When Something’s Wr ng o - Canadian Teachers' Federation Teachers 2007.pdf · 2013-10-16 ·...

WhenSomething’s Wr ng

Strategies for Teachers

o

Canadian PsychiatricResearch Foundation

MISSION STATEMENTCPRF is a national charitable organization founded in 1980 to raise and distribute funds for psychiatric research and awareness in Canada.

133 Richmond St. West, Suite 200, Toronto, ON M5H 2L3

Phone: 416-351-7757 • Fax: 416-351-7765E-mail: [email protected] • Web: www.cprf.ca

Charitable No. BN 11883 5420 RR0001

Rev.3 4/2007

How to Use ThisHandbookA child’s difficult or unusualclassroom behaviour createstremendous stress for him/ her, the teacher and the other students. In some cases, behavioural disturbances can be temporary; in others they may reflect a mental disorder.When Something’s Wrong: Strategies for Teachers has beendesigned to help you, theelementary or secondary school teacher, understand and implement ways to helpchildren with behaviour problems that are due to common mental disorders.The handbook is made up of eight sections, which can beused independently:

• Anxiety Disorders Separation Anxiety Disorder General Anxiety Disorder (GAD) Social Anxiety Disorder Panic Disorder (PD)Obsessive Compulsive Disorder (OCD)

• Autism

• Depression

• Eating Disorders Anorexia and Bulimia Nervosa

• Impulse Control Disorders Oppositional Defiant Disorder (ODD)Conduct Disorder (CD)Attention-Deficit/HyperactivityDisorder (AD/HD)

• Schizophrenia

• Tourette Syndrome

• Resources

Anxiety

Disorders

Autism

Depression

Eating

Disorders

Impulse

Control

Disorders

Schizophrenia

Tourette

Syndrome

Resources

The mental health issues addressed in these sectionswere selected by focus groups made up of teachers,guidance counsellors, psychologists, social workers,behaviour resource teachers and child/ adolescentpsychiatrists. When Something’s Wrong: Strategies forTeachers is a “quick reference” source. It can be used alone, or together with When Being aGood Parent or Teacher is Not Enough, a two-volumeset presented by Health Education Consultants inassociation with the American Academy of Child andAdolescent Psychiatry and written by Barbara N.Buchanan, M.D. and Anne E. Yarnevich, M.S.W..(Copyright 2000 by Health Education Consultants.)

In each colour-coded section you will find:

• A brief description of possible classroombehaviours that can accompany some of themore common childhood and youth mentalhealth problems.

• Suggested strategies to help you deal with theseissues in the classroom.

• Summaries of existing medical or therapeutictreatments.

At the end of each section and at the end of thehandbook you will find:

• A list of resources for further information orprofessional help.

For further information and additional copingstrategies, please see CPRF’s second handbook WhenSomething’s Wrong: Ideas for Families. It is designed towork together with this teacher handbook.

Sections included in the family handbook which arenot found in this handbook include:

• Managing Problem Behaviour in Children

• Posttraumatic Stress Disorder (PTSD)

• Borderline Personality Disorder (BPD)

• Bipolar Affective Disorder (formerly known asManic Depression)

• Suicide

• Working with Your Health Practitioner

Please note that all data included in this handbook (i.e., statistics and figures) is based on availablescientific literature at the time of printing.

This handbook is not a diagnostic tool. A professionaldiagnosis is always essential, and a second opinion isrecommended. The purpose of the handbook is to givethe teacher useful strategies to cope with and assist astudent with behaviour difficulty. You may already usesome of the strategies listed, but we hope it willprovide additional suggestions that will be of value,not only for students with mental health problems,but also for general classroom management.

It has been shown that one in five school children hasa mental health problem. Many of these children willexhibit their difficulties in the classroom, throughproblems with mood, behaviour or thinking. Asignificant proportion may have a brain dysfunctionfor which effective treatment is available. If yourecognize a student who may have one or more of thedisorders described, initiate a referral through theappropriate school services. Early identification andtreatment can lead to improved outcomes.

All of these young students can benefit from strategicclassroom interventions provided by informedteachers.

A team approach, involving teachers, parents, schoolsupport staff (psychology, social work, behaviourresource), public health nurses and other healthprofessionals, may be required to provide optimalassistance to some children and teenagers. Thesupport system may vary from one school to another,but in all cases the teacher plays a central role in day-to-day activities. This may include: recognition ofbehavioural difficulties that may indicate possiblemental disorders, classroom management, and theuse of appropriate classroom strategies. Inrecognizing mental health problems, it is important toconsider that some may be relative to culturaladjustments of ethnic groups or to behaviouralexpectations arising from differences in originatingcultures of specific students. Students undergoingmajor adjustments in the home (e.g., divorce, death)may also experience adjustment difficulties that areexpressed through behaviour. Ongoingcommunication between teacher, student, parent andother involved professionals will be necessary to applythe information in this handbook effectively.

We gratefully acknowledge and express appreciation tothe many people who have made this project possible:

CREATOR and COMMITTEE CHAIRAndrea DrynanItinerant Behaviour Diagnostic Resource TeacherToronto District School Board

ADMINISTRATORSThe Canadian Psychiatric Awareness Committee (Education Committee – Canadian Psychiatric Research Foundation)

COMMITTEE MEMBERS Valerie ArgueWriter, EditorDominique Brugniau Principal, Lester B. Pearson Public SchoolRupert Castello Principal, Smithfield Middle School Amy CoupalToronto District School Board & Learning Disabilities Association of OntarioDianne Domelle Former Program Leader, Health and Physical Educator (TDSB) Faculty of Education, University of TorontoJane Drynan Past President, Canadian Psychiatric Awareness CommitteeDeborah Duncan Special Education Itinerant Resource Teacher (TDSB)Evelyn FreedmanConsultant – Children’s Aid Society Ontario Institute for Studies in EducationJosephine KizoffGuidance TeacherSteve Lico Medical Education Manager, JANSSEN-ORTHO Inc.Marg McKenziePrincipal, Broadacres Jr. SchoolLaurie MoirPrincipal, Elmlea Jr. SchoolDr. Ester SaltzmanSpecial Education Co-ordinator, Toronto District School BoardDebbie Schatia Children’s Aid Society of TorontoSandra Sharwood Canadian Psychiatric Awareness Committee Liaison

Acknowledgements

Martin SoonItinerant Resource Support Team , Vincent Massey Diagnostic CentreMaryanne ShawChild Therapist, Centre for Addiction and Mental HealthCatherine Wong Special Education Teacher

MEMBERS OF FOCUS GROUPSwho provided information on the needs of teachers who have children with behaviour problems in the classroom.

SCHOOLS AND TEACHERSwho participated in the pilot phase of the project, theevaluation and workshop days.

