Kids in Pain

Problems with Special Education

2011-07-16T16:03:00.003-04:00

In recent years I had the dubious pleasure of serving as head honcho of special education for a rural school district. I say "dubious pleasure" because while I learned a great deal, and liked my colleagues, the job was impossibly stressful and frustrating. I left the position voluntarily after I concluded that at the governmental level, the special education system is ridiculously mired in red tape. The legal system has effectively trumped the educational system when it comes to program delivery. Actual instruction of students with disabilities is at the tip of an unnecessarily bureaucratic, legislatively-driven and expensive iceberg.

Not only that, but even after several decades, special education remains the bastard child of the educational system. The shuffling of kids with disabilities into the mainstream, then back into special classes and schools, then back into the mainstream again, seems less a function of their educational needs than it does a reflection of State budgets and backroom politics. Student placements are rationalized as "good for the child" depending whether the bucks are available.

I admit to being cynical about this matter; but, I do believe special education as we know it will collapse under it's own weight unless certain problems are addressed. Here are some of them:

Administrators & General Education Teachers

The majority of school administrators and general education teachers have little or no training in special education. Many administrators view special ed students as thorns in their side, detrimental to standardized test results and as "discipline problems." Many general educators -- and particularly secondary education teachers -- resent the fact that special education students are placed in their classes. That is because they have not been properly prepared for inclusion of special education students, and because increasingly, they are being held accountable for test-outcomes.

Students with disabilities should never have been thrust upon general education teachers who have not been adequately prepared to deal with them, or who do not want them. Such teachers may do more damage than good to a student with disabilities. Most general education teachers require extensive, additional training if they are to work effectively with students with disabilities. Even then, close administrative supervision is necessary.

Special Education Teachers

It is also true that -- through no fault of their own -- most special education teachers are insufficiently trained. Special educators are unrealistically expected to be "experts" in cognitive, affective, social and physical disabilities, as well as child development and instructional technique. Many feel overwhelmed by the needs of the student population. Special education teachers are often responsible for a high number of students with disabilities, each one of whom has his/her own Individual Education Program (IEP). For these reasons, many special education teachers leave the field after only a few years.

Students with disabilities often have significant mental health issues, but few special education teachers have sufficient understanding of the psychology of students with disabilities. Even though most states require teachers to hold a Master's degree, even that doesn't cut it. Special education teachers need advanced training in child psychology. Mental health professionals also need to be housed in schools so they may provide direct and indirect services to students with disabilities.

Delivery of Special Education Services

Some educational classifications (for example, Emotional Disturbance) are so broad as to be nearly meaningless. If special education teachers are to truly meet the needs of students with disabilities, student concerns must be given greater definition. Concerns for student mental health should be given equal footing with scholastic concerns. In addition to instructional needs, attention should be given the emotional and psychological needs of students with disabilities.

Since the Individualized Educational Program (IEP) determines the "curriculum" a classified child receives, and since each student has his/her own IEP, it is difficult for teachers to provide coherent, group classroom instruction. Differentiated instruction is difficult to deliver, given individual student needs and the limited preparation time provided to most teachers.

Although most students do receive the special education services listed on their IEPs, a significant minority of kids gets many more services than they need. Those who get more than they need usually have parents who are insisting upon certain services, thinking "more is better," and threatening districts with legal action.

Significant funds are expended by districts trying to ward off what are often frivolous lawsuits. Unscrupulous attorneys needlessly initiate legal action against districts, knowing the districts will not waste time and money fighting them.

Some "student advocates" are nobly committed to their work, and perform an important service for students with special needs. But, some work for attorneys and care more about a pay check than about kids' needs. A hard-core few have an ax to grind, and are out to "get" school districts or administrators. Parents may have a hard time telling the difference. There is a need for certification of student advocates to ensure they meet standards supporting quality instruction.

At base, special education is legally-driven, not educationally-driven. Special education law has been drafted by attorneys, not educators. IEPs are legal documents that often bear little relationship to classroom realities. The law changes constantly, and it is humanly impossible to keep up with it.

Many services rendered to classified kids have no empirical basis, but are provided because (a) they have historically been available, or (b) parents want them. "Hippotherapy" (horseback riding) is but one example of such a service. Behavioral optometry or "vision therapy" is another. And, many services that have only temporary impact are provided for the same reasons: Applied Behavior Analysis (ABA), for example.

Even "useful" services may be provided long past the time they are effective. For example, some kids receive occupational therapy (OT) or physical therapy (PT) while making negligible progress. Special education administrators may provide such services on a student's IEP simply to keep the legal wolves away from the door.

I think we need to take a long, hard look at special education and -- as a society -- at what comprises a "disability." Everyone involved in the education of students with disabilities needs more sophisticated training. We need to wrest control of special education from the grip of lawyers and return it to educators, where it belongs, in the meantime cutting red tape. Furthermore, we need to develop more (and better) instructional and vocational programs for kids who do not benefit from traditional, academic fare. Finally -- since child mental health concerns have reached crisis proportions -- we also need to integrate mental health into schools to a far greater degree.

* * *

On the Misdiagnosis of ADHD

2010-09-01T16:02:00.010-04:00

I have been avoiding writing about Attention-Deficit Hyperactivity Disorder, but I suppose the time has come to talk about it. That is because one recent study conducted at Michigan State University, and published in the Journal of Health Economics, indicates that immaturity has been mistaken for ADHD in about one million children nationwide. The results imply that nearly one in five children has been incorrectly diagnosed, and many children have been treated with stimulant medication for a disorder they do not have.

The findings may be startling to some, but not to me. I have long thought ADHD is over-diagnosed, and am reluctant to diagnose ADHD until several other factors have been ruled out. Rule-outs for ADHD include depressive disorders, anxiety disorders, psychosis, myriad neurobiological disorders, certain sleep disorders, dietary factors, poor socialization, immaturity, and differences in temperament. Some parents -- usually those who are young, stressed out, or narcissistic -- seek a diagnosis of ADHD for their own convenience, and may exaggerate problems they have with their child. Most parents are surprised to discover that I am not going to render a diagnosis of ADHD without first having interviewed them, and before I have met with their child on several occasions.

I have not been happy with the authors of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) (currently in its fourth manifestation), because over the years they have reduced diagnosis to a formulaic process, and DSM to a cook book, diminishing the importance of clinical judgment as they have done so. One of the reasons ADHD is over-identified, I believe, is because -- thanks to DSM -- anyone who can read can "diagnose" ADHD based upon observable behaviors, overlooking the fact that the same behaviors are common to the disorders enumerated above. A diagnosis of ADHD is easy to make if one simply looks at the criteria listed in DSM, but many times that diagnosis will simply be . . . wrong.

The diagnosis of ADHD is a subjective one even if done correctly, and that has also led to misdiagnosis. It is all too easy to see what one wants to see. Adults who are otherwise well-intentioned -- but have little patience for the hi-jinx of children -- are likely more prone to think a child has ADHD than those who are more accommodating. Although there are numerous checklists that purportedly compare the behavior of a child with that of his or her peers, they are also susceptible to bias on the part of a parent, teacher or professional. The phrase, "Perception is reality" has all too often held sway when it comes to diagnosis of ADHD.

Finally, and although it may make me unpopular with some practitioners, I should mention the fact that ADHD is big business. The Center for Disease Control and Prevention estimates that the social cost of ADHD ranges between 36 and 52 billion dollars per year. Some practitioners not only diagnose ADHD, but also run treatment groups and derive a significant portion of their income from children and youth so diagnosed.

Now, having made remarks about the misdiagnosis of ADHD, I can say that when properly diagnosed, medical and psychological treatment for those with the disorder can be life-changing. I have seen kids who were totally "off the wall" and failing in school make dramatic gains in behavior and scholastic achievement once they were treated, and know adults who have been able to improve their relationships and vocational situations when helped. There are times when ADHD should be the primary diagnosis for a given individual . . . but, probably not as many times as has been true in the past.

Bullies & Bullying, Part Two

2010-08-24T12:58:00.009-04:00

Shortly after I finished writing the first part of Bullies & Bullying, a 15 year old girl named Phoebe Prince, originally from Ireland, and living in Northhampton, Massachusetts, hung herself. Her suicide followed incessant bullying inside and outside of school. Phoebe herself asked school personnel for help. Her parents also contacted school authorities on at least two occasions about their daughter's predicament. Little or nothing nothing was done about it.

A few weeks later, a second suicide took the life of an 11 year old boy who had been taunted by peers for supposedly being "gay." The child hung himself using an extension cord. Again, the school district was implicated for having done nothing, despite the fact the boy's mother had filed several complaints with the district for inaction.

Although the schools may not have legal responsibility for stopping bullying behavior, they certainly have the moral and ethical responsibility to do so. But, when they are unresponsive to student and parent pleas for intervention, or when bullying programs are clearly ineffectual, how is one to proceed? Although many do so, why should a child have to transfer from one school to another to avoid being a victim? Or, should a child continue to suffer at the hands of other students due to the failure of adults to provide a safe and secure environment at school?

I think not.

In my private practice, I have found that many children and youth strive to do what teachers and administrators tell them to do with respect to bullies. Most kids are told to simply ignore bullies: Good policy when it comes to verbal abuse, perhaps, but ignoring someone who is pushing you, or tripping you, or hitting you . . . that's damn tough! But, many kids do try to ignore physically aggressive peers, with the result that they get victimized again, and again, and again. The continuing victimization only feeds feelings of helplessness and hopelessness, the cornerstones of depression.

In the first part of Bullies & Bullying, I suggested that school personnel may do little or nothing to help kids who are being harassed and victimized by their peers, this despite the fact that many districts have zero tolerance policies and bullying programs to prevent student aggression. But, zero tolerance policies are of little utility, for they often target the student who is victimized as well as the student who is the bully. Children who fall prey to bullies may be unfairly disciplined for having done nothing!

