Recognizing the signs of student MENTAL HEALTH problems

11/27/2011
Adolescent Mental Health
DR. RICHARD H. HARDING, MD

Adolescence is a difficult time for many teens, but how does a teacher know the difference between typical teen issues and behavior that might signal a more serious problem? Mental health problems in teens are real, painful and, left untreated, can have serious consequences.

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For some teens, adolescence can be the period of their lives when mental health problems appear. In fact, according to a study by the National Institute of Mental Health, 90 percent of people who develop a mental health problem show warning signs during their teen years.

These problems can interfere with the way teens think, feel, act, and interact. When left untreated, mental health problems can sometimes lead to school failure, family conflicts, drug and alcohol abuse, trouble with the law and suicide.

Mental health disorders that can affect teenagers include depression, schizophrenia, bipolar disorder, anxiety disorder, ADHD (attention deficit and hyperactivity disorder) and eating disorders.

Sharon (Shari) Sevier, Ph.D., LPC, is the director of guidance and counseling for the Rockwood School District in Eureka, Mo., and she also operates a private practice. She deals with teen mental health issues on a daily basis.

According to Dr. Sevier, there are a wide variety of issues affecting today’s teens. “There are high school kids who are feeling so much pressure to achieve,” she said. “A lot of it is perceived, but nevertheless it is very real to them and it becomes overwhelming.” Other students are “truly dealing with mental health — depression, anxiety. They want to escape the pain that they’re in.” For these students in particular, early intervention can change — or even save — lives.

Startling Statistics

The facts are sobering. About four million, nine to 17 year olds have a major mental health disorder that results in significant impairment at home, at school and with peers, according to a report of the Surgeon General’s Conference on Children’s Mental Health. At least one in five children and adolescents has a mental health disorder, and one in 10 has a serious disorder. And most tragically, the National Center for Health Statistics reports that suicide is the third leading cause of death among teens and young adults 15 to 24 years old.

Research supported by the National Institute of Mental Health (NIMH) has found that half of all lifetime cases of mental illness begin by age 14 and that despite effective treatment, there are long delays — sometimes decades — between first onset of symptoms and when people seek and receive treatment. Untreated mental disorders can lead to a more severe, more difficult-to-treat illness, and to the development of co-occurring mental illnesses.

Early Recognition is Key

While the statistics are startling, early recognition of mental illnesses, early diagnosis, and referral to appropriate treatment can greatly improve the lives of adolescents and young adults.

When young people who suffer from emotional or mental health problems get help through counseling and other treatment, it can change the course of their lives.

Research shows that teens with mental health problems who do get appropriate treatment have increased scholastic test scores, and that effective mental health interventions and a positive school climate contribute to improved student achievement.

Mental health intervention can also delay the onset of substance abuse, if intervention occurs before the ages when young people are most likely to begin experimenting with or using drugs and alcohol (research findings, New York Office of Mental Health).

Spotting the Signs

Dr. Sevier credits the American Psychiatric Foundation’s (APF) Typical or Troubled?TM school mental health education program with helping her conduct 59 staff trainings in her district.

As Richard K. Harding, M.D., Board member of APF and child and adolescent psychiatrist explained, “the Typical or Troubled?™ program is designed to educate school staff — counselors, teachers, coaches, custodians and others — about recognizing the warning signs of mental illness in adolescents, and if they notice the warning signs in a student to talk with them and refer them to help within the school or if necessary to a mental health professional.”

Counselors, teachers and other school staff may be the first to notice symptoms. They see students every day and have a unique role in helping troubled teens get help. How do you tell the difference between typical teenage behavior and something more serious?

Some of the signs that there might be a serious problem include:

  • Increased tardiness or absences — one of the earliest signs
  • Angry or aggressive behaviors
  • Poor concentration — student can’t focus, fidgets
  • Student seems withdrawn, silent, lacks friends — especially if this is a change in behavior
  • Student appears overly anxious or worried, even fearful

The Typical or Troubled?™ program includes more detail on all the warning signs and information about mental health problems in adolescents.

The teen years are complex — even normal adolescents may display alterations of mood, distressing thoughts, anxiety and impulsive behavior. So how can you distinguish normal teen behavior from behavior that might signal a more serious mental health problem?

The answers to two questions can provide insight and guidance: The first is, “how frequent?” Are warning signs happening over and over again? Warning signs persist over a couple of weeks, and don’t go away. The second question is “how extreme?” If a warning sign or behavior shows up, even if it is infrequent, the important question to ask is: “is this warning sign extremely different from this student’s usual way of behaving?”

A “yes” answer to either question is a good indicator that there may be a serious problem. If these indicators are present, the counselor or teacher should talk to the student and connect them to the school mental health staff.

Types of Mental Health Problems

There are four major overall categories of mental disorders:

  • Mood disorders (depression, bipolar disorder)
  • Anxiety disorders (Post-traumatic stress disorder, obsessive-compulsive disorder, social phobia)
  • Psychotic disorders (such as schizophrenia)
  • Behavioral and disruptive disorders (oppositional defiant disorder, conduct disorder)

While only mental health professionals can diagnose these disorders, it is helpful to be familiar with the characteristics.

