Please Don’t Make My Students Cry

One of my after-school students recently came home from his school in tears.  His third-grade class had watched a documentary about underwater exploration, and the idea of being stuck in a submarine had given him anxiety.  After the movie, his teacher said something about the class taking a field trip in a submarine; I wasn’t there, but I think she was trying to encourage the students to imagine going in a submarine.  My student misunderstood (probably because he was already anxious) and cried out, “Do we have to go in the submarine?”  His teacher apparently responded with something like, “[student], why are you always so scared of everything? You’re going to ruin the activity for everyone.”  According to my student, the teacher was very annoyed with him.

Again, I wasn’t there, so it’s possible that my student misinterpreted his teacher’s feelings.  He might be wrong about what she said or how she said it.  I hope he’s wrong, because the idea of an adult–a teacher–speaking that way to one of my students is very upsetting.  The idea of a teacher speaking that way to any anxious student is upsetting.  See, I would hope this teacher would be sensitive to my student’s feelings since she obviously knows that he struggles with his fears.  What she doesn’t know is that he has Generalized Anxiety Disorder (GAD), a condition “characterized by persistent, excessive, and unrealistic worry about everyday things.”  In fact, it’s very likely that this teacher doesn’t even know what GAD is; unlike depression and Obsessive-compulsive Disorder, GAD isn’t typically discussed in pop culture, and most teaching programs do not require training in psychology.

My student’s family has not disclosed his condition to his school.  They have chosen not to pursue accommodations for their son because they worry about stigma and discrimination, very real risks.

This incident inspires several questions.  First, should parents report their children’s mental illnesses to their school?  Second, was my student’s teacher out of line in her criticism of my student?  In considering that question, assume she really said what my student believes she said, and that she exhibited some amount of anger when she made those statements.  Finally, and most importantly, should all teachers be required to complete some amount of training in psychology?  Teachers are increasingly knowledgable about learning disabilities and the Autism spectrum (not knowledgable enough, many parents will say, and I agree), but childhood mental illness is largely ignored in both certification and continuing education programs for teachers.

Please share your feelings in the comments, and stay tuned for posts about disclosing your child’s mental illness and psychology training for teachers.

All stories about my students are shared with permission from the student and her/his family.

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PRESSED: Jennifer Lawrence criticizes mental illness “stigma” – Movies News – Digital Spy

Published Monday, Feb 25 2013, 6:35am EST | By Catriona Wightman |3 comments

Jennifer Lawrence has revealed that she wants to reduce the stigma surrounding mental illness.

Lawrence picked up the ‘Best Actress’ Oscar for her role as Tiffany in Silver Linings Playbook last night and later said backstage that she hopes the movie has helped to break taboos about mental health.

“I don’t think we’re going to stop until we get rid of the stigma for mental illness,” she said. “I know [director] David O Russell won’t, and I hope that this helps.

“It’s just so bizarre how in this world if you have asthma, you take asthma medication. If you have diabetes, you take diabetes medication. But as soon as you have to take medicine for your mind, it’s such a stigma behind it.”

Lawrence also joked with reporters when one journalist asked if she is worried that she has “peaked too soon” in her career, as she replied: “Well, now I am! God!”

via Jennifer Lawrence criticizes mental illness “stigma” – Movies News – Digital Spy.

Why I Love Labels, Part 1

The insert in a sample pack of Zoloft saved my life.

The Zoloft helped, too. So did cognitive-behavioral therapy, my family, and a couple great self-help books. But the first and most dramatic step away from agony and toward relief was taken the moment I read the insert beside a small cardboard blister pack.

The insert described a panic attack.

