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Disproportionality in Exclusionary Discipline and the Identification of Emotional Disturbance

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Disproportionality in Exclusionary Discipline and the Identification of Emotional Disturbance

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Disproportionality in Exclusionary Discipline and the Identification of Emotional Disturbance

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Theory of Counseling

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By Joanna Smykowski

Updated December 17, 2018

Reviewer Tiffany Howard, LPC, LCADC

Source: pxhere.com

Named after its creator, Adlerian theory refers to the practice and belief that people as individuals should be validated, connected, and made to feel significant. The theory applied in therapy focuses on the entire individual, not just the bits and pieces that need improvement, and embraces the personality as the development of children and environmental influences. This is important in discovering ways to help the person move forward if they are seeking to improve their lives.

The theory was created in the early 1900's by Alfred Adler who founded this new way to approach psychology after parting ways with Sigmund Freud. Adler was originally an ophthalmologist before he entered psychiatry and shortly after established his theory. He believed that "a misbehaving child is a discouraged child," and also believed that discouraged individuals would act out when they feel unloved or unsupported.

Much of the theory is based on having a sense of community. Individuals who feel that they belong will act cooperatively and healthy, forming loving bonds with other individuals. But those who feel like outcasts, for example, will act out in any number of ways to express that feeling of inadequacy. The goal then would be to create a community with that individual.

Alderian Theory - A Sense Of Belonging

One of the greatest things Adler believed was giving people a sense of belonging. People are their best selves when they feel connected and loved by those around them. This is especially important in family units that thrive on help from each in the family. When someone in the family feels like they are not appreciated, whether it be a child or adult, they will act in ways that are not healthy. This can include withdrawing, competing, or giving up altogether. Feeling discouraged will only further this behavior and will cause the person to become isolated from their family.

Many times, parents will punish bad behavior. This discipline can effectively eliminate the poor behavior, but without an understanding of where the behavior stems from can prevent the behavior from being eliminated. Misunderstood children who act out may just feel left out. One theory Adler believed was that birth order influenced these feelings. Early encounters with devaluation can also influence poor behavior. By embracing the child fully in addition to discipline, the parent can see an improvement.

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Understanding Unique Beliefs
When we take the time to analyze where our personal beliefs come from and how they influence repetitive behavior, we can then start taking steps to growth and healing. Also, looking at the ways, we seek validation and acceptance are key to understanding our behavior. These things are not static. They can be changed with time, therapy, and dedication. But it's first important to understand where they come from based on our childhood backgrounds.

Children who feel unloved will seek validation and acceptance through their behavior. When a child isn't given attention for positive behavior, they will seek attention for bad behavior. They might break something or cause a fuss with their sibling to gain that parental attention they crave, even if it's negative. This becomes internalized, and the child then carries that behavior into adulthood.
Accepting The Individual
The Adlerian theory also accepts the person as a whole individual instead of just as a collection of behaviors, beliefs, and influences. In this practice, it is stressed to study the entire individual as this is what will give us clues as to where growth can begin. If we were to focus on the bad behaviors, for example merely, then the person might feel that their other qualities don't have any value. But by highlighting the good qualities and showing the person that they are valued, their negative behaviors and beliefs can slowly be replaced.

People improve when they are made to feel valued. By placing value on the individual and accepting them as a whole, they can begin to make positive changes in their lifestyle. The same applies to children. Kids improve when they're made to feel valued and appreciated. By celebrating their accomplishments and highlighting their talents, they will shy away from attempting to gain attention through poor behavior.

Adlerian Theory As Therapy

As therapy, this theory benefits the individual by helping them understand where their behaviors stem from, how they can change their view of themselves, and how they can change their view of their childhood. This happens in four steps with a licensed therapist.

At the beginning of therapy, the therapist engages their client in developing a close relationship. They establish their goals and boundaries before diving into the real work, essentially building a foundation of trust. This is pertinent in order to move forward. If this doesn't happen, then the entire therapy falls apart.

Afterwards, the therapist encourages their client to talk about their experiences, emotions, behaviors, family, upbringing, and drives. This helps establish a foundation of how the individual came about to acting the way that they do now. Was there a significant life event that made them feel shameful or guilty? Did this event push them into the shadows or become quiet so that their verbalized thoughts weren't made to feel silly? This helps the therapist understand the current behaviors and beliefs of the client.

The next step is helping the client develop new ways of thinking. They're encouraged to take on a new perspective on their situation as well as reshape how they view their past experiences so that they can move forward. Once this step is achieved, the client can create new goals for growth in their life.

Finally, the client is reoriented. They are shown that they can make changes to their lifestyle to reinforce their new perspective. This new positive perspective can give them the confidence to take steps in achieving their goals. Having shed the weight of shame, guilt, ugliness, or lack of self-worth, their lives will improve significantly as a result.

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The goal of therapy is to show the client that they have control over their thoughts, beliefs, and behaviors. Sticking to beliefs that were created early can be changed with time, effort, and help from their therapist. Those beliefs can be transformed into a new belief that they do have worth and that their opinions matter. Once they're shown that old beliefs don't have to have a bearing on their current life, they can confidently move forward.

How Can Adlerian Theory Help?

Adlerian therapy can help individuals gain confidence in themselves to help them make confident decisions. It can aid them in being independent without the fear that they might fail. Though failure is a part of life, constantly feeling like a failure due to an internal belief can interfere with their daily living. Once that fear is removed, that person can live their best life and form cohesive relationships with others.

Ultimately, the goal of this therapy is to replace long-held negative beliefs, so the person becomes more self-reliant, confident, and socially empowered. This leads to healthier decisions as well as healthier relationships. That confidence will continue to shine through their lives as they continue to make better decisions for themselves. Though this type of therapy takes time, replacing those beliefs can open up a host of opportunities for that person that they didn't think possible.

How It Doesn't Help. This type of therapy is not for people who expect quick results. It also doesn't cater to those who only want to be in therapy for a brief amount of time. Adlerian therapy takes effort, dedication, and commitment. While it can help the individual transform into a healthy and happy adult, it doesn't happen overnight. (And in truth, most therapy will take the same effort.)

Another limitation is that the therapy involves a deep dive into early life events. This might be intimidating for those who do not wish to confront childhood memories that might be painful, upsetting, or disturbing. Since it is important to establish the reasons for current behavior and thoughts, Adlerian psychotherapists insist on establishing a childhood timeline. This might not work for some individuals.

Individuals who are less insightful or who do not wish to challenge current beliefs will also find that this type of therapy is unsatisfying. Most types of therapy will likely cover a section of their belief systems, so it's important, to be honest. Without that dedication, this therapy (and potentially other types of therapy) may not be effective.

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Where To Get Help. To take advantage of the beneficial therapy Adlerian psychologists can offer, it's important to call a specialist as soon as possible. For child development, there are many childcare facilities available to the public that follow Adlerian theory. This can be a positive upbringing for your child to encourage them to be their best selves preemptively.

For help that starts at the click of a button, follow this link: https://www.betterhelp.com/start/
Read more about Alfred Adler and his theory in the following articles:
Psychology Today. https://www.psychologytoday.com/therapy-types/adlerian-therapy

Good Therapy. https://www.goodtherapy.org/learn-about-therapy/types/adlerian-psychology

Alfred Adler Graduate School. http://alfredadler.edu/about/alfred-adler-theory-application

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Adlerian Theory: Understanding The Individual | Betterhelp

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By Joanna Smykowski Updated December 17, 2018 Reviewer Tiffany Howard, LPC, LCADC Source: pxhere.com Named after its creator, Adlerian theory refers to the practice and belief that people as individuals should be validated, connected, and made to feel significant.

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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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Dr. Kathleen Ries Merikangas, Ph.D, Ms. Jian-ping He, M.Sc., Dr. Marcy Burstein, Ph.D., Ms. Sonja A. Swanson, Sc.M., Dr. Shelli Avenevoli, Ph.D., Ms. Lihong Cui, M.Sc., Dr. Corina Benjet, Ph.D., Dr. Katholiki Georgiades, Ph.D., and Dr. Joel Swendsen, Ph.D.

Abstract

Objective

To present estimates of the lifetime prevalence of DSM-IV mental disorders with and without severe impairment, their comorbidity across broad classes of disorder, and their sociodemographic correlates.

Method

The National Comorbidity Survey-Adolescent Supplement NCS-A is a nationally representative face-to-face survey of 10,123 adolescents aged 13-18 years in the continental U.S. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview.

Results

Anxiety disorders were the most common condition (31.9%), followed by behavior disorders (19.1%), mood disorders (14.3%), and substance use disorders (11.4%), with approximately 40% of those with one class of disorder also meeting criteria for another class of lifetime disorder. The overall prevalence of disorders with severe impairment and/or distress was 22.2%; (11.2% with mood disorders; 8.3% with anxiety disorders; 9.6% behavior disorders). The median age of onset for disorder classes was earliest for anxiety (6 years), followed by 11 years for behavior, 13 years for mood, and 15 years for substance use disorders.

Conclusions

These findings provide the first prevalence data on a broad range of mental disorders in a nationally representative sample of U.S. adolescents. Approximately one in every 4-5 youth in the U.S. meets criteria for a mental disorder with severe impairment across their lifetime. The likelihood that common mental disorders in adults first emerge in childhood and adolescence highlights the need for a transition from the common focus on treatment of U.S. youth to that of prevention and early intervention.

Keywords: Epidemiology, adolescents, mental disorders, National Comorbidity Survey, correlates

INTRODUCTION

There has been tremendous growth in the field of child psychiatric epidemiology over the past two decades. The results of numerous community surveys in specific regions of the U.S. ⁻ have shown that about one in every three to four children suffers from a mental disorder and that about one in ten has a Serious Emotional Disturbance, ⁻ with few affected youth receiving adequate mental health care. However, there has been a lack of empirical data on the prevalence and distribution of a wide range of DSM-IV mental disorders from a nationally representative sample of children or adolescents. Such information is necessary to establish resource allocation priorities for prevention, treatment, and research.

Based on the recommendations of the landmark Surgeon General's Report on Mental Health and the recommendations of a subgroup of the National Institute of Mental Health (NIMH) National Advisory Mental Health Council, the NIMH established several research initiatives to address the lack of national statistics on mental health in children. Instruments for assessing mental health were added to two large national surveys including the Strengths and Difficulties Questionnaire (SDQ) to the National Health Interview Survey, and selected modules from the National Institute of Mental Health Diagnostic Interview Schedule for Children (DISC) Version 4 to the National Health and Nutrition Examination Survey. In addition to these measures, the National Comorbidity Survey Replication (NCS-R) was extended to assess a broad range of DSM-IV disorders in a nationally representative sample of youth aged 13-18 years, referred to as the National Comorbidity Survey Adolescent Supplement (NCS-A). ⁻

The goals of the present report are: (1) to present the lifetime prevalence estimates of mental disorders and the proportion of disorders that are associated with severe impairment in a nationally representative sample of U.S. adolescents; (2) to examine the magnitude of overlap in the major classes of mental disorders; and (3) to describe the individual and familial sociodemographic correlates of these disorders.

Method

Sample and Procedure

The NCS-A is a nationally representative, face-to-face survey of 10,123 adolescents aged 13-18 years in the continental US. The survey was administered by the professional interview staff of the Institute for Social Research at the University of Michigan. The NCS-A was carried out in a dual-frame sample that included a household sub-sample and a school sub-sample., , The overall NCS-A adolescent response rate combining the two sub-samples was 82.9%. Comparisons of sample and population distributions on census sociodemographic variables and the school sample on school characteristics revealed only minor differences that were corrected with post-stratification weighting.

One parent or parent surrogate of each participating adolescent was asked to complete a self-administered questionnaire (SAQ) that contained informant questions about the adolescent's mental health. The full SAQ was completed by 6,491 parents. These recruitment and consent procedures were approved by the Human Subjects Committees of both Harvard Medical School and the University of Michigan. Once the survey was completed, cases were weighted for variation in within-household probability of selection (in the household sub-sample) and for residual discrepancies between the sample and the US population on the basis of socio-demographic and geographic variables. These weighting procedures are discussed in more detail elsewhere., Socio-demographic variables assessed in the NCS-A include age (in years), sex, race/ethnicity, parent education, urbanicity, and marital status of parents. A poverty index ratio, based on family size and the ratio of family income to the family's poverty threshold level, (≤1.5 poor, ≤3, ≤6, and > 6) was also included.

presents the weighted socio-demographic characteristics of the study sample. About half of the sample was male (51.3%) and the mean age was 15.2 years, with a larger proportion of youth aged 13-14 years (36.2%), and approximately equal distributions of youth aged 15 (20.5%), 16 (21.0%), and 17-18 (22.3%) years. The sample was comprised of 65.6% non-Hispanic Whites, 15.1% non-Hispanic Blacks, and 14.4% Hispanics. In terms of family characteristics, 84.5% of the sample had parents who had completed at least high school, 14.7% had a poverty index ratio at 1.5 or lower, nearly half of the sample resided in a metropolitan area, and 78.6% had parents who were married or cohabiting.

