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ASCA Ethical Standards for School Counselors

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ASCA Ethical Standards for School Counselors

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American School Counselor Association. (2016). ASCA ethical standards for school counselors. https://www.schoolcounselor.org/getmedia/f041cbd0-7004-47a5-ba01

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Reference:
National Eating Disorders Association. (2015). Educators toolkit. https://www.nationaleatingdisorders.org/sites/default/files/EducatorToolkit3.pdf

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National Institute of Mental Health (NIMH)

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Research shows that mental illnesses are common in the United States, affecting tens of millions of people each year. Estimates suggest that only half of people with mental illnesses receive treatment. The information on these pages includes currently available statistics on the prevalence and treatment of mental illnesses among the U.S. population. In addition, information is provided about possible consequences of mental illnesses, such as suicide and disability.

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Research shows that mental illnesses are common in the United States, affecting tens of millions of people each year. Estimates suggest that only half of people with mental illnesses receive treatment. The information on these pages includes currently available statistics on the prevalence and treatment of mental illnesses among the U.S.

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Learning your child has schizophrenia-or suspecting your child may have it-can feel overwhelming and scary. But early identification and treatment are important in managing the symptoms and improving your child's long-term prognosis.

Schizophrenia is a mental illness that causes people to interpret reality abnormally. It involves a range of cognitive, emotional, and behavioral problems that impair a child's ability to function.

Prevalence

Onset usually occurs between the late teens and the mid-thirties. The peak age of onset for males is the early twenties and for females the late twenties, but it may occur at any age. According to the Institute of Mental Health, about .25 to .64% of Americans have schizophrenia.﻿﻿

Childhood schizophrenia, characterized by onset before age 13, is only found in 1 in 40,000 children. Childhood schizophrenia presents special challenges in terms of diagnosis and treatment.﻿﻿

Scientists haven't found a single set of causes for schizophrenia. It's suspected that there are multiple genetic and environmental factors that play a role:﻿﻿

Genetic Factors - Family, twin, and adoption studies support a strong genetic component in schizophrenia. Parents of children with schizophrenia are ten times as likely to also develop schizophrenia.﻿﻿ If an identical twin has the illness, the likelihood that the other twin will develop schizophrenia is over 40 percent.﻿﻿

Environmental Factors - There may be some environmental factors that contribute to schizophrenia in children, especially if there are already genetic components at play. Prenatal infections, obstetric complications, and maternal famine may play a role.﻿﻿

Childhood schizophrenia is often associated with cognitive delays. Cognitive decline typically occurs at the time of onset of schizophrenia. Intellectual deficits appear to be stable over time without continued deterioration.﻿﻿

Hallucinations - Seeing or hearing things that aren't actually there

Delusions - False ideas that are believed by the individual but not by others

Disorganized thinking - Evidenced by derailed or incoherent speech

Flat affect - Monotone, diminished facial expressions, and appear apathetic

Paucity of speech or thought - Only speaking when prompted and replying with short answers

Bizarre behavior - Inappropriate, disorganized, or odd behavior inappropriate for a child's age

The course of schizophrenia varies from person to person. But, there are hallmark phases that individuals tend to experience.

Prodrome phase - Most individuals with schizophrenia experience some functional deterioration before the onset of psychotic symptoms.﻿﻿ Social withdrawal, bizarre preoccupations, unusual behavior, academic failure, or a decline in hygiene and self-care may begin before any signs of psychosis.

Acute phase - This phase is marked by prominent symptoms, such as hallucinations, delusions, disorganized speech and behavior, and a serious deterioration in functioning. This phase may last several months depending on the response to treatment.﻿﻿

Recuperative/Recovery phase - After the acute psychosis subsides, there is generally a several-month period when the individual continues to experience a significant impairment. Flat affect and social withdrawal are often present.﻿﻿

Residual phase - Children with schizophrenia may have several months or more between acute phases. However, most individuals will continue to be at least somewhat impaired. Some individuals never progress to residual symptoms and continue to have symptoms despite treatment.﻿﻿

When to See a Doctor

It's hard to identify schizophrenia in children. Young children have excellent imaginations so it's common for them to have imaginary friends with whom they carry on conversations. That type of pretend play doesn't mean your child is having hallucinations.

Kids also aren't good at telling adults about their symptoms. When young children are asked questions about hallucinations or delusions, many of them say yes. But, that doesn't mean they have psychosis.

Instead, in a paper published in 2013, researchers believe kids may report having those symptoms because they have overactive imaginations, cognitive limitations, or they simply misunderstand the question. So asking your child questions like, "Do you ever see things that no one else sees?" isn't likely to give you much insight into whether your child should see a doctor.﻿﻿

Symptoms also tend to begin gradually. Over time, however, a child may develop psychosis and the symptoms become much more obvious. If you notice developmental delays, strange eating rituals, bizarre behavior or ideas, change in academic performance, or social isolation, consult your child's doctor.

Since schizophrenia in children is rare, there's a good chance the symptoms may stem from something else. But it's important to find out the reasons for the changes that you're seeing.

There isn't a lab test that identifies schizophrenia. Mental health professionals make the diagnosis based on several factors, after gathering a full history, observing the child, and interviews with the parent and child. Other conditions must also be ruled out.

Schizophrenia Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Many of the symptoms of schizophrenia in children are also found in other disorders, such as autism spectrum disorders, mood disorders with psychotic features, or obsessive compulsive disorder.﻿﻿

Medical conditions may also result in psychosis. Central nervous system infections, endocrine disorders, genetic syndromes, autoimmune disorders, and toxic exposures may cause children to exhibit symptoms similar to those found in schizophrenia.﻿﻿

Drug use may also cause psychosis. Hallucinogenic mushrooms, stimulants, inhalants, and cannabis are just a few of the drugs that may lead to psychotic symptoms. Prescription drug misuse may also lead to acute psychosis. Symptoms resolve within a few days to weeks after the drug is discontinued.﻿﻿

All of those other conditions must be ruled out before a diagnosis of schizophrenia can be made.

Treatments

Antipsychotic medication is the primary treatment for schizophrenia in children as well as adults. Individuals with schizophrenia are at significant risk of relapse if antipsychotic medication is discontinued. It's essential for parents to maintain contact with physicians to monitor symptoms, side effects, and adherence.﻿﻿

Talk therapy may also be helpful to children with schizophrenia. Children and their parents may benefit from psychoeducation and problem-solving sessions. It may be important for siblings to get involved in therapy so they can understand their brother or sister's behavior.﻿﻿

Social skills training, relapse prevention, and basic life skills training may be helpful. Some children with schizophrenia may need specialized education programs or vocational training programs.

If a child becomes a danger to herself or others, a psychiatric hospitalization may be necessary. Inpatient treatment can be helpful in getting symptoms under control.

Childhood-onset schizophrenia is associated with low intellectual functioning and higher rates of negative symptoms across the lifespan. According to a 2011 study published in Pediatric Clinics of North America, childhood-onset schizophrenia is associated with greater social deficits in adulthood compared to those with other mental illnesses.﻿﻿

It's also been linked to lower level of employment and a lesser likelihood of living independently, compared to other psychiatric disorders.﻿﻿

Adolescents are at a higher risk of suicidal behavior during their first episode of psychosis. At least 5 percent of people who exhibited symptoms of schizophrenia before age 18 die by suicide or accidental death directly related to behaviors caused by their psychotic thinking.﻿﻿

If your child is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

Individuals with schizophrenia also are at a higher risk of physical health conditions such as heart disease, obesity, hepatitis, diabetes, and HIV. There isn't a cure for schizophrenia, but symptoms can be managed with treatment. Early intervention is key to improving the outcome for children with schizophrenia.﻿﻿

Coping and Support

Learning your child has schizophrenia-or suspecting that he or she may have it-can feel scary and overwhelming. It's important to learn as much as you can about schizophrenia in children, however, so you can best support and advocate for your child.

Ask your child's doctor for resources on schizophrenia. Attending support groups for people who have a family member diagnosed with schizophrenia could serve as a wealth of information.

The National Alliance on Mental Illness, NAMI, may also be a valuable resource. NAMI is a mental health organization who has local affiliates who provide support, education, and services in communities throughout the United States. NAMI may be able to help you locate the resources, tools, and information you need to help your child.

It's important to take care of yourself as well. Attend a support group or seek therapy for yourself. Managing your stress level will be key to helping you be best equipped to support your child.

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Here Are the Warning Signs of Schizophrenia in Children

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Learning your child has schizophrenia-or suspecting your child may have it-can feel overwhelming and scary. But early identification and treatment are important in managing the symptoms and improving your child's long-term prognosis. Schizophrenia is a mental illness that causes people to interpret reality abnormally.

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What is delusional disorder?

Delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions.

A delusion is an unshakable belief in something that's untrue. The belief isn't a part of the person's culture or subculture, and almost everyone else knows this belief to be false.