ADVISORSSandi Brauti Supervising Principal of Leadership DevelopmentToronto District School Board

Tina Ferrari-OryshakPsychoeducational Consultant, Toronto District School Board

Bill Hogarth Director of Education, York Region District School Board

Bev OhashiPrincipal, Earl Haig Secondary School, Toronto District School Board

MEDICAL ADVISORSDr. Marshall KorenblumPsychiatrist-in-Chief, Hincks-Dellcrest Centre; Chair, EducationCommittee of the Canadian Academy of Child Psychiatry; Director,Post Graduate Education for The Division of Child Psychiatry;Associate Professor, Faculty of Medicine, University of Toronto

Dr. Stan KutcherAssociate Dean, International Medical Development & Research,Faculty of Medicine, Dalhousie University

Dr. Len LevinExecutive Director, New Haven Learning Centre

Dr. Paul SandorAssociate Professor, Department of Psychiatry, University of Toronto;Director, Tourette Syndrome Clinic, Toronto Western Hospital;Associate Member, Dept. of Human Development and AppliedPsychology, OISE/UofT

PROJECT EDITORS PROOFREADERValerie Argue, Krista Saleh Lynn McAuliffe

Acknowledgements

Judy Hills, past CPRF Executive Director

Funding Support Phase 1 &� Phase 2

SPONSORSDepartment of Psychiatry, DALHOUSIE UNIVERSITYJANSSEN-ORTHO Inc.

CO-SPONSORSThe Charles & Marilyn Gold Family FoundationHydro OneThe Toronto StarCanadian Psychiatric Awareness Committee

CONTRIBUTORSThe Hospital For Sick Children FoundationHudson’s Bay CompanyJunior League of TorontoLundbeck CanadaOntario English Catholic Teachers’ AssociationOntario Secondary School Teachers’ FederationPfizer CANADA Inc.Sanofi-SynthelaboMrs. David Young

SUPPORTERSCanadian Association for School HealthOntario Principals’ Council

Acknowledgements

ONTARIO ENGLISH

CATHOLIC TEACHERS’ASSOCIATION

Canadian Psychiatric Awareness Committee

THE CHARLES AND MARILYN GOLD

FAMILY FOUNDATION

An

xietyD

isorders ANXIETY DISORDERS Anxiety disorders aremental disorders characterized byexcessive or inappropriate levels ofanxiety that are so severe they interferesignificantly with daily living. Taken as agroup, they are the most commonmental disorders in youth, affecting upto ten percent of children andadolescents. Anxiety disorders arisefrom a complex interplay of genetic andenvironmental factors and differentforms begin at different times duringthese years. For example, separationanxiety disorder usually begins duringmid-childhood, while panic disorderusually has an onset in lateradolescence. Anxiety disorders are notbenign conditions. Untreated, they canlead to depression, alcohol abuse orother problems. Moderate to severedisorders lead to poorer academic,vocational and interpersonal outcomes,a decreased quality of life and higherutilization of health care systems. Earlyeffective interventions can providesymptomatic relief, improve long-termoutcomes, and possibly prevent thedevelopment of other psychiatricdisorders. In classroom situations, these children may appear to be “shy” oravoidant. They may be reluctant to dogroup work or speak out in class.

In adolescence, social isolation orsubstance abuse may begin. Rarely, if ever, do youth with anxiety disordersact in a manner that disturbs classroomroutine, and they are often notidentified as having difficulties.

The common anxiety disorders are:Separation Anxiety Disorder, GeneralAnxiety Disorder (GAD), Social AnxietyDisorder, Panic Disorder (PD), andObsessive Compulsive Disorder (OCD).

For Posttraumatic Stress Disorder (PTSD),please see CPRF’s When Something’sWrong: Ideas for Families handbook.

An

xietyD

isorders

Separation Anxiety Disorder isusually seen by mid-childhood.It is characterized by severepanic-like episodes that beginwhen the child is separatedfrom his/her parent orcaregiver and has difficultyparticipating in age-appropriate social activitiessuch as sleep-overs, summercamp, etc. These episodesmay come to a teacher'sattention when childrenrefuse to attend school, cryand have tantrums when leftat school, refuse toparticipate, or exhibitexcessive “homesickness”during over-night school trips.

Separation Anxiety Disorder Anxiety D

isorders

refusal to attend school

tantrums, tears, clinging when left at school by theparent

excessive “homesickness” during over-night schooltrips

clining to the teacher

• Provide reassurance to both child and parent.

• Inform child and parent that the anxiety normallydecreases over time, with the appropriate strategies.

• Use distraction techniques — for example, involve thechild in other activities.

• Encourage reading, writing, drawing, painting in ajournal to alleviate fears.

• Encourage and reward independent activities.

• Create a “coping” book whereby the child has a guideto help take various steps for dealing with his/heranxiety. For example:

Stage 1 — In Class– Take five deep breaths.– Draw in journal.– Count from fifty backwards.– Visualize a calm place.

Stage 2 — Outside– Take time out.– Walk down hall.– Go to mentor or teacher.

Stage 3 — Outside– Go to office.– Get medication, if required.– Call home.

• Provide student with frequent feedback, praise,encouragement and support.

• Use “whole class” relaxation techniques.

Behaviour Characteristics

Classroom Strategies

General Anxiety Disorder isthought to affect some threeto five percent of youth and is often found together withother anxiety disorders ordepression. It tends to havean onset in early adolescenceand is associated withinhibited temperament orexcessive childhood shyness.Young people with GAD worryincessantly about mostthings. It is the extreme,severe nature of their worriesthat leads to a diminishedquality of life.

General Anxiety Disorder (GAD) Anxiety D

isorders

constant worry or tension

extreme need for reassurance

somatic symptoms (headaches, stomach aches)

avoidance of stressful situations such as tests

clingy behaviour in young children

• Reassurance alone may not be sufficient to resolve thisanxiety condition.

• Establish down– to – earth, realistic expectations andinteractions.

• Encourage physical exercise to reduce anxiety.

• Check in with the student at the beginning of eachday.

• Create a “things to do today” sheet. This gives thestudent an overview of the work expected for the day.Prepare the child/adolescent in advance for anychanges in daily routines.

• Modify the child’s program if necessary.

• Encourage use of a study schedule to prepare for testsand assignments. The schedule needs to clearly outlinethe activity and amount of work to be completed eachday.

• Give clear directions.

• Create a “coping” book, as outlined under SeparationAnxiety Disorder.



Social Anxiety Disorder usuallymanifests itself in adolescence.It is characterized by severeanxiety, at times mixed withpanic, that occurs only insocial situations and is oftenaccompanied by blushing. It is the most common of theanxiety disorders and mayprecede the development of depression. Up to 30percent of youth with socialanxiety disorder developproblems with alcohol use. It can be severely debilitatingand can result in socialisolation.

Social Anxiety Disorder Anxiety D

isorders

refusal or severe reluctance to participate in activitiesthat will permit social scrutiny; e.g., public speaking;eating or dressing in public; social activities, such asdances; gathering in social settings, such as malls

physical symptoms such as blushing, a shaky voice,nervousness, or sweating prior to or during socialsituations

strong fear that others will notice their anxiety

• Gradual desensitization — through small groupactivity, for example.

