Forgetfulness and Memory Loss at Work

Memory loss results from disruption at any of these processes

Forgetfulness and Memory Loss 

Forgetfulness or failure to remember information, is a common complaint. All of us have at some time or the other forgotten to make that important call, to pick up some items from the store, an anniversary or birthday, or a colleague’s name. Students forget what they have “learnt” during exams. We often can’t remember where we have left our car keys, our wallet or that important document. Is it normal? And more importantly; when do we need to seek help?

Forgetfulness or memory loss and difficulty concentrating are common symptoms of mental health disorders. This is specially so in depression, anxiety disorders, ADHD (Attention Deficit Hyperactivity Disorder), and dementias as shown in the examples below.

A young working professional seeks help for increased forgetfulness and poor ability to focus at work. Further probing reveals decreased interest in doing things at work and home. She is also irritable, depressed and her sleep is disturbed. These symptoms of low mood can exist in the background of memory loss and problems with focus.

A student during exams has high anxiety causing memory loss. She cannot recall the answer to a certain question. She gets nervous. This causes her to make mistakes in the next question. She tends to panic; fail to recall what she studied. This vicious cycle is common in anxiety disorders and can manifest as problems with concentration, memory and forgetfulness.

An older person does not just forget the name of his neighbour (something that may happen to any of us); but also who she is. He has problems using money, and with shopping. Difficulties at work manifest towards the end of the career. Dementias affect the aged; cause memory loss and affect the context of the memory. 

A young professional has problems organising and completing projects at work. There may be a history of attention and academic problems in school. Working memory gaps are common in this group. ADHD is a common cause of this problem in adults.

Memory Processing in the Brain

To understand further, it helps to know in brief how memory works. It is a 3 stage process

Encoding

The stage when sounds, images and other sensations are given meaning is called encoding. Sensations are coded electrically for access by other brain areas. (We hear a catchy song from a new movie).

Storage

The process of association or tagging the input with other bits of data to make it persist. The song thus gets stored in our long term memory. Initially, the song remains for a very short while. At this point it is in our working or short term memory. It is encoded. However, we forget the song as the next scene unfolds on screen. The song is repeated at the end of the movie; someone hums the song as we leave the hall. The visuals of the song, and the feelings evoked, the fact that it was a famous actor, then reinforce the memory and makes it persist.

Retrieval

When we need to use this stored data, the brain fishes it out from its long term memory. The more the associations or tags we formed earlier, the more easily the brain can access the information.

Problems in memory can therefore occur at any of these stages. Many of these occur at the stage of encoding because we are simply not paying attention; and many other distractions are vying for our focus at the same time. (e.g checking our FB messages while studying). The brain does not multi-task, it can only do one thing at a time.

Repetition, rehearsal and organisation help in fixing and storage of long term memory. The more widespread and elaborate the connections, and the more data available about an input, the more the connections formed by the brain, and the easier it is for the brain to retrieve the information when required. Many cases of forgetting are due to retrieval failures. The information is there in long term memory but we are unable to access it. This is why we can recall certain things at a later date.

Depression affects memory in many ways. Being unable to concentrate is a symptom of depression. Repeated depressive thoughts also block the learning process through distraction. This affects the stage of encoding. Disturbed sleep which is a common symptom in depression hampers fixing into long term memory.
Forgetfulness is common in ADHD of adults. ADHD lowers the power to focus. The person is easily distracted. The attention span is reduced. This impairs short term or working memory. ADHD persists in up to 40% of aduts.
Anxiety gives rise to pointless thoughts (“my father will be so angry if I don't crack this exam”) which frustrates attempts to retrieve the matter learned. The anxiety provoking thoughts distract from the text which is being studied and impedes the  encoding process.
In dementia there is destruction and loss of brain cells. Dementia blocks all stages of the memory and learning process. The process is not reversible.

Forgetfulness and Memory Loss – when to seek help?

• When it affects our work, or the quality of our work
• When the failure to learn and recall affects our daily activities and functioning
• When there are also problems including sleep, appetite, inter-personal or behaviour changes.
• When it is strange - leaving keys in the fridge 
• When it can harm - often leaving cooking burner on, leaving doors unlocked at night

In normal forgetfulness, the person may recall the memory when some cues are given. The memories were encoded, they just needed some reminder to access them. In clinical disorders resulting in memory loss the memories were never laid down in the first place, or the storage structures in the brain are destroyed. Access to these memories may not be possible. 

References

1. Brydges CR, Ozolnieks KL, Roberts G. Working memory - not processing speed - mediates fluid intelligence deficits associated with attention deficit/hyperactivity disorder symptoms. J Neuropsychol. 2015 Dec 31. doi: 10.1111/jnp.12096. [Epub ahead of print]

Aptitude Testing & Work Choice – evolutionary perspective

Aptitude testing for responsible work choice

Aptitude testing for career guidance has existed only since the 1930s. Aptitude testing was not needed until work choice became freely available about 200 years ago. Before that a person had no choice in his field of work. People trained for whatever their parents did. If they had access to patronage or money they could take up a profession. Now, with the concept of Right to Education, governments seek to extend career choice to all socioeconomic strata. With this new privilege of work choice comes the responsibility of choosing wisely. Aptitude testing takes into account abilities, personality, intelligence and motivation for making a career choice.

Work choice

a brief history

For 10,000 years we did the work our parents did. In the initial millennia of mankind’s existence, work was necessary for survival. Primitive man was a hunter-gatherer to fulfil the biological need for food. As the first human settlements evolved man became a cultivator. He learnt to fashion tools, and make storage vessels. This gave rise to occupations like farming, pottery, and weaving. Densely populated centres evolved, as in Jericho. Families specialised in different trades. Son followed father in the family occupation. Skills were learnt and passed on from one generation to the next. Social hierarchies were formed loosely based on occupation. This often comprised a ruling class of administrators, the merchants, and then the labourers.

In India, occupation formed the initial basis of the caste system. Did an individual have the freedom to choose his profession or trade? The Mahabharat tells us the story of Eklavya, a tribal who wished to become an archer. Drona, the greatest teacher of the time, refuses to take him on. Eklavya through an extraordinary feat of dedication and disciplined study becomes a better archer than Prince Arjuna. However, though he had undoubted skill, aptitude and interest; he was not allowed to transgress the rules of society. Martial art was reserved for the warrior caste – the Kshatriyas – and Ekalavya was punished for aspiring to the same.

5000 years ago the first script evolved. Writing of language in a cuneiform script developed in Mesopotamia (Sumer) in 3200BCE. This heralded a radical change in the way knowledge was communicated and disseminated. Education was imparted informally to groups of children until the age of 13-14yrs. Thereafter these usually followed in the profession of their fathers.

2000 years ago we see the first example of career screening. The Jews selected brighter boys to continue studies as disciples of the rabbi. They would then become masters and rabbis themselves. However, the individual himself had no choice in the matter.

1000 years ago the elite had access to education through universities. The University of al-Qarawiyyin in Fes, Morocco, is the oldest existing, continually operating and the first degree awarding educational institution in the world. An important development in choice of education is the concept of academic freedom. This concept originated in University of Bologna (est 1088 CE, still extant) which was the first to guarantee students freedom in the interests of education. The university also gave students a choice in the curriculum to be studied. However, university education was still for a privileged few and limited to a career in the church or as a professional (law or medicine).