People with delusional disorder often experience non-bizarre delusions. Non-bizarre delusions involve situations that could possibly occur in real life, such as being followed, deceived or loved from a distance. These delusions usually involve the misinterpretation of perceptions or experiences. In reality, these situations are either untrue or are highly exaggerated.

Non-bizarre delusions are different from bizarre delusions, which include beliefs that are impossible in our reality, such as believing someone has removed an organ from your body without any physical evidence of the procedure.

People with delusional disorder often continue to socialize and function well, apart from the subject of their delusion. Generally, they don't behave in an odd or unusual manner. This is unlike people with other psychotic disorders, who might also have delusions as a symptom. In some cases, however, people with delusional disorder might become so preoccupied with their delusions that their lives are disrupted.

What are the types of delusional disorder?

There are different types of delusional disorder, which are determined based on the main theme of the delusions the person experiences. The types of delusional disorder include:

Erotomanic: People with this type of delusional disorder believe that another person, often someone important or famous, is in love with them. They may attempt to contact the person of the delusion and engage in stalking behavior.

Grandiose: People with this type of delusional disorder have an overinflated sense of self-worth, power, knowledge or identity. They may believe they have a great talent or have made an important discovery.

Jealous: People with this type of delusional disorder believe that their spouse or sexual partner is unfaithful without any concrete evidence.

Persecutory: People with this type of delusional disorder believe someone or something is mistreating, spying on or attempting to harm them (or someone close to them). People with this type of delusional disorder may make repeated complaints to legal authorities.

Somatic: People with this type of delusional disorder believe that they have a physical issue or medical problem, such as a parasite or a bad odor.

Mixed: People with this type of delusional disorder have two or more of the types of delusions listed above.

What is the difference between delusional disorder and schizophrenia?

Schizophrenia is a spectrum (or range) of conditions that involve psychotic symptoms, which include:

Disorganized speech or behavior.

Negative symptoms (a decrease in emotion in a person's facial expressions and motivation).

Delusional disorder is different from schizophrenia because there aren't any other psychotic symptoms other than delusions.

In addition, in contrast to schizophrenia, delusional disorder is relatively rare, and daily functioning isn't as impaired as it is in schizophrenia.

Who does delusional disorder affect?

Delusional disorder most often occurs in middle to late life, with the average age of onset being 40 years.

The persecutory and jealous types of delusional disorder are more common in people assigned male at birth (AMAB), and the erotomanic type is more common in people assigned female at birth (AFAB).

People who tend to be socially isolated are more likely to develop delusional disorder. These populations include:

Immigrants who have language barriers.

People who are deaf.

People who are visually impaired.

Elderly people.

How common is delusional disorder?

Although delusions might be a symptom of more common disorders, such as schizophrenia, delusional disorder itself is rather rare. Approximately 0.05% to 0.1% of the adult population has delusional disorder.

What is the most common type of delusional disorder?

The most common type of delusional disorder is the persecutory type - when someone believes others are out to harm them despite evidence to the contrary.

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Delusional Disorder: Causes, Symptoms, Types & Treatment

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A delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions, which are unshakable beliefs in something untrue.

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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)

https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596

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Diagnostic and Statistical Manual of Mental Disorders

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Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies.

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From Dr. Tamar Chansky Creator of Worrywisekids.org

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Ybanez-Llorente, K. (2014). Addressing anxiety in school settings: Information for counselors. American Counseling Association. 62, 1-15. https://www.counseling.org/knowledge-center/vistas/by-subject2/vistas-school-counseling/docs/default-source/vistas/article_62

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Addressing Anxiety in School Settings- information for Counselors

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King, W. (Host). (2008). Teen anxiety disorder [Video/DVD] Aquarius Health Care Media. https://video.alexanderstreet.com/watch/teen-anxiety-disorder

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Search streaming video, audio, and text content for academic, public, and K-12 institutions. Alexander Street is an imprint of ProQuest that promotes teaching, research, and learning across music, counseling, history, anthropology, drama, film, and more.

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National Institute of Mental Health (NIMH)

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What are eating disorders?

Eating disorders are serious, biologically influenced medical illnesses marked by severe disturbances to one's eating behaviors. Although many people may be concerned about their health, weight, or appearance from time to time, some people become fixated or obsessed with weight loss, body weight or shape, and controlling their food intake. These may be signs of an eating disorder.

Eating disorders are not a choice. These disorders can affect a person's physical and mental health. In some cases, they can be life-threatening. With treatment, however, people can recover completely from eating disorders.

Who is at risk for eating disorders?

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Although eating disorders often appear during the teen years or young adulthood, they may also develop during childhood or later in life (40 years and older).

Remember: People with eating disorders may appear healthy, yet be extremely ill.

The exact cause of eating disorders is not fully understood, but research suggests a combination of genetic, biological, behavioral, psychological, and social factors can raise a person's risk.

What are the common types of eating disorders?

Common eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant restrictive food intake disorder. Each of these disorders is associated with different but sometimes overlapping symptoms. People exhibiting any combination of these symptoms may have an eating disorder and should be evaluated by a health care provider.

What is anorexia nervosa?

Anorexia nervosa is a condition where people avoid food, severely restrict food, or eat very small quantities of only certain foods. They also may weigh themselves repeatedly. Even when dangerously underweight, they may see themselves as overweight.

There are two subtypes of anorexia nervosa: a restrictive subtype and a binge-purge subtype.

Restrictive: People with the restrictive subtype of anorexia nervosa severely limit the amount and type of food they consume.

Binge-Purge: People with the binge-purge subtype of anorexia nervosa also greatly restrict the amount and type of food they consume. In addition, they may have binge-eating and purging episodes-eating large amounts of food in a short time followed by vomiting or using laxatives or diuretics to get rid of what was consumed.
Symptoms of anorexia nervosa include:

Extremely restricted eating and/or intensive and excessive exercise

Extreme thinness (emaciation)

A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight

Intense fear of gaining weight

Distorted body or self-image that is heavily influenced by perceptions of body weight and shape

Denial of the seriousness of low body weight

Over time, anorexia nervosa can lead to numerous serious health consequences, including:

Thinning of the bones (osteopenia or osteoporosis)

Mild anemia

Muscle wasting and weakness

Brittle hair and nails

Dry and yellowish skin

Growth of fine hair all over the body (lanugo)

Severe constipation

Low blood pressure

Slowed breathing and pulse

Damage to the structure and function of the heart

Drop in internal body temperature, causing a person to feel cold all the time

Lethargy, sluggishness, or feeling tired all the time

Infertility

Brain damage

Multiple organ failure

Anorexia nervosa can be fatal. It has an extremely high death (mortality) rate compared with other mental disorders. People with anorexia are at risk of dying from medical complications associated with starvation. Suicide is the second leading cause of death for people diagnosed with anorexia nervosa.

If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website. If you suspect a medical emergency, seek medical attention or call 911 immediately.

What is bulimia nervosa?

Bulimia nervosa is a condition where people have recurrent episodes of eating unusually large amounts of food and feeling a lack of control over their eating. This binge eating is followed by behaviors that compensate for the overeating to prevent weight gain, such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike those with anorexia nervosa, people with bulimia nervosa may maintain a normal weight or be overweight.
Symptoms and health consequences of bulimia nervosa include:

Chronically inflamed and sore throat

Swollen salivary glands in the neck and jaw area

Worn tooth enamel and increasingly sensitive and decaying teeth from exposure to stomach acid when vomiting

Acid reflux disorder and other gastrointestinal problems

Intestinal distress and irritation from laxative abuse

Severe dehydration from purging

Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals), which can lead to stroke or heart attack

What is binge-eating disorder?

Binge-eating disorder is a condition where people lose control of their eating and have reoccurring episodes of eating unusually large amounts of food. Unlike bulimia nervosa, periods of binge eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder are often overweight or obese.
Symptoms of binge-eating disorder include:

Eating unusually large amounts of food in a short amount of time, for example, within two hours

Eating rapidly during binge episodes

Eating even when full or not hungry

Eating until uncomfortably full

Eating alone or in secret to avoid embarrassment

Feeling distressed, ashamed, or guilty about eating

Frequently dieting, possibly without weight loss

What is avoidant restrictive food intake disorder?

Avoidant restrictive food intake disorder (ARFID), previously known as selective eating disorder, is a condition where people limit the amount or type of food eaten. Unlike anorexia nervosa, people with ARFID do not have a distorted body image or extreme fear of gaining weight. ARFID is most common in middle childhood and usually has an earlier onset than other eating disorders. Many children go through phases of picky eating, but a child with ARFID does not eat enough calories to grow and develop properly, and an adult with ARFID does not eat enough calories to maintain basic body function.
Symptoms of ARFID include:

Dramatic restriction of types or amount of food eaten

Lack of appetite or interest in food

Dramatic weight loss

Upset stomach, abdominal pain, or other gastrointestinal issues with no other known cause

Limited range of preferred foods that becomes even more limited ("picky eating" that gets progressively worse)

How are eating disorders treated?

