Podcast: Ask Me Anything About Student Mental Health
Jenn talks to Dr. Melinda Macht-Greenberg about how to support and check in on loved ones during the school year. Melinda discusses the mental health challenges students are facing and talks about child and adolescent mental health.
Melinda Macht-Greenberg, PhD, is a Harvard-trained child psychologist and faculty member at Tufts University who provides expert advice to parents about children and their education. Dr. Macht-Greenberg also works with families on improving educational outcomes for their children in both private and public schools to maximize a child’s success.
Jenn: Welcome to Mindful Things.
The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.
Hi folks. Good morning, good afternoon, good evening to you. And thank you for joining, wherever, wherever you’re joining to talk all about student mental health. I’m Jenn Kearney, and I am joined today by Dr. Melinda Macht-Greenberg.
And a lot of folks tuning in I’m sure can agree on this, whether they’re still in an educational setting or are decades beyond, school is super stressful for way too many reasons. At times it might be overwhelming at best, whether it’s getting used to new schedules, new educators, new subjects, new classmates, or dealing with things even worse than that.
It can put mental health on the back burner, even though everything I just mentioned, mental health is actually an undercurrent through all of those.
So these are the reasons and so many more are why I’m really excited for Dr. Macht-Greenberg to join me today as we talk about supporting students without burdening ourselves, mental health challenges that students are facing, how we can check in on loved ones during the academic year and beyond, and a lot more than that.
So if you are unfamiliar with her, Melinda Macht-Greenberg, PhD is a Harvard trained child psychologist and faculty member at Tufts University who provides expert advice to parents about children and their education.
She also works with families on improving educational outcomes for their children in both private and public schools with the goal of maximizing a child’s success.
So Melinda thank you so much for joining today. I know before we were chatting, that it’s been like a year since we’ve seen each other, so it’s really nice to see you after a year or so.
Melinda: Yeah, you too, you too.
Jenn: I wanted to start by asking, I know we had talked lightly about this previously, but you’ve been doing a ton of work this summer with a lot of kids. You mentioned it’s over 2,000 kids in person.
And I imagine that a lot of the observations that you had seen included some of the impact of the last year and a half, the pandemic and beyond. Can we kick off this chat by having you talk a little bit about what your work was about this summer and what you’ve noticed in school aged kids?
Melinda: Absolutely. So thank you, Jenn. It’s great to be here. It’s always wonderful to talk with people about a topic that I think is so critical and important to the lives of so many. And I am fortunate in my career that I get to do many different things.
As you mentioned, I’m on faculty at Tufts University, where I teach clinical classes on assessment and diagnostic formulation. I also provide psychotherapy and clinical assessments, and I do a lot of work as both a clinical and school psychologist.
At the intersection of education and psychology, working with many families who have kids who have special needs, psychological needs, physical and medical conditions, helping them to be able to get the most out of their educational experience.
I also consult to camps, to day camps, and as part of that, I had a wonderful opportunity this summer to work at day camps in the area, consulting with directors and staff on how to support kids as in particular, kids were, many of them were reentering back into a live in-person busy social world.
And there were many challenges for many kids. Certainly there were a whole bunch of kids who were happy to be back together and to have the freedom to engage with each other. These were day camps, so kids were wearing masks, staff were wearing masks.
It was a hundred degrees, as you may remember this summer, it was really hot, really humid in New England or really rainy. So it was impressive to see that there were so many kids who were wearing masks, who would just fade into the background as they would begin to engage back into the social world.
What was interesting and what I was able to see in many of, with many of the kids that I worked with, and in general, in my career, I work with kids from preschool through college, and I do a lot of parent coaching.
So I have an opportunity to hear and talk about kids of all different ages, but in particular, what I was able to see in this social and emotional setting was how many kids were presenting with signs of, really what I would consider to be low level trauma.
That the stress and anxiety of the past, what the past, it had been the past year and a half, was a burden that was very difficult for many kids. There were kids who were anxious. There were kids who were mildly depressed.
Certainly we have many kids that where this presentation reaches a clinical threshold, but there were many more kids who would never meet the diagnosis, but the criteria for a diagnosis, but yet were presenting with very similar kinds of signs and symptoms of really being fearful or troubled, irritable, having a hard time getting along with others, having a much harder time being part of a community.
And I think that the impact of months and months, we’re now approaching 19 or 20 months, we’re approaching our third COVID affected school year, and COVID is not over in the school world, in the education world.
The impact of this low-level chronic stress paired with an increase in social isolation, left many kids with, something that I talked about as kind of a pandemic reactive syndrome, where they were really struggling and were not themselves.
