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Psychosis (Schizophrenia)

Schizophrenia and other psychotic disorders are medical illnesses that result in strange or bizarre thinking, perceptions (sight, sound), behaviors, and emotions. Psychosis is a brain-based condition that is made better or worse by environmental factors - like drug use and stress. Children and youth who experience psychosis often say "something is not quite right" or can't tell if something is real or not real. It is an uncommon psychiatric illness in young children and is hard to recognize in its early phases.

The appearance of symptoms of psychosis before age 12 is rare (less than one-sixtieth as common as the adult-onset type), but studying these cases is important for understanding this disorder. For those who might develop psychotic disorders or schizophrenia as adults (adult-onset), it is not uncommon for them to start experiencing early warning signs during puberty or adolescence. The period of time when an adolescent experiences the early warning signs of psychosis is called prodrome. During this time, youth recognize that their experiences (hearing or seeing things that are not there) are strange or concerning. They may not easily admit these problems unless asked. Being aware of the early warning signs and offering support is crucial.

Childhood-onset - Most children with schizophrenia show delays in language and other functions long before their psychotic symptoms (hallucinations, delusions, and disordered thinking) appear. In the first years of life, about 30% of these children have transient symptoms of pervasive developmental disorder, such as rocking, posturing, and arm flapping. Childhood-onset of psychosis may present with poor motor development, such as unusual crawling, and children may be more anxious and disruptive compared to those with later onset.

It is especially important to pay attention to sudden changes in thoughts and behaviors. Keep in mind that the onset of several of the symptoms below, and not just any one change, indicates a problem that should be assessed. The symptoms below should not be due to recent substance use or another medical condition.

A quick and confidential way to determine if you may be experiencing psychosis is to take a mental health screening. A screening is not a diagnosis, but a way of understanding if your symptoms are having enough of an impact that you should seek help from a doctor or other professional. Take a psychosis screen here.

Early Warning Signs

Feeling like their brain is not working

Feeling like their mind or eyes are playing tricks on them

Seeing things and hearing voices that are not real

Hearing knocking, tapping, clicking or their named being called

Confused thoughts

Vivid and bizarre thoughts and ideas

Sudden and bizarre changes in emotions

Peculiar behavior that seem unusual

Increased sensitivity to light, sounds, smells or touch

Concept that people are "out to get them"

Fearfulness or suspicion that isn't warranted

Withdrawal from others

Severe problems in making and keeping friends

Difficulty speaking, writing, focusing or managing simple tasks

The behavior of children with this illness may change over time. Psychosis can develop gradually or suddenly. Children and youth may begin talking about strange fears and ideas. They may start to cling to parents or say things that do not make sense. Others who used to enjoy relationships with peers may become more shy or withdrawn or seem to be in their own world.

Treatment

Early diagnosis and medical treatment are important. It is especially important that children and youth with the problems and symptoms listed above receive a complete evaluation. These children may need individual treatment plans involving other professionals. A combination of medication and individual therapy, family therapy, and specialized programs (wraparound services, early psychosis treatment) is often necessary. Changes in life style (keeping stress low, taking fish oils), additional supports (therapy and school support) and psychiatric medication can be helpful for many of the symptoms and problems identified.

Making the choice about whether or not to use medications can be difficult. Second-generation (atypical) antipsychotic drugs are usually tried first because they may cause fewer side effects than standard drugs. Serious side effects of second-generation antispychotic drugs can include weight gain, diabetes and high chloresterol. Currently, the Food and Drug Administration approves the use of two second-generation drugs in children ages 13-17, Risperidone (Risperdal) and Aripiprazole (Abilify).

Parents need to ask their family physician or pediatrician to refer them to a child and adolescent psychiatrist who is specifically trained and skilled at evaluating, diagnosing, and treating children with schizophrenia.

To learn more visit:

Other Resources

National Association of Child and Adolescent Psychiatry
Schizophrenia in Children

Schizophrenia.com.
Childhood Schizophrenia and Bipolar Disorder Schizophrenia Medication Treatment

The Mayo Clinic - Childhood Schizophrenia Treatments and Drugs

National Institute of Mental Health,
Schizophrenia

National Alliance on Mental Illness - Early Onset Schizophrenia

NARSAD: The Mental Health Research Association
60 Cuttermill Rd, Suite 404
Great Neck, NY 11021
Toll-Free Number: (800) 829-8289
Fax Number: (516) 487-6930
Email Address: info@narsad.org
Website URL: www.narsad.org

National Schizophrenia Foundation
403 Seymour Ave. - Suite 202
Lansing, MI 48933
Phone Number: (517) 485-7168
Fax Number: (517) 485-7180
Email Address: inquiries@nsfoundation.org
Website URL: www.nsfoundation.org

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Psychosis (Schizophrenia) in Children and Youth

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Psychosis (Schizophrenia) Schizophrenia and other psychotic disorders are medical illnesses that result in strange or bizarre thinking, perceptions (sight, sound), behaviors, and emotions. Psychosis is a brain-based condition that is made better or worse by environmental factors - like drug use and stress.

