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Center for Parent Information and Resources

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Center for Parent Information and Resources

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https://www.parentcenterhub.org/

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Finding the motivation to make positive lifestyle changes can be hard for anyone. For teenagers, it can be especially difficult when parents are the ones telling them to do it. But if they've fallen into unhealthy habits like vaping or alcohol abuse, change can be beneficial. Motivational interviewing is a form of therapy that creates a safe, non-judgmental environment for teens to establish their own goals and values and see how changing unhealthy behaviors can benefit them in the long run.

This series of articles comes from the Child Mind Institute, with most available in English and Spanish. Why might teens be resistant to therapy and how can parents and others to help them get the treatment they need? The articles explain how motivational interviewing can help teens gain the self-confidence to make important behavioral changes. To read more about motivational interviewing, and to connect with the articles in both English and Spanish, please visit CPIR's abstract.

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Center for Parent Information and Resources | Your Central Hub for Parent Centers Serving Families of Children With Disabilities

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Finding the motivation to make positive lifestyle changes can be hard for anyone. For teenagers, it can be especially difficult when parents are the ones telling them to do it. But if they've fallen into unhealthy habits like vaping or alcohol abuse, change can be beneficial.

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Links updated, November 2021
This information in Spanish

The mental health of our children is a natural and important concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnosed and untreated for years. ( 1)

We refer to mental disorders using different "umbrella" terms such as emotional disturbance, behavioral disorders, or mental illness. Beneath these umbrella terms, there is actually a wide range of specific conditions that differ from one another in their characteristics and treatment. These include (but are not limited to):

anxiety disorders;

bipolar disorder (sometimes called manic-depression);

conduct disorders;

eating disorders;

obsessive-compulsive disorder (OCD); and

psychotic disorders.

You may be reading this fact sheet with one of these specific disorders in mind, or you may be looking for information about emotional disturbances in general. In either case, keep reading to find out what different emotional distubances have in common, how they are defined in federal law, and where to find more detailed information on specific disorders.
Quick-Jump Menu
Definition
IDEA defines emotional disturbance as follows:
We've chosen to use the term "emotional disturbance" in this fact sheet because that is the term used in the nation's special education law, the Individuals with Disabilities Education Act (IDEA).

"...a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance:

(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors.

(B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

(C) Inappropriate types of behavior or feelings under normal circumstances.

(D) A general pervasive mood of unhappiness or depression.

(E) A tendency to develop physical symptoms or fears associated with personal or school problems." ( 2)

As defined by IDEA, emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance. ( 3)

Characteristics

As is evident in IDEA's definition, emotional disturbances can affect an individual in areas beyond the emotional. Depending on the specific mental disorder involved, a person's physical, social, or cognitive skills may also be affected. The National Alliance on Mental Illness of Southern Arizona puts this very well:

Mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. ( 4)

Some of the characteristics and behaviors seen in children who have an emotional disturbance include:

Hyperactivity (short attention span, impulsiveness);

Aggression or self-injurious behavior (acting out, fighting);

Withdrawal (not interacting socially with others, excessive fear or anxiety);

Immaturity (inappropriate crying, temper tantrums, poor coping skills); and

Learning difficulties (academically performing below grade level).

Children with the most serious emotional disturbances may exhibit distorted thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings.

Many children who do not have emotional disturbance may display some of these same behaviors at various times during their development. However, when children have an emotional disturbance, these behaviors continue over long periods of time. Their behavior signals that they are not coping with their environment or peers.

Causes

No one knows the actual cause or causes of emotional disturbance, although several factors-heredity, brain disorder, diet, stress, and family functioning-have been suggested and vigorously researched. A great deal of research goes on every day, but to date, researchers have not found that any of these factors are the direct cause of behavioral or emotional problems.

According to NAMI, mental illnesses can affect persons of any age, race, religion, or income. Further:

Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan. ( 5)

Frequency

Of the 74.5 million children in the United States, an estimated 17.1 million have or have had a psychiatric disorder. ( 6) Half of all psychiatric illness occurs before the age of 14, and 75% by the age of 24. The most common psychiatric disorders in childhood are anxiety disorders, AD/HD and disruptive behavior, depression and bipolar disorders, and eating disorders. ( 7)

Help for School-Aged Children

IDEA requires that special education and related services be made available free of charge to every eligible child with a disability, including preschoolers (ages 3-21). These services are specially designed to address the child's individual needs associated with the disability-in this case, emotional disturbance, as defined by IDEA (and further specified by states). In the 2016 school year, more than 349,000 children and youth with emotional disturbance received these services to address their individual needs related to emotional disturbance. ( 8)

Determining a child's eligibility for special education and related services begins with a full and individual evaluation of the child. Under IDEA, this evaluation is provided free of charge in public schools.
10 Basic Steps in Special Education Questions Often Asked by Parents about Special Education Services Evaluating Children for Disability Developing Your Child's IEP
There is a lot to know about the special education process, much of which you can learn here on the CPIR site. We invite you to read the wide range of publications we offer on the topic, especially:

A Look at Specific Emotional Disturbances

As we mentioned, emotional disturbance is a commonly used umbrella term for a number of different mental disorders. Let's take a brief look at some of the most common of these.

We all experience anxiety from time to time, but for many people, including children, anxiety can be excessive, persistent, seemingly uncontrollable, and overwhelming. An irrational fear of everyday situations may be involved. This high level of anxiety is a definite warning sign that a person may have an anxiety disorder.

The term "anxiety disorder" is a broad term covering several different disabilities that share the core symptom of irrational fear. These include such different disorders as generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder (also called social phobia), and specific phobias. ( 9)

According to the Anxiety Disorders Association of America, anxiety disorders are the most common psychiatric illnesses affecting children and adults. ( 10) They are also highly treatable. Unfortunately, only about 36.9% of those affected receive treatment. ( 11)

Also known as manic-depressive illness, bipolar disorder is a serious medical condition that causes dramatic mood swings from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. ( 12)

For most people with bipolar disorder, these mood swings and related symptoms can be stabilized over time using an approach that combines medication and psychosocial treatment. ( 13)

Conduct Disorder

Conduct disorder refers to a group of behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. ( 14) This may include some of the following behaviors:

aggression to people and animals;

destruction of property;

deceitfulness, lying, or stealing; or

truancy or other serious violations of rules. (15)

Treatment will depend on the child's symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

helping the child learn how to better solve problems, communicate, and handle stress, as well as how to control impulses and anger (what's known as cognitive-behavioral therapy);

family therapy;

peer group therapy (to help better social and interpersonal skills); and

medications (although these are not typically used to treat conduct disorder). (16)

Eating disorders are characterized by extremes in eating behavior-either too much or too little-or feelings of extreme distress or concern about body weight or shape. Females are much more likely than males to develop an eating disorder. ( 17)

Anorexia nervosa and bulimia nervosa are the two most common types of eating disorders. Anorexia nervosa is characterized by self-starvation and dramatic loss of weight. Bulimia nervosa involves a cycle of binge eating, then self-induced vomiting or purging. Both of these disorders are potentially life-threatening. ( 18)

Binge eating is also considered an eating disorder. It's characterized by eating excessive amounts of food, while feeling unable to control how much or what is eaten. Unlike with bulimia, people who binge eat usually do not purge afterward by vomiting or using laxatives. ( 19)

According to the National Eating Disorders Association:

Treating an eating disorder generally involves a combination of psychological and nutritional counseling, along with medical and psychiatric monitoring. Treatment must address the eating disorder symptoms and medical consequences, as well as psychological, biological, interpersonal, and cultural forces that contribute to or maintain the eating disorder... Many people utilize a treatment team to treat the multi-faceted aspects of an eating disorder. ( 20)

Obsessive-Compulsive Disorder

Often referred to as OCD, obsessive-compulsive disorder is actually considered an anxiety disorder (which was discussed earlier in this fact sheet). OCD is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors (handwashing, counting, checking, or cleaning) are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety. ( 21)

A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain. ( 22) Treatment for most people with OCD should include one or more of the following:

therapist trained in behavior therapy;

Cognitive Behavior Therapy (CBT);

medication (usually an antidepressant). (23)

"Psychotic disorders" is another umbrella term used to refer to severe mental disorders that cause abnormal thinking and perceptions. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there. Schizophrenia is one type of psychotic disorder. ( 24) There are others as well.

Treatment for psychotic disorders will differ from person to person, depending on the specific disorder involved. Most are treated with a combination of medications and psychotherapy (a type of counseling). ( 25)

More about School

As mentioned, emotional disturbance is one of the categories of disability specified in IDEA. This means that a child with an emotional disturbance may be eligible for special education and related services in public school. These services can be of tremendous help to students who have an emotional disturbance.

Typically, educational programs for children with an emotional disturbance need to include attention to providing emotional and behavioral support as well as helping them to master academics, develop social skills, and increase self-awareness, self-control, and self-esteem. A large body of research exists regarding methods of providing students with positive behavioral support (PBS) in the school environment, so that problem behaviors are minimized and positive, appropriate behaviors are fostered. (See the resource section at the end of this fact sheet for more information on PBS.) It is also important to know that, within the school setting:

For a child whose behavior impedes learning (including the learning of others), the team developing the child's Individualized Education Program (IEP) needs to consider, if appropriate, strategies to address that behavior, including positive behavioral interventions, strategies, and supports.

Students eligible for special education services under the category of emotional disturbance may have IEPs that include psychological or counseling services. These are important related services available under IDEA and are to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.

Recognizing and Addressing the Impact of COVID-19 | As young people return to in-person schooling in the 2021-2022 school year, they may bring with them the impact of the pandemic's trauma. This makes it essential that schools consider the possibility that many students will need to be re-evaluated to determine if they need additional services, especially behavioral support and mental health services, than they needed prior to COVID-19. Two resources of great relevance to reopening schools and returning students are the following:

Other Considerations

Children and adolescents with an emotional disturbance should receive services based on their individual needs, and everyone involved in their education or care needs to be well-informed about the care that they are receiving. It's important to coordinate services between home, school, and community, keeping the communication channels open between all parties involved.

The Importance of Support

Families often need help in understanding their child's disability and how to address the needs that arise from the disability. Help is available from psychiatrists, psychologists, and other mental health professionals that work in the public or private sector. There is also a network of mental health support operating in every state as well as locally.

To locate systems of support in your community or state, visit the organizations we've listed below. They can connect you with local resources, including support groups that provide connection and understanding, information, referral, and advocacy for those living with emotional disturbance.

There are also support groups available from organizations that address specific mental disorders under the umbrella term of emotional disturbance. See the resources at the end of this fact sheet to identify some of these groups.

Resources of More Information

AACAP | American Academy of Child and Adolescent Psychiatry | AACAP offers Facts for Families, a series in English, Spanish, and several other languages that includes many briefs on specific mental disorders, including the ones mentioned in this publication.

AACAP also operates different Resource Centers, which offer consumer-friendly definitions, answers to frequently asked questions, clinical resources, expert videos, Facts for Families, and much more. Visit the Resource Center home page if you are concerned with one of the following:

Anxiety Disorders

Autism

Bipolar Disorder

Conduct Disorder

Depression

Oppositional Defiant Disorder

NIMH | National Institute of Mental Health | NIMH is clearly a source of authoritative information on specific mental disorders. Phone: 1.866.615.6464. TTY: 1.866.415.8051

NAMI | National Alliance on Mental Illness | NAMI is an excellent source of information and connection on mental illness, including the individual disorders mentioned in this fact sheet. NAMI's website and toll-free helpline are available in English and Spanish.

SAMHSA is the Substance Abuse & Mental Health Services Administration. It offers many resources to consumers, including:.