As a psychologist there is little I can do to promote change in the many schools and school districts my young clients attend, but I have developed a somewhat controversial way of helping students cope with bullies and bullying. It consists of "going by the book," and if that fails, falling back on the "law of the jungle," a phrase I use that harks back to Evan Hunter's book, Blackboard Jungle, and the movie classic of the same name.

Playing it By the Book

When a child reports that he is being bullied by another child or children, and if it is a continuing problem --and assuming he has done nothing to provoke aggression -- I first recommend he (1) report it to his teacher. If the bullying continues, or the teacher fails to respond, or if after teacher intervention the bullying continues, the next step is to (2) report it to administration, typically the assistant principal. If the bullying still continues, or if the administrator fails to respond, the next step is to (3) involve parents if that has not already occurred. The parents should then request a conference with teacher(s), guidance counselor(s), and administrator(s) in attendance to see if the matter can finally be resolved.

Most of the time -- but not always -- involvement of parents puts school personnel on high alert, and the bully soon feels the heat and ceases his or her aggressive behavior. That is especially true if the parents are influential in the community or otherwise have pull. In some cases, however, school personnel continue to look the other way, or worse, find fault with the student who is being victimized. It also happens that things get better for the victimized child for a time, then fall back into their previous pattern.

The Law of the Jungle

If reporting bullying to teachers and administrators falls on deaf ears, and if parental involvement with school administration fails, and only in the case that no weapons are involved, the time has then come for the child who is being victimized by a bully (or bullies) to take the matter into his or her own hands. The Law of the Jungle comes into play. The child must stand up to the bully, and be ready to fight back.

Preparations are necessary.

First, the parents of the child must be informed that because no civilized remedy seems possible, a more aggressive approach to bullying -- "taking a stand" -- must be considered. Although the potential legal consequences for taking a stand are likely small, these should be discussed with parents. In my experience, most adults readily endorse a more aggressive approach. That is especially true of fathers when it comes to sons.

Second, the child and parents must accept the real possibility that the child may be injured in an altercation. Most children are pleased to have adult permission to take a stand, and many are fearless.

Third, the child must understand that if a fight occurs in school, he or she may receive disciplinary sanctions. This usually involves a brief suspension. Again, most are accepting of this, particularly when parents signal their acceptance.

Fourth, the child must be instructed to wait for provocation, then confront the bully verbally. Physical force should be used only if the child is threatened directly. (Some bullies will back down once a child confronts them verbally, but most will not).

Fifth, the child should be shown how to block and throw a punch, especially a jab. A jab has the greatest chance of landing successfully.

Finally -- and this is most important -- the child should be told that he or she need not win a fight in order to succeed in thwarting a bully. Most bullies are cowards, and will soon find another victim who will not fight back. Taking a stand is more important than being a fighter.

Now, I understand many psychologists and educators will find fault with what is clearly politically incorrect guidance on my part. The reality is that the Law of the Jungle often holds sway in schools and certainly in neighborhoods, however, and that is particularly true when adults have abdicated their responsibility to enforce sanctions.

I would welcome any feedback to what is a somewhat controversial position.

Bullies & Bullying, Part One

2010-03-09T22:37:00.012-05:00

Many of the kids I see in my private practice are boys, and a healthy percentage of those are middle school students in grades six, seven and eight. More than a few of them are tormented by bullies, and do little or nothing to "invite" bullying. The kids I see are simply trying to keep their heads above water academically while negotiating the perils of puberty. Most are short in stature, or overweight, or both. Most are neither athletic nor troublemakers. Many -- but by no means all -- have poor self-esteem made worse by bullying. All of them are suffering.

The school districts they attend have zero tolerance rules in place, meaning that the administrators have developed unthinkingly even-handed-- and sometimes harsh -- ways of dealing with student fights and aggression. In literally all districts, unless the instigator of a fight can be identified, all students involved in a fight are given identical discipline, usually (but not always) in-school or out-of-school suspension (ISS or OSS). All students are advised to report aggressive peers to teachers or administrators before matters get out of hand or a fight erupts. This would be a sensible policy if it worked, but the kids I see say to a person that it does not work, and most have lost faith in the policy and the adults who are empowered to enforce it.

All of the boys who have been the victims of bullies tell me they have informed responsible adults they are being targeted, but that the adults so informed do little or nothing to prevent bullying from happening again. Only today, one boy told me he told the Assistant Principal in his school several times he was being pushed and hit by another student, and that the Assistant Principal spoke to the offending student, then let him go . . . to push and hit the targeted student yet again. Another boy told me that when he reported a bully, the administrator told him that he "must have done something" to provoke the other child. Yet another boy was effectively abandoned by his district with the recommendation he enroll in a private school, which he then did. Blaming the victim allows some school personnel use to avoid the problem of bullying altogether, presumably relying upon kids to determine the pecking order or reasoning "boys will be boys."

Now, it is certainly possible that the boys I have seen are lying to me, and that in fact, they are doing something to provoke the bullies involved . . . but I sincerely doubt that. It may also be true that in some respects the boys I see act or look like "victims," but even if so the abuse they suffer lacks justification. In my mind, to say that some kids deserve to be bullied -- because they look or act a certain way -- upholds a standard of brutality that we should not tolerate in our society, much less in our schools. It is roughly analogous to the warped belief that because a women dresses provocatively, or acts flirtatiously, she deserves to be sexually harassed or assaulted.

Please do not think me naive: Having been a teacher and a school administrator, I am well aware of the difficulties posed by monitoring student behavior. But, it is also true that many teachers and administrators ignore the problem of bullying, or assume bullying programs and character education will win the day. Adults must step up to the plate and intervene swiftly to stop bullies from acting aggressively. It is also true that application of zero tolerance rules misses the point, for the bully and the bullied are given similar discipline for dissimilar behaviors. Fairness goes out the window in the quest for equal treatment of students . . . more on that later!

Cutters & Cutting

2009-06-23T09:25:00.020-04:00

A cutter is a person, usually an adolescent and most often a female, who cuts herself in what is typically a private ritual. Razor blades, knives, compass points, shards of glass, or any sharp implement may be used in a self-injurious, but rarely lethal, manner.

Cutters usually do not want to commit suicide. Many talk about cutting as providing relief from emotional "pressure" they feel. Most try to hide scabs and scars left by this self-injurious behavior, and some will go to great lengths to avoid detection. Many feel guilty about their behavior. Cutters may target any part of the body for self-injury, but arms, legs, and torso are perhaps most common. In some cases, cutting is accomplished as part of a ritual, and may be associated with a certain song, incantation, or object that has special meaning to the cutter. A few cutters openly seek attention, and may even post photographs online or elsewhere. Cutting has been associated with depressive disorders, post traumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, and Borderline Personality Disorder (BPD).

It is difficult for most people to understand why a child might want to cut herself, or how drawing of blood might relieve feelings of stress or pressure, but cutters do derive certain gratification from the behavior. Sadie, a 15 year old girl who has cut her thighs with an Exact-O knife for nearly a year, put it this way:

When my father yells at me, I just can't take it sometimes . . . . So I go up to my room, lock the door, turn on my IPod real loud, then get my gear from my closet, take down my pants and find a place I haven't cut. It's . . . somehow, it feels good to cut, not too deep . . . and it's important to get it all in a straight line, so I have parallel lines, maybe two inches . . . and I use tissues to blot the cuts or sometime just let them scab up . . . .

The website http://www.selfinjury.com/ has posted graphic representing different motivations youth have for engaging in cutting behavior. Some youth cut to relieve the great stress they feel in their home, school, or peer group environments. The behavior is triggered by a particularly stressful life event, and leads -- paradoxically -- to a feeling of relief. Other youth feel alienated, detached, or isolated, and engage in cutting to feel "real" or alive, in the way that a tired person might throw cold water on his face to wake up. In fact, some therapists persuade cutters to use ice cubes rather than sharp implements on their skin.

Successful treatment of cutting typically involves more than dealing with the specific behavior, however, for that does not resolve underlying problems. The successful therapist must help the youth who is cutting identify stressful life situations and to develop strategies for eliminating or reducing them. The reasons for a youth feeling alienated or detached from her environment must also be explored. The youth must be encouraged to access and express difficult emotions, many of which may cause her to relive painful experiences. In some cases, and especially when abusive situations are present, a youth must be removed from her dysfunctional home environment. Collaboration between therapist and youth -- a therapeutic alliance -- is essential.

Teachers and parents often suspect a youth is cutting, or see the evidence directly. Cutting should not be ignored, or regarded as a "stage," because it signals that a child is in trouble. Rather, the youth should be addressed privately, non-judgmentally, and calmly. The adult should communicate concern to the youth, and suggest that the youth seek treatment. Teachers may also want to tell parents in confidence if they suspect their son or daughter is cutting, and offer to find help through the guidance department, school psychologist, or social social worker.

Acting Out, Part Eleven: Gang Culture

2008-07-28T12:42:00.021-04:00

The phenomenon of youth gangs is not new, of course, but the behavior of youth in gangs has become appreciably more violent over the years. Gone are the days of switchblades and zip guns. Weapons of choice now include Smith & Wesson .38 revolvers, machetes, and assault weapons, including AK-47's. Gangs such as the Crips, Bloods, Latin Kings, MS-13, and others are responsible for much violence, some of which has found its way out of urban centers and into suburban -- and even rural -- environments.

Especially in urban areas, schools have had to take steps to contain youth gangs. Although it is slightly dated, a report from the Office of Juvenile Justice and Deliquency Prevention (2000) draws a clear connection between the presence of gangs in schools and students' violent behavior, possession of deadly weapons, and involvement with drugs. Alarmingly, over one third of youth age 12 and over describe the presence of at least one gang in their school. Security measures taken by schools including such things as guards and use of metal detectors correlate positively with gang activity.