Table 1

Measures

Diagnostic assessment

Details of the diagnostic and risk factor measures are described by Merikangas et al. Briefly, a modified version of the World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI), a fully structured interview administered by trained lay interviewers to generate DSM-IV diagnoses was administered to adolescents. Modifications to the CIDI involved enhancing the wording and appropriateness of the instrument for assessment of adolescents. Lifetime disorders assessed in the CIDI included mood disorders and episodes (major depressive disorder [MDD] or dysthymic disorder, bipolar I or II [BPD]), anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder [GAD], posttraumatic stress disorder [PTSD], separation anxiety disorder [SAD]), behavior disorders (attention deficit/hyperactivity disorder [ADHD], oppositional defiant disorder [ODD], and conduct disorder [CD]), substance use disorders (alcohol abuse/dependence, drug abuse/dependence), and eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder). Parents (or parent surrogates) were mailed a self-administered questionnaire (SAQ) in order to collect additional information on adolescent sociodemographic characteristics, developmental background, mental and physical health, and other family- and community-level factors. Parents who completed the SAQ provided full DSM-IV diagnostic information about MDD and dysthymic disorder, SAD, ADHD, ODD, and CD, whereas those completing the abbreviated SAQ only reported on ADHD. Based on prior research that has documented the value of supplemental parent reports, , information from both the parent and adolescent were combined for major depression and behavior problems and classified as positive if either informant endorsed the diagnostic criteria. Definitions of all psychiatric disorders adhered to DSM-IV criteria and diagnostic hierarchy rules were applied for every disorder, with the exception of oppositional defiant disorder and substance use disorders. Psychiatric disorders derived from the modified CIDI showed good concordance with a clinical reappraisal sub-sample.

Impairment criteria embedded in DSM-IV required endorsement of some/a lot/extreme level of impairment or moderate/severe/very severe level of symptom severity. In order to more clearly identify disorders that were clinically significant, our definition of severe lifetime disorders used higher thresholds of impairment that required endorsement of "a lot" or "extreme" impairment in daily activities, or "severe or very severe" distress. Severe emotional disorders required both distress and impairment to be present, and severe behavior disorders (ADHD, ODD, and CD) required endorsement of symptom criteria by both the parent and the adolescent.

Statistical Analysis

All statistical analyses were completed with the SUDAAN software package and utilize the Taylor series linearization method to take into account the complex survey design. Cross-tabulations were used to calculate prevalence and comorbidity. Logistic regression analysis was used to examine demographic correlates of prevalence; regression models included all sociodemographic variables simultaneously, and adjusted odds ratios are presented. Age-of-onset curves were generated using the Kaplan-Meier survival analysis method. Multivariate significance tests were calculated using Wald Chi-Square tests based on coefficient variance-covariance matrices that were adjusted for design effects using the Taylor series method. Statistical significance was based on two-sided design-based tests evaluated at a level of significance of 0.05.

Results

Lifetime Prevalence

presents the lifetime prevalence rates of DSM-IV mental disorders by sex, age group, total DSM-IV disorders and disorders with severe impairment. Mood disorders affected 14.3% of the total sample, corresponding to 11.7% who met criteria for MDD or dysthymia and 2.9% for BPD. Females were twice as likely to experience unipolar mood disorders as compared to males, and somewhat more likely to experience BPD. The prevalence of all mood disorders increased uniformly with age, with a nearly two-fold increase from the 13-14 year age group to the 17-18 year age group. Severe cases of mood disorder (11.2% of the total sample) represented 74.4% of all MDD or dysthymic disorders, and 89.7% of all cases of BPD. The sex-specific rates for severe disorders (not presented in the table) maintained the same general patterns as were observed for the overall prevalence rates.

Table 2

Nearly one in three adolescents (31.9%) met criteria for an anxiety disorder, with rates for individual disorders ranging from 2.2% for GAD to 19.3% for specific phobia. All anxiety disorder subtypes were more frequent in females (the greatest sex difference being observed for PTSD). The aggregate category of any anxiety disorder was stable across age groups, but considerable variance was observed by disorder subtype. In particular, the prevalence of PTSD, panic disorder, social phobia and GAD showed modest but consistent increases with age. Severe anxiety disorders were present in 8.3% of the total sample, representing all individuals with panic disorder or agoraphobia, a moderate proportion of individuals with GAD (54.5%) or PTSD (30%), and only a small proportion of individuals with social phobia (14.3%), SAD (7.9%) and specific phobia (3.1%); yielding prevalence rates of 1.3% for social phobia, and 0.6% for SAD and specific phobia, respectively.

The prevalence of ADHD was 8.7%, with three times as many males being affected by this condition as females. The prevalence of severe ADHD was 4.2%, or approximately half of all cases in the sample. ODD was present in 12.6% of the sample (6.5% for severe cases) and 6.8% met criteria for CD (2.2% for severe cases). Although the rates of ADHD and ODD remained relatively stable by age group, rates of CD increased to a peak of 9.6% among the oldest adolescents.

Substance use disorders were present in 11.4% of the sample, corresponding to 8.9% of adolescents with drug abuse/dependence and 6.4% with alcohol abuse/dependence. These disorders were somewhat more frequent in males, and a five to eleven-fold increase in prevalence was observed across increasing age groups. The rates for severe substance use disorders were identical to those of the DSM-IV disorders because impairment criteria were embedded in the diagnostic definitions for these disorders. Concerning other conditions, 2.7% of adolescents had manifested eating disorders at some point in their lifetime. These disorders were more than twice as prevalent among females and demonstrated modest increases with age.

Finally, 49.5% of the total sample was affected by at least one class of disorder, but less than half had disorders with severe impairment (27.6%), and only 22.2% exclusive of substance use disorders. Approximately 20% of the sample (40% of all affected individuals) also met criteria for a disorder from at least one additional class. These comorbidity rates were similar for males and females. No age differences were observed for adolescents affected by one class of disorder, but comorbidity with additional classes strongly increased with age.

presents the age-specific incidence curves for each of the broad classes of lifetime mental disorder. Anxiety disorders occurred earliest with a steep slope beginning in early childhood, and leveling off after age 12. Risk was fairly low for mood and behavior disorders until early adolescence when it began to rise steadily. Substance use disorders appeared to have the latest age of onset with a steep increase in incidence after age 15. The estimated risk at age 18 was 17.6% for behavior disorders, 18.2% for mood disorders, 23.8% for substance use disorders, and 26.2% for anxiety disorders. The median age of disorder onset was 6 for anxiety disorders, 11 for behavior disorders, 13 for mood disorders, and 15 for substance use disorders (data not shown).

displays the proportion of adolescents affected by one or more broad classes of disorder among those with at least one DSM-IV disorder. A small majority of affected adolescents (61%) met criteria for disorders from one class only, with anxiety disorders being the most frequent condition to occur alone (35%) and smaller proportions having only behavior (14%), mood disorders (6%), or substance use disorders (6%). About one-quarter (25%) of adolescents affected by at least one class of disorder also met criteria for a disorder from one additional class, 11.0% were affected by three classes of disorders and 3% were affected by four classes of disorder.

Socio-demographic Correlates

presents the results of multivariate analyses of the association between individual and familial sociodemographic characteristics on classes of lifetime mental disorders in the adolescents. Mood and anxiety disorders were more prevalent among females in these multivariate analyses, whereas males had higher rates of behavior and substance use disorders. Rates of mood and substance use disorders were higher among older adolescents. There were few racial/ethnic differences in the major classes of mental disorders, with the exception of increased rates of anxiety disorders and lower rates of substance use disorder among non-Hispanic Black adolescents compared to non-Hispanic White adolescents, and higher rates of mood disorders among Hispanic adolescents compared to non-Hispanic Whites.

Table 3

With respect to parental characteristics, the prevalence rates of anxiety disorders, substance use disorders and behavior disorders were higher for respondents whose parents were divorced or separated relative to respondents of currently married or cohabitating parents. Rates of mood disorders were lower among children of parents who were never married compared to currently married or cohabitating parents. Parental poverty level and urbanicity were not associated with any of the classes of mental disorder. However, the most consistent association between parental characteristics and mental disorders in children emerged for parental education. Adolescents whose parents were not college graduates were at increased risk for all disorder classes.

The findings from multivariate analyses for these sociodemographic characteristics and classes of severe mental disorders (results not shown, but available upon request) were highly similar to those of all mental disorders, with limited exceptions. In particular, anxiety disorders were more prevalent in older adolescents, among 'other' ethnic minorities, among adolescents whose parents were not college graduates, and among adolescents whose parents were divorced or separated.

Two-way interactions for any significant main effects were tested for each class of disorder. After adjusting for family-wise experimental errors with a Bonferroni correction, no interactions were observed between individual and parental demographic correlates and anxiety or behavior disorders. There were four significant interactions for other disorders: (1) the prevalence of mood disorders was higher in White adolescents in homes with higher levels of parental education than that in Blacks and Hispanics; (2) rates of substance use disorders increased more dramatically with age for males than females; (3) sex differences in substance use disorders were largest for Blacks compared to other ethnic groups; and (4) increased rates of substance use disorders were observed among Hispanic adolescents whose parents were divorced, however, rates were decreased among Blacks whose parents were never married or divorced.

Discussion

These findings provide the first lifetime prevalence data on a broad range of mental disorders in a nationally representative sample of U.S. adolescents. The prevalence rates reported here closely approximate those of our nationally representative sample of adults using nearly identical methods, suggesting that the majority of mental disorders in adults emerge prior to adulthood. These rates are somewhat higher than those of prior studies, but within the ranges of estimates summarized in a meta-analysis of international community surveys of mental disorders in youth. In addition, the NCS-A provides a more comprehensive assessment of a wide range of DSM-IV disorders and subtypes than most previous studies. Despite the high prevalence rates, however, only about one in every four-to-five youths meet criteria for a lifetime mental disorder that is associated with severe role impairment and/or distress. The prevalence of severe emotional and behavior disorders is even higher than the most frequent major physical conditions in adolescence, including asthma or diabetes which have received widespread public health attention.

The finding that only about half of youth with a lifetime DSM-IV disorder report severe impairment confirms previous research demonstrating that a smaller proportion of youth with mental disorders actually have sufficiently severe distress or impairment to warrant immediate intervention. According to prior research, about one out of every ten youths with a current mental disorder fulfill criteria for Serious Emotional Disorder (SED) based on the Substance Abuse and Mental Health Services Administration (SAMSHA) definition (e.g., a mental health problem that has a drastic impact on a child's ability to function socially, academically, and emotionally). , While our study did not strictly assess all of the criteria for SED, our estimates of severe disorders were based on the full diagnostic criteria for DSM-IV disorders accompanied by severe impairment in major life roles.

Our data document the early onset of major classes of mental disorders. Among affected adolescents, 50% of disorders had their onset by age 6 for anxiety disorders, by age 11 for behavior disorders, by age 13 for mood disorders and by age 15 for substance use disorders. These findings closely approximate those of prospective studies of child and adolescent samples that have documented the incidence and progression of childhood mental disorders., ⁻ The early age of onset of anxiety has been well-established and our findings on specific subtypes of anxiety closely track those of prospective community-based research that reveal differential peak periods of onset of specific subtypes of anxiety. ⁻ Prospective studies have also shown that the average age of onset of major depression and dysthymia is between 11 and 14 years, with a steady increase in incidence across adolescence that continues through early adulthood. Our cross-sectional data reflect this increase with a near doubling of rates from 13-14 years (8.4%) to 17-18 years (15.4%). Also consistent with prior cross-sectional and prospective research, the median onset of behavior disorders is slightly earlier than that of mood disorders, with a later peak for conduct disorder than for oppositional defiant disorder. Finally, the later onset and steeper increase in rates of substance use disorders across adolescence has been repeatedly demonstrated, despite different prevalence periods and assessment methods.

About 40% of affected youth in the NCS-A reported more than one class of lifetime disorder, with mood disorders being the most likely to co-occur with other classes. Non-random patterns of comorbidity between discrete classes of mental disorders have been documented extensively in prior community samples of youth. ⁻ Future analyses of these data will investigate specific concurrent and prospective comorbidity patterns as well as their sociodemographic and clinical correlates.

In addition to providing prevalence estimates, the findings also confirm observations from previous U.S. and international investigations of adolescents concerning the association of sociodemographic characteristics and mental disorders. In particular, female adolescents were more likely than males to have mood and anxiety disorders, but less likely to have behavioral and substance use disorders. Non-Hispanic Blacks were less likely to have substance use disorders compared to Whites, a finding that is similar to prior community studies of adolescents and adults. The increased prevalence of mood and substance use disorders in older adolescents has also been observed in previous investigations, thus indicating the importance of prevention strategies for early and mid-adolescence. By contrast, the stability of certain anxiety and behavioral disorders across this same developmental period suggests that earlier interventions before puberty may be appropriate for many of these conditions.