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Since adolescents are often moody, it can be difficult to recognize when your child has become depressed and might need help. The thing people tend to notice first is withdrawal, or when the teenager stops doing things they usually like to do. There might be other changes in their mood, including sadness or irritability. Or in their behavior, including appetite, energy level, sleep patterns, and academic performance. If several of these symptoms are present, be vigilant about the possibility of teen depression.

This is especially important because by the time family members and other people around a teenager note their lack of interest in most things-or what we call anhedonia-they've usually been depressed for some time. Depression is an internalizing disorder, i.e. one that disturbs a patient's emotional life, rather than an externalizing one, which takes the form of disruptive or problematic behavior. As such, it takes a while not only for others to recognize it but often for the patient themselves to realize that their thinking, and emotional responses, are disturbed.

Note that there are actually two kinds of depression. In major depressive disorder -the most familiar form of depression-the symptoms occur in what may be severe episodes that tend to last from seven to nine months. But there is also another form of depression called dysthymia, in which the symptoms are milder, but they last longer, even years. So while the experience of dysthymia may be less debilitating for the child at any given moment, the risk is that there is more accrued damage and more time in which the child is kept out of the healthy development process.

When a teenager is depressed, their suffering isn't the only reason it's important to get help. In addition to the disorder itself, there are add-on effects that may cause lifelong issues. With depression symptoms comes low energy and poor concentration, two factors that are likely to have a significant impact on social and academic functioning.

It's easy to see the effects of poor academic functioning: falling behind in school undermines a child's confidence and self-image and can impact their future if it's prolonged. But social learning is just as critical as academic learning in adolescence. Deficits in social skills not only put depressed teens behind their peers but in themselves can compound their depression.

It's important to understand that a teenager who is depressed may also develop anxiety and may need to be treated for two separate disorders. It may be that depression leads to anxiety-the negative state of mind of a depressed teenager lends itself to uncertainty. If you're not feeling good about yourself, confident, secure, or safe, anxiety may find fertile ground. It may also be because the regions of the brain affected by anxiety and depression are close together and mutually affected.

Two serious problems that are directly associated with teenage depression and anxiety are suicidal thinking (or behavior) and substance abuse. Suicide is the third leading cause of death among adolescents and young adults aged 15 to 24, and we know that most kids who commit suicide have been suffering from a psychiatric illness. Especially at risk are teenagers who hide their depression and anxiety from parents and friends. That's why it's important to be alert to signs of these disorders-withdrawal, changes in school performance, eating habits, sleeping patterns, things they enjoy doing-even when teenagers aren't forthcoming about how they feel.

Similarly, the majority of teenagers who develop substance abuse problems also have a psychiatric disorder, including, most commonly, anxiety or depression, which is another important reason to get treatment in a timely way.

Fortunately, early involvement of health care professionals can shorten the period of illness and decrease the likelihood of missing important life lessons.

The most common treatment a mental health professional is apt to use is some form of cognitive behavioral therapy, and depending on how young the child is, it may involve teaching the parents as well. Cognitive behavioral therapy is based on the idea that a person suffering from a mood disorder is trapped in a negative pattern of thought. Depressed kids tend to evaluate themselves negatively, interpret the actions of others in a negative way, and assume the darkest possible outcome of events. In CBT, we teach sufferers to challenge those negative thoughts, recognize the pattern and train themselves to think outside it. And in many cases, we see real improvement.

If the depression is moderate to severe, treatment may involve medications such as antidepressants. A combination of psychotherapy and medication usually works better than either alone.

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What Are the Symptoms of Depression in Teenagers? - Child Mind Institute

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What are teen depression symptoms? Child Mind Institute provides information on how to tell if your teenager is just moody or depressed, and how to address the issue.

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Quick Facts on Major Depressive Disorder - Child Mind Institute

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Facts on depression: a brief overview including the signs and symptoms and how it's treated for children suffering from depression and their caregivers.