Eating disorders can be treated successfully. Early detection and treatment are important for a full recovery. People with eating disorders are at higher risk for suicide and medical complications.

A person's family can play a crucial role in treatment. Family members can encourage the person with eating or body image issues to seek help. They also can provide support during treatment and can be a great ally to both the individual and the health care provider. Research suggests that incorporating the family into treatment for eating disorders can improve treatment outcomes, particularly for adolescents.

Treatment plans for eating disorders include psychotherapy, medical care and monitoring, nutritional counseling, medications, or a combination of these approaches. Typical treatment goals include:

Restoring adequate nutrition

Bringing weight to a healthy level

Reducing excessive exercise

Stopping binge-purge and binge-eating behaviors

People with eating disorders also may have other mental disorders (such as depression or anxiety) or problems with substance use. It's critical to treat any co-occurring conditions as part of the treatment plan.

Specific forms of psychotherapy ("talk therapy") and cognitive-behavioral approaches can treat certain eating disorders effectively. For general information about psychotherapies, visit the National Institute of Mental Health (NIMH) psychotherapies webpage.

Research also suggests that medications may help treat some eating disorders and co-occurring anxiety or depression related to eating disorders. Information about medications changes frequently, so talk to your health care provider. Visit the U.S. Food and Drug Administration (FDA) website for the latest warnings, patient medication guides, and FDA-approved medications.

Are there clinical trials studying eating disorders?

NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions, including eating disorders. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

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

Reprints

The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

For More Information

MedlinePlus (National Library of Medicine) ( en español )
ClinicalTrials.gov ( en español )

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 21-MH-4901
Revised 2021

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This brochure provides information about eating disorders including who is at risk, common types of eating disorders and the symptoms of each, treatment options, and resources to find help for yourself or someone else.

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Most children have occasional tantrums or meltdowns. They may sometimes lash out if they're frustrated or be defiant if asked to do something they don't want to do. But when kids do these things repeatedly, or can't control their tempers a lot of the time, it may be more than typical behavior.

Here are some signs that emotional outbursts should concern you:

If your child's tantrums and outbursts are occurring past the age in which they're developmentally expected (up to about 7 or 8 years old)

If their behavior is dangerous to themselves or others

If their behavior is causing them serious trouble at school, with teachers reporting that they are out of control

If their behavior is interfering with their ability to get along with other kids, so they're excluded from play dates and birthday parties

If their tantrums and defiance are causing a lot of conflict at home and disrupting family life

If they're upset because they feel they can't control their anger, and that makes them feels bad about themselves

When children continue to have regular emotional outbursts, it's usually a symptom of distress. The first step is understanding what's triggering your child's behavior. There are many possible underlying causes, including:

ADHD: Many children with ADHD, especially those who experience impulsivity and hyperactivity, have trouble controlling their behavior. They may find it very hard to comply with instructions or switch from one activity to another, and that makes them appear defiant and angry. "More than 50 percent of kids with ADHD also exhibit defiance and emotional outbursts," says Vasco Lopes, PsyD, a clinical psychologist. Their inability to focus and complete tasks can also lead to tantrums, arguing, and power struggles. That doesn't necessarily mean they've been diagnosed with ADHD - in fact, ADHD is sometimes overlooked in kids who have a history of severe aggression because there are so many bigger issues.

Medication won't necessarily fix defiant behavior or aggression; it can reduce the symptoms of ADHD, anxiety, and other disorders and improve the conditions for working on those behaviors. Behavioral approaches that have parents and children working together to rein in problem behavior are key to helping the situation.

Find the triggers
The first step in managing anger is understanding what triggers set off a child's outbursts. So, for instance, if getting out the door for school is a chronic issue for your child, solutions might include time warnings, laying out clothes and showering the night before, and waking up earlier. Some kids respond well to breaking tasks down into steps, and posting them on the wall.

Consistent parenting
When a child's defiance and emotional outbursts occur, the parent or caregiver's response affects the likelihood of the behavior happening again.

If a child's behavior is out of control or causing major problems, it's a good idea to try step-by-step parent training programs. These programs (like Parent-Child Interaction Therapy, or PCIT, and Parent Management Training) train you to positively reinforce behavior you want to encourage in your child, and give consistent consequences for behaviors you want to discourage. Most children respond well to a more structured relationship, with calm, consistent responses from parents that they can count on.

Here are some of the key elements taught in parent training:

Don't give in. Resist the temptation to end your child's tantrum by giving them what they want when they explode. To give in only teaches them that tantrums work.

Ignore negative behavior and praise positive behavior. Ignore minor misbehavior, since even negative attention like reprimanding or telling the child to stop can reinforce their actions. Instead, lavish labeled praise on behaviors you want to encourage. (Don't just say "good job," say "good job calming down.")

Use consistent consequences. Your child needs to know what the consequences are for negative behaviors, such as time outs, as well as rewards for positive behaviors, like time on the iPad. And you need to show them that you follow through with these consequences every time.

Wait to talk until the meltdown is over. One thing you don't want to do is try to reason with a child who is upset. As Stephen Dickstein, MD, a pediatrician and child and adolescent psychiatrist, puts it, "Don't talk to the kid when they're not available." You want to encourage a child to practice at negotiation when they're not blowing up, and you're not either.

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Is My Child's Anger Normal? - Child Mind Institute

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Most children have occasional tantrums or meltdowns. They may sometimes lash out if they're frustrated or be defiant if asked to do something they don't want to do. But when kids do these things repeatedly, or can't control their tempers a lot of the time, it may be more than typical behavior.

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When children act out more than occasionally - with frequent tantrums, outbursts or defiance - the first step to dealing with the problem behavior is finding out what's behind it. And the cause may not be obvious.

Especially when children are young, they may not be able to tell you what they're feeling. And in fact they may not even know what's bothering them.

Tantrums and outbursts are usually signs that kids are struggling with feelings they don't have the skills to manage. They may be overwhelmed by their frustration or anger and not know how to express themselves more effectively, or calm themselves down. They may need help developing skills to control their behavior.

( For more information see How Can We Help Kids With Self-Regulation.)

But if it's happening a lot, it could be caused by a number of underlying issues.

Anxiety

We tend to think of anxious kids as shy, clingy or timid, but anxiety can also cause kids to act out. When anxious children are put into situations that trigger their anxiety, they may lash out or have a tantrum in an effort to escape that situation.

It's not uncommon for it to happen at school, where demands and expectations may put pressure on them that they can't handle. For instance, if a child who has social anxiety feels criticized, they might throw books and papers on the floor, or punch the person making them uncomfortable. And that behavior can be very confusing to teachers and other staff, since it seems to come out of nowhere.
(For more information see How Anxiety Leads to Disruptive Behavior.)
ADHD

ADHD is usually diagnosed when kids are having trouble paying attention. But for many children with the disorder - and their parents - behavior is a big problem, too. They may ignore instructions. And they may lash out, throw a tantrum or be defiant when they are asked to do things they don't want to do.

This behavior is often a result of ADHD symptoms. They may not do what they're told because they are distracted, or because it's unusually hard for them to tolerate tasks that are difficult or boring. They're especially likely to misbehave if they're asked to stop doing something they enjoy, like playing a video game. So things like homework, going to bed, getting dressed and coming to dinner can become battlegrounds.

Children with ADHD are also more impulsive than other kids. They may be overwhelmed with frustration or other powerful feelings, and might impulsively throw a shoe or push someone or yell "shut up!"
(For more information see ADHD and Behavior Problems.)
Learning Disorders

If a child acts out repeatedly in school or during homework time it could be the result of a learning disorder. If, for instance, they have trouble with math problems or a writing assignment, rather than ask for help, they might rip up the paper or start something with another child to create a diversion.

Kids who find learning harder than other kids do can be very frustrated and lose their temper frequently. And if they don't know they have a learning disorder, they can worry that they're stupid. So they often tend to hide their struggles. Getting into trouble might be less painful than letting people know that something is wrong with them. Paying attention to when the problem behavior happens can lead to exposing a learning issue and getting a child help.
For more information see Supporting the Emotional Needs of Kids With Learning Disorders
Sensory Processing Problems

Children who have trouble processing sensory information can have extreme and confusing behavior when their senses are overwhelmed. They might do things like scream if their faces get wet or have a meltdown if they're in a situation that's too bright, noisy or crowded. They might refuse to wear clothes that they find uncomfortable or eat food that feels wrong in their mouths.