So we put a lot of thought into how to be able to meet the needs of students who were kind of coming back into this level, this type of a social world. And I think that it was a tremendous benefit.
So we saw that as the kids were with us for more and more weeks, that we could really kind of see a lot of those signs of distress fade away. But it did take that sort of intentional thought about how to be able to help and support them.
So I’m curious to see, as I’m talking with families now about the beginning of this school year, what are some of the thoughts and questions that folks have about how to be able to support kids, children, adolescents, all ages in being able to sort of return to that level of sort of mental health and sense of safety and security.
Jenn: So I know that you had mentioned that it’s considered a lot of these kids were expressing symptoms of like low-level stress or trauma or depression.
If it’s something that might go unrecognized or fly under the radar, do you have any advice for a parent to bring this up to a provider if they feel like their child may not, air quote, like pass the standard for diagnosis?
Melinda: So I feel that it’s very important to talk about these things. We’re in a world where talking about mental health issues still has some level of stigma attached to it.
As much as those of us who do this work every day, really sort of fight against that and work very hard to de-stigmatize mental health, I’ll tell you that just as a quick aside for all of these campers, I would actively talk about how I am a psychologist.
I am a helping doctor, and I really work very hard in just this normalized setting to help people to feel that psychologists are people that they can turn to in life. So I think for families, I would say to keep asking until you find somebody who listens.
Oftentimes families will begin with their pediatrician or healthcare provider, and that’s a wonderful, wonderful resource. But if you don’t feel that you’re necessarily getting a response that you’d like, keep asking.
Talk to your child’s teacher, talk to your child’s principal, go to your child’s guidance counselor, go onto different kinds of websites looking for mental health providers so that you can ask the questions that you have, because oftentimes there are very simple solutions.
And if you have a gut feeling as a parent, that something’s not quite right, parents are experts in their children, you know if something’s not quite right, if you don’t feel like somebody is listening to you, keep looking until you find somebody who does.
Jenn: Do you have advice about, or ways to start the conversation with teachers, coaches, if we are worried about our kids?
A lot of parents tuning in might be concerned about their kids’ behaviors, but might also feel like they’re just lashing out at home and their behavior isn’t as problematic outside of the house. How can they start that conversation and break the ice?
Melinda: So that’s a really good question because oftentimes kids will begin in life, presenting with their distress at home. After all home is their safest place. Home is where we all want to relax and let our guard down.
And school is a place where kids are really kind of on and are doing their best and kids will often try and really kind of keep it together and then fall apart the second that they get home. My perspective is to really think about the whole child.
When we’re talking about kids and adolescents, there’s not the school person and the home person, it’s one person who was really trying to manage through their day. And if the school is not approaching you as a parent to say, we’re seeing something, then there are many ways and opportunities to be able to engage with your school system.
The first thing is, it depends on the age of your child and where they are developmentally because elementary schools operate differently than middle schools and high schools. In elementary schools you have a primary teacher.
So the first person always to approach is your child’s general education primary teacher. It can become a little bit more challenging in middle and high school when there’s a team of teachers, but still in middle school, most middle schools, at least in Massachusetts, teach in a team model.
Your child may be part of the green team or the Avengers team or whatever they call the team, the discovery team, and there’s usually a lead teacher as part of that team who you can reach out to.
At the high school level you may want to begin by talking to somebody like your child’s guidance counselor, because that might be a person who has access to information about across the board.
So I would suggest beginning with an email, everybody’s busy, but email can be a really effective way of communicating and it’s also a way of documenting what your concerns are. So begin by emailing a contact person at the school to talk about and set up a time to speak with them about what you are seeing and what your level of concern is.
There are many supports within the school system that are available. Some of them are through general education. Some of them are through the special education world. It can be hard to know how to access those services, but it does begin with your child’s primary teacher.
And again, if you feel like you’re not getting a response from the first person, or if you feel like somebody is saying to you, this is typical, I see this all the time, you don’t need to worry, but in your gut, as a parent, you’ve got that nagging feeling that there’s something that’s going on, keep asking and talking to somebody until you get that response that you’re looking for.
Jenn: One of the things that I love about having you on here is that you share a perspective that’s really unique because you’ve coached both parents and kids.
And I’m curious if you can explain from both perspectives, why the return to school is always such a stressful experience and what in particular, yes, the pandemic, but what has made this year so much more anxiety inducing than prior years?
Melinda: So in general, as you said at the beginning, back to school is both exciting and stressful for kids and families. First of all, all transitions can be challenging for many kids. So if you’re starting in a new school year, it’s an automatic transition, both from the previous school year and from the summer.
