Thursday, April 29, 2010
I’ve been asked this question several times. There are so many opinions and ideas floating around as facts. This makes it difficult for those looking for help. So let’s look at common misconceptions of mental illnesses.
It’s all in the mind.
Depression and other mental illnesses have a biological basis. It is not anyone’s figment of imagination nor because someone ‘wants’ to be depressed. We can’t just ‘get over it’ because someone tells us to do so. It is a medical condition which needs treatment.
It’s the result of weak character.
No specific causative factors have been identified. Biological, environmental, social and cultural factors interact in different ways and can trigger the onset of mental illness. Personally, I’m always impressed by the strength of character people with mental illness show as they learn to manage their illness.
Parents didn’t raise their children properly.
It is not nice but my only thought is that the person who said this wasn’t thinking straight. Why would you say that about someone else’s child? Parents’ support and understanding of the illness is vital to the child’s recovery but it has nothing to do with why the child is diagnosed with mental illness (unless there are specific traumatizing incidents involving the parents).
What reason do children have to depressed?
As a child, I used to get headaches. People would ask me why a child would get headaches. I still haven’t made the connection!
Children can have clinical depression just the same as adults. Given the same conditions, two different children can respond/develop in varying directions. Their biological make up may make one child fight back while the other becomes more anxious. One supportive adult can make a world of a difference. Cultural variations such as support from extended families can impact how the children respond.
There is no treatment for mental illness / medicines will cure it and you don’t need to do anything else.
Yes, mental illness can be treated. No, medication alone doesn’t ‘fix’ it. Treatment is multi-pronged and is different for different people. Those with mild symptoms choose to manage their illness by making certain lifestyle choices and help from professionals/family members/friends. Others need medication.
Whenever parents express anxiety about medication and their side effects, I tell them that pills help control the symptoms. They bring you to the drawing board, so to speak. The next step is to teach the child, coping skills and strategies. Behavioral therapy, exercise, meditation/breathing and relaxation techniques are part of the treatment package.
As for prayer, it helps some people and others have too many questions about their condition. My personal opinion is yes, prayer helps us handle the stress and anxiety caused by our fear of the illness. But would I tell others they must pray? No! It is a state of mind the individual must reach through his/her own exploration.
People with mental illness recover and are functional members of society. The right information helps chart their path to recovery. Pass it on.
Tuesday, April 20, 2010
She had some problems with writing so we saw an occupational therapist. Then the school started to complain about her behavior and that she wasn’t keeping up with the academics. My daughter said that other children teased her and called her ‘dumb’ and ‘stupid.’ Finally we took her out of that school and now we are trying to get admission in this special school.
These parents were referred to me by the coordinator of the center. I wanted to write about this because of a very unique problem. This thirteen year old had had educational testing. She fell within the borderline range with mild behavioral problems. The parents were actually seeking admission in to a vocational center for young adults with mental illness!
There is so much misinformation floating around-sometimes even people in the education field don’t know the difference between mental retardation/intellectual disability and mental illness. (Mental retardation is the older title which is now classified as intellectual disability).
Intellectual Disability: The American Association for Intellectual and Developmental Disabilities defines intellectual disability as significant limitations in intellectual functioning and adaptive behavior. These limitations are present from birth onwards.
Intellectual functioning or cognitive functions include skills needed to perform well academically like
- reasoning (eg understanding cause and effect), and
- problem solving (identifying the problem in a situation and coming up with the best solution in that context).
Adaptive behaviors are those which enable the smooth functioning of our daily lives. They help us apply what we have learned to our daily lives.
For example, look at the skills involved in cooking a meal for four people.
I have to plan the meal, make a list (mental or actual) of the ingredients along with the quantity needed and then go shopping.
What skills do I use in shopping?
- math skills-number, weight, money
- social skills-be polite to shop keeper, ask for price of vegetables; not be gullible if he quotes an unreasonable amount
- perceptual skills-to help me buy fresh vegetables instead of dry or stale products
- working memory-to remember what I must buy
Once I get back I have to clean, prepare the ingredients, follow the recipe in the correct order…the steps involved are endless. Every time I prepare a meal, I have o go through the whole process with different ingredients and different methods of preparation.
How do we find out about the ‘significant limitations?’ Standardized IQ tests are given by educational psychologists to assess a child’s intelligence.
Intellectual disability may occur on its own or with a mental illness
Mental illness is a group of disorders which show abnormalities in thinking, mood, and behavior. Intellectual functioning is affected as an outcome of these abnormalities.
