Understanding & Accommodating Students with Depression

2. Understanding & Accommodating Students with Depression In the Classroom

3. Overview • What is Depression? • The Alarming Statistics. • Criteria for DSM-IV Diagnoses. • What are common causes of Depression? • Characteristics of Depression in Children? • What Teachers Need to Know • Common Strategies & Interventions for Students with Depression • Accommodations for Students with Depression • Treatment Options for Children

8. History • Prior to the late 1970's the inclusion of a discussion of childhood depression in a course like this one would have been a rarity. • Many clinicians at that time seriously questioned whether children were even capable of exhibiting depressive disorders. • This notion was heavily influenced by the psychoanalytic view that, prior to adolescence, children lack the degree of superego development necessary to have true depressive disorders.

9. History • Research during the last two and one-half decades has clearly suggested that children and adolescents often display evidence of psychopathology where depression is the most prominent feature. • It is now accepted that the depressive features displayed by children/adolescents are often consistent with DSM IV criteria for Major Depressive Disorder.

10. What is Depression • Depression is a mood disorder that can begin at ANY age, characterized by persistent sad or irritable mood throughout the day. • Individuals with depression have decreased interest in daily activities. • Display decreased pleasure in previously enjoyed social interactions • Often have consistent feelings of worthlessness and guilt.

11. What is Depression • Depression usually manifests itself as: Major Depressive Disorder Multiple & severe symptoms last every day for two weeks of more. • Other children and adolescents can develop: Dysthymic Disorder Milder form of depression which lasts at least one year and impairs functioning at home and at school.

12. The onset of most mental illnesses occurs during adolescence and young adulthood. Statistics Approximately 8% of adults will experience major depression at some time in their lives. Approximately 1% will experience bipolar disorder. Mental illnesses affect people of all ages, educational and income levels, and cultures. Mental illnesses can be treated effectively. 20% of Canadians will personally experience a mental illness during their lifetime.

13. (1:00 - 6:30 min)

14. DSM-IV CRITERIA • A. Five (or more) of the following symptoms are present during the same 2-week period and represent a change from previous functioning; • At least one symptom is (1) depressed moodor (2) loss of interest or pleasure . • (1) depressed mood - most of the day, nearly every day, as indicated by subjective report or observation by others. - In children and adolescents, can be irritable mood. • (2) Diminished interest or pleasure in all, or almost all, activities - most of the day, nearly every day (as indicated by subjective account or observation made by others)

15. DSM –IV CRITERIA • 3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. • (4) insomnia orhypersomnia nearly every day • (5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). • (6) fatigue or loss of energy nearly every day

16. Depression in children and adolescents does not represent a personal weakness or a character flaw, nor is it the result of poor parenting.

17. Depression is more than just “feeling down”, having a “bad day”, or having normal reactions to a significant life event.

18. CAUSES • The causes of depression are not entirely understood, but are thought to be multi-factorial. • Studies indicate that depression is, at least in part, an inherited condition involving abnormalities in neurotransmitter functioning. • Although inheritance is an important factor in major depression, it does not account for all cases of depression. • Environmental factors may either play an important causal role or exacerbate underlying genetic vulnerabilities.

19. Some of the common causes of depression which have been identified include the following: Brain Chemistry Imbalance Genetics Female Sex Hormones Poor Nutrition Drugs, Both Legal and Illegal Circadian Rhythm Disturbance Medical Illnesses Stressful Life Events

20. Signs & Symptoms Characteristics of Depression in Children • Higher Levels of Irritability • More Somatic Complaints • Difficulty concentrating • Forgetfulness/ Memory Difficulties • Easily Irritated by Peers • Physical Look of Depression (sadness) • Planning and Organizing troubles • Heightened Sensitivity to Criticism • Less likely to Engage in Peer Activities • Incomplete Tasks • Less Alert or Attentive • Reluctance to Attend School • Attendance Issues (missed days) • Poor Performance & Follow-up

21. What Teachers Need to Know • Depression impacts many areas that affect a student`s success in school, including: • Memory • Speech • Thought • Emotions • Personality • Planning • Anxiety • Frustration • Social Interactions • Academic Achievement • Physical & Motor Activity

22. What Teachers Need to Know Teachers often miss the signs of depression in students. Depression in children is commonly seen in conjunction with anxiety disorders, attention deficit hyperactivity disorder, oppositional defiant disorder , and conduct disorder.