The strong links between adolescent mental disorders and parental characteristics indicate the importance of the family context in the development of mental disorders. Our finding of a prominent effect of parental education on mental disorders has been well-documented for both child physical and mental health outcomes., Divorce was often associated with mental disorders in youth, particularly anxiety, behavior and substance use disorders. The mechanisms underlying the impact of non-intact homes on mental disorders in youth, including both biologic or genetic vulnerability, and indirect influences on disruptions in the home environment, warrant further study., , However, the significant interactions observed among several sociodemographic characteristics attest to the complexity of these associations. For example, increased rates of substance use disorders among Hispanic adolescents whose parents were divorced may reflect interactions of individual, familial and broader environmental influences that should be considered simultaneously in modeling the nature of risk and resilience in adolescent mental disorders., The lack of strong effects for some sociodemographic characteristics, such as poverty, may also be attributable to the multivariate statistical approach that adjusted for confounded variables.

The present findings should be interpreted in the context of several study-specific limitations. First, the cross-sectional nature of the survey limits our ability to document temporal ordering of mental disorders and putative risk and protective factors. Second, assessment of lifetime disorders is based on retrospective recall that is subject to numerous types of bias. Although we employed a number of methods to increase the validity of retrospective reports of age of onset, it is unlikely that we were able to completely correct for recall biases. A third limitation is that surrogate information was obtained only from one parent using a self-administered questionnaire rather than a direct interview, and only for a limited number of disorders assessed in the survey. The lack of prior evidence for integrating parent and child reports based on different modes of administration led us to apply an empirical approach based on previous research on cross-informant diagnostic estimates. In addition to study-specific limitations, a critical view is warranted concerning current diagnostic nomenclature more generally. Adolescence is a period of change and maturation in which emotional and behavioral difficulties may be common, and it is difficult to establish universally acceptable definitions of disorder or severity thresholds. The high comorbidity across classes of disorders also raises questions regarding the permeability of diagnostic categories and the plasticity of adolescent development. The pertinence of current and alternative developmentally-appropriate diagnostic criteria for adolescent mental disorders deserves careful attention and would benefit from continued debate.

Despite these limitations, our findings document the high prevalence of mental disorders in youth, and specify that just over one in four-to-five adolescents in the general population suffers from disorders that result in severe impairment. Considered with recent estimates indicating that the annual economic burden of mental disorders on the well-being of American youth and their families approaches a quarter of one trillion dollars, these findings underscore the key public health importance of mental health in American youth. The present data can inform and guide the development of priorities for future research and health policy by providing previously lacking prevalence estimates in a nationally representative sample of U.S. adolescents, as well as the individual, familial and environmental correlates of mental disorders. Prospective research is now needed to understand the risk factors for mental disorder onset in adolescence, as well as the predictors of the continuity of these disorders into adulthood.

Acknowledgments

The National Comorbidity Survey Adolescent Supplement (NCS-A) and the larger program of related NCS surveys are supported by the National Institute of Mental Health (U01-MH60220) and the National Institute of Drug Abuse (R01 DA016558) with supplemental support from Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust. The NCS-A was carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative.

This work was supported by the Intramural Research Program of the National Institute of Mental Health. The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or U.S. Government.

Footnotes

Disclosure: Drs. Merikangas, Burstein, Avenevoli, Benjet, Georgiades, and Swendsen, and Ms. He, Ms. Swanson, and Ms. Cui report no biomedical financial interests or potential conflicts of interest.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Contributor Information

Dr. Kathleen Ries Merikangas, Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health.

Ms. Jian-ping He, Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health.

Dr. Marcy Burstein, Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health.

Ms. Sonja A. Swanson, Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health.

Dr. Shelli Avenevoli, Division of Developmental Translational Research, National Institute of Mental Health.

Ms. Lihong Cui, Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health.

Dr. Corina Benjet, National Institute of Psychiatry Ramón de la Fuente, Mexico.

Dr. Katholiki Georgiades, McMaster University.

Dr. Joel Swendsen, National Scientific Research Center (CNRS), Bordeaux, France.

References

1. Costello E, Mustillo S, Keeler G, Angold A. Prevalence of psychiatric disorders in childhood and adolescence. In: Levin B, Petrila J, hennessy K, editors. Mental Health Services: A Public Health Perspective. Oxford: 2004. pp. 111-128. [ Google Scholar]

12. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: Substance Abuse and Mental Health Services Administration: Center for Mental Health Services; 1999. [ Google Scholar]

26. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: Substance Abuse and Mental Health Services Administration: Center for Mental Health Services; 1999. [ Google Scholar]

45. O'Connell ME, Boat T, Warner K. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, D.C: The National Academies Press; 2009. [ Google Scholar]

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Lifetime Prevalence of Mental Disorders in US Adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A)

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Dr. Kathleen Ries Merikangas, Ph.D, Ms. Jian-ping He, M.Sc., Dr. Marcy Burstein, Ph.D., Ms. Sonja A. Swanson, Sc.M., Dr. Shelli Avenevoli, Ph.D., Ms. Lihong Cui, M.Sc., Dr. Corina Benjet, Ph.D., Dr. Katholiki Georgiades, Ph.D., and Dr. Joel Swendsen, Ph.D.

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Sigmund Freud

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3) Free Association

A key part of learning to conduct psychoanalytic psychotherapy involves developing skills and techniques aimed at accessing and understanding unconscious processes.

This includes facilitating the client's free association, where the client expresses whatever thoughts or feelings come to mind without censorship. As unconscious ideas and emotions emerge, the therapist helps the client explore and make meaning of them.

Free association is a psychoanalytic term used to describe the free association of ideas that can give an insight into the unconscious mind of the patient.

In free association, the patient is encouraged to speak freely and to verbalize anything that comes to mind. In this way the patient may be able to bring content to the surface that has previously been censored by the ego.

This technique involves a therapist giving a word or idea, and the patient immediately responds in an unconstrained way with the first word that comes to mind. The analyst then offers an interpretation of the relationship observed.

It is hoped that fragments of repressed memories will emerge in the course of free association, giving an insight into the unconscious mind.

Free association may not prove useful if the client shows resistance, and is reluctant to say what he or she is thinking.

On the other hand, the presence of resistance (e.g., an excessively long pause) often provides a strong clue that the client is getting close to some important repressed idea in his or her thinking, and that further probing by the therapist is called for.

Freud reported that his free-associating patients occasionally experienced such an emotionally intense and vivid memory that they almost relived the experience. This is like a "flashback" from a war or a rape experience.

Such a stressful memory, so real it feels like it is happening again, is called an abreaction. If such a disturbing memory occurred in therapy or with a supportive friend and one felt better-relieved or cleansed-later, it would be called a catharsis.

Frequently, these intensely emotional experiences provided Freud a valuable insight into the patient's problems.

4) Dream Analysis

According to Freud, the analysis of dreams is "the royal road to the unconscious." He argued that the conscious mind is like a censor, but it is less vigilant when we are asleep.

In dream analysis, the analyst attempts to unravel and interpret the symbolic nature of the patient's dreams. The true concerns of the patient are often disguised in their dreams and may be experienced symbolically, i.e. they dream about something that represents their concern, rather than dreaming directly about the concern itself. The true concerns of the patient are often disguised in this symbolic form to protect the conscious mind from developing full awareness of the underlying concern.

As a result, repressed ideas come to the surface - though what we remember may well have been altered during the dream process.

As a result, we need to distinguish between the manifest content and the latent content of a dream. The former is what we actually remember.

The latter is what it really means. Freud believed that very often the real meaning of a dream had a sexual significance and in his theory of sexual symbolism, he speculates on the underlying meaning of common dream themes.

5) Transference Analysis

Another core technique is examining transference, which refers to how the client relates to the therapist in ways that unconsciously reflect early important relationships, and countertransference, the therapist's own unconscious reactions to the client that can give insight into the therapeutic relationship dynamics.

So, trainees learn to attend carefully to the emotional interchanges within the therapy relationship as a source of insight into both parties' unconscious relational patterns stemming from their developmental histories.

Of key importance in psychoanalytic therapy is transference. Freud had originally noticed that his patients sometimes felt and acted toward him as if he were an important person from the patient's past.

Sometimes, these feelings were positive, but sometimes they were negative and hostile. Freud assumed these were relics of attitudes held toward these important persons in the patient's past.

Freud felt that this transference was an inevitable aspect of psychoanalysis, and used it to explain to patients the childhood origins of many of the concerns and fears.

In psychoanalysis, transference is seen as essential to a complete cure. Analysts use the fact that transference is developing as a sign that an important repressed conflict is nearing the surface.

Countertransference

In psychoanalysis, countertransference refers to the emotional reactions and unconscious biases a therapist might have towards a patient, often influenced by the therapist's own past experiences or unresolved feelings.

It's the therapist's emotional response to the patient's transference.

Clinical Applications

Psychoanalysis (along with Rogerian humanistic counseling) is an example of a global therapy (Comer, 1995, p. 143) which has the aim of helping clients bring about a major change in their whole perspective on life.

This rests on the assumption that the current maladaptive perspective is tied to deep-seated personality factors. Global therapies stand in contrast to approaches which focus mainly on a reduction of symptoms, such as cognitive and behavioral approaches, so-called problem-based therapies.

Psychoanalytic therapy has been seen as appropriate mainly for the neurotic disorders (e.g. anxiety and eating disorders) rather than for psychotic disorders such as schizophrenia. It is also used for depression although its effectiveness in this area is more questionable because of the apathetic nature of the depressive patients.

A related problem is the greater likelihood of transference in depressive patients undergoing psychoanalysis. They are likely to show extreme dependency upon important people in their life (including their therapist) and more likely to develop transference (Comer, 1995).

Anxiety disorders such as phobias, panic attacks, obsessive-compulsive disorders and post-traumatic stress disorder are obvious areas where psychoanalysis might be assumed to work.

The aim is to assist the client in coming to terms with their own id impulses or to recognize the origin of their current anxiety in childhood relationships that are being relived in adulthood. Svartberg and Stiles (1991) and Prochaska and DiClemente (1984) point out that the evidence for its effectiveness is equivocal.

Salzman (1980) suggests that psychodynamic therapies generally are of little help to clients with specific anxiety disorders such as phobias or OCDs but may be of more help with general anxiety disorders.

Salzman (1980) expresses concerns that psychoanalysis may increase the symptoms of OCDs because of the tendency of such clients to be overly concerned with their actions and to ruminate on their plight (Noonan, 1971).

Comer also suggests that psychoanalysis may not be appropriate for patients suffering from obsessive-compulsive disorder in that it may inadvertently increase their tendency to over-interpret events in their life.

Depression may be treated with a psychoanalytic approach to some extent. Psychoanalysts relate depression back to the loss every child experiences when realizing our separateness from our parents early in childhood. An inability to come to terms with this may leave the person prone to depression or depressive episodes in later life.

Treatment then involves encouraging the client to recall that early experience and to untangle the fixations that have built up around it. Particular care is taken with transference when working with depressed clients due to their overwhelming need to be dependent on others.

The aim is for clients to become less dependent and to develop a more functional way of understanding and accepting loss/rejection/change in their lives.

Shapiro and Emde (1991) report that psychodynamic therapies have been successful only occasionally. One reason might be that depressed people may be too inactive or unmotivated to participate in the session. In such cases a more directive, challenging approach might be beneficial.

Another reason might be that depressives may expect a quick cure and as psychoanalysis does not offer this, the client may leave or become overly involved in devising strategies to maintain a dependent transference relationship with the analyst.

Critical Evaluation

Therapy is very time-consuming and is unlikely to provide answers quickly.

People must be prepared to invest a lot of time and money into the therapy; they must be motivated.

They might discover some painful and unpleasant memories that had been repressed, which causes them more distress.

This type of therapy does not work for all people and all types of disorders.

The nature of Psychoanalysis creates a power imbalance between therapist and client that could raise ethical issues.

There has been criticism in recent years that if psychoanalysis is of benefit to people, it is only of benefit to those who possess certain qualities. The acronym YAVIS has been used to indicate that patients who are young, attractive, verbal, intelligent, and successful would be the ones most likely to benefit from psychoanalysis.

Few studies appear to support the first three of these suggestions, although as well as the latter two suggestions there is evidence that psychoanalysis also works best with those clients who are highly motivated and have a positive attitude towards therapy.

Eysenck (1952) delivered the most damaging indictment of psychoanalysis when he reviewed studies of therapeutic outcomes for neurotic patients. He found that about half recovered within two years. What was so damning for psychoanalysis was that for similar patients who received no treatment at all (waiting list controls), the figure was about two thirds.

Critics of Eysenck's findings discovered that he had made a number of arbitrary judgements about 'recoveries' that were unfavorable to the groups that received psychoanalytic treatments.

Bergin (1971) found that by selecting different outcome criteria, improvement in the psychoanalytically treated group rose to 83% whilst the percentage of control group patients showing significant improvement dropped to 30%.

Fisher and Greenberg (1977), in a review of the literature, conclude that psychoanalytic theory cannot be accepted or rejected as a package, "it is a complete structure consisting of many parts, some of which should be accepted, others rejected and the others at least partially reshaped."

Eysenck's claims against the effectiveness of psychoanalysis showed the difficulties of evaluation in this area. Individual differences in patients and therapists, and the relationship between them, might confound attempts to measure the effectiveness of a particular type of treatment. Measuring the outcome of treatment may also present problems in defining what is meant by 'cure'.

