Psych/ Anxiety

OldDude · Sep 4, 2015

I've told you guys this before...if I was assigned to that age group I'd rather quit and go to work on one of those Bering Sea crab fishing boats like Deadliest Catch. My 5th graders are starting to get too complex for me...I salute you! Good Luck. Oh yea, no suggestions :no:

Jules A, MSN · Sep 4, 2015

While we do have an increased awareness of mental health problems now I think some of the increase in all psych complaints coming out of school is multifaceted. Some of it possibly comes from our present expectations in society that everyone is a future rocket scientist, no one is allowed to get their feelings hurt and a discomfort score of Zero is the only one acceptable for the special little snowflakes we are raising. There are some people who are naturally more anxious than others and I hate the implication that this immediately needs to be identified, scrutinized and usually medication is demanded. That children as young as 7yo are getting a bipolar diagnosis and are being placed on meds like Lithium and Depakote because they are aggressive and oppositional makes me sick. You are fortunate to have a great therapist and hopefully she takes the grains of salt as grains of salt and is able to identify the true psychopathologies which you will see are the exceptions rather than the rule. Rule outs always include trauma, neglect and abuse. Something as obvious as a child not getting sleep because the household is up all night doing drugs and fighting can result in behavioral disturbances and often gets overlooked. Children are now kicked out of daycare for biting?? Really? Don't all kids go through the phase where they are exploring the world by biting? Which usually abruptly ends the minute a peer bites back? Maybe I'm just too old and out of touch but some of this stuff makes no sense to me.

On the flip side I'm also seeing a very limited tolerance for any behavioral disturbances in class. I have done ED assessments on kids EPd for throwing a book, hitting a peer and just being generally disruptive. I have seen patients in my OP practice who have been sent by the school for an evaluation and psych clearance prior to being able to return to school for the above "infractions". Sadly many of these children are also those with IEPs so I'm left wondering WTH? While I know having disruptive students in a classroom isn't ideal I think we are going to need to decide, are we "all inclusive"? Imo expecting children with behavioral problems to be integrated into classrooms with children who don't have these problems does a diservice to both types of students. I get that this is politically incorrect in a time when everyone who shows up for school is awarded a high school diploma but I think we need to rethink our strategies.

Jules A, MSN · Sep 4, 2015

How do you all handle anxiety so disruptive it is making kids physically and visibly sick?

OOPS I didn't even answer your question in my rant. :) Hopefully your therapist can assist with coping skills, family therapy etc prior to them seeking medication. Something to remember is that children can also be very manipulative and will do whatever necessary to get their needs met especially if that includes not leaving Mama and attending school. There needs to be some ruleout of the fakers also, and I know that might sound harsh because we are talking about tiny little cuties but I have seen it often which is why family therapy is so helpful to see the whole picture and set up coping strategies.

Farawyn · Sep 4, 2015

I've told you guys this before...if I was assigned to that age group I'd rather quit and go to work on one of those Bering Sea crab fishing boats like Deadliest Catch. My 5th graders are starting to get too complex for me...I salute you! Good Luck. Oh yea, no suggestions

This made me lol for real.

JenTheSchoolRN, BSN, RN · Sep 4, 2015

I work grades 7-12 as well and YES, a million times, yes. Our counselor's load keeps growing. The number of 504 meetings I am attending is growing.

It does affect a kid's physical health. Last year, I had a few kids that vomited during school and it was anxiety-related. I wish I had a comprehensive answer, but I tried to find tools that worked for each kid. When a student walked in and I knew they were visibly upset/anxious, I directed them to the quiet corner and let them take 5 to take some deep breaths and let them know we can talk about it after that time period. For a lot, that space helped.

Farawyn · Sep 4, 2015

OOPS I didn't even answer your question in my rant. :) Hopefully your therapist can assist with coping skills, family therapy etc prior to them seeking medication. Something to remember is that children can also be very manipulative and will do whatever necessary to get their needs met especially if that includes not leaving Mama and attending school. There needs to be some ruleout of the fakers also, and I know that might sound harsh because we are talking about tiny little cuties but I have seen it often which is why family therapy is so helpful to see the whole picture and set up coping strategies.

