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Recognizing Depression (Part II)

By Dr. Sheri Bauman for American School Counselor Association

What tools are there for screening for depression?

It is important to clarify what is meant by screening. Screening is not diagnosing. Screening is a way to learn whether symptoms are present and how severe they are. Students who score above the cutoff should be referred for a more thorough evaluation by a physician and/or psychologist. The referral to a physician is important because there are some medical conditions that will produce symptoms similar to depression, and those should be ruled out and/or treated. There are several well-researched screening tools that are available and easy to use in the school setting. All are self-report measures. Each will be briefly described here, and the reader is encouraged to contact publishers or go to publishers' websites for further information. Counselors may wish to compare costs, ease of scoring, and psychometric properties in deciding which inventory would be most useful in their setting.

The Children's Depression Inventory (CDI) is appropriate for use with children and adolescents, ages 7 – 17, and is written at a first grade level. It has 27 items in the regular form, and also is available in a 10-item brief form of the most important items. This screening inventory has three statements after each stem, and the child marks the one that is most like him/her. It is quick to administer and score, and is also available in a Spanish version.

Reynolds Child Depression Scale (RCDS) can be used with children ages 8 – 12. The Reynolds Adolescent Depression Scale (RADS) is designed for use with 13 – 18-year-olds. The children's scale is written at 2nd grade reading level, and the adolescent scale is written at third grade level. Each has 30 items, with easy administration and scoring procedures. The children's scale is available in Spanish.

The Beck Depression Inventory for Youth (BDI-Y) is one of the Beck Inventories of Emotional and Social Impairment that are designed for use with children ages 7 – 14, and the 20 items are written at second grade level. Students respond to statements by indicating how frequently a statement is true for them. No Spanish version is available.

The Center for Epidemiological Studies – Depression Scale for Children (CES-DC) is appropriate for adolescents ages 12 – 18, is written at a sixth grade reading level, and has 20 items. Scoring is straightforward.

What can school counselors do about depression?

The first step for the school counselor is to educate oneself and be alert for danger signals among students. Screening all students is not a recommended practice, but screening those students who exhibit one or more symptoms or behaviors described in Part I of this article is a helpful practice. The counselor must adhere to all ethical standards, including informed consent, when administering screening measures. If the student scores above the cutoff for the particular inventory, the school counselor must inform the parent or guardian, and recommend that a full physical and psychological evaluation would be in the child's best interest.

Counselors also need to educate teachers and other staff members that these behaviors and signals, which may be disruptive to learning, may also be clues that a child has an undiagnosed depressive disorder. Teachers are in daily contact with students, and may be the first to observe changes, or see a drawing or writing that is cause for concern. Encouraging teachers to work with counselors and refer these students is an important contribution to prevention efforts.

Parents also need information and education about depression. Many pamphlets and fact sheets are available, and some can be obtained online. Include such information in newsletters, when speaking at parent information programs, and in building a library of useful books that can be loaned to parents. These are all ways to partner with parents in helping their children.

Offering to communicate with treatment providers in order to learn what strategies might be most applicable in school is a way to form important links. Finally, offering support to students who are depressed is an essential service. That support might involve monitoring progress, checking with the student regularly, and/or inviting the student to be in a support group if appropriate.

In conclusion...

There is some evidence that depression is appearing at younger ages in recent years. Because depression interferes with a student's academic, social, emotional, and behavioral functioning, school counselors must be active in identifying children who may have this disorder.

Since depression in children is linked to increased risk of suicidal thoughts and behaviors, early intervention for depression is an effective measure to prevent suicide in youth. Suicide is the third leading cause of death in adolescents, and the sixth for 5- to 14-year-olds. Treatment has been found to be effective with children and adolescents, so identifying and referring students may be a matter of life and death.

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: SOMETIMES I GET SAD (BUT NOW I KNOW WHAT MAKES ME HAPPY)

The incidence of childhood depression has increased dramatically in the last 15 years, and it is affecting younger children than ever before. This storybook helps children ages 5-10 to learn about depression and what to do about it. The main character, Sara, is depressed for a variety of reasons but she gets help from a combination of individual and group counseling. Sometimes she still gets sad, but now she knows how to make herself feel better. To find out how you can purchase this tool to help children who are depressed, 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.

LOOKING FOR HANDS-ON SCHOOL COUNSELING TOOLS?