But if you’re a, so every school year starts with a teacher who is unfamiliar to your child or a set of teachers in middle school and high school, and there’s an unfamiliarity with how that adult in their life is going, or adults are going to respond to them.
The child may also be in a new class with different kids, and until they get to know everybody, there is a level of stress in change for all of us in something unfamiliar. But kids in particular do best with predictability, kids do really well with knowing what to expect, which makes sense, because in general kids don’t have a lot of control over many things in their lives.
And one of the things that they rely on are sort of these things that I call anchors of normalcy, what are the things that they can rely on and that they can know will happen that give them a sense of control, of understanding the world around them and feeling like they are safe and secure.
When that’s disrupted, and starting a new school year is always a disruption, it takes a little while until everybody kind of settles in. Now we add on a whole bunch of other layers. So that’s just the base layer of starting a school, a new school year.
Let’s add on top of that, the fact that we’re still in the middle of this pandemic, there are questions that are spiraling around them. Some people under the age of 12 are still not yet vaccinated and there’s a lot of conversation about that.
People have gone from, students have gone from last year where for many students, much of the year was remote and online learning until the very end of the school year, but they are not familiar with all of those student behaviors.
And that was one of the things that we saw a lot this summer, especially with younger kids. There’s so many of those things that teachers do as part of the school day around teaching kids to follow directions of how everybody lines up and how people raise their hand and how you wait your turn.
All of those kinds of things of being part of a community, kids did not have for months and months, and the younger the kids, the less they’ve even had of that in their life period. So if you had a kindergartner or first or second grader, and this is their third year of COVID, they don’t really necessarily know the school world without it.
So then you’re adding on top of basic issues around change, now you’ve added stress and angst around medical concerns. And on top of that, you have what we’re seeing is a lot of disruption in school. And that disruption is, a lot of it is related to a couple of things, it’s related to COVID, it’s related to curriculum and its related to social experiences.
In terms of COVID, one of the biggest disruptions we’re seeing is that if somebody has symptoms in school, at least in Massachusetts, they’re using a process of test, what they call test and return or test and stay.
So if you have symptoms, you tell your teacher you have a sore throat or runny nose, or you start coughing, kids are sent to the nurse’s office. They’re given a COVID test. If the test is negative, they return to class. If the test is positive, they’re sent home. Okay.
So now we’ve got a child, if you can just imagine, a child is in the nurse’s office and now they’re just been told that they have a positive COVID test, alright. The level of anxiety in just saying those words makes everybody’s blood pressure go up, but this is happening, if not to a particular child, it’s happening around all students all the time.
That family is obviously notified to come and pick up their child, but at some point in the day, close contacts, however, we want to define that, other kids who are in the class also are notified, those families are notified.
And if then any of those kids develop symptoms, then they need to be staying home while they get a COVID test and things like that. Disruption, disruption, disruption.
Kids do well with predictability, now we’ve just taken away predictability because at any moment, what kids are learning is that they may not be able to go to school the next day and they’re missing out then on education, so then they feel like they’re falling behind.
We’re only at the end of September and I’ve already talked with so many students who are telling me that if they miss school and they are, because they are awaiting a COVID test result, they feel like they’re falling behind on understanding what’s the class doing and what are assignments that they’re missing.
So levels of stress build on top of each other for kids. Then there’s curriculum stress which we could talk about and then there’s the sort of social stress. So this year is atypical in many, many ways. And understanding that is really going to be the key to helping students to be able to manage successfully.
Jenn: Curious about what some of the signs would be that caregivers should be on the lookout for just to see if their kids are adjusting well or are having difficulties, obviously admitting to a provider that they feel like they’re falling behind is markedly different than what a parent might be noticing at home.
Melinda: So I mean, I think, again, it be begins with knowing your child, your child and adolescent. And if you see that there is something in the way that they are acting or thinking or behaving, that is not characteristic of them, that’s always the first sign.
Then we would begin to look for signs of distress. So the first thing is just, are they, is something different and is it going on for a period of days or weeks? I mean, obviously everybody can have a rough couple of days, but something that is going on for more than a couple of days, for a couple of weeks.
Beyond then, we would look for different kinds of behavior changes that could be what we would consider in psychology to be symptomatic. You might notice, for example, sleep disruption, that they have a harder time falling asleep, staying asleep, or they’re waking up really early.
So sleep disruption or other disruption in routine behaviors can be a sign of some kind of internal distress. Similarly, if you notice that your child doesn’t have the level of appetite that they used to.
They’re either not as hungry or they may be overeating, or they may be gravitating to foods that are not necessarily as healthy as you might like, but they seem to be trying to, look, to satisfy some kind of craving, that might be a change.
