making it accessible to an ever-growing number of children. The emphasis has been on more directive techniques, like game therapy, as well as on training other people in the child's life to use play therapy techniques. For example, Filial Therapy was developed by Bernard and Louise Guerney to teach parents basic play therapy techniques. The Primary Mental Health Project, developed at Rochester University in New York, has demonstrated that play therapy techniques can be taught -- in a relatively short period of time -- to paraprofessionals, who in turn can make a significant difference in preventing emotional problems in at-risk children.

Yet in spite of all of the exciting ways that play therapy techniques are being used to treat children, many counselors still associate play therapy with its early roots. They may think that play therapy needs to be done in a well-stocked play room, and that it requires years of specialized training. They may see it exclusively as a long-term process, impractical for the vast majority of today's children. Nothing could be further from the truth.

Play therapy techniques can be utilized anytime and anywhere, because children like to play anytime and anywhere. Play is a way that children relate to others, and it is not confined by time or place.

Once could easily argue that play, in and of itself, is therapeutic. Many studies have shown that humor in any form is beneficial to the body and the mind. When we laugh, our immune systems become stronger, stress bio-chemicals such as cortisol are reduced, our attitude improves and we become more optimistic and even more friendly. It would certainly seem likely that play would have these same results -- and not just for children. Play has the same health and mental health benefits for adolescents and adults, as well as for children.

As counselors and therapists, our challenge is to bring play techniques into all of our work. Don't think of play therapy as a single modality, the way that it was practiced thirty or more years ago. It is simply a tool to communicate with children. When you play with children, you are establishing a relationship with them on their terms. When you play with children, you are helping them find the joy in living, no matter how serious the problems they must face. When you play with children, you are finding your own pleasure in your work.

I once heard a story about a child psychiatrist, who dressed for work every day in a clown suit. I don't know whether the story is true, but I like to think about what it would be like to be a depressed child and have a clown for a therapist. Or what it would be like to be an ADHD child and go to someone for help who did not judge me because I was having problems in school, or because I frequently lost my temper? What would it be like to step into a world of play, even for one hour a week, where the true joy of childhood was never forgotten?

I am not advocating that you go out and by a clown suit. There are subtler ways to tell children that you will share your sense of fun. There are simpler ways that you can tell children that you will enter their world of imagination, and share a view of the world where life is not just one problem after another. There are hundreds of techniques that can be used to help children through play and playfulness. Just remember that you never need a reason or an excuse to play.

Changed By Trauma: Helping Youth Cope In The Aftermath Of Tragedy

By Debra Whiting Alexander for The Bureau For At-Risk Youth

City bombings, random acts of crime, wars, violence at home and school…today, a growing number of children are victims and witnesses to acts of human cruelty -- and even second-hand exposure to trauma can be problematic. Children have experienced more and more events that are beyond normal human experience, and what they have learned is that life is not safe.

Most adults are not prepared for the experience of helping youth through such intense emotional, psychological, physical and spiritual injuries. The effects can be far-reaching. Not only does trauma impact learning (students can't learn when they aren't relaxed), it can change the whole course of a child's or adolescent's continued healthy development. Schools have the unique opportunity to respond to traumatized children in a number of helpful ways, but it can be difficult to know where to begin and what to do.

Common Reactions

It's natural for all children impacted by trauma to feel, think and behave differently in response to an abnormal event in their lives. Intense emotions, frightening thoughts, physical symptoms, and spiritual confusion are all normal reactions following a life-changing event.

Children and teens cope in a variety of ways to overwhelming stress. A few of the more common symptoms include: anxiety, worry, anger, sadness, nightmares, and fear. Some kids become overactive, while others appear lethargic and withdrawn. They may complain of physical aches and pains, have difficulty concentrating in class, and have trouble sleeping or eating. They may want to avoid friends, social activities and school. Some children will talk repeatedly about what happened, while others will refuse to discuss it at all. They may display aggressive behaviors, and express distressing and repeated themes in play, art or writing. All ages may act younger than they are. Separation anxiety and clinginess are especially common.

Encourage Open Discussion

The more children and teens are able to talk about and/or express what happened with people who understand, the sooner the difficulties will diminish. Most children, however, regardless of their age, need help identifying their thoughts and feelings following a tragedy. They also benefit from a structured environment in which they are permitted to talk directly about what happened and learn effective coping skills.

What you can do:

• Help kids feel safe. Address common fears and adjust for them in daily routines.
• Provide physical comfort. It's especially important for younger children, but everyone benefits from a nurturing environment.
• Take time to listen. Allow for structured opportunities to listen to all thoughts and feelings that students want to voluntarily share. Teens especially may have a need to analyze and fully discuss with one another what happened and why.
• Address concerns and answer questions. Keep your answers and explanations simple and direct. Children want real facts. Be honest without sharing graphic or disturbing details. If you don't know the answer to a question, be honest about that too. Correct any distortions and misinformation you hear.
• Remain composed. Provide a calm, serious and undramatic response to what children say and ask.
• Use open questions. To help facilitate discussions ask questions like, "What is your understanding about what happened?" "What would you like to know?"
• Create a climate of acceptance. Don't criticize, judge or shame a child for anything they say or do and make sure everyone in your group or class understands this rule. Accept and validate everything that is expressed.
• Understand cultural differences. Some behaviors and styles of expression within your student population may be common to their culture. Be careful not to assume that behaviors different from your own mean they are trauma-induced problems.
• Educate. Reassure students that the more they tell the story, the less intense and frightening the emotions become. Help them understand the wide range of normal reactions they can expect to see and prepare them for what may be different in the days, weeks and months ahead. Remind younger children that thoughts and feelings can't make bad things happen.
• Talk about changes. Ask children about the ways they feel different and what they notice in those around them. Normalize their examples and acknowledge the common and unique ways all have felt changed by the experience.

Decrease Stress

Like adults, children and youth will react to stress differently and have varying thresholds for it. Minimize stress whenever you can.

What you can do:

• Take time to relax. Be flexible and lower your expectations of children for a while. Take breaks through the day and help children relax through simple breathing exercises, silent meditation/prayer, classical music or taking walks where the sounds of nature can be heard.
• Model coping tools. Explain what you do to help yourself. Brainstorm with kids other ways they can take care of themselves.
• Hold parent meetings. Educate families about trauma reactions and ways families and caregivers can help. Your job as a teacher, administrator or counselor will be made easier when parents have the tools and understanding of how best to support their kids.
• Maintain routines. There is comfort in the predictable routines in life. Make sure children know what to expect throughout the day.
• Monitor media. Review for age-appropriate content and themes. Even some family movies can restimulate post-trauma stress.
• Increase supervision. Prevent unsupervised gatherings and emotional drama at school by monitoring halls closely and having supportive adults available to all kids throughout the day.
• Be proactive. Provide a way to channel energies into constructive activities like helping others.

Reassure And Remind

All children need the loving support of the adults around them in order to regain a sense of security and trust. They need to know that no matter what happens, the adults around them will do everything in their power to keep them safe.