Visit the Guidance Channel Shopping Mall! There you will find thousands of resources, many of them national and international award-winners, including reproducible handouts, therapeutic games, multimedia programs, videos, curricula, prevention-awareness items and much more. Be sure to check out our online Childswork/Childsplay catalog, as well as our At-Risk Resources and Wellness Reproductions online catalogs, for innovative tools to address the social and emotional needs of your clients.

FOR ADDITIONAL NEWSLETTERS...

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).

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.

Looking For Hands-On Counseling Tools?

Visit the Guidance Channel Shopping Mall! There you will find thousands of resources, many of them national and international award-winners, including reproducible handouts, therapeutic games, multimedia programs, videos, curricula, prevention-awareness items and much more. Be sure to check out our online Childswork/Childsplay catalog, as well as our At-Risk Resources and Wellness Reproductions online catalogs, for innovative tools to address the social and emotional needs of your clients.

For Additional Newsletters...

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.

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.

Responding To Student Stress: Guidelines For Educators

By Ellis Copeland, Ph.D. for National Association Of School Psychologists

When children experience stress, they seldom know how to define it. They often express it by telling adults that their stomachs hurt, they have headaches, or they can’t go to school. Adults need to realize that when children describe such symptoms, they really may be trying to tell us that they are stressed out!

Basic Facts

Causes of Stress

Although demands in life are natural, we experience stress when we are unable to cope and/or believe or are unaware that we do not have the resources to meet such demands. As each of us possesses diverse abilities and levels of confidence in them, our reactions to life’s challenges vary widely. For example, a roller coaster ride may be a thrill to one child and a major stressor to another. Every person reacts to stressors (events in the environment and/or perceptions that cause stress) in different ways. The sources of stress also differ based on stages of development. For example, children in elementary school are stressed about issues related to fear of abandonment and the unknown. On the other hand, teens tend stress over fitting in with their peers and developmental changes related to puberty.

However, there are some common factors that can cause stress for all students. According to today’s children and teens, the most primary sources of stress are peer relationships, as well as school and home environments.

Peer relations are extremely important to most youth and appear to become more and more significant as children grow. While most kids want to be accepted by peers, many times they don’t and that fact is taking toll on American children. Victims of bullying experience a great deal of stress. In addition, children without a strong sense of self can be especially susceptible to negative peer pressure. They often feel the need to follow the crowd to be accepted.

Stressors specifically related to school include fear of failure, test anxiety, and/or viewing oneself as academically inadequate. A new stressor is “high stakes testing” as children sense the importance of the occasion. Moving to a new school and transitioning from elementary school to middle school are also stressful events for most youth. Other school-related stressors include unclear expectations and lack of structure in the classroom.

Although children should be able to escape stress at home, the fact is that many cannot. A large number of children experience stress due to “latchkey” situations, lack of structure, and poor boundaries. Parental expectations, whether they are too high or too low, can also cause children stress. Domestic violence can cause an enormous amount of stress -- whether or not a child is the actual target of abuse. Changes in the home environment, such as a divorce, can create a feeling of instability, as well.

In the 1970s and 1980s, major life events were considered to be the main source of stress-related illness. It was believed that we could determine whether people were under too much stress by asking if they had experienced to events such as death in the family, a job change, or a move to a new home. However, researchers later found that “hassles” or daily problems were just as likely to be predictors for emotional and/or physical illnesses as were major life events. They realized that stress is most often cumulative.

The impact of cumulative stress can be seen when we see children who handle many stressful events adequately, suddenly sick or to “lose it” over the slightest injustice. When they finally react to cumulative stress, everyone is often surprised by the response. However, when they look back at what was going on in the children’s lives, the array of contributing factors is usually clearly evident.

Identifying Students Under Stress

Stress can be both positive and negative. Helpful stress, also referred to as eustress, has the power to energize us to solve problems and accomplish goals. However, harmful stress, known as distress, can adversely affect our bodies, minds, and/or behaviors.

Reactions to stress vary from one youth to another. Children will develop individual styles of handling stress and those styles may change with age. As mentioned earlier, symptoms of stress in young children are often difficult to distinguish from symptoms of minor illnesses. Common symptoms include irritability, stomachaches, and headaches. Fearful children may use words such as "feeling bad" or "afraid” to express distress. Periods of stubbornness and/or regression to earlier behavior are often indicative of too much stress. Behavioral warning signs may include:

• Tardiness;
• Daydreaming or withdrawal;
• Excessive tears;
• Inappropriate laughter;
• Fidgeting;
• Rudeness;
• Constant need for praise and attention;
• Changes in academic performance; and
• Giving up on assignments too quickly.

