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Supporting Students Experiencing Early Psychosis in Middle and High School

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Supporting Students Experiencing Early Psychosis in Middle and High School

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What Teachers Should Know

Bipolar disorder affects how the brain functions, causing shifts in a person's moods and energy levels. It's also called manic depression, manic-depressive disorder, manic-depressive illness, bipolar mood disorder, and bipolar affective disorder.

People with bipolar disorder go through episodes of low-energy depression and high-energy mania.

Depression episodes may include:

sadness or feelings of worthlessness or guilt

loss of interest in usual activities

sleeping too much or inability to sleep

inability to concentrate and a drop in academic performance

inability to experience pleasure

overeating or loss of appetite

thoughts of death or suicide

Mania episodes may include:

increased physical and mental activity

racing speech and thoughts

elevated mood and exaggerated optimism

inflated sense of self-importance

decreased need for sleep

difficulty concentrating

reckless or aggressive behavior

anger, excessive irritability, or impatience

poor judgment and making rash decisions

In adults, mania or depression episodes can last weeks or months. In kids and teens, episodes can be much briefer, going back and forth between mania and depression throughout a day.

Without treatment, bipolar disorder can worsen as children get older. But following a medication treatment plan and making a few lifestyle changes - like eating a nutritious diet, getting enough sleep, exercising regularly, and managing stress - can help kids and teens with bipolar disorder control the symptoms and lead normal lives.

Students with bipolar disorder may:

need seating near the front of the room to help avoid distractions

show drops in grades and changes in class participation

need additional time for tests and assignments or require modified schedules

miss class time due to appointments with health care professionals

need to visit the school nurse for medication

need to carry a water bottle and have unlimited access to restrooms (especially students taking lithium)

need to talk with a school counselor or psychologist periodically

be at a higher risk for suicide

What Teachers Can Do

Treatment for bipolar disorder usually involves the use of medications, such as mood stabilizers, and counseling or psychotherapy. Teachers need to watch for extreme behavioral changes or any signs of suicidal thoughts. Educators should take these signs seriously. The student's parents or guardians, psychologist, or other health care professionals can talk to school staff about how to respond to such situations.

Encourage your students with bipolar disorder to participate in all school-based activities as best they can, when they can.

Plan and agree on a "safe place" with your student - a place to go if he or she feels overwhelmed or just needs to relax. You also can agree on a "safe person" (possibly you) your student can talk to. When your student needs to go to the safe place or talk with the safe person, allow for a discreet exit without drawing his or her classmates' attention.

If the student does not have an individualized education plan (IEP) or a 504 education plan, consult with a school counselor, psychologist, or social worker to see if developing a plan with parents or guardians would help. If the student does have an IEP or 504, make sure to follow the plan's requirements.

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bipolar mood disorder and bipolar affective disorder

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Bipolar Disorder Factsheet (for Schools)

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Bipolar disorder affects how the brain functions, causing shifts in a person's moods and energy levels. It's also called manic depression, manic-depressive disorder, manic-depressive illness, bipolar mood disorder, and bipolar affective disorder. People with bipolar disorder go through episodes of low-energy depression and high-energy mania.

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Educating the Child with Bipolar Disorder

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Educating the Child with Bipolar Disorder

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OCD is like an unwelcome guest with bad manners. It moves into a mind - and it doesn't want to leave.
Students with OCD may appear to be daydreaming, distracted, disinterested, or even lazy. They may seem unfocused and unable to concentrate. But they are really very busy focusing on their nagging urges or confusing, stressful, and sometimes terrifying OCD thoughts and images. They may also be focused on completing rituals, either overtly or covertly, to relieve their distress.

While frustrating to educators, OCD may be torture for the students who have it. This disorder may be difficult to identify because its observable symptoms are similar to other conditions and mental disorders, and mental rituals cannot be observed. Symptoms in children and adolescents can change over time, and they tend to wax and wane for no apparent reason. School personnel who have a good understanding of the variety of behaviors that may signal OCD are better equipped to initiate a plan to assist the student.

The Effect of OCD on Academic Performance

Even very bright and motivated students can struggle with OCD. Although students with OCD typically have average to above-average intelligence levels, they may be unable to learn the same way others do because their focus is frequently on their obsessions or compulsions. Depending on the severity of the symptoms, some students find it difficult to learn and, for some, it's almost impossible to concentrate on and complete schoolwork.

Although they want to pay attention, participate in discussions or presentations, study, and complete homework, they feel compelled to respond to their obsessions or urges.

Students who have untreated OCD re likely to have a very difficult time concentrating in the classroom and completing homework assignments. They may experience overwhelming anxiety or strong urges, possibly describing the feeling of mounting anxiety or intensifying urges as if they were a rising volcano or a tea kettle about to boil - and relief comes when the pressure is released. Unfortunately, the release is usually a compulsive behavior that may be disruptive to learning and possibly to the classroom.