Detailed information on specific emotional disturbances, or related issues such as positive behavior supports, is also available from these sources:

Anxiety Disorders Association of America | https://adaa.org/

Center on Positive Behavioral Interventions and Supports | The PBIS Center provides research-based information on how to provide behavioral supports to children who need them. | https://www.pbis.org

Conduct Disorders | A soft place to land for battle-weary parents
https://www.conductdisorders.com/community/

Encyclopedia of Mental Disorders | http://www.minddisorders.com/index.html

National Eating Disorders Association
1.800.931.2237 | www.nationaleatingdisorders.org

Something Fishy | (eating disorders)
https://www.something-fishy.org

**Highly Rated Resource! This resource was reviewed by 3-member panels of Parent Center staff working independently from one another to rate the quality, relevance, and usefulness of CPIR resources. This resource was found to be of "High Quality, High Relevance, High Usefulness" to Parent Centers.
________________________________________

References

2 | Code of Federal Regulations, Title 34, §300.8(c)(4)(i)

3 | Code of Federal Regulations, Title 34, §300.8(c)(4)(ii)

5 | Ibid.

7 | Ibid.

11 | Ibid.

13 | Ibid.

14 | American Academy of Adolescent and Child Psychiatry. (2013, August). Conduct disorder: Facts for families. Washington, DC: Author. Available online at:
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Conduct_Disorder_33.aspx

15 | Ibid.

16 | Johns Hopkins Medicine Health Library. (n.d.). Conduct disorder in children. Baltimore, MD: Author. Online at:
https://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/conduct_disorder_90,P02560

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Links updated, November 2021 This information in Spanish The mental health of our children is a natural and important concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnosed and untreated for years.

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https://www.pacarepartnership.org/uploads/MH_fact_sheet_minn07.pdf

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http://www.worrywisekids.org/node/136

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Child Anxiety Tales online parent training for parents of anxious children and teens

We are excited to introduce you to a state-of-the-art online evidence-based parent-training program for parents of children struggling with anxiety.

Child Anxiety Tales is a 10-module evidence-based online parent-training program that empowers parents with tools and strategies to use to help their child manage anxiety and stress. The program includes:

1. Symptom Checker - a screener to help parents assess the nature and severity of their child's anxiety

2. What parents need to know about different types of anxiety and symptoms of anxiety

3. Step-by-step guidelines for how to talk to their child or teen about anxiety and how to help them challenge their fears

4. Tools and Strategies to teach kids so they can better manage anxiety day to day

5. Tips from experts on how to maintain long-term progress and success

The program was developed by Dr. Philip Kendall and Dr. Muniya Khanna, preeminent researchers and experts in the treatment of anxiety, through a grant funded by the National Institutes of Mental Health to increase public awareness and support for anxiety in children and adolescents. The program provides only the most well-researched information and techniques based on cognitive-behavioral principles, the recommended first-line treatment approach for child anxiety.

Child Anxiety Tales can be found on the website, www.CopingCatParents.com which has information, books, and referral network to help if parents are looking for providers or resources to help support their child.

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WorryWiseKids.org | New on-line resource for parents of anxious kids!

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Child Anxiety Tales online parent training for parents of anxious children and teens We are excited to introduce you to a state-of-the-art online evidence-based parent-training program for parents of children struggling with anxiety. Child Anxiety Tales is a 10-module evidence-based online parent-training program that empowers parents with tools and strategies to use to help their child manage anxiety and stress.

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Child Mind Institute | Transforming Children’s Lives.

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The Child Mind Institute is an independent nonprofit dedicated to transforming the lives of children struggling with mental health and learning disorders.

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School Mental Health Roles and Responsibilities

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School Mental Health Roles and Responsibilities

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School Mental Health Roles and Responsibilities(1) (1)

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Teaching Students with Emotional Disturbances

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Teaching Students with Emotional Disturbances

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Counseling Youth Who Have Bipolar Disorders

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Counseling Youth Who Have Bipolar Disorders

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Local Resources (Mental Health Included)

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Local Resources (Mental Health Included)

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Working to deliver a better special education service

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Teaching Strategies for Behavioral Disorders

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Teaching Strategies for Behavioral Disorders

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Behavioral disorders also known as conduct disorders are one of the most common forms of disability among children and young adults and is the most frequently cited reason for referral to mental health services. The appearance of behavioral disorders is increasing dramatically in our K-12 classrooms. As a result, their presence severely constrains the ability of the school systems to educate students effectively. The prevalence of behavioral problems among children and young adults is substantial. Many surveys indicate that behavioral disorders vary among young adults, ranging from 2 and 6 percent among K-12 students. This percentage translates into 1.3 to 3.8 million cases of behavioral disorders among the school and pre-college population.

Behavior disorders have also been referred to in a variety of different terminologies, including but not limited to:

1. Emotional and Behavior Disorders (EBD)

2. Emotional Conflict (EC)

3. Serious Emotional Disturbance (SED)

Behavioral disorders become apparent when the student displays a repetitive and impact persistent pattern of behavior that results in the significant disruption of other students. Such disturbances may cause significant impairments in academic, social, and or occupational functioning. Among the characteristics of a behavioral disorder among children and adolescents are:

General Strategies

Multidisciplinary educational teams, including parents, must design programs to meet the individual behavioral and academic needs of identified SED students. Most students can benefit from supportive treatments provided in general education programs. For others, at least temporary placements in special education classrooms, schools, or institutional programs may be appropriate.

Special education programs usually attempt to provide a structured environment where students experience a high degree of success; rules and routines are predictable; and students are consistently rewarded for appropriate behavior. Behavior management techniques, such as positive reinforcement, token economies, contracting, and time-out, which rely on direct measurement and monitoring of behavioral change, are commonly used in SED programs. The assessment and systematic teaching of social skills through modeling, discussion, and rehearsal are frequently used to help students increase control over their behavior and improve their relations with others. In addition, supportive therapies involving music, art, exercise, and relaxation techniques, as well as affective education, individual, and group counseling are sometimes employed to improve self-understanding, self-esteem, and self-control. The following are strategies that may be effective with students with EBD:

Teacher Presentation

Laboratory

Group Interaction and Discussion

1. Acknowledge the contributions of the student with an emotional disorder.

2. Call for responses and participation commensurate with the student's socialization skills.

3. As the student's comfort level rises and when a safe topic is available, encourage the student to be a group spokesperson.

4. Along with the student, devise a contingency plan in which inappropriate forms of response are replaced by appropriate ones.

5. Gradually increase the challenges in the student's participation in group exercises while providing increased positive reinforcement.

6. Help the student to feel as though he or she has something worthwhile to contribute to the discussion.

7. Some students may experience considerable strain in social adjustment in a group context. It may be necessary to work gradually toward group activities. One can devise a strategy of progressing from spectatorship to one-to-one instruction and eventually to small group discussion.

8. Should monitor carefully to ensure that the nondisabled students do not dominate the discussion or detract in any way from the successful performance of the student with the behavioral disorder.

Reading

1. It is necessary to target specific pro-social behaviors for appropriate instruction and assessment to occur such as:

1. Taking turns, working with partner, following directions.

2. Reading in group or with others.

3. Increasing positive relationships by means of awards when they read appropriately.

4. Demonstrating appropriate reading

2. Instructional strategies involving self-control, self-reinforcement, self-monitoring, self-management, problem solving, cognitive behavior modification, and metacognitive skills should be focused on teaching students reading skills

Research

1. Review and discuss with the student the steps involved in a research activity. Think about which step(s) may be difficult for the specific functional limitations of the student and jointly devise accommodations for that student.

2. Use appropriate laboratory and field strategies.

3. Depending on the site of the research check the previous two sections.

4. Show clear examples of what the students should expect as an outcome of their research.

Field Experiences

1. Use appropriate general strategies.

2. Consider alternate activities/exercises that can be utilized with less difficulty for the student, but has the same or similar learning objectives.

3. In field activities acknowledge the contributions and assistance of the student with an emotional disorder.

4. Help the student to feel as though he or she has something worthwhile to contribute to the field trip.

5. Use a buddy system.

6. Gradually increase the challenges in the student's participation in field exercises while providing increased positive reinforcement.

7. Group participation in field activities is highly desirable because it enhances social contacts.

8. Make the student with the behavioral disorder become one of the field trip leader of an activity which can often reduce their disorder.

9. Special efforts should be made to get students with behavioral disorders to interact with other students.

10. You should encourage students to practice field skills during their free hours.

11. Every effort should be made to arouse the interest of such students in activities, so they will learn to perform the activities with success and pleasure with appropriate behaviors.

Testing

1. Be sensitive to the student's reactions to the various aspects of assessment.

2. For each student, accumulate in his or her portfolio several examples of work (quizzes, assignments, projects) that demonstrate knowledge of the subject matter or the unit of study.

3. Make special arrangements for the student with an emotional disorder according to what their special needs are and that they do not compromise the integrity of the testing situation.

4. Stay on top of student progress through informal assessment, don't wait until it's too late to discover that there is a problem.

5. Provide private room/smaller group setting/alternative test site (with proctor present); alternatively screens to block out distractions.

Organizations

Council for Exceptional Children-Council for Children with Behavior Disorders (CCBD)
The Council for Children with Behavioral Disorders (CCBD) is dedicated to supporting the professional development and enhancing the expertise of those who work on behalf of children with challenging behavior and their families. It is a division of the Council for Exceptional Children (CEC).

CCBD Foundation
The CCBD Foundation was founded in 1997 by the Council for Children with Behavioral Disorders (CCBD), to support its mission of improving the education of children and youth with emotional or behavioral disorders (EBD).

Resources

Council for Exceptional Children (Behavior Disorders/Emotional Disturbance)
The Council for Exceptional Children (CEC) page on EBD. The Council for Exceptional Children (CEC) is the largest international professional organization dedicated to improving the educational success of individuals with disabilities and/or gifts and talents.

BehaviorDisorder.org
The site offers information on behavior disorders, conduct disorders, and other behavior problems.

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Behavioral disorders also known as conduct disorders are one of the most common forms of disability among children and young adults and is the most frequently cited reason for referral to mental health services. The appearance of behavioral disorders is increasing dramatically in our K-12 classrooms. As a result, their presence severely constrains the ability of the school systems to educate students effectively.

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School-Based Eating Disorders Prevention Program

Eating Disorders are diseases of isolation; they disrupt every part of an individual's life. Disordered eating patterns, as well as diagnosable cases of Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder are progressive, chronic and sometimes fatal.

FREED's school-based prevention program is designed to inform and empower all members of the school community in their understanding of body, weight, size and related issues connected to disordered eating and eating disorders.

Participants acquire the skills and knowledge to build resiliency in the face of unrelenting societal and internal pressures, while also gaining information about resources in order to help the people they care about. We want our students to understand what a healthy relationship with body, food and exercise looks like, and to be part of building and maintaining a healthy school climate.

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eating disorders education and prevention program

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the foundation for research and education in eating disorders

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developing effective and accessible treatments

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School-Based Eating Disorders Prevention Program Eating Disorders are diseases of isolation; they disrupt every part of an individual's life. Disordered eating patterns, as well as diagnosable cases of Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder are progressive, chronic and sometimes fatal.

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http://www.worrywisekids.org/node/70

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Even in the best of situations, all children experience some anxiety in the form of worry, apprehension, dread, fear or distress. Occasional nervousness and fleeting anxieties occur when a child is first faced with an unfamiliar or especially stressful situation. It can be an important protection or signal for caution in certain situations. In fact there are specific expected fears that accompany each stage of child development.

Anxiety: Normal and Necessary
From toddlers to teens, life's challenges may be met with a temporary retreat from the situation, a greater reliance on parents for reassurance, a reluctance to take chances, and a wavering confidence. Typically these concerns will resolve when the child learns to master the situation or the situation changes. Incorporating their newfound abilities, whether it is mastering a new school, the neighborhood pool, taking tests, encountering dogs, kids move on from their fears and have no lasting ill-effects. Parents can facilitate a child's successful adjustment to a new challenge by: (1) being accepting of the child's concerns, (2) listening to the child's perceptions, and gently correcting misinformation, and (3) patiently encouraging a child to approach a feared situation one step at a time until it is becomes familiar and manageable.

