Kids with mental illnesses a challenge for schools
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Teacher Patty Britt assigns her first-graders a task. Emily refuses to participate and flies into a rage, screaming, pounding fists on the table, lashing out. Britt tries to teach her 27 other students above Emily's wails. They strain to hear the teacher's voice. When Emily's fury fails to let up, Britt carries her, flailing, to the nurse's room or, if it's only the first or second time that day, steers her to the sink or the bookshelf.
"The last 150 days - every day, every minute - have been bad, unless I let her wash the sink or read a book. Those are the only things that calm her," Britt says.
"If I had to stop every time she flew into a rage, I would not have taught a thing all year."
At the innocent age of 6, Emily has been diagnosed with bipolar disorder, or manic depression. Eleven other students at Sammamish's Discovery Elementary School also have disorders -- ranging from depression to anxiety -- severe enough that school counselors provide behavioral therapy or teachers' aides.
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An average of one or two children in every Washington classroom suffer from emotional or behavioral problems that can range from mild depression to severe anti-social behavior, according to a report by Washington Kids Count, a University of Washington-based project that collects data on the well-being of children.
"It's not just Emily. Some of our students are worse behaviorally," says Discovery Principal Nancy Weinstein. "I've been kicked and scratched black and blue this year."
A dozen students with severe emotional and behavioral problems out of Discovery's 700 may not sound like a lot, Weinstein says, but "these are kids who need continual attention."
And most students with these types of disorders receive that attention in regular education classes. Though each district has a few separate classrooms for students too violent or unable to cope in a regular classroom, most students today are "mainstreamed" - immersed in regular classes for most, if not all, of the school day. Many receive special services, such as part-time teachers' aides, psychiatric counseling and behavioral interventions.
The notion of mainstreaming grew out of 1975 federal legislation aimed at making high-needs students' environments less restrictive. In this state, most of these students have been mainstreamed in the past 10 years.
Emily's team of teachers, a counselor, a psychologist and the principal decided against placing her in a separate classroom because she's so young and intelligent, already reading at a fourth-grade level. Schools tend to place students in separate classes as a last resort, after considering their age, academic ability and whether they are a danger to themselves or others.
"Emily really is so bright we didn't want to put her ... with other kids who have very severe problems as her role models," Weinstein says.
The frustration that Emily's teachers have felt is one reason Tonya Rosenberg and her husband, Andy, want to tell their daughter's story. They also hope to chip away at the stigma of mental illness in children.
"I think the school is as supportive as they know how to be in this situation, but most of the teachers know nothing about mental disorders, had never even heard of bipolar before," Tonya Rosenberg says.
"I've been educating myself and them, too."
More being diagnosed
Doctors and medical researchers are not certain what is causing more children to be diagnosed with mental disorders. The fact there are more specifically defined disorders today may cause parents, teachers and even doctors to look for signs of those disorders in children when they spot problems, researchers say.
Others point to sociological reasons, citing increases in single-parent families, more poverty and a speeded-up society, all of which may cause stress on children.
"All of those things converge, and whether any one of them is the specific culprit is a matter of speculation, but I wouldn't dismiss any of them," says Christopher Varley, a UW child psychiatrist.
"The supports that used to exist around kids aren't there as much anymore."
Compounding the problem for schools is a shrinking number of social services to which students can be referred, from state agencies to private mental-health groups.
"It's not easy to get alternative support anymore," says Doug Cheney, a UW assistant professor in special education. "We have a broader range of behaviors in school because we don't refer them out to different services anymore."
That range includes depression and panic disorders to schizophrenia, and now educators say they are seeing an explosion in the number of children diagnosed with bipolar disorder. Marked by extreme changes in mood, energy and behavior, bipolar disorder is unlike the normal mood swings of young people in that it significantly affects their ability to function at school, at home and with peers. Though there is controversy within the medical community about diagnosing children as bipolar, many doctors say they are now recognizing the signs in pre-adolescents.
For school districts, the costs of dealing with special-needs students can range from $500 to $100,000 per child per year.
Although districts receive additional state money for special-education students - about $7,600, or twice what's provided for regular-education students - it's often not enough. The Issaquah district, like many, uses an additional 30 percent of its local levy to supplement special-education funding.
Looking for new ways to help
The growing toll on teachers and districts prompted state Superintendent of Public Instruction Terry Bergeson to launch a task force in 1998 to find ways to help teachers and better provide for students' needs.
The task force recommended earlier intervention, pilot programs, teacher training and, above all, a statewide system to coordinate schools, social services, health care and families.
So far, only four pilot programs have started statewide.
Syre Elementary School in Shoreline is in its third year of a four-year pilot grant funded by the U.S. Department of Education and the Office of the Superintendent of Public Instruction. The $740,000 grant pays for research to track students, schoolwide teacher training, family events and extra counselors to work with severely disturbed students and those showing early signs of emotional or behavioral problems.
Cheney, who co-chaired the task force, says early intervention can save school districts hundreds of thousands of dollars.
More summer training for teachers on ways to handle students with mental disorders is planned, says Douglas Gill, special-education director for the state superintendent's office.
"We're finding that teachers can avoid a lot of behaviors when the classroom is very structured and well-organized," Gill says.
But such programs address only a small piece of the puzzle, Cheney and others say.
"We are not in the medical and counseling profession - we're educators," says Sharon Hartung, special-education director in the Northshore School District.
"In other states, it's a mandate that schools and community services work together, and we need that here.
"Another huge job schools have is getting families to help because we can't do it alone."
Officials in the state superintendent's office plan to pilot a program that would require physical exams, including mental-health screening, for all children entering kindergarten, says the department's health-services supervisor, Judy Maire.
But, she adds, "Even if, through exams, we find kids who need services, who's going to treat them?"
The scope of the problem also concerns Richard Brandon, director of the Washington Kids Count project.
"If we have one or two kids per class with these problems, do we have consistent state policies for identifying them and for linking families to state services? The answer is no, we don't."
In Britt's first-grade class, Emily recently returned from two weeks of evaluation and intensive behavioral therapy at Fairfax, a mental hospital that Issaquah School District educators recommended to her parents.
Fairfax doctors started Emily on a new medication for bipolar disorder, her fifth since December. It's showing positive results. She's calmer, starting to socialize with peers, and it has curbed her violent streaks.
Until recently, Emily sat alone at a desk separated from the rest of the students, who are clustered at tables. Britt says she tried to keep Emily with the group, but she made the others "so tense that nobody at her table could concentrate."
While she hates to admit it, Britt was eager for the end of the school year.
"I've taught for 20 years, and nothing in my bag of tricks has worked with her. I just can't reach her," Britt says. "In order to get any teaching done at all, I just have to let her do what she wants."
Britt had an afternoon aide to work with Emily and a full-time aide for another high-needs student in her class. But it wasn't nearly enough, Britt says.
"I do resent this brilliant child taking so much of my time when my other students need me," she says.
"But even though Emily needs so much attention, you want to help her because she wants help. And that's why we keep trying to make it work."
Colleen Pohlig can be reached at 206- 515-5655 or cpohlig@seattletimes.com.