500 years ago formal apprenticeship was first originated. A young person usually between the ages of 10-15yrs was formally bound to a master craftsman for 3-7 years. A supply of labour in a particular trade and a certain standard was thus ensured. In the early 17th century children of paupers and vagrants were put under compulsory apprenticeship – refusal could lead to imprisonment. Later children of the gentry apprenticed to merchants, manufacturers, doctors and lawyers. By the 18th century, apprenticeship existed in every level of society except the highest. However even then, the boy himself had little or no say in his career. Career was dictated by the financial situation of the father and availability of a master. The poor had no choice.

200 years ago educational reforms were initiated when the UK National Education League began its campaign for free, compulsory and non-religious education for all children in the 1870s. Students can now take up any of a whole gamut of ever increasing fields. There is now a surfeit of careers to choose from. Students are now forced to choose between subjects when they transition from secondary school to high school. From an absence of choice they are confronted with an array of career choices. It is now important to choose a career in which the individual has a high chance of success and job satisfaction.

80 years ago aptitude testing for job screening and career guidance was developed by the US Employment Service to improve the fit between the individual and the job. Many other aptitude tests have been developed since. Aptitude tests are used in career guidance to measure different abilities and match them with the requirements of various work fields. Given the importance of work in relation to individual well-being, aptitude testing is now a basic tools in job selection. Aptitude testing combined with assessments of soft skills like personality and work style provides comprehensive data for individual career guidance. However, even today, society at large believes that career decisions happen ‘naturally’. Though so much has changed – higher education is easily available, social and gender restrictions have eased and we can choose to do what we are good at – many of us still follow the path of least resistance and do just as our forefathers did 10,000 years ago.

References

1. Kathleen Mary Kenyon. Encyclopedia Bratannica. Jericho. http://www.britannica.com/EBchecked/topic/302707/Jericho Accessed 21-Apr-2015
2. The History of Education. Ed Robert Guisepi. http://history-world.org/history_of_education.htm Accessed 21-Apr-2015
3. Wikipedia. University of al-Qarawiyyin. http://en.wikipedia.org/wiki/University_of_al-Qarawiyyin . Accessed 02-Apr-2015
4. Wikipedia. University of Bologna. http://en.wikipedia.org/wiki/University_of_Bologna Accessed 06-Apr-15
5. Family Search. Apprenticeship in England. https://familysearch.org/learn/wiki/en/Apprenticeship_in_England Accessed 08-Apr-2015
6. The 1870 Education Act. http://www.parliament.uk/about/living-heritage/transformingsociety/livinglearning/school/overview/1870educationact/ Accessed 09-Apr-2015
7. John F. Reeves. Aptitude Assessment for Career and Educational Guidance. http://www.theworksuite.com/id15.html Accessed 08-Apr-2015

Is your ADHD teenager ready for hostel?

ADHD teens with appropriate life skills can live independently

Does your teenager with ADHD have the life skills to survive in hostel? She did well in her 12th board exams and scored high in the CET. To attend the engineering college of her choice she has to move from home to a hostel in another city. Given her difficulty organising her daily schedule, would she be better off doing the same subjects at the local engineering college? The answer would depend on her personality and the life skills she has acquired.

ADHD teenager personality types

Teenagers with ADHD are of 3 character types: the optimistic, the terrified and the lost. They are placed into these categories depending on their productivity and anxiety (either too much or too little).

• The optimistic teen does not worry. He is excited about the independence that college life will bring, but may not realise that freedom comes with responsibilities (financial, social and personal). If he's still disorganised at home he will be more so in hostel where the distractions are multiple and there is no guiding hand.
• The terrified teen is intensely anxious. She needs reassurance and help in planning the future step by step. If she still waits for you to clear her way round a difficulty she will hesitate to seek help when she is in hostel.
• The lost teen displays a lack of energy and positive view towards life. He is easily depressed and defeated. He has to be repeatedly reminded and encouraged to do what needs to be done. If you still have to push him to get work done he's unlikely to function well from hostel.

Life skills for teenagers with ADHD

ADHD hinders development of the  coping and self-management component of life skills due to inattention and impulsivity. Adolescents with ADHD need to focus on three aspects of this component for transition to independent living away from home.

1. Motivation is first – there has to be the will to achieve. The ADHD teen needs clear goals and has to evaluate them objectively — are they achievable? Clear short-term, mid-term and long term goals are necessary – persistence is required. If a particular course is not available in the local colleges, can he take the initiative to locate an alumnus from school who is pursuing the same elsewhere? He must make a list of pros and cons  – then make a choice – and not procrastinate.
   
2. Time management is a big challenge for most students with ADHD. They should not take on too much initially. ADD adolescents should concentrate on their classes, keep track of assignments, and organize daily notes. They should use a planner to schedule daily activities. A large calendar on the wall for upcoming assignments, project submissions, and exam dates is a big help. The teenager with ADHD needs to get to know her limits, then push them a little at a time to see if more is achievable. She should set some daily routines – get up at the same time everyday, have healthy, regular meals (this is often neglected when staying away from home), and do the laundry.
   Attendance at classes is non-negotiable (all colleges insist on a minimum attendance). The teenager with ADHD must ensure she takes her medication on time and follow-up regularly for refills. When taking a break she should do something that has a limited time span. For example she could read a few pages of a book, watch TV for 15 minutes, or chat with a friend for 10 min.  She must make time for the additional administrative tasks college entails: paying her college fees, creating and sticking to a budget, making time to go to the ATM. These tasks should be entered in the weekly planner.
3. Self-understanding and awareness of strengths and challenges is the key to making intelligent choices. The ADHD adolescent should not hesitate to seek help, from teachers, friends and the counsellor specially if falling back in his schedule. Strategies for learning and study skills training with the counsellor are helpful.

The ADD teenager, like any other adolescent, is transitioning from dependence on the family to increasing adult independence. The life skills he acquires would dictate the ease of this transition. Teenagers with ADHD who have acquired the necessary life skills would be better able to cope with the transition from home to hostel without adversely affecting academic performance.

References

1. Economic and Social Commission for Asia and the Pacific. Life Skills Training Guide for Young People. United Nations. 2003 (Accessed 08-Nov-2014)
2. ADDitude. The Real Whirled: 8 Essential Life Skills for ADHD Teens. Accessed 25-Nov-14.

Mental Health and Academic Performance in Children

10yr window to treat mental health problems affecting academic performance

Mental health & academic performance

Mental health has a direct impact on academic performance in children. Neglected childhood psychiatric disorders like ADHD and Learning Disorders adversely affect the child’s academic performance and educational attainment. Poor educational outcomes affect the child’s health, employment, and status as an adult. This is especially so for psychiatric conditions that are seen at 7 years and persist beyond 16 years of age.

Mental health disorders in children have a greater impact on academic performance than chronic physical illness. The presence of a single mental condition results in morel board exams failures and backlogs. This association is more than for chronic illnesses of the neurological, lung, heart, or digestive systems. Physical impairments are not associated with exam failures. More than half the teenagers who fail to complete their secondary education have a diagnosable psychiatric disorder. Mental health problems in childhood impede academic performance as the student is unable to take advantage of learning opportunities at school and at home.