What you can do:

• Remind children of what went right. You might ask, "Who helped?" "What good things happened when we needed them to?" "What unexpected things have people done to help others?"
• Address issues of death concretely. Let kids know the greater the loss, the longer the time it will take to feel better again. Acknowledge that death is permanent and sad and that grieving is a process. Reassure them that it won't always feel as sad as it does right now.
• Empower. Give children choices and outlets for expressing thoughts and feelings. Help them regain a sense of power and control. Review general safety rules and precautions and practice problem-solving skills.
• Identify resources. Help students think about all the outside resources they have to support their continued healing. Family members, counselors, nurses, doctors, friends, clergy and spiritual beliefs and values can be helpful resources to seek out for extra help.
• Renew hope. Help kids understand that trauma is a part of life, but not all of it. Explain that they won't forget what happened, but can survive the memory. Reassure them that healing happens even in the hurt.

Most kids recover from a trauma without professional assistance, but others may develop post-traumatic stress disorder (PTSD) or other persistent problems that will require help from someone trained in treating post-trauma stress.

Children are changed by trauma and although the emotional recovery process isn't easy or quick, it is possible to find hope and healing in the aftermath. The support children receive from caring adults after a tragedy can help them avoid long-term emotional harm. The school environment is an important, if not critical piece to children's adjustment and full recovery.

Healthy Bodies And A Healthy Body Image: Opportunities For Wellness

By Peggy Wouts R.N, B.N, M.N, Calgary Eating Disorder Program at Alberta Children’s Hospital

The cultural climate today, predominantly within North America, is one which harbors a "fear of fat." A variety of factors influence this climate and have implications for our population’s mental and physical health. For example, our cultural idealization of thinness has created a standard of female beauty and worth. This idealization not only encourages but also normalizes dieting as a strategy to achieve this standard (Austin, 2000). The diet industry is a multi-billion dollar industry because its profitability resides in the predominant belief that our bodies must change in size and form in order to succeed and achieve. Further, the media and fashion industries form feminine and masculine standards, which are unrealistic and predominantly unattainable. These factors are highly associated with body dissatisfaction, unhealthy eating behaviors, unhealthy weight control behaviors, and eating disorders (Austin, 2000).

Dieting, fear of fatness and unhealthy eating behaviors have been reported in girls as young as nine years old (Mellin, Scully, & Irwin, 1992). Thirty to forty percent of 9-year-old girls and eighty percent of 10 to 11-year-old girls have dieted. Young girls have indicated in surveys that they are more afraid of becoming fat than they are of cancer, nuclear war, or losing their parents (Berzins, 1999; National Eating Disorder Information Center [NEDIC], 1999). While females attempt to reduce their body size, males more often report an obsessive preoccupation with their muscularity to the point where they spend more time at the gym or take steroids and other performance-enhancing drugs in the face of serious side-effects (Pope, Olivardia, Gruber, & Borowiecki, 1999).

Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, rank as the third most common chronic illness among adolescent females in the United States (Neumark-Sztainer, 1996). Common features of these disorders include abnormal eating and an over-concern with weight and shape (Russell & Ryder, 2001). According to the American Psychiatric Association (2000), prevalence rates of Anorexia Nervosa are between 1-3.7% of the population and the rates for Bulimia Nervosa are between 1.1-4.2%. What is most concerning is that eating disorders have the highest mortality rates of all psychiatric illnesses, with 10-20% eventually dying, approximately half by suicide and half by physiological breakdown (Garner, Vitousel, & Pike, 1997).

While a large percentage of the population is dissatisfied with their bodies and engage in unhealthy weight control behaviors, childhood obesity is also becoming alarmingly prevalent. The prevalence of overweight youth in the United States has more than doubled over the past two to three decades. It has increased by 54% among 6 to 11-year-old children and 39% among 12 to 17-year-olds (Kendall & Wilken, 1998). Approximately 18% to 25% of all adolescents are overweight (Hill & Townbridge, 1998). It is also reported in the Youth Risk Behavior Survey that more than 25% of students felt they were overweight and used dangerous methods such as pills, laxatives, and vomiting to lose weight (Illuzi & Cinelli, 2000).

The prevention of obesity is currently at the top of the public health agendas of North America and much of Europe (Study Group, European Atheroschlerosis Society, 1987; USDHHS, 1990, 1996; Aggett et al. 1994; CDC, 1996; Seidell, 1999). Prevention programs to date have predominantly focused on nutrition and physical activity for children, however those factors associated with eating disorders have not been integrated into these programs. Further, there is concern with regard to the potential impact on disordered eating when the ultimate goal is to reduce the incidence of obesity and losing weight becomes the only focus and weight is recognized as the only indicator of health.

It is important to acknowledge the relationship between eating disorders, unhealthy eating behaviors, weight control behaviors, and unhealthy attitudes towards our bodies. Dieting for weight loss and a preoccupation with weight is associated with the later development of eating disorders (Neumark-Sztainer, 1996). Dieting may be associated with eating behaviors such as meal skipping, binge eating, and lower intake of those nutrients, which are essential to the healthy growth of adolescents. Obesity involves physical consequences and may influence social and economic development within a society which values “thinness” (Neumark-Sztainer, 1996). The similarities between those who struggle with eating disorders and obesity and those who engage in dangerous weight control behaviors, and unhealthy eating behaviors highlight the potential for collaborative promotion and prevention programs. Attentiveness and intervention is needed throughout a wide a range of unhealthy attitudes and behaviors associated with weight preoccupation.

Preventing illness, such as eating disorders and chronic disease associated with obesity, must incorporate the promotion of healthy body image and the prevention of eating disturbances. The high cost and relatively low success rates of treatment for these disturbances justify investment of time and resources in prevention efforts (Neumark-Sztainer, 1996). Further, most experts agree that for every $1 spent on promotion and prevention programming, approximately $7 is saved in later health care costs (Steinhauer, 1999).

Effective prevention and promotion programs foster the participation and collaboration of professionals, parents, and youth. For example, school programs, which are targeted towards changing individual perceptions and the social environment, create the potential for healthier behaviors. Programs that address eating disorders through didactic teaching of signs and symptoms have been shown to be minimally effective in behavioral change and may even do more harm (Roesen & Newmark-Sztainer, 1998). It is imperative therefore that the emphasis be placed on positive body image and the dangers of unhealthy eating behaviors -- not on specific eating disorders or their causes (Russell & Ryder, 2001).

While it is important to educate the public about nutrition and healthy active living, it is also important to consider our cultural climate. Unhealthy eating behaviors associated with weight disturbances are unlikely to change with the delivery of information focusing only on nutrition and active living. Programs must provide the opportunity for youth, parents, and professionals to critically think about their own attitudes related to their bodies in relation to peer groups, communities, and culture. Devoting time for discussion about these influences is a valuable way for individuals to learn from one another and learn about one’s own perception of reality. The underlying issue of bullying and put-downs about bodies is important to address as a form of harassment and must be addressed as part of creating a healthy environment for youth. The development of acceptance of all body sizes and shapes and the acknowledgement that there is more than appearance contributes to healthy environments and healthy behaviors. Overall it is imperative that prevention and promotion initiatives shift the focus from only weight to wellness with an emphasis on maximizing health (Russell & Ryder, 2001).

While it may appear that obesity and eating disorders exist at opposite ends of the health-care spectrum, the prevention of both share significant commonalties. Issues such as unhealthy body image, disordered eating, and unhealthy and dangerous weight reduction behaviors are prevalent in both obesity and eating disorders. Integrating these commonalties into the prevention of both obesity and eating disorders involves a wellness approach. This approach considers the development of self-esteem, resiliency in children and youth, and resiliency within our communities. To date the prevention of obesity and eating disorders have remained as separate fields of practice, however there is clearly opportunity for collaboration. To remain as separate practices neglects valuable approaches which would only enhance health.