Despite the obvious connection between gang culture and violence, gang membership remains the stuff of romance, though not in the way West Side Story portrayed the antagonism between the Sharks and the Jets. Today, gang culture is romanticized through popular music, particularly gangsta rap. Of course, the culture of gangs includes norms for dress, demeanor, and behavior that hold appeal for many youth. The appeal cuts across lines of race and sex, and to a great extent, socio-economic status. The clear association between gang culture and drugs means that youth who are attracted to gangs are also susceptible to drug abuse.

Although youth gangs pose clear danger to peers and adults in authority, only a small percentage of students are bonafide members of gangs, and it is probably the influence of gang culture that is of greatest concern. Gang culture attracts youth for reasons that reflect basic human needs, and so are readily understandable. These include:

A need to be wanted and accepted . . . to belong
Support, structure, and values
The desire to be acknowledged and respected; to have status
Excitement and "fun"
A need for power and influence

White and Mason (2006) state that gang culture provides youth with a social identity. They state:

Groups of young people band together for social, cultural and familial reasons. They also do so for protection. Youth group formation, which in some cases may include the evolution of the group into a gang, is thus often intertwined with violence or the threat of violence in the lives of young people. Over time, group identification becomes central to individual social identity, and the fate of the collective is inseparable from the security and social belonging of the individual.

It is easy for whites to blame the appeal of gangsta lifestyle on aspects of Black society, but truthfully, the appeal of gang life has little to do with color. Gangs -- and the youth who comprise them -- come in all colors. Kids attracted to the gangsta lifestyle are typically alienated from traditional institutions (including school), are depressed and unmotivated, and have parents who have failed to forge meaningful relationships with them. Some of the kids are significantly impaired in their capacity to form meaningful bonds with others (see Acting Out, Part Nine: Empty Kids), but most are simply followers looking for a home.

Only this afternoon I was talking with a 17 year old youth who has adopted the behavior, dress and mannerisms of gang culture. He told me he and his friends get together to write and record hip-hop lyrics. He told me that the songs he writes authentically depict his personal history, which includes paternal abandonment and a mother addicted to crack. He also told me one of his buddies cries when his music is sung or recorded. When that happens, he said, both he and his friends comfort the boy. Their group is a family, albeit a fragile one.

The way schools are set up now, the number of children and youth needing genuine, caring relationships far outstrips our capacity to deliver the goods: the financial resources and trained personnel just aren't there. And no, special education does not help: Sorry, but no services are provided kids who are socially maladjusted! Only a few lucky kids will find teachers and counselors who have time and energy to meet their needs for affection and adult guidance. If we are to avoid a future society like that in Kubrick's A Clockwork Orange,* change must come, and schools are the logical place to start.

Comprehensive approaches have been shown to be effective when cities or communities are faced with significant gang violence. Operation Ceasefire in its various manifestations has reduced homicides among youth. The Department of Health & Human Services in its evaluation of school-based programs notes that several are effective, including the PATHs Program (see http://www.psychoed.net/ for discussion).

-------------

* Warning: This link takes you to an extremely graphic and troubling scene of home invasion by a youth gang set sometime in the future. As I write this, similar home invasions by youth, and particularly Asian youth, are happening with greater frequency.

Acting Out, Part Ten: Needs & Attention

2008-06-14T17:00:00.012-04:00

Attention

A ten year old boy is in the school cafeteria, stuffing down French fries as if he hasn’t eaten in a week. Ketchup dribbles down his chin and onto the table. “Ben, stop that!” chides the aide assigned to his table. Mrs. McGovern, Ben’s teacher, looks up from her lunch. “Oh, that’s typical . . . He’s just looking for attention.” The aide – thinking that he should ignore this behavior – turns away. Ben looks perplexed. He grabs four more fries and crams them in his mouth.

In a residential treatment facility across the state, a group of counselors is discussing Erikka, an adolescent girl. The previous night she took a paper clip to her arm until the blood came. In the morning she was taken to the hospital for a tetanus shot. “The nurse said she did it for attention,” one of the counselors reports. The other counselors nod knowingly.

Each day -- in schools, on playgrounds, in homes and in residential care – many behaviors that troubled children and youth show are described as attention-seeking. Oftentimes, labeling of behavior as attention-seeking serves as an “explanation” for the behavior. Books and articles discuss attention as if it is an end in itself. Sometimes it seems that nearly all social behavior may be regarded as attention-seeking!

Are people -- even children -- truly that simple? I think not.

The failure to understand the complexity of children’s behavior causes some adults to ignore what they perceive as youthful efforts to gain attention. Although certain literature indicates that ignoring inappropriate behavior is one of the best ways to deal with it (Alberto & Troutman, 1999; Madsen, Becker & Thomas, 1968; Sulzer-Azaroff & Mayer, 1991), this is an appropriate management technique only some of the time (Redl & Wineman, 1952). Many times, ignoring inappropriate behavior is counter-therapeutic, even dangerous. Ignoring behavior may cause it to increase in frequency, severity or duration. We need sophisticated ways of understanding the behavior of children if we are to intervene in a ways that are helpful and meaningful.

The Relationship of Human Needs to Behavior

Approaches to child behavior involving understanding of motivation are more useful than simplistic explanations invoking attention-seeking. Assuming children understand what is expected of their behavior, caregivers must also strive to help children and youth understand the forces that drive their maladaptive actions. It is only through development of such self-understanding that troubled children and youth may make real progress in school and other treatment settings. Helping children and youth understand the basic needs that drive behavior enables them to identify those needs and ultimately, to meet them appropriately. Of course, helping kids understand their behavior takes time and some psychological sophistication on the part of the adult.

Several writers have attributed human behavior to basic needs that are universal. Some time ago White (1959), for example, posited that human beings “naturally” strive to attain competence. Needs for achievement, influence, and social affiliation have also been held to underlie human behavior (Atkinson, 1981; McClelland, 1961). The Circle of Courage popularized by Brendtro, Brokenleg and VanBokern (1990) suggests common needs for belonging, mastery, independence and generosity. Maslow (1968) described five needs that are common to all people: (1) physiological, (2) safety and security, (3) love and belongingness, (4) self-esteem, (5) self-actualization. He furthermore linked deprivation of needs to maladaptive behaviors such as those characteristic of obsessive-compulsive disorder.

All of these perspectives hold that human needs are primary determinants of behavior. A hungry person seeks food. The frightened toddler seeks the security provided by a parent. The adolescent strives to belong to a clique, to achieve in school or in sports. The adult attempts to develop expertise, to make a contribution to society. A need once gratified generally loses its motivating force. If the need goes unmet, however, it may have an adverse affect upon behavior, and perhaps become a point of fixation for the individual.

When one takes the position that human needs drive behavior, the inappropriate actions of troubled children and youth described as attention-seeking may be re-conceptualized as need-seeking. This perspective has several advantages for children and their caregivers, for it supports an positive stance towards education and treatment. Chief among the advantages are the following:

Need-seeking implies that children and youth have been deprived of the basic material for building productive relationships. Attention-seeking implies that behavior is intentional, purposive, and possibly malicious.
Need-seeking invites empathy, for behavior is regarded as reflecting unmet biological, social, or individual predispositions. Attention-seeking invites neglect or punishment, for inappropriate behavior is seen as volitional.
Need-seeking suggest that human behavior is complex, and that if appropriate measures are taken it may be changed in a predictable manner. Attention-seeking implies that if behavior is simply ignored it will “go away.”

Drawing connections between specific child behaviors and the needs they reflect is challenging. The caregiver must take a sincere interest in the child, and establish and test hypotheses about his or her behavior through observation and experience. Assessment of behavior through techniques such as the conflict cycle or Life Space Crisis Intervention (LSCI; see Long, Wood & Fecser, 2001) may prove helpful. At least some knowledge of one or more theories of motivation (see above) is essential.

I believe it is because we have reduced many child behaviors to "attention-getting" that we see more children with significantly troubling behavior. When we really try to understand the motivations for maladaptive behavior we will see change for the better.

References

Alberto, P.A., & Troutman, A.C. (1999). Applied behavior analysis for teachers (5th ed.). New Jersey: Merrill.

Atkinson, J. W. (1981). Thematic apperceptive measurement of motivation in 1950 and 1980. In G. d'Ydewalle & W. Lens (Eds.), Cognition in human motivation and learning (pp.159-198). Hillsdale, NJ: Erlbaum.

Brendtro, L. K., Brokenleg, M., & Van Bockern, S. (1990). Reclaiming youth at risk: Our hope for the future. Bloomington, IN: National Education Service.
Long, N. J., Wood, M. M., & Fecser, F. A. (2001). Life space crisis intervention, 2^nd ed. Austin: Pro-Ed.

Madsen, C. H., Becker, W. C., & Thomas, D. R. (1968). Rules, praise, and ignoring: Elements of elementary classroom control. Journal of Applied behavior Analysis, 1, 139-150.

Maslow, A. H. (1968). Toward a Psychology of Being, D. Princeton: Van Nostrand.

McClelland, D. (1961). The achieving society. Princeton: Van Nostrand.

Redl, F., & Wineman, D. (1952). Controls from within: Techniques for the treatment of the aggressive child. New York: Free Press.

Sulzer-Azaroff, B., & Mayer, G.R. (1991). Behavior analysis for lasting change. Fort Worth, TX: Harcourt Brace College Publishers.

White, R. (1959). Motivation reconsidered: The concept of competence. Psychological Review, 66, 297-333.

Acting Out, Part Nine: Freddy

2008-05-22T15:01:00.028-04:00

When I was in my early twenties I took a job teaching secondary students with learning, emotional and behavioral disorders. I was told mine would be a "new" classroom, and in fact it was: a tiny, converted storage room with no closet space, and with a minuscule window in one corner. It would take me until Christmas -- and after many promises -- to get a chalk board. The fact that the room had absolutely no sound proofing led me to dub it the "echo chamber," and explained why at the end of each day I had a headache. Imagine how it helped my students!

