Ms. Thames watches Joanna chewing over the question about her recent drop in grades and why her behavior in class has suddenly gone from quiet and reserved to unruly and sarcastic.

It has been several minutes now. Having inquired about friends and class schedules, Thames pushes further, asking if there are any changes at home.

Joanna admits she has been having trouble sleeping and has not been feeling very well in classes, making it difficult to concentrate. Gently probing, Thames inquires about her family. Joanna admits that her grandmother recently died, and that her father and mother are constantly arguing about the fine print of the will and the inheritance. Also, Joanna’s older sister recently moved in with her boyfriend, leaving her alone with her 2-year-old brother.

School therapy is among the most rapidly growing and widely diversified group in the therapeutic field, and is swiftly becoming a fixture of the school system.

In addition to attending to students with learning disabilities and special needs, school therapists are also expected to deal with a host of psychological and social problems from the general student body.

Problems can range from a withdrawal from sports and friends due to a delayed onset of puberty, to slipping grades and disorderly behavior stemming from any number of relationship conflicts whether in school or at home.

More often than not, school therapists are mistakenly seen as versatile foot soldiers, expected to combat the far-reaching complications fueling teenage angst, social dysfunction, withdrawal and general non-conformity.

However, the recent rise in struggling, learning-impaired students, the severity of school violence, and the trend of teenage suicide have forced the public to take a closer look at the daily obstacles facing school therapists, where the true battles are being fought, and how caregivers, teachers and peers can help in lowering these statistics.

A Problem on the Rise

Student’s academic success hinges on a number of criteria that they are introduced to in their formative years. Along with elementary education and social interaction, students begin to learn how to complete their assignments, organize their work, follow rules and cooperate with other students.

However, throughout this early stage of development, a number of children are observed to show symptoms of learning disabilities (LDs) or behavioral unrest, perhaps stemming from Attention Deficit/Hyperactivity Disorder (AD/HD) – an early warning sign for future academic difficulties if left unregistered by either the school or the parents.

Common warning signs for young students include: trouble following directions or getting along with peers; feeling discouraged about attending school; frequently getting into trouble at school or demonstrating unruly behavior.

“Kids with LDs and/or AD/HD may not pick up on cues around them,” says Diana Browning Wright, MS. “They may not understand what teachers and other kids expect from them or how to bargain with others. They may have a hard time waiting for the teacher to call on them. They may have a problem concentrating on things that aren’t interesting to them. They may not have learned skills to be a good group member – taking turns, giving and accepting feedback, getting agreement and compromising.”

When these symptoms are not recognized or reported by either parents or teachers, LDs or AD/HD can spiral into a wide range of social/behavioral problems, formed by the child to compensate for their projected inability to compete in an academic setting with other students.

Many students with LDs or AD/HD feel shunned by their peers, and cut off from meaningful interrelation with others. And, some may develop criminal behavior or substance abuse addictions to take the place of these relationships.

Victims in the Classroom

Students with LDs often dissociate themselves from the general commune of students, making them highly susceptible to extreme behavior and mannerisms. Students struggling to conceal their LDs or associated academic shortcomings may target other learning disabled individuals, by bullying and antagonizing them, and therefore distancing themselves from any association with them.

Other factors,  such as difficulties at home or pressures from friends, may contribute to the severity of the abuse inflicted on the victim.

“The kinds of intimidation and harassment that would get an employee fired at almost any job is routinely tolerated by school authorities when it occurs between students,” says Laurence Miller, PhD, clinical and forensic psychologist.

“Studies have shown the effects of school victimization to include lowered self-esteem, increased loneliness and isolation, anxiety and panic attacks, depression and suicidal thoughts, psychosomatic symptoms and post-traumatic stress disorder (PTSD).”

While mass-murdering incidents, such as the 2007 Virginia Tech massacre and the 1999 rampage at Columbine High School in Colo., have forced open the public eye to retaliatory effects of school victimization, school bullying and violence have not subsided.

According to the National School Safety Center, almost 3 million violent crimes are committed on or near a school campus each year, accounting for 11 percent of all reported U.S. crimes.