• Do not force the student into situations that arehumiliating; for example, forced speaking in front ofthe class; instead, provide an option such as a grouppresentationor a presentation to a small group. Allowuse of multi-media presentations to reduce amount ofspeaking.

• Reassure the student that he/she is not alone infeeling embarrassed.

• Encourage relaxation techniques, such as visualizationand deep breathing.

• Ask friendly classmates to invite the child to talk, playor join a club.



Panic Disorder expresses itselfin later adolescence. It canaffect up to five percent ofyouth and often occurs withdepression or other anxietydisorders. It is characterizedby a sudden onset of severepanic that arises suddenly,and without warning, insituations where there is nodanger. Symptoms include:shortness of breath, heartpalpitations, dizziness,tingling, urgent urination andintense fear. Often, attacks areaccompanied by a strongdesire to flee the location inwhich they occur. Repeatedattacks lead to anticipationanxiety, and then to avoidanceof locations in which they haveoccurred or from which thereis no easy exit. In some casesthis can lead to agoraphobia.

Panic Disorder (PD)Anxiety D

isorders

panic attack in the classroom, which can lead to a needto “escape”

avoidance of school

intense physical symptoms (e.g., shortness of breath,heart palpitations, dizziness, sweating)

intense fear during the attack

• Permit leaving the classroom if a panic attack occursbut set a time for return; attacks usually last five toten minutes.

• Encourage “coping” behaviour and discourageavoidance.

• Create a “coping” book, as outlined under SeparationAnxiety Disorder.

• Model calm behaviour.

• Use relaxation and deep breathing techniques to helpreduce fear and stress (e.g., visualize a calm and safeplace, take five deep breaths).



Obsessive Compulsive Disorder,which can begin throughoutyouth, affects up to threepercent of the population andis characterized by intrusive,unwanted ideas, thoughts orfears (obsessions) and repeatedritualized actions or behaviours(compulsions) performed todispel the anxiety brought onby obsessions. It may occur withtics (see Tourette Syndrome) orwith depression. It can lead tosignificant functionaldisruption and a reducedquality of life.

Children with OCD often sufferthe added stress of teasing,rejection, and even bullyingfrom peers. Encourage thestudent to talk about thedisorder with classmates,friends and family, and therebyincrease acceptance of it.

Obsessive Compulsive Disorder (OCD)Anxiety D

isorders

persistent perfectionism; e.g., written schoolworkerased and rewritten to the point of making holes inthe paper

constant questioning, asking for reassurance

repeating rituals

having to do something exceedingly slowly to feel ithas been done properly

• Keep up normal routines in the classroom. Routine andstructure can help a child reduce the rituals and encourageexposure to what may otherwise have been avoided.

• Provide brief, clear, explicit instructions, well-structuredassignments.

• Use humour, not ridicule, to help the child distancehimself/herself from irrational fears.

• Try not to get involvedin the child’s rituals by respondingto an obsessive need for reassurance.

• Do not criticize his/her obsessive behaviours. See them assymptoms, not faults.

• Recognize and reward small improvements; e.g., finishinga task on time without continual erasing to make itperfect.

• Modify expectations during a stressful time. Stress,particularly in the area of change, can increase symptomsof anxiety. Try to provide schedules and advance warningand preparation for changes in routines.

• Do not compare the child with other children in theclassroom. The behaviours are part of an illness.

• Provide a warm and supportive learning environmentwhere mistakes are viewed as a natural part of thelearning process.



Treatment of anxiety disorders usually requires acombination of treatment interventions by qualifiedmedical or mental health professionals. Medications maybe used along with other forms of treatment such asCognitive Behavioural Therapy, sometimes inconjunction with family therapy or counselling.

Anxiety Disorders Association of Canada(Ask for a referral to your provincial chapter for localresources)Toll-Free: 1-888-223-2252E-mail: [email protected]: www.anxietycanada.ca

Anxiety Disorders Association of America8730 Georgia Avenue., Suite 600Silver Spring, MD 20910Phone: (240) 485-1001Web: www.adaa.org

Got Issues Much? Celebrity Teens Share Their Traumasand Triumphs(Randi Reisfeld, Marie Morreale, Scholastic, 1999).

Also Relevant:

Canadian Centre on Substance Abuse (CCSA)Phone: (613) 235-4048Web: www.ccsa.ca

Centre for Addiction and Mental HealthPhone: (416) 535-8501Web: www.camh.net

Resources

Treatment

AutismAUTISM Autism is an Autistic SpectrumDisorder of neurobiological origin thatappears about four times morefrequently in boys than girls. It usuallymanifests itself before the age of threeand, with no known environmentalcomponent, occurs throughout theworld in families of all ethnic, racialand social backgrounds. There appearsto be a genetic predisposition, withabout a four percent increased riskamong siblings of children with thedisorder.

Autism affects the way sensory input isprocessed by the brain, leading to aninability to develop normalcommunication and language skillsand, in many cases, an associateddiagnosis of cognitive impairment.Children with autism frequently fail todevelop useful speech, and those whodo develop it have trouble initiatingand sustaining conversations.Although a few have distinct skills incertain areas, such as music ormathematics, they often haveconsiderable cognitive difficulties inother areas. Many children with autismare able to learn, however, especially ifearly diagnosis and intervention takeplace during the preschool years.

Autism belongs to a group of relateddisorders called Autism SpectrumDisorders (ASD), which includesAsperger’s Syndrome (difficultiessimilar to autism, but children withthis disorder are higher functioningand their symptoms may not appearuntil school age or later). Also includedin this group are the more raredisorders, Rett Syndrome andChildhood Disintegrative Disorder.

Au

tism


There are many differences among children with autismand the various behaviour characteristics may be presentin widely differing degrees.

underdevelopment or lack of non-verbal speech andother communication skills needed for socialinteraction and learning

repetitive or idiosyncratic use of language

lack of interest in activities and relationships withothers, including peers; little or no eye contact and, inextreme cases, complete withdrawal

lack of empathy and awareness of the needs of others

compulsive behaviours, such as fixations or repetitivebody movements, and inflexible adherence to rituals orroutines

toileting and sleeping difficulties

short attention span and inability to focus on a task

lack of reaction, or over-reaction, to sensory input —children with autism may be so unaware of pain that theycan hurt themselves and not respond; they also needmore time than others to shift between auditory andvisual stimuli

excessive anxiety and problems with self-control, whichcan lead to temper tantrums, or possibly evenaggression or self-injurious behaviour

seizures, which may sometimes develop in latechildhood or adolescence

possibly, the presence of special abilities


Research indicates that the most successful method foreducating children with autism involves structured,intensive behavioural interventions.

• Provide as much structure as possible; a highlystructured, skill-oriented program designed to meet theindividual needs of the child works best.

