Mental Health and LDs
Mental health is a key issue for educators. Students’ mental well-being has strong implications for their learning and behaviour in the classroom. As such, the Ministry of Education of Ontario has developed the document Supporting Minds: An Educator’s Guide to Promoting Students’ Mental Health and Well-being, which provides information to help educators understand mental health problems and support students’ mental well-being.
According to Supporting Minds (page 11),
- anxiety problems,
- behaviour problems (including ADHD and conduct disorder),
- mood problems (e.g., depressive disorders), and
- substance use problems.
The following article addresses mental health in connection with learning disabilities (LDs). It has been compiled from Integra’s document, LDMH: A Handbook on Learning Disabilities and Mental Health. Please note that a full reference list can be found in the original Integra handbook, cited below.
What is Mental Health?
Mental health is part of our overall health and includes:
- How we feel, think, and behave;
- How we cope with the ups and downs of everyday life;
- How we feel about ourselves and our life;
- How we see ourselves and our future;
- How we manage stress and its impact;
- How we manage the negative things that can happen in life;
- Self-esteem or confidence (CMHO, n.d.).
What is the Relationship between LDs and Mental Health?
The relationship between Learning Disabilities (LDs) and Mental Health is complex. Persons with LDs have unique patterns of processing information and individual learning styles. Moreover, these learning styles change with development, and the impact of LDs varies as a child grows and develops. It can be hard to ‘show what you know’ when you have LDs, and sometimes it can be hard to make sense of certain things, such as social interactions. In response to these challenges, children and youth often experience social and emotional stresses, including feelings of frustration, worry, or loneliness.
We know that persons with LDs are two to three times more likely to experience mental health challenges (Wilson et al., 2009). When it is hard to ‘show what you know’, it is understandable that we might see higher rates of school-related stress (Sparks & Lovett, 2009) and more school drop-out. Individuals with LDs are more likely to experience anxiety, depression and suicidal ideation (Svetaz, Ireland, & Blum, 2000).
The Impact of LDs on Mental Health
Children and youth with LDs typically experience repeated failure. In school, they may work incredibly hard but the outcome may not reflect the effort. Over time, it can be more difficult for a child to keep trying and often, we see behaviours that are identified as ‘non-compliant’ or ‘oppositional’ yet which may reflect an understandable coping strategy of avoidance or hopelessness.
This may lead to a lower sense of mastery and fewer opportunities to feel competent at something or to achieve success. Children and youth with LDs may feel like they’re not meeting others’ expectations, that they’re letting down their parents and teachers, and not working hard enough when they’re trying so hard. This can all lead to the experience of negative feelings, including worry, anger, frustration, and sadness.
Most of us do not enjoy experiencing difficult emotions. It is an understandable reaction to want to avoid experiencing hardship. Children and youth learn that it may be ‘better to be bad than look stupid’, and may act out to distract from or avoid the challenging situation, or may self-medicate, or engage in strategies to avoid experiencing negative emotions and stressors.
This may complicate their readiness to accept help, accommodations or to engage in therapy. In the short-term, experiential avoidance reduces distress but in the long-term, this is a maladaptive strategy. By not staying with and tolerating intense negative emotions, individuals miss out on opportunities to gain mastery and skills to self-regulate and to cope, and to develop resilience.
LDs Complicate Mental Illness
One way to think of it is to consider mental health on a continuum.
- In the green zone is good mental health in which we feel positive, confident, and well able to manage our feelings.
- The yellow zone reflects stress/distress. These may reflect typical responses to common life stresses, such as a job loss, marital distress, worries about relationships, or school stress. Most of us experience periods of time in which we feel in the ‘yellow zone’.
- The red zone reflects mental health challenges that are more serious. The symptoms may be more severe, intense, and long-lasting and typically significantly interfere with everyday functioning. Often, ‘red zone’ problems are managed best with intervention, which may include therapy or counselling and sometimes medication.
When we consider the continuum of mental health with respect to LDs, most children and youth with LDs would experience ‘yellow zone’ levels of stress and distress. However, a number of children and youth may also experience significant mental health issues that interfere with day to day functioning, putting them into the ‘red zone’. These children and youth with Learning Disabilities/Mental Health issues (LDMH) and their families may need intervention to engage in school successfully, to navigate peer relationships, and to manage intense emotions and behaviours.