Poor academic performance may be a marker for mental health problems in childhood. We screened secondary school students performing poorly at academics for mental health disorders. 2/3 of these children had at least one mental health disability. ADHD and Depression were the most common mental health disorders in this population. One third of the children had more than one mental health disorder. Our study showed that screening children who had poor academic performance would help in the early identification of treatable psychiatric disorders. This in turn would improve academic performance and subsequent adult outcomes.

Mental health problems in children negatively impact physical health, employment and social status as they grow into adults. These adverse health, employment and social status outcomes are especially seen in those children with psychiatric disorders at age 7 that persist to age 16. There is a large window of opportunity between ages 7 to 16 during which psychiatric disorders can be addressed to prevent adverse outcomes in adulthood.

Mental health problems in childhood have a higher impact on academic performance than chronic physical conditions. Psychiatric disorders account for a large chunk of school failures in children. Poor academic performance in children may be a marker for the presence of undetected mental health problems. Treatment of childhood disorders like ADHD improves academic performance. There is a decade window between the ages of 7 and 16 years to prevent adverse impacts on physical health, employment and social status by treatment of mental health problems that are resulting in poor academic performance.

References

1. Case, Anne, Angela Fertig, and Christina Paxson. "The lasting impact of childhood health and circumstance." Journal of Health Economics 24.2 (2005): 365-389. 
2. Stoep VA, Weiss NS, Kuo ES, Cheney D, Cohen P. What Proportion of Failure to Complete Secondary School in the US Population Is Attributable to Adolescent Psychiatric Disorder? Journal of Behavioral Health Services & Research, 2003, 30(1), 119-124.
3. Neville Misquitta, Sayyara Ansari. Prevalence of ADHD, Depression and Dysgraphia in School Children. 15th IACAPAP. New Delhi. 30-Oct-2002

ADHD treatment improves academic performance

ADHD treatment improves academic performance

ADHD medication enhances academic performance when started early. ADHD drug treatment improves reading ability in children with Attention Deficit Hyperactivity Disorder (ADHD) and Dyslexia. New research shows that drug treatment of ADHD also improves maths ability especially when started early - at least by the 4th standard. Children starting treatment a year or two later show progressively greater declines in academic performance.

ADHD is characterised by inattention and hyperactive-impulsive behaviour. Parents who bring their children to the clinic are focused only on issues arising from the child's hyperactivity. Impairments due to inattention are not immediately apparent in the pre-school years. Depending on the severity of ADHD, inattention is unmasked when the child enters academic life in primary school or during the transitions to middle school, high school, and college. At each  of these stages an increasing demand is placed on the cognitive faculty of attention which the child's brain is not capable of meeting.

Children with ADHD fail to absorb formative academic concepts in primary school. However, rote learning or tutoring by the parents helps the child clear these initial stages. It is only later when the cognitive load exceeds the child's capacity to concentrate that academic problems become manifest. By this time the child's academic progress has already taken a downward trajectory. Reversing this trend and repairing the negative impact on the child's self-esteem entails considerably more effort, time and sustenance at these later stages. The earlier treatment for ADHD is initiated, the better.

Inattention in ADHD is due  to altered brain proteins. These are involved in modulation of the neurochemical - dopamine. This results in reduced dopamine in the synapse (fluid filled space that transmits information from one brain cell to another).  Altered dopamine modulation in the frontal lobe of the brain makes the child impulsive and distractible. ADHD medications act on dopamine and noradrenaline receptors to keep each dopamine molecule longer in the synaptic cleft. Dopamine is then available to stimulate the receptors for longer.

Parental concerns regarding side-effects of ADHD drug treatment on the developing child are largely unfounded. There is now evidence that shows long-term treatment with therapeutic doses of ADHD medication does not affect the developing brain or other standard measures of growth. ADHD drug treatment also does not increase the risk for addiction. As with any other medication side effects can arise at the start of treatment. Adherence to the review schedule will help monitor and mitigate these. All medication is prescribed after carefully weighing the risks and benefits. In the case of ADHD the risks are poor academic functioning and subsequent narrowing of career options at best, to dropping out or expulsion from school and subsequent delinquency at the worst. The benefits of treatment are highlighted in the  report card shown above.

Drug treatment of ADHD enhances academic performance and learning by reducing the inattention and hyperactivity of ADHD. The child with ADHD has attentional and impulse control issues. Inattention and hyperactivity interfere with classroom learning. The earlier ADHD treatment is started the better the outcome in terms of academic achievement. Many children have experienced these benefits.

References

1. Kathryn E Gill, Peter J Pierre, James Daunais, Allyson J Bennett, Susan Martelle, H Donald Gage, James M Swanson, Michael A Nader and Linda J Porrino. Chronic Treatment with Extended Release Methylphenidate Does Not Alter Dopamine Systems or Increase Vulnerability for Cocaine Self-Administration: A Study in Nonhuman Primates. Neuropsychopharmacology , (18 July 2012) | doi:10.1038/npp.2012.117
2. Penny Corkum, Melissa McGonnell and Russell Schachar. Factors affecting academic achievement in children with ADHD. Journal of Applied Research on Learning. Vol. 3, Article 9, 2010.
3. Zoëga, et al. A Population-Based Study of Stimulant Drug Treatment of ADHD and Academic Progress in Children. Pediatrics 2012;130:2011-3493

Dyslexia - Difficulty with Reading, Maths & Spelling

Difficulty with reading, spelling and maths is rampant among Indian students. Two recent reports have highlighted this academic underachievement. The academic infrastructure is definitely a major contributor. However, unrecognised dyslexia or other learning disability also needs to be considered by every concerned parent and enlightened teacher. We have already discussed the management of dyslexia. Here we underline the urgent need for action.

India ranked 72nd of 73 countries in a comparative international survey (PISA) of 15-year-old students. All students were assessed on the same test for knowledge and skills in reading, mathematical and scientific literacy. A sample of more than 5000 students from 200 Indian schools were assessed in this program. In none of these categories did more than 17% of Indian students scored above baseline levels as compared to 81% of students from OECD countries (US, UK, Australia etc).

15-year-olds scoring above baseline 

Test	India	China	OECD avg
Reading	11-17 %	95.3%	81%
Mathematics	12-15%	94.5%	75%
Science	11-16%	96.3%	82%

The Annual Status of Education Report (2010) paints an equally dismal picture.
Reading ability

• Only half the students in Class 5 can read the Class 2 text

Maths

• Only a third of Class 1 children can recognise numbers 1-9
• Only a third of Class 3 students can do subtraction in two digits
• Only a third of Class 5 students can do simple division
• A third of Class 8 students could not use a calender

This may be a scathing indictment of our education system, but it also reflects the presence of unrecognised Learning Disorder in our students. Learning Disorder affects 5-10% of students worldwide. Learning Disorder manifests in varying combinations and severity of difficulty with reading, spelling and arithmetic.

If your child has difficulty reading, spelling or in mathematics

• Have them assessed for dyslexia or other learning disability
• The earlier remedial teaching is instituted the more likely the child is to benefit
• Identification of dyslexia or learning disability entitles your child to waivers at the 10th and 12th board exams.