Corsini and Wedding (1995, 2013) claim that, depending on the criteria involved, estimates of 'cure' as a result of psychoanalysis range from 30% to 60%.

Although changes in the occurrence of symptoms might be a suitable way of measuring the effectiveness of behaviorist techniques, the effectiveness of psychoanalytic therapy, which typically spans several years, is more subjective, measurable only by the extent to which the clients themselves feel that their condition has improved .

Fonagy (1981) questions whether attempts to validate Freud's approach through laboratory tests have any validity themselves.

Freud's theory questions the very basis of a rationalist, scientific approach and could well be seen as a critique of science, rather than science rejecting psychoanalysis because it is not susceptible to refutation.

The case study method is criticized as it is doubtful that generalizations can be valid since the method is open to many kinds of bias (e.g., Little Hans).

However, psychoanalysis is concerned with offering interpretations to the current client, rather than devising abstract dehumanized principles.

Anthony Storr (1987), the well-known psychoanalyst appearing on TV and Radio 4's "All in the Mind", holds the view that whilst a great many psychoanalysts have a wealth of "data" at their fingertips from cases, these observations are bound to be contaminated with subjective personal opinion and should not be considered scientific.

Neo Freudians

Subsequent psychoanalytic theorists built upon but also challenged Freud's drive theory.

Object relations theory shifted focus to relationships and attachment, with key figures like Melanie Klein, Donald Winnicott, and John Bowlby emphasizing how internal working models of self/other based on early caretaker relationships shape personality and relational patterns.

Harry Stack Sullivan and interpersonal psychoanalysis highlighted social and cultural factors influencing mental health. Heinz Kohut's self-psychology focused on empathy, attunement, and disorders of the self like narcissism.

Intersubjective and relational psychoanalysis theories view the client's and therapist's subjectivities as co-created in an intersubjective field, with attention to enactments and dissociated self states, especially for trauma survivors.

Attachment Theory vs Psychoanalysis

Attachment theory, developed by John Bowlby, and psychoanalytic theory, developed by Sigmund Freud, offer complementary perspectives on human development and relationships.

While attachment theory reacted against some psychoanalytic views, like drive theory, the two approaches converge on many topics. Both see early childhood experiences as shaping internal models that influence adult relationships and behavior.

Attachment research provides empirical evidence that unresolved issues from childhood perpetuate across generations, a key psychoanalytic claim. Concepts like internal working models and secure base align with psychoanalytic ideas like transference and the therapeutic relationship fostering insight.

However, attachment theory more strongly emphasizes the impact of actual childhood events, whereas psychoanalysis highlights inner reality and fantasy.

Both offer useful frameworks for understanding how relational patterns persist or change across the lifespan. Their differences can spark productive dialogue on the roles of inner and outer reality in development.

Training

Psychoanalytic education also involves the trainee undergoing extensive personal therapy, where through experiencing the therapy process directly they gain firsthand insight into their own psychological conflicts, attachment history, unconscious reactions, and clinical blind spots.

This helps develop self-awareness and attunement needed to understand and respond helpfully to clients' unconscious communications.

Finally, cultural competence requires analysts to engage in ongoing self-examination around differences and power dynamics related to their own and their clients' sociocultural identities and experiences.

Unconscious assumptions, biases, stereotypes etc. rooted in culture and privilege/oppression influence clinical perceptions and relationships, so their ongoing reflection upon is considered imperative.

The multiple layers of self-exploration around unconscious processes in one's personal therapy, clinical work, supervision, and sociocultural context form the bedrock of psychoanalytic clinical education and skill development.

Learning Check: You are the Therapist

A young man, 18 years old, is referred to a psychoanalyst by his family doctor. It seems that, for the past year, the young man (Albert) has been experiencing a variety of symptoms such as headaches, dizziness, palpitations, sleep disturbances - all associated with extreme anxiety.

The symptoms are accompanied by a constant, but periodically overwhelming fear of death. He believes that he has a brain tumor and is, therefore, going to die.

However, in spite of exhaustive medical tests, no physical basis for the symptoms can be identified. The doctor finally concludes that Albert's symptoms are probably psychologically based.

Albert arrives at the analyst's office accompanied by his parents. He describes his problems and depicts his relationship with his parents as "rosy" - though admitting that his father may be "a little on the strict side."

It emerges that his father will not permit Albert to go out during the week, and he must be home by 11 pm at weekends.

Additionally, he successfully broke up a relationship between Albert and a girlfriend because he thought they were getting "too close." In describing this, Albert shows no conscious resentment, recounting the events in an emotional, matter of fact manner.

During one session, in which Albert is encouraged to free associate, he demonstrated a degree of resistance in the following example:

This passage is fairly typical of Albert's recollections.

Occasionally, Albert is late for his appointments with the therapist, and less often he misses an appointment, claiming to have forgotten.

During one session, Albert reports a dream in which his father is leaving on a train, while Albert remains on the platform holding hands with both his mother and his girlfriend. He feels both happy and guilty at the same time.

Sometime later, after the therapy sessions have been going on for several months, the analyst takes a two weeks holiday. During a session soon afterward Albert speaks angrily to the therapist.

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Psychoanalysis: Freud's Psychoanalytic Approach to Therapy

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Psychoanalysis is a therapeutic approach and theory, founded by Sigmund Freud, that seeks to explore the unconscious mind to uncover repressed feelings and interpret deep-rooted emotional patterns, often using techniques like dream analysis and free association.

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Eating Disorder Intervention, Prevention, and Treatment: Recommendations for School Counselors

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Eating Disorder Intervention, Prevention, and Treatment: Recommendations for School Counselors

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 Eating Disorder Intervention,  Prevention, and Treatment-  Recommendations for  School Counselors

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Good nutrition and a balanced diet help kids grow up healthy. Here’s how to improve nutrition and encourage smart eating habits.

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Parents, siblings, family members, friends and even strangers can be powerful role models for children. Children learn through simply watching other people which means that our own behaviour can easily be picked up and copied by children.

In relation to eating, this means that children are likely to imitate the eating behaviours of people they spend time with. This includes parents, primary caregivers, brothers and sisters, friends and peers, as well as extended family.

Why is it important to be a good role model?

Children are like sponges, picking up habits and behaviours from those they see around them. This means that role models can play a really important part in shaping children's eating habits. Role models can come in one of two forms: healthy role models and unhealthy role models.

Research shows that children whose parents eat more fruit and vegetables typically eat more of these foods themselves, but that children whose parents eat more savoury snack foods consume more of these too.

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Parents, siblings, family members, friends and even strangers can be powerful role models for children. Children learn through simply watching other people which means that our own behaviour can easily be picked up and copied by children. In relation to eating, this means that children are likely to imitate the eating behaviours of people they spend time with.

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CENTER FOR DISCOVERY
5124 Corinthian Bay Drive
Plano, TX 75093
PH 866.482.3876
Hours 24/7

COVID-19 Update:In-person residential treatment is still offered at this location. Learn about all that we are doing to protect the safety and wellbeing of our patients and staff.

Center for Discovery Plano is a treatment center for for all genders between the ages of 9-18 who have been diagnosed with an eating disorder. Center for Discovery Plano opened in 2015 on beautiful estate-like home in the Willow Bend neighborhood of Plano, Texas. It is a serene and supportive environment for our clients to engage in difficult and life-changing work

The Plano staff is specially-trained to work with young clients across the gender spectrum, including two CEDS certified therapists, who utilize a broad range of therapies. Therapists provide Dialectal Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and Exposure and Response Prevention (ERP) while also engaging the clients in mindful movement, and yoga in a beautiful outside space. In addition, we also provide a specialized binge eating treatment program called Path to Peace.

The Plano eating disorder treatment center also provides continuing education to clients so they do not fall behind in their studies while in treatment. Family members are an integral part of recovery and therapeutic, educational and family visitation opportunities throughout their child's stay.

For insurances this location specifically accepts, insurances we accept include, but not limited to, Blue Shield Blue Cross (BSBC), Beacon, HealthNet, Humana, Optum, and Tricare. For an inquiry if your insurance is accepted for this location, please contact us.

LEARN ABOUT OUR COVID CLEAN COMMITMENT

Nicholas Ciancioso, M.A

PROGRAM DIRECTOR

Dr. Tae Lee, MD

PROGRAM PSYCHIATRIST

Barbara To, LPC

PRIMARY THERAPIST

Dr. Jennifer Zomnir, MD

PROGRAM PHYSICIAN

McKenzie Ramirez, RD, LD

REGISTERED DIETITIAN

Support Group

This location provides free online eating disorder support groups. Our online support groups vary. Find out more about how to join our free support groups.

COVID-19 Update:In-person residential treatment is still offered at this location. Learn about all that we are doing to protect the safety and wellbeing of our patients and staff.

Center for Discovery Plano is a treatment center for all genders between the ages of 9-18 who have been diagnosed with an eating disorder. Center for Discovery Plano opened in 2015 on beautiful estate-like home in the Willow Bend neighborhood of Plano, Texas. It is a serene and supportive environment for our clients to engage in difficult and life-changing work

The Plano staff is specially-trained to work with young clients across the gender spectrum, including two CEDS certified therapists, who utilize a broad range of therapies. Therapists provide Dialectal Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and Exposure and Response Prevention (ERP) while also engaging the clients in mindful movement, and yoga in a beautiful outside space. In addition, we also provide a specialized binge eating treatment program called Path to Peace.

The Plano eating disorder treatment center also provides continuing education to clients so they do not fall behind in their studies while in treatment. Family members are an integral part of recovery and therapeutic, educational and family visitation opportunities throughout their child's stay.

For insurances this location specifically accepts, insurances we accept include, but not limited to, Blue Shield Blue Cross (BSBC), Beacon, HealthNet, Humana, Optum, and Tricare. For an inquiry if your insurance is accepted for this location, please contact us.

LEARN ABOUT OUR COVID CLEAN COMMITMENT

Support Group

This location provides free online eating disorder support groups. Our online support groups vary. Find out more about how to join our free support groups.

GET IN TOUCH / CALL 866.482.3876

CENTER FOR DISCOVERY
5124 Corinthian Bay Drive
Plano, TX 75093
PH 866.482.3876
HOURS 24/7

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Eating Disorder Treatment Center in Plano, TX - Center For Discovery

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CENTER FOR DISCOVERY 5124 Corinthian Bay Drive Plano, TX 75093 PH 866.482.3876 Hours 24/7 COVID-19 Update:In-person residential treatment is still offered at this location. Learn about all that we are doing to protect the safety and wellbeing of our patients and staff.

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Eating Disorders

Do you ever notice yourself being in a constant battle about food? Or constantly comparing yourself to everyone around you? Eating Disorders affect every aspect of your life. Whether you are dealing with disordered eating or an eating disorder I can help you understand how it impacts areas in your life. With working in treatment centers for eating disorders for several years I understand the needs for each level of care and the importance of working closely with a dietitian if needed, in order to provide the best care for you.

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Eating Disorders Do you ever notice yourself being in a constant battle about food? Or constantly comparing yourself to everyone around you? Eating Disorders affect every aspect of your life. Whether you are dealing with disordered eating or an eating disorder I can help you understand how it impacts areas in your life.

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Find Eating Recovery Center locations here. We provide treatment for adult and adolescent eating disorders, mood, anxiety and trauma-related conditions.

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Julie Rami, M.A. Ed., B.S. Spec. Ed.
McCallum Place Teacher
Nancy Anderson, B.S. Ed.
McCallum Place Teacher
What does an eating disorder look like in the classroom?
Many times an educator is the first person who notices some of the warning signs of an eating order. Think of all the time that a student spends in a classroom setting and how many different people consistently see them everyday. This may be the core classroom teachers, the PE teacher, the school counselor and the nurse. So, what are the signs that these individuals should be looking out for?

A student can be tired, have low energy, lack of motivation and drive that was previously there, high levels of distractibility, irritability, constant movement, forgetfulness, and overall just drastic physical changes. They might start missing a lot of school as they are just too tired to get up or just may truly not feel well. Missing assignments start piling up because they don't have the energy or concentration to complete them. Then, inevitably, this leads to a change in overall performance and grades will drop.

What does an eating disorder look like among the peer group and social
interactions?
What does an eating disorder look like from a nurse's point of view?
Often isolation is the first outward sign of an ED amongst teenagers. A change in social habits can look like a child pulling away from the peer group and not engaging in the social patterns they previously enjoyed. They can isolate themselves as the eating disorder worsens as a means to hide their behaviors. At times, the patient can feel rejected or alienated when peers express concerns over their eating habits. Sometimes the ED has been precipitated by teasing and comments from peers. Other times, what starts as an attempt at improving health with diet and exercise gets out of hand but initially the body changes are reinforced through praise. Social media can play a negative role in the validating of disordered eating and body image. Parents should always be aware of their child's presence and identity on all social media outlets.
What does an eating disorder look like on the sports field in and out of school?
A student that struggles with an eating disorder may be a frequent visitor to the school nurse. Their symptoms can include complaints of nausea after eating small or normal amounts, bloating or water retention not attributable to other physical problems, constipation, reflux, chronic sore throat, swelling of glands around the jaws, frequent and unusual dental problems, general complaints of lightheadedness, fainting and frequently feeling cold.

