Students with Mental Illness
The first part of this article covers the following mental illnesses that many students confront: Oppositional Defiant Disorder and Conduct Disorder; Anxiety and Depression; as well as Autism and Asperger Syndrome. Each of these mental illnesses is described in terms of symptoms, school-based strategies, theorists, teaching techniques and ramifications. The Individuals with Disabilities Education Improvement Act, or IDEA, is briefly introduced, along with Section 504 of the Rehabilitation Act of 1973 (i.e., Section 504) and Title II of the Americans with Disabilities Act (i.e., ADA). Finally, the conclusion explores theoretical reasons why some disorders have experienced unpredictable patterns throughout the decades.
Keywords: Autism Spectrum Disorders; Behavior Modification; Collaborative Problem Solving; Implosive Therapy; Individuals with Disabilities Education Improvement Act (IDEA); Mental Illness; Rational Emotive Behavioral Therapy; School Phobia; Systematic Desensitization
Oppositional Defiant Disorder
A child with Oppositional Defiant Disorder (ODD) demonstrates unruliness toward adults by consistently defying rules, acting in a hostile, belligerent manner, and challenging the boundaries that have been set forth by authority figures. These argumentative children have tempers that flare without provocation, and maliciously seek vengeance when they feel that they have been wronged. They are easily annoyed and proactively seek to irritate others without taking responsibility for their actions. They are obstinate, inflexible, and unwilling to cooperate with others, much less settle for a shared sense of compromise (Gomez, Burns, & Walsh, 2008; Stringaris, Maughan, & Goodman, 2010; McKinney & Renk, 2007; Nock, et al., 2007). According to the 2013 version of the Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-5), a part of the diagnostic criteria entails that they struggle in their home, school, or occupation, although they are predominantly defiant at the home among family members with whom they are most intimate.
Although not every individual with Oppositional Defiant Disorder progresses to Conduct Disorder, most teenagers with Conduct Disorder have previously been diagnosed with ODD. Thus, the incorrigible behavior evident in ODD is amplified by those who display Conduct Disorder, and often becomes violent. Indeed, either physical acts of aggression toward people or animals as well as verbally antagonistic threats and bullying behavior are common Conduct Disorder manifestations. Fights are frequently instigated by these teenagers, who wield guns, knives, broken bottles, and other dangerous weapons in such altercations. Thievery, deceit, the purposeful defacement of public property (e.g., vandalism, fire-setting), coercing others into sexual activity against their will, and serious violation of the rules before the age of 13-such as running away from home, truancy, and staying out all night are further characteristics (Maughan, et al., 2004; Olsson, 2009; Rowe, et al., 2010).
An educational strategy that works for students with both ODD and Conduct Disorder includes behavioral modification programs, which offer highly structured and consistent techniques. Such programs are usually constrained in nature, in that they sequester problematic students from the general education environment in order to protect against unwarranted harassment and bullying (Webster-Stratton, Reid, & Hammond, 2004). This arrangement also provides the affected students with individualized care amid a setting with low teacher-student ratios (Toolan, 2008). Insubordinate kids are typically starved for rules, boundaries, and limitations, despite the fact that they might outwardly reject and constantly test the restrictions that such programs set, and do well when defiant deeds are met with fair, unswerving consequences that justly reflect the behavior at hand. Helping students identify the specific triggers that elicit upsurges of volatile responses is a preemptive and thought-provoking first step in reversing unhealthy levels of anger. This should be followed by close deliberation about their bodily responses, problem-solving skills training, definition of the problem, identification, reflection of choices, and role playing. Scenarios conducive for role plays include the following prompts, which should be followed by students' responses:
- Another child stole my Game Boy…
- My sister broke my Xbox…
- Another child stole my money…
- Another child hit me (Cook, 2005, p. 5).