The Right of Children to Free and Compulsory Education Act (RTE) of 2009 lays down the duties of government, local authorities and parents; the responsibilities of schools and teachers; and the norms for schools. These norms include the number of teachers, buildings, minimum teaching hours, teaching aids, library, and recreational equipment. However, the teaching to be done is not mentioned and nor is it monitored. Rote learning is emphasised. Students fail to acquire basic reading, writing and calculation skills that are required to continue learning as adults.

Don't just wait for the government 

Act NOW to secure your child's place in a global future

References:

1. ASER 2010 - Rural. Annual Status of Education Report (Rural)Date of publication: January 14, 2011
2. Maurice Walker. PISA 2009 Plus Results: Performance of 15-year-olds in reading, mathematics and science for 10 additional participants. ACER Press. Victoria. 2011.  ISBN: 978-1-74286-067-1
3. The Right of Children to Free and Compulsory Education Act (RTE). 

Learning Disability - academic underachievement

Impaired spelling and arithmetic in Standard 3 boy with Learning Disorder

Learning Disorder (LD) is characterised by impaired acquisition of academic skills. This impairment in scholastic skills is not due to intellectual disability, physical disorders, emotional disturbances, or environmental, cultural, or economic disadvantage.

There is a gap between ability and application. The child may know what is asked, is able to explain it verbally, but is unable to put it down in writing. Learning Disorder could affect any of the three scholastic Rs – Reading, wRiting or aRithmetic.

Types of Learning Disability

1. Dyslexia – is the commonest learning disability (80%). It is marked by impairment of the ability to recognize and understand written words.
2. Dyscalculia – problems with doing math, understanding time, using money.
3. Dysgraphia – problems with handwriting, spelling.
4. Dyspraxia – problems with hand-eye coordination and balance, difficulties with fine motor skills.

Signs and Symptoms

Most children with a Learning Disability are not diagnosed until they are in Standard 2-3 or 7-8 years of age. Remarks like ‘can do better’ or ‘handwriting needs to improve’ are often the first warning signs to appear in the report card. Many of these children would have been the stars of their nursery or kindergarten class. The transition to assessment of written output in primary school is what unmasks the disorder. The aware teacher is able to help the parents understand and put the parents on the path to remedial teaching.

Parents should watch out for

• Reading may be slow or there is repeated rereading or skipping of an entire section. In the lower classes the child learns to memorise and reproduce entire chapters. Later the child is unable to hold the increasing amounts of material in memory, grades plummet, and confused parents are left searching for answers.
• Problems in copying from the blackboard or a book. This is a frequent complaint of the teacher. Classwork is left incomplete. The child tries to copy from their partner and is punished for distracting the class.
• Poor handwriting or drawing – their exercise books are messy, with frequent scratching out and erasing. This is especially so when the child writes on blank paper. It is also a reason why the child performs poorly in exams – they just cannot write quickly enough. They run out of time before they reach the last few questions.
• Other signs in more severe conditions
• Reversing numbers and letters while reading or writing - For example, confusing ‘b’ and ‘d’
• Mixing the order of letters or numbers. Writing ‘twon’ instead of ‘town’.
• Skipping letters in spelling. The child says ‘grass’ but writes ‘gas’.
• Forgetting words they know well.
• Weakness in mathematics.

Conquering Learning Disorder

• Approach a centre undertaking diagnosis of learning disabilities.
• A complete history of the child’s birth, milestones, health and academic record
• Physical exam to exclude problems related to vision and hearing
• Psychometry - to demonstrate specific academic problems that are not associated intellectual disability
• Psychiatric assessment - to address associated anxiety, phobias and depression that arise out of repeated academic failures.
• Psychiatric assessment - to exclude or address Attention Deficit Hyperactivity Disorder (ADHD) a common comorbidity. 15-40% of children with ADHD also have dyslexia.
• Remedial teaching is essential to overcome learning problems 

Drug treatment for dyslexia?

There is a growing body of research to show that at least in children who have both ADHD and dyslexia there are significant improvements in reading ability with ADHD medication. These improvements in reading ability are not related merely to improvements in attention. The brain systems responsible for therapeutic improvement in children with ADHD + dyslexia are probably different from those in children with ADHD alone. The finding that selective areas of working memory can be enhanced by these medications is important, as poor working memory function appears to be a mental constraint on academic learning.

References

1. Schulte-Körne G. The Prevention, Diagnosis, and Treatment of Dyslexia. Dtsch Arztebl Int. 2010 Oct;107(41):718-26; quiz 27. Epub 2010 Oct 15
2. Sumner CR, Gathercole S, Greenbaum M, Rubin R, Williams D, Hollandbeck M, Wietecha L. Atomoxetine for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children with ADHD and dyslexia. Child Adolesc Psychiatry Ment Health. 2009 Dec 15;3:40..

Inclusive education for children with autism in Pune

Inclusive Education

Inclusive education for children with autism and other developmental disabilities is now approaching reality in Pune. Nine children with autism appeared for the Maharashtra 10th standard (SSC) board exam. The accommodations and waivers granted to these students reflect an infusion of the fresh breath of inclusion into the corridors of the board of education .

Sarva Shiksha Abhiyan (SSA) in Maharashtra

The Education for All Movement, the central government’s flagship SSA, seeks to ensure that every child, including those with special needs, is provided an elementary education. As far as disability is concerned the SSA has adopted a zero rejection policy. It provides for universal access to infrastructure and curricula in schools. Maharashtra is at the forefront of this scheme. In all 380000 teachers from Maharashtra attended workshops on inclusive education through the SSA. 414277 children with special needs were identified and 380723 enrolled under the SSA in Maharashtra as of Jun-2009, . Of these about 9000 children were provided a home-based education.

Beyond elementary school it is up to the state education boards to ensure access to further education. For this the Central Board of Secondary Education (CBSE) initiated accommodations and waivers in 2009. This year for the first time, 9 students with autism from Pune division and 10 students from Mumbai appeared for the Maharashtra SSC 10th standard board exams. Lets look at why this is a significant social event.

Modern education of children with disability traces its history to Jean-Marc Itard a French physician. On the cusp of the 18th and 19th centuries Itard attempted to educate Victor, a feral child discovered in the forests of Aveyron. Although Itard himself judged his work with Victor a failure, this renowned experiment marked the first time that anyone considered the possibility that persons with disabilities could be educated.

Edouard Seguin (mid 1800s), a French educator, developed a method for teaching children with intellectual disability in order for them to take their rightful place in the societies of their day. The early training schools were based on these concepts. The schools were small and homelike with 8 to 10 residents. The original goal was the return of children to their families after a period of intervention.

Institutionalisation

Despite these early efforts, it was later concluded that educational and therapeutic approaches had failed. Persons with intellectual disability were scapegoated and regarded as the root cause of many social problems. Institutionalisation and segregation into special schools became the principal means of ‘protecting’ intellectually disabled persons from society and also for ‘safeguarding’ society against the social ill thought to be caused by an expanding population of defectives (Jackson 1999).

Mainstreaming

Lloyd Dunn (1968), a special educator, declared that most children with mental retardation could be "mainstreamed" in classes with typically developing age-mates. He questioned the need for segregated special education classes for most children with mental retardation. He highlighted the lack of evidence to show that children with mild mental retardation learn any better in special education classes than in regular classes. Lloyd Dunn pointed out that educational techniques had advanced sufficiently to allow the effective schooling of most children with retardation alongside other typical children.

