Wiggly
Worried
Weird
Warrior
- Common psychiatric conditions and how they
manifest in the school setting
HIMANSHU AGRAWAL, MD
NORTHWEST COUNSELING AND GUIDANCE CLINIC
Warm up Exercise
1.
2.
Think about a student you know who is seeking
mental health treatment
Think about why he or she is seeking treatment
Scratch these words out
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ADHD
Depression
Anxiety
Oppositional Defiant Disorder
Conduct disorder
Autism
Bipolar
Instead…try one of these
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So that he can get along better with his teachers,
parents, his friends
So that he may have better grades
So that she has fewer tantrums
So that she cries less frequently
So she hits others/herself less often
So that he can get back on the football team again
or enjoy choir more
So that she stops thinking about suicide
The Big 4
ADHD
 Depression
 Anxiety
 Anger
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Exercise
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4 volunteers please!
Signs of ADHD
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INATTENTION
 Careless
mistakes
 Rushes through work
 Procrastinates to finish assignments
 Does the environment but forgets to turn it in
 Loses items (eraser, pencil etc)
 Desk/ Locker is disorganized/messy
 Day dreamer
 Needs to be told the same instruction multiple times
Signs of ADHD
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HYPERACTIVITY AND IMPULSIVITY
 Excessively
talkative
 Constantly fidgeting, constantly ‘on the go’
 Running/ Climbing in inappropriate spaces
 Difficulty doing things quietly
 Difficulty waiting turn
 Blurts
out answers when it is not his or her turn
 Interrupts others
Myths about ADHD
“I was the same way and the all I needed
was a smack on the head !”
http://www.twitvid.com/HUKCH
“He doesn’t seem to have any problems concentrating
on those #$@!! Video games !!!”
“She doesn’t have ADHD, she’s just shy”
“That child shouldn’t be on ADHD medshe’s already a peanut!”
“That child shouldn’t be on ADHD medshe’s already a peanut!”
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Treatment with stimulants in childhood modestly reduced
expected height and weight
These effects attenuate over time
Data suggest that ultimate adult growth parameters are
not affected
Deficits in height and weight do not appear to be a
clinical concern for most children treated with stimulants
Effect of stimulants on height and weight: a review of the literature.Faraone SV, Biederman J, Morley CP, Spencer TJ. J Am Acad Child Adolesc Psychiatry. 2008
Sep;47(9):994-1009.
“Children become addicted to Ritalin if
they take it for ADHD”
“Children become addicted to Ritalin if
they take it for ADHD”
•
The presence of ADHD may influence adolescent
and adult substance-use disorders in different
ways:
•
•
•
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earlier age of onset,
higher frequency,
longer duration of substance abuse and
transition from alcohol-abuse to other substance-use disorders
Attention-deficit/hyperactivity disorder and substance abuse Davids E, Gastpar M
Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD) Ohlmeier MD, Peters
K, Te Wildt BT, Zedler M, Ziegenbein M, Wiese B, Emrich HM, Schneider U.
“Children become addicted to Ritalin if
they take it for ADHD”
•
Children who take medication to treat attention deficit
hyperactivity disorder (ADHD) face no greater risk of future
substance abuse (13 year follow – up)
–
•
Fischer et al, Pediatrics. 2003
Treatment with stimulant drugs may significantly decrease the risk
that girls with ADHD will begin smoking cigarettes or using
alcohol or drugs.
–
Wilens et al, Archives of Pediatrics and Adolescent Medicine Oct 2008.
ADHD- Practical suggestions for the
classroom
DISTRACTIBILITY
 Seat the child away from doors and windows
 Alternate seated activities with those that allow the child to
move his or her body around the room.
 Whenever possible, incorporate physical movement into
lessons
 Write important information down where the child can
easily read and reference it. Remind the student where the
information can be found.
 Divide big assignments into smaller ones, and allow children
frequent breaks.
ADHD- Practical suggestions for the
classroom
IMPULSIVITY (Interruptive Children)
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Develop a “secret language” with the child to let the child
know they are interrupting.
