In this presentation for the Greater Cleveland staff of Youth for Christ, Dr. Grcevich discusses common obstacles to church participation among adolescents with significant mental health conditions.
Challenges to Church Participation and Spiritual Growth in Students Affected by Mental Illness
1. Challenges to Church Participation
and Spiritual Growth in Students
Affected by Mental Illness
Stephen Grcevich, MD
Child and Adolescent Psychiatry
President and Founder, Key Ministry
Presented at Youth for Christ
Cleveland, Ohio
November 8, 2018
3. Who’s missing from church?
• Children with autism spectrum disorders are 1.84
times more likely to never attend church.
• Children with depression are 1.73 times more likely
to never attend church.
• Children with Oppositional Defiant Disorder are
1.48 times more likely to never attend church.
• Children with anxiety are 1.45 times more likely to
never attend church.
• Children with learning disabilities are 1.36 times
more likely to never attend church.
• Kids with ADD/ADHD are 1.19 times more likely to
never attend church.
Whitehead AL. J ScientificStudy Religion 2018;57(2)377-395.
4. Prevalence of common mental
health conditions in teens
0
5
10
15
20
25
30
35
Anxiety Depression ADHD PTSD
Prevalence Severe Impairment
Source: National Institute of Mental Health
5. A different way of thinking
about mental health ministry
How do we connect
churches and families
impacted by mental illness
for the purpose of making
disciples of Jesus Christ?
• Why mental illness is
different from other
disabilities
• Why church participation is
difficult
• What would a mental
health inclusion model for
churches look like?
6. Can someone be “disabled” at church and
function well in other life activities?
7. Why is church involvement
so difficult?
• Attributes of common
mental conditions
cause difficulty
functioning in common
ministry environments.
• Church culture – our
expectations for what
people do and how
they should act when
we gather together
8. A foundation for a mental
health inclusion ministry model
• Recognition of how non-essential attributes of
our ministry environments and practices
interfere with participation for children and
adults with common mental health conditions
• Implementing a set of strategies across your
ministry environments to help individuals and
families join activities most critical for spiritual
growth.
9. Seven barriers to including
families impacted by mental
illness at church…
• Stigma
• Anxiety
• Capacity for self-control
• Sensory processing
differences
• Social communication
skills
• Social isolation
• Past experiences of
church
10. Discussion Questions
• What are the two or three most important
ministry activities that serve as catalysts for
spiritual growth in kids served by YFC
Cleveland?
• What are some challenges that a ninth grader
with social anxiety might experience that would
hinder them from connecting with YFC
Cleveland or limit their ability to take part in
activities most critical for spiritual growth?
11. What is ADHD?
• A neurodevelopmental
disorder characterized by an
age-inappropriate degree of
inattentiveness and
disorganization, and in some,
but not all instances,
impulsivity and hyperactivity
• Hyperactivity goes away first
as children age
• Impulse control improves
next
• Adults struggle with time
management, task
completion, organization,
maintaining priorities
12. Executive functioning as the fundamental
difference in persons with ADHD
• Cognitive abilities involved in controlling and
regulating other abilities and behaviors.
• Kids with executive functioning weakness
struggle to adapt to new situations and
foresee outcomes of their behavior.
HathawayWL, BarkleyRA. J PsycholChristianity2003, 22(2) 101-114
13. How might having ADHD affect a
teen’s spiritual life?
• Behavior inhibition: Sitting respectfully in an adult worship
service, waiting their turn to talk in group, not interrupting
others
• Nonverbal working memory: finding their Bible when it’s
time for church, group, getting lost on their way to group
• Verbal working memory: applying Scripture in real-life
situations
• Emotional self-regulation: often display immediate,
negative reactions to authority figures
• Reconstitution: Struggles with managing time, setting
priorities, delaying gratification, establishing, maintaining
spiritual disciplines.
14. Unique ministry challenges
presented by students with ADHD:
• Ministry environments are often
less structured than school
• Ministry volunteers generally
lack training as educators
• Parents, physicians often
withhold effective ADHD
medication during evenings,
weekends, many ministry
activities occur when medication
has worn off
• Assumptions regarding ability to
control behavior
15. The more they have to process, the
less capacity they have for self-control
16. How instability of spiritual
growth might arise from ADHD
• Vulnerable to negative peer,
environmental influences
• Effects of intense spiritual
experiences (VBS, retreats,
mission trips) fade when
context is gone
• “Roller-coaster” spirituality
• Shunned for volunteer,
leadership opportunities if
perceived as undisciplined,
disorganized
• Drawn to more participatory,
action-oriented, relational
religious contexts
17. Strategies for promoting ministry involvement,
spiritual formation for kids with ADHD:
• Engaging versus
overstimulating
environments
• Mentors who offer
accountability,
promote use of gifts,
passions for Kingdom
purposes,
• Active learners prefer
doing to talking
• Share your stories!