REFERENCES

Aggett, T.J., Haschke, F., Heine, W., Hernell, O., Koletzko, B., Lafeber, H., Ormission, A., Rey, J. & Tormo, R. (1994). Committee Report: Childhood Diet And Prevention of Coronary Heart Disease. ESPGAN Committee on Nutrition. European Society of Pediatric Gastroenterology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 19, 261-269.

American Psychiatric Association (2000). Practice Guideline for the Treatment of Patients with Eating Disorders. (2end edition). APA: Washington, DC.

Austin, S.B.(2000). Prevention Research In Eating Disorders: Theory And New Directions. Psychological Medicine, 2000, 30, 1249-1262.

Berzins, L. (1999). A Congressional Briefing: Dying To Be Thin: The Prevention Of Eating Disorders And The Role Of Federal Policy. Washington, DC: American Psychological Association: Public Policy Office.

Centers for Disease Control (1996). Guidelines For School Health Programs To Promote Lifelong Healthy Eating, Morbidity and Mortality Weekly Report 45(RR-9), 1-41.

Garner, D.M, Vitousek, K.M, & Pike, K.M (1997). Cognitive-behavioral Therapy For Anorexia Nervosa. In D.M Garner, & P.E. Garfinkel (eds.), Handbook of Treatment For Eating Disorders. New York: The Guilford Press

Hill, J.O. & Townbridge, F.L. (1998). Childhood Obesity: Future Directions And Research Priorities. The Causes And Health Consequences Of Obesity In Children And Adolescents. Pediatrics, 101(3), 554-571.

Illuzzi, S. (2000). A Coordinated School Health Program Approach To Adolescent Obesity. Journal of School Nursing, 16(1), 12-18.

Kendall, R.D & Wilken, K. (1998, May 8). Childhood Obesity No.9.317. Colorado State University Cooperative Extension c Colorado State University Cooperative Extension. 1995-1999. Contact Cooperative Extension Web Manager online at www.colostate.edu/Depts/CoopExt.

Mellin, L.M., Scully, S., & Irwin, C.E. (1992). Prevalence Of Disordered Eating In Girls: A Survey Of Middle Class Children. Journal of the American Dietetic Association, 92, 851-853.

National Eating Disorder Information Center. (1999). National Eating Disorder Awareness Week Campaign. Toronto.

Neumark-Sztainer, D. (1996). School-based Programs For Preventing Eating Disturbances. Journal of School Health, 66(2), 64-70.

Pope, H.G., Olivardia, R., Gruber, A., & Borowiecki, J. (1999). Evolving Ideals Of Male Body Image As Seen Through Action Toys. International Journal of Eating Disorders, 26, 65-72.

Rosen, D.S., & Neumark-Sztainer, D. (1998). Review Of Options For Primary Prevention Of Eating Disturbances Among Adolescents. Journal of Adolescent Health, 23(6), 354-363.

Russell, S. & Ryder, S. (2001). BRIDGE (Building The Relationship Between Body Image And Disordered Eating Graph And Explanation): A Tool For Parents And Professionals. Eating Disorders, 9, 1-14.

Seidell, J.C (1999). Obesity: A Growing Problem. Acta Paediatrica 88(suppl.428), 46-50.

Steinhauer, P.D. (1999). Review Of The Organization And Delivery Of Children’s Mental Health Services In Edmonton And Calgary: Prepared For The Alberta Mental Health Board, The Capital Health Authority and the Calgary Regional Health Authority. Unpublished manucript.

Study Group, European Atherosclerosis Society (1987). Strategies For The Prevention Of Coronary Heart Disease: A Policy Statement Of The European Atherosclerosis Society. European Heart Journal 8, 77-88.

US Department of Health and Human Services (1990). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. USDHHS: Washington, DC.

US Department of Health and Human Services (1996). Physical Activity and Health: A Report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion: Atlanta, Georgia.

Multifaceted Roles For School Personnel In Child Maltreatment

By Tracy Cruise, Ph.D., CSP for The Bureau For At-Risk Youth

Unfortunately, child maltreatment is a common occurrence in our society. Nearly three million reports of child maltreatment are made to child protective service agencies each year, with close to one million of those reports resulting in confirmed cases of abuse or neglect (U.S. Department of Health and Human Services [DHHS], 2002). The majority of these children are often harmed by the very people who are assumed to protect them, their parents or caretakers (79%, DHHS, 2002). As sobering as these incidence figures might be, they are believed to be "the tip of the iceberg." Prevalence figures gathered from retrospective research with adults, reports from adult survivors in anonymous research studies stating that they never disclosed their abuse, and cases that are not reported to child protective service agencies all suggest that the incidence of child maltreatment is actually much higher.

There is no single causal factor resulting in any particular child being more likely to experience abuse or neglect. Boys and girls are equally likely to experience maltreatment, as well as children of all ages, racial and ethnic backgrounds, and socioeconomic levels. Thus, school personnel are almost certain to come face to face with victims of child maltreatment in the school setting.

An example is offered to illustrate just how probable it is for a teacher to have multiple victims of maltreatment in his/her classroom. Conservative estimates suggest that one in four girls and one in 8-10 boys are sexually abused by the age of 18. A K-12 district with 500 female and 500 male students might likely have over 100 female and 50 male victims of sexual abuse. In an effort to make these figures even more meaningful, let's assume the victims are distributed evenly across grades, then there are approximately 8 female and 4 male victims of sexual abuse at each grade level. So if you teach eighth-grade math, you may have as many as twelve victims of sexual abuse throughout your sections. Suddenly these statistics may have a face and a name associated with them. You could extend this line of thinking to the other forms of maltreatment and realize that there might actually be more victims of abuse and neglect in your class or school than you would have thought possible. Furthermore, since children often experience more than one type of maltreatment, it is quite possible that several of these identified victims would also be victims of other abuse or neglect.

Unique Opportunity for School Personnel

School is the largest out-of-home setting in which children spend their time. School personnel come to know individual children well and can identify certain subtle changes. School staff members also have the advantage of familiarizing themselves with normative behavior among certain age groups. Teachers and counselors quickly recognize when a child's behavior is not consistent with that of his/her peers.

Similarly, the centrality of school in children's lives fosters familiar, consistent, and trusting relationships between children and their teachers, counselors, and administrators. School may serve as a safe haven from the violence or loneliness of home. Students may directly or indirectly disclose their abuse to educators hoping the hurt will stop. Personal accounts in the book, Dear Teacher, If You Only Knew...(Seryak, 1997) also reinforce the role educators play in abused children's lives. In this book adult survivors recount stories of teachers who made a difference in their lives, and yet others recall the lack of support they received at a time when they needed it most.

All of these factors support the notion that school personnel are "the front line of defense" when it comes to identifying, reporting, treating, and preventing child maltreatment. Educators are presented a unique opportunity to help maltreated children and have a social responsibility to respond effectively.

Identification of child maltreatment is a first and crucial step in helping to stop a particular child's pain. However, there is no single response pattern or "child abuse syndrome" to help educators accurately identify victims. School personnel can draw from legal definitions, common short- and long-term psychological correlates among victims, and noted abuse-specific behaviors to assist them in making their decisions.

Definitions

Although legal definitions for the various types of child maltreatment vary by state, there are broad conceptual similarities noted among the five most prevalent categories (i.e., physical abuse, sexual abuse, emotional or psychological abuse, neglect, and witnessing domestic violence). Incidence figures following each description are taken from Child Maltreatment 2000 (DHHS, 2002).

