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!
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
Front Door…online church
Challenges to Church Participation and Spiritual Growth in Students Affected by Mental Illness
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
November 8, 2018
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.
Prevalence of common mental
health conditions in teens
Anxiety Depression ADHD PTSD
Prevalence Severe Impairment
Source: National Institute of Mental Health
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
• Why church participation is
• What would a mental
health inclusion model for
churches look like?
Can someone be “disabled” at church and
function well in other life activities?
Why is church involvement
• Attributes of common
functioning in common
• Church culture – our
expectations for what
people do and how
they should act when
we gather together
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
Seven barriers to including
families impacted by mental
illness at church…
• Capacity for self-control
• Sensory processing
• Social communication
• Social isolation
• Past experiences of
• What are the two or three most important
ministry activities that serve as catalysts for
spiritual growth in kids served by YFC
• 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?
What is ADHD?
• A neurodevelopmental
disorder characterized by an
age-inappropriate degree of
disorganization, and in some,
but not all instances,
impulsivity and hyperactivity
• Hyperactivity goes away first
as children age
• Impulse control improves
• Adults struggle with time
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
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
• 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
• Emotional self-regulation: often display immediate,
negative reactions to authority figures
• Reconstitution: Struggles with managing time, setting
priorities, delaying gratification, establishing, maintaining
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
The more they have to process, the
less capacity they have for self-control
How instability of spiritual
growth might arise from ADHD
• Vulnerable to negative peer,
• 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,
• Drawn to more participatory,
Strategies for promoting ministry involvement,
spiritual formation for kids with ADHD:
• Engaging versus
• Mentors who offer
promote use of gifts,
passions for Kingdom
• Active learners prefer
doing to talking
• Share your stories!
• Resource parents for
What advantages might ADHD
provide a follower of Christ?
• Willing to take chances for
• Often energized by ministry
activities that capture their
• Effective on ministry teams
when others have
• Good at scanning
environment for trends
• Overrepresented among
senior pastors, student
How are teens with anxiety disorders
different from their peers?
• They misperceive the
level of threat, danger in
• They think too much
• Academics, family
are often compromised
• They often ruminate,
perseverate and struggle
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
The relationship between anxiety
and depression in teens
• Anxiety is often a
precursor to depression
• Depression generally
• Anxiety (especially OCD)
• Kids with depression
often withdraw from
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
Common spiritual challenges for teens
• 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,
• 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
Strategies for ministry leaders
serving teens with anxiety
• Lots of pictures and video
in preparation for new
• Very dependent upon
• Different expectations for
self-disclosure in groups
• Avoid putting them “on the
spot” without getting their
• Sensitivity to allowing
“preferred” roommates on
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
• Assigning responsibility for the plan (or
components of the plan) with deadlines for
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
• Communicate effectively
• Help families with their most heartfelt needs
• Offer education and support
• Empower your people to assume responsibility for
• 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?
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
Key Ministry promotes meaningful
connection between churches and
families of kids with disabilities for
the purpose of making disciples of
Free training, consultation, support and
What Does Key Ministry Do?
Help from Key Ministry
• Conferences (Inclusion Fusion Live –April 5-6)
• Video training
• Book study
• Available to church, ministry teams
• Networking with other ministries
• Social media, sermon videos, research to
support your ministry
Resource page on ADHD and spiritual development)
Resource page on anxiety and spiritual development
Resource page on Asperger’s Disorder and spiritual development
(includes video of 2012 Children’s Ministry Web Summit presentation)