Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for the ‘school visit’ Category

Achievement Gap

Posted by Dr. Vollmer on June 23, 2016


White privilege, in academic measures, leads to higher school performance than minority children, creating, what experts call the “achievement gap.” Although many factors contribute to this gap, the increase in stressors, be it poverty, domestic violence, childhood neglect and abuse, make it difficult for children to learn, and to have a supportive learning environment. Further, minorities tend to go to schools with fewer resources to support their education. Given that, what is the role of the child psychiatrist? How can he/she advocate for these kids? Providing mental health care at these schools is one answer. If these schools were staffed with mental health professionals who were trained to help children cope with their environments, could their school performance improve? I bet so, but studies are needed to prove this hypothesis. Plus, what about the funding? Well, if we assume that kids with lower achievement are more likely to drop out, and therefore have fewer employment opportunities, and be more likely to end up in the correctional system, then keeping these kids in school could pay off in the long run. My solution: have every parent sign a consent for mental health treatment, at school, if the need arises and is deemed necessary by school personnel. That way, as soon as symptoms are identified, intervention could be immediate. There, I have solved the problem. Of course not, but I think that is a good first step.

Posted in Child Psychiatry, school refusal, school visit | 4 Comments »

Should Schools Offer Wellness Centers?

Posted by Dr. Vollmer on May 17, 2016

Should I child who refuses to go to school be offered an online education? Should schools offer a place to go to school that is not in the classroom or on the recess yard? These are the types of questions which came up as I spoke about childhood anxiety disorders to school personnel. Anxious children need help coping, but whose job is this? The family or the school or both? The anxious child, generally speaking, does not interfere with the classroom agenda, so should the teacher feel compelled to intervene? What about technology? Can technology be utilized to help anxious kids by using relaxation apps, or deep breathing apps? As the scientist who presented a lecture today on learning models of the brain, “it is fun to ask questions for which there are no answers.” My opinion: schools should offer wellness centers, by that I mean all schools, not just high schools or universities. Children need a place to learn to relax just as much as they need to learn to read and do mathematics. Once there are wellness centers, then the severely distressed kids can be identified and referred to a professional, but most kids will benefit from interventions such as yoga, talking to a trusted adult, and relaxation areas. How do we measure the success or failure of these wellness centers? I would say by measuring the number of children who are at home and refusing to go to school. I suspect that this number will significantly diminish if there were a place for kids to go in which they were out of the social and academic pressure of school. These wellness centers would serve, for some children, as a transitional space between school and home to make the leap from school phobia to school attendance. It is not that children will never need anti-anxiety medication, but I suspect that wellness centers will also slow down the prescriptions given to children, making this another outcome measure. Sometimes psychiatrists need to advocate for common sense. And so I did.



Posted in Psychiatry in Transition, school refusal, school visit | Leave a Comment »

Talkin’ To A School District!

Posted by Dr. Vollmer on May 11, 2016

A school district “community health and safety advisory committee” wants me to talk about childhood anxiety disorders? Oh yes, sign me up. Why does this excite me? I feel that I have a public health mission to educate school professionals about childhood suffering, helping them to understand when they should intervene. I want to talk about the warning signs and then, most importantly, I want to talk about the referral process so that the administrators understand that depending on who they refer to, the child will get vastly different interventions. I also want them to understand the issues surrounding medicating or not medicating school-age children. In particular, I want to emphasize the role of the school personnel in aiding the assessment and treatment of children with anxiety disorders. This will no doubt bring up the issue of the school refusal kids. How does the school help if the child does not make it to school? Does providing online support help or hinder these kids? Hinder, will be my response, in that the school needs to provide a safe place for that child at school so that if the anxiety erupts, the child can stay at school, but go to a counselor who can give this child some comfort and support. Anxiety disorders are internalizing disorders meaning that unlike ADHD where the student typically disrupts learning, with anxiety, children tend to suffer quietly. As such, it is helpful if school personnel can try to attend to the child who is NOT demanding attention, but yet is lonely or lost on the playground. I have dreamed that both public and private schools could target these quietly  suffering children for intervention, as this gives so much  hope for helping these children live more fulfilling lives. Helping a lonely child, a lost child, develop connections such that they enjoy and look forward to school is a game-changer. As we all know, the future is in our children. These  children growing up will take charge of our world, and we hope, they will bring it to new and exciting places. We owe it to them to help them enjoy their childhoods, as part of  enlightened self-interest, since we want them to take care of us one day. I am on a very important mission. Wish me luck.

