Must-Know Strategies for the 5 Most Common Student Mental Health Problems


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Must-Know Strategies

for the

5 Most Common

Student Mental Health Problems



student mental healthThere is no question that you are seeing many more student mental health problems than ever before. Many educators typically lack extensive or even basic training on student mental health problems and end up lacking many or all of the honed, more effective strategies and tools that juvenile mental health professionals have developed. This how-to article for educators and other non-mental health professionals is designed to remedy that oversight as much as possible given the limited space we have for a complex topic. This Top 5 list of student mental health problems is based on the feedback of the teachers, principals, school counselors and special educators that have attended our in-person Breakthrough Strategies to Teach and Counsel Troubled Youth Workshops recently. (You can attend too as our next live conference is coming up soon in Seattle on April 18-19, 2019 — and, even better, our conference scholarships are still open! Just call 800.545.5736 to grab one now.)

Hello from Youth Change Director Ruth Herman Wells, M.S. I have spent my career teaching about key student mental health problems and diagnoses to educators and other non-mental health professionals. I am hoping that you will be able to immediately use the information included in this important article for teachers, principals, special educators and other non-mental health professionals who work with children and teens. Even though non-mental health professionals can’t diagnose, the how-to article below is intended to give you the language to better understand, manage and communicate about your students who are struggling with their emotions and/or thoughts.


Must-Know Strategies

for the

5 Most Common

Student Mental Health Problems


student with conduct disorder1. CONDUCT DISORDER

If you don’t know this disorder backwards and forwards and inside and out, then you are a vulnerable target for your most seriously acting-out students. In our workshops, we spend hours and hours on this disorder because the student who has this disorder is normally by far your most impossible-to-manage student– and this disorder is very common. Affecting an estimated 11-14% of your students, this disorder means that the child or teen is wired differently than other students. Lacking remorse, empathy and relationship capacity, this child’s signature is his extreme acting-out. That was not a misplaced pronoun. “He” is very often a he, not a she. Girls don’t very commonly have this disorder but they can have it, and when they do, their behavior is often beyond extreme.

Here are some passable examples of this disorder from popular culture: J.R. Ewing from the TV show Dallas, Sid the boy in the first Toy Story movie, and Eddie Haskell from Leave It to Beaver. Everyday, ordinary interventions always fail with this population and generally make the situation worse. That means that your go-to interventions that work well or okay with other students, routinely let you down with this population. That’s why working successfully with children who have or may have conduct disorder requires that you use specialized interventions that are different from what you normally use. Since this youngster lacks a heart and relationship capacity, strategies that require empathy or compassion will always fail. There is no way I can capture this problem for you in this tiny space but there are countless free articles on our site to guide you, plus online courses and books. Go to our free, introductory Conduct Disorder mental health article to learn more about this common, serious disorder and to discover the kinds of strategies that must be used– and those that must never be used– with this very difficult-to-control student.


student mental health problem


Sure, lots and lots of adolescents are depressed but that’s not clinical depression. Clinical depression is more serious, more prolonged and more difficult than ordinary adolescent angst. For all mental health diagnoses, a mental health or health professional is needed to diagnose, but whether or not you can diagnose, you can certainly adjust how you work with children and teens who appear to be clinically depressed. The top go-to step for seriously depressed children and teens is working with  a mental health clinician. Next, after that, there are three major strategies that have been shown to be effective. First, depressed students often can benefit from having the chance to vent their concerns. Almost any adult can do a least some listening. Second, exercise, mindfulness training and meditation offer depressed students really useful tools. Along the same line, teaching students how to better manage their upsetting thoughts, can have a lot of value. The third strategy to consider is to arrange with the family for an anti-depressant but there is a risk of self-harm for this option, and this option can be difficult to set up. Studies suggest all three methods together work better than any of the strategies separately.

Depression needs to be taken seriously and it can definitely spur students to behaviors that are very concerning. As a society we are more attuned to paying attention to acting out, not giving as much notice to the more subtle, less obvious, less overt, more quiet phenomena of depression. Don’t let that cultural norm prevent you from devoting time to students whose behavior may be acceptable but their emotional functioning may still be of great concern. Depressed students are just as worthy and needing of your attention as students who command your attention with acting-out behavior. Read more about how to help students who face clinical depression in our free how-to articles.


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bipolar disorder


I am including this student mental health problem here not because it is a very common disorder; it’s actually not as common as many other childhood and teen disorders. I am including it because so many of the teachers and principals that I see in my workshops and at conferences, are confused about what this disorder is all about. This disorder used to be called Manic-Depression and I think that old title was really helpful to remind non-mental health workers what this problems is all about. This disorder means that the child or teen gets really depressed then suddenly starts being out-of-control with little in between. They go from 0 miles an hour to 150 miles an hour in a flash. It is a very unpleasant, distressing disorder that can be extremely hard to manage unless the family gets a diagnosis and follows through very carefully on medication. Medication is the first, second and third best strategy. That is my silly way of saying that medication is just incredibly important.