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Inside Higher Ed | Higher Education News, Events and Jobs

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More than half of the college students who visited their campus counseling centers during the 2015-16 academic year reported symptoms of anxiety, according to a survey by the Association for University and College Counseling Center Directors.

This marks the seventh year in a row that anxiety has been the top complaint among students seeking mental health services. This year, 51 percent of students who visited a counseling center reported having anxiety, followed by depression (41 percent), relationship concerns (34 percent) and suicidal ideation (20.5 percent). Many students reported experiencing multiple conditions at once.

Since 2009, when anxiety overtook depression as the No. 1 concern among college students, the number of students experiencing anxiety has steadily increased.

This survey was conducted between September 2015 and August 2016. In total, 529 counseling center directors representing that many institutions responded to the survey, with an even split between public and private institutions. The majority of respondents came from four-year colleges, but community colleges, professional schools and art schools were also included.

In an effort to reflect the makeup of their student bodies, counseling centers have diversified their clinical staff members. Of new hires, 62.2 percent are white, 15.3 percent black, 7.5 percent Latino and 10 percent Asian. This compares to current clinical staff, who are 70.9 percent white, 10.1 percent black, 7.3 percent Latino and 7.9 percent Asian.

"Student populations have become more diverse," said Micky Sharma, president of the AUCCCD and director of counseling and consultation services at Ohio State University. "Counseling services work to create a staff that represents their student bodies."

At Ohio State, for example, the counseling center now offers clinical services in nine different languages to meet the needs of their international students, who make up about 12 percent of the student body, Sharma said.

Regardless of race, ethnicity, gender or sexual orientation, "anyone could show up with anxiety or depression or a relationship issue," Sharma said. "A university counseling center is charged with providing help for everybody."

Another key finding in the survey is that 41.6 percent of counseling centers hired additional staff members in the last academic year, compared to about 26 percent in 2011 and 36 percent in 2016.

College counseling centers continue to grow to match the demands of their students, according to David Reetz, the lead researcher and coordinator for the 2016 survey and director of counseling and psychological services at the Rochester Institute of Technology.

"More students are seeking services because we continue to be more and more aware that a student's health and well-being have a lot to do with their success in their academic programs and the quality of their student life experience," Reetz said.

In fact, of the students surveyed, about 72 percent who used counseling services said it helped their academic performance in some way.

As more students continue to seek out mental health services and campus counseling centers try to keep up with new hires, the question of student wait times becomes key.

For the first time, this year's survey asked counseling center directors about average wait times for students based on the number of business days between when the appointment was scheduled and when it occurred.

The survey team found that, on average, students waited between six and eight business days for counseling services. However, as might be expected, institutions with a lower ratio of professional staff to students saw shorter wait times.

Reetz noted that the wait-time average is a "tricky number," given that some students opt to schedule their first appointment farther out to accommodate their own schedules.

"Students don't necessarily want to be seen right away," Reetz said, adding that, generally, "the more staff a center has, the shorter that wait time is between initial contact and first appointment."

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Anxiety and depression are the primary concerns for students seeking counseling services

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Survey of campus counseling centers finds increased demand for services, as well as additional positions and more diversity in hiring.

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Basic Description

A blueprint or plan for a child's special education experience at school.

A blueprint or plan for how the school will provide support and remove barriers for a student with a disability.

What It Does

Provides individualized special education and related services to meet a child's unique needs.

Provides services and changes to the learning environment to enable students to learn alongside their peers.

As with an IEP, a 504 plan is provided at no cost to families.

These services are provided at no cost to families.

What Law Applies

The Individuals with Disabilities Education Act (IDEA)

Section 504 of the Rehabilitation Act of 1973

This is a federal civil rights law to stop discrimination against people with disabilities.

This is a federal special education law for children with disabilities.

Who's Eligible

To get an IEP, there are two requirements:

To get a 504 plan, there are two requirements:

1. A child has any disability. Section 504 covers a wide range of different struggles in school.

2. The disability must interfere with the child's ability to learn in a general education classroom.

Section 504 has a broader definition of a disability than IDEA. (It says a disability must substantially limit one or more basic life activities. This can include learning, reading, communicating, and thinking.) That's why a child who doesn't qualify for an IEP might still be able to get a 504 plan.

1. A child has one or more of the 13 disabilities listed in IDEA. The law lists specific challenges, like learning disabilities, ADHD, autism, and others.

2. The disability must affect the child's educational performance and/or ability to learn and benefit from the general education curriculum. The child must need specialized instruction to make progress in school.