Typical Childhood Fears

In response to a growing ability to differentiate familiar faces (parents) from unfamiliar, stranger anxiety (clinging and crying when a stranger approaches) develops around 7-9 months and typically resolves by end of first year.

Early Childhood
As a healthy attachment to parents grows, separation anxiety (crying, sadness, fear of desertion upon separation) emerges around one year and improves over the next 3 years, resolving in most children by the end of kindergarten. As children's worlds expand, they may fear new and unfamiliar situations, and real and imagined dangers from big dogs, to spiders, to monsters. Children from age 3-6 are trying to master what is real and what is not, and until this is resolved, they may have difficulty with costumed characters, ghosts, and supernatural beings. While trying to master fears of what could be they may struggle with the dark, the basement, closets, and under the bed. As a child learns how to manage and put aside these fears, their ability to sleep alone will be secured.

Each year, with access to new information, children begin to fear real world dangers-fire drills, burglars, storms, illness, or drugs. With experience, they learn that these risks can exist as remote, rather than imminent dangers. In middle school, the growing importance of social status leads to social comparisons and worries about social acceptance. Concerns about academic and athletic performance, and social group identification are normal. Learning about various physical and mental health diseases in school may lead to some temporary concerns about risk and safety. Teenagers continue to be focused on social acceptance, but with a greater concern for finding a group that reflects their chosen identity. Concerns about the larger world, moral issues and their future successes are common.

When You Should be Concerned

Anxiety is considered a disorder not based on what a child is worrying about, but rather how that worry is impacting a child's functioning. The content may be "normal" but help is needed when a child is experiencing too much worry or suffering immensely over what may appear to be insignificant situations, when worry and avoidance become a child's automatic response in many situations, when they feel constantly keyed up, or when coaxing or reassurance are ineffective in moving them through. For these children anxiety is not protecting them, but rather preventing them from fully participating in typical activities of daily life-school, friendships, academic performance.

Unremitting anxiety lasting for weeks or months at a time can cause physical distress in the form of headaches, stomachaches, nausea, vomiting and sleeplessness, Difficulty sleeping, reluctance to go to school or elsewhere outside of the child's comfort zone, crying jags, tantrums and clinginess are common. Anxiety can also interfere with a child's concentration and decision-making. An anxious child's thinking is typically unrealistic, catastrophic and pessimistic. They may seek excessive reassurance and yet the benefit of that reassurance is fleeting. Irritability and anger can also be red flags for anxiety when a child becomes frustrated by the stress of worry, or worn down from sleep deprivation. For some children, feeling "different" from other kids can be an additional source of concern.

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Even in the best of situations, all children experience some anxiety in the form of worry, apprehension, dread, fear or distress. Occasional nervousness and fleeting anxieties occur when a child is first faced with an unfamiliar or especially stressful situation. It can be an important protection or signal for caution in certain situations.

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http://www.worrywisekids.org/node/43

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WorryWiseKids.org | Red Flags for Anxiety: What's Normal, What's Not?

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© 2017 Worrywisekids.org/The Children's and Adult Center for OCD and Anxiety. Copying by permission only. Worrywisekids.org is brought to you by The Children's and Adult Center for OCD and Anxiety with support from

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http://www.worrywisekids.org/

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From Dr. Tamar Chansky Creator of Worrywisekids.org

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https://www.insidehighered.com/news/2017/03/29/anxiety-and-depression-are-primary-concerns-students-seeking-counseling-services

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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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How to Help a Child with an Anxiety Disorder

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How to Help a Child with an Anxiety Disorder

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https://www.nytimes.com/2018/10/01/well/family/how-to-help-a-child-with-an-anxiety-disorder.html

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety.

Credit... Getty Images

By

Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York. Anxiety may be missed because it doesn't necessarily declare itself with attention-getting disruptive behaviors; in fact, symptoms may keep some children quiet and inhibited, though in other children, alternatively, anxiety may be misunderstood as oppositional behavior.

Adults may also assume that anxiety in a child is just a phase to be outgrown. A certain amount of anxiety is a normal aspect of development for young children - consider separation anxiety, for example - and it can even be protective, since children need to learn to keep themselves safe and anticipate certain kinds of dangers. But when worrying or avoiding possible threats gets in the way of a child's functioning or a child's enjoyment, it should be a signal to parents that help is needed, not just watching and waiting, not arranging the child's life to avoid the occasions of anxiety.

Kathleen Merikangas, the senior investigator and chief of the Genetic Epidemiology Research Branch at the National Institute of Mental Health, said, "To me, anxiety is one of the most underrecognized or under-treated conditions of childhood and adolescence." These children can get missed, she said, because they may seem to be functioning well; many don't have the kinds of developmental problems or attention issues that draw attention in school, though they may be suffering.

Consider the child whose anxiety about speaking in public gets in the way of participating in class. The child may be silent out of a fear of being laughed at or otherwise rejected, Dr. Merikangas said, but to the teacher, it may look like the child is just not interested. Environmental modifications can really help these children thrive in school, she said; for example, working in small groups with children they know.

The new report, released in September, summarizes the evidence that early temperament in children predicts their later behavior patterns around anxiety; toddlers who show what are called "behaviorally inhibited" behaviors, which parents are likely to perceive as extreme shyness, or anxiety around new people, are more likely to develop social anxiety later on. That doesn't mean that shyness is pathological (as with all varieties of temperament, there's a wide range of function), but it does suggest how important it is to help a child with this temperament who develops difficulties.

The tendency toward anxiety - and toward some specific forms of anxiety, like phobias - may persist throughout childhood and adolescence and into adulthood. And anxiety is closely tied to depression, Dr. Merikangas said. Although there have been reports that anxiety rates among American teenagers have soared, she cited evidence that the international rates of the underlying disorders had stayed consistent from 1998 to 2013; there is no global "epidemic" of clinical anxiety disorders, she said.

But with rates of suicide and suicidal ideation on the rise, it's particularly important to provide information to schools and to parents about recognizing anxiety and getting children help.

Dr. Harold Koplewicz, the president of the Child Mind Institute, said that when anxiety disorders in children are left untreated, anxiety can inhibit their lives, making standard daily activities difficult, from attending school to sleeping in their own beds, and lead to many extra visits to the school nurse or the pediatrician.

But beyond that, he said, "people underestimate that this is a gateway disorder." If children don't get help with these disorders, they may be at risk to develop other mental health problems; the child with severe separation anxiety may develop panic disorder, he said; the child with untreated general anxiety may be at greater risk for depression.

Dr. Merikangas was a co-investigator on a national study of mental disorders in adolescents, which has shown both that anxiety disorders were the most common mental health problems in adolescents in the United States, and also the problems that showed up earliest in those children's lives - the mean age of onset for anxiety disorders was 6. But many adolescents had never received treatment. That makes it essential to get the word out, Dr. Merikangas said, that anxiety is "one of the most treatable symptoms and syndromes, we can really change their lives with minimal intervention."

"All these disorders are remarkably treatable," Dr. Koplewicz said. There are highly effective behavioral and psychosocial therapies, including cognitive behavioral therapies, to help children cope with the demands of daily life. For children who don't respond to psychosocial therapies, he said, medications can be added.

But perhaps because anxiety is a normal response, parents often believe that even severe and disabling anxiety symptoms are just a phase, and on average, there is a two-year lag between the time children develop anxiety and the time they get help. "It's bad for these children's brains," he said. "Having your brain's thermostat miss-set is not good for your brain."

"Anxiety can manifest itself along a continuum," said Rachel Busman, the senior director of the anxiety disorders center at the Child Mind Institute. The report shows that there is some overlap with physical illnesses, such as chronic headaches or stomach aches, often coordinated with school. "That could be a kid's way of saying, 'I'm anxious,'" she said.

And when a child who is having a lot of difficulty with separation gets into the classroom, Dr. Busman said, that child may start throwing things, or running and hiding, and that "bad behavior" may represent the fight or flight response of anxiety. "We've also seen kids who have intense social anxiety and their way of managing it is to be class clown," she said.

Treating children with anxiety always means working with their parents. Jerry Bubrick, senior clinical psychologist at the anxiety disorders center of the Child Mind Institute, said that when children are little, it's normal for parents to operate in "fix-it mode," blocking the staircase so a toddler doesn't tumble down, averting problems before they happen.

As children get older, parents normally pull back, helping children find solutions of their own. "But anxious parents of anxious children remain in fix-it mode," he said, helping their children avoid the situations that make them anxious. Therapy involves exposing children to those situations and helping them develop strategies to manage them; with treatment, Dr. Bubrick said, parents can "let the child experience the anxiety and learn to tolerate and overcome it on their own."

"If you see things you're not sure about, talk to the preschool, talk to the pediatrician, be open to the idea that maybe there is anxiety," even in a young child, Dr. Busman said. Separation anxiety can be a problem even in children who are able to go to school, she said. Parents should pay attention if a child can't be left with a babysitter, a child can't sleep alone at home."These are the kids, they go into the bathroom, and they're like, are you still there?" she said. "We do see really young anxious children."

"If your child is suffering distress and dysfunction, reach out to your pediatrician," Dr. Koplewicz said. When you get to a mental health professional, "make sure you ask the right questions," he said, including asking whether that person has specific experience with treating anxiety and how long the treatment is expected to take.

"You want a professional who understands what they're doing and can explain to you what they're doing."

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How to Help a Child With an Anxiety Disorder

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety. By Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York.

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Photo Credit: https://www.verywellhealth.com/anxiety-disorder-5089639

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Although the term "eating" is in the name, eating disorders are about more than food. They're complex mental health conditions that often require the intervention of medical and psychological experts to alter their course.

These disorders are described in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ( 1).

In the United States alone, an estimated 28 million Americans have or have had an eating disorder at some point in their life ( 2).

This article describes six of the most common types of eating disorders and their symptoms.

Eating disorders are a range of psychological conditions that cause unhealthy eating habits to develop. They might start with an obsession with food, body weight, or body shape ( 3).

In severe cases, eating disorders can cause serious health consequences and may even result in death if left untreated. In fact, eating disorders are among the deadliest mental illnesses, second to opioid overdose ( 4).

People with eating disorders can have a variety of symptoms. Common symptoms include severe restriction of food, food binges, and purging behaviors like vomiting or overexercising.

Although eating disorders can affect people of any gender at any life stage, they're increasingly common in men and gender nonconforming people. These populations often seek treatment at lower rates or may not report their eating disorder symptoms at all ( 5, 6).

Different types of eating disorders have different symptoms, but each condition involves an extreme focus on issues related to food and eating, and some involve an extreme focus on weight.

This preoccupation with food and weight may make it hard to focus on other aspects of life ( 3).

Mental and behavioral signs may include ( 7):

dramatic weight loss

concern about eating in public

preoccupation with weight, food, calories, fat grams, or dieting

complaints of constipation, cold intolerance, abdominal pain, lethargy, or excess energy

excuses to avoid mealtime

intense fear of weight gain or being "fat"

dressing in layers to hide weight loss or stay warm

severely limiting and restricting the amount and types of food consumed

refusing to eat certain foods

denying feeling hungry

expressing a need to "burn off" calories

repeatedly weighing oneself

patterns of binge eating and purging

developing rituals around food

excessively exercising

cooking meals for others without eating

missing menstrual periods (in people who would typically menstruate)

Physical signs may include ( 7):

Experts believe that a variety of factors may contribute to eating disorders.

One of these is genetics. People who have a sibling or parent with an eating disorder seem to be at an increased risk of developing one ( 3).

Personality traits are another factor. In particular, neuroticism, perfectionism, and impulsivity are three personality traits often linked to a higher risk of developing an eating disorder, according to a 2015 research review ().

Other potential causes include perceived pressures to be thin, cultural preferences for thinness, and exposure to media promoting these ideals ().

