...the young man told me. “He cleans it to his satisfaction, uses his own vessels and cooks for himself. No one else uses that space. After high school he had specific career plans but couldn’t get into his course of choice. We noticed changes after that…he spent a lot of time in front of the mirror, checking his appearance. He made his own bath powders with natural ingredients, changed his diet and followed his care regimen very strictly. If we rushed him because of appointments, he would get very angry. At the beginning it was scary and frustrating for all of us. I think our reactions scared him even further. Of course we understand things much better now. He stopped going out to meet friends, because they teased him about his ‘beauty’ treatment. He hardly ever left the house-to meet friends or family.”
The young man shared his story as he drove me in his auto rickshaw to my cousin’s place.
While looking in the mirror is normal and natural it is time to get concerned when the interest in physical appearance is excessive. Worry about looks and weight become the main focus. There is a constant need to do manage one or the other to be ‘perfect.’ As this ties in with teenagers’ self esteem and peer acceptance, the student is under a lot of social (peer) pressure, whether real or perceived.
School is an environment for academic and social skills training. Students, particularly teenagers, spend a lot of time with their peers, by choice or by necessity. Teachers must be aware of what is happening in peer circles. Teenagers may approach teachers in an indirect manner about their problems, or their friends may do so. It is important not to act disinterested or to over react. In times of confusion, students want adults to be calm and settle their fears. Even if we don’t know all the answers, just being able to calm them goes a long way.
Ms.S
Blog on fostering mental health in the Indian school system. It explores behavioral symptoms, and provides practical suggestions on strategies and instructional adaptations in the classroom. Topics covered include side effects of medication and their impact in the classoom, advocacy skills and locating therapeutic resources to help the student(s).
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Friday, May 28, 2010
Tuesday, May 25, 2010
“What will happen if I jump while swinging up high?” Paru asked me for the tenth time in less than five minutes.
Paru was a five year old at the summer camp. She was watching other children on the swings. “You may get hurt. It’s not a good idea to jump off the swing while it is moving,” I replied and waited for the inevitable. Half a minute later, she asked the second question, “Can I jump?”
This summer my days were filled with several such scenarios. The theme was safety and my days were spent reassuring this five year old that, yes,
a) Everyone had to follow the same safety rules and
b) we, the adults, will keep them (children) safe.
I must have answered the same questions thirty or forty times everyday!”
A young teacher trainee who lives across from my cousin’s, described her experiences with a very anxious five year old.
“As I got to know the child better, other clues stood out. It was the time of the ‘swine flu’ scare, teachers had been talking about washing hands thoroughly. Any chance she’d get, Paru would be scrubbing her hands, wanting to “wash the germs away.” I started carrying some hand lotion just for her as the skin on her hands kept peeling.
Whatever paperwork Paru did, be it drawing, coloring or writing, it had to be perfect. She was almost always the last kid to change activities because she was always ‘fixing’ her work.”
It is natural for new experiences to cause a certain degree of anxiety. But for some people (children and adults) the anxiety is so extreme that it interferes with their everyday lives.
In some children it takes the form of repetitive rituals, rigidity in the name of perfection and fear that something may happen if they don’t do tasks in a certain manner. Paru was always late in finishing her tasks because she had to get it ‘right’. Imagine going to higher classes and being late because you are trying to catch up with your previous class!
Severe anxiety affects concentration, time management, organizing, in fact all the skills which fall under executive function spectrum. It affects sleep, eating habits, self confidence and motivation.
As they grow older, children are quite good at hiding these symptoms-after all they don’t want to stand out as being different from their peers. A lot of children try their hardest to get through the school day and then fall apart at home. In these cases, parents see more behavioral problems. It misleads adults into believing that it is a ‘parenting’ problem or that the child chooses to behave well in one situation and not in the other. While some children may misbehave due to poor parenting skills, children with organic conditions don’t chose to misbehave. There is a definite lack of coping skills due to a biological condition.
Ms.S
This summer my days were filled with several such scenarios. The theme was safety and my days were spent reassuring this five year old that, yes,
a) Everyone had to follow the same safety rules and
b) we, the adults, will keep them (children) safe.