• Emphasize the development of language and socialskills.

• Seat the child near your desk.

• Give clear, concrete instructions and repeat frequently.

• Break each skill into discrete units and allow the childto practice it over and over until he/she has mastered it.

• Reward the child for each small step in skill mastery.

• Write “Social Stories” from the point of view of thestudent to help him/her cope with social, learning andbehavioural challenges. These stories — written simplyand in the first person — should include a descriptionof the situation and the desired positive response (“Ican try,” “I am calm,” “I am proud of myself when...,”etc.).

• Keep up normal classroom routines; routine and structurecan help reduce the child’s anxiety and attendantbehaviour problems. Visual and/or written “Things to Do”charts for daily routines or weekly planning can be useful.

• Ensure supervision for transitions (e.g., recess, lunch).

• Provide parents with frequent feedback,encouragement and support. Where significantbehaviour problems exist, try to involve them indeveloping a joint behaviour management program.

• Look for activities the child is good at and encourageand reward these activities.

• Work closely with the child’s multi – disciplinary team ofother teachers and health professionals

Resources

Treatment

Although in many cases symptoms of autism maydecrease or change, they tend to be chronic over thechild’s life. The focus is therefore on encouraging thehighest level of development possible given thelimitations inherent in the disorder. A supportiveenvironment and a multi – faceted educational andbehavioural approach, tailored to the needs and abilitiesof the individual, seem to produce the best results.Although it can be expensive, time-consuming, and notalways readily available, language and social skills may begreatly improved through Early Intensive BehaviouralIntervention (20 to 40 hours a week for two years prior toage six). In some cases, controlled diet or carefullymonitored medication — to alleviate specific symptomsonly — can be helpful. Supportive counselling may helpfamilies cope with the physical and emotional demandsof caring for a child with this disorder.

Autism Society CanadaP.O. Box 22017 16 Heron Rd.Ottawa, ON K1V 0C2 Phone: (613) 789-8943 Email: [email protected] Web: www.autismsocietycanada.ca(See the “Resources” section of the Web site for a goodlist of additional information sources)

Canadian Autism Intervention Research NetworkThe Offord Centre for Child Studies, Faculty of HealthSciences, McMaster University, 107 Patterson Building,Chedoke Site1200 Main Street WestHamilton, ON L8N 3Z5Web: www.cairn-site.com

Center for the Study of Autism Informational Web Site: www.autism.org

Depression

DEPRESSION Clinical depression israre before puberty and normallybegins during adolescence,affecting about five to eightpercent of youth. Clinicaldepression is a “whole body”illness that involves the mood,thoughts and behaviour of theperson. It is also a disorder with astrong genetic component.Unrecognized and untreated,depression is the most commoncause of teen suicide. It goesbeyond “feeling blue” or thefeelings involved in coping with aloss or disappointment. When achild or teen displays lethargy,apathy, a bleak outlook and anirritable personality, it can beconfusing and difficult to lookbeyond the behaviours.

Children and adolescents whoare depressed need to be treatedin a sensitive manner. They needto feel a sense of belonging inthe classroom by being part ofclass meetings and problem-solving activities. Although thereis a tendency to leave a quietstudent alone, it is important tomake a special contact with adepressed child each day.

The great majority of peoplewith a mood disorder likedepression or Bipolar AffectiveDisorder (formerly known asManic Depression) can be helpedwith the appropriate treatment.

For information on BipolarAffective Disorder and suicide,please see CPRF’s WhenSomething’s Wrong: Ideas forFamilies handbook.

Dep

ression


voiced hopelessness

increased irritability or agitation

lack of energy or excessive fatigue

indecision, lack of concentration, or forgetfulness

frequent physical complaints, such as headache orstomach ache

social withdrawal; e.g., from peers and extra curricularactivities

decrease in grades and missed assignments

eating disturbance, weight loss or weight gain

significant sleep disturbances

suicidal writings or notes

may show addictive behaviour, such as heavysmoking, heavy drinking, heavy use of other drugs, orincreased use of these substances


• Don’t compare the child to others; instead, makepositive statements that reflect his/her own pastsuccesses.

• Express optimism that the child will again be able toperform up to his/her own ability.

• Don’t take it personally when your efforts appear to berejected — the depression has led to distorted thinkingand perceptions, making it impossible for him/her torespond with appreciation.

• Provide other expressive outlets, such as journalwriting, creative writing, drawing, role playing anddrama.

• Make a special contact with the student each day —maybe a specific greeting at the door followed by aquestion about something that has been of interest tohim/her.

• Educate all your students whenever and whereverpossible about the topic of depression and thewarning signs of suicidal thinking and behaviour.

• Encourage a healthy lifestyle, especially lots of physicalexercise, which creates mood-enhancing hormones inthe body.

• Get help immediately if you are aware that thestudent is expressing suicidal thoughts.

Resources

Treatment

Treatment of depression includes medication or aspecific psychotherapy such as Cognitive BehaviouralTherapy or Interpersonal Therapy. Particular attention tothe possibility of suicide must be maintained.

The Mood Disorders Society of Canada3-304 Stone Road West, Suite 763Guelph, ON N1G 4W4Phone: (519) 824-5565E-mail: [email protected]: www.mooddisorderscanada.ca

Child and Adolescent Bipolar Foundation1000 Skokie Blvd., Suite 570Wilmette, IL 60091 USAPhone: (847) 256-8525Email: [email protected]: www.bpkids.org

Also Relevant:

Canadian Centre on Substance Abuse (CCSA)Phone: (613) 235-4048Web: www.ccsa.ca

Centre for Addiction and Mental HealthPhone: (416) 535-8501Web: www.camh.net

Centre for Suicide Prevention1202 Centre Street S.E., Suite 320 Calgary, AB T2G 5A5Phone: (403) 245-3900Email: [email protected]: www.suicideinfo.ca(Information and resources available; can direct you tolocal or provincial organizations and services; can directyou to local crisis centres)

Eating Disorders

EATING DISORDERS Anorexia andBulimia Nervosa are serious formsof eating disorders. Anorexia (self-starvation) affects about threepercent of the population; bulimia(the binge-purge syndrome) ismore common. Excessive concern with body weight, body image andfood characterizes both disorders,which can start in childhood andwhich more often affect females.To become thin, people withanorexia starve themselves, whilethose with bulimia binge on high- calorie foods and then purge.

Some groups are at higher risk forthese disorders, including athletes(e.g., gymnasts or ballet dancers)and those who work in certainindustries, such as fashion models.

Eating disorders are almostexclusive to developed cultureswhere there is an abundance offood and being “thin” is highlyvalued (e.g., North America,Europe).

Other eating disorders that noware also currently being discussedand researched are Exercise Bulimiaand Binge-Eating Disorder. Formore information, see CPRF’sWhen Something’s Wrong: Ideas forFamilies handbook.