Kids with sensory problems can also be rigid about routines and get upset or resist changes that seem insignificant to other people. They are also at risk for running away when an environment feels too overwhelming for them. The "fight or flight" response can kick in when kids are feeling overloaded with sensory input, and their panicked reactions can put them in real danger.
(For more information see Sensory Processing Issues Explained)
Depression

Some children who have frequent temper tantrums have a disorder called disruptive mood dysregulation disorder, or DMDD. These kids have severe tantrums with chronic irritability in between outbursts. They tend to view thigs negatively, and are quick to explode over issues that seem minor to other people.

(For more information, see DMDD: Extreme Tantrums and Irritability)

Autism

Children on the autism spectrum are often prone to dramatic meltdowns. These children tend to be rigid - dependent on consistent routines for their emotional comfort - and any unexpected change can set them off. And they may lack the language and communication skills to express what they want or need.

Some behavior problems in kids with autism can be caused by medical issues that have gone unrecognized, especially in kids who are nonverbal. These include things like acid reflux, constipation, allergies, menstrual cramps, ear infections and even bone fractures. All kids exhibit more negative behaviors when they don't feel well, and kids on the spectrum may explode out of frustration that they are in pain and don't know how to communicate it, or make it stop.
For more information see Autism Behaviors: Do They Reflect Medical Issues?
Trauma

Children who have been subjected to trauma or abuse often have trouble managing strong emotions. As babies and toddlers, children learn from adults how to calm and soothe themselves by being calmed and soothed by adults. If they haven't had that experience, because of neglect, they can be quick to act out when they get upset, and have trouble calming down. They need coaching and practice at de-escalating when they feel overwhelmed.

Kids who have experienced trauma also tend to interpret other people as hostile to them, so they may act out irritably in response. They may develop the belief that they're bad, and what's happened to them is their fault. This leads to the expectation that people are not going to like them or treat them well, so there's no point in trying to behave.
(For more information see How Trauma Affects Kids in School .)

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Common Causes of Behavior Problems in Kids | Child Mind Institute

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When children act out more than occasionally - with frequent tantrums, outbursts or defiance - the first step to dealing with the problem behavior is finding out what's behind it. And the cause may not be obvious. Especially when children are young, they may not be able to tell you what they're feeling.

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Harrigan, S. (Director). (2015). Depressive disorders. [Film]. Microtraning Associates.

https://video.alexanderstreet.com/watch/depressive-disorders

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Our mood can often shape our perception of our own situation. The perceptions of our world can influence our overall state of happiness and well-being just as much, if not more, than the circumstances we find ourselves in.

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National Institute of Mental Health (NIMH)

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Learn about depression, including types, signs and symptoms, risk factors, treatments and therapies, and things you can do to help during treatment.

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National Institute of Mental Health (NIMH)

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Does your child go through extreme changes in mood and behavior? Does your child get much more excited or much more irritable than other kids? Do you notice that your child goes through cycles of extreme highs and lows in mood and energy levels more often than other children? Do these mood changes affect how your child acts at school or home?

Some children and teens with these symptoms may have bipolar disorder, a mental illness that causes unusual shifts in mood, energy, activity levels, and day-to-day functioning. With treatment, children and teens with bipolar disorder can improve over time.

What is bipolar disorder?

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes people to experience noticeable, sometimes extreme, changes in mood and behavior. It is a common misperception that children cannot have bipolar disorder. Although most people are diagnosed with bipolar disorder in adolescence or adulthood, the symptoms can appear earlier in childhood.

Bipolar disorder is not the same as the typical ups and downs every child goes through. The mood changes in bipolar disorder are more extreme, often unprovoked, and accompanied by changes in sleep, energy level, and the ability to think clearly.

Children with bipolar disorder sometimes feel very happy or "up" and are much more energetic and active than usual. This is called a manic episode. Children with bipolar disorder sometimes feel very sad or "down" and are much less active than usual. This is called a depressive episode. Bipolar disorder is often episodic, but it usually lasts a lifetime.

Bipolar disorder symptoms can make it hard to perform well in school or get along with friends and family members. Some children and teens with bipolar disorder may try to hurt themselves or attempt suicide. Early diagnosis and treatment can lead to better functioning and well-being over the long term.

Signs and symptoms of bipolar disorder may overlap with symptoms of other disorders that are common in young people, such as attention-deficit/hyperactivity disorder (ADHD), conduct problems, major depression, and anxiety disorders.

Diagnosing bipolar disorder can be complicated and requires a careful and thorough evaluation by a trained, experienced mental health professional.

With treatment, children and teens with bipolar disorder can manage their symptoms and lead full, active lives.

What causes bipolar disorder?

The exact causes of bipolar disorder are unknown, but several factors may contribute to the illness.

For example, researchers are beginning to uncover genetic factors linked to bipolar disorder and other mental illnesses. Research shows that a person's chances of having bipolar disorder are higher if they have a close family member with the illness, which may be because they have the same genetic variations. However, just because one family member has bipolar disorder does not mean other family members will have it. Many genes are involved in the disorder, and no single gene causes it.

Research also suggests that people with a genetic risk of having bipolar disorder may be more likely to develop the disorder after experiencing trauma or other stressful life events.

Some research studies have found differences in brain structure and function between people with bipolar disorder and people without it. Researchers are examining these differences to learn more about possible causes and effective treatments.

What are the symptoms of bipolar disorder?

Mood episodes in bipolar disorder include intense emotions and significant changes in sleep habits, activity levels, thoughts, or behaviors. Children and teens with bipolar disorder may have manic episodes, depressive episodes, or "mixed" episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that often last for several days or weeks. During an episode, symptoms occur every day and last for most of the day.

These mood and activity changes are very different from the child's usual behavior and the behavior of healthy children and teens.

Children and teens having a manic episode may:

Show intense happiness or silliness for long periods of time.

Have a very short temper or seem extremely irritable.

Talk fast about a lot of different things.

Have trouble sleeping but do not feel tired.

Have trouble staying focused and experience racing thoughts.

Seem overly interested or involved in pleasurable but risky activities.

Do risky or reckless things that show poor judgment.

Have an inflated sense of ability, knowledge, and power.

Children and teens having a depressive episode may:

Feel frequent and unprovoked sadness.

Show increased irritability, anger, or hostility.

Complain a lot about physical pain, such as stomachaches and headaches.

Start sleeping a lot more.

Have difficulty concentrating.

Feel hopeless and worthless.

Have difficulty communicating or maintaining relationships.

Eat too much or too little.

Have low energy and no interest in activities they usually enjoy.

Think about death or have thoughts of suicide.

Can children and teens with bipolar disorder have other problems?

Young people with bipolar disorder can have several problems at the same time. For example, they may also be at risk of misusing alcohol or drugs. Sometimes extreme behaviors go along with mood episodes. During manic episodes, young people with bipolar disorder may take extreme risks that they wouldn't usually take or that could cause them harm or injury. During depressive episodes, some young people with bipolar disorder may think about running away from home or have thoughts of suicide.

If your child shows signs of suicidal thinking, take these signs seriously and call your child's health care provider.
If your child is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org . This service is confidential, free, and available 24 hours a day, 7 days a week.

How is bipolar disorder diagnosed?

A health care provider will ask questions about your child's mood, sleeping patterns, energy levels, and behavior. There are no blood tests or brain scans that can diagnose bipolar disorder. However, the health care provider may use tests to determine if something other than bipolar disorder is causing your child's symptoms. Health care providers may need to know about medical conditions in the family, such as depression or substance use.

Other disorders-such as ADHD, disruptive mood dysregulation disorder, oppositional defiant disorder, conduct disorder, and anxiety disorders-have symptoms like those of bipolar disorder. It can be challenging to distinguish bipolar disorder from depression that occurs without mania, referred to as "major depression." A health care provider who specializes in working with children and teens can carefully evaluate your child's symptoms to provide an accurate diagnosis.

How is bipolar disorder treated?

Children and teens can work with their health care provider to develop a treatment plan to help them manage their symptoms and improve their quality of life. It is important to follow the treatment plan, even when your child is not currently experiencing a mood episode. Steady, dependable treatment works better than treatment that starts and stops.

Several types of medication can help treat symptoms of bipolar disorder. Children respond to medications in different ways. They may need to try different types of medication to find the one that works best for them. Some children may need more than one type of medication because their symptoms are complex. Health care providers usually try to prescribe the fewest number of medications and the smallest doses possible to help treat a child's symptoms. Always tell your child's health care provider about any medication side effects. Do not stop giving your child a prescribed medication without speaking to a health care provider. Stopping medication suddenly can be dangerous and can make symptoms worse.

Different kinds of psychosocial therapy can also help children and their families manage the symptoms of bipolar disorder. Therapies based on scientific research-including cognitive behavioral approaches and family-focused therapy-can provide support, education, and guidance to youth and their families. These therapies teach skills that can help people manage bipolar disorder, including skills for maintaining routines, enhancing emotion regulation, and improving social interactions.