As children approach or reach middle school, their responses to stress may include attention-seeking behaviors, mood changes, anger, aggressive behavior, rudeness to adults and others, avoidance of certain activities, changes in the quality of schoolwork, as well as common physical complaints (headaches and/or upset stomachs). Overt anxiety or anxiety mixed with depression is not uncommon. Children and adolescents may also react to stress by regression to behaviors of someone much younger, the pattern being somewhat like an adult who has a temper tantrum as a response to stress.

Distressed adolescents are often truant, lack commitment to schoolwork, and are indifferent to school rules and policies. They are also often unwilling to participate in school activities. Students this age are frequently exposed to alcohol and other drugs and, as a result, they run the risk of trying to cope with stress by experimenting with these substances.

Children and youth exposed to extreme stress in the form of a traumatic event such as war, violence at school, or accidental death of an immediate family member, need special care which should usually be provided by a qualified mental health professional, not the classroom teacher. After a little break from the routine and/or crisis counseling, many children appear okay -- yet they may still be in shock and exhibit some symptoms. Children, who demonstrate intense emotions after a traumatic event, need to be reassured that they are having normal reactions to an abnormal occurrence. They need to feel “normal” after a tragic event, and this can be the most valuable support a school community can offer. If symptoms of intense anxiety, irritability, or unnatural fears present themselves at a later date, be empathic. However, keep in mind that a referral to a mental health professional may be in order.

Interventions

Prevention: How Can We Inoculate Children From the Harmful Effects of Stress?

• Let children know: they can trust you (be honest, reliable, and on time); their school and classroom is safe; and they are important members of the school community.
• Encourage the expression of feelings. Awareness of feelings is one of the major building blocks to self-awareness. When listening to an account of the day`s experiences, ask children how they felt about the day, as well as what they did.
• Help children and adolescents learn how to problem solve. Taking responsibility for their decisions helps them to feel that they can be in control. Children and teens with be strongest coping skills usually have experienced the satisfaction of successfully solving problems.
• Teach and model emotional regulation. The earlier one learns to use emotions to facilitate (rather than interfere) with setbacks, the better the child’s response to stress will be.
• Develop a proactive classroom that is productive and has limited disruptions.
• Explain what is expected in your classroom and why.
• Encourage physical activity as a means of releasing stress.
• Set realistic behavioral expectations based on each child’s developmental level.
• Keep children informed of necessary and anticipated changes within the school or community. Even moving to a new classroom can be a stressor.
• Involve children as helpers and encourage them to make responsible decisions.
• Promote healthy relationships by modeling positive interactions with others. A network of friends for you and your children buffers against distress and negative peer relationships.
• Realize that children (probably in middle school) will be exposed to drugs and alcohol. Let them know that self-medicating with alcohol and drugs is not the way to cope with stress.

Teacher-based Interventions

Teachers have a powerful influence on youngsters -- both positive and negative. When stressors escalate in the classroom, the most important first step is to avoid a global personalized response (such as calling a student a “bad girl” or a group of them “disturbed kids”). Focus instead on the inappropriate behaviors (“five children are not in their seats!”). Then, as a teacher, you can proceed to:

• Evaluate your classroom schedule regularly. Consider whether it has become too demanding or not demanding enough.
• Be aware of children’s behaviors and emotions. Help them to find things that give them personal pleasure. Encourage children to talk to you if there was a problem during the day.
• If a family has “moved in” from a new neighborhood and the child is “lost” or struggling, help the child to feel a part of the school and community. A call home after the first day or week of school may be appropriate.
• Monitor the television programs that children watch in school (including news broadcasts which can produce worries and anxiety). Pay particular attention to and provide supervision for computer games and the use of the internet.
• When a child makes a poor decision, listen without being critical, encourage the child to use reflective thought, and use natural consequences as punishment.
• Over scheduling children in group activities can produce a great deal of stress. Find time for children to play alone and in smaller groups, as well.
• If a problem occurs at school that is not resolved, contact the parent. Most parents want to be informed and can help.
• If signs of stress do not disappear or a child or adolescent has been a victim of a traumatic experience, seek professional help or advice.

Confronting Teen Suicide

By Franklin Schargel for GuidanceChannel.com

It doesn’t seem right that a young person between the ages of 11 and 19, who has lived for such a short time and has a long life ahead, would choose to die. However, if you look up “teenage suicide’ at google.com, you’ll bring up 1,100,000 “hits” -- and with good reason.