More recently, experts have proposed that differences in brain structure and biology may also play a role in the development of eating disorders. In particular, levels of the brain messaging chemicals serotonin and dopamine may be factors ( 9).

However, more studies are needed before strong conclusions can be made.

Eating disorders are a group of related conditions involving extreme food and weight issues, but each disorder has unique symptoms and diagnosis criteria. Here are six of the most common eating disorders and their symptoms.

Anorexia nervosa is likely the most well-known eating disorder.

It generally develops during adolescence or young adulthood and tends to affect more women than men ().

People with anorexia generally view themselves as overweight, even if they're dangerously underweight. They tend to constantly monitor their weight, avoid eating certain types of foods, and severely restrict their calorie intake.

Common symptoms of anorexia nervosa include ( 1):

very restricted eating patterns

intense fear of gaining weight or persistent behaviors to avoid gaining weight, despite being underweight

a relentless pursuit of thinness and unwillingness to maintain a healthy weight

a heavy influence of body weight or perceived body shape on self-esteem

a distorted body image, including denial of being seriously underweight

However, it's important to note that weight should not be the major focus of diagnosing someone with anorexia.

Using body mass index as a factor in diagnosis is outdated because people who are categorized as "normal" or "overweight" can have the same risks.

In atypical anorexia, for example, a person may meet the criteria for anorexia but not be underweight despite significant weight loss ( 7).

Obsessive-compulsive symptoms are also often present. For instance, many people with anorexia are preoccupied with constant thoughts about food, and some may obsessively collect recipes or hoard food.

They may also have difficulty eating in public and exhibit a strong desire to control their environment, limiting their ability to be spontaneous ( 3).

Anorexia is officially categorized into two subtypes - the restricting type and the binge eating and purging type ( 1).

Individuals with the restricting type lose weight solely through dieting, fasting, or excessive exercise.

Individuals with the binge eating and purging type may binge on large amounts of food or eat very little. In both cases, after they eat, they purge using activities such as vomiting, taking laxatives or diuretics, or exercising excessively.

Anorexia can be very damaging to the body. Over time, individuals living with it may experience thinning of their bones, infertility, and brittle hair and nails.

In severe cases, anorexia can result in heart, brain, or multi-organ failure and death.

Bulimia nervosa is another well-known eating disorder.

Like anorexia, bulimia tends to develop during adolescence and early adulthood and appears to be less common among men than women ().

People with bulimia frequently eat unusually large amounts of food in a specific period of time.

Each binge eating episode usually continues until the person becomes painfully full. During a binge, the person usually feels that they cannot stop eating or control how much they are eating.

Binges can happen with any type of food but most commonly occur with foods the individual would usually avoid.

Individuals with bulimia then attempt to purge to compensate for the calories consumed and to relieve gut discomfort.

Common purging behaviors include forced vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise.

Symptoms may appear very similar to those of the binge eating or purging subtypes of anorexia nervosa. However, individuals with bulimia usually maintain a relatively typical weight rather than losing a large amount of weight.

Common symptoms of bulimia nervosa include ( 1):

recurrent episodes of binge eating with a feeling of lack of control

recurrent episodes of inappropriate purging behaviors to prevent weight gain

self-esteem overly influenced by body shape and weight

a fear of gaining weight, despite having a typical weight

Side effects of bulimia may include an inflamed and sore throat, swollen salivary glands, worn tooth enamel, tooth decay, acid reflux, irritation of the gut, severe dehydration, and hormonal disturbances ().

In severe cases, bulimia can also create an imbalance in levels of electrolytes, such as sodium, potassium, and calcium. This can cause a stroke or heart attack.

Binge eating disorder is the most prevalent form of eating disorder and one of the most common chronic illnesses among adolescents ().

It typically begins during adolescence and early adulthood, although it can develop later on.

Individuals with this disorder have symptoms similar to those of bulimia or the binge eating subtype of anorexia.

For instance, they typically eat unusually large amounts of food in relatively short periods of time and feel a lack of control during binges.

People with binge eating disorder do not restrict calories or use purging behaviors, such as vomiting or excessive exercise, to compensate for their binges ().

Common symptoms of binge eating disorder include ():

eating large amounts of food rapidly, in secret, and until uncomfortably full, despite not feeling hungry

feeling a lack of control during episodes of binge eating

feelings of distress, such as shame, disgust, or guilt, when thinking about the binge eating behavior

no use of purging behaviors, such as calorie restriction, vomiting, excessive exercise, or laxative or diuretic use, to compensate for the binge eating

People with binge eating disorder often consume an excessive amount of food and may not make nutritious food choices. This may increase their risk of medical complications such as heart disease, stroke, and type 2 diabetes ().

Pica is an eating disorder that involves eating things that are not considered food and that do not provide nutritional value ( 14).

Individuals with pica crave non-food substances such as ice, dirt, soil, chalk, soap, paper, hair, cloth, wool, pebbles, laundry detergent, or cornstarch ().

Pica can occur in adults, children, and adolescents.

It is most frequently seen in individuals with conditions that affect daily functioning, including intellectual disabilities, developmental conditions such as autism spectrum disorder, and mental health conditions such as schizophrenia ( 14).

Individuals with pica may be at an increased risk of poisoning, infections, gut injuries, and nutritional deficiencies. Depending on the substances ingested, pica may be fatal.

However, for the condition to be considered pica, the eating of non-food substances must not be a typical part of someone's culture or religion. In addition, it must not be considered a socially acceptable practice by a person's peers.

Rumination disorder is another newly recognized eating disorder.

It describes a condition in which a person regurgitates food they have previously chewed and swallowed, re-chews it, and then either re-swallows it or spits it out ( 15).

This rumination typically occurs within the first 30 minutes after a meal ( 16).

This disorder can develop during infancy, childhood, or adulthood. In infants, it tends to develop between 3 and 12 months of age and often disappears on its own. Children and adults with the condition usually require therapy to resolve it.

If not resolved in infants, rumination disorder can result in weight loss and severe malnutrition that can be fatal.

Adults with this disorder may restrict the amount of food they eat, especially in public. This may lead them to lose weight and become underweight ( 16).

Avoidant/restrictive food intake disorder (ARFID) is a new name for an old disorder.

The term has replaced the term "feeding disorder of infancy and early childhood," a diagnosis previously reserved for children under age 7 ( 17).

Individuals with this disorder experience disturbed eating due to either a lack of interest in eating or a distaste for certain smells, tastes, colors, textures, or temperatures.

Common symptoms of ARFID include ():

avoidance or restriction of food intake that prevents the person from eating enough calories or nutrients

eating habits that interfere with typical social functions, such as eating with others

weight loss or poor development for age and height

nutrient deficiencies or dependence on supplements or tube feeding

It's important to note that ARFID goes beyond common behaviors such as picky eating in toddlers or lower food intake in older adults.

Moreover, it does not include the avoidance or restriction of foods due to lack of availability or religious or cultural practices.

In addition to the six eating disorders above, other less known or less common eating disorders also exist.

These include ( 18):

Purging disorder. Individuals with purging disorder often use purging behaviors, such as vomiting, laxatives, diuretics, or excessive exercising, to control their weight or shape. However, they do not binge.

Night eating syndrome. Individuals with this syndrome frequently eat excessively at night, often after awakening from sleep.

Other specified feeding or eating disorder (OSFED). While it is not found in the DSM-5, this category includes any other conditions that have symptoms similar to those of an eating disorder but don't fit any of the disorders above.

One disorder that may currently fall under OSFED is orthorexia. Although orthorexia is increasingly mentioned in the media and in scientific studies, the DSM does not yet recognize it as a separate eating disorder ( 19).

Individuals with orthorexia tend to have an obsessive focus on healthy eating to an extent that disrupts their daily lives. They may compulsively check ingredient lists and nutritional labels and obsessively follow "healthy lifestyle" accounts on social media.

Someone with this condition may eliminate entire food groups, fearing that they're unhealthy. This can lead to malnutrition, severe weight loss, difficulty eating outside the home, and emotional distress.

Individuals with orthorexia are rarely focused on losing weight. Instead, their self-worth, identity, or satisfaction is dependent on how well they comply with their self-imposed diet rules ( 19).

If you have an eating disorder, identifying the condition and seeking treatment sooner will improve your chances of recovering. Being aware of the warning signs and symptoms can help you decide whether you need to seek help.

Not everyone will have every sign or symptom at once, but certain behaviors may signal a problem, such as ( 20):

behaviors and attitudes that indicate that weight loss, dieting, and control over food are becoming primary concerns

preoccupation with weight, food, calories, fats, grams, and dieting

refusal to eat certain foods

discomfort with eating around others

food rituals (not allowing foods to touch, eating only particular food groups)

skipping meals or eating only small portions

frequent dieting or fad diets

extreme concern with body size, shape, and appearance

frequently checking in the mirror for perceived flaws in appearance

extreme mood swings

If these symptoms resonate with you and you think you may have an eating disorder, it's important to reach out to a medical professional for help.

Making the decision to start eating disorder recovery might feel scary or overwhelming, but seeking help from medical professionals, eating disorder recovery support groups, and your community can make recovery easier.

If you're not sure where to start, you can contact the National Eating Disorders Association helpline for support, resources, and treatment options for yourself or someone you know.

To contact, call: (800) 931-2237

Monday-Thursday 11 a.m.-9 p.m. ET

Friday 11 a.m.-5 p.m. ET

Text: (800) 931-2237

Monday-Thursday 3 p.m.-6 p.m. ET

Friday 1 p.m.-5 p.m. ET

Eating disorder treatment plans are specifically tailored to each person and may include a combination of multiple therapies.

Treatment will usually involve talk therapy, as well as regular health checks with a physician ( 21).

It's important to seek treatment early for eating disorders, as the risk of medical complications and suicide is high ().

Treatment options include:

Individual, group, or family psychotherapy. A type of psychotherapy called cognitive behavioral therapy (CBT) may be recommended to help reduce or eliminate disordered behavior such as binge eating, purging, and restricting. CBT involves learning how to recognize and change distorted or unhelpful thought patterns ().

Medications. A doctor may recommend treatment with medications such as antidepressants, antipsychotics, or mood stabilizers to help treat an eating disorder or other conditions that may occur at the same time, such as depression or anxiety ().

Nutritional counseling. This involves working with a dietitian to learn proper nutrition and eating habits and may also involve restoring or managing a person's weight if they have experienced significant weight changes. Studies suggest that combining nutritional therapy with cognitive therapy may significantly improve treatment outcomes (22).

If you think someone in your life has an eating disorder, your best bet is to support and encourage them to seek help from a healthcare professional.

This can be extremely difficult for someone living with an eating disorder, but supporting them in other ways will help them feel cared for and encouraged in their recovery.

Recovering from an eating disorder can take a long time, and this person may have periods of relapsing into old behaviors, especially during times of stress. If you're close to this person, it's important to be there for them, and be patient, throughout their recovery ( 21).

Ways to support someone with an eating disorder include ( 21):

Listening to them. Taking time to listen to their thoughts can help them feel heard, respected, and supported. Even if you don't agree with what they say, it's important that they know you're there for them and that they have someone to confide in.

Including them in activities. You can reach out and invite them to activities and social events or ask if they want to hang out one-on-one. Even if they do not want to be social, it's important to check in and invite them to help them feel valued and less alone.

Trying to build their self-esteem. Make sure they know that they are valued and appreciated, especially for nonphysical reasons. Remind them why you are their friend and why they are valued.

The categories above are meant to provide a better understanding of the most common eating disorders and dispel myths about them.

Eating disorders are mental health conditions that usually require treatment. They can also be damaging to the body if left untreated.

If you have an eating disorder or know someone who might have one, you can seek help from a healthcare professional who specializes in eating disorders.

You can book an appointment with an eating disorder specialist in your area using our Healthline FindCare tool.
Read this article in Spanish.

