Coping with the Crisis in Child Mental Health
Dr Doug Tynan Ph.D., ABPP, A.I. duPont Hospital for Children Division of Pediatric Behavioral Health
Alex Rittberg opened with a few PTA annoucements.
The PTA had given Waggie dog biscuits to all the principals who have dogs. Waggies are natural dog biscuits made by a small startup in Wilmington run by young adults with cognitive disabilities. More details on www.waggies.org. Principals without dogs were given gourmet jelly beans.
Alex asked how people heard about the meeting – BSNPTA email, PIC email, Flyers via US Postal service, word of mouth.
Dr Tynan gave two presentations and gave out one handout.
- Coping with the Crisis in Child’s Mental Health
- Supporting Children with Challenging Behavior at School: Universal and Selective Interventions
Dr. Tynan began his presentation with some startling statistics on the high rates of incidence and the low rates of treatment:
- 9-13% of children between 9 and 17 have a serious, diagnosible emotional or behavioral health disorders.
- Of the young children who show early signs of challenging behaviors, fewer than 10% receive services for the disorders.
- Of the children and adolescents with a diagnosible condition, less than a third recieve any type of treatment.
- The 20/20 problem: up to 20% of children have a diagnosible problem, only 20 of those children with a problem, receive any services for the problem. The situation has not changed since this fact was uncovered 25 years ago.
Some Reasons for Low Identification and Treatment Rates
- Because behaviors fall on a continum, it is often hard to draw the line bwtween a difficult child and one with a formal diagnosis of a behavior problem.
- In a number of studies, over 50% of the students receving special education services also have diagnosable behavior issues.
- There are differences between Psychiatric Diagnosis and Educational Classification.
Some Common Disruptive Behaviors of Childhood
- Adjustment Disorders
- Attention Deficit Hyperactivity Disorder
- Oppositional Defiant Disorder
- Conduct Disorder
- Bipolar Disorder
Many of these behavior issues have overlapping symptoms. Dr. Tynan warned against the “5 minute diagnosis”. Most often, clinicians need input from lots of different people who know the child in addition to first had observations and interviews/conversations with the patient. Also, because such high numbers (up to 50%) of students receiving special educations services also have some type of behavior issue, many diagnoses are missed altogether.
These behavior disorders have no single cause and therefore there is no single treatment to address them.
There are many risk factors: child factors, family environment, community influences. More details are provided in the presentation.
Ideally, behavior disorders are addressed with Evidence based services.:
- Services that have some research to show that they work
- Services that are implemented faithfully to the model
- Outcome data are routinely collected
- These are rare
It is useful to design supportive environments through classroom arrangement, daily schedules, help to transition, activities and expectations, visual cues. Dr. Tynana suggests to avoid clutter and disorganization or you will get cluttered and disorganized behavior.
Teach kids what to do: Follow rules, identify feelings, control anger, friendship skills, etc. Let kids help determine the rules sometimes.
In the second presentation, Supporting Children with Challenging Behaviors, Dr. Tynan went over some background on how to help create situations where better behavior can prevail. Details are in the presentation, but here are some examples:
- Dr. Tynan also suggest identifying teachable moments before bad behavior erupts. Praise for good behavior while it is happening sinks in better than scolding during inappropriate behavior.
- Teach kids what to do: Follow rules, identify feelings, control anger, friendship skills, etc. Let kids help determine the rules sometimes.
- There is a ripple effect with both good and bad behavior where situations tend to build. Postive Behavior Support (PBS) is a environemnt to encourage the good behavior and build upon it.
Helping kids understand and recognize their emotions nd the emotions of others is very important. Dr. Tynan mentioned how this all could be tied in to the curriculum, Health Class for example, so as not to take away from what the children need to learn.