Transforming the School Counseling Profession, 3e © 2011 Pearson Education, Inc. All rights reserved. Chapter Sixteen Helping Students With Mental and

Transforming the School Counseling Profession, 3e

© 2011 Pearson Education, Inc.All rights reserved.

Chapter Sixteen

Helping Students With Mental and Emotional Disorders

Transforming the School Counseling Profession, 3eErford


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Helping Students

The professional school counselor’s primary responsibility is to help students learn.

The No Child Left Behind Act of 2001 and school reform movement has increased the pressure to focus on academic achievement for all students.

Environment and mental health issues affect an increasing number of children andare affecting student achievement,which makes it difficult for schools toprovide an appropriate education foreach child.



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Prevalence of Mental Disorders and Mental Health Issues in Children and Adolescents

One in five children and adolescents has a mild to moderate mental health issue; one in twenty has a serious mental or emotional illness.

Of the children, ages 9-17, who have a serious emotional illness, only 20% receive mental health services.

Children are presenting with mental health concerns at a younger age.



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Prevalence of Mental Disorders and Mental Health Issues in Children and Adolescents

(cont.)

Suicide is the third leading cause of death for adolescents after accidents and homicide.

It is estimated that 7% of adolescents who develop a Major Depressive Disorder will commit suicide and that 90% of teens who commit suicide have a mental disorder.

High incidences of violent, aggressive and disruptive behavior is another reflection of children’s emotional difficulties.



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Factors Contributing to a High Incidence of Emotional DisturbanceThree factors are related to the prevalence ofmental disorders and mental health issuesaffecting children and adolescents: 1. Environmental factors (e.g., breakdown of the

family, homelessness, poverty, violence in the community) are rising and are likely to result in an increase in mental health needs.

2. Low-cost mental health services are limited.3. Special education legislation focusing attention

on children’s special needs has increased.



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Factors Contributing to a High Incidence of Emotional Disturbance

(cont.) Children from ethnic and cultural minority groups

are at risk for mental disorders and are overrepresented in special education programs.

Children and adolescents of color have been unserved or underserved and have had their emotional difficulties overlooked or misdiagnosed.

Estimates suggest that 48% of students with emotional problems drop out of school and that students with severe emotional problems miss more days of school than those in any other disability category.

Lack of adequate community-based mental health resources puts pressure on schools to provide those services.



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The Professional School Counselor’s Role

The role of professional school counselors is in a period of transformation.

The focus has shifted from emphasis on a personal growth model that promoted individual development in the 1950s and 1960s to a more recent focus on a comprehensive developmental model with emphasis on educational goals.

There are arguments as to whether or not professional school counselors are doing enough to meet the complex needs of at-risk children.

Dryfoos (1994) envisions full-service schools where community mental health resources combine forces with school and other agencies to provide adequate mental health services for students.



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Barriers To Providing Mental Health Services In The Schools

The ability of professional school counselors to meet the needs of students with mental health issues is limited by:

Workload and non-counseling-related responsibilities

Duties beyond those described by professional standards, such as lunch duty, bus duty, after-school functions, and administrative duties.

Fragmentation and duplication of services and programs

School- and community-based services and programs often have been developed in isolation, without consideration of existing services and programs.



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Barriers To Providing Mental Health Services In The Schools

Discrepancy between the professional school counselors’ need to understand mental disorders and their knowledge base

Not all professional school counselors possess the knowledge, experience, and expertise needed to recognize the mental health needs of students.



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Current & Future Trends In The Way Services Are

Provided

Some schools have increased their use of community and private resources by hiring psychiatrists and using outside consultants to treat students.

A current service model includes professionals from different disciplines collaborating to promote mental health in children and adolescents (Flaherty et al., 1998).



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Benefits Of The Direct Service Model

Students who attend schools with fully implemented mental health programs are more academically successful and have a greater sense of belonging and safety.

Comprehensive community-based services to children cut state hospital admissions and inpatient bed days by between 39 and 79 percent and reduced average days of detention by 40 percent.

In order to maximize effectiveness, professional school counselors need to develop interdisciplinary and interagency relationships and practices.



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What Professional School Counselors Need To Know About

Mental & Emotional Disorders Professional school counselors must understand normal

social, emotional, cognitive, and physical development. In addition, they should possess knowledge about

mental disorders and mental health issues affecting youth.

Professional school counselors need to be aware of the range of mental disorders in order to identify students experiencing emotional problems, interpret diagnostic information, and recommend school-based interventions.



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What Professional School Counselors Need To Know About Mental &

Emotional Disorders (cont.) The Diagnostic and Statistical Manual of Mental

Disorders (DSM-IV-TR) contains the criteria for diagnosing disorders.

The professional school counselor generally is not expected or trained to make diagnoses.

However, they will be expected to: Identify young people in need of mental health services. Consult with other school-based mental health

professionals. Make referrals to outside community agency resources. Communicate mental health reports to school personnel

and parents.