I must have answered the same questions thirty or forty times everyday!”
A young teacher trainee who lives across from my cousin’s, described her experiences with a very anxious five year old.
“As I got to know the child better, other clues stood out. It was the time of the ‘swine flu’ scare, teachers had been talking about washing hands thoroughly. Any chance she’d get, Paru would be scrubbing her hands, wanting to “wash the germs away.” I started carrying some hand lotion just for her as the skin on her hands kept peeling.
Whatever paperwork Paru did, be it drawing, coloring or writing, it had to be perfect. She was almost always the last kid to change activities because she was always ‘fixing’ her work.”
It is natural for new experiences to cause a certain degree of anxiety. But for some people (children and adults) the anxiety is so extreme that it interferes with their everyday lives.
In some children it takes the form of repetitive rituals, rigidity in the name of perfection and fear that something may happen if they don’t do tasks in a certain manner. Paru was always late in finishing her tasks because she had to get it ‘right’. Imagine going to higher classes and being late because you are trying to catch up with your previous class!
Severe anxiety affects concentration, time management, organizing, in fact all the skills which fall under executive function spectrum. It affects sleep, eating habits, self confidence and motivation.
As they grow older, children are quite good at hiding these symptoms-after all they don’t want to stand out as being different from their peers. A lot of children try their hardest to get through the school day and then fall apart at home. In these cases, parents see more behavioral problems. It misleads adults into believing that it is a ‘parenting’ problem or that the child chooses to behave well in one situation and not in the other. While some children may misbehave due to poor parenting skills, children with organic conditions don’t chose to misbehave. There is a definite lack of coping skills due to a biological condition.
Ms.S
Tuesday, May 18, 2010
Monday, May 17, 2010
Saturday, May 15, 2010
"I’ve noticed Latha has problems staying focused...
...in class since the beginning of this academic year,” the language teacher started the discussion in the teacher’s lounge. “Her assignments are late; her work is sloppy. Comparing it to last year’s performance, I think she is capable of much more! I asked her if she was all right and she mumbled. I don’t know if something is bothering her. Have any of you noticed this change in her?” she asked the other subject teachers.
Latha was actually very fortunate. Her teacher had caught on that something was not ‘right’ and paid attention to her behavior and performance. The other teachers realized Latha had similar attention related problems in their classes and her work was not up to her earlier standards. They didn’t stop with discussing it amongst themselves but contacted her parents to find out if they had noticed any change at home.
Latha’s sister was very ill and the stress was taking its toll on the whole family. The teachers met with the parents to come up with a plan to support her in school and also make accommodations for her. The parents in turn got some therapy services for Latha to help her work out the emotional stress.
In some children, such dramatic changes in performance and inability to attend or focus may not have any external factor. It can be part of the developing condition. Nevertheless, sudden changes in academic performance, ability to attend or focus in class, disinterest or resistance to participate in regular routines should make us sit up and take notice.
As always, keep parents posted on any concerns. Keep in mind that any time parents hear ‘concerns’ there is a lot of anxiety involved. Present information in a non threatening manner and state the identification/treatment as being beneficial to the child. We don’t yet have a systematic approach to identification of problems in our schools across the country. It makes parents feel that teachers complain because they don’t want to go the extra step to modify or adapt to their child. You conversation should make it clear that it is not about making your jobs easy. It is about teaching their child certain skills (emotional, social, academic…).
Ms.S
Latha was actually very fortunate. Her teacher had caught on that something was not ‘right’ and paid attention to her behavior and performance. The other teachers realized Latha had similar attention related problems in their classes and her work was not up to her earlier standards. They didn’t stop with discussing it amongst themselves but contacted her parents to find out if they had noticed any change at home.
Latha’s sister was very ill and the stress was taking its toll on the whole family. The teachers met with the parents to come up with a plan to support her in school and also make accommodations for her. The parents in turn got some therapy services for Latha to help her work out the emotional stress.
In some children, such dramatic changes in performance and inability to attend or focus may not have any external factor. It can be part of the developing condition. Nevertheless, sudden changes in academic performance, ability to attend or focus in class, disinterest or resistance to participate in regular routines should make us sit up and take notice.