Normalization

Wolf Wolfensberger (1972), a scholar, activist and prolific author in the field of development disabilities extended the idea of normalization to the service delivery system itself. He called on all residences, schools, and other services for persons with retardation to be as normative as possible. Parent and professional advocacy groups also fought hard for legislative and legal victories to decrease the size of large institutions.

Inclusion

Inclusive education seeks to overcome every barrier - physical and academic- to ensure the child is educated with their peers (Sigafoos 2003). It stresses the importance of peer interaction in the final outcome for the child who is to enter into the adult world on a level playing field. To this end academics is given a secondary role. The child is supported for all physical needs to enable participation in the classroom experience with their peer group. Academic difficulties are addressed by a remedial teacher or special educator attached to the class who helps the child in parallel with the regular curriculum. The child may be learning at a level many grades below the rest of the class but has the benefit of meaningful social interaction.

It has taken 200 years for the vision of Itard to reach the SSA, the national inclusive education program. The universal principles of justice, fraternity, and equality secured for all citizens by the constitution are driving us to ensure children with autism and other disabilities are educated alongside their peers. That is why nine children with autism have appeared for a board exam in Pune. That is why this is a significant social event.

References

1. CBSE. Amendments/Additions in Examination Bye Laws. 2009
2. Dunn L M. Special education for the mildly retarded—is much of it justifiable? Except. Child. 35:5-22, 1968.
3. Jackson, Mark. Mental Retardation In: A century of Psychiatry. Ed. Hugh Freeman. London: Harcourt Publishers, 1999.
4. Sigafoos, Jeff, Michael Arthur, and Mark O'Reilly. Challenging Behaviour and Developmental Disability. London: Whurr Publishers, 2003.
5. SSA, Inclusive education. Accessed 04-Jul-2011
6. SSA. Kolkotta National Workshop. Accessed 04-Jul-2011

School bullying

Bullying by children in schools has serious mental health effects on the victim and the bully. Up to 25% of high school students report being victimised by bullies. 13% of victims have considered suicide. In rural India 31% of middle school students report being bullied (Kshirsagar 2007). Bullying is twice more prevalent in coeducational schools than in girl schools. The prevalence of bullying increases from 13% in the 3rd grade to 46% in the 6th grade. Bullying is higher in classes with more retained students.

Bullying occurs in a variety of settings that are an extension of your child's school life. Bullying can occur face to face, by texting or on the web (cyberbullying). Bullying is not a phase of growing up, it is not a joke, and it is not a sign that boys are being boys. Bullying can cause lasting harm - to the victim, the bully and the bully-victim (children who are bullied and also bully other children).

Bullying takes many forms

• Verbal: Name calling, teasing
• Social : Spreading rumours, leaving people out of groups on purpose, breaking up friendships
• Physical : Hitting, punching, shoving (5% in Indian schools)
• Cyberbullying

When is it bullying? It’s bullying when there are three features to the interaction

1. Imbalance of power: People who bully use their power to control or harm. The victims may have a hard time defending themselves.
2. Intent to cause harm: The person bullying intends to harm the victim
3. Repetition: Incidents happen to the same person over and over by the same person or group

It’s not bullying when there are

• Mutual arguments and disagreements
• Single episodes of social rejection or dislike
• Single episode acts of nastiness or spite
• Random acts of aggression or intimidation

Effects of bullying

(www.stopbullying.gov)
Those who are victims are at a high risk for mental health problems

• Higher risk of depression and anxiety with increased thoughts of suicide
• More likely to have health complaints
• Have decreased academic achievement
• More likely to miss or drop out of school
• More likely to retaliate (12/15 shooters have a history of being bullied)

Bullies are more likely to manifest behaivour problems that continue into adulthood when these behaviours manifest as criminality

• Higher rates of alcohol/substance abuse
• More likely to get into fights, vandalise property
• More likely to be abusive towards partners, spouses or children later in life.

Bully-victims are the worst affected. They develop both mental health and behavioural problems

Is your child being bullied?

If your child has any of these features it is very likely they are being bullied in school

• Comes home with torn clothing or missing belongings
• Appears sad, moody, depressed or anxious especially on returning home from school
• Prefers to be alone

These symptoms are also likely in victims of bullying

• Is afraid of going to school
• Vomiting
• Sleep disturbances including insomnia and nightmares

These symptoms are commonest in victims

• Frequently falling sick
• Headaches
• Bodyache is the next most common symptom in female victims. In male victims nightmares are the next most common.

Is your child a bully? Consider these common traits of bullies

• Become violent with others, gets into physical or verbal fights
• Get sent to the Principal’s office often
• Has extra money or new belongings which cannot be explained
• Will not accept responsibility for their actions
• Need to win and be best at everything

Do’s and Don’ts

For parents whose children are victims of bullying (Carr-Gregg 2011)
Do NOT

• Tell the your child to ignore the bullying. This allows the bullying and its impact to become more serious
• Blame your child or assume that they have done something to provoke the bullying
• Encourage retaliation
• Criticise how your child dealt with the bullying
• Contact the bully or parents of the bully

Do

• Communicate with your child
1. Listen carefully. Ask who was involved and what was involved in each episode
2. Empathise and reinforce that you are glad your child has disclosed this
3. Ask your child what they think can be done to help
4. Reassure your child that you will take sensible action
• Contact the teacher and/or principal and take a cooperative approach in finding a solution
• Discuss the matter in a face-to-face meeting. Stay calm. Take along any evidence you may have gathered. Ask three key questions
1. How will this matter be investigated?
2. How long will this investigation take?
3. When will you get a follow up meeting to discuss the results?
• Contact school authorities if bullying persists and escalate your communications up the chain of command. Here’s where your paper trail comes in useful

Every child deserves an education free of fear

References

1. Carr-Gregg M, Manocha R. Bullying - effects, prevalence and strategies for detection. Aust Fam Physician. 2011 Mar;40(3):98-102.
2. V .Y. Kshirsagar, Rajiv Agarwal and Sandeep B Bavdekar. Bullying in Schools: Prevalence and Short-term Impact. Indian Pediatrics 2007; 44:25-28
3. www.stopbullying.gov

Academic stress in youth

Stressed youths relaxing

Academic stress is a significant aspect of youth. Youth is the developmental phase between puberty and working adulthood. It is a period of continuing student-hood. This is a distinctive feature of youth - it exists only for those who undergo post-secondary education. This is for the privileged few who do not join the workforce full-time after schooling.

Youth is a valuable time for serious experimentation. The young person is not fettered by long-term commitments. In contrast to adolescence, youth is a period of independence - the peer group is no longer a dominant influence. There is greater freedom to develop as an individual. The young person evolves a personal perspective on life and develops a sense of direction before tackling the duties of adulthood.

However this stage of life is by no means stress-free. By definition youth is associated with academics. Academic demands are perceived as significant stressors by youths (Rao 2000, Goff 2011). These demands include workload and time constraints (Jungbluth and colleagues 2011). On entering college the youth is suddenly exposed to an unsupervised life of parties, college events, projects, and an intense curriculum, all of which make demands on time.

Why do academic stressors acquire such significance in youth? Why do students who have done well in their 12th and got into good courses find it difficult to cope with the academics? Well, until high school the student has a limited syllabus. Students in good schools rely almost entirely on the notes dictated by their teachers. Also the exam system is designed so that most students can achieve high scores with minimal time spent on study. All this changes in college. When the youth enters college, he or she is confronted with the entire gamut of knowledge in a particular field. Without the skills to filter, assimilate and reproduce information in context the youth experiences stress.