It may not be long before the student who has OCD falls behind and sees a drop in grades. In some cases, academic performance deteriorates abruptly and dramatically. And it may be nearly impossible to catch up unless a student can learn to manage the symptoms. For these reasons, it's important that school personnel take OCD seriously and work with the student and the family to provide support.

What Does OCD Look Like at School?

A student may enter a classroom at the beginning of the school year with a diagnosis of OCD, or the disorder may develop later. Whenever a student begins to falter - academically, socially, or emotionally - educators need to intervene. A proactive approach can make an impressive difference in a student's coping ability, academic performance, and interpersonal capabilities.

The first step is being aware of the behaviors that can signal OCD. The disorder includes a wide variety of symptoms in children and adolescents, which are not always obvious. It is important to keep in mind that OCD symptoms can look like other disorders, so it is critical that a mental health specialist trained in OCD and related disorders conduct a diagnostic assessment OCD can be confused for symptoms of ADHD and anxiety disorders, as well as acting out" or misbehavior not associated with a neurobiological disorder. Also, OCD changes in nature or scope from one set of obsessions and compulsions to another, with differing behaviors, and symptoms can worsen and or seem to disappear, often for no obvious reason.

Common Symptoms of OCD at School

Below are common OCD symptoms of children and adolescents in school.

Obsession: Fears of germs or contamination
Compulsions
* Repeatedly washing hands, using antibacterial wipes or hand-sanitizer
* Protecting what is perceived as clean space -- personal desk, locker, or other property
* Avoiding touching surfaces that others may have touched, such as doorknobs, desks, shared supplies, lab tables or equipment, computer keyboards, paints, paste, soap, cafeteria trays, etc.
* Avoiding contact play or sports either because of a fear of catching a disease or fear of contaminating another student
* Avoiding the use of bathrooms
* Seeking reassurance that they or others are not sick or dirty
* Refusing to share items or supplies with others
* Refusing to eat in the cafeteria
* Avoiding certain products because they may contain poison, such as substances used in chemistry

Obsession: Fears that harm, illness, or death, will befall oneself or others; fear of causing harm to oneself or others, including violent or aggressive obsessions (Note: People with OCD who have violent or aggressive thoughts do not have a history of violence or act upon these urges or ideas.)
Compulsions
* Checking behavior, such as making sure doors or windows are locked or turning light switches on and off repeatedly
* Reading a paragraph over and over again to prevent harm from coming to a loved one, another person, or a pet.
* Asking the teacher for reassurance that the student is safe
* Avoiding leaving a perceived safe zone (classroom); avoiding going into unsafe zones (lunch or recess areas) or open spaces such as a gymnasium
* Unreasonable avoidance of peers, teachers, for fear of causing them harm

Obsession: Fears that harm, illness, or death, will befall oneself or others; fear of causing harm to oneself or others, including violent or aggressive obsessions ( Note: People with OCD who have violent or aggressive thoughts do not act upon these urges or ideas OR have a history of violence.)
Compulsions
* Checking behavior, such as making sure doors or windows are locked or turning light switches on and off repeatedly
* Reading a paragraph over and over again to prevent harm from coming to a loved one, another person, or a pet.
* Asking the teacher for reassurance that the student is "safe"
* Avoiding leaving a perceived "safe" zone (classroom); avoiding going into "unsafe" zones (lunch or recess areas) or open spaces such as a gymnasium
* Unreasonable avoidance of peers, teachers, for fear of causing them harm

Obsession: Fears, feelings, or urges related to numbers
Compulsions
* Counting, touching, or saying words a certain number of times due to believing in a magical significance to certain numbers or using those numbers to keep harm away; counting the number of steps between locations and having to start over if interrupted
* Touching objects a certain number of times; not being able to move on unless this touching has been accomplished
* Reading words or pages a certain number of times
* Going back and forth through doorways a certain number of times before it's OK to enter the room
* Avoiding using certain numbers that are perceived as unlucky or not safe; only using numbers that are perceived as safe or lucky. (math problems may be answered improperly, pages may not be read or pages may be numbered out of sequence )

Obsession: Fears, feelings, or urges related to discarding items because something bad will happen; feelings of incompleteness if something is discarded or the need document and preserve all life experiences; fears of contamination; need to buy items in multiples of a particular number; not discarding objects to avoid repetitive rituals such as washing or checking. (Note: This form of hoarding is related to the obsessions and compulsions of OCD and is distinct from hoarding disorder.)
Compulsions
* Saving scraps of paper, candy wrappers, bottle caps, broken items, or other useless items; inability to part with unneeded things
* Keeping books, toys, food, school papers, clothing, or other items for fear that they might be needed sometime in the future
* Buying every item in a store that one has touched (and therefore contaminated) to prevent others from being contaminated
* Accumulating items or objects in a particular area (desk drawer) because they are contaminated and cannot be touched
* Buying multiples of the same item (buying three of everything because it's a magic number)

