Mental Health and Students with Disabilities

Better Pathways

Stakeholder

Conference 2012

Dr Julie McMillan &

Dr Jane Jarvis

Flinders University

Aims

0Review current research related to mental health in school-aged children and young people with disabilities – focus on schools

Prevalence of dual diagnosis Understanding disability as a risk factor for mental

health difficulties Primary prevention and intervention approaches for

students with disabilities

Students with disabilities are not a homogeneous group.

Mental Health

0World Health Organization (2005): “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (p.1).

0Mental health is more than simply the absence of disease or identified difficulties.

0 1 in 5 adults will experience a mental illness.

0 (1 in 4 to 1 in 5 children and young people)

Disability

(a)  total or partial loss of the person's bodily or mental functions; or(b)  total or partial loss of a part of the body; or(c)  the presence in the body of organisms causing disease or illness; or(d)  the presence in the body of organisms capable of causing disease or illness; or(e)  the malfunction, malformation or disfigurement of a part of the person's body; or(f)  a disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction; or(g)  a disorder, illness or disease that affects a person's thought processes, perception of reality, emotions or judgment or that results in disturbed behaviour

Disability Discrimination Act 1992

1 in 12 Australian children (8.3%) aged 0-14 have a disability (2003 data)

Disability and Mental Health

Kidsmatter Primary Mental Health InitiativeIn South Australia (2007/2008):0Students without a disability had a 1 in 8 chance of

having mental health difficulties0Students with one identified disability had a 1 in 3

chance of having mental health difficulties0Students with multiple disabilities had a 1 in 2

chanceDix, K., Shearer, J., Slee, P., & Butcher, C. (2010). KidsMatter for students with a disability: Evaluation report. Retrieved from http://www.kidsmatterprimary.edu.au

Intellectual Disability & Mental Health

057% of people with intellectual disability also had a psychiatric disability

0Young people with an intellectual disability manifest behaviours and experiences which may be indicative of mental illness 3 to 4 times more than that of typically developing peers (Sturgeon 2007).

0Learning difficulties at school were experienced by 84% of students with ID (ages 5-14)

028% of students with ID did not receive any specialist support in school

2008 Report: AIHW Disability in Australia: Intellectual Disability

Disability & Mental Health

0 Around 63% of children with a disability experienced difficulty at school

learning difficulty fitting in socially communication difficulties0 Learning difficulties were experienced by 60% of students

whose main disability was psychiatric0 43% of students with disabilities did not receive any kinds of

specialist support in school – almost half of those students experienced learning difficulties

Australian Institute of Health and Welfare Report on Children with Disabilities (2006)

Disability and Mental Health

0Special education service delivery rates in juvenile detention settings are as high as 7 times the rates in public schools settings

0Detained and committed youth experience higher rates of academic underperformance, school failure, and identification of mental health needs than peers in the community.

Krezmien, Mulcahy & Leone (2008)

0Students with disabilities over-represented in homeless youth, and in youth suicides (Siegel et al.)

Young People with Disability

Less likely to:0Be employed – especially full-

time0Maintain employment0Access post-school education0Be a wage or salary earner0Be married

Bullying and Ostracism

0 Being bullied has been shown to increase students’ risk for academic and emotional problems

0 Study of 8-17 year olds with special needs (including autism, ADHD, learning disability, and medical illnesses)… being bullied and/or ostracized were the strongest predictors of depressive symptoms (American Academy of Pediatrics)

0 Students receiving special education services for behavioural or other disabilities are more likely to be bullied, and more likely to bully others, than are students from the general population (Swearer et al., 2012). This was more pronounced in students with obvious or observable disabilities.

0 Children entering grade 1 with symptoms of anxiety and depression or aggression are at risk of being chronically victimised by classmates by grade 3 (Leadbeater & Hoglund, 2009).

