Parent Advocacy Series: Symptoms of common mental health disorders in school

Last week, Behind the Behavior Psychology posted another blog in the Parent Advocacy Series titled “What are Neurodevelopmental Disorders” which discussed additional classification categories of special education in schools, as well as early signs and means for support. If you would like to learn more about the special education process, as well as expectations and steps to be an advocate for your child’s needs, check out “What is the difference between an Individualized Education Program (IEP) and 504 plan in school?”  Today’s post will highlight additional symptoms, causes, and mental health concerns that could be behind your child’s behavior in school. This blog will list behaviors and symptoms to look for in the school setting and means for accessing support.

Everyone feels sad, angry, or anxious at times. For children and teenagers who are navigating both growing independence, as well as adjustment to change in the school setting, the list of stressors can go on and on. Ordinary worries, stress, or sadness may evolve into distress or impairment. This is particularly common throughout the Covid-19 pandemic when isolation, virtual learning, and other stressors simply exacerbate what is already a big transition for students. Just like caring for physical health, mental health should be addressed and supported openly as research trends show evidence of the increase in anxiety, depression, and other mental health concerns in the school setting. According to the National Alliance on Mental Illness, 1 in 6 school aged children experience mental health conditions each year, yet only half may receive any kind of treatment.

Undiagnosed or inadequately treated mental health symptoms can significant interfere with a student’s ability to learn and develop relationships in school. However, it is not always easy to detect symptoms. While schools can be a source of stress for students, they are also the frontline of early detection and ongoing support for mental health. If you recall from a previous blog, “anxiety,” or “depression,” are not one of the 13 eligibility categories for special education, despite how common these symptoms are present in school. Children who struggle with symptoms of anxiety, mood disorders, traumatic stress or other mental health disorders that are impacting their success, safety, or participation in school may be eligible for special education services under “Emotional Disability,” or other classification areas if there are co-morbid concerns impacting their learning. However, a child does not have to be found eligible for services under an Individualized Education Program (IEP) or 504 plan to access mental health support in school. Mental health providers are available to all students in school. Today’s post will highlight some common mental health symptoms, such as anxiety, depression, and traumatic stress in the school setting. Of note, this list may not capture all symptoms or mental health disorders present in school or home so please talk to your child’s psychologist or school if you have concerns.

Anxiety

Anxiety is one of the most common underlying mental health concerns behind behavior in school that may be impacting a student’s learning or relationships. Anxiety in children and teenagers can present differently, ranging from shyness, outbursts, avoidance, stomach aches, and more. The Covid-19 pandemic has increased the prevalence of anxiety in adolescents and children.  Necessary Covid-19 precautions, including lockdowns and virtual learning have unfortunately distanced students from engaging in many of the activities they loved the most. While younger children may be prone to anxiety about external things, like separating from parents, fear of animals, or something happening to a loved one, teenagers tend to develop stronger worries about internal aspects of themselves. Teenagers are tasked with navigating aspects of identity, development, as well as other school pressures that can lead to worries about how they look, their performance, or how they are perceived. Some common signs or symptoms of anxiety in school can include:

• Excessive worry about things such as school, health of loved ones, performance, social interactions, or the future.

• Frequent headaches, stomachaches, muscle soreness, or fatigue that may lead them to miss or avoid school or social activities

• High levels of distress when separating from a caregiver at school

• Difficulties concentrating in class or completing work (either long-term or after a recent change)

• Low self-esteem or feeling self-conscious in certain school situations that lead them to want to avoid

• Physiological symptoms such as a racing hart, difficulties with breathing, muscle tension, sweaty palms, or trembling hands/feet

• Recurring fears about routine parts of their daily life

• Trouble concentrating

• Irritability or withdrawal

• Drop in grades or school refusal

• Sleep disruption

• Substance abuse

Depression

Experiencing sadness, feelings of hopelessness, or moments of low mood are likely a part of every child or adolescent’s life. However, if children are feeling frequent sad moods, losing interest in previously enjoyed activities, or experiencing hopeless in situations that they may be able to change, these persistent patterns may be evidence of underlying depression. Depression can impact any person at any age, including children. In children, anxiety and depression can often go hand in hand. Similar to anxiety, symptom presentations for depression can differ from children to adolescents. However, depression in children or teenagers can often present as irritability, withdrawal, or other behaviors that may lead symptoms to go undetected or misunderstood due to challenging behavior. This is why it is important to learn what is behind the behavior, rather than simply focusing on compliance or changing it. If depressive symptoms are the reason why a student’s behavior has changed, it is important to seek appropriate treatment to address the student’s needs. Examples of how depression may present in school include:

• Loss of interest in previously enjoyed activities or school topics

• Behavioral concerns

• Increased negative self-talk about abilities or capabilities, even for previously mastered topics.