Obsession: Scrupulosity, or the excessive fear of violating religious or moral rules
Compulsions
* Apologizing or confessing that something is wrong, such as breaking religious, classroom, or school rules
* Constantly seeking reassurance that a task has been completed right or perfectly; seeking affirmation that a mistake was not made
* Saying prayers a certain number of times; excessive praying to atone for being bad; repeatedly confessing perceived sins or bad behavior
* Repetitive praying, confessing to neutralize or undo bad thoughts, intrusive sexual thoughts, or visions of cursing or blaspheming in school or church
* Avoiding answering questions for fear of telling a lie

Obsession: Fears, feelings, or urges related to symmetry or order
Compulsions
* Constantly evening up books or other items on a shelf or desk; aligning edges to be even
* Rearranging items to be in a certain order, such as by color or alphabetical order
* Avoiding a room with square tiles because seeing the tiles would require tracing each of the edges visually
* Fears, feelings, or urges related to sexual content
* Seeking reassurance that one is not gay or lesbian, despite being heterosexual
* Excessive praying to atone for having inappropriate sexual thoughts or images
* Avoiding magazines, books, DVDs, websites, or other media for fear of seeing sexual content

Obsession: Excessive doubting or dread of uncertainty
Compulsions
* Constantly rechecking to see that everything is in a backpack or book bag
* Asking to leave the classroom to recheck a locker or its contents
* Avoiding a school locker to prevent checking the lock over and over again

Obsession: Fears, feelings, or urges related to having something just right or perfect
Compulsions
* Getting up and sitting down repeatedly at a desk, until feeling just right
* Repeatedly revising the way letters, words, or numbers are written to make them look just right; getting stuck rewriting the same letter or word
* Repeatedly filling in circles on answer sheets; getting stuck on one or two questions because too much time is spent carefully filling in the circles, erasing, refilling until it looks perfect
* Erasing and rewriting words over and over
* Extreme slowness with activities or school work until everything is just right
* Repeating various actions for no apparent reason
* Avoiding a hallway until walking in it until it feels just right

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OCD is like an unwelcome guest with bad manners. It moves into a mind - and it doesn't want to leave. Students with OCD may appear to be daydreaming, distracted, disinterested, or even lazy. They may seem unfocused and unable to concentrate.

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What Teachers Should Know

Students with obsessive-compulsive disorder (OCD) have upsetting or scary thoughts or images (called obsessions) pop into their minds that are hard to shake. Common obsessions include contamination, safety, and need for symmetry. Unwanted and intrusive thoughts can be of an aggressive or sexual nature.

People with OCD feel strong urges to repeatedly do certain things - called rituals or compulsions - to banish the scary and intrusive thoughts; ward off things they dread; or make sure that things are safe, clean, or right in some way. Common compulsions include cleaning, checking, counting, repeating, arranging, touching, seeking reassurance.

Doctors consider obsessive thinking and rituals to be OCD when they do one or more of the following:

take up more than 1 hour each day

cause distress

interfere with daily activities

OCD in kids is usually diagnosed between age 7 and 12. Since these are the years when kids naturally feel concerned about fitting in with peers, the discomfort and stress brought on by OCD can make them feel scared, out of control, and alone. Stressful events (such as starting school or a loved one's death, for example) can trigger or worsen OCD.

Students with OCD may:

miss class time to talk to a school counselor or other mental health specialist

need extra time to complete assignments because they reread and rewrite assignments

need to take medicine

have rituals and preoccupations that seem odd to other students, which may make them a target for bullies

benefit from special education services, such as individualized education programs (IEPs) or 504 education plans

What Teachers Can Do

Because OCD symptoms can interfere with learning, some students with the disorder require instructional accommodations, including extra time with assignments or learning breaks if they're feeling anxious.

Teachers need to understand that a student's ritualistic behaviors are part of the disorder. Talking with a school counselor and the student's parents or guardians to learn about the student can help. You might be asked to help the student redirect the behavior or ignore the behavior instead of correcting it or issuing a consequence.

OCD is treatable, but overcoming it isn't a quick or easy process. Students with OCD usually need to work with a therapist and take medicines to help manage their behaviors and the accompanying thoughts and feelings.

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Students with obsessive-compulsive disorder (OCD) have upsetting or scary thoughts or images (called obsessions) pop into their minds that are hard to shake. Common obsessions include contamination, safety, and need for symmetry. Unwanted and intrusive thoughts can be of an aggressive or sexual nature.

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If you need more sessions or perhaps more of a variety, here are some additional lessons for you to try:

Giraffes Can't Dance

Metaphor Basket

Animal Projection Technique

Robot Workshop

Feelings and Food

Boundin'

I use this short film with my small groups to help build positive relationships. After viewing the video, we discuss how the sheep felt and how the jackalope was a good friend. Then, I give each student a workpage (above). I write a group member's name on each student's paper, then explain that they must write and/or draw something nice about that person. In this way, they are acting like the jackalope, helping their group friends feel good about themselves.

Once everyone has finished their work, we share our words and/or pictures one at a time. Then, I ask for the receiver to say how they feel after hearing the positive feedback - I record their response at the bottom of the paper. I make copies of the projects for my own documentation, but let the students keep their originals, which serve as a reminder of how valued they are.