Did you know?

• In the next 24 hours 1,439 teens will attempt suicide. As many as 250,000 adolescents made a serious unsuccessful effort to kill themselves last year.
• Every 90 minutes a teenager or young adult is successful in killing themselves.
• According to experts, suicide is the third leading cause of teenage deaths after automobile accidents and homicide. Almost as many teens die from suicide as the fourth through the tenth leading causes of death combined.
• The suicide rate in the past 25 years has been decreasing, yet the rate for those between 15 and 24 has tripled. The adolescent suicide rate is nearly 33% higher than that of the overall population.
• Many youths have sought help in the month before the suicide.
• The ratio of male to female suicides is four to one. However young women attempt suicide nine times more frequently. Guns are the most common means of suicide among males. Pills are the most commonly used method of suicide for females.
• White males have had the highest increase in suicide, which rose 50% between 1970 and 1978. The incidence for white females increased 12%. Suicide among young blacks has also dramatically increased.
• Half of all children who have made one suicide attempt will make another, sometimes as many as two a year until they succeed.

What are the causes?

Depression

Teens who are feeling suicidal may see no other way out of their problems, no other escape from emotional pain or no one to talk to about how they feel. Depression expresses itself in a variety of ways including: changes in appetite; variations in activity level; loss of sleep; lack on interest in activities that normally give pleasure; social withdrawal; and thoughts of death or punishment.

Substance Abuse Problems

Alcohol and some drugs are depressants. Youth who are depressed may take these substances thinking that they will help ease the pain. However, in reality, they only make situations worse. Substance abuse clouds our judgment and interferes with our ability to assess risk, make good choices, and identify solutions to our problems.

Teenage Stress

There are many pressures on teenagers, many that they have never experience before. These include social, academic, personal, sexual, and relationship pressures. Some teens struggle with weight and eating problems, while others face learning difficulties in school. These risk factors, as well as getting in trouble in school or with the law and fighting with parents, are risk factors for suicide. A traumatic event like a breakup, failing a test, an unintended pregnancy or getting into an accident can also bring on suicidal tendencies.

Violence

Violence is everywhere – in the media, our neighborhoods, and even our homes. Access to the tools of violence, And it is easier to get the tools (guns and pills) of suicide. If there is a gun in the home, youths are 5 times more likely to commit suicide than in homes without a gun.

Lack of parental interest

Many children grow up in single –parent households. Others have two working parents. According to one study, 90% of suicidal teenagers believed their families did not understand them.

Data show that families are spending less time together and more of our young people are spending more and more time in front of television screens.

What are the warning signs?

The list below lists the most prevalent causes of youth suicide. The list is not all-inclusive, but should assist educators in identifying the most common warning signs. Not all youngsters who exhibit these signs will commit suicide. However the greater the number of warning signs, the greater the likelihood of suicide predictors. Youth are most at risk of attempting suicide are those who:

• made previous suicide attempts;
• talk about committing suicide;
• feel that “it is all their fault” ;
• exhibit anger;
• manifest signs of serious depression, moodiness, hopelessness, withdrawal;
• are loners;
• increase use of drugs or alcohol;
• change their sleeping or eating habits;
• cry often;
• are chronically or suddenly truant;
• give away possessions;
• recently experienced the suicide of a loved one or family member;
• have a preoccupation with death and dying;
• lose interest in their personal appearance;
• suffer through turmoil within family (divorce, remarriage, separation, merging of two families) ;
• have a family history of suicide;
• recently faced stressful events or loss in their lives;
• can easily access lethal methods, especially guns;
• exhibit rebellious behavior or run away;
• struggle to concentrate or show a decline in quality of school work;
• lose interest in previously pleasurable activities;
• give verbal hints, such as “I won’t be a problem for you much longer,” or “Nothing matters” ;
• encounter conflicts around sexual orientation;
• go through a romantic break up;
• are under increased pressure to perform, achieve, and/or be responsible; and/or
• take unnecessary risks.

The greater the number of warning signs, the greater the risk.

What can educators do?

1. While no one single symptom – or even a combination of factors is a predictor of suicide. If you suspect that a student is suicidal, teachers and students should tell a counselor or an administrator.

2. Always take suicidal comments very seriously. If a student says that he or she is thinking about suicide, you need to take the comments seriously. If you assume that the person is only seeking attention, you may be making a serious and potentially fatal decision.