Independent Educational Evaluation

Families can ask the school district to pay for an independent educational evaluation (IEE) by an outside expert. The district doesn't have to agree.

Doesn't allow families to ask for an IEE. As with an IEP evaluation, families can always pay for an outside evaluation themselves.

Families can always pay for an outside evaluation themselves, but the district may not give it much weight.

Who Creates It

There are strict legal requirements about who participates. An IEP is created by an IEP team that must include:

The rules about who's on the 504 team are less specific than they are for an IEP.

A 504 plan is created by a team of people who are familiar with the child and who understand the evaluation data and special services options. This might include:

The child's parent or caregiver

General and special education teachers

The school principal

The child's parent or caregiver

At least one of the child's general education teachers

At least one special education teacher

School psychologist or other specialist who can interpret evaluation results

A district representative with authority over special education services

With a few exceptions, the entire team must be present for IEP meetings.

What's in It

The IEP sets learning goals and describes the services the school will provide. It's a written document.

There is no standard 504 plan. Unlike an IEP, a 504 plan doesn't have to be a written document.

A 504 plan generally includes the following:

Specific accommodations, supports, or services for the child

Names of who will provide each service

Name of the person responsible for ensuring the plan is implemented

Here are some of the most important things the IEP must include:

The child's present levels of academic and functional performance-how the child is currently doing in school

Annual education goals for the child and how the school will track progress

The services the child will get-this may include special education, related, supplementary, and extended school year services

The timing of services-when they start, how often they occur, and how long they last

Any accommodations-changes to the child's learning environment

Any modifications-changes to what the child is expected to learn or know

How the child will participate in standardized tests

How the child will be included in general education classes and school activities

Notice

When the school wants to change a child's services or placement, it has to tell families in writing before the change. This is called prior written notice. Notice is also required for any IEP meetings and evaluations.

The school must notify families about an evaluation or a "significant change" in placement. Notice doesn't have to be in writing, but most schools do so anyway.

Families also have "stay put" rights to keep services in place while there's a disagreement about the IEP.

Consent

A parent or caregiver must consent in writing for the school to evaluate a child. They must also consent in writing before the school can provide the services in an IEP.

A parent or caregiver's consent is required for the school district to evaluate a child.

How Often It's Reviewed and Revised

The IEP team must review the IEP at least once a year.

The rules vary by state. Generally, a 504 plan is reviewed each year and a reevaluation is done every three years or when needed.

The child must be reevaluated every three years to determine whether services are still needed.

How to Resolve Disputes

IDEA gives families several ways to resolve disputes (usually in this order):

Section 504 gives families several options for resolving disagreements with the school:

Mediation

Alternative dispute resolution

Impartial hearing

Complaint to the Office for Civil Rights (OCR)

Lawsuit

Funding/Costs

Students receive these services at no charge.

Students receive these services at no charge.

States do not receive extra funding for students with 504 plans. But the federal government can take funding away from programs (including schools) that don't meet their legal duty to serve kids with disabilities.

IDEA funds can't be used to serve students with 504 plans.

States receive additional funding for students with IEPs.

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IEP vs. 504 Plan: What's the Difference?

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Basic Description A blueprint or plan for a child's special education experience at school. A blueprint or plan for how the school will provide support and remove barriers for a student with a disability. What It Does Provides individualized special education and related services to meet a child's unique needs.

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Make Learning Accessible for All Students: Accommodation, Modification, and Intervention

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Make Learning Accessible for All Students: Accommodation, Modification, and Intervention

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School is underway and you are probably busy once again! You juggle a hectic school schedule along with family activities while trying to maintain some semblance of sanity. To assist you, we have some clarification and ideas to help with your teaching. In this post, we'll be identifying several critical terms that all educators should know. We will also share a few ideas and strategies to help you with them. Additionally, just to make the reading more fun, we have a quiz for you down below to check how well you know the difference between accommodations, modifications, and interventions. You may also have some ideas that we didn't include, so please scroll down to the comment section and share them with our audience!

Accommodation

An accommodation is a change in the environment, curriculum format, or equipment. Students use accommodation to gain access to the content and to complete the work or meet expectations. Though the format of the curriculum might be altered, the curriculum or content itself is not. As a result, the work expectation and skill acquisition of the student with the accommodation is the same as other students who do not have accommodation. In essence, the adaptation lies in how the information is presented, how the student demonstrates mastery, the learning environment, expectations regarding time, scheduling, or utilizing strategies to assist with organization.