The video is also great with individual students who may focus on the negative aspects of their life or have anxiety about the bad things that could happen. The jackalope shows the sheep that bad things happen and sometimes, you just need to keep moving forward until you feel better again; you can't let every little thing get you down.

Scaredy Squirrel

Stress Buster Pizza

Puppet Personalities

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If you need more sessions or perhaps more of a variety, here are some additional lessons for you to try: I use this short film with my small groups to help build positive relationships. After viewing the video, we discuss how the sheep felt and how the jackalope was a good friend.

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How School Counselors can Help Teens Overcome Social Anxiety

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How School Counselors can Help Teens Overcome Social Anxiety

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School Counselors Can Help Teens With Social Anxiety

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Social anxiety disorder is one of the most common disorders among adolescents. Research shows there is a way that school counselors can intervene and help.

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Stress vs. Anxiety

Stress

Both Stress and Anxiety

Anxiety

Generally is a response to an external cause, such as taking a big test or arguing with a friend.

Goes away once the situation is resolved.

Can be positive or negative. For example, it may inspire you to meet a deadline, or it may cause you to lose sleep.

Both stress and anxiety can affect your mind and body. You may experience symptoms such as:

Excessive worry

Uneasiness

Tension

Headaches or body pain

High blood pressure

Loss of sleep

Generally is internal, meaning it's your reaction to stress.

Usually involves a persistent feeling of apprehension or dread that doesn't go away, and that interferes with how you live your life.

Is constant, even if there is no immediate threat.

Ways to Cope

Keep a journal.

Download an app with relaxation exercises.

Exercise and eat healthy.

Get regular sleep.

Avoid excess caffeine.

Identify and challenge your negative thoughts.

Reach out to friends and family.

Find Help

If you're struggling to cope or the symptoms of your stress or anxiety begin to interfere with your everyday life, it may be time to talk to a professional. Find more information about stress and anxiety and getting help.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIMH Identifier No. OM 20-4319

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Stress Both Stress and Anxiety Anxiety Generally is a response to an external cause, such as taking a big test or arguing with a friend. Goes away once the situation is resolved. Can be positive or negative. For example, it may inspire you to meet a deadline, or it may cause you to lose sleep.

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Worry and Small Group Activities for Kids

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Worry and Small Group Activities for Kids

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Counselor Chelsey | Simple School Counseling Ideas

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Childhood anxiety is on the rise. If you been a counselor for a while, you may be seeing more anxious students than ever before. It can be challenging to know just what to say or do to give students the support they need. By adding these activities to your next small group, you will help your students understand what anxiety is, how they can recognize it, and what they can do about it.

1- Define What Anxiety Is

Worry is a normal feeling. Kids may feel worried about many things - like going to a new school, or a relative that is sick. Many students, though, might not know how to tell whether or not their worry is normal. Taking time to explain to students what worry is and when it's normal can help students learn to handle their worry in a positive way. By teaching students about what worry and anxiety are, we can empower them to get support when they need it.

In my personal life, I have struggled with anxiety my entire life. However, I didn't know it until I was in my early 20's. Because I didn't know what anxiety was, or what was normal, my anxiety went untreated for a long time.

I love to start off my worry and anxiety small groups with an activity to help students learn the difference between anxiety and normal worries. To start, I explain that although worry is a common and normal experience, it can sometimes turn into anxiety. I then explain anxiety as worries that are intense, frequent, might not seem logical, or include physical symptoms such as quick breathing or a stomachache.

Then, once students know the difference between worry and anxiety, I give them scenarios (or have them come up with their own) and ask them to share whether they think it is worry or anxiety. This is a helpful exercise because it gives students practice in understanding what is a normal worry and what is anxiety.

2- Talk About Anxiety And The Brain

One of the scary parts of worry and anxiety for kids is that they don't understand what is happening in their brain or body. They feel like they can't control their thoughts or the bodily sensations that they are having. This feeling of fear and uncertainty can make their anxiety even worse.

By educating students about what is happening in their brains and bodies when they feel anxious, students can better understand their own feelings. They are then less likely to be anxious about being anxious. Thankfully, there are several YouTube videos explaining the science behind anxiety that are perfect to use in your anxiety small group counseling lessons. Here are two of my favorite videos to use:

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Worry and Anxiety Small Group Activities For Kids - Counselor Chelsey | Simple School Counseling Ideas

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Use these worry and anxiety small group activities for kids to support anxious students at your school. Students will learn what anxiety is, the science behind it, and how they can recognize and cope with their anxiety.

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Suggestions for Eating Disorder Education in Schools

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Suggestions for Eating Disorder Education in Schools

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Suggestions for Eating Disorder Education in Schools

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A group of Canadian researchers offer practical suggestions for preventing eating disorders in schools, and how to identify and work with at-risk students. Issues with current eating disorder educations Researchers suggest that the current eating disorder efforts in schools pay undue attention to the signs and symptoms of eating disorders, whereas more attention is needed to cultivate healthy attitude and behaviors among students.