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What Professional School Counselors Need To Know About Mental &

Emotional Disorders (cont.)

With the parent’s permission, they may be asked to provide input from the school, including observations, behavioral checklists, and samples of schoolwork.



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Multiaxial System of Diagnosis

The DSM-IV-TR uses a multiaxial approach to diagnosis to facilitate a comprehensive and systematic evaluation of a person.

Axis I: Clinical Disorders (e.g., conduct disorders, eating disorders, anxiety disorders, mood disorders, etc.)

Axis II: Mental Retardation and Personality Disorders

Axis III: General Medical Conditions Axis IV: Psychosocial and Environmental Problems

(e.g., occupational, family, or educational stressors) Axis V: Global Assessment of Functioning



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Mental Disorders In Infants, Children, & Adolescents

1. Mental Retardation

2. Learning, Motor, and Communication Disorders

3. Pervasive Developmental Disorders

4. Attention-Deficit Disorders & Disruptive Behavior Disorders

5. Eating Disorders in Children & Adolescents

6. Tic Disorders7. Elimination Disorders:

Encopresis & Enuresis

8. Separation Anxiety Disorder9. Selective Mutism10. Reactive Attachment Disorder11. Mood Disorders12. Substance-Related Disorders13. Psychotic Disorders14. Obsessive-Compulsive Disorder15. Posttraumatic Stress Disorder16. Generalized Anxiety Disorder17. Adjustment Disorders



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Mental Retardation - Diagnosis

Mental Retardation (MR) has an impact on cognitive, emotional, and social development.

MR is diagnosed from results of individual intelligence tests, such as the WISC-IV (IQ<70) and the SBIS-5 (IQ<70).

To be diagnosed as MR, onset must be prior to age 18 years, the student must possess sub-average intellectual functioning, and have impaired adaptive functioning in at least 2 of the following areas:

Communication, social skills, self-care, home living, interpersonal skills, self-direction, leisure, functional academic skills, health, safety, or work.

MR is usually diagnosed in infancy or early childhood. About 1-2% of the population is diagnosed as MR. Boys are 3 times more likely than girls to be diagnosed with MR.



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Mental Retardation - Degrees Borderline Intellectual Functioning- People with an

IQ that is in the 71-84 range and are not diagnosed with mental retardation.

Four Degrees Of Mental Retardation Mild Retardation- The IQ score is in the range of

50-55 to 70. Moderate Retardation- IQ score is in the range of

35-40 to 50-55. Severe Retardation- IQ score is in the range of 20-

25 to 35-40. Profound Retardation- IQ score is below 20-25.



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Mental Retardation - Causes Biological Causes

25-30% of people with mental retardation have biological causes.

Down’s Syndrome is a genetic type of mild or moderate retardation.

Neurological Causes Neurological causes may be associated with

more than 200 physical disorders, such as: Cerebral Palsy, Epilepsy, and Sensory Disorders.

Environmental Causes



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Mental Retardation – Intervention Strategies

Early intervention is essential. Examples of interventions:

Special education, home health care,language stimulation, and social skillstraining can have a positive impact.

Family, group and individual counseling can be effective in promoting positive self-regard and improving social, academic, and occupational skills.

Behavior modification



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Mental Retardation - Prognosis Adults with a mild level of retardation often live

independently and maintain a job with minimal supervision.

People with moderate retardation may be able to live independently in group homes.

Those with severe and profound retardation will probably reside in public and private institutions.



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Mental Retardation - Relevance To Professional

School CounselorsProfessional school counselors:

Are involved in the identification of children with mild retardation.

Help families understand and accept the diagnosis and make the transition to an appropriate school program.

Provide social skills training. Educate other students about Mental

Retardation to promote their understanding and tolerance.



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Learning, Motor Skills, & Communication Disorders

Children diagnosed with these disorders function significantly below normal expectations in a specific area, based on their age, cognitive abilities and education, as well as when their level of functioning is interfering with daily achievement.



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Learning Disabilities Learning disabilities affect approximately 10%

of the population, but are diagnosed in about 5% of students in U.S. public schools.

Common Learning Disorders include: Reading Disorder (dyslexia) Mathematics Disorder (dyscalculia) Disorder of Written Expression (dysgraphia)

These disorders are characterized by significant difficulties in academic functioning in a specific area.



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Reading Disorder Reading Disorder is diagnosed in approximately

4% of the school-age population. Approximately 60-80% are boys. Children with this disorder have difficulty decoding

unknown words, memorizing sight-word vocabulary lists, and comprehending written passages.



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Mathematics Disorder

Dyscalculia is a Mathematics Disorder in which children have difficulty with problem-solving, calculations, or both.



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Disorder of Written Expression

Dysgraphia is a disability of written expression.

This disorder is rarely found in isolation. In other words, another learning disability is often also present.

Children with this disorder have difficulty with handwriting, spelling, grammar and/or the creation of prose.