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Learn about 6 common types of eating disorders and their symptoms

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Eating disorders are characterized by unusual or disturbed eating habits. Learn more here.

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After anorexia: Life's too short to weigh your cornflakes | Catherine Pawley | TEDxLeamingtonSpa

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Rise in Eating Disorders During Pandemic

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Rise in Eating Disorders During Pandemic

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LULU GARCIA-NAVARRO, HOST:

Since the pandemic began, children's hospitals have seen a surge in admissions for eating disorders. And many parents feel desperate, knowing their child is sick but unable to access treatment because of a chronic shortage of therapists and programs that can help them. Kate Wells at Michigan Radio has this story of one family's struggle. And a note to our listeners - this story discusses eating disorders in detail.

GARCIA-NAVARRO: Amelia Haywood (ph) is a little bit nervous to talk about this, but she really wants to. She sits next to her mom in their home in suburban Grand Rapids, Mich. Her long, brown hair hangs loose over a red athletic jacket.

AMELIA HAYWOOD: Yeah. So my name is Amelia. I'm 15 years old. I play volleyball. And about six months ago, I was diagnosed with anorexia nervosa.

KATE WELLS, BYLINE: This disease has sent her to the emergency room four times. And she has been admitted to three different hospitals. It began in March of 2020 when the lockdown started. Suddenly, a girl who had been this athletic, high-achieving eighth-grader just felt lost.

HAYWOOD: People are dying. Everyone's getting sick. You can't see your friends. It was hard because I felt like I didn't have any control over anything except what I ate and how I exercised.

WELLS: So she was like, you know, I'm just going to eat healthy. I'm going to stay in shape. But as the shutdowns and isolation stretched into summer and then fall and then winter, her focus on food and exercise became more intense. It started to consume her. She would make these elaborate meals. And she'd post pictures to Instagram but then actually give them to her sister and lie and say she'd already eaten. She would skip time with friends to fit in yet another run. And she wore baggy sweats to cover up the weight loss. By January, Amelia just felt drained and exhausted all the time.

HAYWOOD: I had, like, basically no emotions. I was just, like, numb. All I wanted to do was, like, lay in my bed.

WELLS: So one Sunday morning, Amelia's mom, Jennifer Ackerman-Haywood (ph), confronted her daughter.

JENNIFER ACKERMAN-HAYWOOD: I just went in there. And I said, Amelia, I know something's up with you. And I'm not going to leave your room until, you know, as long as it takes. You can take your time telling me. But I'm not going anywhere until we have - we have to have a discussion about this because I'm very concerned.

HAYWOOD: And I finally said, I'm struggling with food. It was probably, like, the hardest thing I've ever said in my entire life because I was so scared.

ACKERMAN-HAYWOOD: I immediately was like, of course. Like, this explains everything. Like - and I could kind of like flashback the last month and kind of seeing her decline into a withdrawn person. And I immediately was like, OK. I think she has an eating disorder.

WELLS: The very next day, Jennifer brought Amelia to the pediatrician's. And that is when Amelia was first diagnosed with anorexia. But Jennifer says no one ever alerted her at an earlier checkup that Amelia's growth levels had slowed dramatically. And it wasn't until three weeks after Amelia's diagnosis that Jennifer found out Amelia's EKG had shown her heart rate had become dangerously low.

ACKERMAN-HAYWOOD: And I just thought, wow. We were that close to that. And we didn't know.

WELLS: Two months later, Amelia was so sick, she needed to be admitted to the hospital. Hospitals across the country have seen a surge of patients like Amelia. During the first year of the pandemic, a nationwide network of 15 different hospitals reported their average admissions for adolescent eating disorders doubled. Dr. Terry Bravender treats eating disorders at the University of Michigan CS Mott Children's Hospital. It's one of the places that Amelia was treated.

TERRY BRAVENDER: These are kids whose bodies are failing because of their poor nutritional intake. And the medical hospital is really a safety net rescue for them so that they don't starve to death.

WELLS: Experts believe the pandemic's isolation, social disruption and trauma acted as kind of a mass trigger for many kids and teens who were genetically predisposed to these diseases. Samantha DeCaro is a psychologist with the Renfrew Center. It's a national network of eating disorder clinics.

SAMANTHA DECARO: So the pandemic has created the perfect storm for an eating disorder and disordered eating in the past. It has resulted in a relapse.

WELLS: Even before the pandemic, there was already a shortage of therapists and specialists who know how to treat these illnesses. Doctors say they are hearing from frantic parents who are calling 20, even 60 therapists and cannot get their kid in anywhere. Amelia's mom, Jennifer, says navigating her daughter's illness felt like being in a maze.

ACKERMAN-HAYWOOD: It seems insane because if your child gets a cancer diagnosis or something else, you know, there's a protocol for cancer. You know, there's a protocol for some of these other illnesses out there. There isn't a universal protocol for eating disorders.

WELLS: Amelia kept getting sicker over the spring. And doctors eventually recommended that she get residential treatment at a psychiatric hospital that treats eating disorders.

HAYWOOD: Being able to talk to people who are going through the same thing helped me so much and realize that I'm not alone.

WELLS: Amelia is home now. She is doing so much better. She's on medication. She gets regular therapy. She's back to a healthy weight. She still has days where she struggles with old thought patterns about her body and food. But she wants others to know that it is possible to get better.

HAYWOOD: And I can - I'm starting to get activity back. I'm - I can hang out with my friends and live my life how I want to live. And I know it's really hard to just, like, reach out. But at the end of the day, it's so worth it.

WELLS: This fall, Amelia will be a sophomore. Like so many other kids, she is still grappling with the ways that the pandemic changed her. But she's no longer alone in her bedroom, feeling numb. Now, even on the hardest days, she's got help. For NPR News, I'm Kate Wells in Ann Arbor, Mich.

Copyright © 2021 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

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Children's Hospitals Saw Rise In Eating Disorder Cases During Pandemic

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LULU GARCIA-NAVARRO, HOST: Since the pandemic began, children's hospitals have seen a surge in admissions for eating disorders. And many parents feel desperate, knowing their child is sick but unable to access treatment because of a chronic shortage of therapists and programs that can help them.

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Bulimia is an eating disorder. It is characterized by uncontrolled episodes of overeating, called bingeing. This is followed by purging with methods such as vomiting or misuse of laxatives. Bingeing is eating much larger amounts of food than you would normally eat in a short period of time, usually less than 2 hours.

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Bulimia nervosa - causes, symptoms, diagnosis, treatment & pathology

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Suffering in Silence: Examining Obsessive Compulsive Behaviors in the School Setting

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Suffering in Silence: Examining Obsessive Compulsive Behaviors in the School Setting

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Obsessive-compulsive disorder (OCD) is considered a chronic (long-term) mental health condition. This psychiatric disorder is characterized by obsessive, distressful thoughts and compulsive ritualistic behaviors. Those with obsessive-compulsive disorder are known to have a variety of symptoms and behaviors that are a characteristic of the disorder.

A person with OCD commonly performs the same rituals (such as handwashing) over and over and may feel unable to control these impulses. These repetitive behaviors are often performed in an effort to reduce distress and anxiety.﻿﻿﻿﻿

Characteristics / Traits / Symptoms

The symptoms of OCD may involve characteristics of obsessions, behaviors that would indicate compulsions, or both. Symptoms are often associated with feelings of shame and concealment (secretiveness).

Common Obsessive Symptoms

In OCD, obsessions are defined as repetitive thoughts, urges, impulses, or mental images that cause anxiety or distress. These obsessions are considered intrusive and unwanted.

The person attempts to ignore or suppress the thoughts, urges, or images via some other thought or action (such as performing compulsive actions).

Common obsessions exhibited by those with OCD may include:

Fear of getting germs by touching items perceived as being contaminated (exhibited by fear of touching things that others have touched, the fear of shaking hands, and more)

A strong need for order exhibited by feelings of extreme anxiety when things are out of order or asymmetrical or when objects are moved by someone else and/or difficulty leaving the house (or the room) until objects are deemed perfectly placed

Taboo thoughts which often involve very troubling thoughts about topics such as sex or religion

Aggressive thoughts which often involves fear of harming others or self and may manifest as compulsive behaviors, such as being obsessed with news reports about violence

Common Compulsive Symptoms of OCD

Compulsions can be defined as specific types of repetitive behavior or mental rituals that a person with OCD often engages in (to the point of being ritualistic). These repetitive behaviors help reduce distress that comes from obsessive thoughts.

There is a very strong compulsion to perform these repetitive actions and behaviors, and over time, they become automatic. A person feels driven to perform these repetitive behaviors as a way of either lowering anxiety or preventing a dreaded event from occurring.

Compulsive behaviors may include repeatedly checking things, handwashing, praying, counting, and seeking reassurance from others.

Specific examples of common compulsions in people with OCD include:

Excessive handwashing or cleaning (which may include taking repetitive showers or baths each day)

Excessive organizing (putting things in exact order or having a strong need to arrange things in a very precise manner).

Ritualistic counting (such as counting the numbers on the clock, counting the number of steps taken to reach a certain place or counting floor or ceiling tiles)

Repetitively checking on things (such as checking doors and windows to ensure they are locked or checking the stove to make sure it's turned off)

Most people (even those without OCD) have some mild compulsions-such as the need to check the stove or the doors a time or two before leaving the house-but with OCD, there are some specific symptoms that go along with these compulsions such as:

The inability to control the behaviors (even when the person with OCD is able to identify the thoughts or behaviors as abnormal)

Spending at least one hour each day on the obsessive thoughts or behaviors or engaging in behavior that results in distress or anxiety or erodes the normal function of important activities in life (such as work or social connections).

Experiencing a negative impact in day-to-day life as a direct result of the ritualistic behaviors and obsessive thoughts

Having a motor tic-a sudden, quick, repetitive movement -like blinking the eye, facial grimacing, jerking of the head, or shoulder shrugging. Vocal tics that may be common in those with OCD include clearing the throat, sniffing and other sounds.

Common Traits of People With OCD

Some adults, and most children with OCD, are unaware that their behaviors and thoughts are abnormal. Young children are not usually able to explain the reason they have disturbing mental thoughts or why they perform ritualistic behaviors. In children, the signs and symptoms of OCD are usually detected by a teacher or a parents.﻿﻿

Commonly, people with OCD may use substances (such as alcohol or drugs) to lessen the stress and anxiety associated with their symptoms. The symptoms of OCD may change over time; for example, some symptoms will come and go, others may lesson or they may get worse over time.

Diagnosis or Identifying OCD

There are no diagnostic lab tests, genetic tests, or other formal tests for diagnosing OCD. A diagnosis is made after an interview with a skilled clinician (a professional who has been trained in diagnosing mental health conditions). This could be a licensed clinical social worker, a licensed psychologist, or a psychiatrist (a medical doctor specializing in the field of psychiatry).

The qualifications for who can make a formal diagnosis varies from state to state. For example, in some states, a diagnosis can be made by a licensed professional counselor (LPC) in addition to other licensed professionals. Be sure to check your state's mandates on who can make a diagnosis in your geographic location.

Here are the traits and symptoms that a qualified clinician will look for when formulating a diagnosis of OCD:

Does the person have obsessions?

Does the person exhibit compulsive behaviors?

Do the obsessions and compulsions take up a significant amount of the person's time/life?

Do the obsessions and compulsions interfere with important activities in life (such as working, going to school or socializing)?

Do the symptoms (obsessions and compulsions) interfere with a person's values?

If the clinician finds that the obsessive, compulsive behaviors take up a lot of the person's time and interfere with important activities in life, there may be a diagnosis of OCD.

If you suspect that you, or a friend or family member may have OCD, be sure to consult with your healthcare provider about the symptoms as soon as possible. When left untreated, OCD can impact all aspects of a person's life. Also, keep in mind that early diagnosis and intervention equates to better treatment outcomes.