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ADD & ADHD How Counselors Today Help Children Succeed

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ADD & ADHD How Counselors Today Help Children Succeed

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As an elementary school counselor, you will create a nurturing environment in which children develop the knowledge, habits, and emotional skills to succeed in middle school, high school, and beyond.

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NYU Steinhardt's Online Master's in School Counseling prepares aspiring school counselors to pursue certification and employment in public and private schools.

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What is conduct disorder in children?

Conduct disorder is a type of behavior disorder. It's when a child has antisocial behavior. He or she may disregard basic social standards and rules. He or she may also:

Be irresponsible

Skip school or run away (delinquent behavior)

Steal or do other things to violate the rights of others

Physically harm animals or other people, such as committing assault or rape

These behaviors sometimes happen together. But one or more may occur without the others.

What causes conduct disorder in a child?

Experts believe that many factors play a role in conduct disorder. These are:

Brain damage

A traumatic event

Genes

Child abuse

Past school failure

Social problems

Some children with conduct disorders seem to have a problem in the frontal lobe of the brain. This interferes with a child's ability to plan, stay away from harm, and learn from negative experiences.

Some experts believe that a series of traumatic experiences occurs for a child to develop a conduct disorder. These experiences then often lead to depressed mood, behavior problems, and involvement in a deviant peer group.

Which children are at risk for conduct disorder?

A conduct disorder is more common in boys than in girls. It is also more likely to develop in children or teens who come from homes that are:

Children with these mental health problems are also more likely to have conduct disorder:

Children or teens who are considered to have a difficult temperament are more likely to develop behavior problems.

What are the symptoms of conduct disorder in a child?

Most symptoms seen in children with conduct disorder also happen at times in children without this problem. But in children with the disorder, these symptoms occur more often. They also interfere with learning, school adjustment, and sometimes with the child's relationships.

Each child's symptoms may vary. But the 4 main groups of behaviors are:

Aggressive conduct

Intimidating behavior

Bullying

Physical fights

Cruelty to others or animals

Using a weapon

Forcing someone into sexual activity, rape, or molestation

Destructive conduct

Intentionally destroying property (vandalism)

Arson

Deceitfulness

Violation of rules or age-appropriate norms

These symptoms may look like other mental health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is conduct disorder diagnosed in a child?

A child psychiatrist or qualified mental health expert can diagnose a conduct disorder. He or she will talk with parents and teachers about the child's behavior and may observe the child. In some cases, your child may need mental health testing.

If you notice symptoms of conduct disorder in your child or teen, you can help by seeking a diagnosis right away. Early treatment can often prevent future problems.

How is conduct disorder treated in a child?

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

Treatment for conduct disorder may include:

Cognitive-behavioral therapy. A child learns how to better solve problems, communicate, and handle stress. He or she also learns how to control impulses and anger.

Family therapy. This therapy helps make changes in the family. It improves communication skills and family interactions.

Peer group therapy. A child develops better social and interpersonal skills.

Medicines. These are not often used to treat conduct disorder. But a child may need them for other symptoms or disorders, such as ADHD.

How can I help prevent conduct disorder in my child?

Experts don't know exactly why some children develop conduct disorder. Things such as a traumatic experience, social problems, and biological factors may be involved. To reduce the risk for this disorder, parents can learn positive parenting strategies. This can help to create a closer parent-child relationship. It can also create a safe and stable home life for the child.

How can I help my child live with conduct disorder?

Early treatment for your child can often prevent future problems. Here are things you can do to help your child:

When should I call my child's healthcare provider?

Call your healthcare provider right away if your child:

Feels extreme depression, fear, anxiety, or anger toward him or herself or others

Feels out of control

Hears voices that others don't hear

Sees things that others don't see

Can't sleep or eat for 3 days in a row

Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Call 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.
Key points about conduct disorder in children

Next steps

Tips to help you get the most from a visit to your child's healthcare provider:

Know the reason for the visit and what you want to happen.

Before your visit, write down questions you want answered.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

Ask if your child's condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if your child does not take the medicine or have the test or procedure.

If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your child's provider after office hours. This is important if your child becomes ill and you have questions or need advice.

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Conduct disorder is a type of behavior disorder. It's when a child has antisocial behavior. He or she may disregard basic social standards and rules. He or she may also: Be irresponsible Skip school or run away (delinquent behavior) Steal or do other things to violate the rights of others Physically harm animals or other people, such as committing assault or rape These behaviors sometimes happen together.