I didn't know it at the time, but my students were some of the most difficult kids in the high school. Most were with me all day, still others were assigned to my room when another teacher had prep periods or lunch. My supervisor was a school psychologist whose office was located in the administration building across town, and who never left her office except to eat, which apparently she did in quantity. The high school principal was a glad-hand who was all style, no substance. He was at his best hitting on young, female teachers.

Freddy was one of the tenth graders in my 6:1:1 class. A good-looking boy with wavy hair and glasses, for reasons initially unclear to me he was classified with emotional disturbance. He was also one of my stronger students academically, capable of doing work at the 5th or 6th grade level. I learned that his mother died when Freddy was quite young, and that his father was an alcoholic who was verbally (and probably physically) abusive of his only child. I felt sorry for this boy who was less than ten years younger than I.

All went fairly well during the first few weeks of school. Freddy and the other students performed according to expectations, complaining at most any work they were expected to complete, but doing it anyhow. The kids assigned to my classroom were soon reluctant to enter it, however, and would wait until the corridors cleared before doing so. They grumbled about being assigned to the "retard room." They also started calling themselves Sweathogs, after a popular television show, Welcome Back , Kotter. Having the romantic fantasy that I might also be a "Kotter," I attempted to persuade my students it was "okay" to be in a special education class. My idealism was met with skepticism. Freddy led the charge.

Freddy had friends who were not special education students, and as the school year progressed his unhappiness about being a sweathog became more and more obvious. He insulted his classmates with disabilities, nearly all of whom lacked the skills to counter his verbal abuse; he actively avoided coming to class, and when he did attend refused to complete his work and disrupted it. He was noncompliant with my reasonable requests probably half the time, and the other students were taking notice, and following suit. There was no possibility of segregating Freddy, for the room was too small. Lack of administrative support meant that sending him out of the room proved nothing. He always came bouncing back. I was on my own.

Remembering a minor work of classic fiction I had read, The Blackboard Jungle (1954), and studying the tenets of psychoeducation, I decided I would forge a relationship with Freddy. So, I found ways for him to gain prestige through "acceptable" channels, and used planned ignoring of Freddy's maladaptive classroom behavior when that was feasible. Those strategies would have worked in the majority of cases, I now believe; but what I didn't understand then -- and comprehended only years later -- is that Freddy's relationship with his father was so dysfunctional that he could not extend trust to me. His personality development had been severely compromised through poor parenting, and as classroom authority I was caught up in Freddy's negative transference reaction. The closer I tried to get to Freddy, the more he would push me away, and the nastier he became.

I soon became defensive, caught up in the conflict cycle Drs. Nick Long and Frank Fecser describe so well. At times I took the initiative to "out tough" Freddy. Other times, I tried to appease him. Basically . . . It wasn't pretty.

Winter break gave me brief respite from the anxiety I was now suffering, but when school came back into session things were worse than they had been before. Freddy and his father had come to blows on Christmas day, and Freddy had run away from home. He was living with friends, drinking, smoking marijuana and had some run-ins with police. I was beginning to understand just how troubled Freddy really was.

I had little control over Freddy in school. He became verbally abusive of me, calling me "Chrystal Balls," babbling nonsense, refusing to do his work and continuously challenging my authority. He seemed to have singled me out, and I felt utterly helpless dealing with him. The school administrators gave me little support and my two special education colleagues were living their own hell. My previous desire to develop a relationship with the boy gave way to despair. I prayed Freddy would be absent from school, and celebrated when he failed to report. I really wondered if I was cut out for special education, or for teaching. I tried not to bring my troubles home, but that proved increasingly difficult. I was really stressed out.

My involvement with Freddy did not end well. Towards the end of the school year he was transferred to an older -- and more experienced -- female teacher's class. His behavior stabilized in the new environment and I was left to ponder what I did "wrong." My ego had taken a severe beating, and scars remain.

I have thought about Freddy over the years and now think I was overly zealous in trying to "relate" to him. I believe that due to my age, he saw me as an equal but also -- given his troubled relationship with his father -- as an authority figure who was not to be trusted. I also think I assumed that because I wanted to develop a positive relationship with Freddy, he would want to do likewise. My naivete, or perhaps narcissism, got in the way. In some ways, I empowered Freddy, and he readily took advantage of that. Maybe I forgot that Richard Dadier's attempt to win over a troubled student in The Blackboard Jungle fell flat.

I learned early on that working with troubled and troubling kids is not easy. It is analogous to piloting a submarine through a minefield or perhaps, flying an airplane into the eye of a hurricane. You might survive a few false moves, but more than that and you are lost. Relationship remains critical, far more so than any prescribed procedure for behavior management, but relationship cannot be rushed. Support from colleagues is essential. An empathic stance combined with patient understanding that trust cannot be manufactured generally brings durable results.

It would be nice if teaching ED/BD kids was like Welcome Back, Kotter. Sometimes it is, but more often it is not.

Acting Out, Part Nine: Empty Kids

2008-05-21T09:14:00.015-04:00

When I was in graduate school in the late 1970's, I had the great fortune to serve an internship at Hawthorn Center in Northville, Michigan, a psychiatric facility for children and youth with emotional and behavioral disorders. I was assigned children for psychological assessment and engaged in psychotherapy with kids and their parents. I learned a great deal from my supervisor, a psychologist and all around great guy named Dr. Ira Glovinsky, who has a practice in West Bloomfield, Michigan.

I was also assigned to work with the Founding Director of Hawthorn Center, the renown child psychiatrist Dr. Ralph Rabinovitch, who (I had been told) would size up interns in a nanosecond, detecting any overt or latent psychopathology that might compromise their ability to deal successfully with troubled children. Needless to say, this assignment caused me no little anxiety: for not only was Dr. Rabinovitch an astute clinician and scholar, but he also cut a most imposing figure.

My job was to administer psychological tests to children and youth, and to relate my findings to Dr. Rabinovitch, who would then use them in treatment . . . or not. I don't recall too many specifics, but I do remember one question he asked me: "Is this an empty kid?" I also remember grappling with that question, for I had no idea what the good doctor was talking about. But really, the term "empty kid" is self-explanatory.

Empty kids are children and youth whose consciences are weak, and who are lacking in that stuff that makes us human: empathy. Their emptiness often shows in their eyes, which seem to be devoid of life. Their emptiness is also manifest in their relationships, which are self-serving or based upon quid pro quo agreements and deals: "I don't have friends, I have associates," some empty kids will say.

Empty kids cannot trust, and cannot be trusted. Most have suffered badly in early childhood, and have simply turned off their affective sensibilities. Empty kids typically have diagnoses of Reactive Attachment Disorder, Disruptive Behavior Disorder, Oppositional Defiant Disorder, and Conduct Disorder, although it is also true that many kids with those diagnoses are not "empty." Many empty kids are classified with emotional disturbance in school, and receive special education, although some are found to socially maladjusted and so receive no special education services.

One of the most important things a clinician can do is to assess the degree to which an acting-out child possesses a viable conscience, and relatedly, the capacity for empathy. Moral approaches and appeals to the values of such children usually don't work, for they are value-deficient. Enlightenment approaches may be needed if "logical consequences" for behavior -- rather than punishments -- are invoked. Compensatory approaches to helping should be used cautiously with empty kids, who may try to exploit efforts made by well-meaning adults. Medical approaches may find some application when the child is perceived as being unable to gain control over behavior.

It is true that empty kids may behave with malice and forethought, and most teachers of such kids quickly pick up on their lack of empathy and connectedness. "You'll be reading about him in the paper," some teachers will say, "He's going to wind up in the slammer." Unfortunately, the teachers are often right. Some caring teachers take on such kids as "projects," usually to their regret. Teachers must walk the tightrope very carefully with empty kids, for those kids will quickly take advantage if they see any chink in the armor. Fritz Redl, the master clinician, termed this perceptiveness "diagnostic acuity in battle relevant areas," meaning that some kids are experts when it comes to ferreting out human vulnerabilities.

When I was in my early twenties, green and in my third year of teaching, an kid running nearly on empty put me through the paces . . . . Read on.

Acting Out, Part Eight: More Perspectives on Helping

2008-05-20T10:26:00.010-04:00

In Acting Out, Part One, I described the Moral and Enlightenment approaches to helping Philip Brickman and his colleagues described some years ago. The Moral approach holds the child responsible for his behavior, and for correcting inappropriate behaviors when they occur. The Moral approach is frequently seen in schools, and often appears under the guise of Character Education or something similar to it. The Enlightenment approach holds the child responsible for behavior, but it is the adult who steps in to correct misbehavior. Imposition of discipline, or punishment, is the method. The Enlightenment approach is all too common to schools, of course.

Taken together, the Moral and Enlightenment approaches deliver this message to most kids: Sink or swim.

Of course, most kids with significant emotional and behavioral difficulties sink. Some sink slowly, over months and years, but some drown within a few days. Holding troubled kids responsible for behavior -- and punishing them when they are unable to assume that responsibility -- simply does not work. If we are serious about helping kids with problems, and are not just giving it lip service, child-supportive and non-punitive approaches to helping are needed.

The CPS model developed by Greene and his colleagues (above) provides what Brickman would call a Compensatory approach to helping. Compensatory interventions view the problematic behavior children manifest as maladaptive efforts to cope with challenging situations. They also place ultimate responsibility upon children for finding appropriate ways of addressing those situations, albeit with adult support and guidance. The adult using a compensatory approach recognizes that "children do well if they can," and that often, blaming a child for maladaptive behavior is really blaming the victim of life circumstance. The adult using a compensatory approach helps children develop skills that address challenging situations effectively and appropriately. Compensatory interventions lie at the heart of psychoeducation, in my opinion. Compensatory interventions are those that teach a child to swim, or at least to tread water.