The exact cause of OCD is unknown, but new research is uncovering some strong evidence that points to why OCD occurs. This may help to provide insight into successful treatment of OCD in the future. ﻿﻿

A 2019 study discovered new data that enabled researchers to identify the specific areas of the brain and the processes associated with the repetitive behaviors of those with OCD.﻿﻿

Researchers examined hundreds of brain scans of people with OCD and compared them with the brain scans of those who did not have OCD. This is what the researchers discovered:

MRI brain scans revealed structural and functional differences in neuronal (nerve) circuits in the brains of those with OCD.﻿﻿

The brains of those with OCD were unable to use normal stop signals to quit performing the compulsive behaviors (even when the person with OCD knew they should stop).

Error processing and inhibitory control are important processes that were altered in the brain scans of those with OCD. These functions (error processing and inhibitory control) normally enable a person to detect and respond to the environment and adjust behaviors accordingly.

According to the lead study author, Luke Norman, Ph.D., "These results show that, in OCD, the brain responds too much to errors, and too little to stop signals. By combining data from 10 studies, and nearly 500 patients and healthy volunteers, we could see how brain circuits long hypothesized to be crucial to OCD are indeed involved in the disorder," says Norman.

Early identification and prompt treatment of OCD is important. There are some specific types of treatment as well as medication that may be more effective when the disease is diagnosed early on.﻿﻿

But, in many instances, a diagnosis of OCD is delayed. This is because the symptoms of OCD often go unrecognized, partially because of the wide range of diverse symptoms. Also, many manifestations (such as obsessive thoughts) are kept secret by the person with OCD.

In fact, according to an older study published in the Journal of Clinical Psychiatry, it takes a person on average of 11 years to start treatment after meeting the diagnostic criteria for the disease.﻿﻿

A 2014 study, published by the Journal of Affective Disorders, discovered that early detection and treatment are known to result in better treatment outcomes. ﻿﻿

Often, people with OCD realize significant improvement in symptoms with proper and timely treatment, some people even achieve remission.﻿﻿

Cognitive Therapy

There are a variety of cognitive therapy modalities used to treat OCD.

Exposure and Response Prevention (ERP)

Exposure and response prevention is one type of cognitive therapy that is used to treat OCD. This type of therapy encourages people with OCD to face their fears without engaging in compulsive behaviors. ERP aims to help people break the cycle of obsessions and compulsions to help improve the overall quality of life for those with OCD.

Exposure and response therapy begins with helping people confront situations that cause anxiety. When a person has repeated exposure, it helps to lower the intensity of anxious feelings associated with certain situations that normally engender distress.

Starting with situations that cause mild anxiety, the therapy involves moving on to more difficult situations (the ones that cause moderate and then severe anxiety).

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is a type of therapy offers elements of ERT, but also includes cognitive therapy, so it's considered a more all-inclusive type of treatment, compared to ERP alone.

Cognitive therapy is a type of psychotherapy that helps people change their problematic thoughts, emotions, and behaviors, improving skills such as emotional regulation and coping strategies. This helps people to more effectively deal with current problems or issues.

The therapy can include 1-to-1 sessions with a therapist or group therapy; it's also offered online by some providers.

Motivational Interviewing

Using motivational interviewing is thought to increase engagement in therapy and improve outcomes for people with OCD.

Medication

There are several types of medication commonly prescribed to treat OCD. Selective serotonin reuptake inhibitors (SSRIs) are the preferred initial pharmacotherapy for OCD.

SSRIs include Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine). Tricyclic antidepressants such as Anafranil (clomipramine) may be used.

When taking SSRI's, there are some basic guidelines that apply, these include:

People with OCD need a higher dosage of SSRIs compared to those with other types of diagnoses.

The dosage should start low and gradually increase over a four- to six-week time span until the maximum dosage is reached.

Careful monitoring by the prescribing physician is important (particularly when higher than usual dosages are given).

The medication should be given for a trial period of eight to 12 weeks (with at least six weeks of taking the maximum dose). It usually takes at least four to six weeks and sometimes up to 10 weeks to see any type of significant improvement.

If first line treatment (such as Prozac) is not effective for symptoms of OCD, it's advisable to consult with a psychiatrist (a doctor who specializes in treating mental illness and who can prescribe medications). Other medications, such as the atypical antipsychotics or clomipramine may be given to help potentiate the SSRI medication regime.

If you are prescribed medication for OCD, it's important to:

Be closely monitored by a healthcare provider (such as a psychiatrist) for side effects and symptoms of comorbidities (having two or more psychiatric illnesses at one time) such as depression, as well as being monitored for suicidal ideation (thoughts of suicide).

Refrain from suddenly stopping your medication without the approval of your healthcare provider.

Understand the side effects and the risks/benefits of your medication. You can find some general information about these medications on the NIMH (Mental Health Medications) website.

Report any side effects to your healthcare provider as soon as they are noticed, you may need to have a change in your medication.

As with any type of mental health condition, coping with OCD can be challenging, for the person who is diagnosed with OCD, as well as for the family members. Be sure to reach out for support (such as participating in an online support group) or talk to your healthcare provider or therapist about your needs.

You may need to educate friends and family members about OCD. Keep in mind that OCD is not some type of dark behavioral problem, but rather, a medical problem that is not the fault of anyone who is diagnosed with the disorder.﻿﻿﻿

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Obsessive-compulsive disorder (OCD) is considered a chronic (long-term) mental health condition. This psychiatric disorder is characterized by obsessive, distressful thoughts and compulsive ritualistic behaviors. Those with obsessive-compulsive disorder are known to have a variety of symptoms and behaviors that are a characteristic of the disorder.

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How to Treat Obsessive-Compulsive Disorder

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How to Treat Obsessive-Compulsive Disorder

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Photo Credit: https://www.verywellhealth.com/obsessive-compulsive-disorder-ocd-5084138

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Everything You Need to Know About OCD in Kids and Teens

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Everything You Need to Know About OCD in Kids and Teens

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While working on a project together, you see a friend packing up their work supplies in a very neat fashion. You can't help but point out that they've organized all their pens to be lined up in order of color and all facing the same direction in their box. "Oh," they reply. "That's just my OCD."

While often thought of as a condition related to neatness and particularness, OCD is often so much more.

Children can be particularly affected by OCD. The onset of symptoms can begin at any time, sometimes as early as three years old.

Parents and teachers need to understand the risk factors to make sure that children and teenagers who are at risk of developing OCD receive appropriate attention.

When treated properly, OCD can be controlled. If it goes unaddressed, it could lead to serious quality-of-life issues, not only for the child but also for family members.

Keep Reading To Learn

The truth about OCD

How to recognize symptoms of OCD in children and adolescents

How to successfully manage and treat OCD in young people

What Is OCD?

Obsessive compulsive disorder is highlighted by a pattern of unwanted and intrusive thoughts, fears, images, or sensations that lead to feelings of distress (including anxiety, disgust, "not just right" sensations) and repetitive behaviors aimed at canceling out that distress.

Usually, these unwanted thoughts are called obsessions. Unwanted, repetitive behaviors or mental acts are called compulsions.

Throughout life, most people will experience unwanted thoughts every so often. If the person doesn't have OCD, these unwanted thoughts won't cause much distress because they won't be interpreted as meaningful. The hallmark of OCD is that obsessions and compulsions lead to a clinically adverse impact on the life of a child.

For example, unwanted thoughts might be so bad that children have trouble sleeping at night. The repetitive behaviors may be so impactful and obstructive that the child has trouble leaving the house to go to school, play sports, or participate in their daily routine.

OCD can be devastating for a child or teen, but there's hope for those who receive proper psychiatric care

The good news is that there has been plenty of research into OCD, and there are treatment options available. Similar to other mental health disorders, the sooner this condition is diagnosed, the faster it can be treated.

For children to get the care they need, it is important to take an in-depth look at the obsessions and compulsions that fuel OCD.

Obsessions: What Are They?

Obsessions, as they relate to OCD, are fears that children, teenagers, and other individuals cannot stop thinking about. People living with OCD are usually aware that something is "off," and they often understand that the thoughts they are having are not normal.

These thoughts can make them anxious, and despite their best efforts, they cannot seem to stop thinking about them.

Some of the most common examples of obsessions include:

Fearfulness that they are going to die or get sick, no matter what they do

Concern that a loved one is going to end up getting sick, hurt, or killed

Worry that they have broken a rule and deserve to be punished severely for it

Fear of touching items because they are potentially dirty

Obsession with making sure that every object is placed in a certain, even, orderly manner

Worry that unless something is done in a specific order, it is going to lead to a bad outcome

The truth is that everyone has unwanted thoughts from time to time. The difference between occasional unwanted thoughts and OCD is that, in OCD, children cannot stop thinking about these thoughts and may be paralyzed by them. Often, these obsessions are so bad that kids cannot think about anything else.

Compulsions: What Are They?

For a child to have OCD, they need to have both obsessions and compulsions.

Compulsions are behaviors or mental acts that are typically repetitive and rigid in nature. These compulsions often take the form of rituals and are designed to counteract stress or prevent fearful outcomes. Kids with OCD have to do these behaviors over and over again in a certain order. If they do not, the obsessions take over, and they are worried that there will be a negative outcome. These behaviors might involve safety, cleanliness, orderliness, or symmetry. They have to be done "just right" or children are compelled to start over.

In a sense, these behaviors are rituals that provide children with a source of power. They feel like if they do these repetitive behaviors in a certain way, they can control what happens next.

Some of the most common examples of compulsions include:

Having to wash or clean things in a certain way every time

Thinking phrases over and over again until it "feels right"

Having to erase and rewrite, redo, or re-read things in a certain manner multiple times

Repeating a certain word or phrase much more often than is necessary until it is said an exact number of times or in exactly the right way

Checking every door in the house multiple times to make sure that is locked or passing in and out of doors several times in a row

Inspecting every light in the house to make sure it is turned off before leaving

Checking each homework assignment a certain number of times to make sure it was done properly

Chewing each bite on each side of the mouth the same number of times

Having to place everything in a specific, even, symmetrical order

Counting all items and objects to certain good numbers to avoid unlucky numbers

It's important to note that compulsions often arise out of adaptive behaviors. For example, it is good for children to double-check their homework to make sure it is done properly. On the other hand, if children end up checking their homework a dozen times to the detriment of other activities, this starts to have a clinically adverse impact on not only their life but the lives of family members as well.

The same can be said of checking to make sure that lights are turned off and doors are locked. It is good to make sure that the house is safe before leaving. However, if this prevents the family from leaving the house, this becomes a major issue.

Reclaiming Her Freedom

Read about one young patient's journey to overcome OCD.
MANAGING HER OCD
How Do You Recognize OCD in Children?

It's important for individuals, such as parents, teachers, and athletic coaches, to be able to recognize the potential signs of OCD in children. The sooner you can intervene at the start of a mental health challenge, the better their chance for a successful outcome.

There are lots of normal developmental rituals that are not attributable to OCD, like bedtime rituals. However, if a ritual is starting to affect how a child functions, that can help identify if it's more than a routine and may point to a sign of OCD.

OCD often develops slowly over time. With a gradual onset of symptoms, coupled with a parent's natural tendency to protect and soothe, it might be hard for adults to pick up on a child's symptoms of OCD when they start appearing.

It might be easier to recognize the impact that OCD has on the quality of life in children and those around them.

There are several things to watch for that may be signs of OCD.

The following aren't always signs of OCD. They are examples of behaviors that may signal that a child is in distress and may need help from a trained professional.

Homework

Children with OCD might take an excessive amount of time to complete their homework. This might include children having to read the same line over and over again, having to write each number perfectly for a math problem, or checking homework repeatedly to the point that it takes a very long time to finish.

Leaving the House

Children with OCD might slow the family down when leaving the house. For example, if a child is taking forever to get ready, then they might be checking every door, window, and light to make sure they are in the "right" positions or condition before leaving. They might throw a temper tantrum about leaving before this routine is finished. This behavior often makes the family chronically late for activities.