Also, the use of behavioral contracts is a widely-held approach in many schools, which helps redirect the conduct of rowdy youngsters by offering a series of rewards that accompany the positive strides that they accomplish (Ruth, 1996). This is the more common methodology over the deduction of points due to bad behavior, since the philosophy of most behavioral modification approaches assert that positive feedback yields positivity and criticism breeds retaliation among disruptive students (Cook, 2005). Through behavioral contracts, desirable behavior is tracked alongside a measuring device, such as a weekly calendar in which students receive X amount of stickers for achieving their specified feats, and the designated accumulation of such accomplishments warrants an ultimate reward. Some, however, argue against behavioral contracts because they seem to 'bribe' students into acting appropriately in return for highly coveted stickers, free homework passes, or pizza socials as opposed to modifying behavior for more intrinsic reasons.
Collaborative Problem Solving
Ross Greene has penned several books including The Explosive Child (2010) and Lost at School (2009), which target children with ODD, Conduct Disorder, and other behavioral and emotional disorders. According to Dr. Greene, today's society properly identifies and manages children who have learning disabilities, such as dyslexia. Similarly, he emphasizes that children who act inappropriately should be regarded as having a behavioral disability in which they are unable to incorporate the interpersonal rules that govern specific social spheres, and should be granted the same amount of services that other children receive. Like those who suffer from dyscalculia (the inability to comprehend mathematics), behaviorally disabled children may be deficient in flexibility, problem solving skills, patience, and compliance.
Dr. Greene consequently developed a construct entitled Collaborative Problem Solving (CPS), which is a model that can be used to broach this challenging phenomenon. He alleges that there are currently three tactics that can be drawn upon in a school environment that enable children to adapt to systematic educational and behavioral guidelines. Most schools adopt Plan A, which follows a "Do as I say" philosophy whereby children are expected to blindly accept the series of policies and conventions found within each particular establishment. In Plan C, Dr. Greene describes a dynamic in which the teacher feels hopeless about a child's ability to adequately retain the regulations, and therefore simply "gives up" on the child. Plan B, however, is the route that Dr. Greene encourages through CPS, which embraces three main components, the first of which involves the teacher making observations from the child's perspective about the immediate problem. For example, the child might say that he gets bored during lessons and wants to fulfill his own particular agenda. The second component of Plan B involves that the teacher reveals his requests, which may include a safe learning environment that is conducive for each member of the class. The third component consolidates the desires of both parties together to formulate a plan that is mutually agreed upon. For example, a child who listens attentively, but when becomes restless is allowed to venture toward another part of the room and quietly read a book rather than agitate his peers (Greene, 2009; Greene, 2010).
Anxiety is a condition whereby people feel an overwhelming sense of fear, either in a generalized sense in which the exact cause cannot be pinpointed, or in response to a specific trigger. Anxiety-stricken individuals may constantly feel "wound up," both in terms of the flood of apprehension that encompasses their mind, as well as the demonstrations of physiological tension such as muscle contractions, or an inability to sleep/concentrate. There are a myriad of physiological symptoms that accompany anxiety including but not limited to: rapid heartbeat, chest pain, nausea, hot flashes, shortness of breath, and a shaky, trembling comportment. Not surprisingly, a byproduct of such internal turmoil is irritability, undue exhaustion, and an impaired ability to properly uphold daily responsibilities (Andrews, et al., 2010). There are many diagnostic categories that fall under the umbrella of anxiety disorders, such as Obsessive-Compulsive Disorder, Social Anxiety Disorder, Posttraumatic Stress Disorder and Social Phobia.
One of the ways a social phobia might materialize for children and adolescents is through a school phobia (Csoti, 2003). Although it is not considered a formal diagnosis, school phobia is demonstrated by persistent, irrational fears associated with any aspect of the educational arena. Children who are reticent about leaving their caregivers do not qualify for this grouping since their symptoms likely fit the criteria of another anxiety subset called Separation Anxiety. School phobias, therefore, may be prompted by unknown circumstances, or they may circulate around an event during which the student felt socially or academically shamed. It is likely that the situation couples with other personality factors as well. For example, if a student had a particularly harsh teacher during his formative years who introduced a deep, socially phobic wound, a pertinent question would probe why that student became impaired while the remainder of the class progressed with their normal scholastic experiences. This broaches the issue that other dimensions comprise the etiology of school phobia-forces such as personality, temperament, background, and environmental influences, which also must be examined. School phobics who are consistently absent often face dire consequences, as they lag behind in both their academic lessons and socialization, and run the risk of encountering problems such as the attention of truant officers or even legal quandaries.