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Communication Disorders

Five Communication Disorders are identified in the DSM-IV-TR:

1. Expressive Language Disorder2. Mixed Receptive-Expressive Language

Disorder* Children who possess characteristics of disorders 1 & 2 display language skills that are significantly below expectations based on nonverbal ability and interfere with academic progress.

3. Phonological Disorder* Failure to use developmentally expected speech sounds that are appropriate for the individual’s age and dialect.



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Communication Disorders (Cont’d)

4. Stuttering* Speech fluency interferes with the child’s ability to communicate or make good academic progress.

5. Communication Disorder - Not Otherwise Specified (NOS)* NOS is the diagnosis for disorders that belong in the category but don’t fully meet the diagnostic criteria for any specific disorder.



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Learning, Motor Skills, & Communication Disorders

Approximately 35-40% of boys with Learning Disabilities have at least one parent who had similar learning problems.

Learning Disorders are associated with low socioeconomic status, poor self-esteem, depression, and perceptual deficiencies.

Children with these disorders are often unhappy in school, have negative self-images and social difficulties, and show increased likelihood of dropping out of school.

Depression, AD/HD and Disruptive Behavior Disorders will often coexist with learning disabilities.



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Learning, Motor Skills, & Communication Disorders -

Intervention Strategies Primary interventions occur at school. Children who demonstrate a significant discrepancy

between intelligence and achievement may be eligible to receive special education services.

An Individualized Education Plan (IEP) is developed. The IEP specifies areas of weakness, strategies for

addressing deficit areas, behavioral goals, and criteria for determining whether goals were met.

Motor or attention on-task behaviors are also included in the IEP.

Interventions, counseling, individualized teaching strategies and accommodations, and social skills training are also aspects included in some IEP objectives.



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Learning, Motor Skills, & Communication Disorders -

Prognosis

Learning Disorders (LD) continue to have an impact throughout adolescence and adulthood.

If left undiagnosed and untreated, LD can lead to extreme frustration, loss of self-esteem, inadequate education, underemployment, and more serious mental disorders



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Learning, Motor Skills, & Communication Disorders - Relevance

to Professional School Counselors Professional school counselors:

Serve on child study and special education committees tasked with screening and identifying children with LD.

Are often the first to be aware of how learning problems are affecting the child’s performance in the classroom, home, and with peers.

May be required by the IEP to provide individual or group counseling, help parents and children to understand and cope with the diagnosis, and implement accommodations.

Act as a consultant or collaborator in dealing with coexisting issues, such as low self-esteem.

Coordinate support groups for students with Communication Disorders.



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Pervasive Developmental Disorders (PDD)

PDD is diagnosed in approximately 10 to 20 cases per 10,000.

Males outnumber females by 2.5:1. Four PDDs are described in the DSM-IV-TR, in

addition to PDD NOS:1. Autistic Disorder2. Rett’s Disorder3. Childhood Disintegrative Disorder4. Asperger’s Disorder

Children with PDD are characterized by a flat affect, poor eye contact, language impairment, and minimal social speech. In addition, they do not seek social attention.



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Autistic Disorder

Present in 2 - 20 of every 10,000 people. Causes significant deficits in socialization,

communication, and behavior. Symptoms are evident by age three years. Mental retardation accompanies this

diagnosis 75% of the time. Ability to communicate varies. Children with this disorder do not form close

relationships with others and instead engage in repetitive interactions with inanimate objects.



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Rett’s Disorder & Childhood Disintegrative Disorder

Both disorders are: Less prevalent than Autistic Disorder. Characterized by normal development in early

childhood (5 months-4 years for Rett’s and 2-10 yrs. for Childhood Disintegrative Disorder) followed by a steady deterioration.

Rett’s Disorder Only diagnosed in females. Results in severe or profound retardation.Childhood Disintegrative Disorder Results in significant regression in at least 2 of the

following areas: Language, social skills, elimination, play and motor skills.



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Asperger’s Disorder Characterized by impaired social skills and

repetitive or stereotypical behaviors, not characterized by the delayed language development and impairment in communication skills.

Boys are diagnosed with this disorder five times more frequently than girls.



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PDD & Prognosis Autistic Disorder - Some lead independent lives;

however, 2/3 require care throughout their lives. Asperger’s Disorder- Have the best prognosis.

Many succeed in becoming self-sufficient. Rett’s Disorder and Childhood Disintegrative

Disorder- most likely these individuals will be placed in residential treatment facilities.

**EARLY INTERVENTION IS AN IMPORTANT FACTOR FOR A POSITIVE OUTCOME**



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PDD & Intervention Strategies

Special education services may include: language and physical therapy, services of neurologists, medical specialists, and behavioral therapists.

Smith (2001) suggested using Social Stories, a short story format to inform and advise the child about a situation.

Therapeutic goals may include: development of social and communication skills, enhancing learning, and helping the family cope.

