As a child psychologist, I deal with a lot of schools. I usually get involved for one or more of several reasons:
- a young person is having trouble attending school due to symptoms of anxiety or depression
- a young person is under-achieving in school due to some combination of anxiety, depression, problems with learning, and attentional deficits
- a young person is getting into trouble at school due to disruptive behavior and/or rule violations
- a young person is involved in problematic social interactions such as bullying or is frequently at the center of social drama.
After 20+ years in practice, I could regale you with horror stories about some of my worst experiences with schools, but I am not going to do that. Instead, I want to share some of the more positive ways in which schools have supported my child and adolescent clients. This post was inspired by a reader who wrote that she would like to learn about
. . . how schools can handle symptoms [of mental illness] in a way that respects the student, cares for the rest of the community and manages to handle it without the situation becoming punitive leading to shame for the afflicted student
Here are some examples of excellent support for students coping with mental illness.
Tricia, a 5th grader who struggles with motor and vocal tics (Tourette Syndrome) as well as intense anxiety, dreads the start of school every September. Because her tics are both visible to her peers and include odd vocalizations, she fears that new classmates will think she is weird and make fun of her. In fact, kids often do express curiosity about the tics and she has been bullied on a few occasions. After an awful experience at the beginning of 4th grade, the guidance counselor at her elementary school offered to help her prepare a presentation about Tourette Syndrome (TS) for her classmates. Mr. B explained to Tricia that the students may be less likely to ask questions and tease her if they understand the symptoms better. Together, Mr. B and Tricia created a Powerpoint presentation with information about what TS is, what causes it, and how it is treated. They included in their mini-workshop time for questions. Tricia was very anxious about presenting the material to her classmates, so Mr. B sat right next to her and chimed in whenever she needed help. At the beginning of 5th grade, they tweaked the presentation and added a video about TS. Again, Tricia was nervous about making the presentation, but she did very well. Making sure that other students have accurate information about TS has not eliminated questions or negative comments altogether, but doing so has reduced their frequency. In addition, educating other students has had the added benefit of empowering a few classmates to be “allies” to Tricia. In a recent session, Tricia told me that some 6th graders were teasing her in the lunchroom, and a classmate stood up for her by saying, “You wouldn’t be so mean if you knew what I know!” Tricia plans to continue the practice of teaching her peers about TS at the start of every new school year.
Kyle is a transgender 9th grader who has a been dealing with depression, anxiety, and school avoidance for the past year. He made the social transition from female to male during the summer before entering high school. He moved from a public middle school, where his classmates had known him as a girl named Kylie, to the public high school. The students he met for the first time in high school have generally been pretty welcoming, but there have been some tense moments in class when students who knew Kyle in middle school have publicly challenged his gender. There has also been one incident of significant bullying. Personnel at Kyle’s high school have responded beautifully. When the bullying incident occurred, the offending student was suspended immediately, and his schedule was altered so that Kyle would not be in any classes with him (many times, school personnel disrupt the victim’s schedule to accomplish this goal). When classmates challenge Kyle’s gender or use feminine pronouns, every teacher has gently corrected them. There is no way to make the transition easy for a transgender student, but the faculty and administration at this particular high school are doing an amazing job of creating a safe and welcoming community for all students.
Claire is an 8th grader with a mood disorder. Mostly, she struggles with depression, but she has also experienced some episodes of hypomania. This term refers to periods of elevated or highly irritable mood, increased energy level, decreased need for sleep, impulsive and out-of-character behaviors, and rapid speech. When her mood symptoms are at their worst, she sometimes misses many days or weeks of school. Following these long absences, it is very hard for Claire to re-enter school. She feels anxious and worries about what people think of her.
Claire has attended a small independent school since 4th grade. In middle school, she has been blessed with a dean of students who understands both young adolescent development and mental illness. Here are some of the accommodations that have been offered to Claire since 6th grade:
- During absences, schoolwork is sent home and teachers communicate via email with Claire if she has questions. (There is no expectation that she will be able to get all work done independently or while her mood is at its lowest.)
- Claire receives “Incomplete” on report cards for any classes with outstanding work at the end of a marking period. Once all the work is handed in, the report cards are changed to reflect the actual grades she earned.
- After an extended absence, Claire meets with each teacher before re-entering school. The purpose of these meetings is 1) to review outstanding work, address questions about the material covered in class during her absence, and to make a plan about how she will get caught up; 2) to lessen Claire’s anxiety by allowing her to connect with the teachers and be in the building before attending a full day of school; and 3) to allow Claire to tell her teachers what, if anything, she wants them to say about her return to class. Usually, she prefers something vague such as “It’s great to have Claire back with us now that she is feeling better.”
- When Claire is in school, she checks in weekly, more often when needed, with the school counselor who communicates with me as well as the treating psychiatrist on a regular basis.
- If Claire is having a rough time during a school day, there are additional support people she can reach out to in the event the school counselor is unavailable.
These accommodations work for Claire for several reasons. First, she is a bright and motivated student who wants more than anything to live a “normal” life. She does not take advantage of the accommodations offered her; in fact, I often wish she would utilize in-school supports more than she does. Second, each school year, the dean of students and the school counselor make sure that each and every teacher understands the nature of Claire’s mood disorder and the various ways symptoms may manifest in the school setting. Finally, Claire, her parents, school personnel, the treating psychiatrist, and I are all on the same team. After 4 disastrous years in another school during which Claire’s parents felt they had to fight the administration constantly, a lot of time and energy went into building the relationships that make it possible for Claire to succeed in a rigorous academic environment despite her challenges.
For reasons of privacy, I cannot give a shout-out to the schools responsible for providing such meaningful and effective support for Tricia, Kyle, and Claire. Suffice it to say that when I am meeting a new client and I learn that he or she attends one of these exemplary schools, I know that not only will my client’s opportunities for growth and success be much greater, but my job will be much easier as well.
[Names and potentially identifying data have been changed to protect privacy.]