• Resource parents for
1:1 conversations
18. What advantages might ADHD
provide a follower of Christ?
• Willing to take chances for
God
• Often energized by ministry
activities that capture their
imagination
• Effective on ministry teams
when others have
complimentary skills
• Good at scanning
environment for trends
• Overrepresented among
senior pastors, student
pastors?
19. How are teens with anxiety disorders
different from their peers?
• They misperceive the
level of threat, danger in
their environment
• They think too much
• Academics, family
functioning, friendships,
extracurricular activities
are often compromised
• They often ruminate,
perseverate and struggle
with indecisiveness,
perfectionism
20. How anxiety manifests in teens
Note: Kids may experience different manifestations of anxiety as they
progress through developmental stages
• Separation Anxiety Disorder
• Specific Phobia
• Generalized Anxiety Disorder
• Social Anxiety Disorder
• Panic Disorder
Obsessive-Compulsive Disorder (OCD) is closely related to anxiety,
but categorized separately in DSM-5
J Am Acad ChildAdolescPsychiatry,2007;46(2):267-283
21. The relationship between anxiety
and depression in teens
• Anxiety is often a
precursor to depression
• Depression generally
more episodic
• Anxiety (especially OCD)
more chronic
• Kids with depression
often withdraw from
previously enjoyable
extracurricular activities
22. When is anxiety most likely to cause
problems with ministry participation?
• When kids are dropped
off at age-appropriate
programs (middle school)
• If they’re made to be the
center of attention
• In non-routine activities
(mission trips, retreats)
• Transitions from one age-
group ministry to another
• Small groups where self-
disclosure is expected
23. Common spiritual challenges for teens
with anxiety
• Propensity to misperceive God’s character, intentions
• They frequently need to be “in control.”
• May focus on performance for God as opposed to their
relationship with God
• Rule followers who may be drawn to legalism
• Susceptible to questioning authenticity of their faith,
salvation
• Spiritual concerns often become fodder for obsessive
thinking, compulsive behavior
But… for some, God may use anxiety to draw them into a
deeper relationship with Him
24. Strategies for ministry leaders
serving teens with anxiety
• Lots of pictures and video
in preparation for new
experiences
• Very dependent upon
electronic communication
• Different expectations for
self-disclosure in groups
• Avoid putting them “on the
spot” without getting their
permission first
• Sensitivity to allowing
“preferred” roommates on
trips
25. What might our mental health inclusion
planning process look like?
• Leaders in each ministry area might identify
potential barriers, useful strategies within their
area of responsibility.
• An alternate approach might be to focus on a
strategy (or several strategies) and implement
the strategy across your ministry departments
or environments.
• Assigning responsibility for the plan (or
components of the plan) with deadlines for
implementation important.
26. Seven strategies for promoting mental
health inclusion at church (TEACHER)
• Assemble your inclusion team
• Create welcoming ministry environments.
• Focus on ministry activities most essential to
spiritual growth
• Communicate effectively
• Help families with their most heartfelt needs
• Offer education and support
• Empower your people to assume responsibility for
ministry
27. Discussion Questions
• Are there changes we can make to the
physical spaces where our ministry takes place
to help promote learning and self-control?
• What steps might we take to help students with
common mental health conditions to enter into
our Campus Life and City Life programming?
• What role might students currently served by
YFC Cleveland play in an outreach and
inclusion strategy for peers with common
mental health concerns?
28. Key considerations for an effective mental
health inclusion strategy…
• Inclusion is a mindset – not a program
• A good strategy benefits everyone and
doesn’t require anyone to self-identify
• Ministry is owned by staff and students
• No ministry will be able to include everyone
with mental illness, but every ministry can
welcome, serve and include more students
with mental illness
31. Key Ministry promotes meaningful
connection between churches and
families of kids with disabilities for
the purpose of making disciples of
Jesus Christ.
Free training, consultation, support and
resources
What Does Key Ministry Do?