Might look for changes in mood. For example, your child seems to be a little bit more sad than usual or, in many times for kids, low levels of depression actually are masked with other kinds of behaviors like irritability or overly silly.
There’s kind of the old kind of class clown kind of situation where sometimes kids who get overly silly and can get kind of dysregulated in what can look like great joy and happiness can also sometimes be a sign of actually underlying distress because it’s a change in their presentation.
Also, I would say, if you notice that they’re not as interested in doing things that they otherwise would like to do, preferred activities, fun activities, extracurricular things, if they’re more hesitant to socially engage with others, these can all be signs of anxiety or distress that you might notice.
Certainly if they’re having difficulty concentrating, having a harder time in school, having difficulty reading or following and doing assignments, those can all be signs. So many, many things can be signs. What we want to look for is, is it deemed to be a change in how your child usually is compared to before.
Jenn: So a lot of what you just described as I, part of my job is I write condition education, so I, as soon as you say, changes in appetite, changes in mood, changes in sleep, I go eating disorders, anxiety, depression, trauma, borderline personality.
So like all these things are running through my head. And one of the things that I also know about criteria for it is like some types of depression you have, if it’s a change for X amount of time, then it would be considered a clinical case of depression.
How long should parents wait to talk to a provider about changes in behavior?
Melinda: So there are a couple of criteria that we would look for. And I think the first thing is to say that at any point when you’re concerned, reach out and talk to a provider because you don’t need to, as a parent be sitting with that added worry or anxiety, especially if somebody can provide reassurance.
Because many of the things that we talk about are also developmentally appropriate. For example, if you have a four-year-old who’s having meltdowns and tantrums, well, that’s expected, if it’s happening every day for hours at a time, then maybe you would have some concern.
If you have an older child who’s struggling and having a lot of meltdowns and that’s happening daily, that may be more a level of concern because we don’t necessarily expect that of somebody who’s an adolescent. We really kind of look for three key things, duration, frequency, and intensity.
So if you look at any behavior, again, behavior is always on a continuum because any behavior that might be concerning is also developmentally or situationally appropriate.
So we really want to look for how long has something been going on, and certainly if it seems that it’s been happening, a behavior that’s concerning has been going on regularly for a couple of weeks, that would certainly reach a level or threshold that you would want to reach out to somebody.
But I wouldn’t wait two weeks if it’s happening all the time. Frequency would be, how often is it happening? If you’re seeing a behavior that’s happening once every few months, it’s not as concerning as something that’s happening every day.
So frequency, intensity, and duration. Intensity is the other part. So if it’s a relatively small level of sadness or behavior, that may be something that’s not as concerning as if somebody is having a more intense reaction.
However, I’m always sort of cautious to say that there are just some kids by nature who can become more introverted and quiet or, and may appear as if everything’s okay, but for them being more withdrawn or turning inward, maybe a sign of distress.
Again, if it seems to be a change in what their typical temperament, characteristic, characterological or an interpersonal features are. So again, trust your gut as a parent because you are experts in your children.
Jenn: And I want it to be clear too that my, the way I phrased that was not to induce alarm in any parents, I know from Googling things myself, you can come up with some pretty frightening results. So just wanted to throw that out there.
What recommendations would you have for students, families, and their educators if the student has a co-occurring disability and also is in a marginalized community?
Melinda: Well, there are, so there are many, that’s a really big question and it’s hard to know exactly how to approach every situation because so many, there’s so many variables and so many different opportunities to connect with people, but also limitations.
And there are many kids who, even before COVID, who already had sort of preexisting conditions. Maybe they have particular learning disabilities or anxiety or depression or ADHD or autism.
So these are things where COVID may have magnified a situation, but was not, something was going on before any of the pandemic even began. In more marginalized communities, the hardest part is access.
Access to health care of every kind and every way, as well as access to being able to get appropriate support, particular communities related to economic factors, racial, cultural, people who are new to the United States, who in particular, when it comes to education may be parents from international families who are not used to how our system works.
I support and work with a lot of international families where the parents don’t, weren’t raised in a culture where you can ask questions of your school system, for example, whereas here in the United States, that’s expected.
So helping people to know and know what questions to ask. School can be a place. So obviously pediatricians are a great resource and most people have access to a pediatrician or pediatric healthcare.
But schools are really, can be an untapped resource because everybody has access to school, not necessarily all at the same school all the time with the same resources, but what I’m finding is that more and more communities have actually been bringing in more mental health providers, especially during this COVID period.
So there are more resources that are available. I don’t think there are enough. We had a mental health crisis in the United States before COVID, the level of the mental health crisis for children and adolescents has grown exponentially in the past year and a half.