Here are a few examples of common accommodations:

Respond orally instead of writing the response on paper (response accommodation)

Use large-text print version of text (presentation accommodation)

Have instructions read aloud (presentation accommodation)

Allow the student to sit where he/she feels they learn best (setting accommodation)

Extended time for task or testing (time accommodation)

Take a test over several shorter periods and possibly over several days (scheduling accommodation)

Use a timer to help with time management (organization accommodation)

Take the test in a small group setting (setting accommodation)

Use a calculator, dictionary, or word processor (response accommodation)

Get an outline of a lesson (presentation accommodation)

Modification

On the other hand, modifications do not address how the student learns, but what the student learns. In this case, modifications to the curriculum or assignments are in place so that the student is not expected to learn the same material. For example, students who are not able to understand all of the content or concepts being taught should have modifications. As a result, assessments may cover less material or have fewer questions. The student is still expected to learn and demonstrate mastery, but the content is changed according to the plan designed for that particular child. In addition, the child can have curriculum modifications, assignment modifications, or both.

Here are a few examples of common modifications:

Different questions on a text are given to a student (assignment modification).

Different/alternative projects are assigned (assignment modification).

A different grading scale is used to assess the student (curriculum modification).

The student learns different content than other students, possibly from another grade level (curriculum modification).

Accommodations are for ALL students. Modifications are only for those with an Individualized Education Program.

Intervention

An intervention is a strategy that is implemented for a student to learn a new skill or concept that he may be struggling with. The purpose of the intervention is for the student to master the expected skill or concept taught to the class. As a result, interventions help students make progress towards the expectations or standards. They utilize assessment, planning, and monitoring of student progress.

Some interventions may include:

A student is provided time/access to a state-approved reading fluency program to improve decoding skills.

One student attends an afterschool (or Saturday) session to learn helpful math strategies for solving division problems.

A student participates in a small group for 30 minutes, twice a week, to improve reading comprehension skills

Particular students receive instruction in study skills so they can better learn the content and master academic goals.

Scenarios and a Quiz

Below are several scenarios. After reading each one, decide if it is detailing an accommodation, modification, or intervention. Last but not least, check your answer! If you're on a laptop or desktop, hover your mouse over the top left corner of the "?" icon to the left of each scenario to see the answer.

Mrs. Miller is a fourth grade reading teacher. They are starting to read "Wonder"by R. J. Palacio. To help one particular student, Jackson, Mrs. Miller has allowed him to listen to the book on tape instead of reading the book like his peers.

Mr. Moore seems to be the favorite teacher of all his tenth grade students. He enjoys teaching chemistry and makes learning fun. He has three students in fifth period that get a shortened version of the test for each chapter. Instead of 25 questions like all the other students recieve, these few students have only ten questions.

Ms. Williams teaches eighth grade science. They are about to do a unit on light and sound waves and how they interact with different materials. Each year, her students say this is their favorite unit. She anticipates that even Irene, who has a different grading scale than her peers, will enjoy this unit.

Professor Jones teaches at the community college. He also teaches a dual credit class for the local high school. Fortunately, he is a master at teaching accounting to both college and high school students. Last week, he noticed that some of his students struggled when applying auditing concepts to evaluate the conformity of financial statements. He was able to pull those students aside and review Auditing Standard No. 15 with them. This was a standard they should have learned about in a prerequisite course.

Dr. Taylor is the principal at Crockett Junior High. As she was doing a walkthrough, she noticed that one of the students wasn't able to finish an assignment within the class period. Dr. Taylor noted that the student had the same assignment as the other students. She suggested that the teacher provide extra time for the student to finish the assignment.

Suggest Helpful Accommodations, Modifications, and Interventions

What are some accommodations, modifications, and interventions that you have found helpful with your students? We would love for you to share with us, but be sure to use a fake name for your student(s). Also, if you have a great website to share that lists strategies and ways to accommodate, modify, and intervene, our readers would appreciate you sharing it. Just jump to the comment section below and pay it forward.

Find other TechNotes posts on accommodation, modification, and intervention here.
Header image attribution: People photo created by lookstudio - www.freepik.com

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Make Learning Accessible for All Students: Accommodation, Modification, and Intervention

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School is underway and you are probably busy once again! You juggle a hectic school schedule along with family activities while trying to maintain some semblance of sanity. To assist you, we have some clarification and ideas to help with your teaching. In this post, we'll be identifying several critical terms that all educators should know.