Life Space Crisis Intervention (LSCI) is also an example of the compensatory approach. While LSCI actually consists of a number of tools for helping troubled and troubling kids, the adult guides the process . . . and the child. The adult views maladaptive behavior as the child's best effort to solve a problem, and offers the child a better way. The child is not seen as "responsible" for his or her inappropriate actions, but with assistance is viewed as responsible for making changes to behavior.

Of course, there are times when children simply cannot control their behavior, and lack the resources needed to help themselves with adult support. Kids with ADHD, Tourette's syndrome, brain damage, moderate and severe mental retardation, and some forms of autism/spectrum disorders provide examples. Compensatory approaches fall short under such circumstances, or may be used as back-up interventions. Brickman's Medical approach recognizes that at times, adults must step in when a child lacks the basic resources needed for self-control. Medical interventions include administration of psychopharmacological drugs, institutionalization, and custodial care.

Acting Out, Part Seven: Collaborative Problem Solving (CPS)

2008-05-15T13:54:00.015-04:00

Collaborative Problem Solving, or CPS, is an approach to acting-out that may be employed by teachers and child care workers as well as mental health professionals. Dr. Ross Greene of Harvard University and Massachusetts General Hospital is the chief proponent of CPS, and has popularized the approach through his best-selling The Explosive Child. He and a Dr. J. Stuart Ablon have also written a book about CPS for clinicians.

I devote one page to CPS on my website, but think I have given it rather short shrift, for CPS seems less a "method" than a philosophy of treatment, one which is respectful of children without being permissive and is optimistic in tenor when it comes to troubled and troubling kids. Greene's mantra, Children Do Well If They Can, is one that is fully in keeping with my own perspective. Children's resilience in the face of trying circumstances is implicit in the message.

CPS is based upon the premise that "explosive" kids have deficits in one or more areas of cognition, and that this makes it difficult for them to communicate their wants and needs effectively. Greene and his colleagues have developed a questionnaire to tease out those deficits, which enable one to think in broad but meaningful terms about behaviors of concern.

Although he does not use the terms Kurt Lewin and his colleagues once used to describe adults' behavior towards children, Greene differentiates the CPS approach from autocratic and laissez-faire styles of discipline. Autocratic adults demand too much of the child's cognitive capacity, Greene asserts, and adults who are laissez-faire fail to challenge the child to change. Greene notes that at times, backing off is essential to child management, echoing Fritz Redl's occasional use of "planned ignoring" working with youth some 60 years ago.

CPS cannot be described easily because as an approach, it incorporates both a philosophy and a process of involvement between an adult, child, and (in clinical settings) the child's parents. It entails "working out a solution [to a conflictual situation] that is realistic, doable, and mutually satisfactory." Adult empathy and problem definition are key to the process, and the child is "invited" to join the adult in collaborating to find a solution. CPS is inherently democratic, respecting the rights, wants and needs of all parties involved.

I cannot say there is anything about CPS that is truly new, but Greene's genius is apparent in the way he delivers his message. He describes the essential elements of productive adult-child communication most ably, and demonstrates how CPS may be used in different situations. He studiously avoids the terms "child management" and "anger management," and I am appreciative of that fact. CPS shows great promise for use in clinical, child care, and educational environments. Now, if only we adults will be sensible, and adopt Greene's approach . . . !

Acting Out, Part Six: Anger Management?

2008-05-13T09:08:00.025-04:00

In my private practice I am often approached by parents who want me to help their child with anger management. I tell them I don't help children "manage" their anger. I do help kids understand where their angry feelings come from, however, and to find productive ways of expressing anger. I also help parents deal intelligently with young children (and some with disabilities) who lack the cognitive skills or maturity to get a handle on their emotions. "Anger management" sounds like something akin to managing a dangerous animal, and I deal with human beings.

In my experience, most anger originates in psychological pain or trauma. Depression, shame and guilt typically accompany it. It is ludicrous, therefore, to try to separate anger from its handmaidens. The therapist must deal with whole, and messy, ball of wax.

The psychodynamic psychotherapy I do starts with an understanding of anger as the behavioral manifestation of deeper feelings. I ask how anger is expressed, under what conditions, and to whom. I keep in mind the fact that anger is often displaced: an innocent bystander may receive the treatment the angry person would really like to visit on someone else! I usually mention that acting angry feels pretty darn good, momentarily at least, and that anger is as helpful as physical pain, because it tells us we need close attention.

Since most kids find it more comfortable to act out their anger than to experience the psychological pain that underlies it, it takes time to locate the point of trauma. Once the origin of anger has been identified, feelings of guilt, shame, and self-blame typically materialize and must be addressed. Conscious recognition that psychological injuries sustained may not be undone -- and that scars remain -- leads first to feelings of depression, but ultimately to acceptance. This approach usually makes "anger management" unnecessary.

Educators and child care workers to not have the training, luxury of time, or place to conduct psychotherapy, however. They may engage in management of surface behavior, or use more sophisticated approaches such as Collaborative Problem Solving (CPS) or Life Space Crisis Intervention (LSCI). These are discussed elsewhere in this blog.

Acting Out, Part Five: Residential School

2008-05-12T08:46:00.015-04:00

For three years I was principal of a grades 7-12 "state approved private school" for children and youth in residential treatment. The students lived in dormitories on campus, and were under the aegis of a private agency. Nearly all of the ninety students had been placed in residential care by the courts, and approximately half were from the City of Buffalo, meaning they were minorities. Those that had not been found to have emotional disturbance by their school districts were typically found to be by the school's Committee on Special Education (CSE), over which I presided. These kids were "nobody's children." Their parents couldn't deal with them, many had committed crimes, they could be verbally and physically aggressive, and the school districts from whence they came wanted nothing to do with them.

As the building principal, I had responsibility for developing an educational program that would work for students of different ages, grades, educational and socio-economic backgrounds, who had different levels of ability and who were in residential treatment for varying lengths of time. It was extremely challenging, for many of the teachers I supervised had been at the school for several years, and all were paid significantly less than their public school counterparts. Despite the fact most found gratification working with their students, they were expected to do too much for too little. Some new teachers I hired left as soon as they could to find jobs that paid better. It is still shamefully true that the dedicated teachers who work in agencies for troubled kids earn less than those in public school districts. It seems kids with emotional and behavioral disorders don't deserve the best education we can provide.

Nearly all of the students in the school arrived with a history of academic failure. Many had learning disabilities, and all lacked motivation. The typical student was diagnosed with Oppositional Defiant Disorder or Attention-Deficit Hyperactivity Disorder, but we had some with diagnoses of Conduct Disorder, Borderline Personality Disorder, and Antisocial Personality Disorder. Various depressive disorders were also commonly diagnosed. Anxiety disorders were less common. Although the agency did not have a psychiatric component, many of the kids were on medication.

The school day was punctuated by sporadic verbal outbursts and often, by physical altercations between students. In more than a few cases, physical restraints were employed by staff to help a child regain self-control. Time-out rooms were used for helping students relax or to de-escalate from challenging situations with peers. We occasionally used Life Space Crisis Intervention (LSCI) techniques to help a child understand the forces that had caused him to become upset or to lose control. It is unfortunate that due primarily to financial constraints, my Assistant Principal and I were the only members of the staff who truly had expertise with LSCI.

Although I was only in my position for a few years, I did manage to make some changes in the school that reduced the number and severity of acting-out behaviors among the students. These involved instructional practices and to a certain extent, staff attitudes in keeping with the psychoeducational perspective. I will describe each in turn.

When I first came to the school, it operated as a collection of 6:1:1 classrooms, meaning that one teacher and an aide was assigned to six students. For better or for worse, the teacher and aide worked with the same group most of the day. Students assigned to good teachers made fair progress, and those assigned to poor teachers made no headway. Teachers and students became enmeshed, and some teachers became embroiled in conflict with kids, tossing them out of class for the smallest infraction of the rules. Most of the older students resented classrooms that functioned on an elementary school model. Little meaningful education was taking place, and in some classrooms teachers played cards with students just to pass the time!

Rather than try to maintain this flawed organizational scheme, I identified areas of interest and expertise held by teachers and for those students in grades 9-12 developed a schedule whereby each student would see no fewer than four core subject matter teachers over the course of each day. The situation was somewhat similar for students in grades 7-8, who saw two subject matter teachers (math/science and English/social studies) each day. Supervision of all teachers was ramped up.

Importantly, I was able to hire some excitingly dynamic teachers, and to bring constructivist teaching strategies into some classrooms. These strategies, which encourage students to solve problems through active investigation and cooperative learning, held great appeal for some of the most troubled and troubling students. The strategies permitted the students to use their innate intelligence and creativity to master difficult subject matter, and at the same time deemphasized skills the students had previously failed to master. Through diligent application of constructivist teaching methods, scores on standardized tests in key subjects rose to levels never before seen in the agency. Most significant, however, was the fact that some students -- who had never before attained scholastic success -- discovered they had abilities they never knew they had. Positive changes in self-perception coincided with diminished acting-out behaviors inside and outside of the classroom.

Introduction of a psychoeducational perspective towards students was met with active resistance on the part of some teachers and staff, most of whom were "old timers" who lacked interest in the therapeutic underpinnings of the psychoeducational model (see http://www.psychoed.net/ for explanation). They saw the school as fulfilling a custodial role, not as an opportunity to develop student potential. I counteracted their negativism by hiring and training of new personnel who were enthusiastic about psychoeducation, and who approached even the most troubled kids as unique human beings whose thoughts and ideas were valuable. Even in the brief time I was Principal I witnessed important changes in students, some of whom had never met an adult who showed them care and respect. It was the new attitude of staff members driving the changes I observed.

As Principal, I learned how thoughtful instruction -- coupled with concern for development of therapeutic relationships -- can be for even the most difficult, acting-out students. It is not just what we do with kids that is important, it is how we do it, and the sincerity of effort we bring to the task. For students with emotional and behavioral disorders, constructivist teaching methods that side-step academic weaknesses, together with a psychoeducational approach to relationships, can be powerful medicine.

