«Sally Patton UNITARIAN UNIVERSALIST ASSOCIATION BOSTON Copyright © 2004 by the Unitarian Universalist Association of Congregations. All rights ...»
• Shame: Although attitudes are improving, the label mental retardation still carries a lot of stigma. So even though parents know that there is nothing to be ashamed of about having a child with mental retardation, they are acutely aware of other people’s negative attitudes and they may still feel embarrassed by their child’s behavior in public.10 Ideas for Teaching As Unitarian Universalist religious educators, we should ensure that our focus is on what children with mental retardation can bring to our faith communities, not only on what we have to do to include them in our religious education programming. Children with mental retardation have many of the same feelings, desires, abilities, and expectations as other children. Rather than make assumptions, we must listen to these children, for they can tell us what they need. Welcoming a child with mental retardation into a religious education program also requires educating both the other children and the adults in the congregation.
We need to establish excellent communication with the child’s parents to determine at what level he or she is functioning.
This comment from a parent illustrates just how important
communication is in creating an effective program:
My child is invisible. The minister supports me, but does not understand how to include my developmentally disabled son. Jonathan is never part of the services when the children 120 Welcoming Children receive recognition for milestones. He will never be part of Coming of Age. Why isn’t there a place for my son!
Consider the following factors when creating a ministry for children with mental retardation. Many are similar to those
described for children within the autism spectrum:
• Attitudes may need to change. Prejudice and discomfort about people with mental retardation is pervasive even today, due largely to misinformation and unfamiliarity. Including a child with mental retardation in the religious education program provides an opportunity to talk about how every person has differences and strengths. Assume that both adults and children will need some awareness training. If the parents of a child with mental retardation are willing, they are often the most appropriate people to explain to the other children about their child.
• Ignore the labels. If we are not careful, the label mental retardation can cause us to expect too little from a child. We should not let a label limit a child’s opportunities or potential.
• Let go of the fear. As with autistic children, children with mental retardation can generate a lot of fear among those who are asked to work with them. Generally, this fear comes from unfamiliarity. Focusing exclusively on the child’s problems causes anxiety.
Help teachers and others focus on strengths and gifts.
• See the world from the child’s perspective. The best antidote to fear, this is particularly helpful in working with children who have temper tantrums or aggressive tendencies. Do not make assumptions; rather, talk to the child and the parents to determine why he or she is acting inappropriately.
• Recognize strengths. All children have strengths and abilities, but it is easier to see these qualities in some children than in others. Helping a child find what Robert Brooks calls his or her “island of competence” can be transformational for both teacher and child.11 Once a teacher starts seeing what is positive in a child, the 121 Mental Retardation and Developmental Delays child will gradually blossom and his or her inappropriate behavior can be handled without fear or tension. Children with mental retardation know they are different and slower than other children.
Helping them find an area of success in which they can shine will be a tremendous boost to their self-esteem as well as a wonderful learning experience for all children.
Most children with mild to moderate mental retardation function easily in regular religious education programming with children their own age, especially if the curriculum includes hands-on learning and teaches to different learning styles. Sometimes, these children need aides. Providing a separate and more structured learning environment may also be needed, especially if the child is hyperactive. Older children with mental retardation may like to help out in the nursery with younger children, or they may be more comfortable in the church service.
In closing, remember these words from Brett Webb-Mitchell:
“The important thing to remember about any definition of mental retardation is that it is a definition of people. They are first and foremost human beings, and because they are human beings, they have the capacity to be engaged by rituals like worship.”12 Mood Disorders Depression is certainly the most widespread mental and emotional disorder afflicting humankind, and very probably the oldest.
—Leon Cytryn and Donald McKnew, Growing Up Sad When we think about mood disorders, we usually think of depression. Most of us have felt depressed at some time in our lives.
Some people believe it is an inevitable consequence of living. Fortunately, for most of us, depression is a temporary state, but for people with bipolar disorder (or manic depression), it is a chronic condition. Depression and bipolar disorder are related, but they differ dramatically in how they affect people’s lives.
Children with depression and bipolar disorder are most often misdiagnosed because many of them have serious behavioral problems that suggest other diagnoses. For example, depression and bipolar disorder can co-exist with other conditions, such as attention-deficit disorder (ADD), learning disabilities, oppositional defiant disorder (ODD), and anxiety disorders. Professionals call these other disorders comorbid conditions. In many cases, a comorbid condition is diagnosed but not the underlying mood disorder, making it impossible to obtain the necessary treatment.
Misdiagnosis can have heartbreaking consequences. Children with mood disorders are frequently explosive and defiant, which can cause parents and siblings endless worry and trauma. The 122 123 Mood Disorders children themselves experience the agony of not knowing why they act the way they do.
As ministers and religious educators, we very often know of a child who is situationally depressed (reactive depression) because of a major life change or tragedy. But we are less likely to know of a child with a mood disorder unless his or her parents have been fortunate enough to receive an appropriate diagnosis. What we may see instead is a child who is angry a lot and difficult to manage.
Ministering to explosive, inflexible children is difficult, but the church setting may be one of the few places where these children can be accepted for who they are. Interacting with children who have mood disorders takes a lot of compassion, tact, understanding, flexibility, and often a willingness to minister outside the church building. While we are challenged to our utmost abilities and resources, we must remember that spiritual healing should be available to everyone, including our most difficult children.
