Common Psychosocial Problems of School Aged Youth

Common Psychosocial Problems of School Aged Youth:

Developmental Variations, Problems, Disorders and Perspectives for Prevention and Treatment

Prepared by the Center for MH in Schools & Student/Learning Supports ? updated in 2018. The Center is co-directed by Howard Adelman and Linda Taylor and operates under the auspices of the School Mental Health Project, Dept. of Psychology, UCLA, Email: Ltaylor@ucla.edu Website: Feel free to copy and share this document.

Contents

Preface

Introduction: Mental Health in Schools

1

Time for Straight Talk about Mental Health Services and MH in Schools 2

Moving Forward: MH in Schools & Student/Learning Supports

4

I. Keeping the Environment in Perspective as a Cause of Commonly Identified 10

Psychosocial Problems

A. Labeling Troubled and Troubling Youth

11

B. Environmental Situations and Potentially Stressful Events

14

II. A Full Range of Programs to Address Behavioral, Emotional, and Learning 16

Problems

A. A Continuum of Community-School Programs: Primary

16

Prevention Through Treatment

B. Accommodations to Reduce Problems

19

C. Developing Systems at a School for Problem Identification, Triage, Referral, and Management of Care

27

D. Treatments for Psychosocial Problems and Disorders

29

III. Frequently Identified Psychosocial Problems: Developmental

31

Variations, Problems, Disorders, and Interventions

A. Attention Problems

32

B. Conduct and Behavior Problems

44

C. Anxiety Problems

62

D. Affect and Mood Problems

76

E. Social and Interpersonal Problems

96

IV. Increasing the School's Capacity to Prevent and Ameliorate Problems

100

A. Capacity Building for Teachers and School Staff

110

B. The Role of Support Staff

112

C. Forming Partnerships with Parents

119

D. Fostering Students' Social and Emotional Development

120

E. Student and Learning Supports: Increasing Availability and

122

Enhancing Access and Use

Preface

School systems are not responsible for meeting every need of their students. But when the need directly affects learning the school must meet the challenge.

Carnegie Council on Adolescent Development, 1989

Estimates of the number of school aged children with emotional problems vary. Incidence and prevalence figures are controversial, with estimates ranging from 2-3% to 22%. For a critique of current data, see the Center's 2018 document Youngsters' Mental Health and Psychosocial Problems:What are the Data? youthmh.pdf

The numbers increase when those referred to as at risk are included. Research suggests, however, that there are a considerable number of false positive misdiagnoses (i.e., the labeling of youngsters who do not have true disabilities/ disorders). What is clear is that schools can accomplish their goal of teaching only when they have addressed the psychosocial problems that interfere with students' learning.

In schools, youngsters with serious emotional and learning problems usually are assisted under the auspices of "special education." Of course, many students with behavior, learning, and emotional problems don't meet the criteria for special education. Their needs must be addressed through support programs and other accommodations.

This resource provides frameworks and strategies to guide schools as they encounter common psychosocial problems.

It is designed as a desk reference aid.

After an introductory overview of mental health in schools:

? Part I stresses ways to keep the environment in perspective as a cause of certain types of problems.

?Part II frames the full range of programs that allow a school and community to address psychosocial problems.

?Part III covers five of the most common "syndromes" students manifest and schools agonize over:

>attention problems >conduct and behavior problems >anxiety problems >affect and mood problems >social/interpersonal problems

?Part IV explores ways to increase a school's capacity to prevent and ameliorate problems.

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To provide a normalizing perspective, the descriptions adopted are those used in the1996 American Academy of Pediatrics' manual (The Classification of Child and Adolescent Mental Diagnoses in Primary Care --DSM-PC). This framework differentiates developmental variations, problems, and disorders in ways that provide a good basis for identifying minor developmental differences and early symptoms so that minor concerns can be prevented from escalating into major disorders. Following this discussion, the focus is on intervention -- emphasizing use of "accommodations" as a first strategy and the role of empirically supported treatments.

At the UCLA Center for MH in Schools & Student/Learning Supports, we have developed a variety of materials relevant to specific problem areas and for school improvement. See the

>Online Resource Catalogue -- . >Online Clearinghouse Quick Finds ? >Center Website Search ?

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Introduction

Mental Health in Schools

1

Time for Straight Talk about Mental Health Services and MH in Schools

When you hear the term Mental Health in Schools or School Mental Health, what comes to mind?

Probably you think about students who have psychological problems, about what services they need, and how schools don't provide enough of such services. This is not surprising given the widespread tendency for the term mental health to be thought of as referring to mental disorders/illness and for relevant interventions to be seen as services (e.g., counseling/therapy).

As a result, many well-intentioned initiatives and policy reports have focused on expanding mental health services in schools. Bluntly stated, however, advocacy for more mental health services in schools often detracts from efforts to encourage policy makers to address the full range of mental health concerns confronting school staff, students, and their families.

Our analyses of policy and practice stress understanding the following matters as key to advancing a broad approach to mental health in schools.*

? The concept of mental health encompasses a continuum of concerns ranging from promoting positive social and emotional development to treating mental disorders.

? Mental health problems are fully enmeshed with psychosocial and educational problems.

? Given the above, schools have a role to play in (a) promoting positive mental health (e.g., social-emotional development), (b) preventing learning, behavior, and emotional problems, (c) intervening as early as feasible when such problems arise, and (d) treating severe and chronic problems.

