Eden Prairie School District
Handouts available at
www.drstevekahn.com
An alternative way to think about mental
health problems
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Spectrum
Students without diagnoses have needs also
At what point does the diagnosis appear?
The necessity of a diagnosis for payment
The person does not become the diagnosis
Two people with same diagnosis are more
different from each other than the same
Are there advantages to the diagnosis?
• Yes, if there is a medicine that helps
• Yes, if there is a treatment plan that helps
• Yes, if the parents change how they are
parenting that may have caused or
exacerbated the problem in the first place
• Yes, if there is a genuine need for school
accommodations
At what point does the diagnosis appear?
• Frequently occurring diagnoses that
affect behavior and learning at school
• Oppositional Deficit Disorder
• Attention Deficit Disorder
• Depression
• Anxiety
• Narcissistic Personality Disorder
• Obsessive Compulsive Disorder
Oppositional Defiant Disorder
• At what point does the diagnosis appear?
• Temper control, anger management problems
• Argumentative, defiant, refuses to comply
with rules
• Deliberately annoys people, angry or
resentful, spiteful or vindictive
• Blames others for their mistakes or
misbehavior, touchy or easily annoyed
Attention Deficit Disorder
• At what point does the diagnosis appear?
• Inattentive, difficulty sustaining attention, careless
mistakes, organization problems
• Does not listen when spoken to directly, follow
through problems, task completion
• Loses things, distracted, forgetful, difficulty engaging
in leisure activities quietly
• Hyperactive-impulsivity type, runs or climbs
excessively, fidgets, squirms
• On the go as if driven by a motor, talks excessively
Major Depression
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At what point does the diagnosis appear?
Depressed mood, irritable, feels sad or empty
Diminished interest or pleasure in daily activities
Decrease or increase in appetite, weight loss or gain
Fatigue, loss of energy, sleep disturbance, feelings of
worthlessness or excessive guilt
• Diminished ability to think or concentrate
• Inability to get over routine events of childhood
(friendship issues)
Generalized Anxiety Disorder
• At what point does the diagnosis appear?
• Palpitations, pounding heart, sweating,
trembling, shaking
• Shortness of breath, smothering feeling, dizzy,
lightheaded, faint
• Feeling of choking, chest pain or discomfort
Narcissistic Personality Disorder
• At what point does the diagnosis appear?
• Grandiose sense of self-importance
• Expects to be recognized as superior without
achievement
• Believes he or she is special, requires
excessive admiration
• Sense of entitlement, lacks empathy, arrogant
or haughty behavior, envious of others
Obsessive Compulsive Disorder
• At what point does the diagnosis appear?
• Preoccupied with details, rules, lists, order,
organization, schedules, perfectionism
• Excessively devoted to work and productivity to
detriment of social life
• Over-conscientious, scrupulous, inflexible about
ethics, morals, etc.
• Hoards stuff, unable to throw things out
• Reluctant to delegate, doesn’t do group work well
Goals for today
• Use six diagnoses to recommend strategies
• Strategies helpful for students struggling with
similar problems but not severe enough to
reach criteria or not yet diagnosed
• Some strategies may also pertain to our roles
as coaches, disciplinarians, administrators
• The idea of K-12 teachers as a community of
adults with a combined impact on students
• Most needed for students with weak parents
Thirteen Years of Healthy Adults
• Perhaps 15-20% of students are living in less
than ideal family situations
• For these students to avoid mental health
problems will depend on the adults they come
to know outside the family
• Only some of the 20% will receive treatment
• And even fewer of those will have parents
who receive treatment
Realistic Expectations for Teachers
• Not responsible for treating the mental health
condition
• A teacher can only be asked to be responsible for his
or her own actions and reactions to the student
• Resist taking on too large a sense of responsibility
• At times a teacher may feel unrealistic pressure from
inside or from peers or supervisors
• Focus on what you say, how you look and how you
sound. Who you are when they ….
Maintaining standards versus
lowering the bar
• Default positions should be:
• Students are held accountable to your
classroom behavioral expectations
• Students are given the grades they earned
• “Goes without saying”
• And if there is an accommodation plan, follow
it rather than question it
• Even if you doubt whether it is helpful
External Events and Internal Feelings
• Similar scenarios in classrooms, lunchrooms,
recess, gym class
• Can lead to….