Nearly six months before I read that insert, I had my first real panic attack. An anxiety attack is different: the horror I felt when separated from my mother was emotional. Panic, alternately, is in the body. You suffocate. You trade hearts with a hummingbird. The beating isn’t heavy like when you run; it’s faster and wilder, and it hurts. It’s a punch from inside your chest, over and over and loud in your ears. Maybe sort of like drowning. And your hands fall asleep or go numb. You sweat, and you feel sick to your stomach, and you notice a million little signs of death, like how your tongue is choking you or the subtle pop of an artery exploding and wasting all your blood. Yes, there’s terror, but it’s bodily, from your core and in your veins. The fear isn’t in your mind, it’s in your brain. And, though sometimes the panic is triggered by a stalled elevator or news from North Korea, a panic attack is a narcissist. It turns you inward, dampens the world. Panic gets caught in its own reflection.

I was young, and it came without warning and then refused to leave, haunting me instead with convincing warnings about aneurysms and punctured lungs. I realized I was dying. Over and over, I realized it. The attacks, which last only a few interminable minutes, became more frequent and then constant. Eventually I was having several complete panic attacks every day, and symptoms of panic between each attack. I went to bed every night with my heart speeding and woke up every morning gasping and shaking. I never had a chance to catch my breath. I literally couldn’t get an hour of relief. It was like that for almost three months. My pediatrician, whom I begged for answers, told me it was anxiety. Ha! I knew anxiety. I’d been diagnosed with separation anxiety at five or six. This wasn’t anxiety, this was me dying! Obviously.

Finally, after a particularly awful night spent struggling to breathe, my mom took me to a psychiatrist. He listened to my symptoms and immediately identified my condition as Panic Disorder, something I’d never heard of. Medicine and therapy, he said, would fix it. I didn’t believe him, though, until he showed me the insert in the sample pack of my new prescription. It listed the symptoms of a panic attack: rapid heartbeat, feeling like you’re being smothered, dizziness, nausea, believing that you’re dying, feeling like you’re going crazy. Tingling extremities. Feeling dreamy and confused and pixilated.

My face basically exploded. “This is exactly what I have!” I said. “Every single thing on this list. All of them! Every day!”

“That’s Panic Disorder,” said the psychiatrist. And, just like that, my life was saved.

HealthyPlace Articles are Up!

If you aren’t familiar with www.healthyplace.com, it’s “the largest consumer mental health site,” and it’s a truly wonderful resource for anyone who suffers from or knows someone who suffers from mental illness. I’ve just had two pieces published on the site: tips about school refusal, and a guest blog post on their new Your Mental Health blog! Please check out both pieces, especially if you have a child who suffers from school refusal.

Thanks!

Coming soon…My Worst Teaching Mistake

Surprising Anxiety Trigger 5: Medications

A variety of medications can cause anxiety, especially in individuals with anxiety disorders. Before giving your child even over-the-counter medications, consider the risk of increased anxiety. Because the benefits of medication sometimes outweigh the side effects, it may be necessary to coach your child through her anxiety or combat the anxiety with medication prescribed by your pediatrician.

You probably already know that stimulants, like caffeine or amphetamines, can trigger anxiety. Children with ADD/ADHD are often prescribed a stimulant as treatment. Some children with comorbid ADD/ADHD and anxiety can tolerate stimulants. Other children, especially those with Panic Disorder, may experience very rapid heart rate combined with feelings of terror. Talk to your pediatrician or psychiatrist for more information.

Some cough and cold medicines, like the decongestant pseudoephedrine (Sudafed), are also stimulants. These medications can cause increased heart rate, shaking, nervousness, and anxiety. Talk to your pediatrician before giving your anxious child pseudoephedrine or similar medications, and report side effects, especially those that are severe.

Antihistamines like Benadryl (diphenhydramine) typically cause drowsiness, but some children experience a paradoxical effect and become excited or energetic. Anxiety can also occur in this situation.

If your child has asthma, you may already have noticed that his inhaler can cause shaking and increased heart rate. If your child’s asthma medication is causing anxiety, it’s important to ensure that the child is still taking the medication appropriately, in spite of his discomfort. Talk to your pediatrician, and check back for an upcoming post about asthma and anxiety.