• Physical abuse: an act of commission by a parent/caregiver resulting in physical injury. This includes hitting, kicking, burning, shaking, biting, or poisoning a child. Physical abuse accounts for about 19% of child maltreatment cases.
• Sexual abuse: sexual acts involving a child in which the child is unable to give informed consent. Sexual abuse includes both acts of physical contact (e.g., kissing, fondling, oral genital contact, intercourse) and noncontact (e.g., being forced to watch the perpetrator engage in self-stimulation, the child being forced to masturbate, exposure to pornographic material). Adults, adolescents and even prepubescent children may perpetrate sexual abuse. Sexual abuse by definition does not have to involve a parent or caregiver. Sexual abuse represents about 10% of all maltreatment cases.
• Emotional or psychological abuse: repeated degrading, terrorizing, or rejecting acts by a parent/caregiver and/or the omission of basic emotional responsiveness (e.g., love, care, support). This form of abuse may occur in isolation but is said to accompany all other forms of maltreatment. About 8% of all maltreatment cases are identified as emotional abuse.
• Neglect: failure of a parent/caregiver to provide a minimal standard of care necessary for a child to achieve physical and psychological development. This is the most common form of maltreatment making up 63% of all cases.
• Witnessing domestic violence: is not typically a separate category of maltreatment as defined by child protective services. However, children who witness such violence are said to be "at risk of harm" and may be reported under such a heading. Children who witness domestic violence are also at greater risk for physical and sexual abuse. No clear incidence data is given on this category.

Psychological Correlates

Some cautions should be noted before describing common psychological responses among maltreated children. First, even though the rates of child abuse and neglect are high and maltreatment should be entertained as a hypothesis when evaluating causal factors of behavior, educators should refrain from "jumping to the conclusion" that every bruise or misbehavior is a result of abuse. Secondly, the following discussed symptoms are indicators of possible abuse (Gil, 1991). The psychological and behavioral responses listed are not unique to victims of child maltreatment, but might also be indicative of Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, or Bipolar Mood Disorders. In fact, children who have been maltreated may be misdiagnosed with any one of these previous disorders, giving educators a false sense of understanding for a child's behavior, affect, or school performance. School personnel should use these indicators to prompt them to consider the possibility that a child has been maltreated and remain open to additional confirming or disconfirming information.

Academic

• Sudden change in academic performance
• Failing grades
• Low standardized test scores -- especially in reading, language, and math
• Difficulty concentrating
• Refusal to participate in certain classes or activities (e.g., dressing-out for gym class, refusing to wear glasses)
• Truancy or absenteeism -- may be to avoid feeling stigmatized or in order to feel safe
• Overachieving to avoid negative consequences of a poor performance
• Staying after school or coming early to avoid home
• Impaired vision or hearing for which aids are not provided or replaced when broken
• Consistently poor hygiene and/or inappropriate dress

Social/Emotional

• Loss of interest in pleasurable activities
• Chronic depressed mood
• Excessive or continual anger -- at self, perpetrator, or others not protecting the child
• Flat or restricted affect
• Dissociation -- psychologically removing oneself from one's body which may be evident through glazed eyes, blank stares, or delayed or absent responses
• Fear of people, objects, or situations
• Nervousness or anxiety -- evident by fidgeting, difficulty attending, or compulsive actions

Behavioral

• Impulsiveness
• Verbally or physically aggressive
• Defiant, acting-out
• Socially isolated or withdrawn
• Social skill deficits -- lack of prosocial behaviors, decreased empathy, inability to make friends
• Regressive behaviors -- tantrums, baby talk, thumb-sucking
• Disturbances in eating behaviors -- lack of appetite, gorging, significant weight loss or gain
• Self-mutilation -- cutting or burning oneself
• Suicide gestures

Abuse-specific Consequences

Just as the general indicators listed above are not conclusive signals of maltreatment, the following abuse-specific symptoms should be given greater consideration, while not prematurely assuming that maltreatment is the only explanation. A child who comes to school tired and poorly groomed might be experiencing neglect, but his/her appearance might also be explained by knowing that his/her single parent has recently switched to working third shift and the entire family is struggling in making the transition.

Sexual behavior problems are more uniquely tied to sexual abuse than other indicators discussed. Although not all victims of sexual abuse will exhibit sexual behavior problems, these behaviors have more discriminative value than other more general symptoms.

Physical

• Repeated marks, cuts, bruises, or other injuries
• Consistently tired in class or low energy level
• Hyperarousal or hypervigilance--sensitivity to noise, movement, or adult mood changes

Behavioral

• Sexually-problematic behaviors (e.g., excessive masturbation, promiscuity, age-inappropriate sexual language or knowledge)
• Fire-setting
• Cruelty to animals
• Hoarding or stealing food

Summary

Child maltreatment affects thousands of children each year, and school personnel have been identified as key respondents in this area. Educators work in a unique context for identifying victims of maltreatment and must stay informed of the literature in order to meet this social responsibility. School personnel continually play a crucial role in the protection of children as they make over half of all reports to child protective services each year (DHHS, 2002). In-services and ongoing training regarding incidence and prevalence rates, possible indicators of the various forms of maltreatment, and suitable interventions should remain a priority for staff. Educators must be willing to consider the possibility of maltreatment when concerns about children arise. Children are often counting on teachers and counselors to care enough to stay informed and get involved.

REFERENCES

Department of Health and Human Services, Administration on Children, Youth and Families (2002). Child Maltreatment 2000. Washington, DC: U.S. Government Printing Office.

Gil, E. (1991). The Healing Power Of Play: Working With Abused Children. New York: Guilford.

Seryak, J. M. (1997). Dear Teacher, If You Only Knew...Adults Recovering From Child Sexual Abuse Speak To Educators. Bath, OH: The Dear Teacher Project.

Making Sense Of Humor

"There are three things which are real: God, human folly, and laughter. The first two are beyond our comprehension. So we must do what we can with the third."
--John F. Kennedy

By Dr. Joel Goodman for GuidanceChannel.com

Since 1977, The HUMOR Project has been doing "what we can with the third." In our presentations to more than two million people throughout the world, we have discovered that there are some common "mythconceptions" about humor. Let's play with them one at a time:

Mythconception #1: People Won't Take Me Seriously If I Use Humor

Myth: People won't respect me professionally if I use humor.

Truth: As shown by the best-selling book, FISH!: A Remarkable Way to Boost Morale and Improve Results, "work made fun gets done."

It is important that we take seriously our goals, roles, and missions in life...and it is also important that we take ourselves lightly. This is crucial, because there is a cosmic joke being played on all of us. Many best-selling books suggest that we should be not only in search of excellence but that we should have a passion for excellence. This is a good message: that we should strive to meet our individual and organizational potential. At the same time, by definition, human beings are imperfect. So, what do we do with the gap between the perfection we seek and the imperfection we need to live with?

"Don't take life so seriously-- You'll never get out alive!" is on one poster in my office. It suggests that the funny bottom line is being able to laugh at ourselves. In other words, you can be a serious professional without being solemn. Your sense of humor can add an important touch of humanity to your life and work.

Mythconception #2: Humor Is Not Serious

Myth: We have more important things to deal with than humor. Humor is childish, frivolous, not-for-keeps.