3. Listen attentively to everything that a potential suicide person has to say. Encourage the person talk as much as he or she wants to. Listen closely so that you can be as supportive as possible, and learn as much as possible about what is cause the pain.

4. Comfort the person with words of encouragement. There is no script to follow in these situations.

5. Don’t lecture or point out all the reasons a person has to live. Instead, listen and reassure the individual that depression and suicidal tendencies can be treated.

6. If you suspect that the individual is at high risk of suicide, do not leave the person alone. If you are in doubt, call 911.

7. Know your limits. Most of us have not been trained in how to handle situations like this. Be supportive; listen attentively; let the person know that you are deeply concerned.

8. There are a number of local suicides “hotlines." Their numbers are listed in your local telephone directories. Check the numbers in front of your telephone director

Social And Emotional Issues Related To Dyslexia

By Dr. Michael Ryan for International Dyslexia Association

Research indicates that dyslexia is caused by biological factors not emotional or family problems. Samuel T. Orton, M.D. was one of the first researchers to describe the emotional aspects of dyslexia. According to his research, the majority of dyslexic preschoolers are happy and well adjusted. Their emotional problems begin to develop when early reading instruction does not match their learning style. Over the years, the frustration mounts as classmates surpass the dyslexic student in reading skills. Recent research funded by the National Institute of Health has identified many of the neurological and cognitive differences that contribute to dyslexia. The vast majority of these factors appear to be caused by genetics rather than poor parenting or childhood depression or anxiety.

Why is dyslexia discouraging and frustrating?

The frustration of children with dyslexia often centers on their inability to meet expectations. Their parents and teachers see a bright, enthusiastic child who is not learning to read and write. Time and again, dyslexics and their parents hear, “He’s such a bright child; if only he would try harder.” Ironically, no one knows exactly how hard the dyslexic is trying. The pain of failing to meet other people’s expectations is surpassed only by dyslexics’ inability to achieve their goals. This is particularly true of those who develop perfectionistic expectations in order to deal with their anxiety. They grow up believing that it is “terrible” to make a mistake.

However, their learning disability, almost by definition means that these children will make many “careless” or “stupid” mistakes. This is extremely frustrating to them, as it makes them feel chronically inadequate. The dyslexic frequently has problems with social relationships. These can be traced to causes:

• Dyslexic children may be physically and socially immature in comparison to their peers. This can lead to a poor self-image and less peer acceptance.
• Dyslexics’ social immaturity may make them awkward in social situations.
• Many dyslexics have difficulty reading social cues. They may be oblivious to the amount of personal distance necessary in social interactions or insensitive to other people’s body language.
• Dyslexia often affects oral language functioning. Affected persons may have trouble finding the right words, may stammer, or may pause before answering direct questions. This puts them at a disadvantage as they enter adolescence, when language becomes more central to their relationships with peers.

My clinical observations lead me to believe that, just as dyslexics have difficulty remembering the sequence of letter or words, they may also have difficulty remembering the order of events. For example, let us look at a normal playground interaction between two children. A dyslexic child takes a toy that belongs to another child, who calls the dyslexic a name. The dyslexic then hits the other child. In relating the experience, the dyslexic child may reverse the sequence of events. He may remember that the other child called him a name, and he then took the toy and hit the other child.

This presents two major difficulties for the dyslexic child. First, it takes him longer to learn from his mistakes. Second, if an adult witnessed the events, and asks the dyslexic child what happened, the child seems to be lying.

Unfortunately, most interactions between children involve not three events, but 15 to 20. With his sequencing and memory problems, the dyslexic may relate a different sequence of events each time he tells the tale. Teachers, parents, and psychologists conclude that he is either psychotic or a pathological liar.

The inconsistencies of dyslexia produce serious challenges in a child’s life. There is a tremendous variability in the student’s individual abilities. Although everyone has strengths and weaknesses, the dyslexic’s are greatly exaggerated. Furthermore, the dyslexic’s strengths and weaknesses may be closely related. I once worked with a young adult who received a perfect score on the Graduate Record Exam in mathematics. He could do anything with numbers except remember them. The graduate students he tutored in advanced statistics or calculus had great difficulty believing that he could not remember their telephone numbers.

These great variations produce a “roller coaster” effect for dyslexics. At times, they can accomplish tasks far beyond the abilities of their peers. At the next moment, they can be confronted with a task that they cannot accomplish. Many dyslexics call this “walking into black holes.” To deal with these kinds of problems, dyslexics need a thorough understanding of their learning disability. This will help them predict both success and failure.