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Children with OCD have intrusive thoughts and worries that make them extremely anxious, and they develop rituals they feel compelled to perform to keep those anxieties at bay. This guide explains the often confusing behaviors that can be associated with OCD, and the treatments most effective for hel…

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Overview:

Oppositional defiant disorder (ODD) is a behavior disorder that puts children persistently at odds with authority figures. Children with ODD are temperamental, disobedient, spiteful, or vindictive to a highly unusual degree. The disorder significantly undermines the child's ability to get along with family, peers, and other adults.

Symptoms:

Unusually quick to lose his temper

Ignores or rebels against rules, at home or at school

Quick to blame others for mistakes or misbehavior

Prone to annoy others and be easily annoyed himself

Disruptive behavior appears to be intentional rather than impulsive

Refuses to cooperate reflexively-even before he knows what is being asked

Treatment:

ODD is usually treated with a type of behavioral therapy that includes parents, or a combination of behavioral intervention and medication. Treatment like Parent-Child Interaction Therapy is designed to increase positive parent-child interactions and teach the parent limit-setting skills that enable children to control disruptive behaviors and increase desired behaviors.

Medicines are not specifically indicated for ODD, but may be administered for co-occurring conditions such as ADHD, or to help the child get the most out of therapy sessions.
Learn more about oppositional defiant disorder.

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Quick Facts on Oppositional Defiant Disorder

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Overview: Oppositional defiant disorder (ODD) is a behavior disorder that puts children persistently at odds with authority figures. Children with ODD are temperamental, disobedient, spiteful, or vindictive to a highly unusual degree. The disorder significantly undermines the child's ability to get along with family, peers, and other adults.

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The School Counselor and Student Mental Health

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The School Counselor and Student Mental Health

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The School Counselor and Student Mental Health

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Students' unmet mental health needs can be a significant obstacle to student academic, career and social/emotional development and even compromise school safety. Even so, most students in need do not receive adequate mental health supports (Centers for Disease Control and Prevention [CDC], 2013).

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The Texas Model for Comprehensive School Counseling Programs

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The Texas Model for Comprehensive School Counseling Programs

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ASCA Ethical Standards for School  Counselors

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ASCA Ethical Standards for School  Counselors

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ASCA Ethical Standards for School Counselors

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DISRUPTIVE BEHAVIOR DISORDERS: OPPOSITIONAL DEFIANT DISORDER (ODD) AND CONDUCT DISORDER (CD) FACT SHEET 

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DISRUPTIVE BEHAVIOR DISORDERS: OPPOSITIONAL DEFIANT DISORDER (ODD) AND CONDUCT DISORDER (CD) FACT SHEET 

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The School Counselor’s Role in Addressing Eating Disorder Symptomatology Among Adolescents

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The School Counselor’s Role in Addressing Eating Disorder Symptomatology Among Adolescents

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If you have a loved one who is suffering from an eating disorder, life as you knew it has been turned on its head. Eating disorders impact entire families. Every member is bound to struggle with this new reality and how they fit into it.

You will have many questons and moments when you are unsure how you can help your loved one. These guidelines are designed to help you navigate those difficult times so that you can provide support as well as implement the self-care you will need in the days, weeks and months ahead.

There are no quick, easy answers.
If one is to recover, one will need to make some changes in perceptions and behaviors. Other family members may need to make changes too. We encourage, you to take advantage of professional help to make these transitions easier.

Allow yourself to not know all of the answers about how to help.
You are no less of a father, mother, sibling, or partner - you are human. There are individuals, groups, books and other resources to help you gain understanding of eating disorders.

Do all you can to help your loved one get into therapy.
Be supportive and give empathy to your loved one, and firmly insist he or she enter therapy with the goal of healing a very severe illness. If your loved one is over 18 and refuses therapy, consider working with a therapist yourself, with the goal of increasing understanding to continue to support your loved one until he/she is ready for help. A therapist will also help you set healthy boundaries for yourself and also bring insight into how to not enable your loved one to use ED behaviors.

Avoid getting involved in discussions or arguments over weight, food or eating.
If you become concerned about dehydration, weight loss or other issues, call your family therapist, if you have one, or request a session with your loved one and his or her therapist and voice your concerns there.

Understand and acknowledge certain behaviors.
If your loved one is food shopping or cooking for the family, realize he or she might be using this nurturing role to deny his or her own needs for food and kindness. Become active in showing your care.

Learn to take care of yourself!
Do not become a martyr or let yourself or family revolve around the eating disorder. Do not neglect fun, other family members, friends or personal goals due to this problem.

