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What to Know About Neurodevelopmental Disorders

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What to Know About Neurodevelopmental Disorders

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What Are Neurodevelopmental Disorders?

Neurodevelopmental disorders (NDs) are types of disorder that influence how the brain functions and alters neurological development, causing difficulties in social, cognitive, and emotional functioning. The most common NDs are autism spectrum disorder (ASD) and attention-deficit/hyperactive disorder (ADHD). Many NDs are not as well known or widely studied.

NDs usually onset during stages of development which makes them most present in toddlers, children, and adolescents, but continue to persist into adulthood, or may go undiagnosed until one is an adult. There are instances in which a child outgrows the symptoms associated with an ND.

There are many different types of NDs, below are a few of the most prevalent ones;

Attention-deficit/hyperactive disorder (ADHD)

Autism spectrum disorder (ASD)

Cerebral palsy

Communication disorders

Conduct disorders

Intellectual disabilities

Learning disorders

Neurodevelopmental motor disorders

Prevalence

NDs are more prevalent in males than females. This gender difference may be due to genetics, biology, and risk factors. Although NDs, like ASD, are more present in males, researchers determined not much of a gender difference in symptoms.

Comorbidity of other conditions is highly likely in individuals with NDs and it is also common for an individual to be diagnosed with multiple NDs. A study that explored the comorbidity of NDs with mental disorders in children ages 7 through 12, determined that of those with NDs, some had coexisting psychiatric disorders or were diagnosed with multiple NDs. The study included 407 boys and girls. After parent interviews, it was determined that 55% of the children were diagnosed with at least one ND.

Of the 181 participants with ADHD, almost 40% did not have a comorbid condition, 26% did however have an anxiety disorder, while others had a variety of other conditions. There appeared to be only 18 children with ASD, and of these boys and girls, 36% also had ADHD, 44% had a tic disorder (TD), 36% had an anxiety disorder, and the others had a variety of other conditions or no comorbidity.

Although more boy participants were diagnosed with an ND, a greater number of girls with an ND had additional comorbid disorders. This study does have its limitations: a large one being that the only measure of the evaluation was parental interviews, which only consisted of just one interview at that.

Symptoms of NDs are dependent on the ND, but general descriptions usually consist of impairments with the following;

The concrete cause of NDs is not yet clear. There are various possible reasons for the onset of NDs. From the research that does exist on the cause of NDs, it is prevalent that both biology and environment play a role. Predispositions like genetics and hormones can be triggered by risk factors such as stress, illness, or trauma.

Epigenetics is an important factor in the development of conditions like NDs. Epigenetics is when an individual's environment and behavior can alter DNA and how genes operate within the body. Early childhood experiences, like trauma, neglect, or toxic environments, have recently been acknowledged as a prime risk factor in developing certain disorders, including NDs.

Research also determined an association between prenatal events and the development of medical conditions. Maternal diet can influence whether an individual grows up to develop metabolic diseases, like obesity and diabetes. Researchers believe that prenatal events, such as diet, could have similar influences on the development of NDs.

There aren't many treatment options for those with NDs, but research has determined some effective interventions. Although there is no cure for NDs there are methods that help with managing and coping with symptoms.

Behavioral Therapy

Therapies like applied behavioral analysis (ABA), cognitive-behavioral therapy (CBT), speech therapy, and developmental therapy have all been shown to be beneficial for ND symptoms. CBT, Psychotherapy, and other behavioral therapies are utilized for adults with NDs like ADHD. ABA has a significant impact on behavior in children with NDs, especially ASD and ADHD.

Transcranial Magnetic Stimulation

Repetitive transcranial magnetic stimulation (rTMS) is a stimulation therapy that is commonly used for depression, but research trials have found prospects for rTMS to offer benefits for those with NDs. In a review of multiple studies, rTMS didn't appear to have any severe adverse effects for children and adolescents with NDs.

rTMS treatment improved social functioning and behaviors for some participants with ASD. There were also benefits in those with tic disorders, in which treatment helped lessen tics. Unfortunately, rTMS did not show prospects for those with ADHD; it caused some irritation, hyperactivity, and inattentiveness in some individuals. Overall, rTMS has the potential to be an acknowledged treatment method for a few NDs.

Medication

Medication is sometimes prescribed to both children and adults with NDs. For ADHD, specifically, physicians may prescribe medication to help in managing symptoms like hyperactivity, agitation, inattentiveness, etc. Medication may consist of stimulants, antidepressants, or other pharmaceuticals suited to enhance cognition.

Medication, however, should not be the first choice when treating NDs like ADHD and AS. Experts express trying therapies and other strategies before medication. For pediatric patients, researchers suggest neurodevelopmental therapies and parenting training before incorporating medication into treatment routines.

Conventional and Alternative Medicine (CAM)

Nutrition, physical exercise, and recreational activities can also play a role in managing symptoms of NDs. It is important to develop healthy lifestyle habits for children and adults with NDs.

Complementary and alternative (CAM) medicines like supplements and mind/body practices, such as acupuncture, yoga, etc., are other options that are explored before seeking medication or are used along with medication.

Adults with NDs most seek out these types of interventions. The national percentage of adults who engage in CAM treatment is 36-38%, but the number of children who participate in CAM treatment is unclear. A population review reported 11.8% of children throughout the population experienced CAM therapy at least once, but this number may not be accurate. It was stated in another report that the amount of children that engage in CAM treatment is between 2%-55%, but this is not a population report.

Family Impact

A child being diagnosed with an ND is a huge adjustment for parents and loved ones. In attempts to make life easier for the child, a significant load is placed on the family. A large number of studies found that parents of children with NDs report feeling a greater amount of stress than those with children without an ND.

Researchers found that this form of stress can have negative influences on the mental health of parents, most commonly in mothers. There also appears to be a negative impact on marriages when overly stressed. These factors are why parents need to engage in positive interventions to manage and cope with the stress of caring for a child with an ND, such as mindfulness stress-reducing practices, marriage counseling, meditation, etc. Studies have found that these interventions have been effective in reducing stress and strengthening the parent's marriage.

A Word From Verywell

NDs are often conditions that persist throughout an individual's life-and symptoms can be challenging to relationships, productivity, social skills, and communication. They can create limitations for a person and impact their abilities to function within society.

Although NDs have their share of challenges, a person can still live a fulfilling life with effective coping and treatment methods. Support of loved ones and caretakers is also an additional attribute to the quality of life for those with NDs.

If you suspect that your child may present symptoms of an ND, speak to your healthcare provider who can refer you to a specialist and provide answers that you and your child need. If you think you may have an undiagnosed ND, consult your physician and consider reaching out to a specialist.

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What To Know About Neurodevelopmental Disorders

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Neurodevelopmental disorders (NDs) influence how the brain functions and alter neurological development, causing difficulties in social, cognitive, and emotional functioning.

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A De-escalation Exercise for Upset Students

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A De-escalation Exercise for Upset Students

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Social & Emotional Learning (SEL)

A simple technique that takes just a few minutes can help an agitated student regain the state of mind needed for learning.

So often we find students in a stressed or anxious state of mind. The most telltale signs are inappropriate behaviors or outbursts, negative comments, and anxiety-ridden movements such as fidgeting, leg shaking, and fist clenching. These signals should raise immediate concern and indicate to educators that a response may be needed. The goal is to guide the student to a self-regulated mindset, but how does a teacher do that?

First let's review what is going on with a student in the middle of an outburst. Cortisol, which is responsible for keeping people alive in the face of danger, is being released. Often referred to as the stress hormone, cortisol plays a crucial role in our ability to protect ourselves. When we experience stressful situations, the release of cortisol helps us respond rapidly, but it comes with a cost, as it negatively affects the brain's ability to function at an optimal level.

