Mental Health, Masking & Dysregulation
Do you know what I did today for a student?
I created a calendar with all of their upcoming assignments and a list of every missing assignment across all of their classes, with their professor’s office hours right at the top so they had everything they needed ready to go. And then I put reminders on my own phone so that I could follow up with her every single day that something was due to make sure it had been submitted.
Now you might be asking yourself, why would I be doing this for a college student?
She is a college student. She is brilliant. She is trying harder than most people around her even realize. And she is in crisis.
She has been diagnosed with ADHD and anxiety, and if I am being honest, depression appears to be settling in as well. She has been to two different doctors seeking help. One did not feel comfortable treating her because she would be going to school across the country. The second wanted to get to know her before starting her on medication. I understand that approach. But here is what I also know: she brought a psychological evaluation to that appointment, one that clearly stated she had anxiety and that medication was recommended.
And still, she is waiting.
Continuing the Story
When we met, I asked her directly because we have that kind of relationship. I said,
“Last week you mentioned that some of your missing assignments were linked to a systems issue, that work had not transferred over to Canvas yet. But can we get to the root of it right now? Is that what happened, or is there a possibility that because you have been struggling, some of these assignments genuinely have not been finished?”
She paused. And then she told me it was the second reason.
She said she felt like she had started some of them, but perhaps had not finished them. And then she told me something that stopped me in my tracks.
She said she blipped out on Friday and Saturday. She had no idea what she did on those two days. She could not remember. She knows she slept for about three hours at some point and that her roommate woke her up. That was it. Two entire days. Gone.
This is what a mental health crisis looks like in a college student who is still trying to show up. This is not laziness. This is not a lack of effort or caring. This is a nervous system that is completely overwhelmed, a brain that cannot access its own planning and organization centers, and a student who is using every bit of energy she has just to get up every morning.
So what did I do?
I became her external prefrontal cortex for right now.
I made the list she could not make. I built the calendar she could not build. I put the office hours where she could see them so that she did not have to go looking for anything. I set up a daily check in so that if she does not reach out to me, I will call her until she answers.
Not because I am hovering, but because right now she needs to know that someone is there. That the structure exists. And that she does not have to hold all of this alone.
This is what we do sometimes as coaches.
We do not just teach strategies. We hold the scaffolding while the student finds their footing again. Our goal right now is simple: get her to the end of the semester. Emotional regulation is the entire focus.
Everything else comes after that.
Let us talk about the prefrontal cortex. This is the part of the brain responsible for:
planning
decision making
organization
follow through
emotional regulation
It is essentially the command center for everything we call executive function.
And here is what we know: when a person is experiencing acute anxiety or acute depression, access to that prefrontal cortex becomes significantly impaired.
When the brain perceives a threat, whether that threat is a physical danger or the overwhelming weight of depression and anxiety, it activates the amygdala. The amygdala is your brain’s alarm system. It triggers the fight, flight, or freeze response. In that state, the brain is not prioritizing planning or organization. It is prioritizing survival. The prefrontal cortex, which requires a calm and regulated nervous system to function well, essentially goes offline.
For students with ADHD, this is compounded. Their prefrontal cortex is already working harder than neurotypical students just to manage daily tasks. Add acute anxiety or depression on top of that and you are looking at a student who is not being lazy, not being irresponsible, and not making excuses - You are looking at a student whose brain is genuinely not able to access the tools it needs to function.
This is what masking looks like in real life.
These students show up. They smile. They tell you things are fine. And then they go home and lose entire days because their nervous system is completely dysregulated. Sound familiar? Because that is exactly what happened with my student.
So what do we do as educators, coaches, tutors, and therapists when we recognize this in a student?
Here are some practical things to consider.
First, reduce the cognitive load immediately. Do not ask the student to figure out what they need. You figure it out with them or for them in that moment. Create the list. Build the calendar. Identify the next smallest possible step and put it in front of them.
Second, regulate before you organize. A dysregulated nervous system cannot take in information or make decisions effectively. Before you dive into the missing assignments or the upcoming deadlines, check in on how they are actually doing. A few minutes of genuine connection can shift the nervous system enough to make the rest of the conversation productive.
Third, become the external structure. Students in crisis cannot generate their own scaffolding. That is not a character flaw. That is neuroscience. Set up the check ins, send the reminders, follow up consistently. You are not doing the work for them. You are holding the structure until their brain can hold it again.
Fourth, communicate with care not urgency. When students are already in a heightened state, urgency from the adults around them adds to the overwhelm. Calm, clear, and consistent is the goal. Let them feel that you are steady even when they are not.
Fifth, know when to escalate. If a student is losing days, cannot remember basic events, and is showing signs of significant depression, they need more than academic support. Encourage professional help, connect them with campus resources, and document what you are observing so that if and when they do see a professional, there is a clear picture of what has been happening.
Back to the student…
My student is still in the middle of her story. She is still waiting for the medical support she needs. But she is not alone, and she knows it.
Sometimes that is the most powerful executive function tool we have.
Do you ever wonder if it is time to call a mental health professional? Are you curious about the red flags? Are you wondering how coaches and therapists can work together when a student is in crisis?
On May 28th at 6:00pm I will be co-hosting a workshop with Ellina Creary from Harmony Counseling. The Hidden Struggle: When Mental Health and Academics Collide - a guide for coaches, therapists, and parents. Click the button below to register. This workshop was literally made for everything we just talked about in this newsletter. I would love to see you there.