32. Help from Key Ministry
• Training
• Conferences (Inclusion Fusion Live –April 5-6)
• Video training
• Book study
• Consultation
• Available to church, ministry teams
• Resources
• Networking with other ministries
• Social media, sermon videos, research to
support your ministry
• Support
34. Additional Resources:
Resource page on ADHD and spiritual development)
http://drgrcevich.wordpress.com/teaching-series-adhd-and-spiritual-
development/
Resource page on anxiety and spiritual development
http://drgrcevich.wordpress.com/resource-page-anxiety-and-spiritual-
development/
Resource page on Asperger’s Disorder and spiritual development
(includes video of 2012 Children’s Ministry Web Summit presentation)
http://drgrcevich.wordpress.com/resource-page-anxiety-and-spiritual-
development/
Notes de l'éditeur
Far too many families from my work work find themselves unable to enter my church world. That’s tragic!
Much of what we do in mental health ministry can be characterized as care and support for adults who are already in a church. But what if we saw mental health ministry as evangelism and outreach to families that struggle to be part of church?
There are five key executive functions: Behavioral inhibition (critical to development of the other functions), non-verbal working memory, verbal working memory, emotional self-regulation and reconstitution.
Behavioral inhibition involves the ability to delay one’s response to an event (allowing time to think), interrupt a chain of responses to an event and the capacity to keep competing events from interfering with the initial response. Without this ability a person would be entirely focused on the immediate consequences of any action or behavior and would be unable to develop the capacity for self-control. Kids in whom the development of this capacity is delayed will be unable to suppress the publicly observable aspects of behavior.
Non-verbal working memory involves the capacity to maintain a picture of events in one’s mind. The ability to analyze situations for recurring patterns in order to predict future events is critical in anticipating consequences of behavior, managing relationships and planning complex, goal-directed behavior. Moral conduct and social cooperation are contingent upon this capacity as well the retention of events in sequence that allows one to estimate the time required to perform a task. Kids who experience delays in developing this capacity will have more difficulty remembering multi-step directions, more difficulty completing tasks (especially tasks that take a long time to complete), and will tend to underestimate the amount of time necessary to complete assigned tasks.
Verbal working memory involves the capacity to think in words. Internalization of speech allows kids to internalize social norms and rules, facilitating moral development. As kids develop this capacity, they’re able to hold a thought in their mind without having to actually say what they’re thinking. A classic example is the inability of little kids to pray silently. Kids with delays in development of verbal working memory would tend to talk excessively compared to peers, have more difficulty organizing and communicating thoughts, struggle more with use of proper grammar and experience more challenges in following rules and directions.
Spiritual issues related to specific executive functioning weaknesses…
We expect (for the most part) untrained volunteers to work with kids at church on Sundays when they’re frequently without the medication that is indispensible to the teachers they work with during the week with Master’s degrees and many years of experience!
Key points…
Welcoming doesn’t have to be overwhelming...primary colors vs. jewel tones
Middle school boys with ADHD may not do well sitting on stackable chairs for an hour-long group discussion.
Because interest is a greater determinant of attention/motivation in kids with ADHD, personal stories are often a more effective strategy for communicating faith essentials.
Kids with ADHD focus better in 1:1 situations... Family ministry approaches are especially important!
Folks in the medical community raise concerns about ADHD being viewed as a positive, but one of two “high-risk, high-reward” genes is associated with ADHD. What’s the potential upside to ADHD, and how might the church benefit?
Neuroimaging studies suggest that children and teens with anxiety experience patterns of brain activity in response to neutral images similar to those seen in kids without anxiety exposed to threatening images.
Discuss the manifestations of each anxiety disorder…
See the link to Anxiety and Spiritual Development under “Additional resources” for specific strategies with first-time attenders, kids attending overnight retreats, mission trips, etc.
Discuss how the vast majority of kids referred to our practice because parents are looking for a Christian clinician are struggling with anxiety.
Intrusive obsessions that kids will somehow be compelled to act in a manner antithetical to their faith – or their family’s faith.
Emphasize the opportunity to visit in advance of the first Sunday at church, rehearsing responses to anxiety-inducing situations.
Pearl…Jeremy Collins’ texts pictures between kids and parents when a child is struggling with separation anxiety.
Discuss “looping” with small group leaders transitioning with kids from one age-group ministry to another.
Importance of family ministry…kids with anxiety likely to have even more 1:1 time with parents.
Reinforce Key Ministry’s Mission…
Free Consultation service
Training
Front Door…online church
Inclusion Fusion