Mental health issues among school age children are a growing concern. Research demonstrates that between 2011 and 2017 there was a 30.5 percent increase in mental illness diagnoses amount U.S. children with as many as 20 percent of children and adolescents being diagnosed with one or more mental disorders.
Mental health issues among school age children are a growing concern. Research demonstrates that between 2011 and 2017 there was a 30.5 percent increase in mental illness diagnoses amount U.S. children (Tkacz & Brady, 2019) with as many as 20 percent of children and adolescents being diagnosed with one or more mental disorders (Elia, 2019). A mental disorder is a characterized by symptoms which create a clinically significant disturbance in one’s thinking, emotion regulation and behaviors (APA, 2013). These disturbances interfere with the healthy development of the child causing significant distress and negatively impacting the child’s ability to be successful in achieving social, emotional, cognitive and academic milestones (Ghandour, et al., 2019). Despite the prevalence of mental disorders amongst children it is estimated that 50 percent of the children experiencing mental health problems have yet to be identified or diagnosed (Tkacz & Brady, 2019), and almost 40 percent of those children who have been diagnosed with a mental disorder are not receiving treatment ("Data and Statistics on Children's Mental Health," 2019).
Research suggests that on any given day educators and school personnel interact with many children who are struggling with mental health issues. For a typical classroom it is estimated that five children would likely meet the diagnostic criteria for a mental health disorder. Children faced with mental health issues often fail to meet developmental and emotional milestones, demonstrate ineffective coping skills, and struggle with healthy social development. Early intervention is key in preventing the devastating effects of long-term struggles with mental health problems. Teachers and educators are in a unique position in being able to identify the difficulties that a child may be experiencing. However, specifically during the elementary years, these issues often manifest in ways that are not always obvious to the teachers with whom the students spend most of their time.
Teacher’s often view concerns in the classroom such as in-attention, failure to follow instructions, work avoidance, problematic peer interactions and tantrums as being evidence of simple non-compliance or a result of poor parenting in the home. Teacher’s often handle these problems using basic behavior modification techniques and/or reward systems. Classroom reward systems are often based on individual behaviors but play out in the classroom setting for all peers to witness. For example, in one such classroom children’s names are put on clothes pins and are moved up and down the color-coded chart according to their behavior and based on their “readiness to learn.” Children who are struggling with or are at risk for mental health disorders often fail to respond to such means of behavior modification. A child who is struggling with anxiety is likely to have low self-esteem, a lack of self-confidence, and a fear of failure.
Work avoidance is an unhealthy but effective coping mechanism often used by those with anxiety to minimize their intense feelings. The behavior chart is likely to have caused additional anxiety due to the fear of public humiliation. However, the introduction of a new fear is not a motivator and will not increase the likelihood of this child completing her work.
In this example, as well as with all mental health disorders, no two people are alike and what causes anxiety in one may not cause anxiety in another. In order to increase effectiveness and minimize unintended negative outcomes for all students, a behavior management system should be individualized, collaborative, and should encourage positive behavior. The teacher should partner with the student to identify goals to rewards. Positive behaviors need to be the focus of the behavior system.
It’s important for educators to remember that just because it doesn’t make sense to them doesn’t mean that it is simply a behavior and not a symptom of a mental disorder. For example, a child with ADHD may struggle to remain seated, have difficulty paying attention, is frequently off task, and is often in trouble for violating classroom rules. Despite these symptoms the same child may be able to focus at length on preferred tasks and appears to pay attention to preferred topics. This inconsistency often results in adults dismissing the child’s struggles as a choice and not a result of a neurodevelopmental disorder. Even with an appropriate diagnosis and ongoing treatment a child with ADHD is at risk for developing other mental health disorders. However, when ADHD goes undiagnosed and untreated the occurrence of other mental health disorders is much more likely and the impact is much greater. The “ready to learn” behavior system, mentioned previously, can also have negative effects for a child with ADHD.
Children with undiagnosed ADHD are continually being redirected, corrected, and punished. Consequently children with ADHD often identify as being “bad” and fail to develop a healthy self esteem. With the “ready to learn” behavior system in the classroom they are continually bombarded with expectations of behavior that they simply do not have the tools to achieve and their failures are on display for everyone to see. Anxiety, depression, low-self esteem, and even more acting out behavior are all consequences that result when ADHD is left untreated.
In order for early intervention to occur we need to first educate our teachers and school personnel regarding how to identify children at risk. Ideally this would occur from the ground up starting with the education of teachers during their undergraduate studies. Course work in early education should focus on behavior and classroom management from a wholistic approach. This approach would consider the whole child — one that considers the home environment as well as the school environment. We cannot simply expect a child to leave their struggles outside of the classroom once they enter the school building. Adverse childhood experiences (ACES) such as divorce or separation, domestic violence and economic hardships increase the likelihood of mental health disorders and need to be considered when dealing with problematic behaviors in the classroom.
A one-size-fits-all behavior management system that utilizes public shaming and punitive measures can no longer be the method used in schools to discipline students and enforce compliance. A trauma informed mindset should be infused in the education of our teachers and should be practiced and supervised while during the student teaching practicum. Educational programming should be developed from a trauma informed perspective and should incorporate expertise from not only the education experts but also those in the field of mental health.
While waiting for the education system to change, school districts need to take on the onerous task themselves. An excellent way for schools to educate themselves is to partner with a mental health agency or professional within the school community. School districts should be proactive in securing individuals or agencies within the community that have the appropriate credentials and specialties relevant to the needs of the students in the district. These professionals can provide one-on-one consultations as well as in-person trainings to faculty and staff.
Additionally, teachers should be encouraged to be proactive in their own education to meet the needs of the student in their classrooms and to collaborate and share resources they have found to be useful.
Understanding Trauma-Informed Education
Trauma Informed Info Graphics
Supporting Students with Adverse Childhood Experiences
Student Behavior Goal Setting Kit
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: Dsm-5. Arlington, VA.
Data and Statistics on Children's Mental Health. (2019, April 19). Retrieved from https://www.cdc.gov/childrensmentalhealth/data.html
Elia, J. (2019, May). Overview of Mental Disorders in Children and Adolescents - Pediatrics. Retrieved from https://www.merckmanuals.com/professional/pediatrics/mental-disorders-in-children-and-adolescents/overview-of-mental-disorders-in-children-and-adolescents
Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., & Blumberg, S. J. (2019). Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children. The Journal of Pediatrics, 206. doi: 10.1016/j.jpeds.2018.09.021
Perou R, Bitsko RH, Blumberg SJ, Pastor P, Ghandour RM, Gfroerer JC, Hedden SL, Crosby AE, Visser SN, Schieve LA, Parks SE, Hall JE, Brody D, Simile CM, Thompson WW, Baio J, Avenevoli S, Kogan MD, Huang LN. Mental health surveillance among children – United States, 2005—2011. MMWR 2013;62(Suppl; May 16, 2013):1-35.
Tkacz, J., & Brady, B. (2019). Pmh28 The Increasing Rate Of Childhood Mental Illnesses And Associated Healthcare Costs In The United States: Trends Over The Past Decade. Value in Health, 22. doi: 10.1016/j.jval.2019.04.1073