1 Welcome to Parent and Teachers as Allies Presented by NAMI The National Alliance on Mental Illness Cynthia K. Adair March 28, 2013.

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Welcome to Welcome to Parent and Parent and

Teachers as AlliesTeachers as Allies

Presented by NAMIPresented by NAMIThe National Alliance onThe National Alliance on

Mental IllnessMental Illness

Cynthia K. AdairCynthia K. AdairMarch 28, 2013March 28, 2013

Welcome to Welcome to Parent and Parent and

Teachers as AlliesTeachers as Allies

Presented by NAMIPresented by NAMIThe National Alliance onThe National Alliance on

Mental IllnessMental Illness

Cynthia K. AdairCynthia K. AdairMarch 28, 2013March 28, 2013

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Parents and Teachers Parents and Teachers as Alliesas Allies

Recognizing Early-onset Mental Illness in Recognizing Early-onset Mental Illness in Children and AdolescentsChildren and Adolescents

““It may be that nature in its wisdom It may be that nature in its wisdom has singled out these two primary has singled out these two primary

custodial human networks for the job of custodial human networks for the job of identifying children at risk, knowing identifying children at risk, knowing that the vigilant eye of parents and that the vigilant eye of parents and teachers will sound the first alarm teachers will sound the first alarm

when a child fails to thrive”when a child fails to thrive”

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Today’s SituationToday’s SituationToday’s SituationToday’s Situation 12 % of children in USA 12 % of children in USA

under 18 have a under 18 have a diagnosable mental diagnosable mental illness. (2001, Surgeon illness. (2001, Surgeon General)General)

Parents and teachers can Parents and teachers can be overwhelmed by be overwhelmed by child's mental illness. child's mental illness.

50% of adult cases of 50% of adult cases of mental illness had signs mental illness had signs and symptoms by age 14and symptoms by age 14

Three quarters have Three quarters have begun by age 24begun by age 24

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Today’s SituationToday’s SituationToday’s SituationToday’s Situation Left untreated these Left untreated these

disorders can lead to disorders can lead to a more severe, more a more severe, more difficult to treat difficult to treat illness.illness.

Serious lack of Serious lack of resources for children resources for children with mental illness.with mental illness.

Parents and teachers Parents and teachers are frontline allies in are frontline allies in the battle against the battle against long-term devastation.long-term devastation.

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How did we get here?How did we get here?How did we get here?How did we get here?

Historically Historically doctors did not doctors did not diagnose early in diagnose early in childrenchildren

Mental illness was Mental illness was linked to poor linked to poor parenting parenting

Belief was they are Belief was they are just “bad kids”just “bad kids”

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Learning and Working Learning and Working TogetherTogether as Allies as Allies

ObjectivesObjectives

Develop a basic concept of Develop a basic concept of psychiatric disorderspsychiatric disorders

Address the challenges of teaching a Address the challenges of teaching a special needs childspecial needs child

Identify ways teachers, counselors, Identify ways teachers, counselors, nurses and other school personnel nurses and other school personnel can improve success for students can improve success for students with psychological disorderswith psychological disorders

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Is it all in Their Head?Is it all in Their Head? Mental Illnesses are Mental Illnesses are Neurobiological Brain Neurobiological Brain

DisordersDisorders caused by chemical imbalances in caused by chemical imbalances in the brain. They’re medical illnesses just as the brain. They’re medical illnesses just as credible as diabetes, cancer or heart disease.credible as diabetes, cancer or heart disease.

Brain disorders can usually be controlled Brain disorders can usually be controlled using medications, therapy, support groups, using medications, therapy, support groups, family and classroom understanding.family and classroom understanding.

2/3 of youth with mental illness do not receive 2/3 of youth with mental illness do not receive treatmenttreatment

Of the 100,000 teens in detention, about 60% Of the 100,000 teens in detention, about 60% have behavioral, cognitive, or emotional have behavioral, cognitive, or emotional problemsproblems

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Why is Mental Illness Why is Mental Illness Difficult to Diagnose?Difficult to Diagnose?