Although Major Depressive Disorder will be discussed here, the DSM-5 lists several specific types of Mood Disorders including Dysthymic Disorder, Bipolar I and Bipolar II, Cyclothymic Disorder, and Major Depressive Disorder ("Understanding," 2009; Zimmerman, et al., 2010). Depression is marked by a profound sense of sadness and a loss of interest in everyday activities that had once been pleasurable. Depressed persons often deviate from their normal weight, with either a noticeable weight gain or loss since this debilitating condition either renders them unable to maintain a balanced sense of food intake or leaves them too desolate to tend to their dietary needs altogether. Interference in sleep patterns is also common, in that people with depression either find themselves in a deep slumber for the majority of the day or suffering from cruel, insomnia-ridden nights. Further symptoms include feelings of unworthiness and guilt, hopelessness and helplessness, an inability to concentrate on daily tasks, and suicidal ideations.
One potential solution to school phobia is the use of systematic desensitization (Egbochuku & Obodo, 2005; London, 2009), which would likely require the service of a non-school based counselor. Systematic desensitization operates from the principle that people with specific, illogical fears often go to great lengths to avoid the stimuli that prompts their excessive angst. For example, people who suffer from pteromerhanophobia or aviophobia (fear of flying) might be paralyzed with anxiety when confronted with the notion of sky travel. Long-distance trips are avoided and alternate routes are inconveniently mapped out, and this avoidance undoubtedly limits their lifestyle. The avoidance also fuels the phobia. The process of systematic desensitization first introduces these individuals to the idea of flying intellectually, in a relaxed environment, and then gradually increases the dosage into more tolerable realms.
For example, the therapeutic trajectory for a patient with this phobia might include the following:
- Talking about flying;
- Looking at pictures of people flying;
- Conducting interviews with pilots and flight attendants who fly for a living;
- Visiting aircraft museums and touching the planes;
- Sitting in an airplane;
- Going on a short-distance plane ride.
The philosophy is that taking a slow-to-warm-up stance helps to steadily diffuse the fear, and eventually alleviate it altogether. In the instance of school phobia, the same therapeutic principles apply to fearful students, in that they might initially talk about their fears, and then progressively increase their exposure to school-based activities. They might take a series of "field trips" to their source of trepidation; first to the neighborhood that houses the school, then to the playground and after-school events, followed by the engagement in an abbreviated school day, which will prepare them to finally immerse themselves in their regular schedule.
A related strategy that can be applied toward school phobics is called implosive therapy, in which the therapist incites strong emotions within the student by focusing on worst possible case scenarios that they might encounter (Spiegler & Guevremont, 2009; Troester, 2006). They talk about the possibility of failing courses, being shamed by teachers, and encountering awkward social situations such as falling in the middle of the cafeteria and being ridiculed by classmates. The rationale behind this approach is that these situations do in fact occur from time to time; denying their potential existence makes the eventual mishap that much more tragic, and reinforces students to recoil into their insulated comfort zones. Furthermore, through the process of implosive therapy, the student can examine the intimidating after-effects of these situations in an innocuous environment and experience firsthand that life does, indeed, move forward despite undergoing periodic bouts of humiliation.
Additional courses of action that may be taken with a school phobic includes enlisting the student in group therapy (Bostick & Anderson, 2009), which is favored over individual sessions since it mandates cooperative participation amongst one's peer group, as well as allowing the student to take a "time out" when overwhelmed, in which case he would be permitted to leave the classroom and proceed to a trusted place where he could discuss his problems, such as the counselor's office. Finally, short-term tactics that alleviate the school phobic's immediate problems include receiving home-bound instruction and/or participation in online activities. Generally these modalities merely serve as band-aids that cover the student's initial duress without delving beneath the surface to investigate and relieve causal factors.
Cognitive-Behavioral therapies are renowned for making significant improvements in the lives of depressed...
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