Praise the child for interruption-free conversations.
Write the schedule for the day on the board or on a
piece of paper and cross off each item as it is completed.
When necessary, give consequences immediately
following misbehavior. Be specific in your explanation,
making sure the child knows how they misbehaved
ADHD- Practical suggestions for the
classroom
HYPERACTIVITY (Fidgetiness)
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Ask the child to run an errand or do a task for you, even if it
just means walking across the room to sharpen pencils or
put dishes away.
Encourage the child to play a sport—or at least run around
before and after school.
Provide a stress ball, small toy, or other object for the child
to squeeze or play with discreetly at his or her seat.
Limit screen time in favor of time for movement.
Make sure the child with ADD/ADHD never misses recess
or P.E.
ANXIETY & DEPRESSION
Signs of Depression
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MOOD
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Sad
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Mad
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Loss of pleasure/ interest in activities
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Suicidal thoughts (including self injurious behaviors)
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Excessive risk taking (sense of foreshortened future)
PERSPECTIVE
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Worthlessness (Self derogatory statements)
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Helplessness
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Hopelessness
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Inappropriate guilt
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Errors in Thinking
Signs of Depression
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SLEEP
Too little (insomnia)
 Too much (Hypersomnolence)
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WEIGHT
Loss of appetite and weight
 Excessive weight gain
 Failure to reach appropriate weight for age
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Signs of Depression
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ENERGY
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CONCENTRATION
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Fatigue
Social Isolation
Psychomotor agitation (clenched fists et al!)
Especially if this is a shift from baseline
Sudden drop in grades
VAGUE PHYSICAL COMPLAINTS
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Headaches
Stomachaches
Joints, back etc.
Depression- Practical suggestions for the
classroom
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Try and ask frequent questions about friends and family to
show empathy and compassion.
Try and accommodate tardiness and absences from school by
providing study guides and make up work.
Discourage bullying, teasing, and other undesirable behavior.
Create a peace corner or safe area for a depressed student
when his or her feelings erupt or become overwhelming.
Try and break larger project into more manageable pieces for
the student who has low energy.
Provide an outlet for the child to express his or her feelings,
such as a writing journal or an online diary.
ANXIETY
Bucket loads instead of spoonfuls!
Signs of Anxiety
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EXCESSIVE WORRIES
Multiple themes- safety, health, futures, career, taxes!!
 Perfectionist, inconsolable
 Strange Rituals
 Irritability
 Frequent headaches, stomachaches etc – ‘Worry self sick’
 ‘Shy bladder’
 Panic attacks
 Dissociation (zoning out/ going into trances)
 Get startled easily
 Nightmares
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Anxiety- Practical suggestions for the
classroom
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Classroom seating should be away from classmates who are
loud or misbehave
If a large group activity is anticipated, warn the child ahead
of time.
If a change in routine is anticipated (e.g. substitute teacher),
warn the child ahead of time.
Always ask the child ahead of time if it is okay to call on them
to participate, and tell her what she might expect during the
activity.
When anxious children are absent from school, they may be
very distressed about the work they have missed. Assign a
study buddy to copy notes and share handouts
Anxiety- Practical suggestions for the
classroom
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Instead of class presentations, give the child the
option of presenting just to the teacher, or
audio/video taping the presentation at home.
Consider “lunch bunches” of 2-3 kids so they can
create shared experiences. Don’t always allow
children to choose their own group.
Mistakes are OK, sometimes even encouraged and
celebrated!
Systematic desensitization(Baby steps!)
Anger
Anger
Anger
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Atypical Antipsychotics
Clonidine and Tenex
Lithium
Anti- Seizure medications
If treatment is working…
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Calmer, less disruption , fewer outbursts
Improved concentration, restlessness
Improvement in irritability, behavioral problems
Better Grades
Fewer Time Outs
Social Stundedness
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Autism Spectrum
Abuse/ Trauma
Schizophrenia
The Big 4
ADHD
 Depression
 Anxiety
 Anger
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Thanks
himanshua@nwpltd.org