As always, keep parents posted on any concerns. Keep in mind that any time parents hear ‘concerns’ there is a lot of anxiety involved. Present information in a non threatening manner and state the identification/treatment as being beneficial to the child. We don’t yet have a systematic approach to identification of problems in our schools across the country. It makes parents feel that teachers complain because they don’t want to go the extra step to modify or adapt to their child. You conversation should make it clear that it is not about making your jobs easy. It is about teaching their child certain skills (emotional, social, academic…).
Ms.S
Wednesday, May 12, 2010
“I have felt like this ever since my brother died…” the young man recounted.
“It has been seven years now. I can’t seem to shake the sadness off. It colors my every thought and activity. Some periods are worse than others… I thought I hid it very well but my family picked up on it. After repeated reminders to see a therapist, my sister made the appointment for me. I am on my way…wonder what change this will bring?”
As children grow in to teenagers, there are definitely changes in the range and intensity of emotions. Sometimes, the changes are too intense and mercurial. How do you grade ‘feelings’ as a warning sign?
Watch out for excessive feelings-sadness, anger, anxiety, fear. Is the student’s expression/reaction in proportion to the situation or is it in extremes? Sometimes these feelings are reactions to actual events-like loss of a loved one or a traumatic incident. In some children there doesn’t have to be an overt reason. There can be underlying biological factors which cause these extremes.
As children grow in to teenagers, there are definitely changes in the range and intensity of emotions. Sometimes, the changes are too intense and mercurial. How do you grade ‘feelings’ as a warning sign?
Watch out for excessive feelings-sadness, anger, anxiety, fear. Is the student’s expression/reaction in proportion to the situation or is it in extremes? Sometimes these feelings are reactions to actual events-like loss of a loved one or a traumatic incident. In some children there doesn’t have to be an overt reason. There can be underlying biological factors which cause these extremes.
Do the student’s interactions and expressions reflect poor self esteem? Does the student feel competent and productive? Or is there a sense of futility? “I am useless, everything about me, my work, etc, is useless or worthless. Nothing ever works for me…This (my life) is never going to change…I look awful…I’m too thin…I’m too fat…” These are certainly calls for help.
Tracking the student’s progress in academics/social interactions at the same time gives you credible data in talking to the parents. If parents notice these changes, it is a good idea to talk to the teachers and see if there is a similar pattern at school.
Always write significant events or behaviors down in a diary or notebook. That way, when you do seek professional help, you have the actual information with you. Memory is not perfect and you may forget small but important details.
Ms.S
Tuesday, May 11, 2010
My daughter’s school called me today,” the mother told me.
“They were concerned because she has lost so much weight in the last few months. I noticed it as well. Hearing it from her teacher reinforces my doubts. I have to take her to the doctor. This is too drastic a change and I must find out what is going on.”
Changes in eating habits maybe due to various reasons, biological or emotional. It is always a good idea to find out what is going on. Remember not to make it intrusive or punitive-especially with teenagers. Teachers who have the trust of their students will always pick up news and tidbits about their class. If they do notice something unusual or an early warning sign, they must inform the parents.
Giving parents bad news is an art in itself. It is difficult for us to hear news which opens up the unknown. When teachers express concerns, it is important not to make any diagnosis and to suggest regular pathways (‘check with doctor, monitor eating habits,’ instead of ‘see a psychiatrist’). See if you can agree to talk again in a couple of weeks to review any new information you may have. Let the parent know that you’ll be around to see if the child needs help in any other area (with friends, in class). That way if there are associated problems later, you’ve already laid a foundation and the parent is prepared for it.
Assumptions that this is just a phase and not doing anything about it only serve to push the problems underground. Being open and non-judgmental helps students come forward with their problems.
Ms.S
Changes in eating habits maybe due to various reasons, biological or emotional. It is always a good idea to find out what is going on. Remember not to make it intrusive or punitive-especially with teenagers. Teachers who have the trust of their students will always pick up news and tidbits about their class. If they do notice something unusual or an early warning sign, they must inform the parents.
