1. Are you a teacher or a therapist? Understanding and managing emotional problems in the classroom 9 th Annual Western Regional Student Assistant Conference Ogden, Utah Douglas Goldsmith, Ph.D. Executive Director The Children’s Center

2. Unmet Mental Health Needs While as many as 13.7 million of the nation's children have a diagnosable mental illness, only about one-third of these children receive mental health services. Even though advances have been made in treatment development for some childhood disorders, the prevalence of child and adolescent mental illnesses, the usage rates of mental health services, and the gap between them have remained essentially the same for almost 15 years. Whitehouse Conference on Mental Health (1999)

3. Unmet Mental Health Needs In the United States, one in ten children and adolescents suffer from mental illness severe enough to cause some level of impairment (Burns, et al., 1995; Shaffer, et al., 1996). Yet, in any given year, it is estimated that about one in five of such children receive specialty mental health services (Burns, et al., 1995). Whitehouse Conference on Mental Health (1999)

4. The road to detention There is broad evidence that the nation lacks a unified infrastructure to help these children, many of whom are falling through the cracks. Too often, children who are not identified as having mental health problems and who do not receive services end up in jail. Whitehouse Conference on Mental Health (1999)

5. Who is responsible? Responsibility for mental healthcare is dispersed across multiple settings: schools, primary care, the juvenile justice system, and child welfare. But the first system is the family

6. Consequences of Behavior Problems In the United States, children's (ages 1-19) emotional and behavioral problems and associated impairments are most likely to lower their quality of life and reduce their life chances. No other set of conditions is close in the magnitude of its deleterious effects on children and youth in this age group. Children with these disorders are at a much greater risk for dropping out of school and of not being fully functional members of society in adulthood. Surgeon General’s Report on Mental Health (1999)

7. Outcomes of ED Learning disabilities and speech and language handicaps account for the majority of the 11% of school age children in special education. Fewer than 1% of children are found eligible in the school category of emotional disturbance. Compared to children in the two largest categories of special education (LD and SL) who are mostly mainstreamed (over 80%), fewer than half the children under the ED category are mainstreamed. Surgeon General’s Report on Mental Health (1999)

8. From recognition to treatment Before these children got into special education: Parents reported recognizing a problem at a mean age of 3.5. Outside agency records (e.g., discipline referral, prescription medication) indicated problems at a mean age of 5 (i.e., kindergarten) The first documented intervention involving some sort of pre-intervention was at age 6.5. The first eligibility for special education was at about 7.8 years (i.e., toward the end of second grade) In more than 50% of the cases, these children were placed in the category of LD, not in the category of ED. These children finally got the right services at age 10.

9. Utah Statistics Every month in Utah: –12 youth 1-19 die as a result of injury –14 teens attempt suicide –77 teens 15-17 give birth –1048 children are abused or neglected –487 domestic violence cases appear in court –80,892 children live below the poverty level Utah Children 2005

10. Abuse & Neglect Abuse and neglect cases under 18 –2004 - 12, 582 Juvenile violent crime –2003 - 13, 787 Substance abuse offences –2003 - 12, 324 Domestic violence –2003 - 5, 846 Utah Children 2005

11. Sexual Activity Chlamydia Cases –1997691 –20031,207 Utah Children 2005

12. What is the average child thinking about in class? Divorce issues Witnessing domestic violence Physical/Sexual abuse After-school issues Parental unavailability Peer issues – bullying Drug abuse Etc., etc. etc.

13. Prevalence of Mental Health Issues ADHD –7-8% of children –3:1 males to females Co-morbid disorders –Oppositional Defiant Disorder 40-70% –Conduct Disorder 20-56% –Anxiety Disorder 18-30% –Major Depression 10-40% –Bipolar Disorder 6-10% Barkley 2005

14. Psychiatric Disorders in the Classroom ADHD Anxiety - Masked Anxiety Depression Obsessive Compulsive Disorder Bipolar Disorder Post Traumatic Stress Disorder Autism Spectrum Disorder

15. A brief introduction to attachment theory

17. The Attachment Relationship “Almost every infant will develop an affective tie with a caregiver, and will endeavor to use that caregiver as a source of comfort and reassurance in the face of challenges or threats from the environment” Weinfield, Sroufe, Egeland & Carlson, 1999

18. Almost every child will develop an affective tie with a teacher, and will endeavor to use that teacher as a source of comfort and reassurance in the face of challenges or threats from the classroom

19. Development of Attachment Biological process Recognition of the caregiver Utilization of the caregiver as a “haven of safety” and a “secure base” in order to explore the environment

20. Secure Base The infant returns to the secure base for protection and comfort in the light of any threatening or distressing event

22. Secure Attachment The caregiver is perceived as a reliable source of protection and comfort

23. February 2005

24. Teacher’s Pests Helicopter Parents – the hovering parent gets in the way of self-reliance Monster Parents – the lurking parent who is always looking for reasons to disagree Dry-Cleaner Parents – drop off their kids and want them cleaned up by the end of the day

26. Attachment Concepts Always be bigger, wiser, and kind Set and maintain limits Nurture, nurture, nurture See emotional outbursts as need for emotional repair Help children learn to regulate their emotions Let them know that they are important to you

27. We must always keep our demands and expectations in balance with the capacity of the individual child