Eatin

gD

isorders


Anorexia Nervosa

signs of starvation: thinning or loss of hair; appearanceof fine, raised white hair on the body; bloated feeling;yellowish appearance of the palms or soles of feet; dry,pasty skin

loss of menstrual periods

significant weight loss in the absence of related illness

significant reduction in eating, coupled with a denial ofhunger

unusual eating habits: preference for foods of a certaintexture or colour; compulsively arranging food; unusualmixtures of food

Bulimia Nervosa

evidence of binge eating: actual observation; verbalreports; large amounts of food missing

frequent weight fluctuations

evidence of purging (vomiting, laxative/ diuretic abuse,emetics, frequent fasting, excessive exercise)

swelling of parotid glands under the jaw (caused byfrequent vomiting)

frequent, unusual dental problems

evidence of calloused knuckles caused during purging


• Know the warning signs of anorexia and bulimia.

• Discuss your concerns with the student.

• Convey your concerns about his/her health andfunctioning — don’t focus on weight loss or body size.

• Expect to be rejected by the child/adolescent when youdiscuss your concerns about his/her possibly having aneating disorder. This is an illness of denial and distortedthoughts regarding body image.

• Go with the student to get help from a resource person,such as a guidance counsellor, public health nurse orsocial worker.

• Teach media literacy and critical thinking regarding bodyimages in advertisements.

• Keep in mind that others in the student’s life may begiving positive feedback on the student’s “greatwill–power” or “perfect figure.” These kinds of commentsmay help to reinforce the student’s destructive behaviour.

Resources

Treatment

Treatment of eating disorders is difficult andmultifaceted. For both anorexia and bulimia, anevaluation should be done by a mental healthprofessional to rule out underlying anxiety or depressionand to assess various risk factors like perfectionism,sexual abuse and a family history of eating disorders. Amedical and endocrinological evaluation is also necessary.Regaining weight and maintaining it at a reasonablelevel is the goal of treatment for anorexia. Remission ofthe binge – purge cycle is the goal of treatment forbulimia.

A large part of treatment involves helping the youngperson reshape his/her negative and unrealistic bodyimage. In serious cases, hospitalization may be necessary.

The National Eating Disorder Information CentreCW 1-211 200 Elizabeth StreetToronto, ON M5G 2C4Phone: (416) 340-4156 Toll-Free: 1-866-NEDIC-20 (1-866-633-4220)Web: www.nedic.ca

National Association of Anorexia Nervosa and Associated Disorders Box 7 Highland Park, IL 60035 Phone: (847) 831-3438 Web: www.anad.org

National Eating Disorders Association (NEDA)603 Stewart Street, Suite 803Seattle, WA 98101Phone: (206) 382-3587E-mail: [email protected]: www.nationaleatingdisorders.org

Impulse C

ontrol

Disorders

IMPULSE CONTROL DISORDERS A variety ofbehavioural disturbances aredescribed as impulse controldisorders. These include:Oppositional Defiant Disorder (ODD),Conduct Disorder (CD), andAttention-Deficit/HyperactivityDisorder (AD/HD). Altogether, thesedisorders affect up to eight to tenpercent of youth. AD/HD has aprevalence of about three to fivepercent. Impulse control disordersnormally begin before puberty. Theonset of impulse control symptomsafter puberty suggests anotherdisturbance such as mood orpsychotic disorder. Impulse controldisorders can be associated withpoor academic and/or vocationaloutcomes. They often co-exist withone or more language or learningdisabilities and can lead tosubstance/alcohol abuse or criminalactivity. In many cases of CD or ODD,appropriate adult guidance and limit-setting are helpful. With AD/HD,medical treatments may benecessary. Many youth with CD/ODDexhibit outbursts of anger and/oracts of violence. Youth with AD/HDtend to be inattentive, hyperactiveand impulsive. A few young peoplemay seem to show no remorse foractivities that hurt or harm others.These youth may be exhibiting amore severe behavioural-socialdisturbance called sociopathy. Theyrequire interventions of a differenttype and magnitude than youth withusual impulse control disorders.

Impulse Control

Disorders

Oppositional Defiant Disorderusually becomes evidentbefore eight years and notlater than early adolescence.ODD is a pattern of defiant,disobedient, and hostilebehaviour towards authorityfigures. ODD can be morecommon in families thatinclude a parent with a mooddisorder. Many youth withODD have a background ofuntreated AD/HD or alanguage or learningdisability. Boys with thisdisorder outnumber girls.

Oppositional Defiant Disorder (ODD)Im

pulse ControlD

isorders



outbursts of anger

low frustration tolerance

low self – esteem covered by cocky or “tough”demeanor

swearing

deliberately challenging people

often arguing with adults

history of conflict with teachers and peers

use of drugs or alcohol in school

history of academic problems and school failure

early sexual activity

• Teach the use and concept of self-talk to assist childrenin reducing their anger; e.g., “I have a right to be mad,but I’m not going to lose it.” Also, if they have kepttheir cool, teach them to praise their own success; e.g.,“I really handled that well.”

• Encourage an angry child who is old enough to writeto put his/her angry feelings in writing.

• Look for situations in which you can problem-solvetogether. Give the child responsibility he/she canhandle easily and give praise for success.

• Help children develop emotional literacy so they canlearn words to express angry feelings. Script languagefor them.

• Be a positive role model –– try not to lose your temper.

• Communicate your observations in a neutral,non – confrontational manner; e.g., “I notice that youdon’t follow instructions when given” or “I notice thatyou have been arguing.”

• Provide opportunities for a variety of expressiveoutlets; e.g., story – writing, painting, drama, clay, orusing a punching bag in a safe place.

• Establish clear expectations, rules and boundariesfor the whole class. Establish clear consequencesand rewards.

• Try to develop a mentoring relationship between thestudent and another teacher or caring adult.

• Encourage an aggressive child to engage in sports;e.g., jogging, tennis, aerobics, karate.

• Have a child/adolescent who is angry run around theschoolyard or track.

• Provide a safe place for children to go when they areangry –– a place to calm down.

• Untreated, this disorder can get progressively worseand can put you and others in danger, emphasizingthe importance of a professional diagnosis.


Conduct Disorder ischaracterized by a persistentbehaviour pattern where thechild or adolescent violatesthe rights of others or theaccepted rules of behaviour.Children with conductdisorder usually initiateaggressive behaviour andreact aggressively to others.They may group together to take advantage of other children. Boys with thisdisorder outnumber girls.

Other mental/neurologicaldisorders (untreated AD/HDand depression are commonin youth with CD).

Untreated, this disorder canget progressively worse andcan put you and others indanger, emphasizing theimportance of a professionaldiagnosis.