Clinical depression

Individuals experience deep despair, sadness, crying, sleep disturbance, chronic fatigue and other physical symptoms, or thoughts of death or suicide. As many as one in 13 adolescents experience symptoms of depression at some time. Adolescent girls are twice as likely to experience bouts of depression.

In a school setting, it may be evidenced by withdrawal, silence, body/stomachaches and trips to the nurse.

Bipolar disorder

Bipolar disorder is a type of mood disorder, with marked changes between extreme elation or happiness, irritability and severe depression. An estimated one in 100 teenagers has bipolar disorder. Those with bipolar disorder may be in a good mood and very productive during the manic phase and in deep despair during the depressive phase. Suicide can be a very real concern for adolescents with bipolar disorder.

Extreme ups and downs in attitude and behavior are signals that someone may be suffering from bipolar disorder.

Anxiety disorders

Anxiety disorders include panic disorder, post traumatic stress disorder, obsessive-compulsive disorder and social phobia. A person with anxiety disorders experiences overwhelming or terrifying fear, or fearful anticipation of danger or problems, often with no apparent cause. Symptoms can be incapacitating, or characterized by mild but incessant anxiety or repetitive rituals.

These disorders frequently run in families, and young people have a nearly one in seven chance of developing some type of anxiety disorder. Obsessive-compulsive disorder frequently arises during teen years, and can be the most disabling of the anxiety disorders.

Signs may include fidgeting or tapping, body/ stomachaches and trips to the nurse.

Eating disorders (anorexia and bulimia)

Eating disorders are characterized by unrealistic, irrational thoughts about weight. Suffers refuse to maintain a body weight at or above a minimal normal weight for their age and height. Some others repeatedly engage in episodes of binge eating and purging. One in 20 adolescents suffers from an eating disorder, and nine in 10 of those are girls. Anorexia is easier to see than bulimia, due to low body weight. Taken to the extreme, eating disorders can affect the heart and result in death.

Warning signs include extreme thinness, signs of throwing up or excessive time in the restroom.

Schizophrenia

Schizophrenia is the most chronic and debilitating of all psychiatric conditions. It causes strange thinking, strange feelings, unusual behavior or hallucinations. People suffering from schizophrenia may be high functioning and then experience a big decline in performance. They may be distrustful, cease being social or respond to voices only they may be hearing. Early intervention may improve a young person’s prognosis.

Symptoms may include very disturbed and/or paranoid statements.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD causes problems paying attention and concentrating, with hyperactive and impulsive behaviors. It can seriously impact one’s ability to learn and overall school performance, and can lead to later difficulties or failure in education, job and marriage.

In a school setting, frequent disruptions in the classroom may be a sign of ADHD.

Oppositional Defiant Disorder

In children with oppositional defiant disorder, there is a pattern of persistently negative behavior that can be hostile. This kind of behavior, if it happens in the classroom, can be distracting and disruptive to the classroom.

Consistently being disobedient and disrespectful is a signal.

Conduct Disorder

People with conduct disorder exhibit verbal and physical aggression toward people and even animals.

Without appropriate treatment, most young people with this condition can face a dim future. Studies of juveniles in prison found that approximately nine in 10 had conduct disorder.

Warning signs include aggressive, violent behavior or outbursts.

Take Action to Make a Difference

The process for referring an adolescent to appropriate help within the school when noticing signs of trouble can vary for different schools and school districts. Many times the school or district has set up a referral system and policies which guide action. Oftentimes there is a social worker, psychologist, or other mental health professional on the school staff, or associated with the school district. School counselors have a network of professionals within the school community to whom they can refer students who need help.

Parental involvement is crucial. A school representative should make sure to inform parents about their child’s behavior in school, and discuss resources available to them. It is important to focus on making the first meeting with parents a positive experience. It will help pave the way for future meetings or discussions that may have to address a sensitive issue like a student’s troubling behaviors. Make an effort to maintain frequent and open communication with parents. And it’s also important to communicate the positive — not just the negative. Parents tend to have a hard time listening or discussing issues if all they are hearing about is poor progress or problem behavior.

Only a mental health professional can diagnose a mental health disorder. When talking to parents, it is important for non-mental-health professionals to discuss only those observable behaviors that they believe are warning signs.

If the parent chooses to move forward, he or she would work with a mental health professional such as a child and adolescent psychiatrist who will do an evaluation. The parent may choose to talk to their family physician or pediatrician. Following the evaluation, treatment may include psychotherapy, medications or a combination of both.

By noticing early warning signs, school counselors, teachers and other school staff can work with mental health professionals and parents to assure that young people get the help they need to remain healthy. A practical piece of advice from Dr. Sevier is to pay attention. In her words, “You have to know your students well enough to notice when their behavior changes.”

Resources:

The following resources provide additional information on mental health and how you can help:

— American Psychiatric Association: www.healthyminds.org

— American Academy of Child and Adolescent Psychiatry: www.aacap.org

— American Psychiatric Foundation: www.psychfoundation.org

Dr. Harding is currently the Associate Medical Director of Behavioral Science for Palmetto Health Alliance in Columbia, South Carolina. He is the immediate past Professor and Chair of the Department of Neuropsychiatry and Behavioral Science and Adjunct Professor of Pediatrics at the University Of South Carolina School Of Medicine.
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