23. What Teachers Need to Know Schools and teachers can play important roles in the early identification, intervention, and prevention of depression in children and adolescents.

24. What Teachers Need to Know Schools can serve an important role by de-stigmatizing depression and providing information about the disorder to students and parents. For Example: Cirriculum that teaches small changes in thinking can make a big difference in mental well-being.

25. What Teachers Need to Know It is important to know that students with depression might not ask for help or assistance. Often, children believe that no one cares about them, or it can be due to their negative worldview and belief that nothing can be done to help them. Younger students with depression usually do not have the language skills or self-awareness to recognize and report their feelings of depression. Middle & High school students often lack self-awareness of their depressed mood.

26. INTERVENTIONS Common Strategies & Interventions: • Develop Clear Expectations & Guidelines for the Student • Provide Frequent Feedback • Teach Goal Setting & Monitoring • Teach Problem-Solving • Assist Student in Developing, Organizing, and Planning his or her day across a variety of domains (academic, social, personal, familial) • Modify Work Demands Based upon the Student`s Performance Levels and Stamina • Develop a Primary Contact to Assist with Coordinating Academic Responsibilities and the Intervention

27. INTERVENTIONS • Strategically Increase Opportunities for Social Interactions • Create a No Harm Contract, if necessary. • Create a Home-School Communication System to Address ¸Academic, Social, Emotional, and Adaptive-Behavior Skills • Two-way Communication with All Team members and Staff who Work Directly with the Student • Monitor Student Compliance with Medications as well as Side-Effects and Effectiveness of Treatment • Make Modifications to the Intervention when Necessary.

28. Accommodations & Modifications • If sleep disturbances are an issue, allow the student to arrive late or shorten their school day • Reduce homework and extend deadlines • Allow the student to take frequent breaks to move around to avoid sleepiness • Provide resource room assistance at the end of the day for the student to catch up on any missed work • Break large projects down into smaller pieces • Preferential seating (closer to the teacher, closer to the door, etc.)

29. Accommodations & Modifications • Coordinate coursework with other teachers • Develop a checklist to manage all school work to facilitate organization and task completion • If needed, provide the student with photocopies of class notes and audio/video tapes of class activities/lectures. • Ensure that the student is an active participant in the accommodation process • Work with a guidance counselor to match the student with a peer tutor, if needed • Know the side affects of any medication the student may be taking and accommodate those needs accordingly

30. Accommodations & Modifications • Conference regularly to help the student stay on schedule • Word banks or other devices can assist with retrieval of information from memory • Testing accommodations: extended time, alternative demonstration of knowledge, vary test format, allow student to take test later in the day • In school counseling can be provided by guidance counselor/social worker/psychologist

31. TREATMENT OPTIONS Medication • SSRIs (Selective Serotonin Reuptake Inhibitors) are the most effective drugs currently used to treat children and adolescents with major depression. Therapy • Play therapy is appropriate for children • For adolescents, CBT (Cognitive-Behavioral Therapy) has been shown to be the most effective therapy for changing negative thought patterns and behavior (Schools can use the expertise of mental health professionals such as school psychologists, social workers, and counselors in designing and implementing interventions for children with depression.)

32. Works Cited Crundwell, R.M., & Killu, K. (2007). Understanding and accommodating students with depression: In the classroom. Teaching Exceptional Children, 40,(1), 48-54. Handle with Care: Strategies for promoting the health of young children in community-based childcare. From: http://www.cmha.ca/data/1/rec_docs/121_handle_with_care.pdf http://video.google.com/videoplay?docid=-1559115186254879470 http://abcnews.go.com/Health/video/depression-children-11526380 http://www.5min.com/Video/Preschooler-Depression-516942736 http://www.youtube.com/watch?v=9L7kBM-oQ9c&feature=related http://depression.about.com/od/causes/tp/commoncauses.htm http://www.phac-aspc.gc.ca/publicat/miic-mmac/chap_2-eng.php