Having mental health challenges or disorders, such as anxiety, depression, and explosive reactions, in addition to LDs, can complicate the picture for diagnosis and treatment. For example, a youth with depression and LDs might struggle with a slower rate of thinking and difficulties with concentrating, which could reflect either the depression or the LD, or both.
Evidence-based treatment for anxiety, such as cognitive behaviour therapy (CBT) for example, might include demands for reading and writing that might be difficult for a child with LDs. The pace of manualized treatments may not be tailored to meet the particular learning needs of the child or youth. Having LDs can also complicate the child or youth’s ability to cope with stress, such as getting stuck in problem solving or having difficulties regulating emotions.
LDs and Emotion Regulation
For children and youth with LDMH, regulating (or managing) emotions is particularly difficult (Milligan, Badali & Spiriou, 2013). The prefrontal cortex (the same part of the brain that is involved in executive functioning) has a role in moderating the amygdala (a part of the brain that processes intense emotions). When the connection between the prefrontal cortex and the amygdala is not working well, we see emotion dysregulation (Banks et al, 2007; Gyurak et al, 2011).
Children and youth who have trouble containing intense emotions may seem stuck in the ‘on’ position and may have trouble exerting control over their emotions and behaviours. Under-regulators may tend to be in the ‘fight’ response of the fight, flight or freeze reactions, or may need help from others to manage intense emotions. We may see behaviours including meltdowns, low tolerance for frustration, overreaction, quick temper, and difficulties in calming down.
Sometimes children and youth have difficulty managing intense emotions and they keep the emotions tightly within. This may reflect a ‘flight’ or ‘freeze’ response to perceived threat. Behaviours for this group may include withdrawal, avoidance, becoming easily upset, or shutting down.
LDMH: A Framework for Understanding Challenging Behaviours
There is a wide range of reasons why we may see challenging behaviours in a child or youth, particularly those with LDMH. For example, what might look like stubbornness or oppositional behaviour might actually reflect a child with LDs in slow processing and executive functioning, as well as anxiety, who needs more time to process instructions, to get started on an activity, and who freezes up when faced with something new or unpredictable.
In addition to LDs and mental health considerations, other factors that may contribute to the behaviour we are seeing on the surface may include physical issues such as sensory integration problems (i.e. too much noise in classroom) or a child who is tired or hungry, environmental considerations (e.g., conflict or recent change in the home or learned behaviours), or social challenges (e.g., bullying, exclusion, or conflict with peers).
In children and youth, behaviour is also often a form of communication that something else is happening.
Behaviours for children and youth with LDMH may be more complicated than they appear on the ‘surface’. When we can ask “what else might be going on underneath the behaviour?” or “what is this behaviour communicating?”, we can start to develop a richer understanding of the behaviour and therefore possible solutions.
One helpful analogy is to think of the behaviour as the tip of the iceberg (what we see on the surface) and the various factors contributing to the behaviour as the portion of the iceberg that is underwater and out of sight. In order to help a child or youth with the ‘behaviour’, we have to try to understand what is ‘under the surface’ and come up with a plan to address lagging skills or behaviours.
Children and youth with LDMH have tremendous potential and we all have an opportunity to support the resilience of this group. By seeking to understand a child’s learning strengths, to empathize with the challenges, and to foster the development of lagging skills and opportunities for success, we create an environment for positive well-being.
Protective factors for positive mental health and well-being include developing knowledgeable and accommodating communities to support a sense of belonging; fostering supportive relationships with at least one caring adult; developing ‘islands of strength’ to improve self-esteem; supporting self-advocacy in children and youth and empowering caring adults to respond to self-advocacy efforts; directly teaching lagging skills and providing evidence-informed therapy interventions that are tailored to the child or youth’s learning needs.
Related Resources on the LD@school Website
Children’s Mental Health Ontario (CMHO). (n.d.). Mental Health: The Basics. Retrieved from http://www.kidsmentalhealth.ca/children_youth/introduction.php
Integra. (2016). LDMH: A Handbook on Learning Disabilities and Mental Health. Retrieved from https://www.childdevelop.ca/sites/default/files/files/Sept%2022%20Integra%20LDMH%20Handbook%202016.pdf
Ministry of Education of Ontario. (2013). Supporting Minds: An Educator’s Guide to Promoting Students’ Mental Health and Well-being. Retrieved from http://www.edu.gov.on.ca/eng/document/reports/SupportingMinds.pdf