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National Institute of Mental Health (NIMH)

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Generalized Anxiety Disorder: When Worry Gets Out of Control

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Information about generalized anxiety disorder including common signs and symptoms, treatment options, and how to find help.

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Definition

Students with emotional disorders are a very heterogeneous group with a wide range of issues that are unique to each individual. However, there are some key characteristics that are used to define this disability category, mostly relating to issues of personal identity and emotional well-being. An emotional disorder may be present if a student responds to a situation with an inappropriate behavior or emotion, and particularly, if this emotion is depression or long term unhappiness. Students with emotional disorders typically have a very difficult time maintaining personal relationships with others, and these personal problems lead to physical symptoms in time. If the student has difficulty learning, but there is no intellectual or sensory cause of this difficulty, then an emotional disorder may be to blame. This disability category does include some mental illnesses such as schizophrenia.

It should be noted that one or more of the previously mentioned characteristics has to be present for an extended period of time, and must have a negative impact on the student's academic performance before being considered an emotional disorder. Signs of an emotional disorder need to be taken seriously, as they can lead to physical aggression and self-injurious behavior. However, care must also be taken to recognize the difference between emotional disturbance and general teenage angst. There are as many causes of emotional disturbance in children as there are children in this category, but they can generally be divided into either biological causes, environmental causes, or a combination of the two.

Prevalence

The U.S. Department of Education reports 5,971,495 students receiving special education services in the 2003-2004 school year. Of that number, roughly 7.7%, or 461,055 students, received special education services based on a classification of emotional disturbance. However, within this group of 461,055 students, there was a definite disproportionally between gender, race and socioeconomic background. African-American students were far more likely to be diagnosed as emotionally disturbed than white students, reflecting possible race bias in this category. Research has pointed to a direct correlation between low income status and emotional disorders, but the exact reasons for this correlation are unknown.

Characteristics

Each student with an emotional disturbance will have characteristics that are unique to that individual. However, these students will all share deficits in three specific areas, namely emotional development, behavioral development, and cognitive development.

These students may have specific emotional characteristics/conditions such as anxiety disorder, mood disorder, oppositional defiant disorder, conduct disorder, and schizophrenia. Not addressing any one of these disorders with the appropriate support system could have potentially tragic results. Behavioral characteristics of an emotional disorder include externalizing behavior and conversely internalizing behavior. The former can result in problem behavior and physical aggression while the latter results in depression and anxiety. Finally, students with emotional disorders have a number of academic issues as well, and each year half of the students in this category drop out of school entirely.

One intriguing possible contributing factor to emotional disturbance can be found in deficits in communication. An estimated 71% of students with emotional disorders also have expressive and receptive language disorders that impact their ability to understand and communicate with peers and adults.

Impact on Learning

Students with emotional disorders can be found at every level of cognitive functioning, but the majority of these students tend to have low average intelligence. Most achieve below grade level in academic achievement, with the greatest deficits in both math and spelling. Many have a coexisting learning disability of some type. Students that exhibit externalizing behaviors are at the greatest risk for continued deficits in academic functioning. Students with emotional disorders are less likely to attend post-secondary school than students in many other disability categories. An effective educational program for students with emotional disorders will provide emotional and behavioral supports that foster the replacement of problem behaviors with more appropriate behaviors. Positive behavior support systems are one especially effective strategy to achieve this goal, as are the implementation of wraparound services.

Teaching Strategies

Wraparound planning is a collaborative process that has shown great promise in supporting students with emotional disorders, both in research and in more practical application. This planning process brings all of the involved service providers (i.e., adult rehabilitation services, mental health services, guidance counselor) and individuals together to create a natural support system that is founded on the strengths of the individual student and the community in which that student lives. The family is an integral part of this process, and the overall goal is to devise a program that will capitalize on the strengths and interests of the student while utilizing community resources for placement and intervention.

Generally, academic achievement and problem behaviors often go hand-in-hand for students with emotional disorders. To put this another way, the more difficulty they have with a classroom task, the more likely that maladaptive behavior will result. Supporting the academic performance of these students will thus have the added benefit of decreasing externalizing and internalizing behaviors. Best practices for students with emotional disorders are often best practices for all students. A strategy such as allowing students to choose between classroom tasks, for example, is an effective way to decrease problem behaviors in general. Consistent and specific praise is also a great technique to utilize with all students in the classroom, but can be particularly effective with students with emotional disorders.

It is very important to not make assumptions about any family of a child with an emotional disorder. Many emotional disorders have an organic cause, and the parents of the child may well be loving and supportive in every way. However, some of these students have indeed been abused in some fashion in their young lives, and this too can be a cause of emotional or behavioral issues. Trust can be a very large issue for these children. Forming a relationship with these students that is built on empathy, trust, and mutual respect can often be the solution to many problem behaviors, and can have a lasting impact of the emotional development of the child.

Assistive Technology

Some modification in instruction will be necessary to allow a student with an emotional disorder to demonstrate mastery in a number of academic areas, and most especially in the area of writing. Word processing software can be an excellent supplementary aid for these students, allowing them to edit and revise their work as they produce it. These programs can strengthen spelling skills and writing cohesion simply by making the writing process easier overall. Of particular benefit are word processing programs that read the text as it is typed, providing an additional audio cue for the student.

Organizations

There are a number of excellent organizations that can help support classroom instruction for students with emotional and behavioral disabilities. The information presented in this module is intended as just a very brief description of emotional disorder and its impact on learning. Much more in-depth information and instructional strategies can be accessed through the following organizations:

American Academy of Child and Adolescent Psychiatry

The AACAP (American Academy of Child and Adolescent Psychiatry) is the leading national professional medical association dedicated to treating and improving the quality of life for children, adolescents, and families affected by these disorders. Composed of over 7,500 child and adolescent psychiatrists and other interested physicians, its members actively research, evaluate, diagnose, and treat psychiatric disorders and pride themselves on giving direction to and responding quickly to new developments in addressing the health care needs of children and their families.