Dyslexics also perform erratically within tasks. That is, their errors are inconsistent. For example, I once asked a dyslexic adult to write a hundred-word essay on television violence. As one might expect he misspelled the word “television” five times. However, he misspelled it a different way each time. This type of variation makes remediation more difficult.

Finally, dyslexics’ performance varies from day to day. On some days, reading may come fairly easily. However, another day, they may be barely able to write their own name. This inconsistency is extremely confusing not only to the dyslexic, but also to others in his environment.

Few other handicapping conditions are intermittent in nature. A child in a wheelchair remains there; in fact, if on some days the child can walk, most professionals would consider it a hysterical condition. However, for the dyslexic, performance fluctuates. This makes it extremely difficult for the individual to learn to compensate, because he or she cannot predict the intensity of the symptoms on a given day.

What does the dyslexic person feel?

Anxiety

Anxiety is the most frequent emotional symptom reported by dyslexic adults. Dyslexics become fearful because of their constant frustration and confusion in school. These feelings are exacerbated by the inconsistencies of dyslexia. Because they may anticipate failure, entering new situations can becomes extremely anxiety-provoking.

Anxiety causes human beings to avoid whatever frightens them. The dyslexic is no exception. However, many teachers and parents misinterpret this avoidance behavior as laziness. In fact, the dyslexic’s hesitancy to participate in school activities such as homework is related more to anxiety and confusion than to apathy.

Anger

Many of the emotional problems caused by dyslexia occur out of frustration with school or social situations. Social scientists have frequently observed that frustration produces anger. This can be clearly seen in many dyslexics.

The obvious target of the dyslexic’s anger would be schools and teachers. However, it is also common for the dyslexic to vent his anger on his parents. Mothers are particularly likely to feel the dyslexic’s wrath. Often, the child sits on his anger during school to the point of being extremely passive. However, once he is in the safe environment of home, these very powerful feelings erupt and are often directed toward the mother. Ironically, it is the child’s trust of the mother that allows him to vent his anger. However, this becomes very frustrating and confusing to the parent who is desperately trying to help their child.

As youngsters reach adolescence, society expects them to become independent. The tension between the expectation of independence and the child’s learned dependence causes great internal conflicts. The adolescent dyslexic uses his anger to break away from those people on which he feels so dependent.

Because of these factors, it may be difficult for parents to help their teenage dyslexic. Instead, peer tutoring or a concerned young adult may be better able to intervene and help the child.

Self Image

The dyslexic’s self-image appears to be extremely vulnerable to frustration and anxiety. According to Erik Erikson, during the first years of school, every child must resolve the conflicts between a positive self-image and feelings of inferiority. If children succeed in school, they will develop positive feelings about themselves and believe that they can succeed in life. If children meet failure and frustration, they learn that they are inferior to others, and that their effort makes very little difference. Instead of feeling powerful and productive, they learn that their environment controls them. They feel powerless and incompetent. Researchers have learned that when typical learners succeed, they credit their own efforts for their success. When they fail, they tell themselves to try harder. However, when the dyslexic succeeds, he is likely to attribute his success to luck. When he fails, he simply sees himself as stupid.

Research also suggests that these feelings of inferiority develop by the age of ten. After this age, it becomes extremely difficult to help the child develop a positive self-image. This is a powerful argument for early intervention.

Depression

Depression is also a frequent complication in dyslexia. Although most dyslexics are not depressed, children with this kind of learning disability are at higher risk for intense feelings of sorrow and pain. Perhaps because of their low self-esteem, dyslexics are afraid to turn their anger toward their environment and instead turn it toward themselves.

However, depressed children and adolescents often have different symptoms than do depressed adults. The depressed child is unlikely to be lethargic or to talk about feeling sad. Instead he or she may become more active or misbehave to cover up the painful feelings. In the case of masked depression, the child may not seem obviously unhappy. However, both children and adults who are depressed tend to have three similar characteristics:

• First, they tend to have negative thoughts about themselves, i.e. a negative self-image.
• Second, they tend to view the world negatively. They are less likely to enjoy the positive experiences in life. This makes it difficult for them to have fun.
• Finally, most depressed youngsters have great trouble imagining anything positive about the future. The depressed dyslexic not only experiences great pain in his present experiences, but also foresees a life of continuing failure.