Conduct Disorder (CD)Im

pulse ControlD

isorders



aggressive behaviour; e.g., bullying, threatening, physical fighting, cruelty to animals, stealing (may use a weapon)

destruction of property; e.g., fire-setting, breaking windows, throwing objects

lack of empathy; e.g., callousness and absence of guiltfeelings, blaming others for one’s own misbehaviour

frequent disobeying of class rules

use of drugs or alcohol at school

early sexual activity

open displays of hostility/ “toughness”

academic problems with reading and verbal skills

deceitfulness (e.g., lying, stealing, “conning”)

• Actively teach what is appropriate and what is notwith young children. Specifically define what isconsidered unacceptable behaviour.

• Have firm, clear rules and consistent naturalconsequences for unacceptable behaviours.

• Avoid consequences that are too extreme –– either tooharsh or too easy.

• Provide lots of positive feedback when the studentdoes something well.

• Observe the child’s negative behaviour as a symptomof a disorder you are both working to solve together.

• Encourage a child/ adolescent to behave appropriatelywhen angry by engaging in physical outlets suggestedin the ODD section.

• Encourage social opportunities for the student toexpress feelings and work on activities he/she does well (e.g.,sports, the arts, recreation activities).

• Try to develop a mentoring relationship between thestudent and another teacher or caring adult.

• Suggest a support group for parents of children withconduct disorder.

Attention-Deficit/HyperactivityDisorder (AD/HD)

Impulse Control

Disorders

The three main symptoms of Attention-Deficit/Hyperactivity Disorder, also known as Attention DeficitDisorder (ADD) or Hyperactivity Disorder, are inattention,hyperactivity, and impulsivity. Although most normalchildren have these symptoms at times, children withAD/HD have one or more of these symptoms morefrequently and more severely than their peers. If leftuntreated, AD/HD can cause significant problems withrelationships and performance at home, in school, and inthe community.

AD/HD tends to run in families. It is estimated thatapproximately three to five percent of school-agedchildren have it, and AD/HD is reported two to threetimes more often in boys than in girls. Children withAD/HD often most clearly show symptoms in situationsthat require sustained and quiet focus. In most cases,AD/HD continues throughout adolescence and intoadulthood, although the symptoms change somewhatand may decrease in intensity over time. Whiledistractibility and impulsivity tend to remain,hyperactivity may take on the form of restlessness ornervous energy. In fact, this high energy level, which canalso be accompanied by a high level of enthusiasm,intuitiveness and creativity, has been described as one ofthe advantages of having mild AD/HD, especially if it issocially or occupationally enhancing.

AD/HD is often found along with language and learningdisabilities, behaviour problems, and changes in mood. Itcan also be found with other impulse control disorders(CD/ODD). These symptoms can make it difficult todistinguish AD/HD from other mental disorders such asFetal Alcohol Syndrome (FAS), making it extremelyimportant to get a professional diagnosis as early aspossible.


constant distraction by external stimuli

difficulty listening and following directions —the child may appear to daydream frequently

difficulty concentrating and attending to task

poor attention to detail; makes careless mistakes

inconsistent performance in school work — one dayhe/she may be able to do a task, the next day not

disorganization — the student loses belongings,his/her desk may be very disorganized and messy

low self-esteem due to poor work performance

If also Hyperactive and/or Impulsive:

appearing to be in constant motion

fidgeting with hands or feet, squirming, falling fromchair

finding nearby objects to play with

roaming continually around classroom, great difficultyremaining in seat

talking excessively

blurting things out, often inappropriately

often interrupting, intruding on others

problem waiting for his/her turn

engaging in physically dangerous activities

displaying aggressive behaviour

difficulty with transitions

social immaturity, low frustration tolerance


• Raise questions. If you suspect you may be dealingwith AD/HD, make sure a professional evaluation hasbeen done. Keep questioning until you are convinced!

• Ask the child what will help. Children with AD/HD areoften very intuitive. They can tell you how they learnbest if you ask them.

• Children with AD/HD need structure. Make lists. Haveas predictable a schedule as possible.

• Break down large tasks into small tasks. This is one ofthe most crucial teaching techniques for children withAD/HD. Mix high and low interest tasks.

• Keep a list of “Things to Do” by the student’s desk sohe/she can check off tasks as they are completed. Useincentives.

• Repeat directions and keep them brief. Have thestudent repeat them back to you.

• Allow for escape-valve outlets, such as leaving class fora moment. If this can be built into the rules of theclassroom, it will allow the child to leave the roomrather than “lose it”.

• Seek out and praise success as much as possible.

• Use feedback that helps the child become self-observant. Children with AD/HD often have no ideahow they come across. Ask questions like “Do youknow what you just did?” or “Why do you think thatother girl looked sad when you said what you said?”, orsay “Stop” and “Look”. Perhaps develop a private signalsystem to let the student know when “off track”.

• Provide consistent and immediate consequences andtry to make them positive rather than negative.

• Provide the child with a work area that is as“distraction-free” as possible.

• Know your limits. Don’t be afraid to ask for help. Beinga teacher in a classroom with a student who hasAD/HD can be extremely challenging.

• Work closely with the child’s parents or caregivers.

Resources

Treatment

Youth with ODD/CD are often treated with a variety ofinterventions. Behavioural therapies may be the mosteffective. When dealing with young people and impulsecontrol disorders, it is very important to make sure thatall co-morbid disorders (disorders that co-occur) areappropriately screened for and treated.

Research indicates that the best treatment for AD/HDincludes early diagnosis along with a combination ofmedication, behavioural therapy, classroommodifications, and individual and family counselling.Medication is often necessary to address the coresymptoms of the disorder. The appropriate medicationfor AD/HD can have significant benefits, such as anincrease in attention span and academic productivity, adecrease in impulsivity, and an improvement in peer andteacher relationships. Professionals who are consideredto be qualified to make a diagnosis of AD/HD includelicensed clinical, educational, and neuro-psychologists,psychiatrists, or other professionals with training andexpertise in the diagnosis of mental disorders, such aspediatricians.

ADDsupport.org (A Canadian Web site designed to help families andprofessionals find information and resources on AD/HD)Web: www.addsupport.org

Children and Adults with Attention-Deficit/ HyperactivityDisorder (CH.A.D.D.)8181 Professional Place, Suite 150Landover, MD 20785Phone: 1-800-233-4050Web: www.chadd.org

ConductDisorders.com (Web site that includes a parentmessage board and links to information about CD, ODD,and related problems)Web: www.conductdisorders.com

Learning Disabilities Association of Canada (LDAC)Phone: (613)238-5721Email: [email protected]: www.ldac-taac.ca

SchizophreniaSCHIZOPHRENIA Schizophrenia is abrain disorder that ischaracterized by disturbances inperception and disorganization inthinking and behaviour. Thisdisorder has nothing to do with asplit or multiple personality, which is a common misperception. It is comprised of two groups ofsymptoms: negative (such associal withdrawal, apathy,emotional unresponsiveness) andpositive (such as delusions,hallucinations, bizarre behaviour).