I’m not sure if there is anything that even comes close to being as helpful as meds, but skill training can be very useful. The skill training must focus on teaching the child to take their meds. Skill training also needs to prepare the child and family to cope effectively with any issues that they may develop about the medication or its side effects as regularly taking medicine as directed is crucial to getting and keeping this youngster stabilized. When the child is unmedicated or missing doses, their manic behavior can quickly get very extreme and inappropriate, even illegal. If you are not a mental health professional and you think you are working with a child who could have this serious disorder, you need to alert your supervisor at once and hopefully you will be able to arrange a thorough evaluation. This disorder typically is found to start when the person is a young adult or older adult but it can occur earlier.




This disorder looks at first to be just like conduct disorder but that is not a very accurate perception. The difference between conduct disorder (C.D.) and oppositional defiant disorder (O.D.D.) may not be readily obvious but it is incredibly important. Treatment for O.D.D. varies dramatically from that offered for conduct disorder. While students with O.D.D. and C.D. typically both misbehave and can be aggressive and non-compliant, the behavior of the student with C.D. is normally far more extreme, frequent and damaging to people, animals and property. While that difference is important, the really important difference is that the child with C.D. lacks a conscience and that is a huge problem. Lacking a conscience, relationship capacity and empathy for others, the student with C.D. can track towards crime and other behaviors that society doesn’t permit.

The student with O.D.D. is believed to have a conscience, but that conscience isn’t doing very much to help. A good conscience can provide very good brakes for bad behavior. Absent that conscience, a child will do what they want, when they want, to who they want. That is precisely what makes children with C.D. so potentially dangerous and so very hard to manage in any environment. Being diagnosed with O.D.D. is far more hopeful than being diagnosed with C.D. as the hope is that if that conscience can be better activated, the student can behave better.

While both sets of students need extensive training to manage their fist, mouth and actions, the student with O.D.D. has a far more optimistic prognosis. The student diagnosed with C.D. will never learn to care about others and is pretty much always going to be reined in using consequences and possibly rewards. The student with O.D.D. can really do very well once their conscience is more dominant and they have mastered how to be a civilized, law-abiding, compliant human. If you are not a mental health professional, be sure to try to arrange a thorough mental health evaluation so you know whether you’re working with an apple or an onion. While these two disorders can look somewhat the same, you have to be very careful to proceed differently depending on which disorder is actually occurring in a student.


trauma informed5. STUDENTS WITH TRAUMA

Unlike the previous items, this issue is not a mental health diagnostic category. However, “trauma-informed” practice has been a prominent concept lately so that combined with the huge frequency of trauma, led me to include this issue here. If you work with kids, you are working with some youngsters who have faced, or are facing traumatic events such as abuse, violence, abandonment or crises. Students facing trauma who are evaluated by a mental health clinician, can receive varying mental health diagnoses (like depression and PTSD, for example), but it is that common thread of trauma that I wanted to address.

Students who are traumatized often have little energy for school or whatever service your site offers. These youngsters need help from a mental health professional but they also need to not face more unnecessary stress in your environment– even when they don’t do much school work, are selectively mute and uninvolved in activities. The key here, regardless of the diagnosis, is to strike a balance between being sensitive to what this child may be living through and your mission. When the child is more functional, increase expectations a bit but if the increase sends the child into a tailspin, then return to the last level where the youngster was successful. When the child is less functional, decrease expectations a bit and work cooperatively to maximize the child’s involvement but without adding to the child’s already heavy load.

Many of your work refusing students are children who are coping with traumatic events. After enduring serious incidents of trauma, children may be diagnosed with PTSD, Post-Traumatic Syndrome Disorder, which is a very concerning diagnosis. These youngsters, in particular, need your site to be a haven, not more misery, so working with these children very carefully and delicately is strongly recommended. Children who have lived through much horror at a young age and lack resilience, are very brittle and easily broken. The bottom line is that you  may be the only sane, sober adult in the child’s universe. If instead of being helpful, you are yet another harmful adult, you can help track the child in the wrong direction. Conversely, if you offer help, empathy, guidance and a moderate, unstressful intervention plan, you can often engineer some progress, albeit slow.


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About Ruth Herman Wells

Author/Trainer Ruth Herman Wells, M.S. is the director of Youth Change Professional Development Workshops. In 2011, Ruth was rated as a Top 10 U.S. K-12 educational and motivational speaker by Speakerwiki and Speakermix. She is the author of several book series, a columnist, adjunct professor for two universities, and a popular keynote speaker and workshop presenter. Ruth's dozens of books includes Temper and Tantrum Tamers and Turn On the Turned-Off Student.