Truth: Humor can be a life-saver, a life-enhancer, and a link to learning! There is a big difference between behaviors that are childish and perspectives that are child-like. In fact, having a childlike perspective is one of the most important adult coping skills.

When I speak to schools, corporations, and associations throughout the United States and abroad, I offer many reasons why humor is fun, but not for fun. Here is a taste:

Laughter and Learning Go Hand-in-Hand

Humor has important implications for people involved in teaching and learning. My perspective is that laughter (HAHA!) and learning (AHA!) can go hand-in-hand, and that in many cases, laughter can liberate learning. I am convinced that this is how it works: humor serves to capture students' attention ("tickling" their curiosity about the subject at hand)... to free up their attention (by allowing for the release of stressors which might otherwise have preoccupied them)... and to hold their attention (thus providing motivation and momentum for learning). Once you capture, free up, and hold attention, then retention has a better chance of happening.

Many schools pay lip service to this notion. As I've traveled the country doing presentations for hundreds of school districts, I have been intrigued to see in every school system philosophy words to the effect: "One of the goals of education is to help students experience the joy of learning." At the same time, many schools discourage humor. Phrases like "Don't smile until Christmas!" (told to new teachers) reinforce the myth that education and enjoyment are mutually exclusive.

As professionals, we need to give ourselves the gift of humor to help us tickle job-related stress before it tackles us. At the same time, we need to truly invite students to experience the joy of learning and encourage them to nurture humor as a vital life skill. In fact, in his longitudinal study of what made for "success" in Harvard College graduates, Dr. George Vaillant found humor to be one of the key mature coping mechanisms that insured that stress didn't kill more quickly and commonly. In other words, you can use humor to add years to your life and life to your years.

Jest for the health of it!

Perhaps the most significant bottom line is your health -- without it, you're dead (literally or figuratively). The old adage, "Laughter is the best medicine," appears to be on target -- for you individually and for your organization. Norman Cousins' best-selling book, Anatomy of an Illness, certainly has opened up many people's eyes to the notion that "S/he who laughs lasts." Cousins, an outstanding leader and great humanitarian, describes how he intentionally used various sources (books, films) to tap his own sense of humor, hope, and optimism in recovering from a painful and debilitating illness. William Fry, Jr., M.D., who has done research on the physiology of laughter for almost 50 years, lends support to Cousins' notion that laughter is like "internal jogging." Laughter can have a positive effect on blood pressure and respiration, suppresses stress-related hormones, and activates the immune system.

We at The HUMOR Project believe so much in the humor-health connection that we have given grants to over 350 schools, hospitals, and human service agencies to help them tap the power of humor. These grants have helped establish humor rooms and comedy carts in hospitals, "geriantics" programs in nursing homes, and comedy clubs for "at risk" students.

"Stress" and "burn-out" have become household words. Humor can be a powerful antidote to stress -- it can help us to move from a "grim and bear it" mentality to a "grin and share it" orientation.

This notion is captured well by George Burns, who hit the century mark. George said that "You can't help growing older, but you can help growing old." By using humor, we can prevent what I call a "hardening of the attitudes." If you stand rigidly in the face of stress, you are much more easily knocked off-balance. If you are flexible mentally, you are in a much better position to "roll with the punches" that life throws you.

"A smile is the shortest distance between two people," according to Victor Borge.

We have used that quote on our envelopes for the past 27 years, because we believe that humor can be a powerful-- and delightful-- way to build positive working relationships, to increase motivation, and to improve morale. This has significant implications these budget-crunched days when "teamwork" is an important strategy for "doing more with less."

Finally, humor is power. It can serve as a mirror of what is going on in society and, perhaps more importantly, it can also serve as a vehicle for change. Larry Klein, one of the writers for The Tonight Show, noted that humor "is the only form of revolution we have left in this country."

It may not be the only form, but it can be a powerful formula for helping people work through the challenges of change and conflict. Given the current world situation filled with terrorism, war, a challenging economy, and international tension, humor could help preserve our sanity and humanity in the midst of some insane and inhumane realities. In short, humor can transform a negative situation into a positive.

As Erma Bombeck once said, "When humor goes, there goes civilization."

Mythconception #3: To Be Humorous, You Have to Be a "Natural" Joke-Teller

Myth: Humor equals only joke-telling.

Truth: Humor certainly includes jokes, but it goes way beyond! Humor is much more important than mere joke-telling...humor is an attitude, a perspective, a set of skills that can help us achieve important goals in our lives and jobs.

Some people think that to be humorous, you had to be born with the comedy gene -- or you're out of luck (and humor). I posed this issue to Steve Allen in an interview in our Laughing Matters magazine. His perspective was that we may be born with a certain genetic ceiling and floor when it comes to "humor"-- but it's what we do in our lives that influences whether we end up on the ceiling or floor. In other words, there is hope.

Although joke-telling is one way to transmit humor, it's not the only way. In fact, there are literally thousands of ways to invite smiles and laughter in addition to joke-telling (as suggested by the subtitle of my book: Laffirmations: 1,001 Ways to Add Humor to Your Life and Work). So, if joke-telling is not your forte or if it is inappropriate for you to become the stand-up comic on the job, there are alternatives.

Here are some tips to get you going:

(1) Put humor into the physical environment -- by osmosis, it may filter into the organizational culture. This could be accomplished by having a humor bulletin board with light-hearted sayings, such as the words of Robert Frost, "The brain is a wonderful organ. It starts the moment you get up in the morning and does not stop until you get to work."

(2) Anticipate ways of injecting humor into potential conflict situations. This is called "prepared flexibility," which is what leadership is all about anyway. Having available a repertoire of quotes may help you through some sticky situations. The next time you’re in a conflict, you can disagree without being disagreeable… jest say with a twinkle in your eye, "Save time... see it my way!"

(3) Develop your comic vision. Look for humor and it will find you. Make believe you are Allen Funt (the creator of the Candid Camera television show) for five minutes each day... especially in the most serious of places. For instance, one of my graduate students passed along this sign she saw in front of a church announcing the two services for a particular Sunday: "Theme of 9:30 AM Service: Jesus Walks on Water...Theme of 5:00 Service: Searching for Jesus." As a professional, you are sometimes expected to "walk on water," and yet, you may be searching for yourself in the process. Searching for humor is a wonderful way to find yourself.

(4) Use humor as a tool rather than as a weapon. Laughing with others builds confidence, brings people together, and pokes fun at our common dilemmas. Laughing at others destroys confidence, demolishes teamwork, and singles out individuals or groups as the "butt." In the words of one fifth grade teacher who attended one of my presentations in 1979: "You don't have to blow out my candle to make yours glow brighter." Humor is laughter made from pain, not pain inflicted by laughter.

(5) Laugh at yourself. Set the tone by modeling your ability to take your job seriously and yourself lightly. One of the simplest and most powerful ways of doing this is to "tell stories on yourself" whenever possible and appropriate.

Rose Cellino-Reynolds, who attended our annual international conference on “The Positive Power of Humor & Creativity,” told me about the time she went to a meeting filled with salespeople. The big thing for these salespeople was to wear a beeper. Rose did not have a beeper and was feeling a bit out of place. So she went home that night and came back to the gathering the next morning with tongue-in-cheek… wearing her garage door opener. As Rose suggests, "Learning to laugh at oneself is the first step in developing a sense of humor." Your sense of humor can magically open all kinds of doors for you!

Life Is Serious... Life Is a Laughing Matter

Life is serious. Life is a laughing matter. Both are true. The wonderful thing is that we have the choice. By choosing humor and laughter, we can survive and thrive.

