These are some of the stories that I have told over the years.
A Community Ally Mental Wellness Toolkit https://bc-counsellors.org/community-ally-mental-wellness-toolkit/
Education for the Heart (2013) http://www.bcpvpa.bc.ca/downloads/adminfo_pdf/Dec13BurnardWeb.pdf
Mental Illness – Remains one of the last Bastions of Stigmatization (2006)
Mental Illness is one of those issues that we, as a society, still shun as “acceptable” conversation topics, albeit unless under our breaths or in slight whisperings. For some, it seems to harken back images of barbaric asylums and 1800 “sloggings.” While we are beginning to more freely engage in the formerly “taboo” subjects of religion, and politics we remain unable, almost paralysed at times, to broach the topic of mental illness. We dare to discuss other’s mental health, let alone our own psychological state. In an age where we are confronting the realities of alcohol on the fetus and the emotional and financial tolls of the FAS child on our social and educational institutions, the mentally ill population continues to be relegated to a subordinated status in private as well as political arena. Perhaps, some of the stigmatization comes from our own naivete and limited understanding of the concept.
Mental illness is a nebulous and complex construct. To advance my own knowledge, I have benefited from the definition that delineates “psychosis” from “neurosis.” Psychoticism, including the major mental illnesses of schizophrenia and manic-depression, implies a perceptual and cognitive distortion of reality. On the other hand, neurotism or neurotic behaviour includes emotions and cognitions that from a community perspective, do not seem to be out of synch/touch with reality. In other words, neurotics are ‘fully functioning’ human beings...with hang-ups.
Neuroticism subsumes a continuum of behaviours: from personality disorders, including sociopath and borderline, histrionic (dramatizers), and narcissitics, to depression and eating disorders, to common addictions of tobacco and drug intake, excessive shopping, computer usage, fitness regimes, and/or any forms of rigidity. These are simply coping mechanisms or manners of dealing with insecurities or anxieties. In fact, while major mental illness affects few in number, personally I have never met anyone who isn’t neurotic or possess some type of neurosis. When described as such, one could quite confidently suggest that any and all of these characteristics are indicative of mental illness. Evidently, any attempt to clarify the area of mental illness is met with further permutations and esoteric notions.
What we can conclude thus far is that the definition of mental illness can be quite robust depending on the lens that is used for examination; a nebulous topic that is rarely broached for discussion. To further complicate our investigation is the fact that the causes of any mental illness are multifactorial.
Society alienates and marginalizes the mentally ill not only by limiting and at times denying its very existence, but it further disenfranchises individuals by affording limited emotional and financial support. As the illness is manifested at an individual level with limited deleterious effect at the community level, the impact on society is overlooked and minimized.
We not only shun the topic but we shun treatment as well. In most workplaces it is still considered taboo/unacceptable to admit that one is seeing a therapist. We have a difficult time admitting that we need help. Personally, I have found the healthiest people are those who, through therapeutic intervention, have had the courage to challenge old habits and dysfunctional thoughts. It is extremely difficult to question these misguided beliefs without assistance. Interestingly, given how important mental health is, we invest so little time in managing it. In fact, when we do seek treatment, we spend less time looking for an effective therapist than we invest shopping for consumer goods.
In terms of education, to a large extent educators are not usually aware when a child is managing a mental illness. If guardians approach the school an effective individual educational plan can be developed wherein course adaptations that permit flexibility in achieving the learning outcomes can be provided. For example, in supporting a child who cannot function in a large social setting due to an anxiety disorder, adaptations can include home support, out of classroom testing, an extension of time constraints and self-paced work. In cases of mental illness, an interagency approach is recommended for a coordination of service delivery. This partnership among service agencies and parents is much more effective to developing a coherent support plan for the child, but is imperative given the recent reallocation and thus reduction of funding dedicated to this population of students. In the past, if there were a comorbidity of ailments or a dual diagnosis with a physical component we had the opportunity of classifying mental illness under the generic category of chronic health. This is no longer the case. The Ministry of Education has clearly delineated mental health issues into a category that receives less funding and requires the child to be more specifically designated “severe mental illness.” The result: another avenue requiring labelling for this group in order to gain much needed assistance.
On the Fetal Alcohol Spectrum Disorder (FASD) Child and Education (2001)
This notion conjures up a number of questions and concerns…What are the limits, the constraints? Is an FASD child educable given inabilities to retain information and generalize concepts across settings? For what vocational opportunities are we preparing the child? When is integration with other children appropriate?
These are all pressing concerns that require a shift in our paradigms of understanding regarding models of learning, educational theories and the role of the classroom teacher. As Twain aptly stated we cannot let education get in the way of learning. Educators are no longer simply conduits of prescribed curriculum but must respond to the emotional needs of students given the significant role they play in the lives of these children today.