Building Competence

Executive Function0 “the supervisory and self-

regulatory functions that organise and direct cognitive activity, emotional response, and overt behaviour” (Gioia et al., 2002, cited in Meltzer, 2005)

0 “a collection of inter-related processes responsible for purposeful, goal-directed behaviour” (Meltzer)

0 This is an area of particular difficulty for many students with learning disabilities

0Planning0Organising0Prioritising0Shifting0Memorising0Checking0 Inhibiting0Regulating

Building Competence

Resilience0 Resilience refers to a set of competencies and dynamic

processes that enable individuals to adapt in the face of adversity (Masten, 2001).

0 The traditional concept of resilience focuses on at-risk individuals coping with conditions of significant hardship

0 However, more recent primary prevention efforts in schools aim to build associated competencies such as self-efficacy, problem-solving skills, and self-regulation in populations of young people even where identified risk or extreme adversity has not been identified.

Building Competence

Self-Efficacy0 Self-efficacy is the belief that one has the capacity

to exert control over his or her actions and environment to achieve a particular result or effect.

0 Bandura (1994): the “most effective way of developing a strong sense of efficacy is through mastery experiences” (p.2), whereby the individual feels the effects of his or her personal agency or control.

0 This means that the student needs to encounter learning tasks that enable success/mastery

through personal effort.

Building Competence

A ‘Growth’ Mindset0 “While not denying biological contributions to emotional

disorders, research and therapy within [the cognitive] tradition is showing, more and more, that many people with depression or anxiety disorders are victims of their maladaptive beliefs and are helped greatly when these beliefs are altered.”

Dweck, 1999, p. 144

0Both self-efficacy and the related incremental mindset are strongly associated with intrinsic motivation, appropriate goal setting, persistence, and the capacity to overcome failure and disappointment (Bandura, 1994; Dweck, 2006), all of which are important to mental health.

On Target

Too Easy I know some things

I have to think I have to work This takes

persistence I hit some walls I’m on my toes I have to re-group I feel challenged Effort leads to

success

0 I get it straight away

0 I already know how…

0 This is basic0 I’m cruising0 I feel relaxed0 I’m bored0 Success takes

very little effort

Too Hard I don’t know where to

start I can’t figure this out I’m missing key skills

or knowledge I’m running on the spot I feel frustrated I feel angry This makes no sense Effort doesn’t pay off

Adapted from Tomlinson (2006)

Vygotsky’s Zone of Proximal

Development

Anxiety & Frustration‘Learned Helplessness’

BoredomLack of engagement

Appropriate Challenge

Self-efficacy

Problem Solving

Resilience

Executive Functioning

Coping Skills

Academic Success Cycle

Effective Strategy Use

Efficient Performance

Academic Success

Self-efficacy/Positive

Academic Self-concept

Focused Effort

Adapted from Meltzer, Reddy, Pollica & Roditi (2004)

Students with learning difficulties need to be explicitly taught effective learning strategies, and then provided with opportunities to apply them to tasks that will help them experience academic success, leading to increased self-efficacy and motivation to exert effort towards future tasks.

It is important for students to understand that hard work and the use of the right strategies for the right tasks will lead to success.

Executive functioning is critical for social problem solving and emotional regulation – not just academic problem solving.

Framework for MH Promotion

17

A public health strategy for children’s mental healthWaddell, C., Hua, J., Garland, O., DeV. Peters, R., & McEwan, K. (2007). Preventing mental disorders in children. Canadian Journal of Public Health, 98, (166-173).

Universal Programs0Around 25% of children have a mental health

problem.010% fulfil criteria for mental health disorder.0Recent growth in mental health research in

schools.0Schools can promote positive mental health and

prevent disorder.0Mental health, social emotional learning,

emotional literacy, emotional intelligence, resilience, character education.

Universal Programs: Effectiveness

Internalizing Behaviour0 Impact on universal

populations was positive but small

0 Impact on higher risk children was higher; quite strong

Social Emotional learning0Small to moderate effects

Universal Programs: Effectiveness

Externalizing Behaviour0Positive but small for universal

populations. Stronger for high-risk children

0 Impact stronger for older students (CBT)

Attitudes towards school0Small to moderate

Effective Universal Programs

0Across the range of outcomes investigated, more dramatic effects were found with high-risk children.