Public Information Office
3615 Wisconsin Ave., NW
Washington, DC 20016-3007

Web: www.aacap.org

Center on Positive Behavioral Interventions and Supports

The OSEP-funded National Technical Assistance Center on Positive Behavior and Intervention Supports was established to address the behavioral and discipline systems needed for successful learning and social development of students. The Center provides capacity-building information and technical support about behavioral systems to assist states and districts in the design of effective schools.

5262 University of Oregon
Eugene, OR 97403-5262

Email: pbis@oregon.uregon.edu
Web: www.pbis.org

Center for Disability and Development

Dept. of Educational Psychology
4225 Texas A&M University
College Station, TX 77843-4225

Council for Exceptional Children

The Council for Exceptional Children (CEC) is the largest international professional organization dedicated to improving educational outcomes for individuals with exceptionalities, students with disabilities, and/or the gifted. CEC advocates for appropriate governmental policies, sets professional standards, provides continual professional development, advocates for newly and historically underserved individuals with exceptionalities, and helps professionals obtain conditions and resources necessary for effective professional practice.

1110 North Glebe Road, Suite 300
Arlington, VA 22201-5704

Federation of Families for Children's Mental Health

This organization is dedicated exclusively to helping children with mental health needs and their families achieve a better quality of life. They provide leadership to develop and sustain a nationwide network of family-run organizations; focus the passion and cultural diversity of our membership to be a potent force for changing how systems respond to children with mental health needs and their families; help policy-makers, agencies, and providers become more effective in delivering services and supports that foster healthy emotional development for all children.

1101 King Street, Suite 420
Alexandria, VA 22314

Email: ffcmh@ffcmh.org
Web: www.ffcmh.org

National Alliance for the Mentally Ill (NAMI)

NAMI is the National Alliance on Mental Illness, the nation's largest grassroots organization for people with mental illness and their families. NAMI is dedicated to the eradication of mental illnesses and to the improvement of the quality of life for persons of all ages who are affected by mental illnesses. NAMI members and friends work to fulfill our mission by providing support, education, and advocacy.

Colonial Place Three
2107 Wilson Boulevard, Suite 300
Arlington, VA 22203-3754

Web: www.nami.org

Mental Health America

Mental Health America is dedicated to helping ALL people live mentally healthier lives. They work to fulfill this mission by education the public about ways to preserve and strengthen mental health; advocating for access to effective care; fostering innovation in research, practice, services and policy; and providing support to individuals and families.

2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311

Web: www.nmha.org

National Mental Health Information Center

The National Mental Health Information Center was developed for users of mental health services and their families, the general public, policy makers, providers, and the media. They provide free information about mental health via a toll-free number, their website, and more than 600 publications.

P.O. Box 42557
Washington, DC 20015

Web: www.mentalhealth.org

References

Hunt, N., and Marshall, K. (2006). Exceptional children and youth. Boston, MA: Houghton Mifflin Company.

National Dissemination Center for Children with Disabilities (2004). Fact Sheet 5. Retrieved February 1, 2008 from www.nichcy.org/pubs/factshe/fs5txt.htm.

Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives. Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

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Students with emotional disorders typically have a hard time maintaining relationships, and these personal problems may lead to physical symptoms in time.

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Teaching Students with Emotional Disturbances

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Teaching Students with Emotional Disturbances

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Teaching Students with Emotional Disturbances_ 8 Tips for Teachers

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Eating Issues and Body Image in Elementary School- Detection and Prevention Strategies for School Counselors 

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares.

Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry. These are called obsessions. To alleviate the anxiety caused by their obsessive thoughts, they perform repetitive, ritualized actions called compulsions. A child with OCD might need to line things up, touch things in a certain order when leaving the room or wash his hands repeatedly.

Obsessions Common in Kids With OCD

Contamination: Kids with this obsession are sometimes called "germaphobes." In schools, this plays out with kids worrying about other kids sneezing and coughing, touching things that might be dirty or getting sick in many different ways. This is the most common obsession seen in children.

Magical thinking: This is a kind of superstition, like "step on a crack, break your mother's back," taken to extremes. For example, kids might worry that their thoughts can cause someone to get hurt, or get sick. A child might think, "Unless my things are lined up in a certain way, mom will get in a car accident."

Catastrophizing: Some kids easily jump to the conclusion that something terrible has happened. For example, if her parents are five minutes late picking her up, a girl who is catastrophizing might tell herself that they've decided to abandon her.

Scrupulosity: This is when kids have obsessive worries about offending God or being blasphemous in some way.

What ifs: Kids may be plagued by a lot of different kinds of thoughts about bad things they could do. "What if I hurt someone? What if I stab someone? What if I kill someone?"

The "just right feeling": When OCD first develops, from about 6 to 9 years of age, kids may not know why they are doing something, but just that they need to do it until they get what we call the "just right feeling." So: "I'll line these things up until it just kind of feels right, and then I'll stop." And then over time - in the 9- to 12-year-old range - it evolves into magical thinking and becomes more superstitious in nature.

Behaviors You Might See in Students With OCD

Frequent requests to go to the bathroom: This could be to wash hands, if someone near the child was coughing or sneezing, or if she touched something that she perceives as contaminated. She could be washing items-pens, pencils, backpacks, books. It could also be an excuse to get out the classroom and just be away from everyone, and have some respite.

Constant reassurance-seeking: This takes the form of repetitive questions. "Are you sure that's the answer? Could you tell me again? Did you hear what I said?" Checking doors, windows, lockers, desks. Over and over and over again.

Getting stuck on tasks: Sometimes kids with OCD will need to finish something to completion, or understand it to completion, before they're able to move on. So if a child is working out what he did wrong on a math test, and the teacher says, "Now let's open the textbook and start a new chapter," he's not going to be able to shift gears.

Retracing: If a child leaves the classroom and worries that she left a pencil behind, she'll go back into the classroom and go to her desk and check. If she had a bad thought as she went through the doorway, she might have to "fix it" by going back through the doorway again saying a good word. If she had a bad thought when she went down a flight of stairs on the way to class, she might need to go back up that same stairway at the end of the period, even if it means being late to her next class.