Think of it like this: You're in the ocean on a surfboard waiting for the perfect wave. A short distance away, you see a shark fin pop out of the water, heading your way. Immediately two chemicals- cortisol and adrenaline-are released and you enter the fight, flight, or freeze response: You can fight the shark, flee by paddling as fast as you can, or freeze and hope the shark loses interest in you. Whatever your response, you find yourself in a moment of stress, anxiety, uncertainty, and fear due to heightened cortisol levels.

Now let's consider how this might look in a learning environment. At the end of a class, two students learn that they have received a poor grade on a science test. This is not a life-or-death situation like the approaching shark, but the physiological response is the same. The students' cortisol levels are high and they are anxious, a state of mind that doesn't support clear, conscious thinking. Upon entering their English class, the two students are visibly upset. One heads straight for their seat and begins to cry, while the other throws their book bag on the floor and punches the desk. For the teacher, recognizing these signs before beginning class is important.

The Stress Response and the Brain

The young brain can be confusing, complex, and often misunderstood, not only from the perspective of adults but more importantly from that of the students themselves. In order for students to understand how their brain functions, it's important to teach them about a few parts of the brain and their functions. To keep it simple, teach them about the amygdala, prefrontal cortex, and hippocampus.

The amygdala directs rapid responses when necessary-the fight, flight, or freeze response. When the amygdala detects a threat, it responds faster than the prefrontal cortex, which directs the ability to make decisions and problem-solve, and the hippocampus, which is responsible for remembering details and storing memories. The two areas of the brain most needed for academic work are thus bypassed. As a result, an anxious, stressed, or fearful state of mind can lead to poor decision-making, inability to think with clarity, and impulsive behaviors.

Learning how to calm ourselves is imperative for our well-being, and the following technique, which is designed to decrease negative impulses and emotions, can be shared with students. The goal is to lead them to more regulated thinking and learning.

A De-escalation Technique

Let's go back to the two upset students in their English class. They aren't ready to work, but the teacher can help by taking a few minutes to guide them back to a state of calm.

This process should take anywhere from four to six minutes and be centered on the student. I've provided a sample of what a teacher might say at each stage, but you should modify those statements so they feel natural to you.

If you have a paraprofessional or in-class support teacher, you can ask a student who seems upset to step out into the hallway or into an area of the classroom set aside for de-escalation. Or you can do this as a whole-class starter activity for anyone who might have something worrisome on their minds. Students can either choose this de-escalation technique-thinking over their answers instead of sharing them out loud-or engage in a warm-up activity connected to the class such as completing a journal entry or worksheet.

Give the student time to regain their calm: Say, "I notice you're really upset. Let's work together on breathing slowly for one minute in order to manage your impulses."

Direct the student to be aware of their thoughts and feelings: Say, "What's going on in your brain and body right now? Tell me how you feel and what you're thinking, and if you're ready to focus on moving forward with getting calm."

Have the student redirect their thoughts: Say, "Take a minute, close your eyes, breathe slowly, and think about something that makes you happy. I know you told me how much you love your grandma's fresh-baked cookies. Think about walking into grandma's house in a calm state of mind as you smell the cookies, taste the cookies, and feel the warmth of them right out of the oven."

Give the student positive feedback on becoming calm: Say, "Now open your eyes. How are you feeling? If you need more time to settle down, let me know. You should feel happy and excited about your work in getting to this point."

Give the student a little more time to refocus: Say, "Take a minute and do something for you. Go for a walk and get some air, or tell me about your baseball game the other night."

Have the student reflect for the future: Say, "The next time you're feeling this way and I'm not with you, what can you tell yourself in order to take charge of your thinking and behavior, and get yourself to a regulated place?"

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A De-escalation Exercise for Upset Students

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A simple technique that takes just a few minutes can help an agitated student regain the state of mind needed for learning.

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Students Diagnosed with Attention Deficit Hyperactivity Disorder Collaborative Strategies for School Counselors

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Students Diagnosed with Attention Deficit Hyperactivity Disorder Collaborative Strategies for School Counselors

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Shillingford-Butler, M. A., & Theodore, L. (2013). Students diagnosed with attention deficit hyperactivity disorder: collaborative strategies for school counselors. Professional School Counseling, 16(4), 235–244. https://doi.org/10.1177/2156759x150160403

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Students Diagnosed with Attention Deficit Hyperactivity Disorder_ Collaborative Strategies for School Counselors

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School Counselors Serving Students with Disruptive Behavior Disorders

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School Counselors Serving Students with Disruptive Behavior Disorders

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Grothaus, T. (2013). School counselors serving students with Disruptive Behavior Disorders. Professional School Counseling, 16(4), 245–255. https://doi.org/10.5330/psc.n.2013-16.245

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School Counselors Serving Students with Disruptive Behavior Disorders

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Setting Students Up with ADHD for Success

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Setting Students Up with ADHD for Success

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Students with attention-deficit/hyperactivity disorder benefit from these easy-to-implement strategies-and so do their peers.

©Shutterstock/Monkey Business Images

Teachers often come to the classroom with an unclear understanding of attention-deficit/hyperactivity disorder, and they are rarely provided with strategies that detail how to work with students who have been diagnosed with ADHD, even though such students make up an increasingly large number of their students-11 percent and growing as of 2011, according to data gathered by the Centers for Disease Control and Prevention.

As a special education teacher and tutor who coaches struggling students (many with ADHD), I have found several classroom strategies to be effective.

Create Urgency

I often hear parents or other advocates urge teachers to accommodate students with ADHD by giving them a lengthy or indefinite amount of time to turn in assignments. This creates a situation where deadlines are unclear, yet most of the students with ADHD that I have worked with need a clear deadline to create the urgency and adrenaline necessary to complete the task.

Provide deadlines: I teach students time management skills by breaking projects into chunks, each with a detailed description, rubric, and due date. For example, a research paper might have a separate due date for a topic, completed research, outline, rough draft, and final paper. I grade each step in the process, and each grade contributes to the final grade. This teaches students how to break up large projects to ensure timely completion.

Time tasks: Timing tasks that could be rote and boring-like learning math facts and letter sounds, increasing reading fluency, and memorizing vocabulary-turns what could potentially be a tedious task into a game or competition with oneself. Timing is used not to create anxiety but to increase performance over time-students are never graded on timed activities and don't share their scores. Instead they're challenged to beat the clock and to do better than they did last time. Graphing scores as a visual reminder of progress helps students learn about goal setting and develop a growth mindset.

Activate Interest

Students with ADHD are often capable of focusing intensely on something they're interested in. They can play video games or make their own YouTube videos for hours, but they need help connecting class content with their interests to achieve that focus.

Engage students' passions: My students are more engaged when they see that I'm passionate about a subject. We all want to know why we should learn something. Providing a hook to each lesson in the form of a story, game, or question gets students excited to figure out a problem.

For example, when we learn about making inferences, I bring in an assortment of strange looking objects or pictures of objects viewed from strange angles. Students do a gallery walk and write down observations about the objects-facts like, "it is metal," or "it is green." They also list any prior knowledge they have. They use the facts and their prior knowledge to make inferences about what the objects are.

This activity helps students have a more concrete basis for understanding how to make an inference when they're reading. It also usually leads to interesting discussions on how prior knowledge can greatly impact understanding.

Give students choices: Giving kids a choice in the books they read, activities they complete for a grade (visual art display, paper, slide or video presentation, blog, skit, podcast, etc.), and the ways they learn a skill encourages participation.

Allow for Breaks and Movement

I've found that taking breaks results in more focus for all of my students, but especially those with ADHD.