Acting-Out, Part Four: Attachment

2008-05-02T22:07:00.012-04:00

I wish I could say all kids who act out are easy to get along with on a one-to-one basis, but that would be a lie. Some kids are nearly impossible to deal with, I'm afraid, and try to make life difficult for anyone who tries to cozy up to them. Teachers and therapists -- well meaning souls that they are -- are fair game, and may unwittingly end up in power struggles with very tough customers. Fortunately, these children and youth are in the minority of those who act out. What they have in common is impaired capacity to form and maintain viable human relationships: To Trust.

Damage to a child's psyche is most significant when it occurs early in the process of development. John Bowlby (1907-1990), Mary Ainsworth (1913-1999), and others have documented the importance of early relationships on the capacity of children to develop viable attachments to others in later life. Although some (e.g., Sir Michael Rutter (1933- )), have disputed the central importance of parent-child relationships, nevertheless it is generally agreed that neglect and abuse in the first months of life can have a deleterious impact on a child's ability to value others' needs and perspectives, to demonstrate empathy, to trust and to love. Insecure attachment and Reactive Attachment Disorder are possible outcomes for children who have not received close and consistent care during infancy and early childhood.

The difficulty some kids have developing meaningful attachments has obvious implications for their capacity to control their emotions and impulses to act upon them. Such children and youth do not consider the impact of their behavior upon others, and feel free to behave in any manner permitted by their caretakers. They often say they "don't care" what others think about them, and when they say it they mean it. So-called "structured" school programs may be necessary to provide external controls where inner controls are lacking, and parents may struggle to design home situations built around logical consequences for inappropriate behavior.

The capacity for attachment should not be construed as a black or white matter, however. More than a few kids who act out have at least some ability to relate meaningfully to others, and so may be salvageable. Fritz Redl (1902-1988) stated that many children with attachment disorders have "islands" of value that may be therapeutically reached and developed by the astute adult. The educator, therapist, or parents who deals empathically with such a kid may be rewarded with a working connection that helps the child to extend trust to others.

Acting Out, Part Three: Chad

2008-04-13T18:03:00.012-04:00

Kids who act out almost always seem like "good kids" on a one-to-one basis, and many interact well with therapists, school administrators and teachers. Although a handful are manipulative of adults, and curry favor only so they may be forgiven their sins, in fact most are looking for some connection to someone upon whom they can rely. It is when they are away from such an adult -- and under the influence of a psychologically powerful peer or the peer group -- trouble starts. The many teachers I have known will describe such a student starting with the words, "He's really a great kid, but . . . ."

I have only recently started working with a young man who -- together with two friends -- has been charged with felonies for theft of city property. I will call him Chad. Anticipating a difficult legal battle, Chad's attorney has collected statements from his teachers, all of whom speak to his gentle nature and good motivation in school. They are uniformly positive and supportive. Yet, it is also true Chad has two prior arrests for possession of alcohol, and that he is well known to the local police. You see, Chad was abandoned as an infant, for his parents were drug addicts who were involved in prostitution, fraud, and other criminal activities. His parents were arrested on serial occasions. Chad was raised by his aunt and uncle.

I have met with Chad on five occasions, and have been impressed by his friendly and accepting approach to nearly everything: his crimes, the charges he is facing, his parents' behavior, the fact that he was abandoned. He is polite and soft-spoken. He has interests in the arts. He doesn't get easily rattled, and doesn't rock the boat by being verbally aggressive or physically abusive. He is a "really a great kid."

Although Sigmund Freud might be a good therapist to such an acting-out young man, it certainly wouldn't take Freud to figure out why Chad might be harboring anger under that placid exterior.

Another kid in pain.

Acting-Out, Part Two: Definition

2008-04-01T21:32:00.013-04:00

There are numerous definitions of acting-out behavior. Here, it refers to actions taken by a child that are physically, socially, and/or verbally aggressive in nature. A good description of acting-out behavior is this one from the Child Development Reference, Volume 1, for it identifies the pain that lies just beneath the surface, and that the child is seeking to relieve:

Acting out originally referred to the psychodynamic concept of expressing repressed impulses, but now it more generally refers to maladaptive behavior exhibited by children and adolescents. Rather than coping with the resurfacing of negative emotions (i.e., anxiety, fear) associated with past traumatic experiences or a dysfunctional family environment, the child or adolescent acts out these emotions by engaging in externalizing behaviors. These behaviors range from the less serious (i.e., disobedience, moodiness) to the more severe (i.e., suicidal tendencies, violence).

When a kid is engaged in explosive behavior most adults have difficulty empathizing with the child and understanding the pain, anxiety and fear the child may be experiencing. The tendency is to stifle the kid's behavior with Moral appeals to conscience, or failing at that, to adopt a punitive Enlightenment stance. Lecturing and moralizing is easy . . . as is sending a child to a corner, doling out two detentions, or simply whacking the kid.

The pretzel logic of many adults dictates that it takes too much time to understand why a child might act out . . . it's conceptually messy, too, and indeed the motives may never be found. So what if the offending behavior returns the next day, escalates, or transforms itself into passive-aggressive behavior that is nearly impossible to confront. Adults will prevail!

This morning I read in the Yahoo News that a group of third grade students in Waycross, Georgia, collected materials they were going to use to "hurt" their teacher. The items included a broken steak knife, duct tape, and hand cuffs. The nine children, ages eight and nine and all classified for special education, planned somehow to attack the teacher. Some students were assigned the tasks of covering up windows and cleaning up after the attack. A spokesperson for the school district said the students involved were generally "good kids." The response of the school system was to "discipline" the children, and at least one was given long-term suspension.

One wonders what would motivate a group of children to plan an attack against their teacher. The News article stated that the kids were angry with the teacher because she had punished a student for standing on a chair. In my opinion, the News article has only identified the tip of a very large iceberg. But, since adult pretzel logic dictates that the students simply be disciplined for their scheme, it is unlikely we will ever know.

Acting-Out, Part One: Perspectives on Helping

2008-03-19T15:33:00.013-04:00

There are many people, and more than a few educators and psychologists, who would say kids who act out in school, at home or in the community are not in pain. They would say kids who act out are making poor choices about behavior, or want attention, or are simply flaunting the rules. Viewed from those perspectives, it gets easy to punish kids for their actions and to consider the problem solved. That is what we have been doing for several decades. Yet, we still have kids who act out. Just who are we trying to fool? Or maybe the question should be, "Just who is the fool?"

Over 25 years ago, social psychologist Philip Brickman and his colleagues at the University of Michigan described four approaches helpers characteristically take towards people with problems. The approaches are based upon the assumptions helpers make about people's responsibility for having caused their problems, as well as for solving those problems. I have fallen back on Brickman's (1982) model of "helping and coping" many times, using it to think about what we do as helpers, and how we do it. It certainly finds good application here.

Schools and some less-than-effective child care centers often tackle children's emotional and behavioral problems from one of two of Brickman's four approaches.

The Moral model is often applied, and assumes that the child is (1) responsible for his or her "problem" behavior, and (2) for finding some way to correct it. In schools, the Moral model is probably best exemplified by Character Education. The purpose Character Education is to help children understand and live by basic human values such as honesty, generosity, etc. Otherwise, the Moral model finds informal application through exhortation to children to "do the right thing," "play by the rules," and so forth. Under the Reagan administration, adolescents were instructed to "just say 'no'" to sex, drugs, and other temptations prevalent in modern society.

There is nothing inherently wrong with the Moral model, for it reinforces the instruction many children have received at home, in church, and in organizations such as the scouts. It does place the responsibility for "moral" behavior squarely on the child's shoulders, however, and the weight may simply be too much for some children. For example, children and youth raised in emotionally or physically abusive situations may find it difficult to restrain themselves and to "do the right thing" when provoked. Making morally correct decisions proves impossible for certain children who have not had the advantage of seeing adults do so. Although certain approaches to intervention are based upon the Moral model (Dr. William Glasser's Choice Theory comes to mind), they may not be very useful with the troubled and troubling children we are discussing here.

When the Moral model fails to work in schools and elsewhere, as it does with increasing frequency, would-be "helpers" often turn to the Enlightenment model. The Enlightenment model assumes that (1) the child is responsible for his or her maladaptive behavior, but (2) leaves adults responsible for finding the "solution" for that behavior. Enlightenment solutions are often punitive. So, the child who has failed to master his own demons becomes subject to whatever consequences superiors deem necessary. Detention, suspension and expulsion are the stock in trade of schools; in child care institutions, deprivation of privileges, confinement and/or restrictions are commonplace.

It is understandable that even well-meaning adults turn to punishment when appeals to a child's sense of right and wrong fail; after all, that is the way our society works. Unfortunately, in schools and child care institutions as in society, the Moral and Enlightenment models of helping and coping Brickman describes help only those who know the difference between socially acceptable and unacceptable behavior, and who can contain their emotions and impulses to act before matters get out of hand. Not all children and youth are capable of such self-control.

In a forthcoming section of this blog I will describe the remaining models of helping and coping Brickman and his colleagues named: the Medical model and Compensatory model. Now, however, I will turn my attention to children and youth who act out their pain in obvious, and often self-defeating, ways.

Depression, Part Six: The Schools

2008-03-10T15:55:00.007-04:00

The vignette about Brenda posted previously (Depression, Part Five) may seem extreme to some readers, but in fact there are many young people like Brenda who are struggling merely to survive. In some cases, school personnel become aware of a student's situation and seek placement in special education, but in many cases the student escapes notice. There are simply too many needy kids and too few professionals to find them all, however. This is what has happened in Brenda's case. Her poor attendance has enabled her to go undetected: Out of sight, out of mind.