Description Major depression is sometimes called unipolar disorder or clinical depression. According to David Fassler and Lynne Dumas, the authors of Help Me, I’m Sad, depression often takes different forms in children, depending on their ages.1 Frequently, the symptoms are masked because the child is too young to express his or her feelings. Instead, he or she may start bullying others, picking fights, or complaining about unexplained aches and pains. These are not symptoms ordinarily associated with adult depression.
Another difficulty is that depression often changes in adolescence. Young children who are depressed repeatedly complain of physical problems, such as stomachaches and restlessness, and they experience great anxiety when separated from their parents.
Adolescents who are depressed, however, tend to sleep more, feel hopeless, lose or gain weight, or abuse drugs or alcohol. Many of these symptoms can be indicators of other disorders, complicating the depression diagnosis.
124 Welcoming Children In his book When You Worry about the Child You Love, Dr. Edward Hallowell identifies several signs that may indicate a child is
• chronic, ongoing complaints of being sad
• feelings of helplessness and emotional pain
• loss of interest in usual friends and activities that used to be enjoyable
• unusual irritable and cranky behavior
• much less attention paid to dress and personal hygiene
• loss of memory and shortening of attention span
• atypical changes in weight and sleep patterns
• substance abuse
• involvement in new, potentially self-destructive behavior
• family history of depression or other brain disorders 2 Dysthymia is a mild form of depression, in which the symptoms are less severe but may last longer. Children and adolescents with dysthymia are generally unhappy or dispirited all the time.
They are gloomy and brood a lot about not being loved, and they have little self-esteem. In fact, these individuals’ depressive symptoms become so deeply ingrained that they seem to be personality traits.3 Dysthymia often occurs as a consequence of a pre-existing condition, such as ADD, a conduct disorder, a learning disability, an anxiety disorder, or a physical disability.
The majority of young people with dysthymia eventually develop major depression and go on to have recurrent episodes of depression or bipolar disorder. It is therefore critically important to identify and treat children with dysthymia in order to prevent later, more severe depression.
Bipolar disorder is commonly described as manic depression.
There are several types of bipolar disorder; however, all of them include the basic symptom of extreme and debilitating mood swings that can cause a serious lack in judgment. Diagnosing a particular type of bipolar disorder is based on which moods a 125 Mood Disorders
person experiences and how often they occur.4 The moods associated with bipolar disorder are as follows:
• Depression: People with bipolar disorder experience clinical depression as one of their moods (see earlier explanation of clinical depression).
• Mania: This mood is characterized by excessive energy and frenzied thoughts and behaviors over a long period of time, such that a person’s ability to function is impaired. Specific symptoms include heightened mood, exaggerated optimism and selfconfidence; decreased need for sleep without experiencing fatigue;
grandiose delusions and an inflated sense of self-importance; excessive irritability and aggressive behavior; increased physical and mental activity; racing speech, flight of ideas, and impulsiveness;
poor judgment and distractibility; reckless behavior such as spending sprees, rash business decisions, erratic driving, sexual indiscretions; and in the most severe cases, hallucinations.
• Hypomania: This is is a sense of heightened awareness and activity that tends to spin out of control. Specific symptoms are inflated self-esteem or grandiosity; decreased need for sleep;
pressured speech; flight of ideas; difficulty paying attention; agitation, hyperactivity, and a feeling of being driven to pursue activities; and involvement in reckless activities.5
• Mixed state: This mood has symptoms of both mania and depression. Symptoms may occur together at one time or sequentially over a period of a few days. Thus, the person may swing between depression, hypomania, and mania. The mixed state is more common in children and adolescents than hypomania or mania. Given this, children and adolescents are often misdiagnosed with ADD because of the similarities between its symptoms and the mixed state. Two-thirds of the people with bipolar disorder experience mixed states.6 126 Welcoming Children Bipolar disorder is different in children than in adults. Children cycle back and forth between moods more often than adults do. Sometimes, the cycling is so rapid that it is difficult to tell what is happening. More often than adults, children experience manic states in which they are depressed at the same time they are displaying manic behavior. According to Mitzi Waltz in Bipolar Disorders, children’s symptoms emerge gradually over the years, such that parents are shocked when the more dramatic symptoms finally occur.7 This is one of the reasons that early diagnosis of bipolar disorder is so difficult.
Dmitri and Janice Papolos, authors of The Bipolar Child, feel
that almost all children who are bipolar share certain temperamental and behavioral traits:
• Difficulties in infancy: Infants have a surprising lack of need for sleep, are extraspirited, seem precocious, and do everything early and with gusto.
• Separation anxiety: Infants and small children become extremely anxious if they are separated from their mother or primary caregiver even for a moment.
• Night terrors: Children have terrifying dreams of blood, mutilation, and fighting.
• Fear of death and annihilation: These fears accompany night terrors. Many times, these children are overcome by abject terror.
• Raging: These children frequently erupt into out-of-control rages. They often look like they are in a trance-like state. These rages can be traumatic for both the child and the family.
• Oppositional behavior: Many bipolar children are incorrectly diagnosed with oppositional defiant disorder because they can be hostile, disobedient, and negative. Bipolar children cannot cope well with transitions, so they respond negatively and become highly inflexible. The stress they feel often leads to rages and meltdowns.
127 Mood Disorders
• Rapid cycling: These children rapidly cycle from depression to mania and back again. Some cycle over a period of days, and some seem to alternate mood states several times during the day. Some children in the mixed state cycle so rapidly that they get trapped in the switch process. This results in marked agitation, high energy, and constant restlessness. When this happens, many children are misdiagnosed with ADD. Rapid cycling is much more characteristic of bipolar children than bipolar adults. This is one reason it is so difficult to diagnose bipolar disorder in children.