Strategies for Students with Psychological Disabilities

Working with Students Who Have Psychiatric Disabilities
 

Increasing numbers of students are enrolling in postsecondary institutions who report having a mental illness. Recent increases in the size of this group are due in part to improved medications that result in symptoms mild enough for them to enjoy the benefits and meet the challenges of postsecondary education. Students with psychiatric disabilities are entitled to reasonable academic accommodations as provided by the American Disabilities Act (ADA) of 1990 and 2008 amendments. Providing effective accommodations allows students equal access to academic courses and activities.

What is a Mental Illness?
 

"Mental illness" refers to the collection of all diagnosable mental disorders causing severe disturbances in thinking, feeling, relating, and functional behaviors. It can result in a substantially diminished capacity to cope with the demands of daily life.

A mental illness is a hidden disability; it is rarely apparent to others. However, students with mental illness may experience symptoms that interfere with their educational goals and that create a "psychiatric disability." These symptoms may include, yet are not limited to:

• heightened anxieties, fears, suspicions, or blaming others
• marked personality change over time
• confused or disorganized thinking; strange or grandiose ideas
• difficulty concentrating, making decisions, or remembering things
• extreme highs or lows in mood
• denial of obvious problems and a strong resistance to offers of help
• thinking or talking about suicide

Psychiatric Diagnoses
 

A student with a mental illness may have one or more of the following psychiatric diagnoses (American Psychiatric Association, 1994).

Depression. This is a mood disorder that can begin at any age. Major depression may be characterized by a depressed mood most of each day, a lack of pleasure in previously enjoyed activities, thoughts of suicide, insomnia, and consistent feelings of worthlessness or guilt.

Bipolar affective disorder (BAD, previously called manic depressive disorder). BAD is a mood disorder with revolving periods of mania and depression. In the manic phase, a person might experience inflated self-esteem, high work and creative productivity, and decreased need to sleep. In the depressed phase, the person would experience the symptoms of depression (see above).

Borderline personality disorder (BPD). BPD is a personality disorder which includes both mood disorder and thought disorder symptoms. This diagnosis has both biological and environmental determinants. Individuals diagnosed with BPD may have experienced childhood abuse and family dysfunction. They may experience mood fluctuations, insecurities and mistrust, distortion of perceptions, dissociations, difficulty with interpersonal relationships, and limited coping skills.

Schizophrenia. This is a mental disorder that can cause a person to experience difficulty with activities of daily living and possibly delusions, hallucinations, and paranoia. Schizophrenic individuals typically demonstrate concrete thought processing and appreciate structure and routines.

Anxiety disorders. These are mood disorders in which the individual responds to thoughts, situations, environments, or people with fear and anxiety. Anxiety symptoms can disrupt a person's ability to concentrate and focus on tasks at hand. Symptoms may be in response to real or imagined fears. Specific anxiety disorders include generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, social and specific phobias, and post-traumatic stress disorder (PTSD).

Autism Spectrum Disorders (ASD). Autism is a Pervasive Developmental Disorder. Pervasive Developmental Disorders are characterized by severe and pervasive impairments in several areas of development: reciprocal social interaction skills, communication skills, or the presence of stereotyped behavior, interests, and activities (DSM-IV-TR, p. 69)

Autism is a “spectrum” and individuals who fall within this label range in abilities as well as in presentation of stereotypical behaviors (Rogers, 2005). Individuals with Asperger's Syndrome are typically considered “high-functioning” on the spectrum.

Examples of stereotypical characteristics of Autism may include:

• Limited interests (fixation or interest on only one thing)
• Repetitive motor behaviors (hand flapping, rocking, hitting, self-talk, etc.)
• Rule bound behavior (may insist that students sit in the same places always)
• Fascination with common objects (interest in blades of a fan, piece of string)
• Difficulty with transitions (transitioning too quickly/unpredictably may cause melt-down)
• Unusual response to sensory information (hypersensitivity to light, sounds, touch, tastes, and smells)

The Tips for Working with Students with Autism Spectrum Disorder (ASD) document provides specific strategies and suggestions for working with this population of students.

Functional Limitations
 

The following functional limitations related to psychiatric disabilities may affect academic performance and may require accommodations (Center for Psychiatric Rehabilitation, 1997).

• Difficulty with medication side effects: side-effects of psychiatric medications that affect academic performance include drowsiness, fatigue, dry mouth and thirst, blurred vision, hand tremors, slowed response time, and difficulty initiating interpersonal contact.
• Screening out environmental stimuli: an inability to block out sounds, sights, or odors that interfere with focusing on tasks. Limited ability to tolerate noise and crowds.
• Sustaining concentration: restlessness, shortened attention span, distraction, and difficulty understanding or remembering verbal directions.
• Maintaining stamina: difficulty sustaining enough energy to spend a whole day on campus attending classes; combating drowsiness due to medications.
• Handling time pressures and multiple tasks: difficulty managing assignments, prioritizing tasks, and meeting deadlines. Inability to participate in multi-task work.
• Interacting with others: difficulty getting along, fitting in, contributing to group work, and reading social cues.
• Fear of authority figures: difficulty approaching instructors or staff.
• Responding to negative feedback: difficulty understanding and correctly interpreting criticism or poor grades. May not be able to separate person from task (personalization or defensiveness due to low self-esteem).
• Responding to change: difficulty coping with unexpected changes in coursework, such as changes in the assignments, due dates or instructors. Limited ability to tolerate interruptions.
• Severe test anxiety: the individual is rendered emotionally and physically unable to take an exam.

Instructional Strategies
 

Students with a history of psychiatric disabilities can be intelligent, sensitive, creative, and interesting.  Many will share their background, challenges, and experiences freely and comfortably.  For others, disclosure of  highly personal information will be more difficult.  It is essential that all conversations be kept highly confidential at all times.  The following are other strategies that will help in promoting student success:

• Address a variety of learning styles (e.g. auditory, visual, kinesthetic, experiential, or a combination of styles).
• Incorporate experiential learning activities.
• Clearly articulate behavioral expectations and provide both verbally and in writing.
• Embrace diversity to include people with psychiatric disabilities.
   

Academic Strategies & Accommodations
 

Some students with mental illness may require accommodations to allow them equal access to classes, programs, and coursework. Students are encouraged to register with the DSS office in order to receive accommodations. The following are typical accommodations and/or strategies that may be helpful for a student with a psychiatric disability.

• Beverages permitted when students have this as an accommodation- some students require frequent drinks due to medications.
• Prearranged or frequent breaks.
• Tape recorder use.
• Notetaker or photocopy of another student's notes.
• Early availability of syllabus, assignments, and textbooks.
• Availability of course materials (lectures, handouts) in electronic format.
• Private regular feedback on academic performance.
• Maintain a positive and optimistic attitude and praise the student’s successes.
• Remember your job is not to do the work for the student, but you can often be a big help just by listening and correcting or helping your student to remember.
• Have patience and be flexible!  Be ready to explain a concept in many different ways and offer as much practice as necessary.
• Make sure your student thoroughly understands one concept before moving on to the next. 
• Have the student repeat information back to you.  Verbalizing helps a person to remember and will confirm what he/she understood.
• Encourage good study habits in your student.  Many students have little or no study skills.  Some may need to be referred to study skills seminars.
• Break down tasks and information into small increments and present them to the student sequentially (and in writing).
• Keep instructions as simple and clear as possible.  Some students highly value structure and clarity.

Source: Adapted from "Academic Accommodations for Students with Psychiatric Disabilities," University of Washington (DO-IT), Seattle, Washington.