By Stephanie Watson
WebMD Health News
About 1 out of every 5 kids in the United States has a mental health or learning disorder like depression, social phobia, or ADHD, according to the Child Mind Institute, a nonprofit that focuses on mental health care for children.
Children who aren’t diagnosed and treated early on can face a lifetime of educational, legal, and emotional issues, according to the organization’s 2016 Children’s Mental Health Report. While schools play an important role in recognizing early signs of mental health problems in children, “outdated approaches to discipline” put kids further at risk, according to the report.
Institute president Harold S. Koplewicz, MD, tells WebMD why schools can — and should — do more to identify and help these at-risk kids.
WebMD: What is happening to kids with mental health issues in schools?
Koplewicz: The bad news is that schools overwhelmingly have adopted a zero-tolerance discipline policy. Kids are kicked out much faster than ever before. In 1974, school suspensions were 1.7 million. In 2001, we had 3.1 million suspensions. The current antiquated way of focusing on bad behavior is throwing more kids out of school, but it’s not effectively increasing high school graduation rates.
WebMD: What does the report say about the availability of mental health services in schools?
Koplewicz: Only a quarter of all preschools in the United States have access to a mental health professional. And schools that do have access to a psychologist, psychiatrist, or social worker have a decrease of about 45 percent in preschool suspensions. The whole idea that we’re suspending preschoolers is kind of frightening. When schools have access to a mental health professional, even on a very intermittent basis, teachers feel more capable of keeping the kids in school.
WebMD: Why don’t more schools offer these programs?
Koplewicz: I think schools don’t realize how common these disorders are. I also think they don’t recognize that there are some interventions that are remarkably effective.
WebMD: What are some of the consequences of not having these programs in schools?
Koplewicz: Children with mental health and learning disorders are at higher risk of disobeying in school. That risk puts them at higher odds of dropping out of school, which increases their rates of interactions with the juvenile justice system and later on with prison. We found that the dropout rate nationally is 7 percent, and the dropout rate for kids who are in special education is about 21 percent. The dropout rate for kids in special education who also have an emotional disturbance is almost 40 percent.
WebMD: What are the best interventions for children with mental health issues?
Koplewicz: I think the most effective programs are positive behavioral interventions and supports (PBIS), which focus on reinforcing kids’ positive behaviors. It takes an effort, from the head of the school all the way to the lunchroom staff and the custodial staff, to focus on when kids are doing positive things. Schools that have adopted this cultural change of positive behavior intervention and support have a 30 percent decrease in in-school suspension. We know that if you keep kids in school, they have a better chance of graduating high school. And when they graduate high school, they have a lower risk of going to jail.
WebMD: How can schools identify which kids are in need of mental health services?
Koplewicz: I would love to see national screening. Schools do hearing tests and vision tests. They should also do mental health screening. I think there should be a 10-question screener in 7th grade and again in 9th grade. The reason for doing it in those grades is to see results pre-puberty and post-puberty.
I think we also need all elementary school teachers to have a good understanding of what is abnormal behavior. If they see a kid who can’t stand in line, can’t wait his turn, is calling out all the time, is more physically aggressive, is difficult to engage, and has disruptive behavior – those issues should be addressed. I think that if we gave teachers the skills and knowledge, and simultaneously asked for self ratings in 7th and 9th grade, we would certainly be better at identifying the kids who are most likely to be part of that 40 percent that are going to drop out of school.
WebMD: What can parents do if they know or suspect their child has a mental health issue?
Koplewicz: I would imagine that the number one problem parents have is that they’re ashamed. If we can get parents to not feel defensive about it and instead say, “It’s not a matter of my child being defective — it’s just that my child has symptoms that are making their functioning in school more challenging. And as a good parent, I need to find out what those symptoms are, what those symptoms mean, and whether there is something I can do to make their life easier at school.”
Parents should learn the warning signs that their children might be struggling with a mental health disorder. If they see those signs, they should reach out to the child’s school, and to their pediatrician or mental health professional for guidance.