Oral steroids, which are sometimes used to treat persistent allergic reactions* can cause anxiety and other changes in mood. A doctor should monitor your child while she is taking oral steroids.

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*like if your mosquito bites somehow lose their minds and turn your usually beautiful leg into this monstrosity…

The above medications are some of the most likely to cause anxiety, but any drug that makes a child feel “weird,” sick, “antsy,” groggy, or dizzy can inspire panic. Warn your child about possible side effects before they start, but skip mentioning any real dangers associated with the medication. Utilize relaxation techniques and distraction while your child acclimates to new medication, and, most importantly, always discuss medication changes and effects with your doctor.

Are You Prepared for the New DSM?

The Diagnostic and Statistical Manual of Mental Disorders (DSM), often called the bible of psychology, lists every official psychological disorder and includes the criteria for each disorder. It is published by the American Psychological Association (APA), “a scientific and professional organization that represents psychologists in the United States.”

Rather than focus on the experience of each disorder, the DSM exists to allow standardized* diagnosis and classification of human psychological disorders. Because psychological understanding evolves and improves (hopefully) over time, the DSM is updated as needed. The current version, published in 2000, is the DSM-IV-TR. (The “TR” stands for “text revision,” since the changes between the DSM-IV and the DSM-IV-TR were primarily related to language.) A new version of the DSM, The DSM-5, will be released this May. While you may not find yourself particularly concerned with the new DSM, The Anxiety-Free Child explains why changes can be so important:

“Although the DSM does not outline how anxiety in children or other specific conditions should be treated, it does outline what counts as an official disorder and how the disorder is classified. Classifications and definitions of mental health disorders play a huge part when it comes to insurance coverage as well as qualifications for treatment and services offered by mental health professionals, schools and other agencies.

“In other words, if you or your child’s mental health issue no longer has a valid label as per the DSM or your symptoms no longer meet the specifically defined criteria, you may no longer be eligible for treatments and coverage.”

Read The Anxiety-Free Child’s Guide to DSM-5 for a complete explanation of the upcoming changes to the DSM, including the controversial removal of Asperger’s!

*to the extent that qualitative, subjective illnesses can be standardized

Note: Fearless Learning is not affiliated with The Anxiety-Free Child and does not endorse their program. Nor do we disaprove of the program…we just don’t have an official stance at this time beyond saying you should read the above article.

Coming soon: what are the merits of labels, anyway?

NEW support group for parents of anxious kids!

Parents in the New York area: please check out Fearless Learning’s new support group, facilitated by Kiri Van Santen. Our first meeting will take place when we have enough members, so join the group now, and stay tuned for updates.

More about the group

RSVP to our first event!

Surprising Anxiety Trigger 4: Upset stomach

Welcome to part four of my Surprising Child Anxiety Triggers series!  Today’s trigger is gastrointestinal distress, or “upset stomach.”

The stomach flu is, in my opinion, the worst (non-serious) thing ever. The worst. Worse than stubbing your pinkie toe or getting ten paper cuts. Worse than reality TV. The worst. In fact, like many children with Obsessive-compulsive Disorder, many of my compulsions were done to prevent throwing up.  Gastrointestinal distress is so horrible I’ve separated it from other illnesses and given it its own post.

If an anxious child feels sick to her stomach, two separate things can cause her to panic:

First, if she’s afraid of the stomach flu/food poisoning, she’s likely to panic if she thinks that’s what’s causing her discomfort.  In fact, she might panic even if she knows she’s only sick because she ate too much or too fast, because feeling like she’s going to throw up is terrifying no matter what. (This is especially true for children who are afraid of losing control or embarrassing themselves.) If your child or student is specifically worried about GI symptoms, teach her how to minimize her risk of upset stomach by eating slowly and calmly.  A coach or a cognitive-behavioral therapist can help create a plan to help overcome fear of stomach upset.  In the meantime, have your child or student practice slow, steady breathing, and help her minimize her discomfort by addressing the possible cause.  Note: anxiety can cause or increase nausea, so address anxiety symptoms first or concurrently.