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Advice for Parents of Children with Behavioral and Psychiatric Disorders

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Advice for Parents of Children with Behavioral and Psychiatric Disorders

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Since 1984, Foundation Scientific Council member Judith L. Rapoport, M.D., has been Chief of the Child Psychiatry Branch at the National Institute of Mental Health. We asked her what advice she could offer parents and siblings of children affected by behavioral and mental health disorders. Our conversation ranged widely and included discussion of attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), learning disorders, anxiety, phobias, depression, and the fallout from divorce. Dr. Rapoport also addressed ways to help children with autism, bipolar disorder, and schizophrenia. If a child appears to be having a psychological or behavioral problem, what course of action should a conscientious parent take?
There's an important rule of thumb: there is no "disorder" until a problem begins to significantly interfere with a child's quality of life. Children have all sorts of experiences that can worry a parent. For example, they might be in the back seat during a car accident and may now be fearful of getting into a car. That's normal, and the way you handle it is to have them get back in the car-that is, don't accommodate their fear. Or, many children feel sad, but for good reason, such as when they lose a pet. But when fear or sadness or an inability to concentrate takes over and starts to interfere with the child's life, either at home or at school, that's when you should take action.
Where, and to whom, should a parent turn for help?
A good place to start is the nearest medical school or teaching hospital, even if it's a considerable drive from home. You want to ask who at the school or hospital, or within its department of psychiatry, sees children. Find out who in particular specializes in the kind of problem your child may be facing. Once you are presented with the name of a doctor or therapist, it's smart to ask how much experience that person has had with other children like yours, and what approaches to treatment he or she might take. Often, you'll find therapists who can offer several different approaches, who will want to match the approach to the specifics of your child's case.
What are the various therapy options and who will be recommending them?
Parents will find that some of the experts in these institutions may be psychologists or psychiatric social workers. This reflects an important development over recent decades in which there have been many advances in psychological and behavioral treatments that don't involve the use of medications. There are many forms of therapy, depending on the disorder. The type of psychotherapy I strongly believe is effective for childhood depression is not the same therapy that would be used for children with phobias, or OCD. For anxiety, a behavioral treatment might take the form of relaxation therapy or even biofeedback. There's a broad spectrum of approaches and impressive advances that have been made across these areas.
When are medications appropriate for children?
There is no blanket approach. Some medications are clearly useful in children, and some studies have shown that it can be useful to give drug therapy and psychotherapy together, at least in the beginning of treatment. I'm often asked by behavioral therapists to consult as a psycho-pharmacologist*. They may want to add a medication to help a child stick with a behavioral therapy. In ADHD, many times a pediatrician will prescribe a stimulant such as Ritalin, and that will solve the problem by itself. However, parents should know that they are not locked in to any one approach. If, a few months after you begin a therapy, it doesn't seem that you are getting anywhere, you should reconsider and be open to trying a different approach.
Are Ritalin and other stimulant treatments for ADHD over-prescribed?
About 70 percent of youngsters in the U.S. with ADHD are given a stimulant; it is probably the treatment of choice. Stimulants make people more alert and focused. Does your child need such treatment? Parents need to judge how much the problem is interfering with their child's life. In school, has the child responded to logical first steps, such as sitting in the first row of the classroom, or getting very clear instructions and regular feedback from the teacher? Such approaches can be very helpful in mild cases. You have to go with what produces substantial benefit, in terms of normalizing the child's life.
Are stimulants addictive?
Parents can take some comfort in knowing that Ritalin and similar drugs are not addictive in children. A child's mood is not elevated by stimulants. And epidemiologic studies have shown that children with ADHD who take these medications do not have a greater tendency to abuse drugs later on.
Turning to another topic: depression. How can a parent tell the difference between a child who is sad and one who is depressed?
Children do become sad, and this could be due to so many possible triggers. There's chronic demoralization--you often see this in children with learning disabilities, especially in families in which the parents are high achievers and have trouble accepting the child's difficulties. Often, children are sad in response to a particular event-- like the loss of pet, as mentioned before. But it could easily be other, broader disappointments. For example, when peers become a very important part of a child's life, something that intensifies in the teen years, and a child has problems trusting or relating well to peers, this can lead to sadness. If parents are getting divorced--a very common situation-a child may be having a hard time. One or both parents may be putting the child in a difficult position that he or she doesn't know how to handle. There are also children and adolescents with chronic depression for which there does not appear to be any specific trigger. Getting the right professional consultation is key, especially if the depression is significantly affecting the child's quality of life.
Let's discuss what to do in the most serious cases-- when a child is thought to show signs of bipolar disorder or schizophrenia or psychosis.
Childhood-onset schizophrenia is very rare, and when this seems a possibility, getting a consultation from a really experienced mental health professional is critical. Psychosis-- hallucinations, hearing voices--is a symptom of schizophrenia in many adults. However, in children, a broad array of disorders may cause them to report having psychotic experiences. For example, sometimes a seriously depressed child reports hearing a voice saying "you're a bad person." The literature indicates that, at some point, about 5 percent of all children talk about delusional things. Yet only 1 percent end up with a schizophrenia diagnosis, which, when it occurs, usually doesn't start generating symptoms until the late teens or the twenties.