There are many kids in schools who are depressed, and the great majority go unnoticed. That is because passivity among students is easily seen as "good behavior" by educators, who are content when students are complacent and minding their own business. Most depressed kids are not defiant, and their occasional irritability is usually written off as typical, teenage behavior. "He's just having a bad day today," teachers will say, "She must have her period." Although such appraisals are often accurate -- for adolescents are subject to emotional ups and downs -- educators often miss the mark.

* * * * *

There is often little to be done even when school professionals are aware of a student's mental health problems. To find a student "emotionally disturbed," for example, the student must be struggling academically in addition to having significant emotional and/or behavioral problems. As a practical matter, as long as a student is pulling down good grades he or she cannot be classified for special education. That is true even if the student is contemplating suicide . . . or murder. As a result, there are many students who in the eyes of educators are "ticking bombs," and for whom nothing can be done. "Just wait a few years," teachers say, "You'll be reading about Kyle in the paper." The predictions frequently become grim reality.

Even when a student is classified as emotionally disturbed, the services received in school are usually insufficient. A good academic program may help a student develop skills, and even better self-esteem, but core problems typically remain. School counselors may provide some support -- and provide salvation for a few students -- but many lack the time and training to have major impact. School psychologists, who when properly trained can be quite effective, are often relegated to testing roles and see students for counseling infrequently. In nearly all schools the focus is what happens "in house," and not on what happens at home, or in the neighborhood. Few educators risk making inquiries into a student's relationships with parents, for example, and fear repercussions if they dig too deeply into a student's personal life. The bottom line is that in most cases, schools can do little to intervene when students have significant mental health problems.

Depression, Part Five: Brenda

2008-02-21T11:11:00.009-05:00

I am in my private office with a sixteen year old girl named Brenda. An otherwise attractive young lady, she is far too thin for her height and her hair is disheveled. She wears dirty jeans and a rumpled sweatshirt. There are dark circles under her eyes which she attributes to poor sleep that is punctuated by nightmares. Due mainly to poor attendance she is failing all of her school subjects despite good ability, and she plans to quit school at the end of the year. She has no plan for the future other than to "get a job." Her mother, a single parent with no other children, who is also depressed, works night cleaning offices. Brenda says she is not interested in that type of work.

Brenda's mother, a recovering alcoholic who "made a lot of mistakes when [she] was younger," does not know who Brenda's father might be. She raised Brenda with the help of her own mother, who died when Brenda was three. At the age of four, Brenda was sexually abused by one of her mother's many boyfriends. Brenda has no conscious recollection of this, although it was documented with photographs obtained by police after the fact. Brenda was verbally and emotionally abused by another one of her mother's boyfriends, and at the tender age of twelve tried to kill herself by swallowing half a bottle of aspirin. She was hospitalized briefly, then released back into her mother's care.

At the age of thirteen Brenda started drinking and prostituted herself after running away from home. She hitched a ride with a truck driver and was picked up by police in another state after several days on the street. Once home, and urged by school authorities to do so, Brenda's mother then filed papers to have her deemed a "Person in Need of Supervision." The court placed Brenda on probation and arranged for counseling for her, which she received for two years. During that time she was prescribed medications by three different psychiatrists. She says one of the medications helped her, but Brenda stopped taking it when her mother changed jobs and could no longer afford to buy it.

Brenda's primary diagnosis is Major Depressive Disorder. She feels "down in the dumps" nearly all of the time and often becomes angry at her mother over trivial matters. She eats junk food for breakfast when she has breakfast and on some days may not eat at all. She does not seem to care about herself, the future or what it might hold for her. A boy who was interested in her stopped seeing her after she stood him up for the fourth time, then became abusive of her by spreading rumors about her in school. Brenda again began entertaining suicide at that time. Thanks to a clinic with a sliding scale, she is back on medication which she often "forgets to take."

She often fails to keep her appointments with me, and her mother says she has given up on Brenda. Her prognosis is guarded to poor at this time.

Depression, Part Four: Bradley

2008-01-15T17:14:00.004-05:00

Many years ago, when I was in my twenties, I worked as a secondary school special education teacher. I had a self-contained class of seven students with emotional and learning disorders. In retrospect, many of the kids I taught suffered to some extent from depression.

Oddly enough, I remember many of my past students better than kids with depression I have worked with more recently, probably because as a teacher I felt frustrated with my inability to help in any significant way. I was always looking for ways to get through to them. Not only was my training as a teacher deficient with respect to psychological problems, however, but it was also not my appointed role to counsel students or give them therapy. I was supposed to motivate and instruct them, knowing they lacked nearly all interest in academics. Treatment -- such as it was -- was left to guidance staff who were, I now understand, also unprepared to help. In fact, inside or out of school, few of the depressed students in my class received any meaningful assistance for their problems.

It is also true that in those days, even if depression in my adolescent students had been recognized it would probably not have been treated successfully. Antidepressant medications existed, but were not nearly as useful as those we have today. Cognitive-behavioral approaches to psychotherapy were in their infancy. Psychodynamic psychotherapy, while effective, was an expensive proposition. Parents of most special education students lacked financial resources, or had their own problems. Adolescents were not supposed to get depressed, anyway.

I remember well a 14 year old boy named Bradley whose behavior was all over the place. He could start the day acting infantile, babbling like a baby and sucking his thumb; become giddy and goofy, then verbally aggressive; then, he might lapse into sobbing . . . all before lunch time. He was always knocking over his desk, then laughing about it or crying. At times, he crawled around on the floor of the classroom barking, a behavior which at first I did not understand. Although he had average intelligence and good verbal skills, he was at a loss to explain his behavior, which as a teacher I was told simply to ignore. That, of course, was impossible: Bradley's behavior affected the entire classroom. I suppose that today, he might be diagnosed with bipolar disorder.

Bradley lived in a neighborhood that could best be called middle class, and both of his parents worked. They raised dogs in their garage to supplement their income, having what today would be called a "puppy mill." When they got angry at Bradley they made him go to the garage. More than a few times he spent all night sleeping with the animals. He once told me he was so hungry in the garage he ate dog food.

Whenever I see My Life as a Dog, by Lasse Hallstrom, I think of Bradley. In that (1985) movie, a boy named Ingemar moves in with his aunt and uncle as his mother lies dying, hoping against hope that his dog Sickan is safe in a kennel and will join him soon. Essentially an orphan, when after his mother dies he is informed Sickan is also dead, he takes on the behavior of the dog he has lost, growling and barking at friends and family. His behavior is at once understandable and pitiable. This beautiful film, a comedic tragedy, makes me laugh but also brings tears to my eyes.

I wonder where Bradley is now, and if sometimes he acts like a dog.

Depression, Part Three: Developmental Factors (cont'd)

2007-12-28T12:35:00.002-05:00

As was suggested previously, the way depression manifests itself depends very much upon the individual child and his or her circumstances. Although severe depression may cause any person to retreat from the world, and are obvious, dysthymia and milder variants of depression may not be obvious even to the affected individual. Like many adults, kids often do not realize they are depressed. Kids that do possess understanding of their symptoms may communicate their feelings selectively to trusted friends, if at all.

Just to complicate matters, symptoms of depression morph, and show themselves differently over the course of development. Jane E. Brody, a frequent commentator on psychological issues, writes in the December 2nd, 1997, New York Times:

The symptoms of childhood depression vary with age. In a article last year in Contemporary Pediatrics, Dr. Susannah L. Sherry, director of the Cambridge (Mass.) Youth Guidance Center, and Michael S. Jellinek, chief of child psychiatry at Massachusetts General Hospital in Boston, wrote that in infants and toddlers, depression might appear as a failure to thrive or gain weight normally or as delays in speech and motor development. Dr. Fassler listed a sad or emotionless facial expression, minimal activity, unresponsiveness or withdrawal and excessive or unusually little crying.

Preschoolers may wet their pants or fail to control their bowels. The Massachusetts doctors added, ''Their play may be reckless, aggressive, destructive or show a preoccupation with morbid, even suicidal, themes.'' Or they may have frequent accidents. School-age children may lag in social and academic skills that show up as school phobia, social isolation, a poor self-image, poor grades or antisocial behavior like stealing or lying. Other common signs include frequent physical complaints, like stomachaches and headaches, excessive worrying or guilt over minor mistakes, sleep disturbances and undue fatigue.

Among older children and teen-agers, depression may assume more classic forms, like admitting sad, bored or empty feelings. But other common characteristics can be deceiving. Consider it a red flag for depression if an older child experiences extreme mood swings, engages in dangerous activities, fails academically, runs away from home, abuses drugs or steals or lies.

Because the symptoms of depression among teenagers are similar to those seen in adults, and because adolescents typically understand the nature of their problems more readily than children, treatment is more straight-forward. "Treatment of choice" involves psychotherapy and anti-depressant medication. With a child -- and particularly with a young child -- a therapist may work most effectively with the parents or care-takers, understanding that in the majority of cases, the child's symptoms are reactive to some situation in the home.

Depression, Part Two: Developmental Factors

2007-11-23T15:30:00.002-05:00

It is hard to imagine a seven or eight year old child being depressed, but it happens. Those children who have experienced a loss, have conflicts with parents or siblings, or who have difficulty learning are perhaps most at risk for depression. Older children are even more susceptible to the disorder, however. This is due in part to changes in cognitive development allowing contemplation of past and future events. The adolescent is able to look back on traumatic experiences and -- using those experiences as a springboard -- to anticipate a bleak future.

Although depression by itself usually has a generally adverse impact upon motivation -- and therefore learning in school-- it is often found in a nasty mixture of anxiety disorder and/or ADHD. Sorting out "what caused what" with respect to problems may be impossible. Children often carry multiple diagnoses as testament to the confusion, or disagreement, of multiple professionals. Oppositional Defiant Disorder (ODD) or Intermittent Explosive Disorder are occasionally thrown into the pot. Drug and alcohol abuse are commonplace. So, to speak of depression in isolation from other difficulties is somewhat misleading.