Second, like many of the triggers on this list, GI distress can mimic anxiety symptoms.   Both panic and GI distress can cause nausea, stomach pain, lightheadedness, and increased heart rate.  Anything that mimics panic can cause panic.  In part, this is because panic is terrifying, so thinking that you’re going to panic can …make you panic.  To combat this, encourage children to relax into their panic with complete acceptance.  Say, “you’re having a panic attack.  It’s very common, and it can’t hurt you.  It’ll be over soon even if you don’t do anything.”  Remind anxious children to breath slowly (without gasping or hyperventilating) and simply allow the panic to rise and then fall.  Accepting panic is extremely difficult, even for adults, but it’s extremely effective.

Coming soon: how to coach a child through a panic attack.

More in this series:
Hunger
Dehydration
Illness

Surprising Anxiety Trigger 2: Dehydration

Sometimes, late afternoon on a long day, I start to feel a little sick. I’ll notice that my heart’s beating kind of hard, and I feel a little dizzy. Maybe my hands are shaking just a little, or maybe my head hurts. Confused, I’ll struggle to identify the unpleasant but familiar sensation, and then I’ll realize–I haven’t had anything to drink all day except the milk in my morning cereal. I have a masters degree, and I sometimes forget to drink. Does your ten-year-old know the symptoms of dehydration? Whenever a child complains to me about anxiety symptoms, the first thing I do is talk them through their relaxation and coping steps, and the second thing I do is make them sllloooowwwwwlllly drink a big glass of water.

Dehydration is a serious health risk. On hot summer days or dry winter days, it’s important to encourage children to drink more than usual. Teachers should never prevent thirsty children from getting a drink of water.

The Mayo Clinic has more information about the signs and risks of dehydration.

More in this series:
Surprising Anxiety Triggers
Hunger
Illness
Upset stomach

Consistency after a Crisis

The past two weeks have been a challenge. On October 28th, a mandatory evacuation forced me out of my apartment and onto a generous friend’s couch. I packed for one or two nights: extra socks, a flashlight, a toothbrush. I expected to spend that Sunday and Monday finishing some research and maybe taking advantage of my friend’s cable, but unfortunately, the power went out on the second night. What we heard on the emergency radio I’d packed didn’t prepare us for the strange drive down to my building the following morning, or the heartbreaking images and stories that broke in the following days. Nor was I prepared, Tuesday morning, to see the extensive damage Sandy inflicted on my building. My two night sleepover turned into an indefinite and unsettling vacation spent on couches and pull-out beds.

As soon as they heard what happened, my friends and family began offering supplies, assistance, and places to stay. I’m amazed and humbled by the generosity I’ve been shown (even my credit card company called to ask if they could help!), and I’m grateful to have lost so little to the storm. My building is still uninhabitable, but significant progress has been made, and I hope to be allowed home in about a week.

Since nutrition, sleep hygiene, and exercise all have effects on mood and stress, a healthy routine is particularly important for people with mental illnesses. Unfortunately, it’s hard to keep things consistent when you don’t have a permanent place to stay.  To support my own mental wellness, I’m sleeping regular hours, eating vegetables and whole grains, and staying active. I know that my body needs these things in order to function well. Unfortunately, children and even adolescents don’t always realize the importance of routine. Further, children and teens have yet to undergo certain neurological developments that aid in self control. When a crisis or even a real vacation interrupts your anxious child’s routine, look for ways to maintain consistency. Give each day a structure. Get everyone up in the morning even if school is closed, and maintain family dinners even when staying with friends or in a hotel.  Routines are inherently comforting, and they help your anxious child see that the world hasn’t ended.