There has been some confusion about bipolar disorder and ADHD. It turns out that some portion of children with ADHD, even when they respond to treatment, have remaining "mood dysregulation" problems. This diagnosis now appears in the latest edition of the Diagnostic and Statistical Manual (the "DSM-5" handbook for clinicians). Bipolar disorder in childhood is very rare.
What advice can you offer parents and siblings living with children who are already diagnosed with serious disorders, from bipolar disorder to schizophrenia and autism?
Following a diagnosis, the first thing parents need to do is make sure that everyone in the family gets on the same page. Sometimes, meeting with a family therapist can help--not necessarily on a regular basis, but for orientation purposes and during times when the child's condition creates family problems. For example, sometimes siblings will feel that the situation at home is too unpleasant, and they can't bring friends to the house. The basic rule is: everybody has to feel safe at home. Whether or not you have guidance from outside, it helps to have family meetings in which you talk about what's going on and what siblings' roles should and should not be. It's important for parents to agree on a consistent approach when coping with a child who is ill. It's also important for parents, if they can, to find a skilled caretaker they trust to look after their child so they can have some time away once in a while, on weekends.

There are many things families can do to help children with psychological disorders. The isolated child with a disorder, who has some interest or talent, may be helped by taking part in a special class or art camp. If a child is interested in computers, he or she could be enrolled in a program that might be an entrée to new friendships.

We've seen parents do some amazing things with children who are autistic--very moving examples of children who, because of their parents' efforts, were able to take part in mainstream education. Sometimes the child's teacher can educate the class about the child's problem. In the case of one very sick child I know, this happened and the child's memories of school went from being very miserable to feeling very good about it. It was remarkable. Of course, you can only think of trying such things in school districts prepared to accommodate children with special needs.

Finally, one of the major changes in the last 30 years is the advent of patient support groups. Such groups exist for most common disorders. There's a Tourette's group in just about every city- support groups for children and their parents to meet others in the same situation. The public is now very conscious, too, of a condition like autism. Those who are affected need not be isolated or alone. They should be able to say, "I'm not the only one who has this problem."
Going forward, what are the prospects for affected families?
I am upbeat. There has been so much useful research on diagnosis, prognosis, and the different types of treatments that are available. Parents will benefit enormously from seeking out good information, and from connecting with the many good support groups. Regarding treatments, many of the medications we have are good. Without question, they have made a tremendous difference for children and for their parents. And with continuing research, we are going to see important new treatments, over time.

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Advice for Parents of Children with Behavioral and Psychiatric Disorders

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You want to ask who at the school or hospital, or within its department of psychiatry, sees children. Find out who in particular specializes in the kind of problem your child may be facing.

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Addressing Anxiety in School Settings: Information for Counselors

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Addressing Anxiety in School Settings: Information for Counselors

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Eating Disorders and Athletes Infographic

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Eating Disorders and Athletes Infographic

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Accommodations for Students with Bipolar Disorder

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Accommodations for Students with Bipolar Disorder

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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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Error! You must specify a value for the Video ID, Width, Height and Anchor parameters to use this shortcode! 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.

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Addressing Conduct Disorder in Elementary Children

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Addressing Conduct Disorder in Elementary Children

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Credit: Julius-Maximilians-Universität Würzburg, JMU

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

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

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

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

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

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

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

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

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

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

Provided by Julius-Maximilians-Universität Würzburg

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

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Suffering in Silence- Examining OCD in School Setting

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The School Counselors Role in Eating Disorders

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The School Counselors Role in Eating Disorders

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Addressing Mental Health in School Crisis Prevention & Response

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Addressing Mental Health in School Crisis Prevention & Response

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addressing mental health in school crisis prevention and response_1_ (1)

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Is it a modification or is it an accommodation_1_(1)

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Information about Individuals with Disabilities Education Act (IDEA)

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Information about Individuals with Disabilities Education Act (IDEA)

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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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Special Education Fact Sheet: Section 504

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Special Education Fact Sheet: Section 504

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Resources on many disorders. Information for families and educators.

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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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Techniques to teach students with anxiety

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Techniques to teach students with anxiety

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Anxious students may not be able to verbalize the specific cause of their anxiety; they just know they are experiencing excessive and ongoing worry and/or fear about something. They may avoid situations or activities in school. They may start to decline in academics and have trouble focusing and concentrating, which many school counselors and teachers may confuse with ADHD. However, anxious students also typically exhibit other symptoms, which tend to become a pattern, such as always being sick on test day. Students with anxiety also may have irrational and negative thoughts.

Anxiety symptoms may present differently among students at different ages, who may not be able to express what's causing their anxiety and may instead exhibit symptoms. It is vital to be on the lookout for any of these symptoms:

attendance problems

clinginess/separation anxiety

panic attacks

academic problems/decline in schoolwork

frequent urination

frequent crying

difficulty concentrating/staying focused

blushing/sweating

feeling weak/tired

excessive worrying

health problems such as headaches or an upset stomach

avoidance of people/situations

sleeping problems

lots of "what ifs?"