Obsessive erasing: A child could be erasing a lot because the letters have to look perfect. Or he could have used a word that disturbs him. For example, if he has a fear of vomiting and he's written the word vomit, he might not be able to stand seeing that word, so he erases it. Kids start having erasers worn down to the metal. Teachers start to see holes in the paper. Words will be drawn over on the back of the page. A lot of different areas of writing become problematic.

Behaviors Often Confused With Another Disorder

Some behaviors associated with OCD are easy to confuse with ADHD, learning problems or being oppositional.

Distraction: If a child is busy thinking that if she doesn't turn the pen cap and count to four the right way then her mom is going to get sick, she's not going to be paying attention in class. And if her teacher calls on her to answer a question, her distraction might look like ADHD, but it isn't.

Slowness on exams, papers and tasks: Sometimes when kids take a long time, they're struggling with the perfectionism of needing to do things the right way. This could look like learning problems, or inattention, but it isn't.

Avoidance: Teachers might see a child who doesn't want to sit on the floor, or pick things up that touched the floor, or get his hands dirty in art class. He may avoid a lot of playground activities - kids with germ fears will view the playground the way some adults view the subway: it's gross. Why touch anything there?

Tapping and touching symmetrically: If a child sits down at her desk and she accidentally kicks the chair of the kid next to her with her right foot, she's going to have to then kick it with her left foot. That might look like somebody who's being oppositional, or somebody who's got too much energy, but actually it's OCD.

Complaints of anxiety and fatigue: There's one interesting theory that kids with OCD are smarter than other kids. And if you consider how much thinking they're doing, they're really using their brain more frequently than a lot of other kids are. But when that's coupled with a lot of anxiety, you can have a lot of fatigue. So it's common for kids with OCD to want to come home and take a nap after school.

How to Help Students With OCD

For children struggling with OCD, functioning in school can be complicated and very difficult. Here are some things you can do to help them, and the class as a whole, focus on learning:

Seating arrangement: If the school has noisy hallways, you might not want to have a child with OCD sit by the door. You might have her sit in the front, where she's less able to hear the noise and can stay more focused on her work. On the other hand, a child who has very observable symptoms, and doesn't want other kids to see her fidgeting with her hands, rocking or getting up a lot, might be better off closer to the door, toward the back of the room.

Extended time for tests and papers: If writing is a problem for a child who needs to find the perfect way to say something, he's going to need more time to finish those essay questions or papers.

Laptops for writing: If writing and rewriting/erasing is really problematic for a child, consider letting her use a laptop for taking notes, and having all assignments be typed instead of handwritten.

Private testing rooms: Research is quite clear that kids with OCD do better, are less overwhelmed and are more in control of their thoughts and their reactions if they're in a quiet place away from the other kids.

Skip reading out loud: Kids who feel they need to read perfectly may have to go back and reread sentences or whole paragraphs over and over to make sure they've got them right. So reading becomes a very laborious task, and reading in front of the class can become a nightmare. So if we know doing this is a problem for children, we can spare them.

Books on tape: If kids get so hung up reading that it takes forever, listening to the books can be a solution.

Break homework into chunks: If looking at a whole page of math makes kids feel overwhelmed and anxious - think of the potential for mistakes! - the problems can be broken up over four pages. It helps kids stay focused on doing the problems instead of worrying.

How to Minimize Behavioral Problems

Plan an escape route: Try working out a communication system so that if the student feels symptoms coming on, she can signal to you and leave the classroom, or go to a protected place in the classroom, without interrupting the class. It can prevent an embarrassing and disruptive blowup of symptoms in the classroom, and the other kids picking on or bullying her about it.

Be aware of triggering events: It's very important for teachers to know what kind of things might trigger the symptoms. Fatigue is a huge piece of OCD, and it can be exacerbated by medication. So it's important to know that if a child is drowsy in class, and maybe he's putting his head down, it's not because he's being oppositional or disrespectful, but because he's overwhelmed with fatigue.

Advance notice: Irritability and frustration are two of the longer-lasting things that kids with OCD are feeling on a daily basis. Changes in schedule can be very disruptive for a child with OCD, so it can be helpful for teachers to give advance notice of things. Kids who know what to expect are less likely to be thrown by the change.

Children with OCD are often teased and bullied because of their symptoms. Kids feel very uncomfortable about their rituals, knowing that they're being watched. It can be helpful to educate the whole class about what's going on, especially if a child is going to be in the same school for a number of years, and it can inspire a surprising amount of support from other children.

Peer understanding program: A peer understanding program includes a presentation in the classroom that explains (with the child participating) what OCD is. The child might say, "Listen, I have OCD. It's an anxiety disorder. It makes me think that my hands are dirty and I have to wash my hands a lot, so if you see me getting up and going to the sink to wash my hands, that's why." Psychologists can role-play with the teacher and child ahead of time, to anticipate questions his classmates might ask, and how to answer them.

A buddy system: A buddy is like a peer coach who sits next to the child and prompts him to keep up with note taking and staying on task. It can be great for the buddy, to foster a sense of confidence and pride and to be able to help someone in need, and great for fostering friendship.

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares. Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry.

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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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ADDA - Attention Deficit Disorder Association

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Written by Michelle Frank, Psy.D., as adapted and updated from Peter Jaska's article, "ADHD Facts" originally posted on the ADDA website in 1998

REFERENCES:

Auerbach, J.G., Atzaba-Poria, N., Berger, A., Landau, R., Arbelle, S., Raz, Y., & Ebstein, R. (2010). Dopamine risk and paternal ADHD symptomatology associated with ADHD symptoms in four and a half-year-old boys. Psychiatric Genetics, 20(4), 160-165. doi: 10.1097/YPG.0b013e32833a1f27.