Schizophrenia affects about onepercent of the population. Thisprevalence appears to be thesame across countries, cultures,and socioeconomic groups. Thedisorder usually begins in theadolescent or early adult yearsand normally begins with the“negative” symptoms.

The causes of the disorder are atopic of ongoing research. Currentevidence indicates that geneticfactors are the most important,but that non-genetic factors suchas drug abuse, childhood headinjury and infection during amother’s pregnancy (e.g., theinfluenza virus) can also play apart in the development ofschizophrenia.

It is important to note thatschizophrenia is associated with ahigh risk of suicide, so earlyintervention and treatment is key.

Schizoph

renia


loss of ability to relax, concentrate or sleep in the earlystages

showing no emotion, sitting still for long periods oftime

denying that anything might be wrong

odd speech and expressions

delusions — false beliefs that have no basis in reality;e.g., “someone is spying on me”

hallucinations — hearing voices that make insults orgive commands; sufferers more often hear voices thansee things that are not there

disordered thinking — illogical thinking and looseassociations between thoughts

marked impairment in school performance (decreasein grades)

difficulty relating to others, social isolation orwithdrawal

marked impairment in personal hygiene and grooming

peculiar or bizarre behaviours, such as talking to aninanimate object, collecting garbage, or hoarding food

possible suicidal thoughts and behaviours (especiallyin early stages)

• Keep in mind that the symptoms of schizophrenia canbe similar to other disorders and illnesses, such asmood disorders or epilepsy. A professional diagnosis isessential.

• Try to express a low degree of emotional response tothe student’s behaviour.

• Try not to take the student’s negative behaviourpersonally. He or she is behaving this way due toillness and not by choice.

• If your student expresses thoughts that are distortedor delusional, do not try to disprove them. Make acalm statement of dis-agreement and then leave it.Appealing to reason and logic will not be productive.

• Communicate in brief, clear sentences. Giveinstructions one at a time.

• Seek professional help, above all. Work with a team.Continue (as much as possible) with the student’s dailyactivities.


Resources

The treatment of schizophrenia requires a range ofinterventions. Symptoms of schizophrenia generallyrespond well to anti-psychotic medications, and thereare many different ones available in Canada. Themajority of people with schizophrenia will improvegreatly with the appropriate medication and many willfind their hallucinations and delusions subsidesignificantly. Many of these medications will helpimprove negative symptoms as well, making it morelikely for patients to benefit from social therapies. It isalso necessary and important for people to stay on theirmedication in order to prevent the return of symptomsonce they recover from an acute phase. Extensiveresearch to create better, long-acting medicines isongoing (e.g., new long-acting atypical medications thatare injected into the body are now available).

The best approach to recovering from schizophreniaincludes taking medication, attending social therapies,and leading a healthy lifestyle, including effective stressmanagement activities, eating a proper diet, andexercising regularly.

Treatment

Schizophrenia Society of Canada50 Acadia Avenue, Suite 205Markham, ON L3R 0B3Phone: (905) 415-2007Toll-free: 1-888-SSC-HOPE (1-888-772-4673)Email: [email protected]: www.schizophrenia.ca(Also able to direct you to further resources in yourprovince or community)

Schizophrenia.com(An online, not-for-profit information, support andeducation centre)Web: www.schizophrenia.com

TouretteSyn

drome

Tourette Syndrome

TOURETTE SYNDROME TouretteSyndrome (TS) is a neurochemicaldisorder characterized by tics—involuntary, sudden rapid movementsor vocalizations that recur at irregularintervals. Although people with TS canusually suppress their symptoms tosome extent, like sneezes, tics areultimately irresistible; hence the use of“involuntary” to describe them. Ticsrange in severity from mild to moreexaggerated movements and sounds(see the following list of BehaviourCharacteristics for examples) and tendto increase with stress or excitement.Children with TS can be misunderstoodbecause of the complexity andsuppressibility of symptoms; parents,friends and teachers may find it hardto believe that these behaviours reallyare involuntary.

TS is a childhood onset disorder, withsymptoms typically appearing aroundthe age of seven. Estimated to affectin the neighbourhood of one in 100people, it is four times more commonamong boys than girls, for reasonsthat are unknown. The most commonfirst symptoms are facial tics, such asrapid blinking or mouth twitching. Insome cases, involuntary sounds such asthroat clearing and sniffling may bethe initial sign; in others, motor andvocal tics can appear at the same time.

Generally inherited, it is thought thatTS may result from the interaction ofseveral genes with environmental orother factors. Many (but certainly notall) children with the syndrome haveassociated problems such as ObsessiveCompulsive Disorder or Attention-Deficit/Hyperactivity Disorder (AD/HD). Moreinformation about these disorders canbe found in the respective sections ofthis handbook.


tics — involuntary movements or vocalizations rangingin complexity from blinking, facial twitching, head orbody jerking, shoulder shrugging, throat clearing,sniffling, tongue clicking, yelping, etc., to jumping,twirling, bending, touching others and, rarely, hittingor biting oneself, uttering ordinary words or phrasesout of context or, even more rarely, explosivelyvocalizing socially unacceptable words

fatigue, with attendant sleepiness or irritability andhyperactivity, caused by associated sleep disturbances

learning problems related to organization and/or eye-hand coordination difficulties with handwriting andwritten math work; generally, difficulties withexpressing thoughts in written form

behaviour problems resulting from poor self-esteemand/or school performance due to TS symptoms or, insome cases, from obsessive compulsive, attentiondeficit or impulse control difficulties


The following strategies recognize two importantcharacteristics of Tourette Syndrome: 1) tics tend toincrease with stress, and 2) they tend to decrease withconcentration on absorbing activities.

• Seat the child near your desk if that reduces stress.

• Create a reassuring classroom structure: establish adaily routine; give tasks in manageable chunks withclear, concrete instructions.

• Encourage concentration by integrating the student’sinterests with the curriculum.

• Allow extra time for work and assist with thedevelopment of routines and time management skills.

• Recognize progress rather than criticize disorganization.

• Trying to suppress tics is stressful and distracting forthe student. Allow him/her to move discreetly and toleave the classroom if symptoms becomeoverwhelming.

• Set untimed tests; if tics are a problem, use a privateroom where suppressing them is not necessary.

• Use aids such as a computer or tape recorder to helpthe student overcome handwriting difficulties andproduce work equal to his/her ability.

• Involve the parents and the child in determining anyspecial education needs and how best to manage TS inthe classroom.

• Arrange extra help (e.g., informal support from thespecial education resource teacher, peer tutoring, ortutoring outside of the school) for children who need it.

• Recognize that TS does not affect intelligence.

• Where significant behaviour problems exist, provideimmediate, constructive feedback and try to develop ajoint behaviour management program with parents,involving regular and frequent communication. Ensuresupervision for transitions (e.g., recess, lunch).

• Students with any neurobiological disorder are at higherrisk of depression (see the section on Depression forsymptoms and strategies). Get help immediately if youare aware that the student is expressing suicidalthoughts.