• Variation in how teachers or administrators
feel and act
• Sounds like fluff until we talk about keeping
our focus on us every minute of every day
Extra stress and demands from
certain students
• Students as external events
• Our response to the challenges they place
before us
• How we feel when they….
• What we do when they….
• Thoughts precede feelings
• Viewing skills
External Events in Other Professions
• Psychology: Clients all have mental health
diagnoses
• Truck drivers: Have to deal with traffic
• Physicians: Patients with serious medical
conditions
• And the most horrible external event of all:
• Dentists: Other people’s mouths!
Advice to “Pay Forward”
• The next few slides are worded so that they
can be used in emails, phone calls with
parents and conferences
• The advice is also for all adults who work with
and care about children
• The word adult can be replaced with
“teacher,” “parent,” “recess supervisor,” etc.
Honoring sovereignty
• Start where they are at
• Avoid comparisons to peers and benchmarks
• The more often a mistake is made (perhaps) the
more important the learning may be
• Maybe that is why the mistake needs to be
repeated for 6, 12, 18 months!
• Growth takes time, patience is required
Protect the connection
• Forgive instantly, before responding
• Treat them better than they deserve
• When they are acting their age, the adult should be
careful not to act the child’s age
• Adults need to be the best adult they can be,
especially when the children are not at their best
• Adults resist racing children to the basement
• The richest times to protect the connection are the
times when they are challenging
I’d like to be able to do this. What
drugs would I need to be on? (ha ha)
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Thoughts precede feelings
Thoughts and feelings precede behavior
External events
External events do not cause internal feelings
Options to how adults respond to the external
events children present to them
• Standard of behavior for us is higher
• Often expect children to control themselves
Act insightfully (and learn from the
times you don’t)
• Keep a journal. Look for the times when you are not
able to find what to teach
• Those are the times that will teach you about your
blind spots
• Pay more attention to what you give them, rather
than what they give to you
• Keep eye on the imaginary mirror behind the child
• Be who we want them to become
• Teaching how to deal with unwanted events
When Parents are the External Event
• Parents who think you only have one student
• Parents who think their child is gifted/talented
• Parents who want to intervene on their child’s
friendship issues
• Parents who act like they are your supervisor
• Bumping into parental denial about limits
We Can Only Do Our Part
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Imaginary mirror
Accept that students will do whatever they do
Focus on our responses
Not so much what they do, but what we do next.
Resist taking on too big a role
This can come from overzealousness when we
know children who are hurting and are not being
helped enough by their parents at home
Terminology
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Accept
Allow
Forgive
Honor
Protect
Celebrate
Terms sound as if we won’t hold them
accountable but we do
Goals: What we do when they
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Focus on the dotted line
Where they end and where we begin
Honor sovereignty
Discipline with reassurance
Celebrate mistakes and disappointments
Protect the connection
Forgive instantly
Presenting our lives as role models
Why This is Hard
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Not external event that causes internal feeling
Hard to “see” the event clearly
Low tolerance for conflict
Need to be accepted or understood
“Over-psychologizing”
Projecting linearly
Sizing
Invisible rulebooks
Inaccurately inserting intent
Hard for us?
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Probably harder for the parent
Not in your job description to teach parents
And their need is great
Few of them ever seek help until it is very late
Phone calls and emails
Parent-teacher conferences
Forward information re: children and parenting
A Few Examples of Things Teachers May
Know That Parents May Not Know
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Developmental realities of their child’s age
Enabling does not foster resilience
Intrusive parenting leads to underachievement
Fading the prompt
A child should get the grade the child earns
Better to get poor grades out of the way before H.S.
Drawbacks of projecting linearly and inserting intent
Better to handle it well even if later
Parents can allow temporary victories
Prevention of Mental Health Problems
in Children and Adolescents
• Reducing the severity of symptoms
• Improving the efficacy of treatment plans
• A slight oversimplification
• If nature, then medicine
• If nurture, then parenting
What are we up against?