This is a student athlete that is "practicing" or "training" for several hours a day and often secretive about their workouts. They can be quite rigid and compulsive with their drive to perfection. These students will find a reason to avoid eating with the team and will be averse to resting, rehydrating and refueling their bodies. They are at a higher risk for stress fractures and also can exhibit dizziness, weakness, fainting and weight loss. Their declining performance should be a red flag to those adults around them. An eating disorder takes on many different faces, but if everyone is aware of these signs and symptoms then help can be sought sooner than later.

Posted in addiction, adolescents, anorexia, anxiety, anxiety reduction, binge-eating, body-dismorphia, bulimia, change, eating disorder, eating disorder therapy, eating disorder treatment, education, males and eating disorders, nutrition, self-image, therapy, tutoring, weight loss

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Eating Disorders in the School Setting - McCallum Place

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Julie Rami, M.A. Ed., B.S. Spec. Ed. McCallum Place Teacher Nancy Anderson, B.S. Ed. McCallum Place Teacher Many times an educator is the first person who notices some of the warning signs of an eating order. Think of all the time that a student spends in a classroom setting and how many different people consistently ...

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Lists NIMH information resources for mental health topics, education and outreach efforts.

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Depression is a hidden crisis among young people of color, which impacts their families, schools and communities. Too often, there is a stigma and a sense of denial associated with depression. Youth in communities of color often feel they have no option for affordable, culturally relevant therapies.

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Angelo State University - Library Online Resources

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Unauthorized use is prohibited; Usage may be subject to security testing and monitoring; Misuse is subject to criminal prosecution; No expectation of privacy except as otherwise provided by applicable privacy laws.

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Angelo State University - Library Online Resources

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Unauthorized use is prohibited; Usage may be subject to security testing and monitoring; Misuse is subject to criminal prosecution; No expectation of privacy except as otherwise provided by applicable privacy laws.

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Recent research on Conduct Disorder has been very promising. For example, research has shown that most children and adolescents with conduct disorder do not grow up to have behavioral problems or problems with the law as adults; most of these youth do well as adults, both socially and occupationally. Researchers are also gaining a better understanding of the causes of conduct disorder, as well as aggressive behavior more generally. Conduct disorder has both genetic and environmental components. That is, although the disorder is more common among the children of adults who themselves exhibited conduct problems when they were young, there are many other factors which researchers believe contribute to the development of the disorder. For example, youth with conduct disorder appear to have deficits in processing social information or social cues, and some may have been rejected by peers as young children.

Despite early reports that treatment for this disorder is ineffective, several recent reviews of the literature have identified promising approaches treating children and adolescents with conduct disorder. The most successful approaches intervene as early as possible, are structured and intensive, and address the multiple contexts in which children exhibit problem behavior, including the family, school, and community. Examples of effective treatment approaches include functional family therapy, multi-systemic therapy, and cognitive behavioral approaches which focus on building skills such as anger management. Pharmacological intervention alone is not sufficient for the treatment of conduct disorder.

Conduct disorder tends to co-occur with a number of other emotional and behavioral disorders of childhood, particularly Attention Deficit Hyperactivity Disorder (ADHD) and Mood Disorders (such as depression). Co-occurring conduct disorder and substance abuse problems must be treated in an integrated, holistic fashion.

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Recent research on Conduct Disorder has been very promising. For example, research has shown that most children and adolescents with conduct disorder do not grow up to have behavioral problems or problems with the law as adults; most of these youth do well as adults, both socially and occupationally.

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Mental Health America is the nation's leading national nonprofit dedicated to the promotion of mental health, well-being, and condition prevention.

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ASCA Mindsets & Behaviors for Student Success

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ASCA Mindsets & Behaviors for Student Success

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Simply Psychology | Self-Care, Theories, Famous Studies & More

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We're committed to being your expert and trustworthy source for psychology theories, relationship advice, and mental health information. Whether you want to learn about theories or studies, understand a mental health disorder, or how to improve your relationships, get the guidance you need to be healthy and happy.

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Resource Guide Psychotic & Mood Disorders

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Resource Guide Psychotic & Mood Disorders

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Resource Guide to Psychotic & Mood Disorders

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A psychotic episode can be confusing and frightening for young people and their families and friends. The Recovery After an Initial Schizophrenia Episode (RAISE) web pages offer a number of tools to help you understand the condition, treatment options, and strategies for living with psychosis. The Questions & Answers page provides information about the most common concerns.

The resources below include printable materials such as factsheets, brochures, and a glossary. You'll also find online and telephone assistance, informative videos, and more. An asterisk (*) appears next to those resources produced by the National Institute of Mental Health (NIMH). This list of resources is not comprehensive and does not constitute an endorsement by NIMH.

Videos
Understanding Psychosis

What is Psychosis? Psychosis and its symptoms and causes are described. Advice is also offered about what to do if someone you know is experiencing psychosis. (Developed by the Center for Practice Innovations, Columbia Psychiatry, New York State Psychiatric Institute for the New York City Thrive Learning Center.)

Voices of Recovery Video Series: Young women, men, and parents share inspiring and informative recovery stories. (Developed by the Center for Practice Innovations, Columbia Psychiatry, New York State Psychiatric Institute with funding from NIMH.)

* Google+ Hangout on First Episode Psychosis: Dr. John Kane and Dr. Amy Goldstein answer viewer questions about first episode psychosis.

Psychosis-Early Detection Saves Minds: D eveloped by NIMH grantee MindMapCT

Treating Psychosis

* Treating First Episode Psychosis: Dr. John Kane discusses treating first episode psychosis using coordinated specialty care.

Implementing Early Treatment of Psychosis: Dr. Lisa Dixon talks about her personal interest in RAISE and about developing first episode psychosis treatment programs in communities.

Antipsychotics, Weight Gain, and How to Keep Kids Healthy: Dr. Christoph Correll, a professor of psychiatry at Hofstra North Shore-LIJ School of Medicine and an expert in pediatric schizophrenia, talks about balancing the benefits of antipsychotic medications with strategies to address their side effects. His core message is simple: encourage healthy living and always begin with the intervention that poses the smallest risk. He also describes more intensive treatments for the weight gain that often accompanies these medications.

Printer-Friendly Fact Sheets and Publications

* Understanding Psychosis

* Glossary

* Schizophrenia Brochures

Schizophrenia: This brochure on schizophrenia explains what it is, when it starts and how to get help.

Esquizofrenia: El folleto explica qué es la esquizofrenia; cómo empieza y a quién le da; los síntomas, las causas y los tratamientos de la esquizofrenia; y cómo ayudar a alguien con este trastorno.

Understanding Psychosis: Resources and Recovery A resource guide to help young people, parents and loved ones understand psychosis. (Developed by the National Alliance on Mental Illness in Minnesota, an NIMH Outreach Partner.)

A Sibling's Guide to Psychosis Information, ideas and resources. (Developed by the Canadian Mental Health Association.)

National Organizations

NIMH does not endorse specific early psychosis clinics, but there are several organizations that may be able to assist you in finding a treatment program in your area. This list may not be comprehensive.

Online Resources

Phone Resources

National Alliance on Mental Illness (NAMI) Information Helpline: This information and referral service can be reached at 1-800-950-NAMI (6264), Monday through Friday, 10 a.m.- 6 p.m., EST or by email at info@nami.org.

National Suicide Prevention Lifeline: A 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress is available at1-800-273-TALK (8255)

SAMHSA's 24-hour Referral Helpline: For substance abuse and mental health services, call 1-800-662-HELP (4357)

Additional Information about RAISE

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RAISE Resources for Patients and Families

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A psychotic episode can be confusing and frightening for young people and their families and friends. The Recovery After an Initial Schizophrenia Episode (RAISE) web pages offer a number of tools to help you understand the condition, treatment options, and strategies for living with psychosis.

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Lists NIMH information resources for mental health topics, education and outreach efforts.

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Schizophrenia Information > Support Groups

Schizophrenia Support Groups and Related Resources

Schizophrenia and other serious brain disorders are an extreme challenge not only for the person afflicted, but for the entire family. It helps a great deal to be able to talk with other people who have, or are, going though the same things that you are - to share tips and local resources in coping, and to work together in getting the best possible treatment in your city or area. Both medical research and anecdotal evidence have revealed that a social support network is a vital part of recovery for mental health consumers.

Below is are good sources on for finding such a support group. Also listed are the National Mental Health Offices that should be able to help with regard to the governmental services for mental health. If there isn't a support group in your area, start one - the national offices of each of these organizations are usually more than willing to help! Try the National Mental Health Consumer's Self-Help Clearinghouse for ideas and support.

Also - for quick and immediate support - join in the schizophrenia.com support group discussion areas listed on the home page. If we've missed a group below, please let us know ( szwebmaster@yahoo.com)

Here is a good example of a more progressive approach to providing information to the public, from the British Columbia Schizphrenia Society: PsychosisSucks

Compeer is a non-profit organization that matches trained community volunteers with children and adults receiving mental health treatment. There are over 100 Compeer programs in the USA, Australia, and Canada.

Canadian Mental Health Association - Office Locator

In Europe

In Australia there is the SANE Australia organization

Compeer is a non-profit organization that matches trained community volunteers with children and adults receiving mental health treatment. There are over 100 Compeer programs in the USA, Australia, and Canada.

In Japan, there is the Zenkaren group
A good Japanese Sibling (Brother/Sisters) Groups Listing here

In India, there doesn't seem to be much available - but these organizations seem to offer some help:

For other countries please visit: Worldwide Support Organizations List

Visit the World Fellowship for Schizophrenia and Allied Disorders - it is a worldwide support organization for family-oriented support groups.

Web Resources - a comprehensive list of organizations, online reading material, and support/consumer websites, all accessible right from your computer.

Free Support Courses on Brain Diseases for Family Members: We also highly recommend that you take a course offered by NAMI (if its available in your area) called Family to Famil y - a 12 week course that helps family members deal with serious brain disorders.

Good Resources to help you when someone you care about has Schizophrenia

Recognizing and Avoiding Relapse

Other resources to help you and your family cope with schizophrenia:

Copyright 1996-2010. Schizophrenia.com. The Internet Mental Health Initiative, All Rights Reserved.

This site does not provide medical or any other health care or fitness advice, diagnosis, or treatment. The site and its services, including the information above, are for informational purposes only and are not a substitute for professional medical or health advice, examination, diagnosis, or treatment. Always seek the advice of your physician or other qualified health professional before starting any new treatment, making any changes to existing treatment, or altering in any way your current exercise or diet regimen. Do not delay seeking or disregard medical advice based on information on this site. Medical information changes rapidly and while Schizophrenia.com makes efforts to update the content on the site, some information may be out of date. No health information on Schizophrenia.com, including information about herbal therapies and other dietary supplements, is regulated or evaluated by the Food and Drug Administration and therefore the information should not be used to diagnose, treat, cure, or prevent any disease without the supervision of a medical doctor.

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Schizophrenia Information > Support Groups Schizophrenia Support Groups and Related Resources Schizophrenia and other serious brain disorders are an extreme challenge not only for the person afflicted, but for the entire family.

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Mental Health in Childhood

Raising a child can be challenging. Even under the best circumstances, their behaviors and emotions can change frequently and rapidly. All children are sad, anxious, irritable, or aggressive at times, or they occasionally find it challenging to sit still, pay attention, or interact with others. In most cases, these are just typical developmental phases. However, such behaviors may indicate a more serious problem in some children.

Mental disorders can begin in childhood. Examples include anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, depression and other mood disorders, eating disorders, and post-traumatic stress disorder (PTSD). Without treatment, these mental health conditions can prevent children from reaching their full potential. Many adults who seek mental health treatment reflect on the impact of mental disorders on their childhood and wish they had received help sooner.

When to Seek Help

How can you tell the difference between challenging behaviors and emotions that are a normal part of growing up and those that are cause for concern? In general, consider seeking help if your child's behavior persists for a few weeks or longer; causes distress for your child or your family; or interferes with your child's functioning at school, at home, or with friends. If your child's behavior is unsafe, or if your child talks about wanting to hurt themselves or someone else, seek help immediately.

Young children may benefit from an evaluation and treatment if they:

Have frequent tantrums or are intensely irritable much of the time

Often talk about fears or worries

Complain about frequent stomachaches or headaches with no known medical cause

Are in constant motion and cannot sit quietly (except when they are watching videos or playing video games)

Sleep too much or too little, have frequent nightmares, or seem sleepy during the day

Are not interested in playing with other children or have difficulty making friends

Struggle academically or have experienced a recent decline in grades

Repeat actions or check things many times out of fear that something bad may happen

Older children and adolescents may benefit from an evaluation and treatment if they:

Have lost interest in things that they used to enjoy

Have low energy

Sleep too much or too little or seem sleepy throughout the day

Are spending more and more time alone and avoid social activities with friends or family

Diet or exercise excessively, or fear gaining weight

Engage in self-harm behaviors (such as cutting or burning their skin)

Smoke, drink, or use drugs

Engage in risky or destructive behavior alone or with friends

Have thoughts of suicide

Have periods of highly elevated energy and activity and require much less sleep than usual

Say that they think someone is trying to control their mind or that they hear things that other people cannot hear

Learn more about warning signs on the National Institute of Mental Health's (NIMH) Child and Adolescent Mental Health webpage.