What can children and teens expect from treatment?

With treatment, daily functioning and well-being can improve over time. Treatment is more effective when health care providers, caregivers, and young people work together.

Sometimes a child's symptoms may change or disappear and then come back. When this happens, your child's health care provider may recommend changes to the treatment plan. Treatment can take time but sticking with the treatment plan can help young people manage their symptoms and reduce the likelihood of future episodes.

Your child's health care provider may recommend keeping a daily life chart or mood chart to track your child's moods, behaviors, and sleep patterns. This may make it easier to track the illness and see whether treatment is working.

How can I help my child or teen?

Help begins with an accurate diagnosis and treatment. Talk to your child's health care provider about any symptoms you notice.

If your child has bipolar disorder, here are some basic things you can do:

Be patient.

Encourage your child to talk, and listen to your child carefully.

Pay attention to your child's moods, and be alert to any major changes.

Understand triggers and learn strategies for managing intense emotions and irritability.

Help your child have fun.

Remember that treatment takes time: Sticking with the treatment plan can help your child get better and stay better.

Help your child understand that treatment can make life better.

How does bipolar disorder affect caregivers and families?

Caring for a child or teenager with bipolar disorder can be stressful for parents and families. Coping with a child's mood episodes and other symptoms-such as short tempers and risky behaviors-can challenge any caregiver.

It is important that caregivers take care of themselves, too. Find someone you can talk to or consult your health care provider about support groups. Finding support and strategies for managing stress can help you and your child.

Where do I go for help?

If you're unsure of where to get help, your doctor, pediatrician, or other family health care provider is a good place to start. A health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist, who has experience treating bipolar disorder and can evaluate your child's symptoms.

Learn more about getting help on the NIMH website. The Substance Abuse and Mental Health Services Administration has an online treatment locator to help you find mental health services in your area.

What should I know about clinical trials?

NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions-including bipolar disorder. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to a health care provider about clinical trials, their benefits and risks, and whether one is right for you. Learn more about  participating in clinical trials.

Reprints

The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

For More Information

MedlinePlus (National Library of Medicine) ( En español )

ClinicalTrials.gov ( En español )

NIH Publication No. 23-MH-8081
Revised 2023

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Information about bipolar disorder in children and teens including causes, signs and symptoms, diagnosis, treatment options, and how to help a child or teen who has bipolar disorder.

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National Institute of Mental Health (NIMH)

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Overview

Disruptive mood dysregulation disorder (DMDD) is a condition in which children or adolescents experience persistent irritability and anger and frequent, intense temper outbursts. Many children go through periods of moodiness, but children with DMDD experience severe symptoms and often have significant problems at home and school. They may also struggle to interact with peers. While there is no treatment specifically for DMDD, researchers are working to improve existing treatment options and identify possible new treatments.

Signs and symptoms

Risk factors

Treatment and therapies

Join a study

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Learn about disruptive mood dysregulation disorder (DMDD), including signs and symptoms, risk factors, and potential treatments and therapies.

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Obsessive and compulsive disorder (OCD) symptoms intensely impact individuals and the entire system...

There is a lot of misinformation out there about intrusive thoughts. Here is your opportunity to...

When I was 9-months pregnant with my second baby, I tried to find a children's picture book to read...

Find Help. Learn More. Support ADAA.

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Generalized Anxiety Disorder (GAD) | Anxiety and Depression Association of America, ADAA

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People with GAD don't know how to stop the worry cycle and feel it is beyond their control.

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Buser, J. (2012). The school counselor’s role in addressing eating disorder. American Counseling Association, 97, 1-18. https://www.counseling.org/docs/default-source/vistas/the-school-counselor-s-role-in-addressing-eating-disorder.pdf?sfvrsn=f1a b2b7e_14

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Bulimia and Teenagers: Risks, Dangers, and Complications

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Bulimia and Teenagers: Risks, Dangers, and Complications

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As a severe psychiatric disorder, bulimia nervosa impacts countless individuals across the world, including women and men of all ages, backgrounds, races, and genders. Teenagers can be susceptible to developing bulimia nervosa, particularly as eating disorders often arise during times of transition and change, such as puberty.

Some family members, teachers, coaches, and trusted friends may mistake bulimia for a "fad" that teenagers will "grow out of", but the reality is that bulimia can result in detrimental physical and emotional consequences, including death.

Denial Is Common Among Family Members

Often, we feel so hopeful and supportive of the young person that we want to avoid rushing to conclusions that they have a "disorder". So, we may fight an inclination to make light of signals that something is off. It is wise to grab the bull by the horns, and investigate and discuss your concerns with the adolescent, rather than wait and hope it "goes away", in silence.

How can you recognize if a teenager you care for is suffering with bulimia? Be aware of these following signs and symptoms that may reveal a severe eating disorder:

Frequent disappearance to the bathroom during and after mealtimes

Fluctuations in weight from purging and bingeing episodes

Ritualistic behaviors involving food, such as hording or stealing food, eating an abnormal amount of food in a short period of time, dieting in a rigid manner or appearing anxious/nervous while eating

Complaint of physical complications, such as dizziness, fatigue, sore throat, tremors, blurred vision, or muscle cramps/weakness

Gastrointestinal distress, such as bloating, indigestion, cramps, constipation, nausea or diarrhea

Socially withdrawn and isolated from family and friends

Loss of period or normal menstruation

Obsessing with body image and weight

Frequent mood swings or personality shifts

Other compulsive behaviors, such as excessively exercising, counting calories, drinking, drug use or stealing

Dental complications, such as eroded teeth, bleeding gums, increased cavities

Smell or odor of vomit on body and/or clothes

Weight Is Not Necessarily an Indicator of Bulimia

These signs may indicate that your teenager is indeed struggling with bulimia and should be taken seriously. Teenagers who are experiencing bulimia may not have as obvious outward signs, as their weight is not necessarily an indicator of this eating disorder.

A teen can be at a healthy weight or even overweight and still be ill with bulimia, which may encourage them to hide their condition for years. For these reason, it is important to be aware of other signs that may indicate a more serious problem at hand.

Factors in the Development of Bulimia

A variety of factors may influence the development of bulimia in teenagers, including:

Genetic predisposition

Family history

Environmental triggers

Societal pressures

Stressful life changes and transitions

Other co-occurring disorders, such as:

Depression

Anxiety

Post-traumatic stress disorder

A teenager who has suffered emotional, physical, or sexual abuse may increase their susceptibility to bulimia. The presence of other mental health disorders can also heighten the risk of bulimia, including alcoholism and substance abuse.

Bulimia Is a Serious Problem

Perhaps the most dangerous characteristic of this deadly eating disorder is how often it is underestimated. Many people may assume that since their teenager is experiencing the transition of puberty and often exploring new things in this phase of their life, abnormal behaviors with food may be justified.

However, if left undiagnosed and untreated, the effects of bulimia can prove detrimental. Some of the complications that may arise from bulimia in teenager include:

Rupture of the esophagus or stomach from persistent bingeing and purging episodes

Dental issues as teeth and gums are exposed to stomach acid from vomiting

Gastrointestinal distress

Other more severe consequences include:

Electrolyte imbalance

Cardiovascular complications (such as cardiac arrest)

Damage to vital organs (such as the intestines, kidneys, and liver)

A teenager who suffers with bulimia can also suffer psychological disturbances, such as increased depression or suicide ideations.

Be Aware of the Signs and Symptoms of Bulimia

As a parent of caregiver of a teenager, it is important to be aware of the signs and symptoms that may result if bulimia has developed. Early identification of bulimia and interventions can lead to prompt treatment, which can dramatically improve the outcome and prognosis for a teen suffering with this eating disorder.

Bulimia is not something that should be taken lightly. If you suspect that a teenager you know is struggling with this eating disorder, be sure to intervene in an appropriate and helpful manner that encourages treatment. Having the opportunity to recover from bulimia can promote healing and spare a lifetime of difficulties and complications.
Article Contributed by Jacquelyn Ekern, MS, LPC and Founder of Eating Disorder Hope and Crystal Karges, MS, RDN, IBCLC for Eating Disorder Hope

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Bulimia and Teenagers: Risks, Dangers, and Complications

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As a severe psychiatric disorder, bulimia nervosa impacts countless individuals across the world, including women and men of all ages, backgrounds, races, and genders. Teenagers can be susceptible to developing bulimia nervosa, particularly as eating disorders often arise during times of transition and change, such as puberty.

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Overview

Anorexia (an-o-REK-see-uh) nervosa - often simply called anorexia - is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.

To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat. They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.

Anorexia isn't really about food. It's an extremely unhealthy and sometimes life-threatening way to try to cope with emotional problems. When you have anorexia, you often equate thinness with self-worth.

Anorexia, like other eating disorders, can take over your life and can be very difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia's serious complications.