Posted in Anxiety, Child Psychiatry, Child Psychotherapy, school refusal, school visit | 2 Comments »

Re-Posting: Since I Did Another School Visit

Posted by Dr. Vollmer on April 12, 2012

Samantha, an 18-year-old junior, diagnosed with autism, attending a regular school, has really matured over the years. She used to need a shadow, a professional, to watch her at school to make sure that her behavior did not escalate out of control. With maturation, she now inhibits her impulses better, and for the most part, she gets angry, but not aggressive. Her family is unbelievably supportive. In ways that I admire deeply, both parents, married to each other, have devoted their lives to her. Samantha has an older sister, Stacy, a girl who every parent dreams of. Stacy attends a prestigious university, she has always done well in school, she has lots and lots of friends, and she is confident without being arrogant. The parents, Tom and Alex, treat both their daughters in ways which are fair, even-handed, and loving. I think about how hard this must be, to raise two totally different kids, but my practice has taught me that some parents do an admirable job. I see these parents as unsung heroes in the autism world. I see how hard they work to balance their autistic child’s needs with that of their other children. I see how much time, energy and patience it takes to help these autistic kids mature. I see that they must advocate for their children, while at the same time, they must be realistic about the limitations.

Samantha had a setback. She threw a book at her teacher. This was not good. The teacher was kind, but firm. Samantha had to write a note of apology. That’s fair. She did. I thought, naïvely, that this would all blow over. Unfortunately, the school administrators did not like her note. They interpreted her few words of apology to mean that she did not feel bad. In point of fact, she felt very bad, but she could not express herself. She froze. The parents understood this, but they could not advocate for her, because it would seem that they are not realistic about Samantha’s limitations. I suggested a school visit where I, with the parents, with his tutors, could talk about Samantha and what she struggles with. For an hour, we discussed how to help Sam. I felt this undulating course where the school administrators were understanding Sam’s autism, alternating with periods, where they could not get their heads around her difficulties.

Autism is really hard to grasp. Sam is a pretty girl. She has no physical malformations. She speaks clearly and when she wants to, she can be articulate. She is good at math, but she has trouble with reading comprehension. She has never had a friend, although she is friendly. When faced with frustration, Sam sometimes goes into a rage. In the past, she became physically aggressive, but in the last two years, she just looks angry, and walks away. When Sam gets angry, the look on her face is one of utter despair. She appears so frustrated that she seems scary and sympathetic at the same time. I do not know why this time she threw a book, because earlier moments of frustration, she could walk away. The teacher asked her to finish her math homework during lunch, a reasonable request, a request that previously caused no anger.

I think of Sam’s anger outburst like a seizure. Sam can explode, but when she is feeling good, she can contain herself, and when she is not feeling well, or she did not sleep well, or she is hungry, then she rages. Epilepsy is not that different. Those who are prone to seizures, usually have seizures when their system is out of balance, for one reason or another. So, if her rage is like a seizure, does this mean she is not responsible for her actions? No, it does not mean that, but then again, it does. By that I mean that she needs to learn responsibility and she needs to learn to control her temper. At the same time, the teachers need to understand that it is harder for her than for other children. Like a seizure, she needs to cool off, before consequences are discussed. An apology, even one that is  not as thoughtful as one would hope, is better than no apology at all. She needs to be praised for attempting to write a note of remorse. It is a good first step.

Education is about setting the bar for each child. Every student needs to be challenged, so they can work hard, and achieve a sense of mastery and accomplishment. It is the job of educators to know how to set that bar. Mental health providers, such as myself, need to help students get rid of the psychological barriers to learning, so a child can get the most out of his educational environment. With that in mind, I suggested the school visit. I need to work with the school to help Sam get the most out of her last few years of high school.

After an hour and a half, the meeting was over, and we all returned to our usual day. Like so many things in my professional life, I do not know how to assess the experience. Was I helpful? Did I say important and thoughtful ideas? Did I give them good tools to work with Sam? Did I justify the effort at putting this meeting together, given everyone’s busy schedule? I do not know. I do know that, to me, the meeting was mandatory. We needed to discuss ways to interpret Sam’s behavior. We needed to sit together and remind ourselves of all the progress Sam has made over the years. We needed to support the parents, to let them know  that we are all on the same team. In the short-term, it is fair to say, we achieved those goals.  In the long-term, about how the meeting changed Sam’s school life, only time will tell.

Posted in Child Psychiatry, school visit | 10 Comments »

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