• Some parents seem to think:
• Parenting is getting to team’s practice on time
• Any amount of interpersonal tension with a
child is warranted when the child behaves
inappropriately
• Narrow sight line, as if they have blinders on
• Gazing at the sky through a straw
• Lack of insight
Teenage Mental Health Problems and
Previous Parent Problems
• General role of parental modeling
• Children learn by watching
• Not just the parenting but also how they see
their parents living their lives
• How parents deal with their own stress and
setbacks
• Missed moments
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What parents failed to teach
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What parents inadvertently contributed to
Moments
• Lying, manipulates one parent against the other
• Whiny, demanding, rude, talks back, torments
younger siblings
• Says "No, you can't make me.” Dawdles in the
morning
• Chores, responsibilities, tidiness, procrastination,
task completion.
• Missing assignments, says they will do something but
then does not
• Put toys away, bed does not get made.
Best times for children to learn
• Are the uncomfortable times
• Are the times of mistakes and
disappointments
• Celebrating mistakes and disappointments
• So much they need to learn
• All moments are needed
Connecting Moments with Long-term Goals
• Learning to welcome all moments for the
teaching opportunity they provide
• Seeing the potential clearly
• Reasons adults give for not doing this well
• Their role models when they were growing up
• How they are “wired”
• How do you expect me to stay calm (or
positive or encouraging) when they….
Finding what to teach
• Different from just taking care of what is right
in front of you
• Instead, using what is right in front of you to
do something really great for years to come
• Long-term view rather than short-term view
• How may I use this? What can I teach?
• Lack of awareness of what adults teach by
how they live their lives
So Much for Parents to Teach
• That their love is forever and is unconditional
• That they are their reservoir of confidence
• That trust, honesty, taking responsibility for
your actions are important in relationships
• Cooperating with authority
• The work ethic, importance of education,
deferring gratification, importance of patience
So Much for Teachers to (try to) Teach
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Oppositional Deficit Disorder
Attention Deficit Disorder
Depression
Anxiety
Narcissistic Personality Disorder
Obsessive Compulsive Disorder
From General to Specific
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Viewing skills helps us stay at our best
Modeling viewing skills teaches viewing skills
Honor sovereignty
Discipline with reassurance
Celebrate mistakes and disappointments
Protect the connection
Forgive instantly
Presenting our lives as role models
Oppositional Deficit Disorder
• Even when you are disrespectful to me I am
respectful to you
• If you don’t do your work I am still rooting for
you
• Whatever hole you dig for yourself I will help
you dig out of it if you let me
Attention Deficit Disorder
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I know it is hard to sit still
He is probably doing the best he can
If he could keep his hands to himself he would
An accurate grade provides feedback
Parents may need to see poor grades to
permit an assessment or to treat the condition
more aggressively
Depression
• Look around. There are other children to play
with.
• Most children get cut from sports before high
school
• Partnering for projects
• Stories about dealing with unwanted events
Anxiety
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Giving your power away
Drama of the Middle School Years
Learning about trust and betrayal
Changing demographics and the college
application process
• What worth is (or should be) based upon
• Myth of the smooth road
Narcissistic Personality Disorder
• Sympathy for the arrogant, self-absorbed
teenager
• Did not come out of the womb this way
• Did not line up and say “please may I have
some of that narcissism?”
• Hold accountable, give feedback, treat better
than they deserve
Obsessive Compulsive Disorder
• Compassion for the repetitive (Is this OK?)
questions
• Erasures and starting over
• Remember you have more and better norms
than the parents have
• You know when it is not the age
Alcohol and drug abuse
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Best practices
How the parent is when off duty at loosest moment
Alcohol part of every social event
Offer people a drink as soon as they arrive
Expect teenagers to drink
Think it’s OK if they drink at home
Need to practice for college
Tried to influence too many issues with same
intensity
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Set the consequence for first use of alcohol or marijuana very high.
Make sure they know what you have decided the consequence will be.
Welcome their friends in your home as long as there has been a chance for
parents to talk.
Introduce yourself to parents when you drop your child off at someone’s house.
Call the other parent and welcome calls from other parents.
Always call before and occasionally call after to compare notes.
Friends are not to bring any of their own beverages into your home.
Tell your teenager to leave any gathering where there is any drinking or drugs.