First Steps for Parents

If you are concerned about your child's mental health, you can start by talking with others who frequently interact with your child. For example, ask their teacher about your child's behavior in school, at daycare, or on the playground.

You can talk with your child's pediatrician or health care provider and describe the child's behavior, as well as what you have observed and learned from talking with others. You also can ask the health care provider for a referral to a mental health professional who has experience and expertise in treating children. (See Choosing a Mental Health Professional for additional information.)

Choosing a Mental Health Professional

When looking for a mental health professional for your child, you may want to begin by asking your child's pediatrician for a referral. If you need help identifying a provider in your area, you can call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357). You also can search SAMHSA's online Behavioral Health Treatment Services Locator, which lists facilities and programs that provide mental health services. It's especially important to look for a mental health professional with training and experience treating children, particularly your child's specific problems.

Asking questions and providing information to your child's health care provider can improve your child's care. Talking with the health care provider builds trust and leads to better results, quality, safety, and satisfaction. Here are some questions you can ask when meeting with prospective treatment providers:

Do you use treatment approaches that are supported by research?

Do you involve parents in the treatment? If so, how are parents involved?

Will there be "homework" between sessions?

How will progress be evaluated?

How soon can we expect to see progress?

How long should treatment last?

To find ideas for starting the conversation with your health care provider, visit the Agency for Healthcare Research and Quality website and read NIMH's Tips for Talking With Your Health Care Provider. Additional information about finding a qualified mental health professional is available on NIMH's Help for Mental Illnesses webpage and through other organizations listed in More Information and Resources.

Assessing Your Child's Behavior

An evaluation by a mental health professional can help clarify problems underlying your child's behavior and provide reassurance or recommendations for the next steps. An evaluation offers an opportunity to learn about your child's strengths and weaknesses and to determine which interventions might be most helpful.

A comprehensive evaluation of a child's mental health includes the following:

An interview with the parents to discuss the child's developmental history, temperament, relationships with friends and family, medical history, interests, abilities, and any prior treatment. It is important for the mental health professional to get a picture of the child's current situation-for example, a recent change in schools, an illness in the family, or another change that affects the child's daily life.

Information gathering from the child's school, such as standardized tests and reports on behavior, capabilities, and difficulties.

If needed, an interview with the child and the mental health professional's testing and behavioral observations.

Treatment Options

The mental health professional will review the evaluation results to help determine if a child's behavior is related to changes or stresses at home or school or if it's the result of a disorder for which they would recommend treatment. Treatment recommendations may include:

Psychotherapy ("talk therapy"). There are many different approaches to psychotherapy, including structured psychotherapies directed at specific conditions. For more information about types of psychotherapies, visit NIMH's psychotherapies webpage. Effective psychotherapy for children always includes:

Parent involvement in the treatment

Teaching the child skills to practice at home or school (between-session "homework assignments")

Measures of progress (such as rating scales and improvements on "homework assignments") that are tracked over time.

Medications. As with adults, the type of medicines used for children depends on the diagnosis and may include antidepressants, stimulants, mood stabilizers, or other medications. For general information on specific classes of medications, visit NIMH's mental health medications webpage. Medications are often used in combination with psychotherapy. If multiple health care providers or specialists are involved, treatment information should be shared and coordinated to achieve the best results.

Family counseling. Including family members in treatment can help them to understand how a child's challenges may affect relationships with parents and siblings.

Support for parents. Individual or group sessions for parents that include training and the opportunity to talk with other parents can provide new strategies for supporting a child and managing difficult behavior in a positive way. The therapist also can coach parents on how to communicate and work with schools on accommodations.

To find information about treatment options for specific disorders, visit NIMH's Mental Health Information webpage. Researchers continue to explore new treatment options for childhood mental disorders: Participating in a Research Study for Children provides information on participating in clinical research.

Working With the School

Children who have behavioral or emotional challenges that interfere with success in school may benefit from plans or accommodations provided under laws that prevent discrimination against children with disabilities. Your child's health care providers can help you communicate with the school.

A first step may be to ask the school whether accommodations such as an individualized education program may be appropriate for your child. Accommodations might include measures such as providing a child with a tape recorder for taking notes, allowing more time for tests, or adjusting seating in the classroom to reduce distraction. There are many sources of information on what schools can and, in some cases, must provide for children who would benefit from accommodations and how parents can request evaluation and services for their child:

There are Parent Training and Information Centers and Community Parent Resource Centers located throughout the United States. The Center for Parent Information and Resources lists centers in each state.

The U.S. Department of Education has detailed information on laws that establish mechanisms for providing children with accommodations tailored to their individual needs and aimed at helping them succeed in school. The Department also has a website on the Individuals with Disabilities Education Act, and its Office for Civil Rights has information on other federal laws that prohibit discrimination based on disability in public programs, such as schools.

Many of the organizations in More Information and Resources also offer information on working with schools as well as more general information on disorders affecting children.

More Information and Resources

Information on specific disorders is available on NIMH's Mental Health Information webpage.

The following organizations and agencies have information on symptoms, treatments, and support for childhood mental disorders. Some offer guidance for working with schools and finding mental health professionals. Participating in voluntary groups can provide an avenue for connecting with other parents dealing with similar issues.

Please Note: This resource list is provided for informational purposes only. It is not comprehensive and does not constitute an endorsement by NIMH, the National Institutes of Health (NIH), the U.S. Department of Health and Human Services, or the U.S. government.

Research on Disorders Affecting Children

NIMH conducts and supports research to help find new and improved ways to diagnose and treat mental disorders that occur in childhood. This research includes studies of risk factors-including those related to genetics, experience, and the environment-which may provide clues to how these disorders develop and how to identify them early.

NIMH also supports efforts to develop and test new interventions, including behavioral, psychotherapeutic, and medication treatments. Researchers are also seeking to determine whether the beneficial effects of treatment in childhood continue into adolescence and adulthood.

Participating in a Research Study for Children

Children are not little adults, yet they are often given medications and treatments that have been tested only in adults. Research shows that, compared to adults, children respond differently to medications and treatments, both physically and mentally. The way to get the best treatments for children is through research designed specifically for them.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for your child. For more information about clinical research and how to find clinical trials being conducted around the country, visit NIMH's clinical trials webpage.

Reprints

This publication is in the public domain and may be reproduced or copied without permission from NIMH. Citation of NIMH as a source is appreciated. To learn more about using NIMH publications, please contact the NIMH Information Resource Center at 1-866‑615‑6464, email nimhinfo@nih.gov, or refer to NIMH's reprint guidelines.

For More Information

MedlinePlus (National Library of Medicine) ( en español)

ClinicalTrials.gov ( en español)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 21-MH-8085
Revised 2021

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Children and Mental Health: Is This Just a Stage?

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This fact sheet presents information on children's mental health including assessing your child's behavior, when to seek help, first steps for parents, treatment options, and factors to consider when choosing a mental health professional. It also provides guidance on how to work with your child's school, a list of resources, and information about clinical trials.

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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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Accommodations for Children with Bipolar Disorder  

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Accommodations for Children 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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Both Individualized Education Programs (IEPs) and 504 plans can offer formal help for K-12 students who are struggling in school. They're similar in some ways but very different in others. This chart compares them side by side to help you understand the differences.

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.

To get an IEP, there are two requirements: 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. And 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.

To get a 504 plan, there are two requirements: A child has any disability. Section 504 covers a wide range of different struggles in school. And 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.

There are strict legal requirements about who participates. With a few exceptions, the entire IEP team must be present for IEP meetings. The team 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

* A school psychologist or other specialist who can interpret evaluation results

* A district representative with authority over special education services

The IEP sets learning goals and describes the services the school will provide. It's a written document. Here are some of the most important things the IEP must include:

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

* 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

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

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.

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

* Mediation

* Due process complaint

* Resolution session

* Civil lawsuit

* State complaint

* Lawsuit

And if you need help navigating special education law in your state, consider reaching out to your local Parent Training and Information Center. The people there can answer questions and give practical advice on issues specific to your area.

Do you want to learn more about how IEPs and 504 plans compare? Watch as an expert explains the differences between them.

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

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

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

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Individualized Education Programs (IEPs) and 504 plans are similar but different. See how they compare in what they provide and the processes and laws involved.

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Is it a modification or is it an accommodation_1_

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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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Working to deliver a better special education service

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Addressing Conduct Disorder in Elementary School Children:An Application of the ASCA National Model

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Addressing Conduct Disorder in Elementary School Children:An Application of the ASCA National Model

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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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"We initially chose IRIS because of the past experiences and their credible research-based, high-quality modules that align with specific areas of growth and need to support a state-directed corrective action plan in our region."

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"We initially chose IRIS because of the past experiences and their credible research-based, high-quality modules that align with specific areas of growth and need to support a state-directed corrective action plan in our region."

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Existential therapy can best be described as a philosophical approach that influences a counselor's therapeutic practice. Existential psychotherapy is neither an independent nor separate school of therapy, nor is it a neatly defined model with specific techniques. It is more appropriate to refer to existential psychotherapies.

Existential therapy was not founded by any particular person or group; many streams of thought contributed to it. Drawing from a major orientation in philosophy; existential therapy arose spontaneously in different parts of Europe and among different schools of psychology and psychiatry in the 1940s and 1950s. It grew out of an effort to help people resolve the dilemmas of contemporary life, such as isolation, alienation, and meaninglessness. Early writers focused on the individual's experience of being alone in the world and facing the anxiety of the situation.

These are some of the major figures of existentialism and existential phenomenology and their cultural, philosophical, and religious writings that provided the basis for the formation of existential therapy.

Soren Kierkegaard (1813-1855): A Danish philosopher, particularly concerned with angst, w word in English that falls somewhere between dread and anxiety. Without angst, we may go through life as sleepwalkers. Especially in adolescence, we are awakened into real life by a terrible uneasiness. Life is one contingency after another, with no guarantees beyond the certainty of death. This is by no means a comfortable state, but it is necessary to our becoming human. Becoming human is a project, and our task is not so much to discover who we are as to create ourselves.

Friedrich Nietzsche (1844-1900): A German philosopher, who emphasized the importance of subjectivity. Nietzsche set out to prove that the ancient definition of humans as rational was entirely misleading. Nietzsche located values within the individual's "will to power." We give up an honest acknowledgement of this source of value when society invites us to rationalize powerlessness by advocating other worldly concerns. If we acquiesce in "herd morality," we will be nothing but mediocrities. If we release ourselves by giving free rein to our will to power, we will tap out potentiality for creativity and originality.

Martin Heidegger(1889-1976): His phenomenological existentialism reminds us that we exist "in the world" and should not try to think of ourselves as beings apart from the world into which we are thrown. The way we fill our everyday life with superficial conversation and routine shows that we often assume we are going to live forever and can afford to waste day after day. Our moods and feelings are a form of understanding whether we are living authentically or whether we are inauthentically constructing our life around the expectation of others. When we translate this wisdom from vague feeling to explicit awareness, we may develop more positive resolve about how we want to be. As presented by Heidegger, phenomenological existentialism provides a view of human history that does not focus on past events but motivates individuals to look forward to "authentic experiences" that are yet to come.

Jean-Paul Sartre (1905-1980): A philosopher and novelist believed that humans are even more free than earlier existentialists had believed. The existence of a space - nothingness - between the whole of our past and the now frees us to choose what we will. The failure to acknowledge our freedom and choices is what results in emotional problems. Sartre called excuses "bad faith." No matter what we have been, we can make choices now and thus become something quite different. But to choose is to become committed: This is the responsibility that is the other side of freedom.

Martin Buber (1878-1965): Left Germany to live in . Buber stated we as humans live in a kind of betweenness; that is, there is never just an I, but always an other. The I, the person who is the agent, changes depending on whether the other is an it or a Thou. Sometimes we make the mistake of reducing another person to the status of a mere object in which case the relationship becomes I/it. The importance of presence allows 3 functions: (1) it enables true I/Thou relationships; (2) it allows for meaning to exist in a situation; and (3) it enables an individual to be responsible in the here-and-now.

Ludwig Binswanger (1881-1966): - Binswanger proposed a holistic model of self that addresses the relationship between the person and his or her environment. He used a phenomenological approach to explore significant features of the self such as choice, freedom, and caring. Existential analysis emphasizes the subjective and spiritual dimensions of human existence. He felt that crises in therapy were typically major choice points for the client. He moved toward an existential view of his patients which allowed him to understand their worldview and immediate experiences as well as the meaning of their behavior, as opposed to superimposing his views as a therapist on their experience and behavior.

Medard Boss (1903-1991): Boss's major professional interest was applying Heidegger's philosophical notions to therapeutic practice, and he was especially concerned with integrating Freud's methods with Heidegger's concepts.