Use brain breaks: Students will take breaks anyway, so making breaks a reward is an easy way to keep them on task. I try to help them increase their focus to 15 to 25 minutes of working time, and after periods of concentration, they receive a short break. During the break, students can stretch, sharpen their pencils, get supplies, talk quietly to a friend, or rest. This timing method, sometimes called the Pomodoro Technique, helps students increase focus over time.

Let students move: I find that I get more out of students if I give them a chance to dance, stretch, or exercise before they have to sit down and work quietly. This can be led by the teacher, a short video, or a student. Usually it's brief and structured, like a game of Simon Says or a set of 10 jumping jacks and a few standing toe touches.

It's important to plan for transitions back to work-I flip the lights and use a hand signal. When I do this, students know to immediately return to their seats, mirror the hand signal, and be silent. Occasionally, I give out a reward to the first two students who are sitting attentively.

Provide Structure

I believe all students thrive when they know what to expect. For students with ADHD, having an orderly environment is essential.

Have clear expectations: Establishing a routine that stays the same even when activities change makes children feel secure. Rules can be taught through an activity with an example and non-example or by acting them out. This strategy is also useful for highlighting age-appropriate social skills like how to listen when someone is presenting or how to determine the appropriate amount of personal space.

Teach study skills explicitly: Students know they can Google facts, but teaching them how to learn creates relevance. Regardless of what subject is being taught, it's possible to incorporate study skills lessons-how to take notes, read a textbook, or study. Students will need these skills in the future when they're required to learn on their own.

You may have noticed that these strategies will help not just students with ADHD-they're useful for all students because they encourage the development of executive functions such as self-regulation.

We rarely look at ADHD as an advantage, but I've found that having students with ADHD in my classroom challenges me to update the way I teach so that my curriculum is more versatile, interesting, and compatible with the skills all students will need in an increasingly fast-paced world.

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Setting Students With ADHD Up for Success

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Students with attention-deficit/hyperactivity disorder benefit from these easy-to-implement strategies-and so do their peers.

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Oppositional Defiant Disorder

No. 72; Reviewed January 2019

All children are oppositional from time to time, particularly when tired, hungry, stressed, or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is a normal part of development for two to three year olds and early adolescents. However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level and when it affects the child's social, family, and academic life.

In children with Oppositional Defiant Disorder (ODD), there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the child's day to day functioning.

Symptoms of ODD may include:

Frequent temper tantrums

Excessive arguing with adults

Often questioning rules

Active defiance and refusal to comply with adult requests and rules

Deliberate attempts to annoy or upset people

Blaming others for his or her mistakes or misbehavior

Often being touchy or easily annoyed by others

Frequent anger and resentment

Mean and hateful talking when upset

Spiteful attitude and revenge seeking

The symptoms are usually seen in multiple settings but may be more noticeable at home or at school. One to sixteen percent of all school-age children and adolescents have ODD. The causes of ODD are unknown, but many parents report that their child with ODD was more rigid and demanding than the child's siblings from an early age. Biological, psychological, and social factors may have a role.

A child presenting with ODD symptoms should have a comprehensive evaluation. It is important to look for other disorders which may be present, such as attention-deficit hyperactivity disorder (ADHD), learning disabilities, mood disorders (depression, bipolar disorder), and anxiety disorders. It may be difficult to improve the symptoms of ODD without treating the coexisting disorder. Some children with ODD may go on to develop conduct disorder.

Treatment of ODD may include:

Parent Management Training to help parents and others manage the child's behavior

Individual Psychotherapy to develop more effective anger management

Family Psychotherapy to improve communication and mutual understanding

Cognitive Problem-Solving Skills Training and Therapies to decrease negativity

Social Skills Training to increase flexibility and improve social skills and frustration tolerance with peers

Medications may be helpful in controlling some of the more distressing symptoms of ODD as well as the symptoms related to coexistent conditions such as ADHD, anxiety, and mood disorders.

A child with ODD can be very difficult for parents. These parents need support and understanding. Parents can help their child with ODD in the following ways:

Always build on the positives, give the child praise and positive reinforcement when s/he shows flexibility or cooperation.

Take a time-out or break if you are about to make the conflict with your child worse, not better. This is good modeling for your child. Support your child if s/he decides to take a time-out to prevent overreacting.

Pick your battles. Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do. If you give your child a time-out in his room for misbehavior, don't add time for arguing. Say "your time will start when you go to your room."

Set reasonable, age appropriate limits with consequences that can be enforced consistently.

Maintain interests other than your child with ODD, so that managing your child doesn't take all your time and energy. Try to work with and obtain support from the other adults (teachers, coaches, and spouse) dealing with your child.

Manage your own stress with healthy life choices such as exercise and relaxation. Use respite care and other breaks as needed.

Many children with ODD will respond to the positive parenting techniques. Parents may ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist or other qualified mental health professional who can help diagnose and treat ODD and any coexisting psychiatric condition.

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Oppositional Defiant Disorder No. 72; Reviewed January 2019 All children are oppositional from time to time, particularly when tired, hungry, stressed, or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is a normal part of development for two to three year olds and early adolescents.

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How Parents Can Watch for the Signs of Psychosis in Their Teens

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How Parents Can Watch for the Signs of Psychosis in Their Teens

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Teens can experience all forms of mental illness, including psychosis. However, as with the signs of depression and other forms of mental illness in adolescence, the key indicators seen in adults may be missed or simply attributed to the normal stress of teenage development.

Psychosis involves a disruption to a person's thoughts and perceptions that make it difficult for them to distinguish between what is real and what isn't. However, it's important to know upfront that psychosis is a symptom rather than a diagnosis.

The severity of psychosis varies. One person may have mild impairment while another struggles with activities of daily living due to their symptoms.

Psychosis generally stems from various psychiatric disorders, although it may also appear in the course of certain medical and neurological conditions. Doctors need to rule out these causes before a psychiatric diagnosis is made.

Early recognition and treatment can slow, stop, or in some cases even reverse the effects of psychosis. Parents need to be informed about what to look for as well as where to turn for help.

Unfortunately, most adults with psychosis say their parents didn't recognize the warning signs when they were younger. According to a survey conducted by the National Alliance on Mental Illness (NAMI), only 18.2% of people with psychosis said their parents saw symptoms of mental illness and intervened.﻿﻿

Many parents may rely on their child's doctor to identify signs of mental illness or psychosis. However, according to NAMI, only 4.5% of people with psychosis report that medical professionals recognized their symptoms.﻿﻿

Symptoms may appear for a while and then disappear. Parents, caregivers, and other adults in a teen's life (such as teachers and coaches) may dismiss the behaviors as a phase or typical teenage mood swings. When symptoms come and go, they may assume a teen is doing fine during periods when symptoms are not present.

The early warning signs of psychosis may be similar to the signs of depression or another mental illness, including:

Mood swings

Unusual movements

Cold, detached demeanor

Inability to express emotions

Loss of interest in usual activities

Difficulty maintaining relationships

Not keeping up with personal hygiene

Problems at school (social and/or academic)

Challenges

It's not uncommon for teens to attempt to hide or disguise their symptoms for as long as possible. A teen who is experiencing psychosis is likely to feel confused, embarrassed, and even afraid.

Signs of psychosis vary from person to person. It's important to get a gauge of your teen's well-being and closely monitor for changes in their mood or behavior that go beyond the normal ups and downs of adolescence.

Parents should also know that sudden psychosis, as in the case of a brief psychotic disorder, is relatively unusual. By contrast, most people with schizophrenia, for example, exhibit signs of psychosis for months, if not years, before they are diagnosed.

Hallucinations

Hallucinations are a common symptom of psychosis and can affect any of the senses including sight, hearing, touch, smell, and taste.