There is also the problem of youths whose career path was chosen by their parents despite their protests or otherwise. These youth may find themselves completely out of their depth in a course for which they have little interest or aptitude.

Students cope with academic stressors using a combination of emotion-focused strategies like self-blame, or bunking, and problem-focused strategies like reading guide books, and cheating. Study skills training and the acquisition of good learning habits are essential life-skills for students. We have already shown that study skills are effective and can be successfully acquired.

Study skills training should be a part of every freshers curriculum.

References

1. Jungbluth C, Macfarlane IM, Veach PM, Leroy BS.Why is Everyone So Anxious?: An Exploration of Stress and Anxiety in Genetic Counseling Graduate Students. J Genet Couns. 2011 Jan 25. [Epub ahead of print]. PubMed
2. Goff AM. Stressors, academic performance, and learned resourcefulness in baccalaureate nursing students. Int J Nurs Educ Scholarsh. 2011;8(1):Article1. Epub 2011 Jan 24.
3. Rao K; Moudud S; Subbakrishna DK. Appraisal of stress and coping behaviour in college students . Journal of Indian Academy of Applied Psychology. 2000 Jan- Jul; 26(1-2):5-13

Study skills - effective learning habits for students

Effective study skills are essential learning habits for students. Some students have a knack of learning much in a short time. Others study for hours without much progress. An important differentiating factor is the method of study. Effective study habits can be learned (Barry L. Richardson and Murray Saffran 1985, D F Alexander 1985). The good student must not rely on “study drugs” as these are associated with addiction, panic reactions, confusion, and medical complications including heart attack and stroke (Steve Sussman and colleagues, 2006).

Habit No 1: Apply book learning to daily life

Those who learn rapidly apply their imagination freely to their studies. They see that every subject of study deals with something vital in the affairs of the world, and probably of personal relevance.
Allow the knowledge you are acquiring to become an active part of your daily life, with some bearing on normal activities. Thinking about studies in this way will help build greater interest and also help you to understand and remember things better.

Habit No 2: Think of the long term reasons for studying

Imagine yourself as the CEO in a multinational company; as an internationally acclaimed designer; as an architect creating the perfect city, as the next software entrepreneur, or picture yourself as the valued management expert. Hold that image in your mind and add some detail to it every day.
Visualising these ultimate goals, will give you fresh energy to keep going, because whatever your dreams; your studies are a necessary step towards achieving them.
Many students don’t know what they want to do after their board or other graduation exams. I’ve found Aptitude Testing to be a great way to get them thinking and motivate them to study. Parents usually get this done after the exams. Aptitude assessment before the exams has the added advantages of motivation for study, as also reducing anxiety related to making career choices.

Habit No 3: Organise your work

Successful study is largely a matter of good organisation.

• Establish a regular routine. As far as possible study at the same time and place each day. A quiet, well-lit room, free from distractions is best.
• Work out a daily timetable, to guide your activities. Do not be over ambitious with your timetable. Keep it flexible and do not try to learn more than you can comfortably manage.
• Begin your major assignments well in advance of the required finishing dates to avoid having to complete them in a rush.

Habit No 4: Follow good study technique

Effective learning habits also minimise test anxiety.
Make notes and underline key sentences. Notes should be brief and to the point. Let notes assist your memory, not replace it.
Concentration is a necessary study habit. Resolve, for instance, to study ten pages without a break and then relax. Break up the learning of a lengthy item into sections, concentrating on each separately.
Start at the appointed time everyday. Do not make excuses – ‘I have to get into the right mood’; ‘I’ll just watch TV for 5 more minutes’. Just plunge into your work.

Habit No 5: Enhance your Memory

Memory depends on association, attention and repetition.

1. Association can be developed by deliberately setting out to form associations or links with given words or facts.
2. Attention is necessary for registration in the mind. Attention comes from interest in the subject, exercising the brain on it, and by focusing on one’s work in as much detail as possible.
3. Interest can be inculcated. The more you know about something, the more interesting it becomes.
4. Develop understanding. It is easier to remember something that is clearly understood. Aids to understanding include a wide vocabulary, good command of language, wide reading and plenty of discussion.
5. Repetition helps in fixing memory. It is most effective if interest and understanding are involved.

Habit No 6: Build a positive attitude

Think positively. Do not picture defeat, or failure. Use your imagination to dwell upon the positive aspects of life - happiness, hard work, success, health.
People who succeed in examinations begin by believing that they will succeed. Keep telling yourself you are certain to be successful when you do the required work.
Examinations are designed for the average student to pass and the outstanding student to get a distinction.

What thousands of ordinary people have done, YOU can certainly do.

References

1. Barry L. Richardson and Murray Saffran. Effects of a Summer Preview Program of Study Skills and Basic Science Topics on the Academic Performance of Minority Students. J Natl Med Assoc. 1985 June; 77(6): 465–471. PMC
2. D F Alexander. The effect of study skill training on learning disabled students' retelling of expository material. J Appl Behav Anal. 1985 Fall; 18(3): 263–267. doi: 10.1901/jaba.1985.18-263.PMC
3. Steve Sussman, Mary Ann Pentz, Donna Spruijt-Metz, and Toby Miller. Misuse of "study drugs:" prevalence, consequences, and implications for policy. Subst Abuse Treat Prev Policy. 2006; 1: 15. Published online 2006 June 9. doi: 10.1186/1747-597X-1-15 PMC.

Teaching, Learning, Aptitude, student

How to stop copycat suicides in students

Over the last two months three teenage students from the same Pune school have died by copycat suicide. 'Copycat’ suicides are frequent among adolescents aged 15-19 years. They occur more often than expected by chance alone. There has been an increase in teenage clusters in more recent years (Gould et al1990).

Patterns of ‘copycat’ suicide

There are two patterns of suicide clusters: point clusters, which are localised in both space and time (spatio-temporal), and mass clusters, which are localised in time only.

Point clusters

A point cluster is a temporary increase in the frequency of suicides within a small community or institution like a school or hospital. This differentiation is important as even limited resources can be effectively mobilised for prevention.

Mass cluster

A mass cluster is a temporary increase in the frequency of suicides within an entire population. Mass clusters are typically associated with high-profile celebrity suicides that are publicised and disseminated in the mass media. Prevention here is mainly by media restraint.

This article is concerned with point cluster copycat suicides that occur in schools.

Causes of ‘copycat’ suicide

Modelling

One of the causes of suicide is social learning. ‘Copycat’ suicides are caused at least in part by exposure to another individual's suicide and through the imitation of suicidal behaviour. Suicide modeling is a real phenomenon and there is ample evidence of its impact on suicide clusters (Mesoudi 2009, Insel and Gould 2003).

Homophily

Point clusters may also occur due to of homophily, the tendency for individuals with similiar interests and outlook to preferentially associate with one another. Students who are have poor academic performance, are delinquent or abuse drugs tend to associate together. These high-risk clusters may form suicide clusters due to each member's independently high risk of suicide (Joiner 1999).