Four prominent developers of existential psychotherapy are:

Viktor Frankl (1905-1997): Central figure in developing existential therapy in Europe and bringing it to the As a youth deeply influenced by Freud, he became a student of Adler who was later influenced by the writings of existential philosophers. Fond of quoting Nietzsche: "He who has a why to live for can bear with almost any how." "That which does not kill me, makes me stronger." "to be alive encompasses the ability to take hold of life day by day as well as to find meaning in suffering." Frankl developed logotherapy, which means "therapy through meaning." His philosophical model sheds light on what it means to be fully alive. The central themes running through his works are life has meaning, under all circumstances; the central motivation for living is the will to meaning; the freedom to find meaning in all that we think; and the integration of body, mind, and spirit. According to Frankl, the modern person has the means to live but often has no meaning to live for. The malady of our time is meaninglessness, or the "existential vacuum," which is often experienced when people do not busy themselves with routine and with work. The therapeutic process is aimed at challenging individuals to find meaning and purpose through, suffering, work, and love. Born and educated in . From 1942 to 1945, Frankl was a prisoner in the Nazi concentration camps at Auschwitz and , where his parents, brother, wife, and children died.

Rollo May ((1909-1994): Rollo May was also influenced by the existential philosophers, by the concepts of Freudian psychology, and by many aspects of Alfred Adler's Individual Psychology. He welcomed flexibility and versatility in the practice of psychoanalysis. May was one of the key figures responsible for bringing existentialism from Europe to the and for translating key concepts into psychotherapeutic practice. According to May, it takes courage to "be," and our choices determine the kind of person we become. There is a constant struggle within us. Although we want to grow toward maturity and independence, we realize that expansion is often a painful process. Hence, the struggle is between the security of dependence and the delights and pains of growth. May's own personal life consisted of struggles with his own existential concerns and the failure of two marriages.

James Bugental: Bugental describes a life-changing approach to therapy. He views therapy as a journey taken by the therapist and the client that delves deeply into the client's subjective world. He emphasizes that this quest demands the willingness of the therapist to be in contact with his or her own phenomenological world. According to Bugental, the central concern of therapy is to help clients examine how they have answered life's existential questions and to challenge them to revise their answers to begin living authentically.

Irvin Yalom: Yalom developed an existential approach to therapy that focuses on four ultimate human concerns: death, freedom, existential isolation, and meaninglessness. Yalom believes that the vast majority of experienced therapists, regardless of their theoretical orientation, employ many of the existential themes discussed in his book, Existential Psychotherapy (1980).

Human nature: The crucial significance of the existential movement is that it reacts against the tendency to identify therapy with a set of techniques. It bases practice on an understanding of what it means to be human. It uses numerous approaches to therapy based on its assumption about human nature. Rather than trying to develop rules for therapy, existential practitioners strive to understand these deep human experiences (feeling alone in the world and facing the anxiety of isolation).

The existential view of human nature is captured, in part, by the notion that the significance of our existence is never fixed once and for all; rather, we continually re-create ourselves through our projects. Humans are in a constant state of transition, emerging, evolving, and becoming, Being a person implies that we are discovering and making sense of our existence. Although the specific questions we raise vary in accordance with our developmental stage in life, the fundamental themes do not vary. - "who am I?" "what can I know?" "what ought I to do?" "what can I hope for?" "where am I going?"

As human beings, we can reflect and make choices because we are capable of self-awareness. The greater our awareness, the greater our possibilities for freedom
* We have the potential to take action or not to act; inaction is a decision.
* We choose our actions, and therefore we can partially create our own destiny.
* Existential anxiety, which is basically a consciousness of our own freedom, is an essential part of living; as we increase our awareness of the choices available to us, we also increase our sense of responsibility for the consequences of these choices.
* We are subject to loneliness, meaninglessness, emptiness, guilt, and isolation.
We can choose either to expand or to restrict our consciousness. Self-awareness is at the root of most other human capacities, the decision to expand it is fundamental to human growth. These are some awarenesses that individuals may experience in the counseling process.
* They learn that in many ways they are keeping themselves prisoner by some of their past decisions, and they realize that they can make new decisions.
* They learn that although they cannot change certain events in their lives they can change the way they view and react to these events.
* They realize that they are so preoccupied with suffering, death, and dying that they are not appreciating living.
* They come to realize that they are failing to live in the present moment because of preoccupation with the past, planning for the future, or trying to do too many things at once.
It is the therapist's task to indicate to the client that a price must be paid for increasing awareness. Ignorance of our condition may have brought contentment along with a feeling of partial deadness, but as we open the doors in our world, we can expect more struggles as well as the potential for more fulfillment.

Even though we have no choice about being thrust into the world, the manner in which we live and what we become are the result of our choices. Because of the reality of this essential freedom, we must accept responsibility for directing our lives. However, it is possible to avoid this responsibility for directing our lives, or exhibiting "bad faith." Two statements that reveal bad faith are: "Since that's the way I'm made, I couldn't help what I did." Or "Naturally I'm this way, because I grew up in an alcoholic family." We are constantly confronted with the choice of what kind of person we are becoming, and to exist is never to be finished with this kind of choosing.
Existential guilt is being aware of having evaded a commitment, or having chosen not to choose. This is the guilt we experience when we do not live authentically. It results from allowing other to define us or make our choices for us.
For existentialists, being free and being human are identical. We are the authors of our lives in the sense that we create our destiny, our life situation, and our problems. Assuming responsibility is a basic condition for change. Clients who refuse to accept responsibility by persistently blaming others for their problems will not profit from therapy.
Frankl suggested that the Statue of Liberty on the East Coast should be balanced with a Statue of Responsibility on the West Coast. His basic premise is that freedom is bound by certain limitations.
The therapist assists clients in discovering how they are avoiding freedom and encourages them to learn to risk using it. Not to do so is to make them neurotically dependent on the therapist. Two central tasks of the therapist are inviting client to recognize how they have allowed others to decide for them and encouraging them to take steps toward autonomy.

(3) Striving for Identity and Relationship to Others

As human beings we strive for discover or create a self - that is our personal identity and we strive for connectedness with others and with nature. Rather than trusting ourselves to search within and find our own answers to the conflicts in our life, we sell out by becoming what others expect of us. Our being becomes rooted in the expectations, answers, values, and beliefs that come from the important people in our world.
The courage to be: We struggle to discover, to create, and to maintain the core deep within our being. One of the greatest fears of clients is that they will discover that there is no core, no self, no substance, and that they are merely reflections of everyone's expectations of them. A client might say: "My fear is that I'll discover I'm nobody, that there really is nothing to me. I'll find out that I'm an empty shell, and nothing will exist if I shed my masks."
Existential therapist may begin by asking their clients to allow themselves to intensify the feeling that they are nothing more than the sum of others' expectations and that they are merely the introjects of parents and parent substitutes. How do they feel now? Are they condemned to stay this way forever? Is there a way out? Can they create a self if they find that they are without one? Where can they begin? Once clients have demonstrated the courage to recognize this fear, to put it into words and share it, it does not seem so overwhelming. In other words, invite clients to accept the ways in which they have lived outside of themselves and explore ways in which they are out of contact with themselves.
The experience of aloneness: Part of the human condition is the experience of aloneness. The sense of isolation comes when we recognize that we cannot depend on anyone else for our own confirmation; that is, we alone must give a sense of meaning to life, and we alone must decide how we will live. Before we can have any solid relationship with another, we must have a relationship with ourselves. We are challenged to learn to listen to ourselves. We have to be able to stand alone before we can truly stand beside another. There is a paradox in the proposition that humans are existentially both alone and related, but this very paradox describes the human condition. To think that we can cure the condition, or that it should be cured, is a mistake. Ultimately we are alone.
The experience of relatedness: When we are able to stand alone and dip with ourselves for our own strength, our relationships with others are based on our fulfillment, not our deprivation. If we feel personally deprived, however, we can expect little but a clinging, parasitic, symbiotic relationship with someone else
Perhaps one of the functions of therapy is to help clients distinguish between a neurotically dependent attachment to another and a life-affirming relationship in which both persons are enhanced. The therapist can challenge clients to examine what they get from their relationships, how they avoid intimate contact, how they prevent themselves from having equal relationships, and how they might create therapeutic, healthy, and mature human relationships.
Struggling with our identity: Due to our fear of dealing with our aloneness, some of us get caught up in ritualistic behavior patterns that cement us to an image or identity which we acquired in early childhood. Some of us become trapped in a doing mode to avoid the experience of being. The therapy process itself is often frightening for clients when they realize that they have surrendered their freedom to others and that in the therapy relationship they will have to assume their freedom again. By refusing to give easy solutions or answers, existential therapists confront clients with the reality that they alone must find their own answers.

Some of the underlying conflicts that bring people into counseling and therapy are centered in existential questions such as "Why am I here? What do I want from life? What gives my life purpose? Where is the source of meaning for me in life?" Existential therapy can provide the conceptual framework for helping clients challenge the meaning in their lives. Questions that the therapist might ask are, "Do you like the direction of your life? Are you pleased about who you are and what you want for yourself, what are you doing to get some clarity?"
The problem of discarding old values: One of the problems in therapy is that clients may discard traditional or imposed values without finding other, suitable ones to replace them. Clients may report that they feel like a boat without a rudder. They seek new guidelines and values that are appropriate for the newly discovered facets of themselves, and yet for a time they are without them. Perhaps the task of the therapeutic process is to help clients create a value system based on a way of living that is consistent with their way of being. It is the therapist's job to trust the capacity of clients to eventually discover an internally derived value system that does provide a meaningful life. They will experience anxiety as a result of the absence of clear-cut values.
Meaninglessness: Faced with the prospect of our mortality, we might ask, "Is there any point to what I do now, since I will eventually die? Will what I do be forgotten once I am gone? Given the fact of mortality, why should I busy myself with anything?" Such a feeling of meaninglessness is the major existential neurosis of modern life. Meaninglessness in life leads to emptiness and hollowness, or a condition that Frankl calls the existential vacuum. Related to the concept of meaninglessness is existential guilt. This is a condition that grows out of a sense of incompleteness, or a realization that we are not what we might have become. It is the awareness that our actions and choices express less than our full range as a person. This guilt is not viewed as neurotic, nor is it seen as a symptom that needs to be cured. Instead, the existential therapist explores it to see what clients can learn about the ways in which they are living their life.
Creating new meaning: The therapist's function is not to tell clients what their particular meaning in life should be but to point out that they can discover meaning even in suffering. Human suffering (the tragic and negative aspects of life) can be turned into human achievement by the stand an individual takes in the face of it. Yet meaning is not something that we can directly search for and obtain. Paradoxically, the more rationally we seek it, the more likely we are to miss it. Finding meaning in life is a by-product of engagement, which is a commitment to creating, loving, working, and building.

Existential anxiety is conceptualized as the unavoidable result of being confronted with the "givens of existence" - death, freedom, existential isolation, and meaninglessness. Existential therapists differentiate between normal and neurotic anxiety, and they see anxiety as a potential source of growth. Normal anxiety is an appropriate response to an event being faced. It can be used as a motivation to change. Neurotic anxiety, in contrast, is out of proportion to the situation. It is typically out of awareness, and it tends to immobilize the person. Being psychologically healthy entails living with as little neurotic anxiety as possible, while accepting and struggling with the unavoidable existential anxiety that is a part of living. When we make a decision that involves reconstruction of our life, the accompanying anxiety can be a signal that we are ready for personal change. Opening up to new life means opening up to anxiety. Existential therapy helps clients come to terms with the paradoxes of existence - life and death, success and failure, freedom and limitations, and certainty and doubt. Facing existential anxiety involves viewing life as an adventure rather than hiding behind securities that seem to offer protection. The therapist must guide clients in finding ways to deal with anxiety constructively. The therapist can help clients recognize that learning how to tolerate ambiguity and uncertainty and how to live without props can be a necessary phase in the journey from dependence to autonomy. When a client becomes more self-confident, the anxiety that results from an expectation of catastrophe will decrease.

Awareness of death is a basic human condition that gives significance to living. It is necessary to think about death if we are to think significantly about life. Death provides the motivation for us to live our lives fully and take advantage of each opportunity to do something meaningful. If we realize we are mortal, we know that we do not have an eternity to complete our projects and that each present moment is crucial. Without being morbidly preoccupied by the ever-present threat of nonbeing, clients can develop a healthy awareness of death as a way to evaluate how well they are living and what changes they want to make in their lives.

Therapeutic Goals: Existential therapy is best considered as an invitation to clients to recognize the ways in which they are not living fully authentic lives and to make choices that will lead to their becoming what they are capable of being. An aim of therapy is to assist clients in moving toward authenticity and learning to recognize when they are deceiving themselves. Existential therapy seeks to take clients out of their rigid grooves and to challenge the narrow and compulsive trends blocking their freedom. Existential therapy aims at helping clients face this anxiety and engage in action that is based on the authentic purpose of creating a worthy existence. "The purpose of psychotherapy is not to 'cure' the clients in the conventional sense, but to help them become aware of what they are doing and to get them out of the victim role." (May, 1981, page 210). Increased awareness is the central goal of existential therapy, which allows clients to discover that alternative possibilities exist where none were recognized before. Clients come to realize that they are able to make changes in their way of being in the world. This requires some time in existential therapy, for it is not a matter of solving problems. Short-term applications of existential therapy require clearly defined and less ambitious therapy goals.