Handwashing

Handwashing is one of the most well-known compulsions when it comes to OCD. Handwashing may arise out of obsessions related to germs, feelings of disgust, or other forms of contamination such as "bad emotions" or fears of developing chronic stress, anxiety, or worry. If OCD is tied to handwashing, then it might be helpful to look at the hands for signs of raw, bleeding skin. If children are washing their hands dozens of times per day, the soap is going to make the skin raw, leading to scars, peeling skin, and bleeding.

Drugs or Alcohol

Sometimes when children are struggling to manage a condition, they may turn to substances as a coping mechanism. If a teen is facing mental health challenges, they may feel socially isolated, misunderstood, or overwhelmed. This occasionally leads to substance misuse.

Sleep Habits

OCD often disrupts bedtime or sleep. Children with OCD may have to go through a very specific routine before they get in bed and fall asleep. They may also have a hard time falling asleep if they have intrusive thoughts or worries that are more intense at night. If this routine is disrupted for any reason, they have to start the entire routine over. It is not unusual for OCD to lengthen the bedtime routine by 30 minutes, an hour, or even longer. This deprives children of much-needed sleep, which impacts school performance, emotional development, and relationships with their peers and family members. If sleep is disrupted consistently it can also negatively impact the effectiveness of OCD therapies, including CBT.

Keep in Mind

These behaviors do not include every way that OCD manifests in kids. It also does not mean that if a child experiences difficulty with these, then they have OCD.

These are several examples where a child may have uncomfortable thoughts, feelings, or sensations that are followed by behaviors or avoidance to feel relief from their discomfort or fear.

If this discomfort-relief cycle causes family distress or dysfunction, parents should consider speaking with a trained professional about the possibility of OCD.

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What Causes OCD in a Child?

Similar to other mental health disorders, there is never a single reason why a child develops OCD.

The following list of risk factors is far from complete but does provide a small glimpse into what could lead to the development of OCD. It is critical to keep in mind that anyone is capable of developing any mental health disorder, including OCD.

Family History, Genetics, and Environment

OCD is heritable. This simply means that if there's someone in your family who has it, there's a higher likelihood that a child might have it. The familial pattern of OCD suggests a genetic component, though there are no specific genes that have been identified to be related to OCD at this point.

When discussing nature vs. nurture, it is important to note the environment plays a role as well. Obsessions and compulsions can be learned over time. If children watch family members and others go through OCD, they may latch onto these behavioral patterns as well. As a result, environmental exposures can play a role in the development of OCD.

Stressful Events

Stressful events can be a risk factor for kids with OCD who may have underlying vulnerabilities. Children who experience trauma may develop PTSD, which can be mistaken for OCD.

While unwanted and intrusive thoughts often occur with trauma and post-traumatic stress disorder (PTSD) and can look similar to OCD, trauma focuses on intrusive thoughts based on the past traumatic event, and OCD typically focuses on future uncertainties and attempts to lessen them.

OCD Can Be Treated and Maintained-Yes, There Is Hope!

It is important to note that there is no cure for OCD. At the same time, there are plenty of ways to manage this condition effectively.

Though people diagnosed with OCD will always have to deal with some symptoms, there are very effective ways to control obsessions and compulsions. Treatment can lead to improvements in quality of life, even if there are minimal symptoms that have to be managed regularly. Over time and with effective treatment, OCD may not have any impact on someone's quality of life.

When it comes to the treatment of a child with OCD, it is important to approach this comprehensively. When all facets of OCD are addressed appropriately, children have the best chance of making a meaningful recovery.

Several components play a role in the treatment of every child with OCD. Like each child's uniqueness, every diagnosis of OCD will respond in its own way to different treatments, and as a result, may require tailoring treatments to the individual to see what works best.

Therapy

Cognitive behavior therapy, usually shortened to CBT, is an effective treatment method for people with OCD. This therapy, and others similar to it, help patients connect behaviors and thoughts.

One of the most important components of CBT is called exposure and response prevention therapy. The goal of this type of therapy is to expose children to a feared object or obsession gradually.

With proper treatment, young people who struggle with OCD can live fulfilling and healthy lives

For example, a child who is afraid of germs might be exposed to dirt. Then, the child, with the guidance of a mental health professional, learns to resist the urge to complete compulsive rituals.

As OCD affects everyone in the family, parents and siblings need to learn how to best support children. Family-based approaches to therapy have been proven to be very successful. Also, there are even parent-led approaches to therapy for kids who are reluctant to go to treatment. The parent learns how to teach their child coping skills.

Even though this type of therapy takes time, it has been shown to vastly improve the quality of life in children with OCD.

Medications

Certain psychiatric medications can help children control the obsessions and compulsions that go along with OCD. If behavioral treatment is difficult to access or appears to be mildly effective, then a serotonin reuptake inhibitor (SRI), a specific class of antidepressant, may be helpful to add to the child's care plan.

Some of the most common antidepressants that might be used in children that have been diagnosed with OCD include:

Anafranil (clomipramine) is used in children ten years of age or older

Fluvoxamine is used in children eight years of age or older

Prozac (fluoxetine) is used in children seven years of age or older

Zoloft (Sertraline) is used in children six years of age or older

If considering medication, parents should speak with doctors in depth about all possibilities to understand the risks and benefits of each medication.

All psychiatric medications have potential side effects. Parents should understand possible side effects, the chances of these side effects developing, know how to spot them, and when to contact their provider about potentially stopping medication.

Many children who are placed on medication for OCD may be able to come off medication once they have learned exposure and response prevention skills and use them regularly.

Each OCD journey is different and should be treated as such by providers and parents alike. For some young people and their families, once-weekly outpatient visits aren't enough. If that's the case, it may be helpful to consider getting a consultation from a psychiatrist for medication. Additional options include a higher level of care, like intensive outpatient or residential treatment or a parent-only approach to help through familial support.

What Should I Do If My Child Might Have OCD?

Parents, caretakers, and family members need to remain vigilant and understand that there is nothing wrong with asking for help for their child. Also, kids and teens need to know that it's perfectly okay-and normal-to reach out for help if they are feeling troubled.

It is important to note that children with OCD are not damaged, broken, or harmed beyond repair. When children with OCD are approached with sympathy and understanding, it is easier for them to open up about their problems.

If you think you know someone who may be struggling with OCD, the first step is to not panic. While the disorder may feel crippling, there are many ways to get help that is tailored to what's needed for each child. Seeking help-and treatment-can provide a child and their family with the tools to feel empowered and in control of their mental health.

A potential diagnosis of OCD should be discussed with the child's care team to determine the next steps. Call your primary care physician or a local mental health facility, like McLean, to find the care you need.

How Does Someone Get Formally Diagnosed With OCD?

Several steps must take place to properly diagnose a child. Usually, this diagnosis is going to be made by a trained professional, such as a psychiatrist or psychologist, along with assistance from other doctors or health care providers, such as a pediatrician.

What to Expect

An evaluation to determine a diagnosis may include both self-and parent-reporting questionnaires and personal interviewing. These interviews include specific questions to identify the presence of obsessions and rituals.

A trained professional sits down and speaks with a child about feelings, thoughts, symptoms, and behavioral patterns. The goal is to identify any specific obsessions or compulsions.

Then, a psychological evaluation takes place in an attempt to identify the reason why these obsessions and compulsions are present. There has to be an anxiety or fear of a negative or "not right" experience that might happen if things are not done in a certain way.

Finally, it is important to determine whether or not these behaviors harm the child's quality of life. During this evaluation, the evaluator often speaks with the family members and friends as well.

To make the official diagnosis, the psychiatrist uses criteria that are published in the Diagnostic and Statistical Manual of Mental Health Disorders, usually shortened to DSM-5. This is published by the American Psychiatric Association and guides mental health professionals.

In diagnosing OCD, it is important to rule out alternative causes of this behavior. Therefore, a physical exam might take place to check for symptoms and problems that could be related to complications of OCD or a possible alternative diagnosis.

If this process is completed and the child meets the criteria for OCD, the treatment and recovery process can begin.

Help Your Child Feel More Like a Kid

Whatever mental health difficulties your child may be dealing with, McLean is here to help. Contact us today at 877.626.8140 to learn more about treatment options for children, teens, and young adults.
YOUTH MENTAL HEALTH
What You've Heard About OCD Likely Isn't True

Amongst mental health disorders, obsessive compulsive disorder is one of the most common. Despite this, there are prominent misconceptions about how OCD presents in individuals that can make it challenging for many to understand the condition.

Each case of OCD is as unique as the person diagnosed with it, and there are many misconceptions about the disorder. Along with many people loosely using the terminology "being OCD" to describe perfectionism, several myths have emerged about OCD.

Myth: People With OCD Want Everything to Be Perfect

People diagnosed with OCD may exhibit perfectionism-related behaviors or have perfectionism-related obsessions. However, they typically stem from attempts to reduce anxiety or distress associated with uncertainty or a specific feared outcome-not because they want everything to be perfect.

Myth: People With OCD Are Just Germaphobes

While it is true that some obsessions and compulsions are related to germs and handwashing, OCD comes in many shapes and forms and often does not manifest only with an aversion to germs.

Myth: People With OCD Should "Just Relax," and It'll Go Away

OCD is a serious mental health disorder. It is a medical condition that deserves the same level of care and compassion as cancer, diabetes, or heart disease. Those of us with OCD would love to relax. However, that may not be achievable through being told to calm down.

If your child is struggling, McLean offers world-class mental health care for children and teens with OCD and related disorders. Let us help you find the treatment option that's right for your child. Contact us today.

Want More Info?

Looking for even more information about OCD in children? You may find these resources helpful.

Interesting Articles and Videos and More

Learn more about youth mental health and what you can do if your child is displaying signs of OCD.

Helpful Links

These organizations may also have useful information:

International OCD Foundation
The mission of the International OCD Foundation is to help people affected by obsessive compulsive disorder and related disorders to live full and productive lives. The IOCDF aims to increase access to effective treatment through research and training, foster a hopeful and supportive community for those affected by OCD and the professionals who treat them, and fight stigma surrounding mental health issues.

OCD Massachusetts
As a non-profit affiliate of the IOCDF, OCD Massachusetts aims to provide public and professional education about OCD to raise awareness and improve the quality of treatment provided in Massachusetts. They also work to improve access to resources for those with OCD and their families and advocate and lobby for the OCD community in Massachusetts.

Not Alone Notes
Not Alone Notes is a nonprofit organization that mails free, handwritten letters to people with OCD and related disorders. Their goal is to remind others they aren't alone, encourage hope, and dispense resources.

Peace of Mind
Now part of the International OCD Foundation, provides educational resources and access to self-help tools, offers scholarship opportunities, supports professional training programs, and spreads awareness about OCD and related disorders.

Books About OCD

Obsessive Compulsive Disorder: Elements, History, Treatments, and Research
by Leslie J. Shapiro
(ABC-CLIO, 2020)

Stuff That's Loud: A Teen's Guide to Unspiraling When OCD Gets Noisy
by Ben Sedley and Lisa W. Coyne
(New Harbinger, 2020)

Acceptance and Commitment Therapy: The Clinician's Guide for Supporting Parents
by Koa Whittingham and Lisa W. Coyne
(Elsevier, 2019)

Understanding OCD: Skills to Control the Conscience and Outsmart Obsessive Compulsive Disorder
by Leslie J. Shapiro
(Praeger, 2015)

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Everything You Need To Know About OCD in Kids and Teens

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While working on a project together, you see a friend packing up their work supplies in a very neat fashion. You can't help but point out that they've organized all their pens to be lined up in order of color and all facing the same direction in their box.

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Photo Credit: https://www.momjunction.com/articles/ocd-in-children-symptoms-treatment-home-care_00722120/

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Each child is an individual with different social, emotional, and academic strengths and weaknesses. Therefore, their educational needs may vary from one season or school year to the next.