Auditory hallucinations are the most common type of hallucination.﻿﻿ A teen may hear voices that tell them what to do or warn them of danger. Some teens report the voice seems to come from inside their brain, while others feel as though they're hearing voices around them from people who do not exist. For some, the voices simply sound like background noise.

Visual hallucinations involve seeing things that aren't really there. A teen may see people or objects that no one else sees. These hallucinations can run the gamut in terms of content and intensity. Some hallucinations are simply confusing (a wall seems to change color, or an object appears in an unexpected place), but they can also be intensely distressing (such as seeing blood on the floor or the face of a stranger in the mirror).

Olfactory hallucinations involve smells. A person may detect odors that aren't really present, such as perfume, rotten eggs, or garbage. Some olfactory hallucinations come and go, while others may be present all the time.

Teens with psychosis may also experience "phantom" physical sensations. People with tactile hallucinations can feel like something is crawling on or under their skin or may turn around thinking that someone has tapped them on the shoulder when no one is there.

Teens who experience delusions have fixed false beliefs that are inconsistent with their culture. For example, a teen may believe that the government is controlling their behavior through the TV or become convinced someone is poisoning them.

Even when there is no evidence in support of these beliefs, teens experiencing psychosis will maintain their delusions. While it can be frustrating, you can't talk to someone who is experiencing delusions into thinking differently or giving up a delusion simply by stating that it is untrue.

Disordered Thinking

At times, teens with psychosis may exhibit disorganized speech.﻿﻿ They may become easily confused during a conversation. Their sentences may not make sense and their speech may contain meaningless words.

The disordered thinking that results from psychosis can affect focus, concentration, and make teens feel uneasy relating to others.

Causes and Risk Factors

The exact cause of psychosis is not known, but researchers suspect there are several contributing factors, such as genetics.﻿﻿ For example, a teen who has a sibling with schizophrenia may carry a genetic predisposition for psychosis.

Psychosis as a Symptom of Psychiatric Disorder

Certain psychiatric disorders may present with psychosis including:

Schizophrenia: Teens with schizophrenia exhibit behavioral changes that may be intense. They may have hallucinations or delusions. Symptoms often affect their education and their relationships.

Schizoaffective disorder: A person withschizoaffective disorder has a combination of prominent mood symptoms typical in bipolar disorder or depression along with psychotic features of schizophrenia.

Schizophreniform disorder: In schizophreniform disorder, symptoms of schizophrenia are of limited duration-typically between one to six months.

Brief psychotic disorder: A person mayexperience a sudden bout of psychosis, typically in relation to a stressful life event, such as the loss of a loved one. In these cases, symptoms usually disappear in less than a month.

Substance-induced psychotic disorder: Teens with serious substance use problems may experience hallucinations or delusions as a result of their substance use.

Mood disorders: Sometimes psychosis occurs in certain presentations of major depression and bipolar disorder.

Psychotic disorder due to medical condition: In some cases, psychosis may be caused by an underlying condition such as a brain tumor or head injury.

Risk Factors

Researchers have also investigated potential environmental risk factors that may interact with and "trigger" a genetic vulnerability for psychosis,﻿﻿ such as:

Fetal hypoxia: Fetal hypoxia occurs when the oxygen supply to a developing fetus is disrupted. It's been proposed that the resulting changes to the fetal brain may affect later predisposition for schizophrenia.﻿﻿ Fetal hypoxia may be caused by a variety of factors, such as bleeding during pregnancy or an emergency cesarean section.

Maternal infection: The child of a mother who experienced an infection during pregnancy may be at a higher risk of schizophrenia.﻿﻿

Paternal age: Several studies have linked a father's age to an increased risk of schizophrenia. For each decade of a father's life, the risk of schizophrenia in offspring increases 1.5 times.﻿﻿

Prenatal malnutrition. Historically, during periods of famine the rates of schizophrenia increase.﻿﻿ A lack of key vitamins, such as B and D, has also been associated with higher rates of schizophrenia.

Trauma: Adults with schizophrenia report higher rates of childhood trauma.﻿﻿

Stressful family environment: Certain stressors that create an unhealthy childhood environment have also been linked to the later development of psychosis.﻿﻿

Psychosis and Marijuana Use

Studies have also demonstrated a link between teens who smoke marijuana and psychosis. In 2011, a team of researchers led by Rebecca Kuepper published the findings of their study in the British Journal of Medicine.

After following nearly 2,000 teenagers over 10 years, the researchers found that teens who had smoked marijuana at least five times were twice as likely to develop psychosis compared to those who had never smoked pot.﻿﻿

Another study found that smoking marijuana may cause symptoms of psychosis to appear earlier.﻿﻿ Researchers found that marijuana smokers were likely to experience psychosis two years sooner than their non-marijuana smoking counterparts.

One reason for this is that researchers suspect marijuana could interfere with normal brain development. During adolescence, the emotional and reasoning centers of the brain are not yet fully formed and need to continue to make new connections. Research has suggested that when teens use marijuana, it may increase their vulnerability to psychosis through this mechanism.

Psychosis is a symptom of a diagnosable condition rather than being one in and of itself.﻿﻿ However, doctors and mental health professionals can evaluate a person's feelings and behaviors to see if they are experiencing psychosis.

The screening tools used for psychosis are usually questionnaires. The guidelines and criteria for diagnosing specific conditions and disorders that cause psychosis are found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

A doctor or mental health professional (such as a psychiatrist) will usually begin by asking questions related to a person's symptoms. Their questions might be about the content of the person's thoughts, when the thoughts began, how long they have been happening, and whether they are constant or come and go.

While they are asking questions, as well as at other times throughout the evaluation, a provider will also observe a person's behavior, demeanor, and appearance for any clues that could indicate a particular diagnosis.

Providers will also want to know what a person's day-to-day life is like and in what ways it has been affected by their symptoms. For example, a provider will want to know if the person is having trouble with self-care such as taking a shower, cleaning the house, doing laundry, going to the store for groceries, and making sure bills get paid on time.

If a person is unable to answer these questions, providers may turn to family members who can provide insight and information.

Knowing about a person's social activities and whether they can go to school or work is helpful for making a diagnosis. It can also help to know whether a person has been able to maintain close relationships with family and friends.

Once a provider has gathered information about a person's psychosis, they can compare it to the various diagnostic criteria for disorders that cause the symptom, as well as look for other potential explanations.

For example, psychosis may be brought on by certain medications or substances but will go away as soon as the drug is stopped.﻿﻿

In some cases, a doctor might want to order other tests to determine a cause for psychosis. For example, a blood or urine test to check for illicit drugs or an MRI of the brain to look for lesions or tumors.

If they are unsure of a diagnosis, a provider may refer a person with psychosis to a specialist for a more thorough evaluation or recommend admission to an inpatient psychiatric facility.

There isn't a cure for psychosis, but there are treatments. Parents, educators, and medical professionals should know that the sooner a teen with psychosis gets help, the better the outcome is likely to be.

Family Intervention

Family intervention is key for teens with psychosis. Studies show that parental participation can be highly protective against relapse.﻿﻿

Interventions that are family-focused may include psychoeducation, communication skills training, and problem-solving therapy. A supportive home environment and learning how to assist a teen's efforts are instrumental to recovery.

Parents of teens with psychosis often experience guilt and anxiety. Siblings will also have their own unique reactions to the situation, which may range from anger to confusion and fear. Family-based therapy is essential for ensuring everyone's emotional needs are addressed.

Medication

Some teens with psychosis may benefit from medication. Antipsychotic medication can help balance certain brain chemicals that contribute to hallucinations, delusions, and disordered thinking.

Antipsychotics come in two classes: typical and atypical, the former representing an older class of medications that are less frequently prescribed. While they are not without side effects, atypical antipsychotics are generally less likely to cause serious side effects (such as tardive dyskinesia) that are associated with typical antipsychotics.

