Psychiatric professionals and educators working with young people who have mental and emotional problems can be viewed as rescuers on either side of a river, trying to save the struggling individuals caught in the roiling waters, in danger of drowning, Dr. David Aversa told the Board of Education last week.
“How do we get them out of the river? That’s not the question,” he said. “How do we stop them from getting into the river?”
Dr. Aversa is a child and adolescent psychiatrist, a forensic psychiatrist, medical director of the Connecticut Psychiatric and Wellness Center in Woodbridge and an associate clinical professor at Yale Child Study Center.
He is a consultant to many school districts, including the Ridgefield Public Schools and its special education department, which is dealing with a steady rise in the number of emotionally troubled and psychologically vulnerable students, even as the overall school population declines.
The number of students in the Ridgefield special education program who are categorized as “emotionally disturbed” has gone from 29 in the fall of 2011, to 46 in 2012, to 53 last fall.
“You are not alone,” Dr. Aversa told the school board. “This is not just a Ridgefield thing. We see it everywhere.”
There are probably many factors contributing to the rising incidence serious emotional and psychological problems among young people.
“Broken homes, divorces — particularly if there’s multiple caregivers, hand-offs,” Dr. Aversa said.
Divorce is common, he said, and divorced parents shouldn’t take his statement as a condemnation, or an assertion that their children were headed for mental health difficulties.
But they should be aware that the rate of serious problems is higher in split families if the divorce was highly acrimonious, or if the parents continue to fight bitterly after parting.
Children from families that go through nasty divorces, and then witness their parents engaged in intense post-divorce battling, are likely to have difficulty dealing with it. “That can be as dangerous as physical abuse and neglect,” Dr. Aversa said.
School and school performance is a source of stress that can affect vulnerable young people’s mental health, he said. Numbers tell the tale, as is evident in the “utilization rate” of psychiatric services by young people.
Dr. Aversa, who also works in child psychiatric inpatient services at Yale New Haven’s Children’s Hospital, hand sketched a utilization graph of the frequency that child and youth psychiatric services are accessed, month by month over a year.
“It peaks in May and June,” he said. That means the need for mental health services peaks as the school year is ending, papers due, exams are given, grades come out.
The graph’s “trough” showing low use of psychiatric services by young people, comes during vacation.
“July and August are pretty quiet,” Dr. Aversa said. “Kids tend to do better in the summer.”
It’s similar at Christmas.
“Our census went down from 20 beds to six over the holidays,” he said.
And it’s the serious cases that use psychiatric services.
“This is the lid on a boiling pot,” he said.
A person’s mental health is determined by a confluence of factors that include their genetic make-up, family situation, the way they grew up — which go a long way to determining how well they can handle stress — and then life’s circumstances. What stresses are they subjected to?
“Everyone in this room,” he said, had some “genetic predisposition” to emotional and psychological problems.
It’s a question of whether their individual ability to handle stresses will be overwhelmed by “the insults” to their mental health as a result life’s events.
Take a cross-section of healthy young men, subject them to the stress of being prisoners of war, and they’ll show a high incidence of psychological problems, he said.
The format of the discussion at the Jan. 29 school board meeting was mostly a question-and-answer session with school board members.
Irene Burgess asked what a school system like Ridgefield’s — with “high expectations” — can do to reduce stress on students?
Dr. Aversa urged educators to focus on students and their needs individually, and not expect every student to meet goals intended for kids who are thriving.
“CMTs, college acceptances — those things matter. But does it matter for that student?” Dr. Aversa said.
Schools should be “educating kids as they are, and each kid has their strengths and weaknesses,” he said.
“We expect most kids to sit in a room and take notes, as they get older — and this doesn’t work for a lot of kids,” he said. “They need physical activity — we take away gym.”
Michael Raduazzo asked Dr. Aversa what was “most troubling” in his work.
“It’s the incident of suicidality and self-destructive behavior,” said Dr. Aversa.
Suicide is “the second leading cause of death” for people between the ages of 9 and 17, he said.
Scott Mason asked how psychological trouble tracks across schools’ range of ages.
“It builds,” Dr. Aversa said. “The highest population we have is middle school and early high school.”
Bullying is an age-old problem for schools and parents. And while the advent of social media may give it a new dimension, bullying persists in the physical variety.
Surveys of students in general — not Ridgefield students in particular — showed that 16% of kids said they’d experienced “cyber-bullying,” he said, but a larger number — 20% — said they’d endured physical bullying. “I always tell kids: Bullying is an adult problem,” he added. “If it happens in your school, it’s the school’s problem.”
Today, technology overload can be a problem.
There are some kids for whom “technology is very unhealthy,” Dr. Aversa said
He views over-availability of electronic media as a prime suspect when kids have sleeping problems.
“The first thing I look at is the room,” he said.
Often, it’s filled with electronics — computer, TV, video game console. “I tell the parents: ‘All that stuff out of the room. If it’s going to be fight, it’s a fight.’ ”
Even technology use that may seem good — like communication with parents — can become excessive, so kids rely on it, limiting growth.
“Sometimes kids are stressed. They text mom. Mom texts back,” Dr. Aversa said. Kids need help, sometimes. But they also need to learn to handle problems.
Brain studies have found similarities between people who habitually overuse electronic media and people with drug or alcohol problems.
“It definitely stimulates the same neural pathways,” Dr. Aversa said.
Parents may want to limit access. “Not every kid needs a smartphone,” he said.
To be able to communicate with kids for safety reasons, he said, there are cell phones without Internet access.
Superintendent Deborah Low had a question that had grown from her efforts to make the schools safer in the wake of the Newtown shootings a little over year ago.
“How can we be more pro-active, identifying students earlier,” she said. “The few lectures I’ve heard, traditional school shooters — it doesn’t happen overnight, it is progressive.”
Dr. Aversa began with some good news. “The decade prior to Newtown, we had a downward trend in violence in school,” he said. “Newtown was a blip, and there was a blip after — there are some theories about copycats.
“But the trends are down.”
Many young people struggle with serious mental health problems of some sort, and a severely disturbed handful engage in random deadly violence. Much more common is the problem of suicide.
Serious mental health problems don’t show a single profile. Every person is unique. But looking at groups does reveal common factors.
“Violence in the home in a big thing,” Dr. Aversa said. “History of violence with kids.
“Substance abuse is a big factor,” he added.
It is a different place from Ridgefield, Dr. Aversa said, but in New Haven, school and mental health authorities work closely with the police and the state Department of Children and Families to reach kids exposed to family violence.
“Any time there’s any violence with a kid, they call us,” Dr. Aversa said.
Mr. Raduazzo recalled the Search Institute’s “developmental assets” survey of kids at Ridgefield High School. “Our students did not feel valued by the community,” he said.
“I think that’s a problem, where they don’t feel like they matter,” Dr. Aversa said.
The general climate of a school is important.
“There are things you can do for every single student that’ll decrease the incidence of violence,” Dr. Aversa said.
Increase opportunities for mentoring, he said, for kids to relate to caring adults.
“If a kid feels supported, and belonging, that tends to be better for all kinds of health outcomes,” Dr. Aversa said. “It’s about creating a sense of community: This school is a family.”