For therapists, working in school systems where violence is such a recurrent issue, a surfacing problem is the growing number of students experiencing PTSD, a mental disorder that sometimes appears after a specific event in which a student has felt extreme fear, helplessness or horror.

“[There] is evidence that early traumatic experiences, especially if these are prolonged or repeated, may increase the risk of developing PTSD after traumatic exposure as an adult,” says David V. Baldwin, PhD. “This may result from state-dependent learning, where previous responses to a terrifying event are repeated even though more appropriate responses (i.e. active defenses) may now be possible.”

The anxiety and fear that follow a series of traumatic encounters, such as intense bullying and physical abuse, can be especially troubling for children. Therapists are finding that some traumatized students may regress to exhibit infantile behaviors, such as thumb-sucking or bed-wetting.

The students’ academic performance may also suffer, and younger students may be more prone to nightmares and fear of sleeping alone. Other behavioral changes may include throwing tantrums, or withdrawing and becoming more solitary.

Once these symptoms of trauma have been noted, there are various ways both caregiver and the school therapist can help alleviate the student’s emotional trauma. The American Psychological Association (APA) suggests:

• Spending more time with children and letting them be more dependent on you during the months following the trauma. For example, allowing the child to cling to you more often than usual. Physical affection is very comforting to children who have experienced trauma.
• Providing play experiences to help relieve tension. Younger children, in particular, may find it easier to share their ideas and feelings about the event through non-verbal activities such as drawing.
• Encouraging older children to speak with you, and with peers, about their thoughts and feelings. This helps reduce their confusion and anxiety related to the trauma. Also, be sure to respond to questions in terms that children can comprehend. Reassure them that you care about them and that you understand their fears and concerns.
• Keeping regular schedules for activities such as eating, playing and going to bed. This helps children restore a sense of security and normalcy.
  

A Stand on Suicide

According to the National Institute of Health, suicide is the third leading cause of deaths among children, teenagers and young adults. Moreover, every year 125,00 young people in the 10-to-24 age bracket are admitted to the emergency room to receive treatment for self-inflicted injuries during the course of attempted suicide. 

School therapists are in a key role to observe student behavior and act when they suspect that a student may be at risk of self-harm. One of the most difficult obstacles for school therapists is differentiating between those who may present a real danger to themselves and those who are merely emulating suicidal symptoms as a way to receive the attention they lack at home.

Warnings signs of those who may be considering suicide, and thus require the immediate attention of the school therapist, as well as caretakers and mental health workers, include:

• Talking or writing about suicide or death
• Giving direct verbal cues, such as “I wish I were dead” and “I’m going to end it all”
• Giving less direct verbal cues, such as “You’ll be better off without me” and “Soon, you won’t have to worry about me.”
• Isolating themselves from friends and family
• Exhibiting unexplained mood improvement after being depressed or withdrawn
• Neglecting their appearance and hygiene
• Dropping out of school or social, athletic and/or community activities

When approaching a possibly suicidal student, therapists need to be consistent, yet not overbearing, with their questions. The APA advises therapists to make a stand in their role as a counselor, and to not be afraid to ask the tough questions.

For instance, therapist should inquire as to whether the student has considered suicide or self-destructive acts. Often, a student will be relieved that someone cares enough to ask about their wellbeing. Therapists need to be persistent as well as prepared to act if a student’s behavior escalates to the point of self-injury.

Also, students displaying suicidal warning signs should not be left unattended until a caretaker and/or professional help can be reached. Therapists are advised not to make confidentiality promises with the student, only a private conversation, in the case that the student’s health is endangered and the therapist is legally required to intervene.

Schools usually have a crisis policy in place that provides teachers with guidelines for identifying and responding to potentially suicidal students. If the school does not have a plan for such situations, the therapist should organize a team to draft guidelines now – do not wait for a crisis situation.

As the number of academic behavioral problems escalates, it is the responsibility of everyone – teachers, caregivers, and peers – to assist therapists in identifying those who most need their services, before simple problem behaviors become severe psychological stresses in the school environment.

—Bob Stott is a staff writer for Therapy Times. Questions and comments can be directed to bstott@therapytimes.com.