Everyone has bad days and may exhibit one or more of these symptoms, but a pattern should raise red flags. Although diagnosing anxiety is not the school counselor's job, it is important to be cognizant of the types of anxiety disorders. These can include generalized anxiety, separation anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety or panic disorder. Any of these can affect a student's ability to perform well in school. Students with anxiety may also be at risk for developing other mental health issues, such as depression, drug/alcohol use and suicidal ideation.
Steps to Support Students
Experiencing anxiety can be frightening, especially for young students. An urgent sense of nervousness and apprehension can be debilitating for anyone. These feelings are amplified when students don't understand why they feel this way or what they can do to feel better. One of the most beneficial things you can do for anxious students is to help them understand their why - not just the surface why, but the deep, underlying reason they become so anxious. A technique to accomplish this is "The 5 Whys," developed by Sakichi Toyoda, an industrialist, inventor and founder of Toyota Industries. He believed by asking "why" five times, the nature of a problem and its origins become clear.

To use this strategy with a student, first ask, "Why are you experiencing anxiety?" Use their answer to pose another why question, and repeat this five times. Here is an example from "Anxiety Annie," a sophomore student with test anxiety:

Why are you anxious about the test? I must get good grades, and tests count 80 percent of my final grade.
Why is it important to get good grades? I want to have happy parents.
Why is it important to have happy parents? It makes me feel good when they approve of me.
Why do you want your parents to approve of you? I want to achieve what my parents achieved; I want to have the kind of life they have.
Why do you want to have the kind of life your parents achieved? I don't want to be the odd man out.

Annie's fifth why indicates she doesn't want to "be the odd man out" - she wants to fit in with her family. Background information on Annie confirms that education is an important aspect of her family dynamic. All adults in her family (parents, grandparents, etc.) were excellent students and have pursued careers in education. Once Annie realized that fitting in was the root of her anxiety, she began to recognize that taking tests wasn't the issue; her sense of belonging was. This helped Annie put her anxiety into focus, and she began to view test taking in a different light.

With understanding, students can begin to determine how they can manage anxiety. You can teach students several techniques to use during class without drawing attention to themselves.

Deep breathing: Slowing heart rate, lowering blood pressure and increasing oxygen intake all have a calming effect. Common exercises are belly breathing and the 4-7-8 breathing exercise (inhale for four counts, hold for seven, exhale for eight).

Grounding: Grounding can distract students' mind from their anxiety and keep them grounded in the present. Common exercises include the 5-4-3-2-1 senses technique (five things you can see, four things you can feel, etc.), counting how many things in shades of a particular color can you see around the room and counting backward by 7, starting at 100.

Imagery: When students create a detailed mental image of a safe and peaceful place, they redirect attention away from what is stressing them and toward an alternative focus.

Progressive muscle relaxation: This is the practice of tightening one muscle group at a time followed by a relaxation phase with release of the tension. Students tense and relax the muscle groups one at a time in a specific order, beginning with the lower extremities and ending with the face.

Positive self-talk and affirmations: This helps students challenge self-sabotaging and negative thoughts. Students can practice through journal writing, negative-thought stopping or snapping a rubber band during negative thoughts. You can help students select affirmations that speak to them. When students repeat the affirmations - and believe them - they can start to make positive changes.

Journaling: Journaling helps students clarify their thoughts and feelings, gaining valuable self-knowledge. Students can process their anxiety by fully exploring and releasing the emotions involved.

Desk yoga: Neck rolls, cat-cow stretch, shoulder shrug, triceps stretch, seated twist and the seated pigeon pose are all exercises students can discretely practice at their desk.

Once students determine which techniques work for them, you can assemble a list with descriptions for the student to discretely tuck into a notebook as a quick reference. Or, the student can keep their journal, list of affirmations or picture of their peaceful place where they can access it without classroom disruption. Having this survival kit available can bring a feeling of control over their anxiety.

Strategies with Teachers
In addition to working with individual students, you can equip teachers with strategies to use with an entire class. All the techniques above can easily be modified for classroom use. Teachers may find these activities useful at the beginning of the day, during transition times or before a test. Teachers can also serve as compelling role models for students. As teachers model relaxation techniques during class time, students internalize the importance of lifelong stress management.

School counselors are tasked with working with the whole student, not just academic, career or social/emotional development. It is crucial that students with anxiety learn positive coping techniques now to become healthy and productive citizens in the future.

There is no quick, easy fix for students with anxiety, especially those who are diagnosed with an anxiety disorder. Offering support and flexibility, however, allows you to help students as they discover meaningful, effective ways to address their anxiety.

Anna Duvall is director of counseling at Lexington High School in Lexington, S.C. She can be reached at aduvall@lexington1.net. Crissy Roddy, Ph.D., is director of counseling at White Knoll High School in Lexington, S.C. She can be reached at croddy@lexington1.net.

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Anxious students may not be able to verbalize the specific cause of their anxiety; they just know they are experiencing excessive and ongoing worry and/or fear about something. They may avoid situations or activities in school. They may start to decline in academics and have trouble focusing and concentrating, which many school counselors and teachers may confuse with ADHD.

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Eating Disorders in adolescence: Information for parents and educators

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Eating Disorders in adolescence: Information for parents and educators