Cutter yesterday, parent's past suicide affecting kid today. Already had 2 high kids. Another who desperately DOES need meds (in my non doctorate nursing opinion) because she hides behind walls, bizzare verbalizations and cries all day, but the mom doesn't want her classified...

I'm changing the details a bit here for privacy, but you get the idea.

I try calming, relaxation, utilize SW and Psych. :sorry:

Yea, I boot the fakers and the drama girls back to class.

JenTheSchoolRN, BSN, RN · Sep 4, 2015

OOPS I didn't even answer your question in my rant. :) Hopefully your therapist can assist with coping skills, family therapy etc prior to them seeking medication. Something to remember is that children can also be very manipulative and will do whatever necessary to get their needs met especially if that includes not leaving Mama and attending school. There needs to be some ruleout of the fakers also, and I know that might sound harsh because we are talking about tiny little cuties but I have seen it often which is why family therapy is so helpful to see the whole picture and set up coping strategies.

My HS kiddo aren't tiny little cuties .

But yes, some have real, real issues. And some with those real issues also know how to play the system. They push the boundaries to the fullest, using accommodations to their absolute limit and beyond. And as with any therapy/plan, all parties involved must be willing to work. And sometimes that just doesn't happen.

Some days, I want to :banghead: . Today's classrooms can be tough. We upped staff at my school again to handle increasing percentages of students with IEPs and 504s.

Jules A, MSN · Sep 4, 2015

Cutter yesterday, parent's past suicide affecting kid today. Already had 2 high kids. Another who desperately DOES need meds (in my non doctorate nursing opinion) because she hides behind walls, bizzare verbalizations and cries all day, but the mom doesn't want her classified...
I'm changing the details a bit here for privacy, but you get the idea.
I try calming, relaxation, utilize SW and Psych.
Yea, I boot the fakers and the drama girls back to class.

It sounds like you have some hard cases. The paranoid, bizarre verbalization one has piqued my interest. She definitely needs a psych evaluation. In some cases parents will agree to a neuropsych evaluation presented as an autism spectrum rule out which seems more palatable to parents now vs psychotic disorder, which of course are very rare in children and adolescents. That seems a decent way to at least get the ball rolling. If in fact the kid is psychotic and the parent refuses to medicate CPS involvement might be warranted.

Keep in mind some of the truly anxious kids can also have some personality traits going on. Puking in general doesn't usually impress me, especially if it is unwitnessed or the famous spittle deposits.

One of the saddest and sickest child I cared for was a Factitious DO by proxy who was as borderline as the day is long, induced by Moms delusions and abuse of course. It became apparent fairly quickly on the unit and with extreme behavioral modification this child made a substantial recovery both in her physical health and negative behaviors only to be discharged back home.

Windchaser22 · Sep 4, 2015

Some could be related to the big white elephant in the room....common core & PARCC along with curriculum speed. Added pressure on kids and educators with teacher appraisal tied to test outcomes in an environment not set up to deal with learning disabilities that make up 20% of a population. Seems plausible. Plus all the other maladies affecting families these days.

Oedgar · Sep 5, 2015

This is a tough one. Some of these issues are real. My son began vomiting every morning in 2nd grade. It would go on from first day of school for months... then still sporadically. Had him checked at dr. None of us are morning people and my whole family has touchy stomachs. By 6th grade he had reached a point where he was vomiting into a barf bag as I waited in drop off line in the car. The scariest thing is that he began feeling this way just leaving the house at other times... even for fun outings. At that point I started therapy and zoloft for him... at age 12. It was an agonizing decision. Nobody wants to put their 12 y.o. on Zoloft. He is nearly 15.... is on a minimal zoloft 25 mg... and doing well. He started high school this year. First few days he felt ill in the mornings but worked through it and did not vomit. We have no idea why this got so bad... except anxiety runs in both families esp mine.

SnowyJ, RN · Sep 5, 2015

Yes!! Our Social Worker and I were just saying this very thing, and we are K-5!! SO MUCH anxiety, DEBILITATING anxiety, where the child just can't pull out of it. Extreme behaviors, sadness....Much worse than even 3 years ago. I know we are putting more pressure on the students than we used to, but I don't really know why so many can't cope.

Jules A gave some good food for thought...