Special Education

Identifying and Referring At-Risk Students

Once teachers are familiar with the characteristics or “warning signs” that indicate eating disorders, they are more likely to notice when students exhibit worrisome eating behaviours. A physical education teacher may notice that one girl’s weight constantly fluctuates, while an art teacher might encounter an underweight boy whose work often portrays images of food or weight loss. At what point should a teacher become concerned that a student is at risk for developing an eating disorder? When does “typical” adolescent concern with body image, food and weight cross the line and begin to reflect an eating disorder?

The rule of thumb is to treat any warning signs seriously. Any combination of indicators from the What Are Eating Disorders? section are legitimate cause for concern. There are two points to remember. First, medical experts tell us that early intervention in an eating disorder may greatly improve the prognosis. Second, it is better to err on the side of caution.

The real question is, what should a teacher do with information about a potential eating disorder? The following three-step strategy is intended to help teachers act on their concerns.

1. Keep clear records

There is a chance that the student, and even parents, will react negatively to any suggestion that there is an eating disorder. Denial that there is a problem is often the first response of students with eating disorders and their families, and any suggestion that there is a problem may be rejected strenuously.

Concerned teachers are advised to keep clear, concise notes of the incidents that have led them to suspect that a student has a problem. These notes should focus on specific observed behaviours, without attempting to reach any definitive conclusion. Teachers should not attempt to “diagnose,” but their careful observations may assist clinicians in the diagnostic process. This does not mean that teachers should go out of their way to “spy” on the student, but simply pay attention to warning signs that surface during the normal course of student/teacher interactions.

2. Consult with other professionals

Since eating disorders generally emerge during the secondary school years, it is often difficult for a single teacher to identify potential danger signs. If teachers have a concern, they may want to compare notes with other teachers. It is important that teachers also share any concerns of this nature with the school counsellor and, perhaps, an administrator.

In many cases, the counsellor may already be aware of the problem and will be able to offer the teacher support and advice. The school counsellor is in the best position to deal with the student and family, and should be able to direct them to the most appropriate community and medical resources.

In some cases, school personnel may have reason to believe that the student has been, or is likely to be, abused, neglected or in need of protection. In these cases, school personnel must report the matter immediately to a child protection social worker. The law is set out in legislation called the Child, Family and Community Service Act (See The B.C. Handbook for Action on Child Abuse and Neglect, 1998).

It is suggested that school counselling offices maintain resource material on eating disorders, such as this resource, as well as information on support services available in the community.

3. Develop ongoing support strategies

Many students undergoing treatment for eating disorders continue with their normal school routines without teachers or classmates realizing that there is a problem. In more severe cases, however, the disorders may be disruptive to their lives at school. As malnutrition and starvation take their toll, a student with anorexia may be hospitalized until their weight is stabilized and increased. When these students are in school, they will benefit from receiving extra supports. The nature of extra support is covered in the next section.

As a general practice, it is helpful to ensure that there is an ongoing communication strategy in place in the school to allow for the flow of information from counsellors and administrators to teachers, and back. School-based team meetings may be an appropriate forum for information sharing.

When Talking with a Student with an Eating Disorder, Do: Speak to the counsellor first about your concerns. Listen carefully and be empathic. Communicate your care and concern. Develop a compassionate conversation that is understanding and supportive. Direct students to a counsellor and family physician. Avoid a power struggle over food or eating. Recognize that eating disorders are about low self-esteem, fear and other often unresolved issues. Provide support by referring students to community resources and reading materials. Support the treatment plan developed by health care professionals to help students recover. Seek collegial and administrative support for yourself. Have patience.