Examples of typical antipsychotic medications include:

Examples of atypical antipsychotic medications include:

Individual therapy is an important part of a teen's treatment for psychosis. There are many different options for psychotherapy, which may be used in conjunction with medications.

One example is cognitive-behavioral therapy (CBT). Together with a trained mental health professional, CBT can help teens learn to handle stress in a healthy way as well as cope with the unique and the challenges that stem from psychosis.

Other forms of therapy that may be used include:

Teens with psychosis, as well as their families, need to be educated about their illness. A person with psychosis who understands their symptoms will be better equipped to cope with them.

Life skills training is also a crucial component of treatment.

They can also develop the life skills they need to effectively carry out their daily activities, such as bathing and preparing meals.

If you're caring for a teen who is experiencing psychosis, you may feel confused, frightened, and overwhelmed. You may even experience a sense of grief. These emotions are normal and common in caregivers but can be especially intense for those caring for someone with psychosis.﻿﻿

As you support and reassure your teen (as well as keep them safe), you need a wide network you can reach out to for comfort, advice, and resources.

You will likely work closely with the medical and mental health providers overseeing your teen's care, but they can also be excellent sources of information and support for you and your family.

There are also support groups specifically for caregivers, both in-person and online, which you may find helpful. Sometimes, just being around others who understand what you're going through is enough to validate your feelings and empower you.

If your teen is still attending school, you may find it useful to reach out to teachers, principals, and administrators. There may be programs in place to support teens who need extra help or supervision in school, which may include counseling that you and your family could take part in.

You may decide that you would like to see a therapist on your own. Working with a mental health professional can provide you with the time and space to express your concerns and frustrations without judgment.

If your family needs more help, look to your community, religious or spiritual center, and local social work offices. Services such as respite care may be available to you.

Even something as simple as having a friend or neighbor assist with groceries, laundry, or transporting your kids to school can be a big help.

A Word From Verywell

If your teen is showing signs of psychosis, you'll need to seek professional help. You can start by bringing up your concerns with your teen's doctor, though they will need to be referred to a mental health professional (such as a psychiatrist) who can give your teen a proper evaluation.

Talk to your teen's doctor about your concerns. They can refer your teen to a mental health professional, such as a psychiatrist, who can perform an evaluation and begin to make a plan for treatment.

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How Parents Can Watch for the Signs of Psychosis in Their Teens

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Teens can experience all forms of mental illness, including psychosis. However, as with the signs of depression and other forms of mental illness in adolescence, the key indicators seen in adults may be missed or simply attributed to the normal stress of teenage development.

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Supporting Students Experiencing Early   Psychosis in Middle School and High School 

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Supporting Students Experiencing Early   Psychosis in Middle School and High School 

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Schiffman, J., Hoover, S., Roemer, C., Redman, S., and Bostic, J. (2018). Supporting Students Experiencing Early Psychosis in Middle School and High School. Alexandria, VA: National Association of State Mental Health Program Directors.

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School and Classroom Strategies: Bipolar Disorder

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School and Classroom Strategies: Bipolar Disorder

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Bipolar Disorder In Children And Teens

No. 38; Updated March 2015

Bipolar disorder (formerly called manic depressive illness) is an illness of the brain that causes extreme changes in a person's mood, energy, thinking, and behavior. Children with bipolar disorder have periods (or episodes) of mania and depression.

Manic Episodes: An episode of mania includes a period where someone's mood has changed and it is elevated (overly happy), expansive, or very irritable and the person also has increased energy at the same time.

Other manic symptoms may include:

Unrealistic highs in self-esteem - for example, a child or adolescent who feels all-powerful or like a superhero with special powers

Great increase in energy

Decreased need for sleep such as being able to go with little or no sleep for days without feeling tired

Increase in talking - when the child or adolescent talks too much, too fast, changes topics too quickly, and cannot be interrupted

Distractibility - the child's attention moves constantly from one thing to the next

Thinking more quickly - for example, thoughts are on "fast forward"

Repeated high risk-taking behavior, such as abusing alcohol and drugs, reckless driving, or sexual promiscuity

Depressive Episodes: People who have bipolar disorder may also experience periods of depression. An episode of depression includes low, depressed, or irritable mood.

Other symptoms of a depressive episode may include:

Decreased enjoyment in favorite activities

Low energy level or fatigue

Major changes in sleeping patterns, such as oversleeping or difficulty falling asleep

Poor concentration

Complaints of boredom

Major change in eating habits such as decreased appetite, failure to gain weight or overeating

Frequent complaints of physical illnesses such as headaches or stomach aches

Thoughts of death or suicide

Some of these signs are similar to those that occur in children and adolescents with other problems such as drug abuse, attention-deficit hyperactivity disorder, major depressive disorder, disruptive mood dysregulation disorder, or even schizophrenia.

Bipolar disorder can begin in childhood or during the teenage years. The illness can affect anyone. However, if one or both parents have bipolar disorder, the chances are greater that their children may develop the disorder.

The diagnosis of bipolar disorder in children and teens is complex and involves careful observation over an extended period of time. A comprehensive evaluation by a child and adolescent psychiatrist or trained mental health professional can help identify bipolar disorder and is the first step to starting treatment. Children and teenagers with bipolar disorder can be effectively treated. Treatment for bipolar disorder usually includes education of the patient and the family about the illness, mood stabilizing medications such as lithium, or atypical antipsychotics, and psychotherapy. Medications often reduce the number and severity of manic episodes, and may also help to prevent depression. Psychotherapy helps the child understand himself or herself, adapt to stresses, rebuild self-esteem, and improve relationships.

Visit Bipolar Med Guide.

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Bipolar Disorder In Children And Teens No. 38; Updated March 2015 Bipolar disorder (formerly called manic depressive illness) is an illness of the brain that causes extreme changes in a person's mood, energy, thinking, and behavior. Children with bipolar disorder have periods (or episodes) of mania and depression.

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Fontaine Center. (2020). Handling an eating disorder. Montgomery Doctor - Fontaine Center - Doctor in Montgomery, AL. Retrieved from https://www.fontainecenter.com/blog/440808-handling-an-eating-disorder

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What Are Eating Disorders?

Eating disorders are problems that affect a person's eating behaviors as well as their attitudes and feelings about food - and about their body.

Eating disorders affect a person's mental health and can cause serious harm to a person's physical health.

There are several types of eating disorders.

What Are the Different Types of Eating Disorders?

Common types of eating disorders are anorexia, bulimia, binge eating, and avoidant/restrictive food intake disorder (ARFID).

Anorexia. People with anorexia:

eat very little on purpose, leading to a very low body weight

have an intense fear of weight gain and fear looking fat

have a distorted body image and see themselves as fat even when they are very thin

People with anorexia are very strict about what and how much they will eat. They may think about food or calories almost all the time.

To lose weight, some people with anorexia fast or exercise too much. Others may use laxatives, diuretics (water pills), or enemas.

Bulimia. People with bulimia:

overeat and feel out of control to stop, called binge eating

do things to make up for overeating, such as:

make themselves throw up on purpose after overeating, called purging

use laxatives, diuretics, weight loss pills, fast, or exercise a lot to prevent weight gain

judge themselves based on body shape and weight

People with bulimia eat much more (during a set period of time) than most people would. If a person regularly binges and purges, it may be a sign of bulimia. Unlike people with anorexia who are very low weight, people with bulimia may be thin, average weight, or overweight. People with bulimia often hide their eating and purging from others.