For example, I have the intellectual capacity to do a project on the moon landing. But if I suffer from sever depression it is going to affect how I manage my time to do the research, organize ideas, and complete the project in a timely manner to present it to the class.
Why does the diagnosis matter? Because the approach to learning (and teaching) varies for the two conditions. The academic, social and behavioral goals are different for the two groups of students. While both groups need to be challenged in each of these areas, baselines change based on the diagnosis. Our expectations are based on the student’s ability. Student A with a moderate IQ (50-69) will need adaptations and modifications, but with the right kind of support can be functionally independent. An exceptionally bright student B can struggle in school because of anxiety, depression or ADHD. The support and modifications needed for student B is different from that of student A.
It is important that parents and educators educate themselves about the differences in these two conditions and place the students in the correct setting.
Thursday, April 15, 2010
A friend’s friend emailed me this week. She was really confused with all the different opinions. Some people say this and others say that.
All in all I found a great deal of confusion about the diagnostic process and how to seek appropriate help.
In places like the US, usually when teachers notice problems, they start the process by communicating to the parents. The general procedure is to notify the parents, try different methods and if the problem persists, refer them to educational psychologists. Of course this is just the procedure. I’ve heard teachers pronounce label kids without sufficient evidence. But there is a specific method to follow in diagnosing the child's condition.
In India, this systematic procedure is not in place yet. The situation is improving in big steps especially with information available from the internet. But what is the role of teachers, friends and family members in this process?
Teachers get to see the symptoms-the behaviors which impede learning. There is a whole range of these-lack of attention, fidgeting, not staying in seat, sleeping in class repeatedly, over reacting to criticism, poor peer relations…The list is fairly long. Teachers can report to the parents that these behaviors are interfering with the student’s learning. Can they tell them that their child has Attention Deficit Hyperactive Disorder, Obsessive Compulsive Disorder, or Bi polar Disorder? No. The diagnosis has to be done by an educational psychologist or if necessary, a child psychiatrist.
Why insist on a psychologist or a psychiatrist? A lot of these conditions have similar symptoms. In some children, anxiety may cause an inability to attend. In others it may be the other way round. An inability to attend causes anxiety in the child (because he knows he is going to get into trouble or because he knows he is behind in the subject). Compulsions may cause a child to repeat certain behaviors while it looks like he is being defiant. Professionals are trained to tease out these facts by using appropriate testing. Based on whether the difficulty is based on a learning disability or an emotional disability psychiatrist referrals maybe neccessary.
Teachers can help gather information in the diagnostic procedure by filling out the checklists or writing their observations down. They have to adapt materials and modify instructional strategies. Teachers also provide emotional support to the student when he/she struggles.
Parents are always concerned about medication-they want to try other options first-yoga, meditation....both these have a significant role to play in regulating these conditions. Even in extreme cases of PTSD (Post Traumatic stress Disorder), Yoga is seen to have a healing influence.
The reason teachers want parents to pursue medication is also understandable-foundation of learning occurs in primary school. If the child can't attend then the foundation is going to be weak. The child will forever be playing catch up in school.
Imagine having to manage 30/40 children in class. Just one goofy kid or one aggressive kid can affect how the rest of them behave in class. That is the teacher's plight.
I have heard parents mention homeopathic medication. I don't know much about it but they seem very happy with the progress in their children.
A friend decided that she'd be happy if her son was able to complete his high school education-he was going into the family business after that. So she decided not to medicate his ADHD.
It's a tough choice for parents-only you can weigh the pros and cons and decide which way you want to go.
Tuesday, April 13, 2010
The note from Babu, my student continued along these lines. His had been an extremely hard life and he grew up to be ‘tough.’ Babu was invariably involved in a physical fight every week; he didn’t care if it was an adult or a peer-he was verbally aggressive when limits were set. He was disruptive in class and teased his classmates when they attended to their work. One day, I had B help me tutor a much younger student. He was very patient and I watched him adapt the materials on his own. At one point the younger student was making noises. Babu looked at him and said calmly, “Hey that noise is bothering me…can you keep it down?”
I think we both changed after that incident. I stopped making assumptions about Babu whenever he was involved in an incident. I made accommodations for the side effects of his medications, put him in groups with calmer peers and adapted some of the materials. He in turn tried to follow rules, asked for quiet times when he was really upset (instead of lashing out) and sought help to stay on top of his grades. It wasn’t perfect but still a big change.
A couple of years later I moved to a different city. Just before I moved I got this letter from Babu, written during his counseling session. I read it every now and then-helps me to remember my attitude impacts my students’ behavior.