• Withdrawal from friends or previous relationships

• Feeling sad, hopeless, or irritable for the majority of the day, several days per week

• Changes in routine habits, such as appetite (eating more or less) or sleep (over sleeping or insomnia)

• Decreased energy and fatigue, even with good sleep patterns

• Engaging in self-destructive behavior or self-injury

• Increased aggression towards others

• Suicidal ideation or talking about death

Traumatic Stress

Children or adolescents can develop traumatic stress symptoms after traumatic event(s) (single or prolonged exposure) in which physical or emotional harm was threatened, witnessed, or experienced. Children at any age can develop traumatic symptoms, which may present as a short-term/immediate symptoms or develop gradually overtime with prolonged or more chronic symptoms. Traumatic stress can result from a single event in the environment, such as abuse, loss of a loved one, accident, or other traumatic event, as well as prolonged exposure to trauma such as bullying, relational conflict, racial trauma, neglect, or other events in or out of the school setting. Students with traumatic stress symptoms or Post Traumatic Stress Disorder (PTSD) might not recognize the link between their symptoms and trauma, therefore they usually require support from a mental health professional experienced in treating trauma. Students with traumatic stress symptoms need time and space to feel safe, as well as begin to learn ways to manage symptoms. Example of how trauma symptoms may present in school include:

• Hyper-vigilance or being overly alert of preoccupied in school setting

• Difficulties forming relationships with teachers or peers or difficulties establishing age appropriate boundaries

• Difficulties with self-regulation, attention, organization and other executive functions

• Negative or intrusive thoughts about performance in school

• Abrupt or gradual change in behavior

• Avoidance of people, places, things, or activities that may be triggering

How can I work with the school to support my child?

If your child is struggling with learning challenges, mental health, or behavior—gathering good information and creating a supportive network for you and your child is the first step. Talking with your child’s teachers, providers, or a mental health professional can help you gather resources, as well as connect you with professionals who can help. School-based mental health services are delivered by professionals trained in mental health treatment for students, such as a school psychologist, counselor, or social worker. If you have concerns about your child’s behavior at home or school, first request to talk with one of these professionals. As mentioned, your child does not have to have an IEP or 504 plan to access support from these professionals in school, however routine or regular services with these professionals can most certainly by implemented into a child’s educational/treatment plan.

Early identification and effective treatment can make a difference in the lives of children and families, which is why it is important to talk to your child’s school or an outside mental health professional if you start to recognize any symptoms. Schools occupy the lives of children and adolescents and while they can be a source of stress, they can also be the frontline of support for your child’s needs. Ask teachers if they have observed any of these behaviors if you have concerns. Over the last several years, schools have taken the initiative to implement necessary and additional trainings to help foster environments to support the mental health needs of student’s in school. Schools can be a wonderful place to access resources to support your child or family and they can also help connect you with outside professionals who can provide treatment for your child’s needs. Psychotherapy, medication, or a combination of both can be effective treatment options. Cognitive Behavioral Therapy conducted by a trained professional, such as a clinical psychologist, is an evidenced based treatment for anxiety and depression and is one approach to helping children and their families cope with mental health disorders. Trauma focused treatments, such as Trauma Focused Cognitive Behavioral Therapy is also an evidenced based treatment for trauma. Overall, having open communication and support across all of your child’s providers, teachers, and caregivers is important.

If you have questions about your child’s needs and how to meet them in and out of the school setting, talk about your concerns with your child’s teacher or school team to determine appropriate steps in understanding what is behind your child’s school learning difficulties and means for support. The school may recommend your child get an evaluation conducted by an outside professional to assess symptoms and determine the best treatment. You can ask directly for referrals if you are unsure where to start. You can also seek additional support from private mental health professionals, such as a licensed psychologist at Behind the Behavior Psychology, PLLC to assess your child’s needs.

*For more general information about special education eligibility, the evaluation process, or supporting your child’s mental health needs contact Behind the Behavior Psychology or follow along for more blogs!