The symptoms of depression are numerous. Among adolescents, they include poor attention and concentration; poor motivation in school (with academic problems as a consequence); poor self-esteem; irritability; lack of pleasure in things that should be pleasureful (anhedonia); and, social withdrawal and/or isolation. Poor sleep, early waking, or (on the other hand) excessive sleeping may be observed. Over-eating, binge eating, or lack of appetite may be evident. Thoughts of suicide that are typically fleeting -- but that may be more seriously contemplative -- may be reported. Self-injurious behaviors (as noted above) are not unusual.

Taken together with the trials and tribulations of normal adolescence, these symptoms may easily be overlooked: after all, many (and probably most) adolescents suffer from occasional dark periods, and angry declarations of suicidal intent ("I'm gonna kill myself!") are commonplace. Denial on the part of even well-intentioned adults rounds out the picture.

Depression in young and preadolescent children can be even harder to diagnose. Acting-out behaviors may mask depression and may motivate parents and educators to punish a child who is already hurting. Changes in emotional response may be quite brief and therefore, easy to overlook. Suicidal ideation during childhood has been shown to be predictive of attempted and actual suicide later in life. The first blush of Bipolar Disorder may be evident in childhood, too; approximately one-third of children diagnosed with depression before the age of twelve will later be diagnosed with bipolar disorder (National Alliance on Mental Illness, 1996).

Feelings of hopelessness and helplessness are frequently associated with depression, and as school and society become increasingly competitive we are likely to see more children and youth falling prey to those feelings. Social inequity, poverty, racial strife as well as international tensions may contribute to feelings of helpless and hopeless. In my opinion, many youth today appear to be suffering from anomie, a term sociologist Emile Durkheim coined to describe alienation due to breakdown of social norms, values and institutions.

Depression, Part One: Overview

2007-11-16T22:04:00.005-05:00

There are probably more students in pain than we know, or care to know, for most of them are considerate enough to hide it from us, or embarrassed by their feelings. Here, I am not talking here about kids experiencing the normal ups and downs of childhood, or of adolescence, but about kids who are truly hurting emotionally, and bear the burden in silence.

These are kids who have been verbally, physically, and sexually abused, or who are anxious, depressed, suicidal, or have some combination of problems. Many of them are in physical discomfort because their emotional distress has morphed itself into physical symptoms. Some of them inflict personal injury upon themselves. Some are so emotionally ill they cannot leave the house to go to school.

It is difficult for adults to accept the fact that many children are in emotional pain because even today -- though we should know better, and in spite of our distorted portrayal of youth in the media -- our society romanticizes childhood. But, our denial does not change reality. Consider these frightening statistics from United States Department of Health and Human Services, for example:

Almost one million children in the United States were victims of abuse and/or neglect in 2005
Nearly 1500 children died from abuse and/or neglect
In most cases, biological parents were the parties responsible for child maltreatment.

And, these statistics regarding depression from the American Academy of Family Physicians:

Three percent to five percent of children and adolescents suffer from major depressive disorder
At any given time, up to 15% of children and adolescents exhibit symptoms of depression
The majority (70%) of children and adolescents who are depressed receive no or substandard treatment
Two-thirds of depressed children and adolescents have another, diagnosable mental disorder
Twenty percent (20%) of adolescents contemplate suicide, and eight percent (8%) attempt suicide
In 2000, suicide was the third leading cause of death among youth ages ten through nineteen.

(Do you think these numbers are okay? If these figures don't bother you, please tell me now and I will stop writing!)

Anxiety is associated with depression, of course, and despite a paucity of hard data most observers would agree anxiety disorders are increasingly a concern among the young. The recent emphasis upon outcomes of high-stakes tests under the inane No Child Left Behind act has created an entire generation of anxious children, in my view, with parents and educators unwittingly contributing to the situation by blindly adopting flawed policy as the status quo. Of course, the "typical" angst of adolescence is also contributory, although for many teens peer pressure has become far more intense. Daily bombardment by the media -- promoting images of what the typical teen should look like (and most importantly, should own) -- has only made the tough developmental stage that is adolescence that much tougher.

Many kids are so stressed-out they become numb, then seek to find sensation through alcohol, drugs, sex, or other risky behavior. More than a few resort to self-mutilating behaviors. Ironically, cutting represents the attempt by a numb teen to feel alive, meanwhile releasing psychic tension and simultaneously representing a cry for help.

Other kids develop psychosomatic problems, which in many cases keep them out of the social and academic pressure-cooker of school. Although "tummy aches" have long been the bastion of kindergartners unready to separate from their parents, psychogenic problems such as asthma, migraines, cluster headaches, irritable bowel syndrome, and other serious maladies are increasingly common among the young. School nurses -- who may or may not be sympathetic to the plight of a child in pain -- frequently find their offices packed with students looking for relief, and who have no better place to go.

The average school administrator or teacher is aware that certain students are suffering, but is neither trained nor qualified to handle what may be serious psychological disorders. School counselors may or may not be helpful, depending upon their professional training, personal predilections, and caseload. School psychologists are locked into testing students with disabilities, running CSE meetings, and typically lack the credentials needed to identify and assist such troubled students. School social workers are typically overwhelmed. "Besides," the questions go, "Is this really the school's concern? Don't we have mental health clinics for this? What are the parents doing? Isn't the purpose of school to help kids learn?"

Given the real pressure educators feel to bring up student test scores under the heat of No Child Left Behind, these questions must be considered valid. But, the fact that the questions are valid does nothing to help kids in pain.

Kids in Pain: Introductory Remarks

2007-11-05T21:06:00.002-05:00

I can't put it any other way: There are numerous children in our schools who are suffering psychologically, and suffering badly. Some of them barely make it to school, and when they do attend, barely make it through their classes. Others see school as the place they may demonstrate the depth of their pain, and do so by acting out inappropriately. Still, there are others who have simply suffered enough, who have become impervious to the pain they have experienced, and who visit it upon anyone who happens to be available. And while such students have hardened themselves to pain, they cause others to suffer in their stead.

So, we have three groups of students: those who are in pain, but hide it; those who are in pain, and act it out; and, those who have simply endured too much pain, and who have insulated themselves against it. As a society, we fret about the first two groups of students, but do little to help them in any meaningful way. Remembering the horror of Columbine, and sensing the rage they feel, we fear the third group. Their behavior elicits feelings of rage and helplessness in us, feelings that may reflect those the students in question have buried inside.

It is not that we -- as a society -- are unaware that troubled and troubling students exist. The press forever rails against the lack of discipline in schools, and school violence makes first page news with grim regularity. We hire security officers to keep the peace, and plant metal detectors and closed circuit cameras at school entrances. We provide special education for students whose emotional disturbance has crossed some critical threshold, employing armies of school social workers, school psychologists and counselors to cope with "difficult" students. In many cases, we ship kids out of public to private schools and even residential treatment centers for help. We send some to jail. A handful of enlightened school districts provides mental health services on premises.

Most of the time, however, we simply punish school troublemakers or banish them from classrooms and school. We "manage" student behavior rather than treat children and youth as feeling, thinking, and responsive human beings. We go about our work with students reactively and with twisted logic: If we manage them well, or punish them, their behavior will change. A few kids get help. Most are ignored and continue to suffer. It really all depends. Luck of the draw.

Our haphazard remedies are insufficient to the number and nature of troubled and troubling students we have: as the Surgeon General (1999) made it clear only a few years ago, over 20% of children ages nine through 17 have a diagnosable mental or substance abuse problem, over 10% have significant problem (whatever that may mean), and some five percent (5%) present extreme difficulties. There are over four million kids who have been hurt and are hurting, the Surgeon General reports, and those are only the ones we know about. Ironically perhaps, a mere 1% of all students receive special education services under the federal classification of emotional disturbance, a figure that represents only one-third of the students who -- as far as the government is concerned -- "should" be identified as such.

Of course, many troubled and troubling students are never classified with emotional disturbance. Many students with problems never come before the Committee on Special Education (CSE), and when they do, many CSEs -- responsible for "labeling" kids -- shy away from the emotional disturbance designation. There are good reasons for this. For one thing, the classification is stigmatizing, analogous in the minds of the general population as crazy. And, members of CSEs often feel inadequate to the task of making the emotional disturbance call, for most lack the training and credentials to actually diagnose a mental disorder. Finally -- and perhaps most importantly -- most public schools and many private schools simply do not know how to handle kids with emotional problems, and do not want to be put to the test only to be found lacking. So, when they are classified, many students with emotional problems or problematic behavior are classified with "learning disabilities," "other health impairments," or other disabilities. Failure to accurately represent the difficulties troubled and troubling students face through accurate classification makes it unlikely they will receive the help they need.

The statistics collected by schools regarding the real needs of troubled and troubling kids are not very useful for the reasons described above, but the National Center for Educational Statistics (NCES) (Youth Indicator #49, Personal Safety, 2005) does provide information that indicates we are missing the boat when it comes to mental health needs of students. Consider, for example, these (2001) findings regarding high school students, who reported on their own behavior within thirty days preceding the survey:

Twenty-nine percent (29%) of males and over six percent (6%) of females carried weapons, including guns (males 6% and females 1-1/2%);
Forty-three percent (43%) of males and twenty-four percent (24%) of females engaged in a physical fight;
Seventeen percent (17%) of males and nearly ten percent (10%) of females drove after drinking alcohol.

And, per Child Trends DataBank,

Twenty percent (20%) of twelfth grade students used marijuana within the past thirty days, and
Ten percent (10%) used illicit drugs other than marijuana.

Even if these numbers are inflated -- which is doubtful -- when it comes to our youth we have our collective head in the sand . . . or maybe it is someplace else. These youthful behaviors reflect struggles that go well beyond "normal adolescence," and suggest that we have turned a blind eye to serious difficulties that germinate in childhood and blossom in puberty.

We must do something about it.