Help build a sense of competence and responsibility.
Allow him or her to take responsibility for the reality of their words, actions, decisions and behaviors.

Increase physical and verbal expression of love in the family.
Be honest about feeling angry, frustrated and powerless. By sharing feelings, all family members grow closer, even though people will feel and think differently about what is happening.

Check to make sure you are hearing each other accurately when discussing subjects and feelings.
Share your concerns with each other and with others in your life, as appropriate. Keeping secrets does not help the situation.

Practice good sense - do not go on diets.
Take an honest look at reasons for dieting and exercise. Are you giving his or her appearance priority his or her health? Are these activities primarily for weight loss? It is hard for the individual dealing with an eating disorder to try to change thoughts about weight loss and the importance of appearance when significant others are reinforcing the importance of weight loss and thinness.

Recognize your loved one for qualities/achievements independent of their appearance.
Sharing what you appreciate about your loved one can support their development of a sense of self that is secure, unique and less subject to changing fads and fashions.

Avoid power struggles over gaining weight or stopping binging or purging.
The eating disorder will always win. Try calling a "cease-fire" and substitute time together in shared activities. Take time to "play" together. This will improve feelings on both sides of the battle and help you develop new ways to relate, rather than relating around food issues.

Do not try to manipulate the eating disordered person.
Avoid statements like, "you are ruining the family" or "just give this up for me." The eating disordered individual is not responsible for your welfare; you are. Each person is responsible for his or her own happiness.

Let your loved one know that you are available for emotional social support.
If you have difficulty doing this, you may want to seek help for yourself in order to learn new ways to develop intimacy with family members. We often reproduce in our relationships with others what we ourselves learned in childhood.

Do not ask, "Are you better?"
This is a loaded question and suggests the eating disordered individual should hurry and get well so everyone would feel better. Judge progress by, "Is he or she more aware of feelings?" - "Is he or she thinking and behaving more realistically?" - And, "Is he or she less critical of himself or herself?" Eating is only a symptom of the underlying concerns.

Realize at best your loved one is probably ambivalent to give up his or her perceived "safe and secure" rituals of disordered eating.
These serve a coping mechanism and it will take time to develop new, trusted patterns.

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Family Support Guidelines When Your Loved One Has an Eating Disorder

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If you have a loved one who is suffering from an eating disorder, life as you knew it has been turned on its head. Eating disorders impact entire families. Every member is bound to struggle with this new reality and how they fit into it.

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Addressing Anxiety in School Settings: Information for Counselors 

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Addressing Anxiety in School Settings: Information for Counselors 

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Credit: Julius-Maximilians-Universität Würzburg, JMU

An overactive molecular signal pathway in the brain region of the amygdala can lead to obsessive-compulsive disorder (OCD). A research team from Würzburg has established this connection.

Some people have an extreme fear of dirt or bacteria. As a result, they may develop a habit of compulsive washing and repeatedly cleaning their hands or body. They are trapped in a vicious circle, as the fear of new contamination returns quickly after washing. Sufferers see no way out. They are even incapable of changing their behaviour when the excessive washing has led to skin irritation or damage.

Around two percent of the general population suffer from some kind of obsessive-compulsive disorder (OCD) at least once in their life. The disorder is characterised by persistent intrusive thoughts which the sufferers try to compensate for by repetitive ritualized behaviour.

Like depression, eating disorders and other mental diseases, OCD is treated with antidepressants. However, the drugs are non-specific, that is they are not tailored to the respective disease. Therefore, scientists have been looking for new and better targeted therapies that have fewer side effects.
Missing protein triggers urge to wash
Professor Kai Schuh from the Institute of Physiology at the Julius-Maximilians-Universität (JMU) Würzburg (Germany) and his team explore the underlying causes of obsessive-compulsive disorder in collaboration with the JMU's Departments of Psychiatry and Neurology.

"We were able to show in mouse models that the absence of the protein SPRED2 alone can trigger an excessive grooming behaviour," Schuh says. He believes that this finding is crucial as no clear trigger for this type of disorder has been identified until now. Previous research pointed to multiple factors being responsible for developing OCD.

Occurring in all cells of the body, the protein SPRED2 is found in particularly high concentrations in regions of the brain, namely in the basal ganglia and the amygdala. Normally, the protein inhibits an important signal pathway of the cell, the so-called Ras/ERK-MAP kinase cascade. When it is missing, this signal pathway is more active than usual.
Hyperactive signal cascade in the brain
"It is primarily the brain-specific initiator of the signal pathway, the receptor tyrosine kinase TrkB, that is excessively active and causes the overshooting reaction of the downstream components", biologist Dr. Melanie Ullrich explains.