Poverty

Community household poverty increases the risk of adolescent suicidal behavior. These communities place adolescents at a higher risk for associating with suicidal others. Adolescents brought up in poor communities would thus be subjected to the processes of both homophily and social modelling for suicide behaviour (Bernburg JG et al 2009 ).

Prevention of copycat suicide

One suicide in the school is tragic by itself. However, given the tendency for teenage suicides to occur in clusters urgent action needs to be taken to prevent further deaths. Successful suicide prevention programs have three general strategies - universal, selected and indicated. (Goldsmith et al 2002).

Universal approaches

These are strategies that target the entire school population. What the school does after the index suicide is important for prevention of point cluster suicides (Doan et al 2003).　
DO

• Respond within 24 hours of the suicide
• Show concern and empathy
• Inform all staff members about the suicide and provide a debriefing session where staff may voice their concerns, apprehensions, and any questions they may have.
• Inform school board members
• Ensure all teachers announce the death of the student by suicide to their first class of the day
• Provide counseling sites throughout the school for students
• Assign a school liaison to handle all media inquiries in order to avoid sensationalistic stories concerning the suicide
• Monitor the school’s emotional climate (Has there been an increase in fights or school delinquency following a death by suicide?).
• Evaluate all activities done following a death by suicide (How did your school respond? What worked and what did not work?).
• Utilize an established linkage system or community network in order to make referrals to the appropriate services as well to exchange information concerning the appropriate steps for treating those affected by the suicide.
• Utilize an established school response crisis team, which should include a diverse group of school professionals, such as the principal, counselor, teacher and possibly the school nurse.

DON'T

A major aspect of preventing cluster suicides lies in not glamourising or memorialising the act in any way. This would include attention to points as below.

• DON'T plant a tree or object in order to honor the student.
• DON'T hold a memorial service for the student at the school.
• DON'T describe in great detail the suicide (method or place).
• DON'T dramatise the impact of suicide through descriptions and pictures of grieving relatives, teachers or classmates.
• DON'T glamorise or sensationalise the suicide.

Selected approaches

Further specific strategies are for at-risk student groups. This would include screening and counselling of the student's known friends and group. Other at-risk children such as those with a previous history of attempted suicide, those known to have mood disorders, or substance use problems should also be specifically screened.

Indicated approaches

Students who show signs of suicidal potential should not be left alone. They should be given empathic support until they can be assessed by a psychiatrist, psychologist or counsellor and more definitive measures instituted. The signs of suicide potential include

• statements about suicide or that things would be better if the student was dead
• talking or writing about death, dying, or suicide

Every Pune school should have a mechanism in place to deal with the aftermath of student suicide to prevent copycat suicides in teenagers.

References

1. Bernburg JG, Thorlindsson T, Sigfusdottir ID. The spreading of suicidal behavior: The contextual effect of community household poverty on adolescent suicidal behavior and the mediating role of suicide suggestion.Soc Sci Med. 2009 Jan;68(2):380-9. Epub 2008 Nov 18.
2. Doan, J., Roggenbaum, S., & Lazear, K.J. (2003). Youth suicide prevention school-based guide (c/p/r/s)—Checklist 7a: Preparing for and responding to a death by suicide: Steps for responding. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute. (FMHI Series Publication #219-7a).
3. Goldsmith SK, Pellmar TC, Kleinman AM, Bunney WE, eds. Reducing suicide: a national imperative. Washington, DC: National Academy Press; 2002.
4. Insel BJ, Gould MS. Impact of modeling on adolescent suicidal behavior. Psychiatr Clin North Am. 2008 Jun;31(2):293-316.
5. Joiner JTE. The clustering and contagion of suicide. Current Directions in Psychological Science. 1999;8:89–92
6. Mesoudi A. The cultural dynamics of copycat suicide. PLoS One. 2009; 4(9): e7252. Published online 2009 September 30. doi: 10.1371/journal.pone.0007252.

Manage exam stress: what Pune’s students need to do

Exams at St Germain's

Pune students need to differentiate true exam stress or test anxiety from rational test anxiety that occurs due to a lack of adequate preparation. Both conditions need to be addressed differently. True test anxiety is diagnosed when the student panics, "blanks out", or overreacts despite the following (Hanoski 2008):

• there is enough time for studying
• study strategies are adequate
• attendance is regular
• class material is understood

Managing rational test anxiety

(Morgan et al, 1986)
When there is adequate time for preparation effective learning habits minimise rational test anxiety.

Effective learning habits

We begin at this stage if the student comes to the clinic 6-8 weeks before the exams. Acquiring effective study skills is essential for all students.

• Plan and stick to a study schedule. This simple yet crucial first step is often neglected.
• Spend at least half the study time in elaborative rehearsal, thinking about what is being rehearsed and relating it to other things that are known or being learnt
• Organise the study material to form retrieval cues or reminders for recall
• Get feedback on how well things have been learnt and remembered
• Review before the exam in the same way things were learnt in the first place. Focus the review on the type of exam.
• Over learn the material. Go back and re-learn it after a few days.

Prior to the exam

 (University of Illinois)

These techniques are applied 1-2 weeks prior to the exam

• Avoid "cramming" for a test
• Combine all the information presented throughout the year. Work on mastering the main concepts.
• Anticipate questions that may be asked and try to answer them by integrating ideas from lectures, notes, texts, and supplementary readings
• Select important portions that can be covered well if you are unable to cover all the material given throughout the term, 
• Set a goal of presenting knowledge of this information on the test.

True (Classic) Test Anxiety

True or classic test anxiety occurs despite effort to study and requires further measures. Again these measures vary as per the phase of the examination.

Pre-test

These measures can be instituted at any time prior to the exam and should become routine for all students.

Adopt a health-promoting lifestyle

Behavioural measures

• Assertiveness - claim space and environment for study, study materials, access to experts
• Time management - especially with a view to program adequate study hours by identifying periods in which time is spent on distractions
• Recreation and social activities - essential for maintaining concentration, and motivation. Should be programmed daily in small quantities

Physical measures

• Nutrition - don’t skip meals. Eat plenty of fruit and coloured vegetables
• Exercise - the amount can be varied. Incorporate some stretching exercises and some aerobics like skipping or same place jogging.
• Relaxation - use a muscle relaxation technique or any form of meditation that doesn't take more than a few minutes
• Sleep hygiene - for adequate, predictable and refreshing sleep

Cognitive and emotional measures

• Cognitive restructuring - see the exam as a means not an end. Keep in mind the ultimate goal you are working towards. This goal may differ from those of your parents and school. Aptitude testing, career guidance and counselling help match your expectations and capabilities with that of your family and school.
• Stress inoculation - take regular mock exams under the same conditions as the actual test
• Anxiety management techniques

Attention to practical aspects of the exam

• Find out where the test is scheduled to take place and how long it will take to get there
• Look at the buildingso that it feels more familiar.
• Know the rules as to what can be taken into the exam room etc [28].

The Day of the Test

• Begin the day with a moderate breakfast, avoid coffee
• Do something relaxing the hour before the test
• Plan to arrive at the test location early
• Avoid classmates who generate anxiety

During the Test

There are basic test taking strategies and specific anxiety management techniques that the student needs to learn (Hinton and Casey 2006).
Before answering

• Review the entire test and then read the directions twice.
• Think of the test as an opportunity to show what you know then begin to organise time efficiently.