Mental illness in youth is a “moving Mental illness in youth is a “moving target”target”

Especially with children, defining Especially with children, defining what is “normal” or typical for each what is “normal” or typical for each childchild

Hard to differentiate between willful Hard to differentiate between willful behavior and symptomsbehavior and symptoms

No conclusive blood tests or x-raysNo conclusive blood tests or x-rays Mental Illness is an inexact scienceMental Illness is an inexact science

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The early warning signs of The early warning signs of childhood and adolescent childhood and adolescent

mental illnessmental illness

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ADHDADHD

HyperactivityHyperactivity Fidgets and squirmsFidgets and squirms Can’t still for longCan’t still for long Inappropriate running Inappropriate running

or climbingor climbing Constantly “on the Constantly “on the

go”go” Has trouble playing Has trouble playing

quietlyquietly Talks excessivelyTalks excessively RestlessRestless

ImpulsivityImpulsivity Blurts out information Blurts out information

inappropriatelyinappropriately Has trouble waiting Has trouble waiting

his/her turnhis/her turn Interrupts when Interrupts when

others are speakingothers are speaking Intrudes upon othersIntrudes upon others Creates problems Creates problems

with other children in with other children in school and at playschool and at play

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ADHDADHDInattentive TypeInattentive Type Can’t pay attention to Can’t pay attention to

details, often caught details, often caught daydreamingdaydreaming

Avoids, dislike or Avoids, dislike or reluctant to engage in reluctant to engage in activities that require activities that require sustained attentionsustained attention

Highly distractible, Highly distractible, forgetful, absent- forgetful, absent- minded, careless, minded, careless, disorganizeddisorganized

Often do not finish Often do not finish school workschool work

Don’t listen to or follow Don’t listen to or follow through on instructionthrough on instruction

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Observations from HomeObservations from HomeObservations from HomeObservations from Home

Something “off” Something “off” from the from the beginningbeginning

Never slows down, Never slows down, or conversely, or conversely, “clueless” with “clueless” with “head in the “head in the clouds”clouds”

Exhausting & Exhausting & demandingdemanding

Always in troubleAlways in trouble

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Oppositional Defiant Oppositional Defiant DisorderDisorder

Conduct Disorder in Conduct Disorder in AdolescenceAdolescence

Oppositional Defiant Oppositional Defiant DisorderDisorder

Conduct Disorder in Conduct Disorder in AdolescenceAdolescence Negative, hostile, defiant behavior; Negative, hostile, defiant behavior;

will not comply with requestswill not comply with requests Persistent arguing with adultsPersistent arguing with adults Intense rigidity and inflexibilityIntense rigidity and inflexibility Touchy, resentful, spiteful Touchy, resentful, spiteful Aggression and cruelty towards Aggression and cruelty towards people and animals, bullying with people and animals, bullying with bats etc.bats etc. DestructiveDestructive DeceitfulDeceitful Lack of remorseLack of remorse Truancy, running away from homeTruancy, running away from home

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Observations from HomeObservations from HomeObservations from HomeObservations from Home

get angry with the child who won’t obey or get angry with the child who won’t obey or cooperatecooperate

shocked & embarrassed by their behaviorsshocked & embarrassed by their behaviors worry about danger to other siblingsworry about danger to other siblings overwhelmed by criticism from family & overwhelmed by criticism from family &

friendsfriends many suspensions add to the burden at many suspensions add to the burden at

homehome can’t take their child anywherecan’t take their child anywhere

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Major DepressionMajor DepressionMajor DepressionMajor Depression Feeling mad, sullenFeeling mad, sullen AnxietyAnxiety Negative self Negative self

judgmentjudgment HypersensitiveHypersensitive Withdraw Withdraw Lethargic, Lethargic,

apathetic, apathetic, dispiriteddispirited

Irritable, Irritable, aggressive, aggressive, combativecombative

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Observations from HomeObservations from HomeObservations from HomeObservations from Home

Nothing pleases themNothing pleases them

Admit this child is no fun & hard to Admit this child is no fun & hard to likelike

They have a “totally different kid”They have a “totally different kid”