Behavioral treatments have been found to be particularly effective in helping children with Autistic Disorders.

Social skills and social communication training are beneficial for children with Autistic and Asperger’s Disorder.



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PDD & Relevance To Professional School Counselors

Professional school counselors may help siblings cope, as well as help parents access supportive resources (e.g. behavioral training programs).

Professional school counselors may need to provide educators with resources as students with PDD are included in regular education classes.



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Attention-Deficit Disorders & Disruptive Behavior Disorders

These disorders have a high rate of comorbidity. Children with AD/HD or Conduct Disorder also

often have Learning Disorders.



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Attention-Deficit/Hyperactivity Disorder (AD/HD)

AD/HD is found in as many as 50% of children referred for counseling.

In 1995, public school systems spent more than 3 billion dollars for services for children with AD/HD.

AD/HD is divided into three types: Predominately Hyperactive-Impulsive Type Predominately Inattentive Type Combined Type (both of the above simultaneously)

To be diagnosed with AD/HD: Onset must be prior to age seven years Symptoms must occur in two or more settings Must interfere with social, academic, or occupational

functioning. Symptoms need to be present for at least six months



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Attention-Deficit/Hyperactivity Disorder (AD/HD) (cont.)

Symptoms may include failure to give close attention to details, difficulty sustaining attention, poor follow-through on instructions, failure to finish work, difficulty organizing tasks, misplacement of things, distraction by extraneous stimuli, and forgetfulness.

Diagnosis is made through medical, cognitive, and academic assessments, as well as through behavior rating scales and observations.



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Attention-Deficit/Hyperactivity Disorder (AD/HD) - Prevalance

Prevalence rates range from 3-7% of children. AD/HD is diagnosed in boys 2-9 times more

frequently than girls. AD/HD is diagnosed in 44% of children receiving

special education services. Girls with AD/HD had lower ratings on

hyperactivity, inattention, impulsivity and externalizing problems and greater intellectual impairment and internalizing problems than boys; however more research is needed to clarify gender differences.

High rates of diagnosis draw particular attention to the ways in which children are assessed. Diagnostic assessments remain controversial.



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Attention-Deficit/Hyperactivity Disorder (AD/HD) - Prognosis

The prognosis for treatment of AD/HD is good. Behavioral interventions have been found to

reduce off-task and distractible behaviors. In addition, psychostimulant medications are

used to help individuals with AD/HD stay on-task.



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Attention-Deficit/Hyperactivity Disorder (AD/HD) Intervention Strategies

Behavioral strategies and the use of stimulant medications are the most commonly used intervention strategies.

Behavioral strategies include developing token economy systems.

Common medications include Methylphenidate (Ritalin) and Dextroamphetamine (Dexadrine). Other medications include Adderall, methylphenidate (Concerta) and Strattera.

The goal of intervention includes staying on task, completing work, and following directions.

Social skills training programs, group therapy, and skill development are other intervention strategies.



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Disruptive Behavior Disorders

The DSM-IV-TR describes two additional Disruptive Behavior Disorders:

Conduct Disorder Oppositional Defiant Disorder (ODD)

Prevalence rates for Conduct Disorder include 6-16% of males under the age of 18 years and 2-9% of females.

Prevalence rates for ODD are 2-16%.



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Disruptive Behavior Disorders - Diagnosis

Diagnosis requires the presence of repetitive and persistent violations of the basic rights of others or violations of major age-appropriate societal norms.

Conduct Disorder can be diagnosed when the student displays:

Aggression against people and animals Destruction of property Deceitfulness or theft Serious violations of rules



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Disruptive Behavior Disorders - Conduct Disorder

Conduct Disorder is divided into childhood-onset and adolescent-onset types.

Adolescent-onset type is diagnosed when no symptoms are present before the age of 10 years.

Many children with ODD qualify for the Conduct Disorder (CD) diagnosis during adolescence and, by the age of 18 years, CD sometimes has evolved into Antisocial Personality Disorder.



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Disruptive Behavior Disorders - ODD

ODD is characterized by a pattern of negativistic, hostile, and defiant behaviors lasting at least 6 months.

Behavioral characteristics include losing one’s temper, arguing with adults, defying or refusing to comply with adults’ requests, deliberately annoying people, being angry and resentful, being easily annoyed by others, blaming others for one’s own negative behavior, and being vindictive.

ODD is correlated with low socioeconomic status and growing up in an urban location.

Symptoms usually first appear around the age of 8 years.

ODD is more prevalent in childhood in boys than girls, but by puberty equal numbers are diagnosed.



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Disruptive Behavior Disorders - Prognosis

Prognosis is best when there has been late onset of symptoms, early intervention, and long-term intervention.

An important element of successful treatment is parents’ support and participation.



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Disruptive Behavior Disorders – Intervention Strategies

Four types of intervention strategies are suggested: Individual counseling Family interventions School-based interventions Community interventions

Residential or day treatment programs are recommended when the child poses a danger to self or others.