Family Problems

Like any handicapping condition, dyslexia has a tremendous impact on the child’s family. However, because dyslexia is an invisible handicap, these effects are often overlooked. Dyslexia affects the family in a variety of ways. One of the most obvious is sibling rivalry. Non-dyslexic children often feel jealous of the dyslexic child, who gets the majority of the parents’ attention, time, and money. Ironically, the dyslexic child does not want this attention. This increases the chances that he or she will act negatively against the achieving children in the family.

Specific developmental dyslexia runs in families. This means that one or both of the child’s parents may have had similar school problems. When faced with a child who is having school problems, dyslexic parents may react in one of two ways. They may deny the existence of dyslexia and believe if the child would just buckle down, he or she could succeed. Or, the parents may relive their failures and frustrations through their child’s school experience. This brings back powerful and terrifying emotions, which can interfere with the adult’s parenting skills.

How can parents and teachers help?

During the past 25 years, I have interviewed many dyslexic adults. Some have learned to deal successfully with their learning problems, while others have not. My experiences suggest that in addition to factors such as intelligence and socioeconomic status, other things affect the dyslexic’s chances for success.

First, early in the child’s life, someone has been extremely supportive and encouraging. Second, the young dyslexic found an area in which he or she could succeed. Finally, successful dyslexics appear to have developed a commitment to helping others.

Both teachers and parents need to offer consistent, ongoing encouragement and support. However, one rarely hears about this very important way to help youngsters.

I believe encouragement involves at least four elements.

First is listening to children’s feelings. Anxiety, anger and depression are daily companions for dyslexics. However, their language problems often make it difficult for them to express their feelings. Therefore, adults must help them learn to talk about their feelings. Teachers and parents must reward effort, not just “the product.” For the dyslexic, grades should be less important than progress.

When confronting unacceptable behavior, adults must not inadvertently discourage the dyslexic

child. Words such as “lazy” or “incorrigible” can seriously damage the child’s self-image. Finally, it is important to help students set realistic goals for themselves. Most dyslexic students set “perfectionistic” and unattainable goals. By helping the child set an attainable goal, teachers can change the cycle of failure.

Even more important, the child needs to recognize and rejoice in his or her successes. To do so, he or she needs to achieve success in some area of life. In some cases, the dyslexic’s strengths are obvious, and many dyslexics’ self-esteem has been salvaged by prowess in athletics, art, or mechanics. However, the dyslexic’s strengths are often more subtle and less obvious. Parents and teachers need to find ways to relate the child’s interests to the demands of real life.

Finally, many successful dyslexic adults deal with their own pain by reaching out to others. They may do volunteer work for charities or churches, or choose vocations that require empathy and a social conscience. These experiences help dyslexics feel more positive about themselves and deal more effectively with their pain and frustration. Many opportunities exist in our schools, homes and churches for dyslexics to help others. One important area is peer tutoring. If dyslexic students do well in math or science, they can be asked to tutor a classmate who is struggling. Perhaps that student can reciprocate as a reader for the dyslexic student. Tutoring younger children, especially other dyslexics, can be a positive experience for everyone involved.

Helping dyslexics feel better about themselves and deal effectively with their feelings is a complex task. First, caring adults must understand the cognitive and affective problems caused by dyslexia. Then they must design strategies that will help the dyslexic, like every other child, to find joy and success in academics and personal relationships.

© Copyright 2004, The international Dyslexia Association (IDA). IDA encourages the reproduction and distribution of this fact sheet.

Mental Health and Children: A Call To Action

By Darcy Gruttadaro, JD for The National Alliance for the Mentally Ill

Many school professionals may not know that they are now being called on to be partners in the transformation of our nation’s mental health system. This call to action began in the Spring of 2002, when President Bush announced the creation of the New Freedom Commission on Mental Health (NFC). Not since President Carter has a President created a Commission to examine our nation’s mental health system. In announcing its creation, President Bush declared, “Our country must make a commitment. Americans with mental illness deserve our understanding and they deserve excellent care.”

Through an Executive Order issued on April 29th in 2002, he charged the NFC with studying the mental health delivery system and making recommendations to enable children and adults living with serious mental illnesses to live, work, learn, and participate fully in their communities.

In April 2003, the NFC issued their final report -- Achieving the Promise: Transforming Mental Health Care in America (available at www.mentalhealthcommission.gov). The Commission traveled around the country to hear testimony from families, mental health experts, school professionals, people living with mental illnesses, and other key stakeholders. The Commission carefully reviewed research and innovative approaches to mental health service delivery.