Administering an inhibitor to attenuate the overactive signal cascade in the animal model improves the obsessive-compulsive symptoms. Moreover, the JMU research team was able to treat the OCD with an antidepressant, similarly to standard therapy in humans. Their detailed results have been published in the journal Molecular Psychiatry.
New targets for therapies pinpointed
"Our study delivers a valuable new model that allows the disease mechanisms to be investigated and new therapy options for obsessive-compulsive disorders to be tested," Professor Schuh says.

The recently discovered link between OCDs and the Ras/ERK-MAP kinase cascade also opens up new targets for therapy. Drugs that inhibit this cascade are already available and some of them are approved for human treatment.

According to Melanie Ullrich, these are cancer drugs, as overactivation of the Ras/ERK-MAP kinase cascade is also a frequent trigger of cancer: "So we are wondering whether such drugs could also be effective in the treatment of obsessive-compulsive disorders and whether they are beneficial in terms of side effects."

More information: M Ullrich et al. OCD-like behavior is caused by dysfunction of thalamo-amygdala circuits and upregulated TrkB/ERK-MAPK signaling as a result of SPRED2 deficiency, Molecular Psychiatry (2017). DOI: 10.1038/mp.2016.232

Provided by Julius-Maximilians-Universität Würzburg

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An overactive molecular signal pathway in the brain region of the amygdala can lead to obsessive-compulsive disorder (OCD). A research team from Würzburg has established this connection. Some people have an extreme fear of dirt or bacteria. As a result, they may develop a habit of compulsive washing and repeatedly cleaning their hands or body.

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What is bulimia nervosa?

Bulimia nervosa is an eating disorder in which a child has periods of out-of-control eating called binging. After eating way too much, the child tries to reverse the binging by doing what's called purging: throwing up on purpose, using laxatives, not eating, or exercising too much. Unlike kids with anorexia nervosa (who are usually extremely thin), kids with bulimia are usually normal weight or somewhat overweight. But the way they maintain their weight is very unhealthy. Bulimia is diagnosed more often in girls than boys and it usually starts in adolescence.

What are the symptoms of bulimia nervosa?

Children with bulimia often hide their binging and purging, so it can be hard to spot.

Common signs of bulimia include:

Eating a lot of food in a very short time

Making up for eating a lot by vomiting, using laxatives, not eating at all, or exercising too much

Having a self-image that is mostly focused on body weight

Missing a lot of meals

Rushing to the bathroom right after eating

Long periods of not eating

Being secretive about eating

Physical effects of vomiting, including sore throat, swollen glands, acid reflux, and teeth damaged by stomach acid

How is bulimia diagnosed?

To be diagnosed with bulimia, a child must eat large amounts of food in a short amount of time (binging) and be unable to control their binge eating. They must also try to make up for the binge eating by throwing up on purpose, using laxatives, not eating, or exercising too much. These behaviors are known as purging. Kids who are diagnosed with bulimia binge and purge at least once a week on average for three months.

The first goal of treatment for bulimia is always to help the child stop binging and purging, which can endanger their health. Two kinds of therapy are most commonly used to treat bulimia nervosa:

Cognitive behavioral therapy (CBT) can help kids understand what causes their binging and purging, develop a more positive body image, and change unhealthy eating habits.

Interpersonal therapy focuses on how the child's relationship with others affects their feelings and eating habits.

If therapy alone isn't working, anti-depressant medications are sometimes prescribed to children experiencing bulimia. Education about nutrition can also help kids learn about the health effects of bulimia and feel motivated to change their behavior.

We have over 60 guides and 700 articles available to help you (in Spanish too!).
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Quick Guide to Bulimia Nervosa - Child Mind Institute

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Download our free guide to bulimia nervosa in children and teenagers. Kids with bulimia nervosa have periods of out-of-control eating called binging. After eating way too much, they try to reverse the binging by throwing up, using laxatives, not eating, or exercising too much.

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Diagnosing Psychotic Disorders: Mood and Psychosis

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Diagnosing Psychotic Disorders: Mood and Psychosis

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Individuals with Disabilities Education Act

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Individuals with Disabilities Education Act (IDEA)

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The U.S. Department of Education’s Individuals with Disabilities Education Act website brings together department and grantee IDEA information and resources. The IDEA makes available a free appropriate public education to and ensures special education and related services to eligible children with disabilities.