School-based interventions may include early education, classroom guidance units, classroom instruction, home visits, and regular meetings with parents.



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Disruptive Behavior Disorders - Relevance to Professional School

Counselors

Of all the categories of mental disorders, professional school counselors will have the greatest need to be knowledgeable about AD/HD and Disruptive Behavior Disorders.

School personnel and parents may look to the counselor for guidance.

Frequently children are not diagnosed with Disruptive Behavior Disorders until they enter school; therefore, professional school counselors may need to work closely with parents to help them understand these disorders and make referrals.



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Disruptive Behavior Disorders – Research and Early Prevention

Recent studies examining the relationship between low reading achievement and Conduct Disorder with perceived school culture, self-esteem, attachment to learning, and peer approval is encouraging the development of a range of school-based and family-focused prevention programs targeting young children.

Two approaches to early prevention: Provide social skills, problem-solving, and anger

management training to the entire school population through a developmental curriculum (e.g., Second Step: A Violence Prevention Curriculum)

Identify high-risk students and provide a small group curriculum for them (e.g., Fast Track)



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Eating Disorders In Children & Adolescents

There are two disorders that can interfere with achild’s early development:1. Pica

Characterized by the ingestion of nonfood substances.2. Rumination Disorder

Characterized by persistent regurgitation and re-chewing of food.

Both Pica and Rumination Disorder are linked to children with Mental Retardation and Pervasive Developmental Disorder.



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Other Eating Disorders Anorexia Nervosa

Prevalent among adolescent girls. Rates of 0.5% - 2%. Person refuses to maintain a normal body weight. Body

weight that is 85% or less than the normal weight for the person’s age and size.

Other symptoms may include fear of becoming fat, a disturbed body image, and cessation of menstrual cycles.

Two types have been identified: Restricting Type (associated with dieting, fasting, or excessive exercise), and Binge-Eating/Purging Type (associated with binge eating, purging, or both).

85% of those diagnosed meet the criteria while between the ages of 13 and 20 years.

Physiological consequences include dry skin, edema, low blood pressure, metabolic changes, potassium loss, and cardiac damage that can result in death.



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Other Eating Disorders Bulimia Nervosa

Individuals diagnosed with Bulimia Nervosa engage in similar behavior to those with Anorexia Nervosa, but do not meet the full criteria for that disorder, usually because their weight is more than 85% of normal.

Involves an average of two episodes a week of binge eating and compensatory behavior such as vomiting, fasting, laxative use, or extreme exercise, for at least 3 months.

Physiological reactions include dental cavities and enamel loss, electrolyte imbalance, cardiac and renal problems, and esophageal tears.



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Eating Disorders - Prognosis 44% of people with Anorexia Nervosa recover

completely through treatment, 28% are significantly improved, 24% are not helped or deteriorate, and 5% die.

The prognosis for Bulimia Nervosa is somewhat better: Treatment that follows recommended guidelines can typically reduce binge-eating and purging by a rate of at least 75%. A positive prognosis is associated with good pre-morbid functioning, a positive family environment, the client’s acknowledgement of hunger, greater maturity and self-esteem, high educational level, early age of onset, less weight loss, shorter duration of the disease, less denial of the disorder, and absence of coexisting mental disorders.



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Eating Disorders –Intervention Strategies

Medical assessment Multi-faceted therapy

Behavior therapy to promote healthy eating and eliminate purging and other destructive behaviors.

Cognitive therapy to help the individual gain an understanding of the disorder, improve self-esteem and gain a sense of control.

Group therapy and family counseling to help deal with emotional difficulties.



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Eating Disorders - Relevance to Professional School Counselors

Signs and symptoms of these disorders will be apparent in school.

Prevention programs and early detection may be the best defense.

Professional school counselors may become aware of students who are regularly eating little or no lunch, engaging in ritualized eating patterns, or purging.

Working with classroom teachers, the school nurse, and parents, professional school counselors can help students and their families become aware of dangerous eating patterns and the long-term consequences of Eating Disorders.

Professional school counselors can also support the efforts of mental health therapists and help parents find resources.



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Tic Disorders The DSM-IV-TR identifies 4 Tic Disorders:

Tourette’s Disorder Chronic Tic Disorder Transient Tic Disorder Tic Disorder NOS

A tic disorder is characterized by sudden, rapid repetitive motor movements or vocalizations [i.e. clearing one’s throat, barking, coprolalia (using obscene words), palilalia (repetition of one’s words or sounds), and echolalia (repetition of what is heard last)].



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Tic Disorders (Cont’d) These symptoms are typically worse under

stress, less noticeable when the child is distracted, and diminish entirely during sleep.

More common in boys and an elevated incidence in children with other disorders such as AD/HD, Learning Disorders, Pervasive Developmental Disorder, Anxiety Disorders, and Obsessive-Compulsive Disorder.