If you've ever been in a painful or difficult situation in which someone says, "Someday we'll laugh at this!"...you might offer the following suggestion: "Why wait?" Laughing at yourself can have both immediate and long-term payoffs. Invest in jest now… humor and laughter are life-skills legacies to give to our young people today.

Copyright © 2003 Joel Goodman. All rights reserved.

Addressing Mental Illness: Timing Is Everything

By Dr. Penny Frese for GuidanceChannel.com

When Fred and I were married, we knew that our children would be at risk for developing a mental illness, even though the risk was a small one. Fred had been diagnosed with schizophrenia when he was 26. Despite repeated hospitalizations throughout his twenties and early thirties, he was working in the state mental health system and completing his doctorate when I met him. We truly believed that with the additional stability of marriage, our mental health problems could be behind us.

Nevertheless, we were careful to make provisions. We were always attentive to the terms of our health insurance, making sure that mental health was included. I held on to my job on a part-time basis, even though we had three children in four years and Fred`s daughter was often with us. In the event that he had a breakdown and could not work, I would be current in my field and hopefully could pick up the slack.

To minimize our children`s risk, we tried hard to create a home environment that was stable and supportive. Although our extended families were widespread, we cemented the bonds with them by traveling, visiting, and having parties. I read books on developing children`s self esteem, and while we set limits, we also encouraged independent thought and decision-making. The children were energetic, docile, and happy.

Yet despite our efforts, as they neared puberty they began to withdraw, become moody, and lost their self-confidence. Social interactions became difficult for them, if not impossible. In the middle of family conversation, Kasha, our eldest, would run from the room in tears. Joe was painfully shy, Claire would turn into the dragon child at the slightest provocation, and Bridget stopped eating. One by one, somewhere between the ages of 11 and 19, they were each diagnosed with major depression. Each was at the point of serious illness when diagnosed.

It was a difficult time, but we had much in our favor. Fred worked in the field and knew good, capable providers. We were more prepared than most people. Fred had been down this road before. We were covered by insurance, and enjoyed the understanding and compassion of our families. We understood that these illnesses were brain disorders and were able to share our concerns with our friends and with our children`s school personnel. They, in turn, were helpful and cooperative, so were our children`s friends. Lastly, and the importance of this cannot be overstated, the children responded to medication. With emotional, financial, social, educational and medical supports in place, we were well positioned for a good response.

The response was good. None of the children needed to be hospitalized. While they each had their own ups and downs in high school and college, they were all able to finish. They are currently working in their chosen careers and living independently. Our son married last summer. They are all covered by their own insurance and know how to provide for their own care, but we are not so confident as to think our troubles are over. We know there will be stressors in their lives that can trigger relapse -- but we have been able to avoid much of the baggage these illnesses bring with them, and we have been able to position many of the supports that will help us through. The key in all of this was early intervention.

Like any illness, the earlier mental illness is recognized and treated, the better the prognosis. While many people are not diagnosed until adulthood, symptoms have often been present since childhood. The trick is to recognize warning signs and intervene before the young person is in crisis. Shortly after Claire was stabilized, she came to me in tears. "Mom, so many kids are just like me and no one is helping them. We`ve got to do something." And so Claire`s Story, our video on childhood depression, began to take shape. We researched where was the best point to educate children about mental illnesses and learned that most mental illnesses begin to present around puberty. Of course, we may see symptoms even before that, but they generally begin to present real problems for normal functioning about 5th grade. Claire wrote the script herself, with help from others in structuring it. Then she recruited her friends and teachers to be in it. We found a funder in the Mental Health Association of Summit County, Ohio, and a producer in the Telecommunications Department at Kent State University.

Today, the video is used with children, their families and caregivers around the world. It teaches kids that depression is a brain disorder, and a deadly one, at that. In the United States, more young people die from depression-related suicide than from the six other leading disease-related causes of death combined! They learn to recognize symptoms and see what treatment means. Most importantly, they learn how they can help their friends or themselves when signs of depression are present. The video tells children to help their friends; take them to the counselor. The best part is, they do it.

About five years after its release, Claire`s Story morphed into the Red Flags Program, a school-based depression awareness and intervention program funded by the Ohio Department of Mental Health for all Ohio`s middle schools. In addition to the video, the program provides a curriculum, and materials for teachers and parents. If children are to get help early, the entire school community must be engaged. With a minimal expenditure of time, money, and materials, children, teachers, and parents learn to watch for symptoms and seek help early. This program, too, is now making its way across the country and around the world. Idaho and South Carolina are implementing versions of the program. Parent booklets were translated into Spanish and Russian to meet the needs of the ethnic communities in the Cleveland area. The Russian booklets were taken to a world conference on children`s mental health, and the entire program was translated into Ukranian for use in their schools.

It only makes sense. When children experiencing a mental illness do not get help, they risk impairment in their intellectual, social, and emotional development. They feel bad and perform poorly. They are told they are lazy, irresponsible, inattentive -- and they believe it. Desperate for friendships or for relief from their misery, they are easy victims to drugs or to alcohol, or to those who would sexually exploit them. Their frustration can sometimes turn to anger and resentment, and with their judgment impaired by the disorder, they can find themselves on the wrong side of the juvenile justice system. Yet often these are our brightest and most creative kids.

To make matters worse, children struggling with these illnesses have difficulty reaching their potential in school. If they make it into college, they are at high risk for dropping out. When they are not in college, they are dropped from their parents` insurance, and generally cannot get or keep a job that carries health insurance. So begins the downward spiral of inadequate public mental health care, public assistance, and poverty.

Early intervention is not the solution to every mental health problem. A small percentage of diagnosed youngsters will not respond to treatment. Mental health problems may not show up until adulthood. But when symptoms are caught early, the child and the family are in a much better position to deal with the disorder. Often they are covered by insurance. Early intervention can circumvent the need for expensive hospitalizations or long-term care. Parents can supervise compliance with the treatment plan. They can teach the child how to take care of himself, how to advocate for himself, and how to help others understand the condition.

Surgeon General David Satcher estimated that one in ten children are in need of mental health services. This need not alarm us -- if we could learn to intervene early, mental illnesses would not appear so catastrophic. The same number of children probably come down with earaches or flu every year. Failure to treat these illnesses could also be catastrophic, but we don`t wait. If symptoms are persistent, we get the child to the doctor. We must respond the same way to mental illness. It`s just a matter of becoming more informed and changing our mindset. Early intervention saves lives, literally and figuratively. It`s a goal worth working for.

Reaching Out To Children Of Incarcerated Parents: What Educators Can Do

By Denise Johnston, MD for The Center for Children of Incarcerated Parents

Almost every public school teacher in the United States has a student who has experienced parental arrest/incarceration. There are more than 10 million of these children; as a group, they share some experiences which have a critical impact on development, and therefore on their emotions, behaviors, social skills and ability to learn.

Parent/Child Separations

Research has found that the first parent-child separations experienced by children of prisoners are usually not due to parental incarceration. For example, most children of prisoners did not live with their imprisoned parent prior to parental incarceration (Mumola, 2000) and a significant number of children -- about 40% of the children of male offenders and 20% of the children of female offenders -- have never lived with those parents (Johnston, 2002).

Parent-child separations in families of prisoners are distressing to children for several reasons:

• They are often preceded by parental inaccessibility and disruptions in parental caregiving.
• They are often associated with on-going family conflict.
• Information about the parents’ problems related to the separation has not usually been shared with the children.

