CHAPTER 2: dYSREgulATion To diSoRdER • 33involve a coordination of care, aligning school efforts, and outside provider treatments
(e.g., psychologist). For some students, Tier 3 interventions can be handled entirely within
the school, while for others there is a sharing of treatment provision within the school and
community.
The three-tier system, putting prevention first, is needed. The Youth Risk Behavior
Surveillance System (YRBSS), which monitors six categories of priority health-risk behaviors
among youth and young adults using the Youth Risk Behavior Survey (YRBS), found that
many high school students (grades 9–12) are engaged in priority health-risk behaviors asso-
ciated with the leading causes of death among persons aged 10 to 24 years in the United
States (Kann et al., 2014). In a nationally representative face-to-face survey of 10,123 adoles-
cents aged 13 to 18 years, Merikangas et al. (2010) found that approximately one in every
four to five youth in the United States meets criteria for a mental disorder with severe
impairment across their lifetimes. Their disturbing numbers were followed by a plea for
the United States to engage in a shift from treatment to prevention and early intervention.
THE RiSKS, CHAllEngES, And diSoRdERS RElATEd To
dYSREgulATion And diSEngAgEMEnT
The range of difficulties is substantial. This is why the three-tier model is in place. A large
proportion of students may be typically functioning, ready to benefit from instruction in
skills such as those taught in mindfulness and yoga programs. Learning these skills can
help them thrive and perform at their highest academic potential. As shown in the three-
tier model, depending on the risks associated with poverty, resources, community violence,
and a host of other environmental, socioeconomic, cultural, community, familial, and even
genetic factors, upward of 50% of students in a given district can have substantial needs.
Because of this complex mix of etiologies, students engage in behaviors (e.g., substance use,
violence, smoking, bullying, and sex), or fail to engage in behaviors (e.g., self-care, sobriety,
caring friendships, and studying), in ways that place them at risk for the leading causes
of morbidity and mortality (Kann et al., 2014). In order to orient the reader and provide a
brief review of the challenges for today’s schools, the most prevalent disorders (e.g., anxiety,
behavioral, substance use) and problem behaviors (e.g., bullying, peer victimization) are
briefly described along with research detailing prevalence, risks, and challenges.
Attention and impulsivity
Attention difficulties and impulsivity create risk for academic failure and disengagement
as well as physical safety risk. When these problems occur at a clinical level, it is referred
to as attention-deficit/hyperactivity disorder (i.e., ADHD). Specifically, ADHD manifests
as a persistent pattern of inattention that may or may not be associated with hyperactivity
and impulsivity (American Psychiatric Association [APA], 2013). Further, the attention,
activity, and impulsivity symptoms interfere with school and daily functions (APA, 2013).
Children and adolescents who have been diagnosed with ADHD fail to pay close attention
to details; do not appear to listen when spoken to; do not follow through with instructions;
struggle to organize tasks; resist tasks that require sustained mental effort; lose things;
and can be easily distracted by extraneous stimuli (APA, 2013). The students who also
experience hyperactivity and impulsivity squirm, tap their feet and hands, struggle to stay