In the first section of our chapter, "School: A Child's World Beyond Home" we cover the legal evolution of the Individual with Disabilities Educational Act (IDEA 2004) and advise a parent how to initiate an Individual Education Plan (IEP), prepare for the IEP meeting (including rehearsal strategies), and locate educational consultants and attorneys.

But the more we talked to people in preparation for this chapter, the more we came to understand that both parents and educators were confused about the construction of an IEP for a student struggling with a bipolar disorder. A model IEP-one that specifically addresses the seasonal variations in mood, energy, attention, motivation, and behavior, as well as one that addresses the frequently co-occurring executive function deficits, needed to be developed.

Therefore, we asked special education advocate, Anne Marie Smith, M. Ed., from Agawam, Massachusetts, to construct an IEP that might provide guidelines for educating a middle school student throughout the school year.

With the hope that the following information is helpful to parents and educators alike, we excerpt the following from The Bipolar Child (pages 305-311.) Also see pages 295-303 in the book for a highly focused and very comprehensive list of accommodations, modifications, and special services that can be incorporated into an IEP.
From The Bipolar Child by Demitri Papolos, M.D. and Janice Papolos (Broadway Books, 2006). All rights reserved.

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Bipolar Children Individual Education Plan (IEP) Model

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Each child is an individual with different social, emotional, and academic strengths and weaknesses. Therefore, their educational needs may vary from one season or school year to the next.

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Not all students who have disabilities require specialized instruction. For students with disabilities who do require specialized instruction in the United States, the IDEA controls the procedural requirements and an IEP is developed. "Special education" under IDEA means the child has been identified as having unique educational needs related to his/her disability and is entitled to an Individualized Education Program (IEP) to meet these needs.

The IDEA process is more involved than that of Section 504 of the Rehabilitation Act. The IDEA requires that measurable growth and progress towards written goals and objectives be documented.

For students with disabilities who do not require specialized instruction but need the assurance that they will receive equal access to public education and services, a document is created to outline their specific accessibility requirements. Section 504 is a federal civil rights law. The purpose of Section 504 is to protect persons with disabilities against discrimination for reasons related to their disabilities.

While students with a 504 plan do not require specialized instruction, and specific goals and objectives are not necessarily outlines nor is data tracked, the plan should be reviewed annually to ensure that the student is receiving the most effective accommodations for his/her specific circumstances.

Unlike IDEA, Section 504 does not guarantee that a child with a disability will receive an individualized educational program that is designed to meet the child's individual educational needs. Rather, it guarantees that accommodations will be made relative to their specific medical needs.

Eligibility for protections under Section 504 depends on the child in question having a physical or mental impairment which must substantially limit at least one major life activity. Major life activities include walking, seeing, hearing, speaking, breathing, learning, reading, writing, performing math calculations, working, caring for oneself, and performing manual tasks. Section 504 requires an evaluation that draws information from a variety of sources.

A child who receives Section 504 protections has fewer rights than the child who receives special education services under the IDEA. The child who receives special education services under the IDEA is automatically protected under Section 504.

Section 504 is designed to guarantee that children with disabilities will not be discriminated against. It is also important to understand that if your child does not qualify for special education services under IDEA, your child does not have the procedural protections that are available under the IDEA.

Under Section 504, the child with a disability may receive accommodations and modifications that are not available to children who are not disabled. These accommodations and modifications are also available under IDEA. For example; accommodations could include, but not be limited to, such things as:

Tests taken in a separate location with time limits waived or extended.

The use of a word processor due to fine motor, visual motor deficits.

Shortened assignments.

Standardized tests answers written directly in the test booklet and transferred onto answer sheet by teacher or assistant.

Class notes provided rather than having the student copy from the chalkboard or overhead.

Allowing the child to leave the classroom 2 to 3 minutes early to avoid crowded hallways.

Preferential seating in the classroom.

Provision of a daily assignment sheet to be filled out by the student and verified by the teacher for accuracy. The parent could then check to make sure that all the work is accomplished. This would assist with homework prioritizing and management.

Please note: These are simply examples. All or none of these may be suitable for your child.

Students with bipolar disorder may or may not have a need for specialized instruction provided within an IEP. For some students, simply being granted accommodations that make allowance for the side effects of medications, related anxiety issues, or results of mood changes is sufficient.

Students with bipolar disorder who are well-controlled on medication may or may not be plagued by racing thoughts, distracting thoughts, an inability to concentrate, decreased energy; all of which will require modifications in the teaching environment or instructional strategies.

For other students, the side effects of medications may be significant enough to require changes in instruction provided or curriculum modifications. Some of the common side effects of medications include: tremors (trembling of hands), blurred vision, loss of coordination, slurred speech, sedation, ataxia (unsteady movement), dizziness, seizures. Some students with bipolar disorder may also have one of a number of other disabilities that impacts their access to the general education curriculum; such as vision or hearing impairment, learning disability, processing problems, or other disability. The co-morbidity rates of ADHD, anxiety disorder, conduct disorder, oppositional-defiant disorder and learning disabilities in students with bipolar disorder tell us that we should explore all avenues available to meet the educational needs of our children.

The following accommodations are meant to serve as a resource for parents unsure of what possibilities exist:

Students on some medications may need:

increased access to water, unlimited access to restrooms (particularly students taking Lithium)

decreased reading assignments or having books on tape or computer screen-reading due to blurred vision

modified school arrival, shortened day, scheduling of core content during the student's most alert time, reducing homework and extending deadlines, providing notes, allowing longer or more frequent breaks, allowing exercise or other movement due to sleep impairment or to sedation of medications

provision of notes and listening guides, work monitoring, extended time on assignments, extra set of books for home use, breaking assignments into more manageable pieces, use of checklists, providing written instructions and/or other visual cues, use of word banks on fill-in types of tests and other modifications that aid retrieval/memory, testing in a separate room, or extended test time, use of multiple choice formats, use of oral exams rather than written demands, use of noise-canceling headsets, - all for impaired concentration, memory

reducing or discontinuing homework may be necessary for some students due to difficulties with concentration, sleep patterns, mood irritability. For these students it may be necessary to schedule a resource room period at the beginning of the day to get assignments ready for the day, or at the end of the day to complete assignments before leaving school

preferential seating can be used to help with vision, focus, reduce visual or auditory distraction, allow for discrete monitoring

and while a 504 plan will simply list the type of accommodation needed and the reasons for it/them, an IEP must contain objectives that are written with specific criteria; such as -Given a grade level reading assignment of 1 chapter with 4 comprehension questions, (name) will answer the questions with 60/70/80% accuracy. Or given an assignment containing 5 long division problems, (name) will complete 3/4/5 problems at 80% accuracy.

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Accommodations for Students with Bipolar Disorder and Related Disabilities - International Bipolar Foundation

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Diagnosing Psychotic Disorders: Mood and Psychosis

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Diagnosing Psychotic Disorders: Mood and Psychosis

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Counseling Youth Who Have Bipolar Disorders

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Counseling Youth Who Have Bipolar Disorders

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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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The Clinician's Pathway Program (CPP) and its assessment tools, the CBQ and JJ, were developed by Dr. Demitri Papolos. By clicking the links below you will leave www.jbrf.org and be redirected to the research site that contains the CPP and the CBQ & JJ assessments. If you have any questions or concerns regarding these tools please direct them to Dr. Papolos's system administrator at CPP@drpapolos.com To Set Up a New CPP Account To Access an Existing CPP Account
Scoring for assessments within the CPP is a fee-based service offered by the private practice of Demitri Papolos, M.D.; this service is independent of JBRF but may be accessed through the JBRF website. Dr. Papolos developed the CBQ & JJ measures and their automated scoring report with the support of JBRF. Questions and/or concerns with regard to the scored report should be addressed to CPP@drpapolos.com

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JBRF - Juvenile Bipolar Research Foundation

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The Clinician's Pathway Program (CPP) and its assessment tools, the CBQ and JJ, were developed by Dr. Demitri Papolos. By clicking the links below you will leave www.jbrf.org and be redirected to the research site that contains the CPP and the CBQ & JJ assessments.

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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.

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At a glance

The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education services to eligible students.

IDEA covers 13 disability categories.

Not every student who struggles in school qualifies.

The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education and related services to eligible students. But not every child who struggles in school qualifies. To be covered, a child's school performance must be "adversely affected" by a disability in one of the 13 categories below.

1. Specific learning disability (SLD)

The "specific learning disability" (SLD) category covers a specific group of learning challenges. These conditions affect a child's ability to read, write, listen, speak, reason, or do math. Here are some examples of what could fall into this category:

SLD is the most common category under IDEA. In the 2018-19 school year, around 33 percent of students who qualified did so under this category.

2. Other health impairment

The "other health impairment" category covers conditions that limit a child's strength, energy, or alertness. One example is ADHD, which impacts attention and executive function.

3. Autism spectrum disorder (ASD)

ASD is a developmental disability. It involves a wide range of symptoms, but it mainly affects a child's social and communication skills. It can also impact behavior.

Various mental health issues can fall under the "emotional disturbance" category. They may include anxiety disorder, schizophrenia, bipolar disorder, obsessive-compulsive disorder, and depression. (Some of these may also be covered under "other health impairment.")

5. Speech or language impairment

This category covers difficulties with speech or language. A common example is stuttering. Other examples are trouble pronouncing words or making sounds with the voice. It also covers language problems that make it hard for kids to understand words or express themselves.

6. Visual impairment, including blindness

A child who has eyesight problems is considered to have a visual impairment. This category includes both partial sight and blindness. If eyewear can correct a vision problem, then it doesn't qualify.

Kids with a diagnosis of deafness fall under this category. These are kids who can't hear most or all sounds, even with a hearing aid.

The term "hearing impairment" refers to a hearing loss not covered by the definition of deafness. This type of loss can change over time. Being hard of hearing is not the same thing as having trouble with auditory or language processing.

Kids with a diagnosis of deaf-blindness have both severe hearing and vision loss. Their communication and other needs are so unique that programs for just the deaf or blind can't meet them.

10. Orthopedic impairment

An orthopedic impairment is when kids lack function or ability in their bodies. An example is cerebral palsy.

11. Intellectual disability

Kids with this type of disability have below-average intellectual ability. They may also have poor communication, self-care, and social skills. Down syndrome is one example of a condition that involves an intellectual disability.

12. Traumatic brain injury

This is a brain injury caused by an accident or some kind of physical force.

13. Multiple disabilities

A child with multiple disabilities has more than one condition covered by IDEA. Having multiple issues creates educational needs that can't be met in a program designed for any one disability.

Having a disability is not enough to qualify for special education. The disability has to have an "adverse effect" on a child's education.

Key takeaways

Each of the 13 disability categories in IDEA can cover a range of difficulties.

Dyslexia, dyscalculia, and written expression disorder fall under the "specific learning disability" category.

"Other health impairment" can cover ADHD.

About the author

About the author

Andrew M.I. Lee, JD is an editor and attorney who strives to help people understand complex legal, education, and parenting issues.

Reviewed by

Reviewed by

Rayma Griffin, MA, MEd has spent 40 years working with children with learning and thinking differences in the classroom and as an administrator.

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The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education services to eligible students. IDEA covers 13 disability categories. Not every student who struggles in school qualifies. The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education and related services to eligible students.

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Is it a modification or is it an accommodation(1)

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Make Learning Accessible for All Students

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Make Learning Accessible for All Students

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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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Working to deliver a better special education service

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Home - ADDA - Attention Deficit Disorder Association

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Empowering adults with adhd to live their best lives A Different Brain Requires a Different Approach Whether you're newly diagnosed, wondering if you have ADHD, or simply ready to take charge of your life - we're here to help. Have ...

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Disruptive Behavior Disorders Fact Sheet

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Disruptive Behavior Disorders Fact Sheet