Binge eating. People with binge eating disorder:

overeat and feel out of control to stop

eat large amounts even when they are not hungry

may feel upset or guilty after binge eating

often gain weight and may become very overweight

Many people with binge eating disorder eat faster than normal. They may eat alone so others don't see how much they are eating. Unlike people with bulimia, those with binge eating disorder do not make themselves throw up, use laxatives, or exercise a lot to make up for binge eating. If a person binge eats at least once a week for 3 months, it may be a sign of binge eating disorder.

ARFID. People with avoidant/restrictive food intake disorder:

are not interested in food or avoid foods

lose weight, or don't gain expected amount of weight

are not afraid of gaining weight

don't have a poor body image

People with ARFID don't eat because they are turned off by the smell, taste, texture, or color of food. They may be afraid that they will choke or vomit. They don't have anorexia, bulimia, or another medical problem that would explain their eating behaviors.

How Do Eating Disorders Affect Health and Emotions?

Eating disorders can cause serious problems throughout the body.

Anorexia can lead to health problems caused by undernutrition and low body weight, such as:

low blood pressure

slow or irregular heartbeats

feeling tired, weak, dizzy, or faint

constipation and bloating

irregular periods

weak bones

delayed puberty and slow growth

People with anorexia may find it hard to focus and have trouble remembering things. Mood changes and emotional problems include:

feeling alone, sad, or depressed

anxiety and fears about gaining weight

thoughts of hurting themselves

Bulimia can lead to health problems caused by vomiting, laxatives, and diuretics, such as:

low blood pressure

irregular heartbeats

feeling tired, weak, dizzy, or faint

blood in vomit or stool (poop)

tooth erosion and cavities

swollen cheeks (salivary glands)

People with bulimia may have these emotional problems:

low self-esteem, anxiety, and depression

alcohol or drug problems

thoughts of hurting themselves

Binge eating can lead to weight-related health problems, such as:

diabetes

high blood pressure

high cholesterol and triglycerides

fatty liver

sleep apnea

People with binge eating disorder may:

have low self-esteem, anxiety, or depression

feel alone, out of control, angry, or helpless

have trouble coping with strong emotions or stressful events

ARFID may lead to health problems that stem from poor nutrition, similar to anorexia. People with ARFID may:

not get enough vitamins, minerals, and protein

need tube feeding and nutrition supplements

grow poorly

People with ARFID are more likely to have:

What Causes Eating Disorders?

There's no one cause for eating disorders. Genes, environment, and stressful events all play a role. Some things can increase a person's chance of having an eating disorder, such as:

poor body image

too much focus on weight or looks

dieting at a young age

playing sports that focus on weight (gymnastics, ballet, ice skating, and wrestling)

having a family member with an eating disorder

mental health problems such as anxiety, depression, or OCD

How Are Eating Disorders Diagnosed?

Health care providers and mental health professionals diagnose eating disorders based on history, symptoms, thought patterns, eating behaviors, and an exam.

The doctor will check weight and height and compare these to previous measurements on growth charts. The doctor may order tests to see if there is another reason for the eating problems and to check for problems caused by the eating disorder.

How Are Eating Disorders Treated?

Eating disorders are best treated by a team that includes a doctor, dietitian, and therapist. Treatment includes nutrition counseling, medical care, and talk therapy (individual, group, and family therapy). The doctor might prescribe medicine to treat binge eating, anxiety, depression, or other mental health concerns.

The details of the treatment depend on the type of eating disorder and how severe it is. Some people are hospitalized because of extreme weight loss and medical complications.

What if I Have an Eating Disorder?

If you think you may have an eating disorder:

Tell someone. Tell a parent, teacher, counselor, or an adult you trust. Let them know what you're going through. Ask them to help.

Get help early. When an eating disorder is caught early, a person has a better chance of recovery. Make an appointment with your doctor or an eating disorders specialist.

Go to all appointments. Treatment takes time and effort. Work hard to learn about yourself and your emotions. Ask questions any time you have them.

Be patient with yourself. There's so much to learn, and change happens a little at a time. Take care of yourself and be with people who support you.

Where Can I Learn More About Eating Disorders?

For more information on eating disorders, visit the National Eating Disorders Association (NEDA).

For more help and support, the National Association of Anorexia Nervosa and Associated Disorders (ANAD) offers these free resources:

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Eating disorders are problems that affect a person's eating behaviors as well as attitudes and feelings about food and their body. This article for teens describes how different eating disorders impact a person's health and emotions.

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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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Bardick, A., Bernes, K., McCulloch, A., Witko, K., Spriddle, J., & Roest, A. (2004). Eating Disorder Intervention, Prevention, and Treatment: Recommendations for School Counselors. Professional School Counseling, 8(2), 168–175. Retrieved from https://opus.uleth.ca/bitstream/handle/10133/1180/Eating%20Disorder%20Intervention.pdf?sequence=1&isAllowed=y.

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what to do When a Student Has an Eating Disorder

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what to do When a Student Has an Eating Disorder

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When a student who is normally engaged and motivated suddenly has trouble paying attention and seems withdrawn, teachers are often quick to notice. It might be tempting to write this off as just laziness or a passing "phase." Yet this might be a sign of a larger problem that is disrupting the student's ability to stay engaged in the classroom. In fact, social withdrawal and isolation is often one of the first signs of a possible eating disorder.

It's estimated that about 5.2% of adolescent girls have been diagnosed with an eating disorder, according to the National Eating Disorders Association (NEDA). Anorexia nervosa, binge eating disorder and bulimia nervosa often begin around age 12 or 13 and they have one of the highest mortality rates among mental illnesses. The NEDA estimates that individuals ages 15 to 24 with anorexia have a 10 times higher rate of dying when compared to their peers. Clearly, it's critical that educators be aware of the signs and symptoms of eating disorders so they can facilitate an early intervention.

The Truth about Common Eating Disorder Myths

When you hear the term "eating disorder," what comes to mind? Often we picture a very thin young woman wearing baggy clothes ... but eating disorders don't always fit this stereotype. For example, a student struggling with bulimia nervosa may appear to be of normal weight or even overweight, even though they are regularly binge eating and then purging. The National Institute of Mental Health reminds us that it's not always young women dealing with eating disorders; while they are twice as common in young women, many young men struggle with this, too.

What to Look For

Instead of relying on the stereotypical image of eating disorders, learn to recognize the common physical, emotional, and behavioral signs of eating disorders. According to eating disorder specialists at McCallum Place, social isolation is one of the first signs that a student has an eating disorder. This may be because they are trying to hide their eating behaviors, or they have experienced teasing or comments about their appearance or eating habits.

Other common physical, emotional, and behavioral signs of an eating disorder, according to NEDA, are:

Frequent complaints about body image

Incessant talk about weight, food or appearance

Rigid attitudes and behaviors towards eating

Focus on perfection

Little or flat emotion

Social isolation

Sudden weight loss or gain

Complaints of abdominal pain or feeling bloated

Feeling faint, cold or tired (may have blue hands and/or feet)

Calluses on knuckles from self-induced vomiting

Dry hair or skin, or thinning hair

Skipping meals, throwing away food

Exercising for long periods of time

Wearing baggy clothes to hide appearance

How You Can Help

As educators, you have a real opportunity to provide help and hope to students who are struggling with eating disorders. Keep in mind these students are struggling with emotional pain and feel like their lives are out of control. They need a supportive adult to listen and help them find hope for a healthier way of living.

The Florida School Counselor Association recommends avoiding comments on the student's weight and appearance. Instead, express your concern for the student's general wellbeing by gently pointing out some of the changes you've noticed, in a non-judgmental way. For example, "I've noticed you seem quieter and sadder than usual. How is everything going?"