Call parents if it turns out there was alcohol or marijuana use in your home.
Be visible at the party. Walk through; fill the chip bowl, etc.
Set the time when you would like the party to end and stay up until everyone is
gone.
Wait up for them, kiss them goodnight.
“It’s over when it’s over”. No after-event events.
Don’t say yes to spring break trips without adults or any kind of hotel party.
Be reluctant to say yes to last minute requests for sleepovers.
Remember: Teenagers notice what their parents do and what their friends’
parents do.
Wrong crowd, risk-taking, adventure-seeking, sexually active,
lack of caution, sense of invulnerability, lies, manipulates, blames
others, doesn't take responsibility, doesn’t feel remorse
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Extremes of parenting styles - either
Gullible, naïve, overly trusting, inconsistent
Parental disagreement
Act as if the parent-child relationship is one of equals
Parent seems to need courtroom like evidence to give a consequence
Side with child against other adults (teacher, coach)
Inadvertently empower teen to become stubborn
Or used consequences that were too big or too long lasting and taught the
child to hide
• Over-protection, bubble childhood
• Didn’t let him scrape his knees, climb and fall out of the tree
Sense of entitlement, too powerful, cocky, arrogant, boastful,
uncompromising, wants to drive own life (but not steering)
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Child was worshipped – special, gifted, talented, granted adult-like status
Artwork was “amazing”, singing voice was “unbelievable”
Didn’t do ordinary discipline, no follow through
Agreed with teen that it was friend’s fault, “just holding it for a friend”
Did not require details of the evening plans
Allowed overnights without phone calls
Did not stick with a parenting strategy
Taught that lines move, limits don’t apply
Parents excuse late assignments, ask for exceptions from teachers
Lax at first, late in enforcing rules – child got used to the freedoms
Lack of confidence as a parent
Timid, reluctant, hesitant
Under-achieving, poor effort/attitude, no
"value" of education
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Parent did not fade the prompt
Did not permit “cards read” in grades 4, 5, and 6
Allowed school achievement to become a parent-child issue
Parents felt and acted responsible for child’s achievement
Threatened consequences but didn’t follow through
Did not teach “without day job – no paycheck”
“Yacked” instead of acted
Did not trust natural consequences
Hovering, helicopter parents
Used the future as a scare tactic
Perfectionism, eating disorders,
depression, cutting, suicide attempts
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What worth is based on
How to self-evaluate
Over-played the striving/achievement/appearance issue
Am I good enough?
Is my parents’ love conditional?
Did not teach them how to be resilient, bounce back
How to view setbacks
Did not allow them to be frustrated so they could learn
Modeled that we can only be happy on perfect days
Too many explanations - why parents made a certain decision
Over-psychologize
Obsessive worrying, reviews, rehash and
rehearses
• Parent sermons, too many why questions, reliance on words
• Lack of strategies to teach closure, healthy ways to distract
oneself from stress
• Bringing up past issues
• No understanding of the point of diminishing returns
• Deal with it for ten minutes and then again tomorrow
• Bedtime worries
• Ability to forgive themselves
• Learn from a mistake, let go, move on.
• Parent agonizes about his or her own life events
Gloomy, negativity, isolates, withdraws from family, pessimism
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Hard to honor sovereignty
Judging and comparing to standards
Repeatedly asks same questions, annoys and nags
Parent tries too much to cheer the child up
Shame as a parenting strategy – “you think you have it so
bad”
General tension in the family or in the marriage
Power imbalance between the spouses, bickering
A high achieving sibling who seems to be a competitor
Parent wears out welcome, made mountains out of molehills
Low self-esteem, clingy, dependent, unsure
of self, hesitant to try new things
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Chores were never done “well enough”
Parent sees the world as an unfair and unforgiving place
Over-focus on dangers (e.g., being abducted)
Unknown is frightening
Boundary problems
Tried to give self-esteem rather than understanding that it
follows mastery + competence
• Parent used child inappropriately as their support person
Available Resources - Free
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Fading the Prompt
Allowing Temporary Victories
Children and Their Pace of Change
Untreated Conditions
All Moments are Needed
Wishing for (but not expecting) a Smooth Road
Our Children’s Weak Moments
What They Do (and What We Do Next)