Focusing exercise

• Take a deep breath. Look straight ahead at something inanimate (the wall, a picture, the clock)
• Focus the mind on the positive thought 'I CAN DO this exam' while breathing out.

Do the easiest parts first

• For essay questions start by constructing an outline.
• For short-answer questions answer exactly what is asked.
• If there is difficulty with an item involving a written response show some knowledge.
• If proper terminology evades you show what you know with your own words.
• For multiple choice questions read all the options first, then eliminate the most obvious. If unsure of the correct response rely on first impressions, then move on quickly. Be careful of qualifying words such as "only," "always," or "most."

Stick to time

• Do not rush through the test.
• Wear a watch and check it frequently
• If it appears you will be unable to finish the entire test, concentrate on parts you can answer well.

Recheck your answers only if you have extra time - and only if you are not anxious.

Anxiety management techniques

Learn a few of these techniques and stick to the ones that suit you. Use them whenever you panic while studying or during the exam. If problems persist despite using these techniques there are safe and effective medications that can be used just prior to the exam.
Thought-stopping

• Anxiety produces negative thoughts ('I can't answer anything', 'I'm going to panic' etc).
• Halt the spiralling thoughts by mentally shouting 'STOP!' Or picture a road STOP sign, or traffic lights on red.
• Once the thoughts are stopped continue planning, or practise a relaxation technique.

Mild pain

• Pain effectively overrides all other thoughts and impulses.
• Lightly press your fingernails into your palm
• Place an elastic band around your wrist and snap it lightly

Use a mantra

• A mantra is a self-repeated word or phrase.
• Repeatedly say 'calm' or 'relax' your breath

Distraction

• Distract attention from anxious thoughts and keep your mind busy
• Look out of the window, count the number of people with spectacles
• Count the number of desks in each row
• Make words out of another word or title

Bridging objects

• Carry something having positive associations with another person or place
• Touching the bridging object is comforting
• Allow a few minutes to think about the person

Self-talk

• In exam anxiety or panic there are often negative messages, 'I can't do this' 'I'm going to fail' 'I'm useless'. Consciously replace these with pre-rehearsed positive, encouraging thoughts:
• 'This is just anxiety, it can't harm me',
• 'Relax, concentrate, it's will be OK',
• 'I'm getting there, nearly over'.

After the Test

• Whatever the result of the test, follow through on a promised reward - and enjoy it!
• Try not to dwell on all the mistakes.
• Do not immediately begin studying for the next test. Do something relaxing for a while! (University of Illinois 2007).

Exam stress in students requires active management. State boards are taking exam anxiety and its adverse fallout seriously. The Central Board of Secondary Education (CBSE) has brought out a handbook, Knowing Children Better, offering information and advice on handling exam stress. When problems persist students and parents should not hesitate to seek psychiatric help (Malhotra 2007).

References

1. Geetanjali Kumar. Knowing Children better. CBSE. New Delhi. 2005.
2. Hanoski TD. Test anxiety: what it is and how to cope with it. http://www.ualberta.ca/~uscs/counselling_links.htm Accessed 27-Jul-08.
3. Hinton A, Casey M. Managing Exam Anxiety and Panic-A guide for students. 18-Sep-2006. http://www.brookes.ac.uk/. Accessed 27-Jul-08.
4. Malhotra S. Dealing with exam stress amongst students: Challenge for psychiatrists. Abstracts of 59th Annual National Conference of Indian Psychiatric Society. Indian J Psychiatry 2007;49:1-60. Available from: http://www.indianjpsychiatry.org/text.asp?2007/49/5/1/33280
5. Morgan CT, King RA, Weisz JR, Schopler J. Introduction to psychology. 7th Edition. New York. McGraw-Hill Book Company, 1986
6. University of Illinois. Test Anxiety. 2007. http://www.counselingcenter.uiuc.edu/. Accessed 27-Jul-08.

Schools, punishment and suicide - teenagers dying of shame

A Pune school joined the ranks of those in which a punished and humiliated teenager committed suicide. A teenage life snuffed out by the psychological pain of humiliation. It was apparently over his talking with a girl student. He was thrashed by the school principal, two teachers and the girl's uncle. This was not punishment - it was physical abuse. The boy did not return home after school. His father, a labourer, went to the school to look for him. The next morning the teenager’s body was found on the railway tracks.

Labourers moving to their work-site

Behaviours perceived as undesirable by teachers

The chain of events in this suicide apparently begins with the teenager talking to a girl student - normal adolescent behaviour. It is in the stage of adolescence that opposite-sex social interaction begins. A co-ed school would be the ideal place for this adolescent interaction. Yet this behaviour was perceived as seriously undesirable by the school authorities. Let’s look at other behaviours perceived as undesirable by teachers (Borg MG, 1998).

• Teachers perceive drug abuse, bullying and destruction of property as the most serious problem behaviours. Inquisitiveness and whispering are rated as the least serious
• Cheating, lying, masturbation and heterosexual activity are considered as more serious in girls. In boys, dreaminess, disorderliness, silliness, quarrelsomeness, and restlessness are considered to be more problematic.
• Female teachers perceive masturbation and obscene notes as more serious than male teachers. Male teachers perceive disorderliness to be more serious.

Punishment in schools

In the next step of the chain of events the teenager was punished for his normal adolescent behaviour.

Punishment is the application of an adverse stimulus after an unacceptable behaviour has occurred. The goal is to reduce the probability that the behaviour will recur. However, punishment, especially in public will also result in loss of self-esteem and humiliation. Public humiliation is known to promote further aggression - not reduce it.

In a school system there are better ways to induce behavioural change while preserving the child’s dignity. All behavioural measures start with defining the problem behaviour. Talking to a girl-student in a co-ed school is only problem behaviour when it is viewed on social class lines. School authorities and teachers need to realise their role as promoters and nurturers of responsible freedom and equality. As educators they need to go beyond their own personal biases.

Humiliation

A major interpersonal risk factor for suicide in India is humiliation (Bhatia et al, 1987). Humiliation is strongly related to aggressive behaviour. Suicide is nothing other than aggression turned inward (Freud. 1919). Middle class status protects the individual against aggression when humiliated (Aslund et al, 2009). That protection was not available for this lower socio-economic status labourer's son.

The outskirts of Pune are a churn of economic activity sucking in people with the promise of opportunity for work. In the mornings the roads from surrounding villages are lined by labourers walking with tiffin in hand to the nearest transport hub. Many among these house their families in one room shacks. It is a tribute to our system that at least for some among them the education of their children in a proper school is not just a dream. It is a shame on us that ten years of education and commitment of parents and the state can be cut short by insensitive punishment and humiliation by parents and educators. One labourer’s child died of that shame.

Top

1. Aslund C, Starrin B, Leppert J, Nilsson KW. Social status and shaming experiences related to adolescent overt aggression at school. Aggress Behav. 2009 Jan-Feb; 35(1):1-13.
2. Bhatia SC, Khan MH, Mediratta RP, Sharma A. High risk suicide factors across cultures. Int J Soc Psychiatry. 1987 Autumn; 33(3):226-36.
3. Borg MG. Secondary school teachers' perception of pupils' undesirable behaviours. Br J Educ Psychol. 1998 Mar; 68 (Pt 1):67-79.
4. Freud S. Mourning and Melancholia. 1919