Products & Services

Symptoms

The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also includes emotional and behavioral issues involving an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight is different for each person, and some individuals may not appear extremely thin. Also, people with anorexia often disguise their thinness, eating habits or physical problems.

Physical symptoms

Physical signs and symptoms of anorexia may include:

Extreme weight loss or not making expected developmental weight gains

Thin appearance

Abnormal blood counts

Fatigue

Insomnia

Dizziness or fainting

Bluish discoloration of the fingers

Hair that thins, breaks or falls out

Soft, downy hair covering the body

Absence of menstruation

Constipation and abdominal pain

Dry or yellowish skin

Intolerance of cold

Irregular heart rhythms

Low blood pressure

Dehydration

Swelling of arms or legs

Eroded teeth and calluses on the knuckles from induced vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia. But people with anorexia generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by:

Severely restricting food intake through dieting or fasting

Exercising excessively

Bingeing and self-induced vomiting to get rid of food, which may include the use of laxatives, enemas, diet aids or herbal products

Emotional and behavioral signs and symptoms may include:

Preoccupation with food, which sometimes includes cooking elaborate meals for others but not eating them

Frequently skipping meals or refusing to eat

Denial of hunger or making excuses for not eating

Eating only a few certain "safe" foods, usually those low in fat and calories

Adopting rigid meal or eating rituals, such as spitting food out after chewing

Not wanting to eat in public

Lying about how much food has been eaten

Fear of gaining weight that may include repeated weighing or measuring the body

Frequent checking in the mirror for perceived flaws

Complaining about being fat or having parts of the body that are fat

Covering up in layers of clothing

Flat mood (lack of emotion)

Social withdrawal

Irritability

Insomnia

Reduced interest in sex

When to see a doctor

Unfortunately, many people with anorexia don't want treatment, at least initially. Their desire to remain thin overrides concerns about their health. If you have a loved one you're worried about, urge her or him to talk to a doctor.

If you're experiencing any of the problems listed above, or if you think you may have an eating disorder, get help. If you're hiding your anorexia from loved ones, try to find a person you trust to talk to about what's going on.

Causes

The exact cause of anorexia is unknown. As with many diseases, it's probably a combination of biological, psychological and environmental factors.

Biological. Although it's not yet clear which genes are involved, there may be genetic changes that make some people at higher risk of developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity and perseverance - all traits associated with anorexia.

Psychological. Some people with anorexia may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which causes them to think they're never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.

Environmental. Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.

Risk factors

Anorexia is more common in girls and women. However, boys and men have increasingly developed eating disorders, possibly related to growing social pressures.

Anorexia is also more common among teenagers. Still, people of any age can develop this eating disorder, though it's rare in those over 40. Teens may be more at risk because of all the changes their bodies go through during puberty. They may also face increased peer pressure and be more sensitive to criticism or even casual comments about weight or body shape.

Certain factors increase the risk of anorexia, including:

Genetics. Changes in specific genes may put certain people at higher risk of anorexia. Those with a first-degree relative - a parent, sibling or child - who had the disorder have a much higher risk of anorexia.

Dieting and starvation. Dieting is a risk factor for developing an eating disorder. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.

Transitions. Whether it's a new school, home or job; a relationship breakup; or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia.

Complications

Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur suddenly - even when someone is not severely underweight. This may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes - minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.

Other complications of anorexia include:

Anemia

Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure

Bone loss (osteoporosis), increasing the risk of fractures

Loss of muscle

In females, absence of a period

In males, decreased testosterone

Gastrointestinal problems, such as constipation, bloating or nausea

Electrolyte abnormalities, such as low blood potassium, sodium and chloride

Kidney problems

If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.

In addition to the host of physical complications, people with anorexia also commonly have other mental health disorders as well. They may include:

Depression, anxiety and other mood disorders

Personality disorders

Obsessive-compulsive disorders

Alcohol and substance misuse

Self-injury, suicidal thoughts or suicide attempts

Prevention

There's no guaranteed way to prevent anorexia nervosa. Primary care physicians (pediatricians, family physicians and internists) may be in a good position to identify early indicators of anorexia and prevent the development of full-blown illness. For instance, they can ask questions about eating habits and satisfaction with appearance during routine medical appointments.

If you notice that a family member or friend has low self-esteem, severe dieting habits and dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, you can talk about healthier behavior or treatment options.

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Anorexia is an eating disorder characterized by an abnormally low body weight, intense fear of gaining weight and a distorted perception of body weight.

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Overview

What is persistent depressive disorder?

Persistent depressive disorder (PDD) is mild or moderate depression that doesn't go away. A person with PDD has a sad, dark, or low mood and two or more other symptoms of depression. The symptoms last most of the day, on most days, over a long period of time.

Healthcare providers used to call the condition dysthymia or dysthymic disorder.

What's the difference between depression and persistent depressive disorder?

Persistent depressive disorder is a type of depression. It's less severe than major depressive disorder - another type - but it's ongoing. It's defined as lasting at least two years in adults and at least one year in children and teens. During this time, symptoms can't be absent for more than two consecutive months to meet the criteria for PDD.

How common is chronic depression?

PDD can happen to anyone at any age. In fact, 3% or more of the U.S. population experiences it at some point in their lives.

PDD is more common in women and in people who have relatives with the same condition.

Symptoms and Causes

What causes persistent depressive disorder?

Scientists don't fully understand what causes PDD. But it might be related to low levels of serotonin. Serotonin is a natural hormone that controls our emotions and feelings of well-being. It also influences other body functions.

PDD may get triggered by a traumatic event in life. Examples include losing a job, having a loved one die, experiencing a crime or going through a breakup.

What are the symptoms of PDD?

The main symptom of PDD is a sad, low or dark mood. Other signs may include:

Feelings of hopelessness, worthlessness or isolation.

Lack of appetite or overeating.

Lack of concentration.

Limited energy.

Low self-esteem.

Trouble at work or school.

Trouble sleeping or sleeping too much.

Most people with PDD also have an episode of major depression at least once at some point, which is sometimes called "double depression."

Diagnosis and Tests

How is persistent depressive disorder diagnosed?

If you think you have PDD, talk to a healthcare provider. There are no tests for chronic depression, so the diagnosis comes from discussions with a provider. The provider might ask:

Do you feel sad a lot?

Are there particular reasons you feel down?

Do you have trouble sleeping?

Do you have trouble concentrating?

Are you taking any medications?

How long have you had these symptoms?

Are the symptoms there all the time, or do they come and go?

Your healthcare provider may order blood or urine tests to rule out other causes. The healthcare provider also might refer you to a psychologist or psychiatrist to talk about your symptoms. These providers are specially trained to discuss mental health.

Management and Treatment

How is persistent depressive disorder treated?

The most effective treatment for PDD combines medications and talk therapy, or counseling.

Antidepressants are prescription drugs that can relieve depression. There are many different kinds of medications for the treatment of depression. The most commonly used fall into two broad categories:

Selective serotonin reuptake inhibitors (SSRIs).

Serotonin-norepinephrine reuptake inhibitors (SNRIs).

You may need to take medication for a month or longer before you feel a difference. Make sure to continue taking the medication exactly as your healthcare provider prescribed. Even if you have side effects or feel much better, don't stop without talking to your healthcare provider first.

Counseling can also help manage PDD. One type of therapy, cognitive behavioral therapy (CBT), is often helpful for depression. A therapist or psychologist will help you examine your thoughts and emotions and how they affect your actions. CBT can help you unlearn negative thoughts and develop more positive thinking.

Prevention

Can I prevent persistent depressive disorder?

Although you can't prevent depression, you can do some things to make it less severe:

Eat a well-balanced diet of nutritious foods.

Exercise several times a week.

Limit alcohol and avoid recreational drugs.

Taking prescribed medications correctly and discussing any potential side effects with your healthcare providers.

Watch for any changes in PDD and talk to your healthcare provider about them.

Outlook / Prognosis

What is the outlook for people with persistent depressive disorder?

With medication, talk therapy and lifestyle changes, you can manage PDD and feel better. But some people have depressive symptoms throughout their lives.

Most people with PDD will have one or more episodes of major depression. If depression gets worse, talk to your healthcare provider.

If you think about hurting yourself or someone else, tell somebody right away. You can tell a healthcare provider, a friend or a family member.

You can also contact the National Suicide Prevention Lifeline:

You're not alone, and there's always somebody who wants to help.

Living With

How can I cope with persistent depressive disorder?

In addition to taking medication and going to therapy, consider doing things you enjoy, such as:

Do something nice for someone else.

Go to a movie, a show or a ballgame.

Hang out with people who have positive attitudes.

Paint, or try some arts and crafts.

Spend time outside.

Spend time with friends, in person or on the phone.

Take a yoga class, learn to meditate, or walk with a friend.