Barkley, R., Murphy, K.R., & Fischer, M. (2008). ADHD in adults: What the science says. The Guildford Press: New York, NY.

Castellanos, X. (2002). Anatomic magnetic resonance imaging studies of Attention Deficit Hyperactivity Disorder.Dialogues in Clinical Neuroscience, 4(4), 444-448.

Castellanos, X., Lee, P., Sharp, W., Jeffries, N., Greenstein, D. Clasen, L., Blumenthall, J., . . . Rapoport, J. (2002). Developmental trajectories of brain volume abnormalities in children and adolescents with Attention Deficit/Hyperactivity Disorder. JAMA, 288(14), 1740-1748. doi:10.1001/jama.288.14.1740.

Cho, S., Son, J., Kim, B., Kim, J., Yoo, H., Hwang, J., Cho, D., Chung, U., & Park, T. (2012). Serotonin 2A receptor gene polymorphism in Korean children with Attention-Deficit/Hyperactivity Disorder. Psychiatry Investigations, 9(3), 269-277. doi:10.4306/pi.2012.9.3.269

Kessler, R., Adler, L., Barkley, R., Biederman, J., Conners, C., Demier, O., Faraone, S., . . . Zaslavsky, A. (2006). The prevalence and correclates of adult ADHD in the United States: results from the National Comorbidity Survey replication. The American Journal of Pyschiatry, 163(4), 716-723.

Faraone, S. (2007). What is the prevalence of adult ADHD? Results of a population screen of 966 adults. Journal of Attention Disorders, 9(2), 384-391. doi: 10.1177/1087054705281478

Gizer, I.R., Waldman, I.D., Abramowitz, A., Barr, C.L., Feng, Y., Wigg, K.G., Misener, V.L., & Rowe, D.C. (2008). Relations between multi-informant assessments of ADHD symptoms, DAT1, and DRD4. Abnormal Psychology, 117(4), 869-880. doi: 10.1037/a0013297.

Henrigquez, B.H., Henriquez, H.M., Carrasco, C.X, Rothhammer, A.P., Llop, R.E., Aboitiz, F., & Rothhammer, E.F. (2008) Combination of DRD4 and DAT1 genotypes is an important risk factor for attention deficit disorder with hyperactivity families living in Santiago, Chile. Revista Medica de Chile, 136(6), 719-724. doi: /S0034-98872008000600005.

Lee, S.S., Humphreys, K.L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood Attention Defict/Hyperactivity Disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review. Clinical Psychology Review, 31(3), 328-341. Doi: 10.1016/j.cpr.2011.01.006

McCarthy, H., Skokauskas, N., Mulligan, A., Donohoe, G., Mullins, D., Kelly, J., Johnson, K., . . . Frodi, T. (2013). Attention network hypoconnectivity with default and affective network hyperconnectivity in adults diagnosed with attention-deficit/hyperactivity disorder in childhood. JAMA Psychiatry, 70(12), 1320-1337. doi: 10.1001/jamapsychiatry.2013.2174.

Metin, B., Krebs, R.M., Wiersema, J.R., Verguts, T., Gasthuys, R., van der Meere, J.J., Achten.E., . . . Sonuga-Barke, E. (2014). Dysfunctional Modulation of Default Mode Network Activity in Attention-Deficit/Hyperactivity Disorder. Journal of Abnormal Psychology, 2014 (Oct 13) [Epub ahead of print].

Minde, K., Eakin, L., Hechtman, L., Ochs, E., Bouffard, R., Greenfield, B., & Looper, K. (2003). The psychosocial functioning of children and spouses of adults with ADHD. Jounral of Child Psychology and Psychiatry, 44(4), 627-646. doi: 10.1111/1469-7610.00150

Polanczyk, G., Silva de Lima, M., Horta, B.L. Biederman, J., & Rohde, L.A. (2007). The worldwide prevalence of ADHD: A systematic review and meta-regression analysis. The American Journal of Psychiatry, 164(6), 942-948.

Spencer, T.J., Biederman, J., & Michk, E. (2007). Attention-Deficit/Hyperactivity Disorder: Diagnosis, lifespan, comorbidities, and neurobiology. Pediatric Psychology, 32(6), 631-642. Doi: 10.1093/jpepsy/jsm005

Tomasi,D., &Vokow, N.D. (2014). Functional connectivity of substantia nigra and ventral tegmental area: maturation during adolescence and effects of ADHD. Cerebral Cortex, 24(4), 935-944. doi: 10.1093/cercor/bhs382.

Uddin, L.W., Kelly, A.M., Biswal, B.B., Margulies, D.S., Shehzad, Z., Shaw, D. Ghaffari, M., . . . Milham, M.P. (2008). Network homogeneity reveals decreased integrity of default-mode network in ADHD. Journal of Neuroscience Methods, 169(1), 249-254.

Volkow, N., Wang, G.J., Kollins, S., Wigal, T., Newcorn, J. Telang, F., Fowler, J., . . . Swanson, J. (2009). Evaluating dopamine reward pathway in ADHD: Clinical implications. JAMA, 302(10), 1084-1091. doi:10.1001/jama.2009.1308.

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Written by Michelle Frank, Psy.D., as adapted and updated from Peter Jaska's article, "ADHD Facts" originally posted on the ADDA website in 1998 REFERENCES: Auerbach, J.G., Atzaba-Poria, N., Berger, A., Landau, R., Arbelle, S., Raz, Y., & Ebstein, R. (2010). Dopamine risk and paternal ADHD symptomatology associated with ADHD symptoms in four and a half-year-old boys.

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NAMI Greater San Antonio

Nominations for Board of Directors

​

NAMI Greater San Antonio is accepting board nominations for the 2024-2026 term. You may apply for the board or submit the name of a member in good standing as of July 31. Please complete the application by filling out the application form ( submitting to the Board Nominating Committee at Click HERE) and execdir@nami-sat.org.

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Mental Health Support | NAMI San Antonio

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National Alliance on Mental Illness, Mental Health is Health, Peer and Family Support, NAMI San Antonio, Texas, United States

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Grey and Brown Modern Travel Agent Trifold Brochure  (1)

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What Is CBT?