As a child, I moved around a lot, thanks to my dad’s job. I went to different schools in different states and countries. Remember how everyone talks about their teachers at ‘get togethers?’ Just go to Facebook or Orkut-there are plenty of shared memories. I remember my teachers-the good and the bad. Students can sense when someone is honestly interested in their education and their lives. Some teachers model right and wrong by their behavior while others are proponents of “do as I say, not as I do.”
Students spend a good chunk of their wakening hours with teachers. As a society, we Indians are more in tuned to respecting authority-or at least not questioning them in the appropriate manner. (Of course, there are always the incidences of violently questioning your teachers…emphasizing the need for mental health support in schools). But I remember instances of teachers being extremely disrespectful to my classmates, their comments making prejudice a virtue. As an adult I look back and understand that these were power struggles-after all the children couldn’t talk back(not many parents had the temerity to stand up for their child in those days).
A few months back some of us were discussing our school days. One of my friends commented that because teachers were so strict, we grew up to be ‘proper’ adults. Others disagreed strongly. One comment stood out in my mind-we tend to think that humiliating someone in the name of discipline is ok. How true is that? My next thought was that we were all reasonably well adjusted adults. What happens to children who aren’t that well adjusted? How does the teacher’s attitude affect their emotional well being and academic performance?
Lots of studies report on the effects of teacher attitudes on students’ performances. We just have to reflect on our own experiences to see the correlation between these factors. Which student did the teacher call frequently for answers? Whose work got the most compliments in class? Who was most often the teacher’s helper? On the flip side, who got the most sarcastic remarks from the teacher? Who got yelled at more often? Who was sidelined by the ‘studious’ kids for being stupid? How did the class dynamics play out-did all the students help one another or at least be polite, or did they group themselves into the ‘smart’ group and looked down on the ‘dumb’ lot? Who sets the tone for the class?
How can we, teachers, ensure that we support the vulnerable child?
Keep an open mind-making assumptions based on our prejudices is a big hurdle.
Believe the child is trying his best-it may not be what you want but recognize the effort.
Listen-there is a point being made either verbally or through the behavior. What is the student trying to communicate?
Increase knowledge base- Sometimes the student does not have control over the behavior. The more you know about mental illness, the better you understand the reasons behind this lack of control.
Employ behavior management techniques-Just because a child can’t always control his behavior, doesn’t mean that he shouldn’t try to do so some of the times. Do this systematically- a haphazard method makes it worse.
Adapt and modify instruction and materials in the classroom-Give reign to your creativity and flexibility.
Work with the parents-after all they want what’s best for their child.
Monday, April 12, 2010
Arun waited for a mintue (for my citicism, I think) and then said, “Oh, I had picked out a smaller tattoo because that’s all I could afford. When the guy at the parlor looked at my arm, he offered a discount on the bigger one. When he finished he said that his younger sister too had lots of scars on her arms from the cuts…”
Was I glad we hadn’t let our mouth run off with the first critical thought on his tattoo!”
A parent was recollecting the journey of her twenty four year old son diagnosed with Bi polar Disorder and then Borderline Personality Disorder.
Earlier posts talked about the skills of a successful learner. Let’s take Chandran, a twelve year old whose school days are getting harder because of an onset of mental health problems. How does his mental affect the Chandran’s ability to function in school?
Chandran is unable to attend to a specific task. It is difficult to listen to the teacher and stay focused in class. He tries to avoid the teacher's eye because he doesn't want to be called out for class participation. He lacks stamina and mental fatigue sets in easily. As a result Chandran can’t work for long periods of time on any assignment. In higher classes this is a big hurdle.
Planning, organizing and time management all involve making judgments and assumptions. A certain degree of flexibility is also necessary, especially when things don’t go according to plan. Every time there is a deadline to be met for assignments or exams the student is under tremendous pressure. Chandran’s mental health problems impact all these areas of study skills. In his case the difficulty is magnified several times over.
Chandran knows he is struggling while others seem to be cruising past. In his heightened sense of awareness, he misinterprets social cues-everybody else seems to be having fun, it is easy for them, teachers don’t like him. Even when he knows he is foundering, Chandran feels too foolish to ask for help or clarify his doubts.
His self concept is already shaky but his lack of coping skills make it worse. Chandran’s interactions with his class mates suffer-he is either overly aggressive or painfully shy and withdrawn. That balance seems to elude him.
His self motivation spiraling down, Chandran sees no reason to try for anything. After all who cares?
Without any help he is stuck in this mire until a crisis strikes. How can we help Chandran?