The Top 4 Student Mental Health Issues
Must-Have Tips on What to Do– and What Not Do
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The Top 4 Student Mental Health Issues
Must-Have Tips on What to Do– and What Not Do
It's really amazing how more and more students seem to have serious mental health issues compared to as little as 15 or 20 years ago. With no disrespect intended, I am often surprised when I speak at school, juvenile justice, foster parent, counseling, social work and mental health conferences at how many common juvenile mental health diagnoses are either misunderstood or unfamiliar to the participants.
Hello from Youth Change Professional Development Workshops director, Ruth Herman Wells. That's me in the image on the right, speaking at a large education conference in Florida in early 2017. Often, when I try to explain a commonly misunderstood diagnosis, I almost get booed out of the building. Okay, that was an exaggeration but once at a Texas conference of several thousand, it did take a while until I got the group to settle down and listen. Then the room got really quiet as they realized that many of them had misunderstood some key diagnostic labels. I'm no diagnostic expert but I do know my basics really well and when you get done reading this, you will hopefully have a better grasp of some of the basics too if you don’t already.
WHY DIAGNOSTIC CATEGORIES ARE IMPORTANT
If you lack the ability to understand, refine and label what you are seeing, you are going to be far less effective. That’s why Eskimos apparently have many names for different types of snow. Understanding the snow differences might be important for travel, sport, fishing, hunting, and so on. Similarly, if you just see acting-out students, and sad kids, and angry kids but can’t refine beyond those rather global discriminations, that makes it much harder for you to intervene correctly, intervene using the correct strategies, communicate to others, explain to parents, or help locate the right mental health counselor, family therapist, psychologist, social worker or doctor, for example. But, the bottom line is that you simply won’t be as effective helping your emotionally disturbed and troubled students. There is a laundry list of woes that result when you don’t know your basic diagnostic categories for juveniles. One big risk: You can do great harm. The other big risk: You are much more likely to miss key opportunities to prevent or best manage serious or worsening issues like self-harm, self-endangering, acting out and law violations from occurring.
THE INFORMATION HERE IS JUST APPETIZERS
I can’t cram a semester’s worth of Juvenile Mental Health Diagnostic Categories 101 into this short article so I am going to give you just the starting point. Your homework is to go deeper than the headlines I am going to be able to give here. I will be giving you a quick description of the problems typically associated each diagnosis, and a quick description of the key issues you must be aware of. It will be your job to get the full picture yourself from a reputable source and not attempt to get by on the condensed information in this introductory article. We have hundreds of easy-to-read articles on tailoring your strategies to fit students' mental health issues. Find them in our How-To Articles Archive. If you haven’t already familiarized yourself with the Diagnostic Statistical Manual (DSM), that is the bible of mental health diagnosing, I urge you to take time to do that for at least the 4 diagnostic categories I am about to give you. They are, in my opinion, the top diagnoses for juveniles in our contemporary time. As a mental health professional, I know how important it is that absolutely every teacher, school counselor, juvenile court worker, foster parent, social worker and principal be familiar with these mental health designations.
THE TOP 4 JUVENILE MENTAL HEALTH DIAGNOSIS
Here are some of the most common, most unfamiliar and misunderstood juvenile mental health issues that appear to be on the rise, occurring in larger numbers than perhaps ever before. As a non-mental health professional, you can't diagnose, but you can carry the concern in your mind and make adjustments accordingly. You already do that with other common juvenile mental health diagnoses like ADD, ADHD and depression. However, while those diagnoses are pretty widely understood, and useful, targeted strategies are well documented, the common disorders below are not as well known and are quite frequently misunderstood.
1. Conduct Disorder
This is your most misbehaved student. The student is usually male and you can see some or all of the following behaviors, however this list is not complete: manipulation, lying, stealing, damage to people, damage to property, no relationship capacity, no genuine remorse, no compassion, abusing animals, delinquency, rule violations, defiance, negative leadership, chameleon-like, persuasive, bullies. The hallmark of this disorder is that the child is believed to have no conscience. Without those critical brakes on the youngster's behavior, this student can appear completely out of control. And he is.