The National Association of School Psychologists recommends the following strategies for helping students whom you suspect might have an eating disorder:

Create an environment for students where they feel safe from harassment

Focus on skill-building and healthy habits rather than weight management (in health and education classes)

Create activities that are not dependent on the student's physical abilities or appearance

Foster an open conversation about eating disorders in general terms and about where to seek help

Know where to refer a student if they need help (the school counselor, school psychologist, school administrator, etc.)

Think of yourself as a bridge that connects the student to resources like the school counselor or an outside counselor who can help them explore treatment options. A student struggling with an eating disorder likely feels alone in their struggle and, by serving as a bridge, you can give them the opportunity to find the help - and hope - they need.

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What to do When a Student Has an Eating Disorder - Blog | Clarity CGC

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When a student who is normally engaged and motivated suddenly has trouble paying attention and seems withdrawn, teachers are often quick to notice. It might be tempting to write this off as just laziness or a passing "phase." Yet this might be a sign of a larger problem that is disrupting the student's ability to stay engaged in the classroom.

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Addressing Eating Disorders in Middle and High School

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Addressing Eating Disorders in Middle and High School

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Muhlheim, L. (2012). Addressing eating disorders in middle and high schools. Retrieved from https://www.eatingdisordertherapyla.com/wp-content/uploads/2015/06/Addressing-Eating-Disorders-in-Middle-and-High-Schools_May2012.pdf

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

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

attendance problems

clinginess/separation anxiety

panic attacks

academic problems/decline in schoolwork

frequent urination

frequent crying

difficulty concentrating/staying focused

blushing/sweating

feeling weak/tired

excessive worrying

health problems such as headaches or an upset stomach

avoidance of people/situations

sleeping problems

lots of "what ifs?"

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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It's not uncommon for students who learn and think differently to also struggle with anxiety. They might worry a lot or be withdrawn at school. They may hesitate to participate in the classroom, make frequent trips to the bathroom or the nurse's office, or even refuse to go to school at all. All of this can get in the way of learning.

What are some classroom accommodations for kids with anxiety? Here are strategies teachers can try.

Providing emotional support

Encourage the student to use self-calming or anxiety-reducing techniques that were taught by a counselor or therapist.

Allow the student to have a self-calming object or family pictures on hand.

Build in "call home" breaks (for students with separation anxiety).

Let the student seek help from a designated staff member with mental health expertise when feeling anxious.

Classroom setup, schedules, and routines

Provide classroom seating where the student is most comfortable (near a door, near the front of the room, near the teacher or a friend).

Let the student sit near the back of the room or by an exit during assemblies.

Assign the student a designated buddy for lunchtime, recess, and/or hallways.

Allow preferential grouping for field trips so the student is with a teacher or friends.

Provide a "take a break pass" to let the student walk down the hallway, get a drink, or leave the classroom when needed.

Create a plan for catching up after an absence or illness (for example, excusing missed homework or having a known time frame for making up work).

Give advance notice of planned substitute teachers or other changes in routine.

Give the student notice and extra time before upcoming transitions, like before recess and lunch, and rehearse transitions in a private or low-stress environment.

Giving instructions and assignments

Clearly state and/or write down classroom expectations and consequences.

Break down assignments into smaller chunks.

Check in frequently for understanding and "emotional temperature."

Provide a signal before calling on the student and a signal for the student to opt out of answering.

Offer written instructions in addition to spoken directions.

Exempt the student from reading aloud or demonstrating work in front of the class.

Let the student present projects to the teacher instead of to the entire class.

Introducing new concepts/lessons

Give extended time on tests and/or separate test-taking space to reduce performance anxiety.

Allow use of word banks, cheat sheets, or fact cards for tests (for students who freeze or "go blank" during in-class tests).

Set time limits for homework or reduce the amount of homework.

Assure that work not completed in that time won't count against the student.

Provide class notes via email or a school portal for the student to preview.

Give notice of upcoming tests (no "pop quizzes").

When students are being treated for anxiety, it's crucial for all of the people working with them to be in contact with their mental health providers about using school strategies like these. Together, you can all ensure the accommodations are a good fit for the student.

About the author

About the author

Amanda Morin is the author of "The Everything Parent's Guide to Special Education" and the former director of thought leadership at Understood. As an expert and writer, she helped build Understood from its earliest days.

Reviewed by

Reviewed by

Jerome Schultz, PhD is a clinical neuropsychologist and lecturer in the Harvard Medical School Department of Child Psychiatry.

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Accommodations for Students With Anxiety Disorders

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It's not uncommon for students who learn and think differently to also struggle with anxiety. They might worry a lot or be withdrawn at school. They may hesitate to participate in the classroom, make frequent trips to the bathroom or the nurse's office, or even refuse to go to school at all.

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Award-winning Anxiety & Anger Relief Programs for Kids

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Anxiety and Anger are tough emotions! Teach kids skills to build resilience using the GoZen! programs.

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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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The difference between IEPs and 504 plans

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

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

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Prutuit, T., Trusty, J., & Ballard, M. (2014). Suffering in Silence: Examining obsessive Compulsive Behaviors in the School Setting. VISTAS Online, 2–12. Retrieved from https://www.counseling.org/docs/default-source/vistas/article_17.pdf?sfvrsn=fc3e0e4_12.

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Credit: Julius-Maximilians-Universität Würzburg, JMU

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

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

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

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

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

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

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

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

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

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

Provided by Julius-Maximilians-Universität Würzburg

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

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This brochure provides information about schizophrenia including symptoms, causes, treatment options, and how to find help for yourself or a loved one.

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School Mental Health Referral Pathways (SMHRP) Toolkit

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School Mental Health Referral Pathways (SMHRP) Toolkit

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Guttman-Lapin, D., Nickerson, A., O’Malley, M., Renshaw, T., Silva, K., & Sockalingam, S. (2015). School Mental Health Referral Pathways (SMHRP) Toolkit. The National Training and Technical Assistance Center for Child, Youth, and Family Mental Health. Retrieved from https://files.ctctcdn.com/bde05f96001/84fa3636-08af-43fc-aeaf-a016f2aa68a6.pdf

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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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Addressing Anxiety in School Settings: Information for Counselors

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Addressing Anxiety in School Settings: Information for Counselors

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The School Counselor and Students with Disabilities

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The School Counselor and Students with Disabilities

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The School Counselor and Students with Disabilities

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The school counselor takes an active role in student achievement and postsecondary planning by providing a school counseling program for all students. As a part of this program, school counselors advocate for students with special needs, encourage family involvement in their child's education and collaborate with other educational professionals to promote academic achievement, social/emotional wellness and college/career readiness for all.

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The School Counselor and Student Mental Health

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The School Counselor and Student Mental Health

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The School Counselor and Student Mental Health

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

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A group of female classmates has been harassing 13-year-old Marie for a month, making fun of her clothing and her weight. She has stopped socializing, other than to check Facebook to ensure no other hurtful things are being said about her. She sleeps fitfully, has stopped eating regularly and her grades have dropped.

Robert, Marie's classmate, didn't make the basketball team, which represented his singular dream. His recently divorced parents and his teachers have noticed he has grown much more irritable, to the point that other students avoid him.

His older brother, Randy, was previously a high school honor student. Now his grades have plummeted.

Kaitlyn, the girl who sits behind Randy in chemistry, smokes marijuana. She is often high in school and nearly always high when she is with her new group of friends. Her younger brother in fourth grade calls his foster mother and goes home sick from school one or two times per week.

Another student, Juan, always seems very sad. For two years, teachers have told his counselor about his mood. In Juan's file, the counselor finds similar reports dating back to middle school.

Under the current criteria, any one of these students might potentially be diagnosed with major depressive disorder, which generally involves a client experiencing six or more of nine common symptoms for a duration of two weeks, or dysthymic disorder, which presents as having a chronic depressed mood with two established symptoms for two years or more.