After a lifetime of mistakes, mishaps, and missed deadlines, is it any wonder that adults with attention deficit hyperactivity disorder (ADHD or ADD) suffer dangerously low self-esteem and perpetually negative thoughts? Cognitive behavioral therapy (CBT) is a short-term, goal-oriented form of psychotherapy that aims to change these negative patterns of thinking and change the way a patient feels about her self, her abilities, and her future. Consider it brain training for ADHD.

Originally a treatment for mood disorders, CBT is based on cognitive restructuring, or the recognition that cognitions lead to emotional difficulties. Automatic thoughts are spontaneous interpretations of events. These impressions are susceptible to distortion, such as unfounded assumptions about yourself (or others), a situation, or the future. Such unhealthy internal dialogs hinder an individual from working toward an intended goal, working to develop productive new habits, or generally take calculated risks.

CBT aims to change irrational thought patterns that prevent individuals from staying on task or getting things done. For an individual with ADHD who thinks, "This has to be perfect or it's no good," or "I never do anything right," CBT challenges the truth of those cognitions. Changing distorted thoughts, and the resulting change in behavior patterns, is effective in treating anxiety, and other emotional problems.

How Does CBT Help People with ADHD?

ADHD is a chronic, persistent delay of self-regulation skills, including executive functioning skills. Delays in EFs create procrastination, disorganization, poor time management, emotional dysregulation, impulsivity, and inconsistent motivation. Although these problems are not included in the official diagnostic criteria for ADhD, they are common in adults with the condition, making it hard for them to regulate their emotions and behaviors.

Individuals who grow up with ADHD (particularly if it has gone undiagnosed) encounter more frequent and frustrating setbacks in life situations - on the job, in social interactions, and everyday organization. Because of these many setbacks, adults with ADHD become self-critical and pessimistic. This, in turn, sometimes causes them to experience negative emotions, cognitive distortions, and unhealthy self-beliefs. It is common for individuals living with ADHD to think they are at fault when situations don't turn out well, when, in many cases, they aren't. They may bring the same pessimism to the future, imagining that tomorrow will go as badly as today.
[Free Resource: Everything You Need to Know About CBT]
Demoralizing thoughts and beliefs that keep individuals from doing what they want to do actually can't stand up to the light of logic. As CBT reveals, these thought processes are distorted in certain characteristic ways:

All-or-nothing thinking. You view everything as entirely good or entirely bad: If you don't do something perfectly, you've failed.

Overgeneralization. You see a single negative event as part of a pattern: For example, you always forget to pay your bills.

Mind reading. You think you know what people think about you or something you've done - and it's bad.

Fortune telling. You predict that things will turn out badly.

Magnification and minimization. You exaggerate the significance of minor problems while trivializing your accomplishments.

"Should" statements. You focus on how things should be, leading to severe self-criticism as well as feelings of resentment toward others.

Personalization. You blame yourself for negative events and downplay the responsibility of others.

Mental filtering. You see only the negative aspects of any experience.

Emotional reasoning. You assume that your negative feelings reflect reality: Feeling bad about your job means "I'm doing badly and will probably get fired."

Comparative thinking. You measure yourself against others and feel inferior, even though the comparison may be unrealistic.

Learning to recognize these distorted thoughts helps you to replace them with realistic thinking.

"Understanding how you think is an effective start to making changes in your life," says J. Russell Ramsay, Ph.D., assistant professor of psychology at the University of Pennsylvania. "Changing thoughts and changing behavior work hand in hand. Widening your view of a situation makes it possible to expand the ways you can deal with it."

How Has CBT for ADHD Changed?

Since 1999, various research initiatives have studied the impact of CBT on the symptoms of ADHD in adults, in both individual and group formats, with a majority of the studies being published in the past 5-10 years. By and large, this research supports the assertion that CBT can help adults better address their ADHD-related challenges. For example, a 2016 neuroimaging study of adults with ADHD who completed a 12-session course of CBT showed improvements in ADHD symptom ratings and beneficial changes in the same brain regions that are typically monitored in studies of medication treatment.

Still, some in the scientific community would like to see more rigorous research conducted with carefully constructed controls. In its 2011 report titled, "Current Status of Cognitive Behavioral Therapy for Adults Attention-Deficit Hyperactivity Disorder," researchers from Massachusetts General Hospital and Harvard Medical School wrote: "The conceptual and empirical basis for CBT approaches in adult ADHD is growing and suggests that targeted, skills-based interventions have a role in effectively treating this disorder. At this stage of development, however, subsequent studies must progress in terms of methodological rigor. Additional randomized controlled trials with active control groups are needed and intervention packages must be tested across multiple trials by more than one research group."
[Click to Read: 10 Therapists Who Do More Harm Than Good]
How Exactly Does CBT Improve ADHD in Adults?

While it is fascinating to learn how CBT may change the brain, most patients with ADHD just want to get out the door without wasting 20 minutes looking for their keys. CBT helps patients manage such everyday challenges.

CBT intervenes to improve daily life struggles - procrastination, time management, and other common difficulties - not to treat the core symptoms of inattention, hyperactivity, and impulsivity.

CBT sessions focus on identifying the situations in which poor planning, disorganization, and poor time and task management create challenges in a patient's day-to-day life. Sessions may help an individual deal with obligations such as paying bills or completing work on time, and encourage endeavors that provide personal fulfillment and well-being, such as sleep, exercise, or hobbies. Learning about ADHD is always a good starting point, as it reinforces the message that ADHD is not a character flaw and demonstrates the neurological underpinnings of daily challenges.

Most adults with ADHD say, "I know what I need to do, I just don't do it." Despite having plans for what they want or need to do, they do not carry them out. CBT focuses on adopting coping strategies, managing negative expectations and emotions, and unwinding behavioral patterns that interfere with the strategies.