So, but there are resources that are available. And many people don’t know that they have that as a resource.
Many people don’t even know that there are those resources in school, for example, social workers and guidance counselors who can meet with your child within the school day and provide care and support.
But it does come, the burden is on the families often to ask for that, and that can be the challenge. And I, again, would kind of come back, I don’t mean to sound like a broken record, but keep asking people in your school until you get the answer that you’re looking for, which is that there’s somebody who’s going to take this seriously.
Jenn: Do you have any advice on, I know we, you just alluded to, we had a crisis already, we have a shortage of mental health providers.
Do you have an advice on finding an available provider that would be the right fit for your child and acknowledging that there is a shortage in the U.S., do you have suggestions for supporting children and families until those services are available?
Before you answer I just want to let folks know, if there is an emergency or a crisis, crisis hotlines are always available. There are volunteers doing it 24/7, so don’t feel like if there’s an emergency, don’t feel like you need to wait until a professional is available. Sorry, please continue.
Melinda: No, that’s such an important thing to mention, because not only are there emergency rooms, but there are emergency assessment teams that will come to the school, that can come to your home to be able to do an assessment.
So absolutely to reach out, there are hotlines as well as individual agencies that you can contact. And then the emergency room is always an option. So absolutely, if you’ve got a level of worry, again, use those resources as much as you need.
Beyond that, I think it’s so important to think about community access. And one of the things that I talk a lot about with schools, which is, it’s not easy to be able to get started, is to be able to really provide the services where people spend their time, and for kids, that’s school.
I really see the schools as much more of a hub where we should be providing more care, whether it’s psychological care, even medical care. When we already have nurses to do eye exams and hearing tests, and now COVID tests and things like that, we should be bringing those services where kids are rather than always trying to find services and resources in other parts of the community.
I think that teachers can also provide a role in providing support. They’re not necessarily trained in the same way, but they are the people who spend the most time with your child and know your child best.
And a teacher who knows and understands that a child is in distress can provide a lot of empathy, can provide a lot of reassurance. And so I think that within the community, teachers can be an untapped resource to provide a lot of that care.
I would also just add that in this time of crisis, many pediatric practices have added behavioral therapists or different levels of counselors to provide short term mental health intervention while somebody is waiting and while they’re trying to work to connect you to other kinds of resources.
And I’ve noticed that this is a wonderful change and improvement that’s happening in our healthcare system. Again, oftentimes this is short term. Sometimes it’s a counselor. Sometimes it’s a developmental pediatrician, maybe. So I would, again, kind of use your school and your pediatrician’s office as the first line to go to.
Jenn: So if a mental health organization is looking to provide more community support, what are some of the key coping strategies that they should include in their community education and really focus in on?
Melinda: Well, so that’s a really good question because I feel like there are so many things. I think the first thing is identification. So providing support, if there’s an agency that is looking to provide support in the community, the first thing is to be able to help to identify who needs that level of support.
Some of that, again, mental health agencies can provide training to educators, and that can be one facet, as well as looking or offering different kinds of screening times or screening days when families can call or reach out or even have walk-in session.
That would be a great thing for agencies to be able to say, you can come to us like an urgent care, but for mental health and we will do short-term, we’ll do a brief assessment to see if there’s a level of concern that would require intervention.
Beyond that, in terms of helping to build coping, there’s so many different things that can be done to help to build coping skills within kids. But it’s challenging in part because you’re dealing with people who are at different developmental levels.
So the kinds of things that we can do for younger children are different than what we can do with older children and adolescents. One of the things that we try and do is provide students with psychoeducation.
So understanding what is anxiety and teaching people that anxiety is universal. We all have some level of anxiety and the difficulty is when that anxiety interferes with some aspect of life, but we all have anxiety about something.
We all have something that worries us. That’s a natural built-in part of who we are as human beings. Providing psychoeducation to people so that they can understand what is something that I’m feeling that is typical or what is something that I’m feeling that maybe is a little bit outside of the range of typical.
Providing that psychoeducation can be a great way of helping people to kind of build that sense of, I know what, I know myself and I can kind of take some action. Helping then to build coping can be a variety of different kinds of things, from teaching people specific skills about how to manage some of that anxiety.
There’s so many things that can do to help around anxiety and depression. Referring for medication, if that would be appropriate. But also there are many things that we can do with kids to help them to build a sense of efficacy, a sense of feeling like they can have an effect on their world.
And I think that part of the COVID pandemic reactive syndrome is this feeling of sort of a helplessness. That there’s a lot that’s happening around me, I have no control over. Maybe I’m told I can wear a mask.