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Tic Disorders - Tourette’s Disorder

Characterized by a combination of multiple motor tics and one or more vocal tics that have been present for at least one year.

These tics commonly interfere with academic performance and social relationships.

It is diagnosed in 4-5 children per 10,000 and tends to run in families.



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Tic Disorders - Chronic Tic Disorder & Transient Tic Disorder

Chronic Tic Disorder - Diagnosed when one type of tic, motor or vocal, has been present for at least one year.

Transient Tic Disorder - Symptoms include motor and/or vocal tics that have been present for at least four weeks, but less than a year.



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Tic Disorders - Prognosis &Intervention Strategies

Prognosis Habit-reversal techniques (behavioral interventions)

showed a 90% reduction in tics as compared to medication that showed only a 50-60% reduction.

Intervention Strategies Identification of any underlying stressors, cognitive-

behavioral method for stress management, education of children and families about the disorder, advocacy with education professionals, and collaborative work with physicians if pharmacological interventions are necessary.

Behavioral strategies (e.g. relaxation training). Social skills training. Pharmacological treatment for children who do not

respond to behavioral interventions (e.g. Haloperidol).



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Tic Disorders - Relevance To Professional School Counselors

Professional school counselors can provide sources of referral and information to parents and teachers during the diagnostic period.

Suggestions concerning classroom modifications to reduce stress, rewards for behavioral control, and adjustment of academic expectations can be facilitated by the professional school counselor.

Social skills training can be implemented to help children deal with peer relationship problems.



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Elimination Disorders: Encopresis & Enuresis

Both are characterized by inadequate bowel or bladder control in children whose age and intellectual levels suggest they can be expected to have adequate control of these functions.

These disorders cannot be associated with a medical condition. Encopresis

Voluntary or involuntary passage of feces in inappropriate places.

Diagnosis is not made in children younger than four years. Sometimes there is an association between Encopresis and

ODD or Conduct Disorder. Sexual abuse and family pressure may also be associated with this disorder.

Enuresis The involuntary or intentional inappropriate voiding of urine,

occurring in children over the age of five years. The subtype, Nocturnal Only, is the most common type. Behavioral interventions are the most successful.



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Elimination Disorders - Relevance To The Professional

School Counselor

Parents will need information and education about how to deal with these disorders.

Parents should be encouraged to rule out medical causes.

The professional school counselor can also be available to help parents cope.



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Separation Anxiety Disorder Separation Anxiety Disorder is the only anxiety

disorder diagnosed exclusively in childhood. It is characterized by excessive distress upon

separation from primary attachment figures. For diagnosis, a child needs to have 3 or more

symptoms present for at least 4 weeks and prior to 18 years of age, e.g.:

Worry about caretakers’ safety. Reluctance or refusal to go to school or be separated

from caregivers. Fear of being alone. Repeated nightmares involving separation themes. Somatic complaints.

Adolescents exposed to domestic violence and living in abusive homes are at particular risk for developing SAD.



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Separation Anxiety Disorder - Prognosis and Intervention

Strategies Prognosis

High rate of recovery with treatment. Intervention Strategies

Treatment can best be determined when the underlying cause of the disorder is understood.

This disorder is considered a sort of phobia and therefore behavioral strategies, such as systematic desensitization, are used.

Family therapy may also be necessary.



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Separation Anxiety Disorder- Relevance To The Professional

School Counselor Counselors can help parents distinguish between mild

and transient symptoms associated with difficulty adjusting to school and true Separation Anxiety Disorder.

Professional school counselors play an important role in helping to plan and implement systematic desensitization.

They can also provide parents with encouragement and support to leave their children at school, and students with the support they need to stay in school.



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Selective Mutism Characterized by a person consistently not

speaking in some social contexts, while speaking in others.

Family dysfunction is often implicated in this disorder.

97% of people diagnosed with Selective Mutism also have symptoms of Social Phobias.

A child with this disorder is often lonely and depressed and the mother is often over-involved or enmeshed with the child.



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Selective Mutism (cont.) Prognosis

Half the children treated are able to speak in public by age ten years.

Prognosis for children over the age of 10 years who still exhibit symptoms is less optimistic.

Older children are often teased by peers or inappropriately managed by teachers and therefore inadvertently encouraged to maintain the behaviors.

Intervention Strategies Behavioral interventions are designed to teach social

skills and increase communication. Play therapy can be used to help children overcome

symptoms and provide a nonverbal means of communication.

Family therapy is also helpful to address family roles.



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Selective Mutism (cont.) Relevance To Professional School

Counselors Help parents and school personnel to decide

whether a referral to an outside agency is necessary.

Part of the treatment team and help provide a safe environment.



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Reactive Attachment Disorder

Begins before the age of five years and is characterized by children manifesting severe disturbances in social relatedness.