Therapist's Function and Role: Existential therapists are primarily concerned with understanding the subjective world of clients to help them come to new understandings and options. The focus is on clients' current life situations, not on helping clients recover a personal past. Existential therapists typically show wide latitude in the methods they employ, varying not only from client to client but also with the same client at different phases of the therapeutic process. They may make use of techniques that grow from diverse theoretical orientations, yet no set of techniques is considered essential.
Throughout the therapeutic process, techniques are secondary to establishing a relationship that will enable the counselor to effectively understand and challenge the client. Clients with restricted existence have a limited awareness of themselves and are often vague about the nature of their problems. They may see few, if any, options for dealing with life situations, and they tend to feel trapped or helpless. A central task of the therapist is to confront these clients with the ways they are living a restricted existence, or how they are stuck, and to help them become aware of their own part in creating this condition.

Client's Experience in Therapy: Clients in existential therapy are clearly encouraged to take seriously their own subjective experience of their world. They are challenged to take responsibility for how they now choose to be in their world. Clients are expected to go out into the world and decide how they will live differently. Further, they must be active in the therapeutic process for during the sessions they must decide what fears, guilt feelings, and anxieties they will explore. Through the process of their therapy, clients can explore alternatives for making their visions real. Clients can begin building and augmenting that range by taking small steps.
Another aspect of the experience of being a client in existential therapy is confronting ultimate concerns rather than coping with immediate problems. Existential therapists assist clients in facing life with courage, hope, and a willingness to find meaning in life.

Relationship Between Therapist and Client: Existential therapists give central prominence to their relationship with the client. The relationship is important in itself because the quality of this person-to-person encounter in the therapeutic situation is the stimulus for positive change. Therapists with this orientation believe their basic attitudes toward the client and their own personal characteristics of honesty, integrity, and courage are what they have to offer. It is essential for the counselor to adopt a flexible style and to draw from different theoretical approaches with different clients.
Rather than prizing therapeutic objectivity and professional distance, existential therapists strive to create caring and intimate relationships with clients. If counselors lack a sense of presence, it will affect the therapeutic relationship in a negative way.
The core of the therapeutic relationship is respect, which implies faith in clients' potential to cope authentically with their troubles and in their ability to discover alternative ways of being.

The existential approach is unlike most other therapies in that it is not technique-oriented. The interventions existential practitioners employ are based on philosophical views about the essential nature of human existence. Existential therapists are free to draw from techniques that flow from many other orientations. They have a set of assumptions and attitudes that guide their interventions with clients. The main guideline is that the existential practitioner's interventions are responsive to the uniqueness of each client. The use of the therapist's self is the core of therapy. Therapy is a creative, evolving process of discovery that can be conceptualized in three general phases.
? The initial phase, counselors assist clients in identifying and clarifying their assumptions about the world. Clients are invited to define and question the ways in which they perceive and make sense of their existence. The counselor teaches them how to reflect on their own existence and to examine their role in creating their problems in living.
? The middle phase, clients are encouraged to more fully examine the source and authority of their present value system. This leads to new insights and some restructuring of their values and attitudes. Clients get a better idea of what kind of life they consider worthy to live and develop a clearer sense of their internal valuing process.
? The final phase, focuses on helping clients take what they are learning about themselves and put it into action, to find ways of implementing their examined and internalized values in a concrete way. Clients typically discover their strengths and find ways to put them to the service of living a purposeful existence.

Areas of application: Existential therapy is especially appropriate for clients who are struggling with developmental crises, doing grief work, confronting death, or facing a significant decision. Some examples of these critical turning points that mark passages from one stage of life into another are the struggle for identity in adolescence, coping with possible disappointments in middle age, adjusting to children leaving home, coping with failures in marriage and work, and dealing with increased physical limitations as one ages. It tends to work well with people who are at a crossroads and who question the state of affairs in the world and are willing to challenge the status quo. It can be useful for people who are on the edge of existence, such as those who are dying, who are working through a developmental or situational crises, or who are starting a new phase of life.

Contributions: It helps clients of all cultures find meaning and harmony in their lives, because it focuses on the sober issues each of must inevitably face: love, anxiety, suffering, and death. These are the human experiences that transcend the boundaries that separate cultures. A strength of the existential approach is that it enables clients to examine the degree to which their behavior is being influenced by social and cultural conditioning. Clients can be challenged to look at the price they are paying for the decisions they have made.

Limitations: The existentialists can be criticized on the grounds that they are excessively individualistic and they ignore the social factors that cause human problems. If a counselor consistently tells certain disenfranchised clients that they have a choice in making their lives better, they may feel patronized and misunderstood.
A limitation within existential theory is that it is highly focused on the philosophical assumption of self-determination, which does not take into account the complex factors that many people who have been oppressed must deal with. In many cultures it is not possible to talk about the self and self-determination apart from the context of the social network and environmental conditions.
Another problem is the lack of direction that clients may get from the counselor. Many clients expect a structured and problem-oriented approach to counseling that is not found in the existential approach, which places the responsibility on the client for providing the direction of therapy.

Contributions of the Existential Approach: One of the major contributions of the existential approach is its emphasis on the human quality of the therapeutic relationship. This aspect lessens the chances of dehumanizing psychotherapy by making it a mechanical process. Existential counselors reject the notions of therapeutic objectivity and professional distance, viewing them as being unhelpful.

Limitations and Criticisms of the Existential Approach: A major criticism often aimed at this approach is that it lacks a systematic statement of the principles and practices of psychotherapy. Some therapists who claim adherence to an existential orientation describe their therapeutic style in vague and global terms (such as self-actualization, dialogic encounter, authenticity, and being in the world). The fact that few techniques are generated by this approach makes it essential for practitioners to develop their own innovative procedures or to borrow from other schools of therapy. It must be realized, however, that philosophical insight may not be appropriate for some clients (seriously disturbed or nonverbal clients).

www.auburn.edu/cspd/fall04/counseling

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Existential therapy can best be described as a philosophical approach that influences a counselor's therapeutic practice. Existential psychotherapy is neither an independent nor separate school of therapy, nor is it a neatly defined model with specific techniques. It is more appropriate to refer to existential psychotherapies.

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Don't Lose Your Child - Dr William Glasser

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Use these resources to raise awareness about depression.

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Use these resources to raise awareness about depression. Depression is a common but serious mood disorder. It causes severe symptoms that affect how someone feels, thinks, and handles daily activities, such as sleeping, eating, or working. For more information on depression, visit the health topic page or view the available brochures.

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NAMI, the National Alliance on Mental Illness, is a mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.

This organization seeks to increase awareness among public and professional communities about the emotional changes that women experience during pregnancy and postpartum.

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Video to Raise Awareness About Postpartum Depression
This video is part of the Mental Health Across the Lifespan Initiative created by the National Institute of Mental Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Delta Sigma Theta Sorority, Inc.

Resources for clinicians and public health professionals

View your state's prevalence of postpartum depression using PRAMStat, an online data platform from the Pregnancy Risk Assessment Monitoring System.

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NAMI, the National Alliance on Mental Illness, is a mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. This organization seeks to increase awareness among public and professional communities about the emotional changes that women experience during pregnancy and postpartum.

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CHADD - Improving the lives of people affected by ADHD

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Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) is the nation’s leading nonprofit organization serving people affected by ADHD.

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Last updated September 2023

About

Attention Deficit/Hyperactivity Disorder (ADHD) is a condition which includes difficulties with attention, increased activity, and difficulties with impulsivity. Estimates show that up to 10 percent of school-aged children and about 4 percent of adults have ADHD. It is usually first identified when children are school-aged, although it also can be diagnosed in people of all age groups. In an average classroom of 30 children, research suggests that at least one will have ADHD.

No single biological cause for ADHD has been found. But most research points to genes inherited from parents as the leading contributor to ADHD. ADHD often runs in families.

The good news is that there are safe and effective treatments for children and adolescents with ADHD. Treatment is most effective when it begins early and when intervention is individualized to the needs of the child.
Choose a topic: Glossary of Symptoms: ADHD
Frequently Asked Questions

1. What is ADHD?

2. How common is ADHD?

3. What causes ADHD?

4. Common signs and symptoms of ADHD?

5. What are the types of treatment for ADHD?

6. When is it okay to stop taking ADHD medication?

7. What are the consequences of untreated ADHD?

Treatment Resources

Parents' Medication Guide

The American Academy of Child and Adolescent Psychiatry (AACAP) and the American Psychiatric Association (APA) created the Parents' Medication Guide series.

Included in these guides are new research on effective treatments for child and adolescent ADHD. The goal of the guide is to help parents make informed decisions about getting the best care for a child or adolescent with ADHD.

Facts for Families

AACAP's Facts for Families provide concise up-to-date information on issues that affect children, teenagers, and their families. Below are links to Facts for Families with information that may be useful to families of children with ADHD.

Video Clips

ADHD: A Guide for Families
Many children have restless behaviors that are typical of ADHD. When fidgeting, poor concentration, or impulsiveness begins disrupting performance in school, at home, or in relationships with other children, the cause might be ADHD. To be a good advocate for your child, you need to learn as much as you can about ADHD.

The following are chapters from the ADHD: A Guide for Families book:

Clinical Resources

Information about Choices in Psychotherapy Treatment

Treatment for ADHD comes in the form of medication and psychotherapy treatment. Both can be important elements of a comprehensive treatment plan. There are several psychotherapies that are helpful for children with ADHD. We have the most evidence that cognitive-behavioral therapy (CBT) and behavioral management techniques can be helpful for children with ADHD.
Learn more about the types of psychotherapy that are available to help children and adolescents with mental illness here.
Information about Choices in Medication
Learn more about how psychiatric medication is used to treat children and adolescents here Learn more about the types of psychiatric medication that are available to treat children and adolescents with mental health disorder here. .
Vanderbilt Diagnostic Parent Rating Scale
Parents who have a child or adolescent with ADHD, or any mental health condition, are often left facing difficult decisions regarding medication.

View up-to-date information about advances in psychopharmacological treatment for mood disorders here.

ADHD Rating Scales

Two rating scales which can be used by clinicians to help identify ADHD and monitor symptoms are the SWAN rating scale and the SNAP-IV rating scale. These scales are completed separately by a parent and a teacher.

The SWAN Rating Scale has 30 items and includes ADHD symptoms and symptoms of oppositional defiant disorder. Download the SWAN Rating Scale.

The SNAP-IV Rating Scale contains 90 items and includes symptoms of ADHD and also ODD and aggression. Download the SNAP-IV Rating Scale.

Research and Training

AHRQ review of ADHD, Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents

The abstract for the Multimodal Treatment Study of Children with ADHD is an NIMH sponsored research study that examined close to 600 children with ADHD and studied how they responded to different treatments. Click here to find a brief description of results from this study:
Multimodal Treatment Study of Children with ADHD

Learn more about the Multimodal Treatment Study of Children with ADHD and results from this large research study.

Books

AACAP's books: and Your Adolescent offer easy-to-understand and comprehensive information on the emotional development and behavior of children from infancy through the teen years.

A Bird's-Eye View of Life with ADD and ADHD: Advice from Young Survivors
Chris A. Zeigler Dendy and Alex Zeigler

ADHD and Me: Forty Years in a Fog
Ken Patterson

For more bibliotherapy resources, visit Living with Mental Illness: Books, Stories and Memoirs.

Getting Help

Getting help is the most important thing that parents can do for children and adolescents with a mental health concern. Parents should try to find a mental health professional with advanced training and experience evaluating and treating children and adolescents with attention-deficit/hyperactivity disorder. Also, it is important to find a comfortable match between your child, your family, and the mental health professional.

A child and adolescent psychiatrist is a physician who specializes in the diagnosis and treatment of mental health disorders that affect children and adolescents. Child and adolescent psychiatrists have completed four years of medical school, and at least three years of residency training in medicine, neurology, or general psychiatry with adults, and two years of additional training in psychiatric work with children and adolescents.

Find a child and adolescent psychiatrist in your area.
Services In School For Children With Special Needs: What Parents Need To Know
To learn about accessing child and adolescent psychiatrists and other mental health professionals, please read Where To Find Help For Your Child.

Oftentimes, parents are unsure when to seek a referral to a child and adolescent psychiatrist. For more information on when to seek a referral, please read this article.

Learn more about understanding mental health insurance, please read AACAP's Facts For Families on Mental Health Insurance.

Related Websites

This Resource Center was made possible through funding from the Lasdon Foundation.

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Attention Deficit/Hyperactivity Disorder (ADHD) is a condition which includes difficulties with attention, increased activity, and difficulties with impulsivity.

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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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Generalized Anxiety Disorder in Younger and Older Children: Implications for Learning and School Functioning 

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Generalized Anxiety Disorder in Younger and Older Children: Implications for Learning and School Functioning 

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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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What does a School Counselor Do? Infographic

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What does a School Counselor Do? Infographic