Children experiencing initial separations from a caregiving parent may show typical signs of emotional distress. If the parent-child relationship was substantial, children may move from initial distress to withdrawal or acting out. Severely affected children who do not receive assistance may eventually become detached and will have difficulty accommodating new caregivers and even the return of the separated parent.

Repeated Parent-Child Separations

Parental criminality is associated with inconsistent parenting, chaotic households. and family conflict, as well as with recurring parent-child separations. Children who are repeatedly separated from their parents in this way usually receive daily care from the parent not involved in the criminal justice system, an allo-parent (like a grandmother who lives in the children’s home) or in another relative’s home (Johnston, 2002; Mumola, 2000).

The effects of repeated parent-child separations, where the child initially had a substantial relationship with the parent, can be devastating. The child not only sustains emotional injury from the loss of the parent, but other consequences of parental absence- - changes of caregiver and placement, loss of family income, a decreased level of physical and emotional support for the child -- may cause even greater damage. Children’s ability to trust and other aspects of their capacity for attachment are undermined; developmental progress may be slowed; and long-term, reactive behaviors like aggression, attention/concentration problems and depression may occur. By the time they become frequent enough to be noticed, these behaviors may appear to have no relation to the arrest and incarceration of a child’s parent.

Parental Arrest

Only about one in five children of criminal offenders have witnessed parental arrest (Johnston, 2001). This type of parent-child separation is specific to children of criminal offenders and is virtually always involuntary or “forced.” In addition, parental arrest is almost always abrupt and unexpected, and most families have not planned for the care of their children in these circumstances. As a result, children are doubly or triply traumatized, witnessing the forcible removal of a parent, losing a caregiver/protector, and often suddenly losing a familiar home, as well. Parental arrest may have profound short-term results, including traumatic stress reactions (Kampfner, 1995). Research also suggests that there are long-term effects of witnessing parental arrest; for example, children who have seen their parents arrested have been found to be more likely to distrust police and the courts, and unlikely to rely on law enforcement for protection (Stanton, 1980).

It is common for teachers to recognize that a child has had a traumatic experience but to be unaware of the cause. They should remember to consider the possibility of parental arrest as they try to determine how best to help a distressed child, and maintain a list of resources and referrals for such children -- including crisis intervention, therapeutic services and services for families involved in the criminal justice system.

Parental Incarceration

A minority of prisoners’ children lived with their incarcerated parent, and many had on-going contact with that parent, prior to parental arrest (Mumola, 2000). Since most incarcerated parents do not receive visits from their children (Bloom & Steinhart, 1993; Mumola, 2000), incarceration may significantly interrupt these parent-child relationships.

Having a parent in prison may also be associated with other problems for children, including a sense of shame or stigma. Studies have found that these feelings in children are strongly related to caregiver attitudes about parental incarceration, as well as to the frequency of criminal justice system involvement among families in the child’s community. Children whose caregivers discuss the parent’s incarceration openly and without embarrassment, and children from neighborhoods with high rates of incarceration, experience less shame and stigma than other children of prisoners.

There is no formal mechanism by which children of incarcerated parents are identified to the community. When school staff members are unaware of an event -- like a parent’s arrest -- that signals this stressor in the child’s life, children of prisoners appear similar to other children living apart from a parent and may go unrecognized for years. The average U.S. prison sentence is more than 4 years, so that a child may pass through several grades -- from the time of parental arrest to the time of the parent’s release -- with his or her teachers completely unaware that the child’s parent has been imprisoned.

Parent-Child Reunification

Only a small number of children of prisoners will fully reunify -- in the sense of living together again -- with their parents following the parents’ release from incarceration (Johnston, 2002). The return of a parent to the child’s home is a major transition for most children, with changes in household arrangements, power relationships within the family, parental authority, family income and/or family resources. Children may experience a wide range of emotions in anticipation of or reaction to these changes, including happiness, anger, anxiety, sadness, shame, excitement and fear. Acting out behaviors may increase, not only in response to these feelings but also as a reaction to changes in household routines and structure.

Other children will not have their formerly incarcerated parents return to their homes, but those parents will return to a more active role in the children’s lives. This circumstance may also be stressful for children, as parent and child relocate each other, re-establish contact and begin to rebuild their relationship. Although less intense than reactions to more traumatic experiences, children may also demonstrate emotional and behavioral reactions to these circumstances, often including anxiety and fear regarding the possibility of the parent’s return to prison.

How Can Educators Help?

Many children of prisoners have very limited relationships with their incarcerated parents. Like other children who live apart from a birth parent, these children may need support and reassurance. In addition, as they move through middle childhood and adolescence, children of criminal offenders need to receive information about parental crime, arrest and incarceration, as well as information and reassurance about intergenerational incarceration. These kids need to know that while they are at higher risk of criminal justice system involvement, that involvement can be avoided by understanding and addressing the factors in children’s lives that lead to juvenile and adult offending.

Other children who have not recently lived with their incarcerated parent have nevertheless had a more substantial relationship with that parent, including some type of parent-child contact. As a result, these children may have more concerns and fears about their parent and his/her criminal justice involvement. They may need emotional support when experiencing transitions -- such as parental arrest, incarceration and release from prison -- but also information about the criminal justice and correctional systems, and about the location, conditions and safety of their parents.

A smaller group of children lived with their parent in a caregiving relationship prior to the parent’s incarceration. These are the children most likely to have witnessed parental arrest and to have traumatic reactions to parental offending and imprisonment. Some of these children will need professional help to address the traumatic effects of these experiences. Others will need a higher level of emotional support, and attention to the structure and stability of their daily lives.

Regardless of the relationship with their incarcerated parent, most children of prisoners can benefit from peer support. Presentation of materials about diverse types of parent-child relationships, and about children growing up in special circumstances -- including the circumstance of parental incarceration -- will help children of prisoners feel more accepted, and more accepting of their situation. Schools in high crime communities should strongly consider developing or contracting with community agencies to provide support groups for older (8+ years of age) children of parents involved in the criminal justice system.

The majority of prisoners’ children come from low-income families and live in disadvantaged, often dangerous areas. Regardless of the effects of their parents’ incarceration, they face the daily risks of living in such communities. Like other children in their neighborhoods, they need the social supports and services that will minimize the effects of environmental hazards, violent streets and overcrowded, deteriorated housing.

At the same time, it’s important to remember that the core issues for children of criminal offenders are parent-child separation, poor quality of care, disrupted households, witnessed violence, and traumatic experiences -- none of which are specific to parental incarceration. Teachers who work with and know about children will need no special skills to help children in this situation, but they will need additional knowledge about the criminal justice system and the effects of parental crime, arrest and incarceration in order to better identify and appropriately respond when these children are distressed.

References & Recommended Reading

Bloom, B. & D. Steinhart. (1993). Why Punish the Children? A Reappraisal of Incarcerated Mothers in America. San Francisco: National Council on Crime & Delinquency.

Center for Children of Incarcerated Parents. (2004). How Many Are There? CCIP Data Sheet No. 3. Eagle Rock, CA: Authors.

Gabel, K. & Johnston, D. (Eds.). Children of Incarcerated Parents. New York: Lexington Books. (1995)

Johnston, D. (2002). What works: Children of Prisoners. In V. Gadsden (Ed.), Heading Home: Offender Reintegration in the Family -- What Works. Lanham, MD: American Correctional Association.