RAD typically occurs in 1 of 2 extremes: Indiscriminate and excessive attempts to receive

comfort and affection from any available adult Extreme reluctance to initiate or accept comfort and

affection, even from familiar adults and especially when distressed

Attachments to the child’s primary caregivers have been disrupted.

Neglect, abuse, or grossly inadequate parenting is thought to cause this disorder.



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Reactive Attachment Disorder (Cont’d)

Some additional symptoms of RAD include low self-esteem, lack of self-control, antisocial attitudes and behaviors, aggression and violence, and a lack of ability to trust, show affection, or develop intimacy.

Behaviors are generally self-destructive in nature.



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Reactive Attachment Disorder (cont.)

Intervention Strategies Early intervention is key. Once the medical needs of the child are addressed,

behavior programs to improve feeding, eating, and caregiving routines can be implemented.

Relevance To Professional School Counselors Professional school counselors need to be aware of the

criteria because a connection has been found between insecure attachment and both subsequent behavior and impulse control problems and poor peer relationships in young children.

This disorder may be associated with eating problems, developmental delays, and abuse, neglect, and other parent-child problems.



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Mood Disorders Characteristics include irritability and somatic

complaints. An estimated 70% of children and adolescents with

serious Mood Disorders are either undiagnosed or inadequately treated.

Major Depressive Disorder is diagnosed in 0.4% to 2.5% of children and 0.4% to 8.3% of adolescents.

Dysthymic Disorder, a milder form of depression is diagnosed in 0.6% to 1.7% of children and 1.6% to 8% of adolescents.

Bipolar Disorder, characterized by episodes of depression and episodes of mania or hypomania is rare in children.



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Mood Disorders (cont.) Prognosis

Psychotherapy and psychoeducational interventions have been shown to be effective.

Intervention Strategies Cognitive and behavioral interventions are

emphasized. Psychoeducational programs focus on

improving social skills and encouraging rewarding activities.

The effectiveness of medications has not yet been established.



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Mood Disorders (cont.) Relevance to the Professional School Counselor

Understanding the diagnostic criteria for Mood Disorders is important so professional school counselors can distinguish situational sadness from a mental disorder.

The professional school counselor will consult with parents, teachers and other mental health professionals when working with a child who appears depressed.



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Substance-Related Disorders Children who live with parents with Substance-

Related Disorders are at a particularly high risk of developing these disorders themselves.

Substance Use Disorders Characterized by maladaptive patterns of using drugs

and alcohol. Two types of Substance Use Disorders

1. Substance Abuse - Characterized by maladaptive use of substances, leading to significant impairment or distress.

2. Substance Dependence -Often includes distress, impairment, development of tolerance, and symptoms of withdrawal.



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Substance-Related Disorders (Cont’d)

Substance-Induced Disorders Substance-Induced Disorders describe

symptoms such as intoxication, mood changes, and sleep-related problems that stem directly from maladaptive patterns of using drugs or alcohol.

Prognosis Many factors are related to a good

prognosis, such as a stable family situation, early intervention, lack of antisocial behavior, and no family history of alcohol abuse.



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Substance-Related Disorders (cont.)

Ten risk factors that predict or precipitate Substance-related Disorders (Lambie & Rokutani, 2002)

Poor parent-child relationships Mental disorders (especially depression) A tendency to seek novel experiences or take risks Family members or peers who use substances Low academic motivation Absence of religion/religiosity Early cigarette use Low self-esteem Being raised in a single-parent or blended family Engaging in health-compromising behaviors



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Substance-Related Disorders (cont.) Intervention Strategies

Prevention through substance abuse education, recognition of risk factors, and early detection and treatment are important strategies.

Accurate screening is also paramount for intervention. Treatment may include detoxification, contracting,

behavior therapy, self-help groups, family therapy, change in a person’s social context, and nutritional and recreational counseling.

Specific interventions include family intervention, remedial education, career counseling, and community outreach.

Treatment programs for youth must target the specific needs of adolescents, including level of cognitive development, family situation, and educational needs.



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Substance-Related Disorders (cont.) Relevance To The Professional School Counselor

The most dramatic increase in exposure and drug use is at 12 to 13 years of age. As a result proactive substance use education programs are necessary.

Professional school counselors have four functions when working with students with possible substance abuse issues:

Identify the possible warning signs of student substance abuse.

Work with the youth to establish a therapeutic relationship.

Support the family system to promote change. Be a resource and liaison between the student, the

family, the school, and community agencies and treatment programs.



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Psychotic Disorders Psychotic Disorders are rarely diagnosed in

children. For example, approximately 1 child in 10,000 develops Schizophrenia.

Some symptoms of Psychotic Disorder are hallucinations, loose associations, and illogical thinking.

The most common symptoms of Schizophrenia are auditory hallucinations and delusions, and illogical conversation and thought patterns.



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Psychotic Disorders (cont.) Prognosis

Prognosis is positive when Psychotic Disorders are treated with a combination of family therapy and medication.