Displays worst symptoms at homeDisplays worst symptoms at home

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Early-onset Bipolar Early-onset Bipolar DisorderDisorder

(Manic-depression)(Manic-depression)

Early-onset Bipolar Early-onset Bipolar DisorderDisorder

(Manic-depression)(Manic-depression)

Overreaction and irritableOverreaction and irritable Rage and anger controlled in schoolRage and anger controlled in school Multiple mood shifts (angel/devil)Multiple mood shifts (angel/devil) Hyperactivity/decrease need for sleepHyperactivity/decrease need for sleep Hypersexual behaviorsHypersexual behaviors Psychotic episode may be reportedPsychotic episode may be reported

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Observations from HomeObservations from HomeObservations from HomeObservations from Home

Ragged sleep cycles Ragged sleep cycles – night terrors– night terrors

Violent rages – Violent rages – tantrumstantrums

Severe separation Severe separation anxiety/refusing to anxiety/refusing to go togo to

schoolschool Child acts worse at Child acts worse at

home than schoolhome than school

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Anxiety DisordersAnxiety DisordersAnxiety DisordersAnxiety Disorders SEPARATION ANXIETYSEPARATION ANXIETY (childhood version of panic) (childhood version of panic)

Intense anxiety being separated from parentsIntense anxiety being separated from parents Worry parents will die/cling to parents Worry parents will die/cling to parents Refusal to sleep alone/ will not go on sleep- over’sRefusal to sleep alone/ will not go on sleep- over’s Claims sickness to avoid going to schoolClaims sickness to avoid going to school

OVER ANXIOUS DISORDEROVER ANXIOUS DISORDER (childhood version of (childhood version of GAD)GAD)

Excessive worry – school, how they look, their standing Excessive worry – school, how they look, their standing with friendswith friends

Dread they will do things wrong/ perfectionistDread they will do things wrong/ perfectionist AVOIDANT DISORDERAVOIDANT DISORDER (Childhood version of Social (Childhood version of Social

Phobia)Phobia) Acute shyness in social situationsAcute shyness in social situations Restriction of social contacts exclusively to close family Restriction of social contacts exclusively to close family

membersmembers

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Observations from HomeObservations from HomeObservations from HomeObservations from Home

Repeated absences Repeated absences from schoolfrom school

““Meltdowns” when Meltdowns” when parents try to force parents try to force activities which activities which generategenerate

anxietyanxiety Parent feels “catch Parent feels “catch

22”accomodating 22”accomodating anxious behavioranxious behavior

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Obsessive Compulsive Obsessive Compulsive DisorderDisorder

Obsessive Compulsive Obsessive Compulsive DisorderDisorder

ObsessionsObsessions Fear of contamination Fear of contamination

– germs– germs Fixation on numbers – Fixation on numbers –

wordswords Excessive doubtsExcessive doubts

CompulsionsCompulsions Rituals (hand washing, Rituals (hand washing,

grooming, cleaning)grooming, cleaning) Repetitive counting, Repetitive counting,

touching, writingtouching, writing Continuous checking, Continuous checking,

questioning, collectingquestioning, collecting

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Observations from HomeObservations from HomeObservations from HomeObservations from Home

Parents report they must cooperate with Parents report they must cooperate with compulsive rituals to placate the child compulsive rituals to placate the child and avoid confrontations and tantrumsand avoid confrontations and tantrums

Bewildered and angry at the child’s Bewildered and angry at the child’s inability to control irrational behaviorsinability to control irrational behaviors

Rituals swamp home life but are more Rituals swamp home life but are more subdued in publicsubdued in public

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SchizophreniaSchizophrenia

Marked by delusions & Marked by delusions & hallucinationshallucinations

Withdrawal/anxious/disruptiveWithdrawal/anxious/disruptive Inappropriate expression of emotionInappropriate expression of emotion Rarely seen before age 14Rarely seen before age 14

1 in 40,0001 in 40,000 Between ages 15 to 19Between ages 15 to 19

1 in 1001 in 100

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Observations from HomeObservations from Home

Child reports Child reports hearing voiceshearing voices

Child stares at Child stares at things not therethings not there

Worries, child Worries, child shows no interest in shows no interest in friendsfriends

Child appears Child appears “blank” all the time; “blank” all the time; little or no emotionlittle or no emotion

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A WORD ABOUT MEDICATION & A WORD ABOUT MEDICATION & YOUTHYOUTH

Medication and/or other pharmacological Medication and/or other pharmacological interventions are utilized at times to treat interventions are utilized at times to treat adults and children with mental illness. adults and children with mental illness.