• Children with TS often suffer the added stress ofteasing, rejection, and even bullying, from peers.Encourage the child to talk about the disorder withclassmates and, through this sharing, increase classacceptance of tics. If he/she is uncomfortable aboutsuch disclosure, talk to the child and his/her parents todetermine the best approach. If the student agrees, apresentation to the class or school is often helpful.


Treatment

The majority of young people with Tourette Syndrome arenot significantly disabled by their tics or behavioursymptoms and therefore do not require medication.However, there are medications to help control symptomsthat interfere with functioning. The type and dosage ofmedication needed to achieve maximum relief ofsymptoms, with minimal side effects, varies for each childand must be determined carefully by a doctor. Otherforms of treatment, such as psychotherapy, relaxationtechniques or biofeedback, may help the child and his/herfamily cope with associated psychosocial problems andstress. Partial and sometimes full remission can occur atany time and may be short or long – lived. Tic symptomsseem to stabilize and become less severe during or afteradolescence.

Resources

Life’s a Twitch!(Life’s a Twitch® is a Web site on Tourette Syndrome andassociated disorders)Web: www.lifesatwitch.com

Tourette Syndrome Foundation of Canada194 Jarvis Street, Suite 206Toronto, ON M5B 2B7Phone: (416) 861-8398Toll-Free: 1-800-361-3120Web: www.tourette.ca

Resources Resou

rces

FOR MORE INFORMATIONNote: Please also see the individual sections in this handbook foradditional resources that are more specific to each section topic.American Academy of Child and Adolescent Psychiatry (One of the most comprehensive, valid, and reliableorganizations to access information in the area of mentalhealth and mental illness)3615 Wisconsin Avenue, N.W.Washington, D.C. 20016-3007Phone: (202) 966-7300 Web: www.aacap.orgBullying.orgBullying.org is a nonprofit Internet resource created to helppeople deal with the issue of bullying through the sharingof resources and the guiding of people towards non-violentsolutions to the challenges and problems associated with bullying.Web: www.bullying.orgCanadian Academy of Child and Adolescent Psychiatry555 University AvenueToronto, ON M5J 1X8Phone: (416) 813-6540E-mail: [email protected]: www.canacad.orgCanadian Centre on Substance Abuse (CCSA)Phone: (613) 235-4048 Web: www.ccsa.caCanadian Health Network(Web site designed to help people find excellent resourcesfrom non-profit health information providers acrossCanada, as well as key international resources)Web: www.canadian-health-network.caCanadian Mental Health Association180 Dundas St. W., Ste. 2301Toronto, ON M5G 1Z8Phone: (416) 484-7750E-mail: [email protected]: www.cmha.caCanadian Psychiatric Association141 Laurier Ave. West, Suite 701Ottawa, ON K1P 5J3 Phone: (613) 234-2815 E-mail: [email protected]: www.cpa-apc.org

Resources

Canadian Psychiatric Research Foundation (CPRF)(author of this handbook)133 Richmond St. West, Suite 200Toronto, ON M5H 2L3Phone: (416) 351-7757E-mail: [email protected]: www.cprf.caCentre for Addiction and Mental Health (CAMH)Phone: (416) 535-8501 (main switchboard)Web: www.camh.netBOOK: Got Issues Much? Celebrity Teens Share TheirTraumas and Triumphs (Randi Reisfeld, Marie Morreale,Scholastic, 1999).KidsHaveStressTooc/o The Psychology Foundation of Canada2 St. Clair Ave. E., Suite 200Toronto, ON M4T 2T5Phone : (416) 644-4944E-mail: [email protected]: www.kidshavestresstoo.orgKids Help PhoneKids Help Phone provides young people with counsellingover the phone or online, a place where they can expressthemselves and ask questions and where they can find outmore information on issues they face. Call 1-800-668-6868or visit the Web site at www.kidshelphone.ca. The service isavailable 24-hours a day and is completely anonymous andconfidential.Learning Disabilities Association of Canada323 Chapel StreetOttawa, ON K1N 7Z2Phone: (613) 238-5721Web: www.ldac-taac.caThe Nation’s Voice on Mental Illness (NAMI)Colonial Place Three2107 Wilson Blvd., Suite 300Arlington, VA 22201-3042Phone: (703) 524-7600Toll-free: 1-800-950-NAMI (6264)TDD: (703) 516-7227*Web: www.nami.orgWeb (for NAMI’s Child and Adolescent Action Centre):www.nami.org/youth

Resources

BOOKLET: Parents and Teachers as Allies, Recognizing Early-onset Mental Illness in Children and Adolescents,Second Edition, 2003. NAMI, The Nation’s Voice on Mental Illness. This booklet can be obtained from NAMI by calling (703) 524-7600. NAMI’s Web site is www.nami.org, forfurther information.National Institute of Mental Health (NIMH)6001 Executive Boulevard, Room 8184, MSC 9663Bethesda, MD 20892-9663 Phone: (301) 443-4513 Toll-Free: 1-866-615-NIMH (6464)Web: www.nimh.nih.govPsychDirect – Evidence Based Mental Health Education &InformationPsychDirect is a Canadian public education Web site of theDepartment of Psychiatry & Behavioural Neuroscience,McMaster University, Hamilton, Ontario.E-mail: [email protected]: www.psychdirect.comSchool Psychology Resources OnlineSchool psychology resources for psychologists, parents andeducators, and research learning disabilities, AD/HD,functional behavioural assessment, autism, adolescence,parenting, psychological assessment, special education,mental health, and more.Web: www.schoolpsychology.net

Final Notes:Remember that many of the above-listed organizations candirect you to local offices, resources, and services.

Most communities prepare a directory of local communityagencies and services to help. It is often found in a “Blue Book”or on a Web site.

There are many resources available for the topics addressed inthis handbook, and those listed in this handbook are only aselection of suggestions. Resources listed in this handbook arenot necessarily endorsed by the Canadian Psychiatric ResearchFoundation, and their use should not replace a professionaldiagnosis by a health care practitioner. These resources should,however, help you to learn more about what you may bedealing with, and to get the help that you need.

Resources

When Something's Wrong (WSW)Handbook Series

When Something’s Wrong: Strategies for Teachers providesinformation and classroom strategies to help educatorsunderstand and assist students with mood, behaviour orthinking disorders.

When Something’s Wrong: Strategies for Families has beendesigned to give parents, caregivers or other familymembers useful strategies to cope with and assist theirchild with mood, behaviour or thinking difficulties.

When Something’s Wrong: Strategies for Employers will beavailable fall of 2007

To order copies of handbooks from this series, please visitour website at www.cprf.ca

For further informationor to donate, contact:

Canadian Psychiatric Research Foundation133 Richmond Street West, Ste. 200

Toronto, ON M5H 2L3

Phone: 416-351-7757Fax: 416-351-7765

E-mail: [email protected]: www.cprf.ca R

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