Certainly getting vaccinated is a wonderful thing, however, as we said, kids under 12 so far, they don’t have access to that. So what can we do to help kids to build that sense of having control? And one of the great things is actually to do projects with kids to help them to give back and take care of other people.
It’s a wonderful way of helping people to cope by doing something for somebody else. And that can be in a variety of ways. It can be done as a family, as a school, as a community, but being able to give back helps people to have a sense of having an impact in the world, and also helps people to be able to take a moment to appreciate some of the things in life that may be going well for them.
Because it’s very easy for all of us to get stuck in that loop of the worries and the troubles and the things that are not going well. And so having those moments of self sort of appreciation and sort of being grateful for what’s going well can also help to build coping. So there are many other strategies, but those are just a few that come to mind.
Jenn: That anxiety spiral is such a huge thing that if you recognize that you’re spiraling into it, it’s a little bit easier to come out of it versus finding yourself all the way in the hole and not knowing when you’re going to be able to get a ladder. You know?
Melinda: Exactly. Exactly
Jenn: Thank you. One of the anxieties that I think is a little bit less addressed in school aged students is selective mutism.
And I’m curious about ways to help students with selective mutism adjust socially after being so socially isolated from their classmates this past year.
Melinda: Right, oh, so I’ve worked with so many kids with selective mutism and I love working with these kids. It’s, the level of impact is tremendous and then helping kids to be able to feel comfortable and more comfortable in that social world is just a wonderful sort of thing to see, to see them kind of emerging in that way.
It’s, in and of itself though, selective mutism is, can be very debilitating. I’ve worked with some kids who were uncomfortable speaking in front of certain groups of people, so sometimes kids will talk to other kids.
They might whisper to a peer in a classroom, but not talk to the teacher. I’ve seen the reverse sometimes where kids will only talk to an adult, only talk to a familiar adult, like maybe a parent or an aunt or uncle or grandparent, but they won’t talk to unfamiliar or less familiar people.
I’ve seen some kids who will not smile, don’t want to open their mouth. And so they’re, so the level of selective mutism can be, is really different for everybody. So helping, sort of similar to other kinds of anxiety, some of it is going to be recognizing first of all, and validating that their concerns are real for them.
I think that kids are really smart and sometimes as adults, we try and provide a lot of reassurance that everything’s going to be okay, or just go do this and it’ll all be fine. And a lot of times smart kids will be like, I don’t know about that. Like I, this is not going so well for me.
So you can certainly provide supportive reassurance, but also really validating that their concerns are real. And one of the things that we do in treating selective mutism, like other forms of anxiety, is to do very gradual exposure in very limited settings, helping then people to be able to expand their comfort zones.
When selective mutism occurs in schools, they can be challenging because I’ve had several teachers who have told me it’s really hard to, for example, assess somebody’s reading ability if they won’t speak.
So we’ve come up then with teachers, really worked very specifically on how to be able to help to do these assessments without putting added pressure on kids. For example, maybe having them record themselves reading to share that with a teacher until they’re ready to be able to actually read in front of the teacher or somebody else.
So that again, it’s sort of recognizing the child where they are, meeting them where they are, providing the kind of support that they need and then very gradually and slowly and carefully helping them to be able to expand.
Jenn: Someone wrote in asking that their teen daughter has several mental health conditions and is struggling to get to school on time.
As a result she’s facing consequences at school. How can this parent work with the school to meet her needs? And for reference, she already has an IEP in place.
Melinda: Oh, excellent. Okay, cause that was going to be my first thing.
Jenn: That would have been, I knew that was going to be, like, get an IEP. Here’s how you can do it. Already got one.
Melinda: Right. So great that there’s an IEP. Like so many things, an IEP is a working living document. So even though you only, having an IEP would only be required to meet with your school once a year and be re-evaluated every three years, you can change and revise and improve and make a more robust document in order to be able to meet emerging needs during the school year.
There are also a lot of protections under an IEP. So for example, students who have an IEP can not necessarily be penalized for something that’s related to their disability.
So if they have an IEP for what’s considered to be an emotional disability, because they are, of their psychological or psychiatric conditions, then there may be some protection that that student can get, rather than having all of those tardies being held against them. Especially if you say, I forgot if you said they’re an older adolescent?
Jenn: Yeah, it’s a teenager.
Melinda: Okay. Where, how many absences you have and how many minutes late, all of those things are counted at the high school level. So one thing would be to make sure that the IEP is really current, reflecting the needs of, and within that, that there are supports from the school side to be able to help your child to be able to go to school.
Those might include things, anything from having comforting or safe, a person who’s a greeter for you at the school, maybe it’s your child’s teacher, guidance counselor, principal, who meets your student at the door.