But based on proposed revisions, when the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) is published approximately two years from now, new criteria will likely suggest that each of these students is depressed - by degrees.

"[The DSM-5] will introduce the idea of looking at disorders such as depression on a spectrum, with certain severity levels used as cut points to identify maladaptive symptoms and functioning, much like we associate blood pressure of 140 over 90 as higher risk," says Gary Gintner, associate professor of counselor education and program leader at Louisiana State University. "Depression, too, will have a dimensional rating that notes severity."

But no matter the process for diagnosis, experts would say that all of these students have serious symptoms of depression and need attention from counselors to help them feel better and address the problem early when it is easier to make inroads.

Gintner says at any one time, about 2 percent of children younger than age 12 have depressive disorders. That number rises to between 4 and 8 percent for those ages 12 to 18. Once adolescent girls hit puberty, their risk of depression is double that of their male classmates (see sidebar, page 34). The rate of depression among young people has increased every decade since the 1940s, according to Gintner, who trains counselors in the use of the DSM and is an expert in planned revisions for the DSM-5.

Each of the professionals interviewed for this article noted that an early diagnosis of depression can make it easier to treat the issue successfully, often with talk therapy.
The diagnosis
That means it is important for counselors - especially those in schools - to be the first line in identifying students struggling with depression.

According to Dr. Graham Emslie, a psychiatrist at Southwestern Medical Center in Dallas and a specialist in child depression, only about 40 percent of adolescents and children needing treatment get adequate care, often because the problem is not spotted. "It is a quiet problem," he says. "We tend to relieve the symptoms or simply not identify it."

One key indicator of depression among students is a precipitous drop in grades, he says, especially if accompanied by other symptoms of depression: low self-esteem, sleep problems, fatigue, apathy and feelings of worthlessness, changes in appetite, loss of pleasure in life and problems concentrating.

Gintner, a past president of the American Mental Health Counselors Association, a division of the American Counseling Association, notes that uncharacteristic or excessive irritability is a symptom associated with depressed adolescents and children. He adds that children may have temper tantrums, stomachaches or headaches associated with depression, while adolescents may be moody, act out or even injure themselves by cutting or burning their skin.

"Many times, the behavior is interpreted as oppositional, but the young person is actually depressed," Gintner says. "The key thing to look for is if they have one of these other depressive symptoms (see sidebar, page 35). And it is critical to identify these problems early when there is a greater chance of treating them successfully."

Often, experts say, life stressors cause depression. For children and adolescents, those stressors don't necessarily stem from a serious personal failure or a major event such as the death of a loved one but rather from common daily hassles or interpersonal problems, such as changes in relationships with peers.

James Matta, an associate professor of counseling at Geneva College in Pennsylvania and senior research principal at the Western Psychiatric Institute and Clinic in Pittsburgh, says counselors should pay particular attention to feelings of hopelessness among young people. "It hinders an individual's ability to form and maintain close relationships with family, friends and early romantic partners," he warns.

Matta, an ACA member who presented on depression in young people at the 2011 ACA Annual Conference in New Orleans, adds that comorbidity is not adequately studied or identified, even though substance use disorders and depression are often linked. Depressed young people are twice as likely to have a substance abuse problem than other adolescents, he says, and "comorbidity is more often seen than not in adolescents with substance use disorders."

Emslie says it is often difficult to determine whether certain characteristics and circumstances cause depression or whether they are symptoms of it. For instance, being bullied can cause children to become depressed, but depressed children might also be more likely to be targets of bullying because they are less likely to defend themselves and perhaps present themselves in a way that encourages bullies.
The treatment
When school counselors are concerned about a student, Matta says, it is critical that they develop a baseline for the student's mood, demeanor and performance in school, using communications with former teachers and counselors as a guide. Early treatment is key, he says.

"We are determining - and it's very affirming to counselors - that psychotherapy or talk therapy is most useful for those with mild to moderate levels of depression," he says. "Cognitive behavior therapy (CBT) and interpersonal therapy seem to be very effective."

Laura Choate, an associate professor at Louisiana State University and the author of books and papers on depression, particularly as it relates to young women (see sidebar, this page), says considerable research has reached that conclusion about treatment. She says the most effective components of CBT to date are psychoeducation about the nature of depression, the development of problem-solving skills, self-monitoring, building relationship skills, communication training (assertiveness, social interactions, family communication, active listening), cognitive restructuring and behavioral activation - for instance, increasing pleasant activities or setting small, achievable goals.

Choate, a member of ACA, notes that a popular "Coping With Depression-Adolescent" program from Kaiser Permanente's Center for Health Research is "among the most studied CBT programs for adolescents and has the most empirical support." The training manual and student workbook in individual and group formats are available for free at kpchr.org/acwd/acwd.html.

Meanwhile, through interpersonal therapy, young people improve relationships by building support and developing their interpersonal competence, Choate says. "Most counselors are not familiar with interpersonal therapy, but there is a strong line of research supporting its effectiveness with adolescents, particularly with girls of color from impoverished backgrounds," she says, noting that Laura Mufson, a researcher and professor at the Columbia University Medical Center, has developed research and training material surrounding the treatment.

Gintner says counseling should include positive interactions, active listening, restoring hope and doing problem solving for real problems. Emslie adds that family therapy is also useful.

Matta notes the American Psychiatric Association released guidelines for treatment of depression in October that suggested talk therapy is most effective initially for clients with less severe cases of depression. "Four to six weeks into treatment, if they are not showing improvement - or in more severe cases - then you consider an antidepressant," Matta says.

Emslie agrees: "Data would suggest that the persistence of the problem in spite of attempts to improve the situation is the best indicator for medication. Unfortunately, only 40 percent of young people who suffer from depression are treated, and only 20 percent of those treated use medication."

A study that Matta helped conduct found that young people with comorbidity who received both talk therapy and the antidepressant fluoxetine (more commonly known by the brand name Prozac) did not have significantly better results than those receiving only talk therapy, though both groups showed significant within-group improvement.

"It was not the specific intent of this study," Matta says, "but its results support the recent recommendation that psychotherapy intervention should be considered the first-line treatment in comorbid populations, with pharmacotherapy being offered to those who do not respond to psychotherapy intervention alone."

But Gintner cautions that the "old class" of antidepressants such as Elavil isn't helpful with children and youth, while selective serotonin reuptake inhibitors (SSRIs) only seem to work with adolescents. He also notes these drugs are not without risks.

"In 2000," he says, "studies began to find risk of suicide ideation or suicidal behavior increased from 2 percent with a placebo to 4 percent on SSRIs. It's a risk, but not a huge risk, so we have to weigh the risk versus the benefit and, sometimes, the benefit is significant." Research has shown that Paxil seems to have a higher incidence of suicidal ideation and acts, he says, while adding that Prozac is the only SSRI approved for use with youth by the U.S. Food and Drug Administration. The FDA recommends that youth taking SSRIs be seen by a psychiatrist every week for a month and be monitored closely, he points out.

Still, experts say better treatment techniques and the refined use of medication are helping increasing numbers of young people. And Matta notes the weighty issue is not without positive data. "Adolescent recovery rate is 90 percent over one to two years from the onset of depressive disorder with treatment," he says. "So we do know how to treat it."

Jim Paterson is a writer and editor and the head of counseling at Argyle Middle School in Silver Spring, Md. Contact him atjamespaterson7@gmail.com

Letters to the editor: ct@counseling.org

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A group of female classmates has been harassing 13-year-old Marie for a month, making fun of her clothing and her weight. She has stopped socializing, other than to check Facebook to ensure no other hurtful things are being said about her. She sleeps fitfully, has stopped eating regularly and her grades have dropped.