0Greater emphasis needed to be placed on targeted approaches.

0Universal and targeted appear to be stronger in combination but optimum balance is unknown.

Targeted Programs0Most effective programs include CBT and Social skills

training for children0Training for parents and teachers in appropriate

reinforcement and better methods of discipline. 0Longer term impact when integrated into the general

classroom0Social problem solving, social awareness and emotional

literacy reinforced in the classroom in all interactions were particularly effective.

0Embedded within a whole-school, multicomponent approach (mobilizing the whole school)

Targeted & Universal

0Longer and more intensive interventions were more effective than short-term.

0Quality of intervention0 Prioritize interventions that are easier for schools to

implement WELL in their settings.0 Complete and accurate implementation is necessary to

be effective.0 Interventions are not effective if they are based on

principles only (need programme fidelity)

Overall Recommendations

0Small to moderate effects for most0Strong effects for high risk children0Particularly specific intensive interventions

0 Integrated: not taught in isolation, linked to achievement0Balance universal and targeted interventions0Robust targeted component is necessary0Teaching skills (CBT & SST)

0Start early and continue0High quality implementation0Embedded school-wide multicomponent approach

Websites

www.beyondblue.org.au Beyond Blue: The National Depression Initiative.http://www.kidsmatterprimary.edu.au “KidsMatter” national mental health program information and resources.www.mindsetonline.com More information and resources related to Carol Dweck’s work on Mindset.www.apa.org American Psychological Association. Information related to mental health and a good section on resources/ publications designed for use with children and adolescents.

References0 Bandura, A. (1994). Self-efficacy. In V. S. Ramachaudran (Ed.), Encyclopedia of human behavior (Vol. 4, pp. 71-81). New

York: Academic Press.0 Dix, K., Shearer, J., Slee, P., & Butcher, C. (2010). KidsMatter for students with a disability: Evaluation report. Retrieved from

http://www.kidsmatterprimary.edu.au0 Dweck, C. S. (1999). Self-theories: Their role in motivation, personality, and development. Philadelphia, PA: The

Psychology Press.0 Gioia, G. A., Isquith, P. K., Kenworthy, L., & Barton, R. M. (2002). Profiles of everyday executive function in acquired and

developmental disorders. Child Neuropsychology, 8, 121–123.0 Hallahan, D. P., Kauffman, J. M., & Pullen, P. C. (2012). Exceptional learners: An introduction to special education (12th ed.).

Sydney, NSW: Pearson.0 Leadbeater, B. J., & Hoglund, W. L. G. (2009). The effects of peer victimization and physical aggression on changes in

internalizing from first to third grade. Child Development, 80, 843–859. 0 Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56(3), 227–238.0 Meltzer, L (Ed). (2007). Executive function in education: From theory to practice. New York, NY, US: Guilford Press. 0 Meltzer, L. J., Reddy, R., Pollica, L. S., & Roditi, B. (2004). Academic success in students with learning disabilities: The roles

of self-understanding, strategy use, and effort. Thalamus (Journal of the International Academy for Research in Learning Disabilities), 2(1), 16-32.

0 Schwabe, L., & Wolf, O. T. (2010). Socially evaluated cold pressor stress after instrumental learning favors habits over goal-directed action. Psychoneuroendocrinology, 35, 977–986.

0 Swearer, S. M., Wang, C., Maag, J. W., Siebecker, A. B., & Frerichs, L. J. (2012). Understanding the bullying dynamic among students in special and general education. Journal of School Psychology, 50(4), 503–520.

0 Tomlinson, C. A. (2003). Fulfilling the promise of the differentiated classroom: Strategies and tools for responsive teaching. Victoria, Australia: Hawker Brownlow Education.

0 World Health Organization (2004). Promoting mental health: Concepts, emerging evidence, practice. Summary report. Retrieved from http://www.who.int/mental_health/evidence/en/promoting_mhh.pdf

0 Young, C. B., Wu, S. S., & Menon, V. (2012). The neurodevelopmental basis of math anxiety. Psychological Science, 23(5),492-501.