A note from Cleveland Clinic
PDD can make you feel sad or down most of the day, most days, over a long period of time. Talk to your healthcare provider if you have depressive symptoms. Medication, counseling and healthy lifestyle choices can make you feel better. If you feel like you might hurt yourself or someone else, seek help immediately. You're not alone.

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Persistent Depressive Disorder (PDD): Symptoms, Causes & Management

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Persistent depressive disorder (PDD) is mild or moderate depression that doesn't go away. A person with PDD has a sad, dark, or low mood and two or more other symptoms of depression. The symptoms last most of the day, on most days, over a long period of time.

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Individuals with Disabilities Education Act (IDEA)

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Individuals with Disabilities Education Act (IDEA)

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Pica is an eating disorder that is characterized by eating items other than food such as paint chips, dirt, paper, or hair. More specifically, those with pica swallow or ingest items that do not have any real nutritional value.

The condition is more common in children, but pica can also occur in adults. It is linked with some types of intellectual and developmental disabilities, such as autism spectrum disorder.

Up to one-third of children between the ages of 1 and 6 may exhibit some type of pica eating disorder.It's important to note that children under the age of 2 are not diagnosed with pica, because it's common for toddlers and younger children to put foreign items in the mouth. Pica can occur in adults who crave having a specific type of texture in the mouth.﻿﻿

People who are pregnant are known to have a form of pica that may be caused by a craving for certain nutrients (such as minerals found in dirt). Iron and zinc deficiencies can trigger pica cravings. Another type of pica thought to be associated with nutrient cravings is called geophagy, which involves eating earthy substances such as clay.

Pica Symptoms and Characteristics

The symptoms of pica have a broad range, but they are all linked with the impact of nonfood items that are ingested. Symptoms of pica occur as a result of the toxic or poisonous content as well as the bacteria in nonfood items that are ingested. The symptoms may include:

Nausea

Pain in the stomach (or abdominal cramping which can indicate that there may be an intestinal blockage)

Constipation

Diarrhea

Stomach ulcers (which may cause blood in the stools)

Symptoms of lead poisoning (if paint chips that contain lead are ingested)

Injuries to teeth (such as broken or fractured teeth from chewing on hard nonfood items)

An intestinal blockage (from eating nonfood items that cannot be digested and end up blocking up the intestine)

Infections (caused by germs and/or parasites that enter the body from the nonfood item that is swallowed)﻿﻿

Fatigue

Behavior problems

School problems

Other symptoms of lead poisoning or poor nutrition﻿﻿

Most people with pica eat regular nutrient-filled foods in addition to ingesting nonfood items.﻿﻿﻿ But in many instances, those who are affected by pica are nutritionally malnourished.

What Do People With Pica Eat?

Common nonfood items ingested by people (children and adults) with pica include:

There are no specific lab tests to diagnose pica; diagnosis is made primarily from taking the history of the patient as well as from reports from family members (particularly for children with pica).

Diagnostic Tests

Tests conducted for those who are suspected to have pica may include the following.

Blood tests: To evaluate the possibility of anemia, low zinc or iron levels

Stool samples: To test for intestinal bleeding from damage caused by swallowing nonfood items

Intestinal blockage evaluation: Done by performing X-rays or other imaging tests

Lead levels: To evaluate for lead poisoning in instances in which the person with pica eats paint chips

Tests to check for parasites or bacteria from eating dirt or other items

Weight loss evaluation

Testing for nutritional deficiencies

Qualifying Factors for a Pica Diagnosis

The criteria of symptoms that qualify a person to be diagnosed with pica include:

Persistent eating of nonfood substances (for one month or longer), even if the foods cause illness or discomfort (such as nausea)﻿﻿

Ingesting a nonfood substance that is not part of a culturally supported or socially normal practice (e.g., some cultures commonly eat clay for medicinal purposes as part of their cultural background)

Eating nonfood items must be developmentally inappropriate (for example, a child who is under 2 years of age commonly puts nonfood items in the mouth and therefore would not be diagnosed with pica until after age 2)

The type of nonfood substances that are ingested often change according to a person's age and the availability of nonfood items.

Although the exact cause of pica is unknown, experts know there are some conditions that cause a person to be more at risk for developing pica. These include:

Developmental disorders and intellectual disabilities, such as autism spectrum disorder

Mental health conditions, such as schizophrenia or obsessive-compulsive disorder

Those with malnutrition or who suffer from hunger, resulting in low levels of nutrients such as iron and zinc, which can trigger specific types of cravings

Stress, such as in kids who have been abused or neglected or those living in severe poverty

During pregnancy, on rare occasions, people who are pregnant crave dirt, which may be related to an iron deficiency ﻿﻿

Other Risk Factors

Pica can be linked with several other conditions, including:

Hair pulling (a disorder called trichotillomania)

Skin picking (a disorder called excoriation)

The overall number of people with pica is not clear, but it is thought to be more prevalent in developing countries than in the U.S.﻿﻿

Causes of Pica in Children With Autism

Several factors have been linked with pica in kids with autism spectrum disorder. The reasons these kids often crave nonfoods may include the following.

Sensory feedback (also referred to as automatic reinforcement): This is the desire to eat nonfoods for a pleasurable feeling.

An inability to decipher between foods and nonfoods: Some children eat nonfood items because they believe they are edible foods.

Nutrient deficiency: This includes a lack of adequate levels of iron or zinc.﻿﻿

The treatment of pica varies depending on the underlying factors linked with the condition. It's important for healthcare providers to address the symptoms that often result from pica; these symptoms differ, depending on which nonfood items are being ingested. Common symptoms that require treatment for those with pica include:

Medications for constipation or diarrhea

Treatment of stomach ulcers

Antibiotic treatment for Infections

Nutritional supplementation for nutritional deficiencies

Addressing other medical problems, such as lead poisoning

Behavioral Treatment for Pica

Pica behavior has similar features to bulimia, trichophagia, and obsessive-compulsive disorder.﻿﻿﻿ Treatment modalities that address the pica behavior itself may include:

A referral to a mental health/behavioral health specialist

Behavior modification program, such as redirecting a child's attention away from the nonfood object and giving rewards for selecting food items instead of nonfood items﻿﻿

Medications for managing behavioral problems, given to help reduce the urges and impulses to eat nonfood items

Professionals

Professionals trained in treating pica may include:

A behavior analyst (with experience in functional behavioral assessment and implementation of behavioral intervention)

A psychologist with experience in applied behavior analysis, which is a type of therapy aimed at improving specific behaviors

A pediatrician who specializes in the treatment of behavioral issues

Outlook (Prognosis)

The success rate for the treatment of pica varies quite a bit, depending on the underlying causes and any related factors. In kids, pica usually improves as they grow up. But for those with mental illness or developmental disorders, it commonly continues into the teenage years or even into adulthood.﻿﻿﻿

Treatment for pica has been found to be more successful in children who have undergone a medical assessment and behavioral evaluation by a mental health or medical professional.﻿﻿﻿ Behavioral assessments help to identify and treat associated problem behaviors (such as aggression).

A thorough medical evaluation can result in the effective treatment of underlying problems, such as nutritional deficiencies, which may end up resolving pica.

Coping with a child who has pica can be very challenging, to say the least. It's important to reach out and find experienced local professionals trained in treating compulsive behavior conditions such as pica.

There are many strategies that can be put into place to help empower parents to better manage the situation; this, in turn, lowers stress and facilitates positive coping.

Educating yourself on the specific underlying factors pertaining to your child's individual situation may also be an effective way to help alleviate stress. For example, if you have a child with autism, there are some proven strategies that can help you take control of the situation (instead of feeling helpless over it).

Some examples include the following.

Blocking: A strategy involving placing your hand on top of the child's hand to prevent the child from putting the nonfood item into their mouth. This strategy helps reduce pica for some kids.﻿﻿

Providing tasty, nutritious snacks at frequent, regular time intervals (such as every half-hour or every hour): More frequent snacks can provide options to the child other than eating nonfood items.

Give rewards (such as stickers): Give a reward for abstaining from eating nonfood items for a specific period of time. Positive reinforcement is a proven strategy that can help parents change unwanted behaviors in their child.﻿﻿

Learn about other strategies to help kids who have autism deal with pica by visiting the Autism Speaks guide for parents. There is also an online tool kit that provides more information on how parents can effectively manage challenging behaviors.

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Pica is an eating disorder that is characterized by eating items other than food such as paint chips, dirt, paper, or hair. More specifically, those with pica swallow or ingest items that do not have any real nutritional value. The condition is more common in children, but pica can also occur in adults.

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My 11-year-old son, Craig, was suicidal. He set fires. He killed animals. He was a danger to himself and everyone around him. ... The people in the system of care really showed that they care about us as a family. They lifted us up and brought us closer. Today, Craig is on the honor roll at school. All the help from the men and women in the system of care has really paid off.