Perhaps your child could have a staggered start time so that they’re not necessarily walking in with everybody else if there’s anxiety related to that, you can also potentially have access to in-home supports through the education system.
And by asking for an evaluation for in-home support by a home behavior therapist from the school system, especially if they’re, it’s related to, getting that transition out the door each day. So there are ways to work with your school to be able to help and get support so that they can enter into the building.
I am seeing more and more kids, especially in high school who are having a very difficult time right now getting to school. And it is a tremendous struggle for many people. So depending on what the situation is, your child, your high school student might be entitled to a different kind of educational environment where that environment has more therapeutic supports built in.
Perhaps it’s a smaller school environment with more therapeutically trained people for some period of time. And we can do this in schools, we can do this for short-term, something called a 40 or 45 day assessment, or for a longer period of time, for as long as they might need.
So, but it is, it is a shared responsibility and a shared partnership between families and schools in order to be able to help kids to be able to access their education and you can’t access it if you can’t get in the building.
Jenn: Do you have any suggestions for options that might be available for a child if they’re considered ineligible for an IEP?
Melinda: Many, I have so many.
Jenn: And that’s the rest of the session, folks, Just kidding, please continue.
Melinda: So that’s a very, that’s a tricky question because I would need to have more information in order to be able to actually provide some specific guidance. There are many reasons that a student is deemed ineligible for special education, but not, that doesn’t mean that that’s the end of the line.
Parents actually have a lot of rights as parents, students have a lot of rights, and there are ways of continuing the discussion, even though a school might say that a child is not eligible for special education, there’s actually recourse, several types of recourse that a family can have.
Sometimes that involves saying, for example, that as a parent, that you disagree with the outcome of the school’s testing, and you would like an independent evaluation.
So asking for an independent evaluation as a way of sort of continuing the discussion by saying, perhaps your assessment didn’t go deep enough or perhaps your assessment didn’t involve all of the areas that my child needs to be evaluated and I’d like an independent evaluator to do an assessment and then come back and meet with the team to talk about those results.
There are, you may want to look for a supportive person who’s knowledgeable in special education. It’s a very complex field.
I’ve been doing this for 30 years and find that there are many ways to be able to, one thing that I can certainly do as a psychologist is to be able to look at and interpret the data, to be able to help to, times to help a school to understand some of what’s involved in the data that they may not necessarily be as aware of, that would indicate the need for special education.
For some kids, if they’re not eligible, however, for special education and you’ve exhausted all resources, there is another intervention plan called a 504 Plan, which is within the general education system, not in special education system like an IEP. And a 504 Plan is another way for a student to get accommodations and support within school if they don’t qualify for the full IEP.
Lastly, I would say there’s another level of support also within schools called MTSS, multi-tiered student services, multi-tiered student, I’m going to say it wrong. That is another layer within general education where students can get intervention, even though they’re not necessarily qualifying for an IEP.
So for example, a student might get reading services under MTSS, even if they’re not qualifying for a reading disability and getting services through an IEP. So there are many, many things, parents are often not aware of all of the options.
I would say to continue to ask and then the last little thing I’ll say about this, I’m happy to talk about it for hours, is that I recently was part of the IEP Improvement Committee through the Department of Education.
And one of the things, there’s parts that are ongoing, but one of the things that has, is recently being added is that there is a website, an interactive website, both for schools and for families to be able to look up different things within the IEP process, including eligibility, to know kind of what your rights are and what direction you might want to take. So that is becoming available soon.
Jenn: Oh, that’s exciting. I was going to ask what the link was, but if it’s not out yet then I can’t share anything.
Melinda: If I can find, if it has just come out recently and there’s a link, I will send that to you and you can share it with people. Absolutely.
Jenn: Fantastic. I’m curious about how we can guide our children back to doing the things that they gave up on, just because they got too hard for them.
Melinda: I’m wondering if that is a question that’s related to things outside of school, sort of fun activities or school-based work. Do you have?
Jenn: My assumption is probably a little bit of both, like not wanting to play on the high school football team because they went from being the best on their Pop Warner to being with all of the best on all the Pop Warners.
Melinda: So that’s, I mean that’s not necessarily related to these COVID times, cause that certainly happens a lot.
And, what I have found is that there are, and sometimes this can take a little bit of exploration to find, is that there are different, there’s an activity for everybody and it may not necessarily be on the varsity football team, but it doesn’t mean that there’s not a football team, it may be a club team, it may be intermural.