The goals and session agendas of CBT center on scenarios and challenges that the patient has encountered and, more important, expects to encounter, particularly between sessions. The therapist uses take-away reminders, follow-up check-ins, and other ways of applying new coping skills so they are used outside of the consulting room. Ultimately, the way that a patient with ADHD functions in everyday life is the best measure of whether the therapy is helping.

What Is a Typical CBT Session Like?

CBT is administered in many different formats, and each therapist tailors sessions to a patient's individual needs. Each session's agenda provides a benchmark for identifying when the discussion is straying off course. Early sessions typically involve an introduction to CBT, the structure of sessions, and setting and refining therapy goals (making them specific, realistic, and actionable), as well as developing action plans for what the patient will do outside of the office. (See "CBT Success Stories.")

Subsequent sessions focus on identifying the most important life situations affecting the patient, and developing coping skills to handle those situations. One of the myths about CBT is that it ignores childhood and the past. These early-life experiences are the raw materials from which people develop deep-rooted, non-conscious beliefs and rules for "how the world is" and our role in it. This stems from human ability to categorize experiences to learn, understand, and predict and manage new situations. The patient's understanding of his or her "rules for the world" is an essential goal in CBT. Uncovering the roots of the "rule book" helps adults with ADHD understand the patterns in their self-criticisms (or criticisms of others), avoidance patterns, and self-defeating behaviors. Ultimately, the main goals of CBT are to overcome impairments and to implement coping strategies. CBT helps in processing new experiences and finding new ways to handle setbacks. It adjusts the old rules to align with present-day life.

For each agenda item, the therapist and patient work together to reverse-engineer the challenge. They try to better understand its nature, including a review of the impact of thoughts, feelings, behaviors, and other factors that have interfered with handling the situation.

Using the CBT framework breaks down the tough task of "managing ADHD" into specific tactics for navigating transition points in a day - getting up and off to work on time, starting a project that you've been avoiding, or setting a time to review a daily planner - which increases coping skills. These coping steps are strategized in a session (and written down as take-away reminders) to use between sessions.

Some of the in-session CBT exercises are based on simple ideas: "Many people with ADHD don't wear a watch," says Dr. Mary Solanto, Ph.D., associate professor of psychiatry at the Mt. Sinai School of Medicine. However, remembering to wear a watch, placing clocks all over the house, and keeping a detailed log of the day helps a lot with time management. How does someone with ADHD remember to do all that? Simple mantras ("If it's not in the planner, it doesn't exist") are basic forms of CBT. They serve as reminders to change one's thought patterns.

"We teach them that, if they are having trouble getting started on a project, the first step is too big," Solanto says.

Solanto advises her patients to write down in their ADHD-friendly planners every task they have to do in a given day - from important appointments to everyday errands. She asks clients to link checking the planner to routine activities, like brushing your teeth, eating lunch, walking the dog, and so on. This helps someone with ADHD stay on task throughout the day, and prioritizes the things to get done. "People with ADHD spend a lot of time putting out fires, instead of thinking ahead to prevent those fires," says Solanto, who has recently outlined her work in Cognitive-Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction. The book teaches therapists how to apply and use Solanto's brand of CBT in their own practices.

CBT makes it easy to address other important issues that affect ADHD symptoms - co-existing mood and anxiety disorders, dependence on technology and gaming, a job search, or overall lifestyle habits - sleep, exercise, and one's self-esteem.

How Do CBT and Medications Mix?

Quite well. For some individuals, using ADHD medications alone results in both symptom improvements and better management of adult responsibilities. Most individuals, however, find that they need CBT to target ongoing struggles with disorganization and procrastination, despite being on ADHD stimulants. As has been said many times, "pills don't teach skills." The combination of medication and CBT is often the treatment of choice for dealing with the wide-ranging effects of ADHD.

There's no evidence that CBT can replace drug therapy for ADHD, or even permit lower dosages, but research does suggest that it works better for ADHD than do other forms of therapy. A 2010 study by Boston's Massachusetts General Hospital found that a combination of drug therapy and CBT was more effective at controlling ADHD symptoms than was drug therapy alone.

"CBT picks up where medication leaves off," says Steven A. Safren, Ph.D., leader of the study and assistant professor of psychology at Harvard University. "Even after optimal treatment with medication, most adults have residual symptoms, and this treatment appears to make them better."

When Can I Expect to See Results?

Results come quickly. CBT typically yields benefits after only 12 to 15 one-hour sessions. However, most patients continue with CBT much longer, as it emphasizes long-term maintenance of coping skills and improvements. In fact, the length of time spent in treatment - over many months, say - is as important as the number of sessions a person undergoes.

Some people ask whether they should take a month off from work or school and do a CBT "boot camp" for four or five weeks. This is generally not recommended. CBT aims to help individuals make sustained changes in their daily lives. Instead of attending 20 daily sessions of CBT in a month, a patient should stretch out those sessions over six months to turn his new skills into habits and to weave them into his lifestyle. This allows time and practice for mastering coping strategies for paying monthly bills, organizing work or school issues, and pursuing other tasks and endeavors in real time.

Some individuals return to CBT for "booster sessions" to address a challenge if they've fallen into old habits. Some resume CBT to adapt their coping skills to a major life change, such as having a child or losing a job.

How Do I Find a CBT Therapist Familiar with ADHD in Adults?

There are many excellent CBT therapists, but relatively few of them specialize in ADHD. Competent therapists can use one of the many CBT treatment manuals for professionals to treat a patient with ADHD. Existing technology raises the question of whether CBT can be done effectively by Skype or by phone. Licensed mental health professionals are bound by various health-care laws, at the state and national level, that may limit this option, but there are other possibilities for video sessions that comply with health-care privacy laws.

CHADD (and its National Resource Center), ADDA, the Academy of Cognitive Therapy (ACT), the Association for Behavioral and Cognitive Therapies (ABCT), and the ADDitude Directory have find-a-therapist features on their websites that offer good starting points. The American Professional Society of ADHD and Related Disorders (APSARD) is developing a listing of ADHD specialty clinics, some of which provide CBT or recommend clinicians in their area who do.