The diagnosis of an FASD child is useful for a number of reasons. It provides us with the knowledge of the course and progression of the disorder, as well as provides vital epidemiological information that can assist with long term planning including housing and healthcare. Equally important, an accurate diagnosis permits us, as adult, parents and educators to understand the motivation behind the FASD child’s cognitions, emotions and behaviours. In doing so, a diagnosis of FASD assists us in adjusting our perspective from that of one of blame to one of support and understanding. An FASD child cannot be held accountable for actions that may not have been understood, intended and most certainly for consequences that could not have been forseen.
By understanding the limitations of the FASD child we can embrace the potential and gifts that these children bring and offer the necessary guidance for each to reach his/her potential.
When devising classroom-based educational interventions two objectives must be accomplished: the development of a structured learning environment and as well as a behavioural management system.
In devising such systems it is enlightening to draw parallels with the ADHD child. In fact, in a substantial number of cases, the FASD child also possesses ADHD traits. As such, the strategies outlined in my article a few months back apply equally in this case as well. The significant difference lies in the commonly evidenced cognitive deficits associated with the FASD child that do not usually exist with the ADHD child. Accordingly, with both student “types” there exists a need to structure and schedule activities, provide clear rules and consequences, and shorten task activities. However, in the case of the FASD child adults cannot employ cognitive rationale strategies in order to effect change, but rather must rely solely upon behaviourally management techniques. Unlike the ADHD child, the FASD child doesn’t comprehend the consequences of his/her actions nor is s/he able to generalize teachings from one setting to the next. Consistency in action simply does not exist and attempting to ask “why” is an exercise in futility.
To reiterate, to a large extent, as obviously there are many exceptions, a hallmark intervention strategy is based on traditional learning theory. The old ‘stimulus-response’ model is effective regardless of whether we are developing a system of behavioural management or of learning for the FASD child. In other words, the home or classroom environment must be set up or structured to the extent of containing a series of stimulus and responses with a consequent reward system. Facilitative conditions are critical and must be in place to encourage learning.
Given the correlation of FASD with high risk behaviours and with the inability to respond appropriately to unsupervised activities, it is imperative that choices be limited and predetermined for the FASD child. Similarly, a period of appropriate behaviour is no guarantee for future success. With most FASD children rather than providing problem solving opportunities, adults need to build parameters that thwart any possible opportunities for risk and institute behavioural management schemes based on stimulus and response models.
To assist in developing these conditions, a visual schedule of planned activities is used for each day to reduce unpredictability. Routines exists for every aspect of the student’s day with blocks of 15-20 minute segments, and opportunities for breaks. Folder systems are developed with limited choice activities. Students have their own space/desk in the classroom where a limited number of distractions are possible, as well as a personalize behaviour system or plan that contains permissible and unacceptable behaviours. A well developed and practiced time-out component is also integral to success.
In terms of a behavioural management system here again, conditions are set to reduce the amount of stress placed upon the FASD child. An understanding of valued rewards and adequate supervision must be made available. Positive behavioural supportive management techniques, as espoused by EBS theory, which emphasize a “valuing” of the child, is paramount. Similar to all children and people alike, FASD need to know that they are cared for and truly “liked.” Where possible, ignoring negative behaviours while reinforcing positive behaviours are cornerstones. Choosing the most pressing aberrant behaviour and establishing a baseline and introducing reinforcements when the child exhibits the appropriate behaviour is recommended. Every opportunity is made available to promote successes.
The level of curriculum instruction and degree of integration are directly related to intellectual development and amount of behavioural regulation exhibited by the child. Most FASD children have cognitive deficits that require a modification of curriculum that focuses on functional skill development and community-based practical work experiences. FASD children with High Borderline to Low Average IQs may have educational gaps due to dysfunctional behaviours or ADHD-type symptoms and as such would benefit from integration into some of academic subjects but still require literacy and numeracy development in learning assistance, alternate, or resource blocks. Regardless of cognitive functioning, most FASD children require additional support in the area of social skill development. The focus of which would build upon friendship skills and emphasize communication skills, as well as the reduction of inappropriate behaviours through anger management training and appropriate labelling of emotions. Opportunities for role modelling of these skills is essential to complementing the individualized instruction. Accordingly, planned peer interactions and community group activities are crucial to the refinement of these skills.
Given the cognitive and behavioural limitations of most FASD children, educators and parents need to provide encouragement based on effort and work habits. It is equally important to reinforce appropriate behaviours and manage disruptive behaviour through positive supports, clear consequences, limited discussion and options, carefully laid out schedules. Planned peer group development and involvement in appropriate social activities are necessary for modeling, learning and participation to take place. Once again, planning with appropriate stimulus and responses systems are crucial.