Because children and youth are in such rapid Because children and youth are in such rapid phases of development, physiological changes phases of development, physiological changes

can occur rapidlycan occur rapidly. . It is It is criticalcritical for for teachers teachers and other school personnel to report changes and other school personnel to report changes in behavior and side effects that they observe in behavior and side effects that they observe

as soon as possible to parents so that they, as soon as possible to parents so that they, along with their child’s doctor, can evaluate if along with their child’s doctor, can evaluate if the current treatment is the best option for the current treatment is the best option for

the child at that time.the child at that time.

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Families Dealing with Mental Families Dealing with Mental Illness Illness

Families get the worst of it!Families get the worst of it!

Coming through the Predictable Stages Coming through the Predictable Stages of Emotional Reactionsof Emotional Reactions

Families Dealing with Mental Families Dealing with Mental Illness Illness

Families get the worst of it!Families get the worst of it!

Coming through the Predictable Stages Coming through the Predictable Stages of Emotional Reactionsof Emotional Reactions

Dealing with a catastrophic eventDealing with a catastrophic event Learning to cope: Going through the millLearning to cope: Going through the mill Moving into advocacyMoving into advocacy

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I. Dealing with I. Dealing with Catastrophic EventsCatastrophic Events

I. Dealing with I. Dealing with Catastrophic EventsCatastrophic Events

Crisis / ShockCrisis / ShockFeeling Feeling

overwhelmed, overwhelmed, dazeddazed

DenialDenial Protective Protective

responseresponse Normalize what Normalize what

is going onis going on Hoping-against-hopeHoping-against-hope

Dawning of Dawning of RecognitionRecognition

Hoping life will go Hoping life will go back to normalback to normal

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Stage I.Stage I.Stage I.Stage I.

NEEDS:NEEDS: SupportSupport ComfortComfort EmpathyEmpathy Help finding resourcesHelp finding resources Early interventionEarly intervention PrognosisPrognosis NAMINAMI

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II.II. Learning to CopeLearning to Cope“Going through the Mill”“Going through the Mill”

II.II. Learning to CopeLearning to Cope“Going through the Mill”“Going through the Mill”

Anger/Guilt/ResentmentAnger/Guilt/Resentment Blame the victimBlame the victim Child should snap out Child should snap out

of it!of it! Fear that it is our Fear that it is our

fault, Self-blamefault, Self-blame RecognitionRecognition

Mental illness Mental illness becomes reality in becomes reality in our livesour lives

Know it will change Know it will change life as we know itlife as we know it

GriefGrief TragedyTragedy Uncertain futureUncertain future SadnessSadness

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Stage IIStage IIStage IIStage II

NEEDS:NEEDS: Vent feelingsVent feelings Keep hopeKeep hope EducationEducation Self-CareSelf-Care NetworkingNetworking Skill trainingSkill training Letting GoLetting Go Co-operation from systemCo-operation from system NAMINAMI

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III. Moving into III. Moving into AdvocacyAdvocacy

III. Moving into III. Moving into AdvocacyAdvocacy

UnderstandingUnderstanding Gain sense of child’s Gain sense of child’s

sufferingsuffering Respect for courage Respect for courage

to cope with illnessto cope with illness AcceptanceAcceptance

Bad things do happen Bad things do happen to good peopleto good people

Nobody’s faultNobody’s fault We will hang in and We will hang in and

managemanage Advocacy / ActionAdvocacy / Action

Focus anger and grief Focus anger and grief towards advocacytowards advocacy

Fight discriminationFight discrimination Get involvedGet involved

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Stage III.Stage III.Stage III.Stage III.