? However, since the mission of schools is education, a mental health agenda (and especially a clinical services agenda) by itself is too narrow to be a high priority for our society's schools.

Those concerned with enhancing the role of mental health in schools must guide policy makers to a clear understanding of

? the many factors that are interfering with learning and teaching

? the large number of students who are experiencing learning, behavior, and emotional problems

? the fragmented and marginalized state of affairs related to the limited set of services, programs, and initiatives currently provided as student/learning supports

? the small proportion of students reached

? the counterproductive competition for sparse resources.

All the above realities work against enhancing every student's civil right to equity of opportunity for success at school and beyond.

Given all this, it is time to focus on transforming student/learning supports. Doing so is fundamental to improving intervention effectiveness in ways that enhance equity of opportunity, promote whole child development, and engender a positive school climate. Doing so requires ending the marginalization of student/learning supports in school improvement policy and then framing and operationalizaing them as a unified, comprehensive, and equitable system that weaves together school and community resources.

2

In the process, a broad definition of mental health in schools can be embedded into a transformed system of student/learning supports. Doing so will help

? reduce the unrealistic and often inappropriate call for more and more one-on-one direct services

? counter the mistaken view that collocating community services on school campuses can ever be a sufficient approach to filling critical intervention gaps at schools and for enhancing community and home engagement

? increase classroom, school-wide, and community interventions that can reduce the need for one-on-one services

? facilitate the weaving together of school, home, and community resources to gain economic benefits and enhance outcomes

? enhance coordination and cohesion of all resources (school, community, family) intended to support young people.

The bottom line in terms of equitable policy is that we cannot continue to provide a small number of sites with a few more health and social services to establish a few islands of excellence (demonstrations, pilots) and "Cadillac models." The scale of need demands moving quickly in fundamentally new directions. With over 90,000 public schools in the U.S.A. and so many students who are not doing well, it is time to embed mental health in schools into a unified, comprehensive, and equitable system of learning supports. This will enhance the fit with the mission of schools and contribute in a powerful way to schools playing a role in fully promoting social-emotional development and comprehensively addressing barriers to learning and teaching.

*For further elaboration of these points, see

>Adelman, H.S. & Taylor, L. (2010). Mental Health in Schools: Engaging Learners, Preventing Problems, and Improving Schools. Thousand Oaks, CA: Corwin Press.

>Adelman, H.S. & Taylor, L. (2012). Mental Health in Schools: Moving in New Directions. Contemporary School Psychology.

>Embedding Mental Health into a Learning Supports Component: An Essential Step for the Field to Take Now.

>Adelman, H.S. & Taylor, L. (2017). Addressing Barriers to Learning: In the Classroom and Schoolwide. access from the Center's homepage at

>Adelman, H.S. & Taylor, L. (2018). Transforming Student and Learning Supports: Developing a Unified, Comprehensive, and Equitable System. San Diego: Cognella Academic.

>Adelman, H.S. & Taylor, L. (2018). Improving School Improvement. Free access from the Center's website at

>Adelman, H.S., Taylor, L., Mayer, M.J., & Dwyer, K.P. (in press). Intersection of School Safety, Mental Health and Wellness, and Family/Community Issues. In D. Osher, M. Mayer, R. Jagers, K. Kendziora, & L. Wood (Eds). Keeping Students Safe and Helping Them Thrive. Santa Barbara: ABC-CLIO.

and the resources cited as part of the National Initiative for Transforming Student and Learning Supports ? .

Send comments, questions, and requests to Ltaylor@ucla.edu .

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Moving Forward: MH in Schools & Student/Learning Supports

Over the last decades, research findings have made it evident that any initiative to expand the school's role in addressing mental health concerns will be marginalized if it is not fully integrated into school improvement policy and planning.

Current school policy proclaims the aim for every student to succeed, and those proposing schoolbased interventions must recognize the full implications of the word every. An intervention focus on all students requires addressing the problems of the many youngsters who aren't benefitting from instructional reforms because of a host of external and internal barriers interfering with their development and learning and that are reflected in the wide range of psychosocial and mental health concerns school must cope with each day.

Enhanced school-community collaboration is essential, but the narrow focus on expanding schoolbased mental health services (including colocating agency resources at schools) is not a viable approach. The limited impact of various initiatives to link health and social services have demonstrated this reality. Simply stated, a mental health services orientation doesn't account for the full continuum of interventions needed to promote mental health and prevent and treat psychosocial and mental health problems.

For many years, our Center's policy analyses have stressed ways to enhance the school's role related to mental health concerns by embedding mental health into school improvement policy and practice. In 2015, the Center established the National Initiative for Transforming Student and learning Supports -- see . In 2017, to more fully underscore the breadth of the work, the Center name was expanded; the name is now the Center for MH in Schools & Student/Learning Supports.

Given our expanded focus, we want to encourage Center users concerned about mental health in schools to avail themselves of a wide range of resources for addressing barriers to learning and teaching and re-engaging disconnected students. With this in mind, we are no longer updating the following Sampling of References Related to Mental Health in Schools. While the list will no longer be updated, it remains a useful resource so we are simply archiving it.

In place of such a list, we are continuously updating our online clearinghouse Quick Finds. SO ... for links to a wide range of relevant resources, we direct you to our Quick Finds. See the drop down menu at .

And when you need more, you can always do >a regular Google search ? >a Google Scholar search --

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