Intervention Strategies Treatment for children and adolescents with Psychotic

Disorders should include family therapy, medication, counseling and special education.

Social skills training should be included as part of treatment. Relevance to the Professional School

Counselor It is unlikely that professional school counselors will

encounter children with this disorder. Counselors may be involved in the implementation and

delivery of special education services as part of an IEP, which may include social and emotional goals.



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Obsessive-Compulsive Disorder (OCD)

One in 200 children and adolescents meets the criteria for OCD.

Children present obsessions about germs or disease and exhibit concomitant compensatory rituals of washing or checking.

Other compulsions include touching, counting, hoarding and repeating.

The average age of onset is 10.2 years.



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Obsessive-Compulsive Disorder (cont.)

Intervention Strategies Cognitive-behavioral interventions. The primary

intervention is exposure to obsessions. Medication is also often used as part of the

treatment plan. Relevance to Professional School

Counselors Professional school counselors can provide

information about the disorder and help parents determine whether a referral is warranted.

When a diagnosis is made, professionalschool counselors can help structure theschool modifications and interventions.



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Posttraumatic Stress Disorder

Triggered by exposure to an extreme threat of death or serious injury, such as sexual abuse or a car accident.

Criteria for diagnosis include: Great fear and helplessness in response to the event. Persistent re-experiencing of the event. Loss of general responsiveness. Symptoms of arousal and anxiety such as sleep

disturbances, anger or irritability. Children may also experience nightmares.

Symptoms can be expressed both behaviorally (i.e., regressions, anxious attachment) or physiologically (i.e., headaches, stomachaches).



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Posttraumatic Stress Disorder (cont.)

Prognosis Prognosis is good with treatment. Children who perceive that they have strong

social support are able to talk about the traumatic event and feelings associated with the event, and who have safe schools and cohesive family environments have a better chance at decreasing their PTSD symptoms more quickly.



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Intervention Strategies Treatment should begin as soon as possible after the

symptoms emerge. Preventive treatment, even before symptoms emerge, is

recommended. Group intervention through critical incident stress

debriefing. The goal of treatment is to help the person access the

trauma, express feelings, increase coping and control over memories, reduce cognitive distortions and self-blame, and restore self-concept and previous level of functioning.

Group therapy with people who have had similar traumatic experiences is also beneficial.



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Therapeutic interventions should be based within the school setting only when:

Comprehensive assessment has been completed. It is determined that school-based support is the

appropriate, least restrictive level intervention. Parents have been informed of all treatment options. The child is experiencing adequate adjustment and

academic success with intervention. Consultation, supervision, and referral are readily utilized

by the professional school counselor.



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Relevance to the Professional School Counselor Provide support to students, staff, and parents in

the event of a trauma. Provide group and individual counseling that offer

accurate information, give people a place to ask questions and talk about the trauma, and screen for symptoms of PTSD.

Professional school counselors need to be aware of the differences between unhealthy and healthy responses to traumatic events, and be able to provide resources to students and families.



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Professional school counselors should have a solid working knowledge of etiological and diagnostic implications of PTSD, the therapeutic options, and ways to facilitate school reintegration of a child who has suffered a traumatic event.



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Generalized Anxiety Disorder Characterized by feelings of worry or anxiety about

many aspects of the person’s life and is reflected in related physical symptoms such as shortness of breath and muscle tension that are difficult to control.

Symptoms must persist for at least 6 months and have a significant impact on the person’s functioning.

Prognosis People who receive cognitive-behavioral therapy

show significant improvement, although few will be free of all symptoms.



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Generalized Anxiety Disorder (Con’td)

Intervention Strategies Strategies include teaching people to cope with

anxiety using procedures such as relaxation and distraction, as well as rational thinking.

Stress management techniques, such as guided imagery, yoga, diaphragmatic breathing, meditation, exercise, and systematic desensitization are also used.

Relevance to the Professional School Counselor Suggest stress management strategies. Help parents understand the disorder. Offer guidance units and small group

counseling sessions to students coping with severe anxiety, as well as workshops to help their parents.



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Adjustment Disorders Characterized by a relatively mild

maladaptive response to a stressor which occurs within three months of the stressor. Stressors may include changing schools, parental separation, or illness in the family.

Maladaptive responses may include anxiety, depression or behavioral changes.

Prognosis Prognosis is good if the disorder stands

alone.



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Adjustment Disorders (Cont’d)

Intervention Strategies Most improve spontaneously without treatment. Counseling can facilitate recovery. Teaching coping skills and adaptive strategies to help

people avert future crises and minimize poor choices and self-destructive behaviors.

A crisis-intervention model is most effective. Relevance to the Professional School Counselor

Provide students with supportive strategies required to cope with the symptoms.

Provide crisis-intervention. Help parents understand the effect the stressor is

having on their children.

Documents

Transforming the School Counseling Profession, 3e © 2011 Pearson Education, Inc. All rights reserved. Chapter Sixteen Helping Students With Mental and