Giving parents bad news is an art in itself. It is difficult for us to hear news which opens up the unknown. When teachers express concerns, it is important not to make any diagnosis and to suggest regular pathways (‘check with doctor, monitor eating habits,’ instead of ‘see a psychiatrist’). See if you can agree to talk again in a couple of weeks to review any new information you may have. Let the parent know that you’ll be around to see if the child needs help in any other area (with friends, in class). That way if there are associated problems later, you’ve already laid a foundation and the parent is prepared for it.
Assumptions that this is just a phase and not doing anything about it only serve to push the problems underground. Being open and non-judgmental helps students come forward with their problems.
Ms.S
Thursday, May 6, 2010
"Looking back, I think we started noticing the changes when my son entered eighth standard.
“Madan was always active in sports. There were some foods he didn’t like but generally he ate well. He was outgoing, cheeky and liked a bit of a dare. His progress reports from school were always positive with an occasional “Can Do Better” thrown in. But all that changed,” Mala described the onset of her son's illness. “Here, listen to me instead,” Madan took over.
“One of the first changes I noticed was in my sleep. I’d never had any problem sleeping at night. When I noticed a difference, I thought it was just the excitement of going to a new class.
Initially, I pretended to sleep when my parents were still awake. When I knew everyone was in bed, I’d stay up and read late or play on the computer. Over time I talked back when my parents asked me to turn in for the night. Then I decided I was going to do what I wanted to do and no one could stop me.
Of course I couldn’t wake up in the morning. I didn’t want the curtains drawn and my room was always kept dark. When someone did try to wake me or draw the curtains I screamed. Hey, I’m not proud of it but it worked. Some nights, I waited until everyone was asleep and left the house through the window. I’d come in the same way and no one knew.
“One of the first changes I noticed was in my sleep. I’d never had any problem sleeping at night. When I noticed a difference, I thought it was just the excitement of going to a new class.
Initially, I pretended to sleep when my parents were still awake. When I knew everyone was in bed, I’d stay up and read late or play on the computer. Over time I talked back when my parents asked me to turn in for the night. Then I decided I was going to do what I wanted to do and no one could stop me.
Of course I couldn’t wake up in the morning. I didn’t want the curtains drawn and my room was always kept dark. When someone did try to wake me or draw the curtains I screamed. Hey, I’m not proud of it but it worked. Some nights, I waited until everyone was asleep and left the house through the window. I’d come in the same way and no one knew.
Then again, I couldn’t wake up in the morning. If I did go to school, I slept through the classes. When the teachers commented slyly or tried to hold me accountable, I was often rude and mocked them. Over the next few years, I lost any fear of repercussions.
I want you to remember that I didn’t know what was happening to me. First I thought I just couldn’t go to sleep. Then I thought, “Oh it’s just my old parents imposing their rules on me.” Next I started to worry that maybe all this was wrong and I should try better. I made resolutions to go to sleep on time, get up in the morning and follow my parents’ rules. After a day or two it was back to my rules. Every now and then the ‘reasoning monster’ would trouble me but I could never sustain the effort to regulate my sleep.
What happened with my lack of sleep? I couldn’t attend school regularly. I was behind in all my subjects and eventually I gave up. I never finished high school. Much, much later, I appeared privately. I am now in college and I still struggle with my sleep. But I understand things a bit better. I watch my caffeine intake and my TV/computer time; I meditate and eat healthy. If I have difficulty sleeping for more than a few days I ask for help. I don’t always follow through but I don’t work myself into staying up in defiance.”
Ms.S
Tuesday, May 4, 2010
“What do people mean when they say this behavior is because of mental illness, that behavior is because of mental illness?"
"Is everybody mentally ill?” my mother asked me. “Isn’t there something wrong with every one of us at some point in our lives? Does that mean that all of us should be medicated, sent to therapy, or excused from some basic social expectations? That doesn't make sense to me!"