CBT Success Stories:

A Physician with ADHD Regained Her Confidence

Mary is a physician who was recently diagnosed with ADHD. At the start of her first CBT session, she sobbed as she unloaded her worries about her job, her marriage, and whether she was too disorganized to raise a child. She had felt like an "impostor" her whole life, having been told, "You're too smart to have ADHD."

She said she was embarrassed by the fact that she had to take a job at an Urgent Care facility after her contract with a group medical practice was not renewed, due to her disorganization and poor follow-through at work.

The therapist asked Mary for an example of a task in her daily life that was tied to any of these worries. Mary said that she was already behind in her charting and had gotten an "unofficial warning" from the facility operations manager. Then, she and the therapist reverse-engineered how she typically handled charting, and explored her mindset ("I hate charting"), emotions ("I'm stressed about everything I have to do"), and escape behaviors ("I end up doing 'hands-on' tasks I can get out of the way") that result in avoiding charting.

Together, they developed an alternate action plan that included a specific implementation strategy ("If I get to a computer terminal, then I can complete the charting for my last patient and at least one overdue chart"), and a formula for acknowledging and accepting her discomfort ("I can tolerate the stress and still open the electronic chart"). Mary also developed a realistic, task-oriented thought to normalize the hassle of charting ("No one likes charting. I don't have to like it to start the next one").

Although initial sessions focused on specific tasks, such as charting, the main outcome was that Mary had some immediate successes at work, and was more engaged in what she had to do. The difficulties she faced with charting were similar to those she faced in other parts of her life, so these initial skills were used to address other important matters. Mary was better able to face her worries and have a framework for catching herself when she was avoiding them. In the course of doing so, Mary's view of herself shifted to that of being competent and confident in managing work, as well as other areas of her life.

A Guy with ADHD Feels Better About Himself

Mark, a 30-something sales representative from New York City, discovered that not all forms of therapy work particularly well for helping him manage his ADHD. Since being diagnosed with ADHD 10 years ago, Mark has been on, off, and finally back on medication. He also worked with several psychotherapists - to no avail. "They either didn't know much about ADHD, or they wanted me to deal with the 'emotional issues' behind it," he says. "That wasn't helpful."

Eight months ago, Mark started to work with a new therapist using CBT. Now things are looking up. He says he feels much better about himself and his marriage.

"A lot of stuff I did got on my wife's nerves - forgetting things she asked me to do, or getting them wrong because I didn't really hear her," Mark says. "I still make mistakes, but they're fewer and farther between. And she knows that I'm really working on it."

For many years, Mark's to-do lists remained mostly undone. Now he's able to cross off 80 percent of the items. Even the tasks that used to seem overwhelming - filing receipts, clearing his desk of clutter - get done without difficulty.

A Journalist Finally Finishes Graduate School, and Regains Hope for His Future

Josh, a 35-year-old journalist, struggled with undiagnosed ADHD for most of his life. He had trouble managing personal commitments and organizing his time at school. "I was hopeless," he said. "My education, employment, and finances were in jeopardy."

Early last year, however, Josh discovered that he had inattentive-type ADHD and began to take stimulant medication to control his symptoms. A few months later, he also began a new style of CBT, which was developed for those with ADHD.

In the program that Josh entered, which was created by Dr. Mary Solanto, Ph.D., adults with ADHD learn in small group settings.

For Josh, it wasn't so much the specific strategies that were taught that helped him, but the other people in the class giving him the motivation to change. "You hear from others with problems like yours, and it helps you make your own strategies for managing those problems," he says.

Solanto believes that CBT is most effective when combined with other forms of treatment, and Josh agrees. Josh says that stimulant medication allowed him to benefit from the class, because it helped him stop and think about how ADHD affected him day to day. "In order to change, you have to be able to learn from experience," he says.

"Our goal is to help people develop good habits and maintain them," Solanto says. "And, just as important, to give support to encourage their use."

Josh certainly sees the method's impact. After starting graduate classes 15 years ago, he finally completed his graduate degree last year. He feels more productive in his career, and says that he has read and written more in the last year than ever before.

"I'm more hopeful," says Josh. "I'm more confident."
[Read This Next: How CBT Can Help Change Your Behavior] Carl Sherman, Ph.D., and J. Russell Ramsay, Ph.D., are members of ADDitude's ADHD Medical Review Panel.

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How CBT Dismantles ADHD Negativity: Cognitive Behavioral Therapy Overview

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CBT is supported by clinical results and research evidence showing that the therapy delivers real-world benefits for adults with ADHD - namely higher self-esteem, productivity, and happiness. Learn more about 'cognitive distortions' and how to unravel them with cognitive behavioral therapy.

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DB-Anxiety Education & Intervention Infographic

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Centers for Disease Control and Prevention

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Deciding if a child has ADHD is a process with several steps. This page gives you an overview of how ADHD is diagnosed. There is no single test to diagnose ADHD, and many other problems, like sleep disorders, anxiety, depression, and certain types of learning disabilities, can have similar symptoms.

If you are concerned about whether a child might have ADHD, the first step is to talk with a healthcare provider to find out if the symptoms fit the diagnosis. The diagnosis can be made by a mental health professional, like a psychologist or psychiatrist, or by a primary care provider, like a pediatrician.

The American Academy of Pediatrics (AAP) recommends that healthcare providers ask parents, teachers, and other adults who care for the child about the child's behavior in different settings, like at home, school, or with peers. Read more about the recommendations.

The healthcare provider should also determine whether the child has another condition that can either explain the symptoms better, or that occurs at the same time as ADHD. Read more about other concerns and conditions.

How is ADHD diagnosed?

Healthcare providers use the guidelines in the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth edition (DSM-5), to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities can also help determine how many children have ADHD, and how public health is impacted by this condition.

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity- impulsivity that interferes with functioning or development:

1. Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

Often has trouble holding attention on tasks or play activities.