In issuing the NFC interim report, the Chair of the Commission declared that our nation’s mental health system is in shambles. Nowhere is that more true than for children and adolescents with mental illnesses. Only about 20% of them are identified and provided treatment. An alarming 80% of children and adolescents with mental illnesses fail to be diagnosed and treated.

In the final report, the NFC called for a complete transformation of the mental health system -- including having our nation’s schools play a bigger role in helping to transform the system.

The NFC Calls On Schools To Help

Goal four of the NFC calls for a transformed system to include early mental health screening, assessment, and referral to services as common practice for children and adolescents. So how can schools help? Currently, no one agency or system is responsible for children with mental illnesses. Children may attempt to access mental health services through the mental health service system, special education, child welfare, juvenile justice, substance abuse services or their primary care physician. This fragmentation often leads to a lack of accountability and confuses families about where to turn to access services.

The NFC report acknowledges that the mission of public schools is to educate all students. Unfortunately, students with mental illnesses, many but not all of who receive special education services, have the highest school failure and drop out rates of any disability group.

Schools are a logical place to reach children because they spend most of their day there. Schools are also a low-stigma setting for families that may be hesitant to seek services in the mental health system. Another compelling reason to involve schools is that mental health is essential for learning. Most students struggling with an unidentified and undiagnosed mental illness are unable to appropriately participate in classroom activities. They also often struggle with social and emotional development. Yet, the majority of those who receive appropriate services thrive.

There are clear incentives for schools to help address the mental health crisis for children and adolescents in this country. Growing evidence shows that school mental health programs improve educational outcomes by decreasing absences, decreasing discipline referrals, and improving test scores (Jennings, J., Pearson, G., & Harris, M., 2000). The key to improving academic achievement is to identify mental health problems early and, when needed, provide appropriate services or links to services.

The No Child Left Behind Act provides another strong incentive for schools to become involved in the transformation. It is designed to improve the academic achievement of all students, including those with mental illnesses. Students with mental illnesses that go undiagnosed and untreated often fall far short of their academic ability. It is imperative that these students, who are often clearly struggling, be identified and linked to appropriate services.

What Can Schools Do?

Today, schools have an enormous amount on their plates. However, schools should know that there are others in their communities ready to help. Under Recommendation 4.2 of the NFC report, the Commission calls for a strengthening of mental health programs in schools -- whether that involves actually providing services in schools or linking students and families to home and community-based mental health services. Here are suggestions, made both by the NFC and NAMI, on what schools can do to help ensure that students that may require mental health services are identified and referred for a complete evaluation and appropriate services:

• Work with parents, local mental health providers, and local agencies to support screening, assessment, and early intervention programs. The NFC report identified the Columbia University TeenScreen Program (www.teenscreen.org) as a model screening program to help identify students with mental health service needs.
• Make sure that school professionals learn the early warning signs of mental illnesses in children and adolescents, to talk with families about mental health related concerns and, when appropriate, suggest a referral for a mental health evaluation (for a list of warning signs, see NAMI’s Parents And Teachers As Alllies).
• Contact local and state-based mental health advocacy groups, including NAMI (the National Alliance for the Mentally Ill), to ask how schools can partner with family organizations to help address the critical need for early identification and intervention. NAMI has over 1,000 state and affiliate organizations in every state. To find contact information for the closest NAMI office, click here.
• Ensure that mental health services are part of school health centers and that there is a strong link to community mental health providers.
• Support the effort to implement mental health services that are federally funded as health, mental health, and education programs.
• Build on a recommendation from President Bush’s Commission on Excellence in Special Education to implement empirically supported prevention and early intervention approaches at the school district, local school, classroom and individual students levels. Click here to learn more about President Bush’s Commission on Excellence in Special Education.
• Create a state-level structure for school-based mental health services to provide consistent state-level leadership and collaboration between education, health, and mental health systems.

NAMI recognizes that schools cannot do this alone. At the same time, we understand the important role that schools can play in helping to address the mental health needs of our nation’s youth. NAMI grassroots leaders stand ready to help. They are increasingly partnering with schools in communities across the country to provide in-service training on the early warning signs of mental illnesses and how best to communicate mental health-related concerns to families.

The NAMI national office recently received funding to develop a national education program to help school professionals better understand mental illnesses in children and adolescents. There is much exciting work ahead. NAMI looks forward to working with school professionals to improve the lives of children and adolescents living with mental illnesses and their families. Stay tuned!

Reference

Jennings, J., Pearson, G., & Harris, M. (2000) Implementing and maintaining school-based mental health services in a large, urban school district. Journal of School Health , 70, 201-205).