Good questions, I though. I remember in my ‘Abnormal Psychology’ classes we used to discuss all kinds of tests –IQ tests, personality tests, aptitude tests, etc. Every time something new was introduced, my friends and I would try to analyze what was wrong with us (we started out wanting to find evidence of our superior intelligence but showed up at other end of the spectrum. We blamed it on the fact that there were no IQ tests standardized for the Indian population in those days). A little bit of knowledge is a dangerous thing here.
Most of us go through rough patches-from childhood onwards. We learn from our mistakes, accept whatever well meaning support (even the back handed kind) we get without too much damage and promise ourselves that next time, we’ll be able to handle the problem much better. Some people build defenses that help avoid the trouble or the pain. But are we all certifiable? (If you look on the net, it certainly seems like it).
Children are very resilient. Does that mean we let them get on with it? No!
Good questions, I though. I remember in my ‘Abnormal Psychology’ classes we used to discuss all kinds of tests –IQ tests, personality tests, aptitude tests, etc. Every time something new was introduced, my friends and I would try to analyze what was wrong with us (we started out wanting to find evidence of our superior intelligence but showed up at other end of the spectrum. We blamed it on the fact that there were no IQ tests standardized for the Indian population in those days). A little bit of knowledge is a dangerous thing here.
Most of us go through rough patches-from childhood onwards. We learn from our mistakes, accept whatever well meaning support (even the back handed kind) we get without too much damage and promise ourselves that next time, we’ll be able to handle the problem much better. Some people build defenses that help avoid the trouble or the pain. But are we all certifiable? (If you look on the net, it certainly seems like it).
Children are very resilient. Does that mean we let them get on with it? No!
First we should try to minimize the conditions which aggravate their problems. If we can’t eliminate the conditions which threaten their mental stability, we should support them through that period. That is the reason to talk openly about mental illness and to remove the stigma around it. Educating ourselves about warning signs, providing emotional support, learning about benefits and side effects of medication, strategies in schools and workplace (as they grow older)…society as a whole must be aware of these-not just families and professionals who work with children/adults with mental illness.
Mental health is a continuum…on one side the child (or adult) is productive, has positive relationships, able to handle change/stress/challenges. One of my friends who has Bi Polar Disorder says it must be like attaining self awareness through meditation-extremely fleeting:)
In the middle lies the child who faces some level of difficulty-unable to function to the best of her ability-socially, intellectually and unable to adapt to circumstances smoothly. With timely support, the child can learn to deal with the problem at that moment but also retain those coping skills for other times. No guarantees in life, right?
For some children (and adults) the need is more complex. The difficulties are present for a significant period of time. The intensity is such that it causes emotional pain and an inability to function within normal parameters. This pain and dysfunction over a significant time frame classifies it as more than a problem, as an illness. The key is that a person’s normal everyday functioning is affected.
In my case, cleaning carpets with a toothbrush is relaxing (because it feels very clean to me) but I can get by with a vacuum cleaner. On very hectic days, I don’t even think about cleaning the carpet.
Describing someone’s behavior as ‘mental, demented, loose, and mad’ are insulting and offensive-not because it is politically incorrect but because it is lacking in human dignity.
Mental health is a continuum…on one side the child (or adult) is productive, has positive relationships, able to handle change/stress/challenges. One of my friends who has Bi Polar Disorder says it must be like attaining self awareness through meditation-extremely fleeting:)
In the middle lies the child who faces some level of difficulty-unable to function to the best of her ability-socially, intellectually and unable to adapt to circumstances smoothly. With timely support, the child can learn to deal with the problem at that moment but also retain those coping skills for other times. No guarantees in life, right?
For some children (and adults) the need is more complex. The difficulties are present for a significant period of time. The intensity is such that it causes emotional pain and an inability to function within normal parameters. This pain and dysfunction over a significant time frame classifies it as more than a problem, as an illness. The key is that a person’s normal everyday functioning is affected.
In my case, cleaning carpets with a toothbrush is relaxing (because it feels very clean to me) but I can get by with a vacuum cleaner. On very hectic days, I don’t even think about cleaning the carpet.
Describing someone’s behavior as ‘mental, demented, loose, and mad’ are insulting and offensive-not because it is politically incorrect but because it is lacking in human dignity.
Ms.S
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