Often does not seem to listen when spoken to directly.

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

Often has trouble organizing tasks and activities.

Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

Is often easily distracted

Is often forgetful in daily activities.

2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person's developmental level:

Often fidgets with or taps hands or feet, or squirms in seat.

Often leaves seat in situations when remaining seated is expected.

Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).

Often unable to play or take part in leisure activities quietly.

Is often "on the go" acting as if "driven by a motor".

Often talks excessively.

Often blurts out an answer before a question has been completed.

Often has trouble waiting their turn.

Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.

Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).

There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.

The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months

Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months

Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

Diagnosing ADHD in Adults

ADHD often lasts into adulthood. To diagnose ADHD in adults and adolescents age 17 years or older, only 5 symptoms are needed instead of the 6 needed for younger children. Symptoms might look different at older ages. For example, in adults, hyperactivity may appear as extreme restlessness or wearing others out with their activity.

For more information about diagnosis and treatment throughout the lifespan, please visit the websites of the National Resource Center on ADHD and the National Institutes of Mental Health.

Reference

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.

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ADHD is one of the most common neurobehavioral disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), and in some cases, are overly active.

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Parent workshop available in online format with Q and A and online option to view when works for you

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Treatment can be very helpful for children with OCD, allowing them to lead full and productive lives.

Pediatric OCD is best treated by a licensed mental health professional using a type of cognitive behavior therapy (CBT) called exposure and response prevention (ERP):

In ERP, kids learn to face their fears (exposure) without giving in to compulsions (response prevention).

A licensed mental health professional (such as a psychologist, social worker, or counselor) will guide them through this process, and children will learn that they can allow the obsessions and anxiety to come and go without the need for their compulsions or rituals. Click here for help finding the right therapist for your child/teen.

Psychiatric medication may be considered if the child's symptoms are very severe and/or not helped by ERP alone.

A specific kind of antidepressants known as serotonin reuptake inhibitors (SRIs) have been found to be helpful in reducing OCD symptoms in children and teens, making ERP easier to do and more effective.*

Medications should only be prescribed by a licensed medical professional (such as your pediatrician or a psychiatrist) who has experience working with kids and teens and would ideally work together with your therapist to develop a treatment plan. Click here to learn more about medications for OCD in children and teens.

Taken together, ERP and medication are considered the "first-line" treatments for OCD. In other words, START HERE! About 70 percent of people will benefit from ERP and/or medication for their OCD.

Family Involvement

OCD can be very isolating, and is unique in that obsessions and rituals can sometimes involve members of the family. Parents and caretakers (and even siblings sometimes) are an important part of a child's OCD treatment, and should be involved in many ways. Click here to learn more about resources for families.

Other Treatment Options

Support groups may also be helpful for kids and teens with OCD, as well as their family members. Support groups offer the chance to meet and learn from other people who understand what they are going through. There are even some support groups specifically for parents of children with OCD.

If your child or teen has participated in traditional outpatient therapy (seeing a therapist 1-2 times a week in their office) and would like to try a more intensive level of care, there are additional options. The IOCDF keeps a Resource Directoryof intensive treatment centers, specialty outpatient programs, and therapists who provide various levels of services for OCD in kids and teens. The following lists therapy options from least intensive to most intensive:

Traditional outpatient. Patients see a therapist for individual sessions as often as recommended by their therapist, generally one or two times a week for 45-50 minutes. (Most therapists in the Resource Directory, as well as many "specialty outpatient clinics," offer this type of treatment).

Intensive outpatient. Patients may attend groups and one individual session per day several days per week. Clinics designated as "intensive treatment programs" in the Resource Directory offer this level of treatment.

Day program. Patients attend treatment during the day (typically group and individual therapy) at a mental health treatment center usually from 9am - 5pm up to five days a week. Many clinics designated as "intensive treatment programs" in the Resource Directory offer this level of treatment.

Partial hospitalization. Same as the day program, but patients attend the treatment at a mental health hospital. Several clinics designated as "intensive treatment programs" in the Resource Directory offer this level of treatment.

Residential. Patients are treated while living voluntarily in an unlocked mental health treatment center or hospital. Clinics designated as "residential" in the Resource Directory offer this level of treatment.

Inpatient. This is the highest level of care for a mental health condition. Treatment is provided in a locked unit at a mental health hospital on a voluntary or sometimes involuntary basis. Patients are admitted into this level of care if they are unable to care for themselves or are a danger to themselves or others. The goals of inpatient treatment are to stabilize the patient, which generally takes several days to a week, and then transition the patient to a lower level of care.

Other options:

Summer Programs and Camps
Many intensive treatment programs now offer summer "camps" for children and teens with OCD. These programs vary in approach and style, but most are about a week long, and range from traditional "sleep-away" camps to daytime camps where children sleep at home or stay with family nearby.Click here to learn more.

What about PANDAS/PANS?

There is a rare type of OCD that occurs in childhood following the immune system's overreaction to an infection such as strep throat, causing sudden onset (seemingly overnight) OCD symptoms.

This type of OCD is called Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) if it is a strep infection, or Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) if it is any other infection.

Children with PANDAS/PANS should still receive ERP from a licensed mental health professional, but they may also need antibiotic treatment from their pediatrician.
For more information on PANDAS, including diagnosis and treatment, click here.*Closely watching a child's reaction to SRIs is important, as they can cause severe behavioral problems, including suicidal thoughts.

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Treatment can be very helpful for children with OCD, allowing them to lead full and productive lives. Pediatric OCD is best treated by a licensed mental health professional using a type of cognitive behavior therapy (CBT) called exposure and response prevention (ERP): In ERP, kids learn to face thei…

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International OCD Foundation | Exposure and Response Prevention (ERP)

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Cognitive Behavior Therapy (CBT) Finding A Therapist Cognitive Behavior Therapy Medicine Insurance Overview Cognitive Behavior Therapy, also called CBT, is an effective treatment for OCD. About 7 out of 10 people with OCD will benefit from either CBT or medicine.