And so one of the challenges often for adolescents is to kind of keep finding something. What I think is often really helpful is to give adolescents different activities to try out. So for example, they may no longer feel that football is going to be the primary sport that they’re going to do, but perhaps running cross country or swimming or Ultimate Frisbee or another kind of thing.
So I think one of the great things about high school is to try a whole bunch of different things. I feel like we have come a little, we’ve gotten a little bit too focused with children on having them kind of pick their sport or pick their one instrument or pick their one area of arts to explore at very early ages.
We’ve got very young children who are now specialists in soccer. And I think that childhood is a time to explore and find what you’re good at but that means you have to try a whole bunch of different things in order to know that. And so I would say kind of keep expanding and trying to open the opportunities rather than constricting them.
Jenn: And I think that’s such a nice thing too, to help with development, like personal development because if you are raising curious children, they’re going to grow into curious adults and that’s where the magic happens.
Melinda: Exactly. And I say this to the college students that I talk with them and advice, that you don’t want to pick your major too early.
You want to take all of those different classes because that’s, college is the time to be able to try something that you might not have thought you would love and turns out to be the thing that you totally fall in love with and do for the rest of your life.
So being open to the possibility is going to be something that will then create possibility that you never knew existed.
Jenn: That’s a really great way of putting it. I want to address that a lot of the questions we’ve had today are parents focusing on their kids. And it’s awesome because this is a session about student mental health, but it also means that a lot of parents tuning in are taking on the stress of their kids and of course that’s natural because they care so much.
But parents are already dealing with their own stress and adding on to the stress is just going to be, it’s kind of like not handing somebody a fire extinguisher and really just handing them a gallon of gasoline.
So how can we minimize taking on our kids’ stress and anxiety without being totally dismissive of it? Where is that balance?
Melinda: That’s a very hard thing to do, right, cause there’s the old saying that as a parent we’re only as happy as our least happy child. And I feel that now and I have adult children.
So it can be very hard not to be, when your child is in distress, that pulls at our heartstrings, that makes us, and because as parents, we are often the biggest advocates for our children to help and support them.
I think what is helpful is actually to try and find balance and support for yourself. Some of that balance may come in doing other kinds of activities that as an adult, that you enjoy so that you can have some balance from all of those stressors.
Some of it might be that you seek out parent coaching. I work with so many parents around so many different kinds of issues because it really helps to give parents accurate information because I do think that as parents we worry a lot about things that maybe we don’t have to worry about.
So getting that accurate information can help to decrease the stress. And I think finding your own support groups, whether it’s a group of friends, whether it’s different kinds of support groups around different conditions or disorders.
There are all kinds of parents support groups that are for different kinds of conditions for kids like autism and ADHD, talking to other parents who have similar kinds of concerns can help to be a way that you can get support and kind of decrease that level of stress in your own life.
Jenn: We received a ton of fabulous questions for the session, but we are bumping up against the end of your very valuable hour. So I have one more question for you, a little bit loaded, but I figured I’d save the best for last.
How do we check in on our kids’ mental health without coming off as being a nosy intrusive parent and is it even possible to do so?
Melinda: So that’s an interesting kind of question because I think that there’s a lot to be said for being a concerned parent. And although sometimes it might feel like it’s being nosy.
I think that being concerned and loving and caring as parents, not only is that helpful to understand what your child may be experiencing, those are the kinds of, in addition, those are the kinds of concerns that fill kids up with a sense of I’ve got people and I’ve got people that care about me and I’m going to be okay.
And we’ve got to, we have to fill our kids up with that sense of, that things are going to be, that I’m okay and I can manage and cope in the world, and a lot of that comes from feeling that there are people who have empathy for what we’re going through and want to hear and want us to talk.
And so I think as a parent opening up that dialogue and opening those conversations, it doesn’t mean that our kids, especially teenage kids, are always going to embrace that but they’re going to know that you’ve asked and by asking, that’s a way of showing that you’re caring and that you’re there for them.
And if you always kind of say to them, you know what, you may not necessarily want to talk to me right now, but I’m always here to listen, that’s the kind of message that’s going to get into our kids and that’s going to resonate with them at some point when they need it down the line.
Jenn: As somebody who had parents who were exactly like that, I can tell you that the return on investment in that is enormous. So that is a wonderful way to end this session.
Dr. Macht-Greenberg, thank you so much for all of your information. This is like chatting with an old friend. I was joking to you earlier about how I haven’t seen you for a year on Zoom, but it feels like I just saw you yesterday.
So thank you for all your wisdom and insight and to everybody tuning in, thank you for joining. This actually--
Melinda: Thank you for having me.
Jenn: Until next time, be nice to one another, but most importantly, being nice to yourself. Thanks again and take care.
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Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.
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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.
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