Johnston, D. (1991). Jailed Mothers. Pasadena, CA: Pacific Oaks College.

Kampfner, C. (1995). Posttraumatic Stress Reactions in Children of Imprisoned Mothers. In Gabel, K. & D. Johnston (Eds). Children of Incarcerated Parents. New York: Lexington Books.

Mumola, C. (2000). Incarcerated Parents & Their Children. Publication NCJ 182335. Washington, D.C.: Bureau of Justice Statistics.

Stanton, A. (1980). When Mothers Go to Jail. New York: Lexington Books.

National Resources

The Center for Children of Incarcerated Parents
Box 41-286
Eagle Rock, California 90041
Telephone: 626-449-2470
Fax: 626-449-4537
Email: ccip@earthlink.net
Website: www.e-ccip.org

The Family and Corrections Network
32 Oak Grove Road
Palmyra, Virginia 22963
Telephone 434-589-3036
Fax 434-589-6520
Email: fcn@fcnetwork.org
Website: www.fcnetwork.org

The National Resource Center on Children of Prisoners
Child Welfare League of America
440 First Street NW, Third Floor
Washington, D.C. 20001
Telephone 202-638-2952
Fax 202-638-4004
Website: www.cwla.org

Reflections on the Transition to Middle School

By Dr. Paula Sachs Wise for National Association Of School Psychologists

I still remember spending the summer of 1960 worrying. I had just graduated from sixth grade and even though I would be going to a junior high in the fall with many of the same kids I had been with in elementary school, the thought of junior high seemed so foreboding. I had heard rumors of eighth and ninth graders trying to fool lowly seventh graders into buying (non-existent) elevator passes; of not enough time to get from one class to another; of not enough time to get to the bathroom during the day; and so on and so forth. Of course I also worried about making friends, finding classrooms, and maybe even about being successful academically.

Although a lot has changed from my own school days, I venture to say that the notion of students worrying all summer before making the transition to middle school or junior high is as prevalent now as it was all those years ago. In fact various studies conducted in the 1990’s found that students were worried about getting to class on time, finding lockers, keeping up with academics, finding lunchrooms and bathrooms, getting on the right bus to go home, getting through crowded hallways, and remembering which class to go to next (Weldy, 1991; Schumacher, 1998). Newer research by Akos and Galassi (2004) questioned students, parents, and teachers about their concerns in student transitions to middle school. Similarities and differences were found among the three groups. All worried about students getting lost and having too much homework; students worried about being late to class; parents worried about students making friends and facing new pressures; and middle school teachers worried about the students finding their way in the school and making friends.

Often ignored in previous research are the positive aspects of the transition to middle school. Aikins, Bierman, and Parker (2005) found that negative expectations on the part of students translated to emotional distress during the transition. Therefore, parents and teachers may want to focus on the good things that go along with this new stage in their students’ lives. There will be increased opportunities to meet new friends and participate in extracurricular activities along with an overall increase in personal growth and independence. In the same study cited above, Akos and Galassi also asked students, parents, and teachers what they looked forward to in middle school. All three groups selected choosing classes and making new friends as positive aspects. Surprisingly perhaps, students looked forward to having lockers (possibly an indication of a need for personal space and privacy) while parents and teachers suggested that participation in sports was a positive aspect of the transition.

Another less studied variable in the transition is what actually happens after the school year begins. Although much of the focus has been about worries before the transition, do students have reason to fear the new environment? How quickly do they adjust to the new environment? Akos and Galassi (2004) suggest that students and parents rate the actual transition process as somewhat easy although teachers rated the transition as not as easy. Students found the academics themselves (e.g., classes, grades, homework, and teachers) to be the most difficult aspects of the transition, while parents found an overall increase in expectations and responsibilities as well as dealing with other students to be the hardest parts of the transition. Two-thirds of the parents found that within four weeks, their students had adjusted to their new school -- although 27% thought that it took longer than four weeks.

Strategies in adjusting to the new school also varied. The remainder of this article will address the strategies suggested by a number of researchers over the years.

General Preparation

Students need to know what to expect in the middle school environment and what will be expected of them. Tours of the new school, orientation meetings over the summer, and maps of the school can help alleviate some concerns. As mentioned above, focusing on the positive aspects of middle school can help to counterbalance some of the anxieties associated with any new situation.

Academic Preparation

Students and their parents and teachers need to know what the academic expectations are in the middle school environment. They need to work on study skills, time management, basic writing and math skills, reading proficiency, and so on. Elementary school and middle school teachers are partners with students and families in making sure that students make a smooth academic transition. Perhaps before the fall semester begins, schools could offer some sort of study skill training for entering students.

Friendships

At all stages of life, close relationships are important. They create support for students and a sense that “we’re all in this together.” The transition to middle school is no exception. Students also need friends to talk to when they are being picked on or when they are facing other problems in their lives.

Families

Family members, especially parents can serve several important roles in easing the transition process. Perhaps most importantly family members can support students through their trials and tribulations. Ask questions, listen, be available to talk things over, provide nutritious food, monitor sleeping patterns, get to know the youngsters’ friends, help students develop good study habits, etc.

Families and Schools Working Together

Family members can also help their students by communicating with school personnel. Attend parent-teacher conferences and take advantage of other opportunities to get to know your child’s teachers.

Enhancing Personal Growth

Elias (2001) makes broader suggestions for easing the transition to middle school. He notes that not only do students need specific strategies for dealing with their new educational settings they also at this point in their lives need increase opportunities for personal growth. He suggests that schools focus on four distinct areas:

Contributions

Students need to feel as though they are contributing positively to their world. Engaging in service activities in their communities (everything from helping seniors to working on the environment) not only helps fill these needs but it also may lead to self-discovery at an age when that is an important issue.

Belonging

Many students are able to form strong positive friendships on their own. Others, however, may need help in this area. Schools should provide numerous activities and groups to engage all students – especially those who have difficulty finding and making connections with others.

Talents

Some students excel in the classroom while others may have talents that are less obvious to school personnel. Defining talent broadly, schools should foster students’ artistic, theatrical, musical, literary, athletic, social, and other abilities. It is important to find at least one area in which each student excels.

Life Skills

Use teachable moments in middle school to help students learn to set goals, engage in planning, work in groups, solve problems, make decisions and develop resilience.

Overall, then there are a lot of strategies that students, parents, and school personnel can employ to make the transition to middle school a smooth and positive experience and a springboard for students to the rest of their lives.

References

Aikins, J. W., Bierman, K. L., & Parker, J. G. (2005) Navigating the transition to junior high school: The influence of pre-transition friendship and self-system characteristics. Social Development, 14 (1), 42-60.

Akos, P., and Galassi, J. P. (2004). Middle and high school transitions as viewed by students, parents, and teachers. Professional School Counseling, 7 (4), 212-221.

Elias, M. J. (2001, Winter). Middle school transition: It’s harder than you think. Making the transition to middle school successful. Middle Matters, pp 1-2.

Schumacher, D. (1998). The transition to middle school. Eric digest. Champaign, IL: ERIC Clearinghouse on Elementary and Early Childhood Education. (ERIC Document Reproduction Service No. ED422119)

Weldy, G. R. (1991). Stronger school transition to improve student achievement: A final report on a three-year demonstration project “strengthening school transitions for students k-13”. Virginia, US: (ERIC Document Reproduction Service No. ED338985)