This disorder is believed to occur with roughly 11-14% of the mainstream population. When the child becomes an adult, the disorder's name is normally shifted to be the adult version of this juvenile diagnosis, switching to a designation such as Anti-Social Disorder. Some passable, but not ideal examples from popular culture: J.R. Ewing from the TV show, Dallas; McCauley Culkin in The Good Son movie; Sid, the boy dismembering toys in the Toy Story movie.
Here is the most important thing to know: Routine, everyday, common intervention strategies –like making amends, for example– fail to rein in this very unmanageable student. That is why in my inservice workshops, teachers and others often underscore that "nothing works" to manage this student. If you believe you are working with a child with this disorder, you must switch to a different style of intervention and avoid or extremely limit relationship-based approaches as not only do these methods fail badly, they usually make the situation worse. In addition, the use of counter-indicated intervention strategies often lead the student to believe that the adult doesn't have a clue so they can just do whatever they want. This assessment is certain to create and/or worsen safety and behavior management issues.
Learn more about this common juvenile mental health diagnosis.
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2. Oppositional Defiant Disorder
Non-mental health professionals often confuse Conduct Disorder with Oppositional Defiant Disorder, abbreviated as ODD. To the lay person, ODD can seem to be very similar to Conduct Disorder. This youngster does engage in problem acting-out behavior but the frequency, severity and duration of the misconduct is usually less than that seen from a student with Conduct Disorder. The overarching, key difference, however, is that the student with ODD does have a conscience but that conscience doesn't appear to be having much positive impact. The key with this youngster is to "pull up" that conscience and get it to do its job better. That goal varies dramatically from the goal for working with students with Conduct Disorder. However, both students need to learn step-by-step to use more socially acceptable behavior, temper any rebelliousness and impulsiveness, and avoid leading or following other students into misconduct. Both types of students need firm rules and over-the-top consequences.
It is important to be aware that mental health counselors, social workers and other clinicians are hesitant to apply the diagnosis of Conduct Disorder as it has such grave implications for the child's future. So often the diagnostician waits until the students' behavior is so extreme that they feel comfortable and confident that they must apply that diagnosis. In the meantime, they may still be required to offer a diagnosis. Since there is no category of "I'm worried this kid may have Conduct Disorder," diagnosticians often "park" the child in a catch-all category. The most popular catch-all category: ODD. So, quite often students initially labeled with ODD are really kids with Conduct Disorder who just haven't acted out enough to "earn" the diagnosis. Sadly, this tendency to "park" youngsters confuses teachers and others who believe the "temporary" diagnosis. So what do you do under these circumstances? Use the methods for Conduct Disorders but don't completely cut off relationship-based methods. However, use just a little bit of relationship-based methods and watch what happens. If the outcome is often grim, consider reducing the use of that class of intervention strategy dramatically as using relationship-based behavior management strategies with students who are actually Conduct Disordered, tends to fail spectacularly.
3. Thought Disorder
Although this is not a terribly common disorder, it is frequently misunderstood. Affecting about 1% of mainstream students, this disorder means that the student sees things no one else can see, hears voices no one else can hear, or has upsetting thoughts that are profoundly disturbing. An extreme, but good example is John Hinckley, who attempted to kill Ronald Reagan to impress Jodie Foster. Children and teens with thought disorder have trouble discerning what is real and what is only in their brain. The most important intervention is to have a mental health professional assess the child and possibly prescribe medicine that can control the disorder. This child has a conscience but her brain is not working right. This mental health problem is primarily a physiological issue although clearly the child's behavior and functioning is gravely affected.
4. Bipolar Disorder
Bipolar Disorder used to be called Manic-Depression. That term was really a big help to aid non-mental health staff to remember what this disorder is all about. This disorder has two parts. The child swings rapidly at random intervals from being very depressed to being very excited and overwrought. This child also has a conscience, but they get so "up" when they swing quickly from being depressed to over-excited, that they can impulsively engage in all manner of problem behaviors. As with the child with thought disorder, medicine is the key. This is also a physiologically-based disorder even though it affects every aspect of the students' life.