NEEDS:NEEDS:Restore balance in lifeRestore balance in lifeResponsiveness from systemResponsiveness from systemActivismActivismNAMINAMI

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Living with Living with mental illness as mental illness as

a childa child

Personal Personal observationsobservations

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Downside of Living with Downside of Living with Mental Illness….Mental Illness….

Social Social Stigma/IgnoranceStigma/Ignorance

Medication Side Medication Side EffectsEffects

BullyingBullying

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How Can How Can YouYou help? help? How Can How Can YouYou help? help?

De-stigmatize mental illness. De-stigmatize mental illness.

Compare Brain disorders to other Compare Brain disorders to other childhood physical illnesses like juvenile childhood physical illnesses like juvenile diabetes and epilepsydiabetes and epilepsy

Recognize that treatment is highly effectiveRecognize that treatment is highly effective

Emphasize better research is underway to Emphasize better research is underway to ensure safe, appropriate medications for ensure safe, appropriate medications for children.children.

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What You Can DoWhat You Can Do Implement Implement

accommodations in class accommodations in class setting (some are very setting (some are very simple)simple)

Listen carefully to what Listen carefully to what the parents & children are the parents & children are sayingsaying

Remove feelings of blameRemove feelings of blame Acknowledge denial and Acknowledge denial and

anger as ‘normal’ anger as ‘normal’ responsesresponses

Communicate empathy Communicate empathy and compassion for the and compassion for the parents dilemmaparents dilemma

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Let Parents Know…Let Parents Know…Let Parents Know…Let Parents Know… De-stigmatize mental De-stigmatize mental

illnessillness Emphasize early Emphasize early

intervention and treatment intervention and treatment are essential treatment are essential treatment steps for their childsteps for their child

Be particularly sensitive to Be particularly sensitive to parents with special needsparents with special needs

Provide parents with Provide parents with resources: knowledge resources: knowledge about the illnesses is the about the illnesses is the keykey

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How you can help the child cope How you can help the child cope with some of the side effects of the with some of the side effects of the

medicationsmedicationsWATER BOTTLE AT DESKWATER BOTTLE AT DESK(Dry Mouth)(Dry Mouth)

AUTOMATIC BATHROOM PASS/ OR SIGNAL AUTOMATIC BATHROOM PASS/ OR SIGNAL (Diarrhea/Frequent Urination)(Diarrhea/Frequent Urination)

DESIGNATED SAFE PLACE TO GO TODESIGNATED SAFE PLACE TO GO TO(Crying Spells and Emotional Meltdowns)(Crying Spells and Emotional Meltdowns)

SCHEDULE CORE ACADEMIC CLASSES LATER IN DAYSCHEDULE CORE ACADEMIC CLASSES LATER IN DAY(Difficulty getting up in the morning)(Difficulty getting up in the morning)

BE SENSITIVE TO WEIGHT FLUCTATION (+ AND -) BE SENSITIVE TO WEIGHT FLUCTATION (+ AND -) (criticism from other children)(criticism from other children)

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NAMI Can Assist…..NAMI Can Assist…..NAMI Can Assist…..NAMI Can Assist….. Provide parents with Provide parents with

resources:resources:

Education is key to Education is key to understandingunderstanding

Offer Parents and Offer Parents and Teachers as Allies Teachers as Allies booklet.booklet.

Encourage them to Encourage them to contact NAMI for:contact NAMI for:

ReferralsReferrals Support groupsSupport groups Education classesEducation classes

Urge them to seek Urge them to seek support for themselvessupport for themselves

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Insert Local Resources on this slideInsert Local Resources on this slide

NAMI – Oklahoma4200 Perimeter Circle Drive, Suite 150Oklahoma City, Ok 73112Office: 405-5230-1900Fax: 405-230-1903

NAMI.org

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Thank YouThank YouThank YouThank You

Special Thanks toSpecial Thanks to

•List and any all partners in making this List and any all partners in making this presentations possiblepresentations possible

•Provide Contact information for the Provide Contact information for the NAMI Affiliate and NAMI State NAMI Affiliate and NAMI State OrganizationOrganization