Students with emotional disturbance and/or behavioural problems may have conditions such as neurosis, childhood psychosis, hyperactivity, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD). Generally a student with emotional disturbance and/or behavioural problems will present with negative behaviours that impinge on their learning and often on their social development. (This category is not intended to include students whose conduct or behavioural difficulties can be dealt with in accordance with agreed school procedures on discipline.)

Emotional Disturbance and/or Behavioural Problems

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My 11-year-old son, Craig, was suicidal. He set fires. He killed animals. He was a danger to himself and everyone around him. ... The people in the system of care really showed that they care about us as a family. They lifted us up and brought us closer.

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What is Obsessive Compulsive Disorder (OCD)?

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What is Obsessive Compulsive Disorder (OCD)?

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

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is an anxiety disorder that can affect children and teenagers. Kids with OCD experience unwanted thoughts, worries or impulses called obsessions. Obsessions are very upsetting and hard to control. Children with OCD develop repetitive actions - called compulsions- to calm the anxiety caused by their obsessions.

Often, compulsions are not connected to obsessions in a realistic way. For example, a child might have an obsessive fear that their parents will be in a car accident. To deal with that fear, they might turn a light on and off five times. Even if they know it doesn't make sense, they feel that the ritual will keep their parents from getting hurt. Professionals call that feeling "magical thinking."

Children as young as five can develop OCD. At that age, they may not even realize that their thoughts and fears are exaggerated or unrealistic.

A child with OCD may hide their rituals until they get to be too overwhelming. They may be able to suppress their rituals at school and then act out when they get home.

Some children suddenly develop OCD symptoms, along with other disturbing symptoms, after they have had an infection, such as a staph infection. This is a disorder called PANDAS or PANS.

What are the symptoms of obsessive-compulsive disorder?

Kids with OCD usually experience both obsessions and compulsions. They use compulsions to control the anxiety that obsessions cause.

Common obsessions that kids experience include:

Fear of contamination (germs, waste, vomit, chemicals, etc.)

Needing everything to be even or symmetrical

Extreme worry about safety, like thinking that the house will burn down or a parent will get hurt

Fear that they might do something violent or terrible

Common compulsions include:

Washing their hands repeatedly

Locking and relocking doors a certain number of times

Lining up objects or touching parts of their bodies symmetrically, like scratching both ears

Counting a certain number of times or repeating something mentally

Repeatedly asking parents for reassurance that something bad isn't going to happen

Compulsions can be thoughts instead of behaviors, so they can be hard to spot. For example, a child's compulsion might be counting to 20 in their head.

How is obsessive-compulsive disorder diagnosed?

To be diagnosed with OCD a child has to have obsessions, compulsions or both. They must get in the way of the child's normal life.

The severity of the symptoms can be measured using a rating scale called Y-BOCS, or the Yale-Brown Obsessive-Compulsive Scale.

How is obsessive-compulsive disorder treated?

The most effective treatment for OCD is a form of cognitive behavior therapy (CBT) called exposure and response prevention.

In this therapy, the therapist exposes the child to small amounts of the thing that usually triggers their obsession. That way, the child gets practice dealing with their anxiety in a safe environment. The therapist helps the child avoid using their compulsion. Over time, the child feels less anxious, and they don't need the compulsion anymore. The therapist can also train the child's family to practice at home.

More severe cases of OCD are often treated with a combination of CBT and medication. The most effective medication for anxiety is SSRIs, or selective serotonin reuptake inhibitors. The medication can reduce anxiety and help the child get more out of therapy. Once kids learn skills in therapy, they can take less medication or stop altogether.

Kids with OCD will often return to their clinician in the years after their treatment for "booster sessions" to freshen up the skills they learned to control their anxiety.

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Quick Guide to Obsessive-Compulsive Disorder (OCD) - Child Mind Institute

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares. Obsessive-compulsive disorder (OCD) is an anxiety disorder that can affect children and teenagers. Kids with OCD experience unwanted thoughts, worries or impulses called obsessions.

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Oppositional defiant disorder is a type of disruptive behavior disorder in which children frequently defy authority with hostility, leading to serious disturbances in their daily life.

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What Symptoms Should Parents Look for?

There are four basic types of behavior that characterize conduct disorder:

Physical aggression (such as cruelty toward animals, assault or rape).

Violating others' rights (such as theft or vandalism).

Lying or manipulation.

Delinquent behaviors (such as truancy or running away from home).

Conduct disorder is characterized by aggression toward others and a callous disregard for their rights and needs. Adolescents and teens with conduct disorder can find acts of aggression, deceit and coercion to be gratifying. Your child may meet the criteria for conduct disorder if you find them engaging in several of the below behaviors:

Many young people with conduct disorder will have trouble:

Feeling and expressing empathy or remorse.

Showing emotion toward others.

Performing well in the school or community and blaming others for poor performance.

They often misinterpret the actions of others as being hostile or aggressive. They respond by escalating the situation into verbal or physical conflict.

In adolescents and teens, conduct disorder may be associated with other difficulties, including:

In younger children, it can be more of a challenge to distinguish signs of conduct disorder from more typical "acting out".

At times, these same symptoms can be seen in children without the disorder. The difference is frequency, intensity, and duration, as well as to what extent it impacts their functioning. In children with conduct disorder, these behaviors happen much more frequently.

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There are four basic types of behavior that characterize conduct disorder: Physical aggression (such as cruelty toward animals, assault or rape). Violating others' rights (such as theft or vandalism). Lying or manipulation. Delinquent behaviors (such as truancy or running away from home).

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What is OCD? | International OCD Foundation

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Obsessive compulsive disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings.…

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Behavior or Conduct Problems in Children

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Behavior or Conduct Problems in Children

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Centers for Disease Control and Prevention

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Children sometimes argue, are aggressive, or act angry or defiant around adults. A behavior disorder may be diagnosed when these disruptive behaviors are uncommon for the child's age at the time, persist over time, or are severe. Because disruptive behavior disorders involve acting out and showing unwanted behavior towards others they are sometimes called externalizing disorders.

Oppositional Defiant Disorder

When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD usually starts before 8 years of age, but no later than by about 12 years of age. Children with ODD are more likely to act oppositional or defiant around people they know well, such as family members, a regular care provider, or a teacher. Children with ODD show these behaviors more often than other children their age.

Examples of ODD behaviors include

Often being angry or losing one's temper

Often arguing with adults or refusing to comply with adults' rules or requests

Often resentful or spiteful

Deliberately annoying others or becoming annoyed with others

Often blaming other people for one's own mistakes or misbehavior

Learn more about ODD
Conduct Disorder

Conduct Disorder (CD) is diagnosed when children show an ongoing pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and with peers. These rule violations may involve breaking the law and result in arrest. Children with CD are more likely to get injured and may have difficulties getting along with peers.

Examples of CD behaviors include

Breaking serious rules, such as running away, staying out at night when told not to, or skipping school

Being aggressive in a way that causes harm, such as bullying, fighting, or being cruel to animals

Lying, stealing, or damaging other people's property on purpose

Learn more about CD
Treatment for disruptive behavior disorders

Starting treatment early is important. Treatment is most effective if it fits the needs of the specific child and family. The first step to treatment is to talk with a healthcare provider. A comprehensive evaluation by a mental health professional may be needed to get the right diagnosis. Some of the signs of behavior problems, such as not following rules in school, could be related to learning problems which may need additional intervention. For younger children, the treatment with the strongest evidence is behavior therapy training for parents, where a therapist helps the parent learn effective ways to strengthen the parent-child relationship and respond to the child's behavior. For school-age children and teens, an often-used effective treatment is a combination of training and therapy that includes the child, the family, and the school.

Get help finding treatment

Here are tools to find a healthcare provider familiar with treatment options:

Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with behavior or conduct problems. In addition to behavioral therapy and medication, practicing certain healthy lifestyle behaviors may reduce challenging and disruptive behaviors your child might experience. Here are some healthy behaviors that may help:

Engaging in regular physical activity, including aerobic and vigorous exercise

Eating a healthful diet centered on fruits, vegetables, whole grains, legumes (for example, beans, peas, and lentils), lean protein sources, and nuts and seeds

Getting the recommended amount of sleep each night based on age

Strengthening relationships with family members

Prevention of disruptive behavior disorders

It is not known exactly why some children develop disruptive behavior disorders. Many factors may play a role, including biological and social factors. It is known that children are at greater risk when they are exposed to other types of violence and criminal behavior, when they experience maltreatment or harsh or inconsistent parenting, or when their parents have mental health conditions like substance use disorders, depression, or attention-deficit/hyperactivity disorder (ADHD). The quality of early childhood care also can impact whether a child develops behavior problems.

Although these factors appear to increase the risk for disruptive behavior disorders, there are ways to decrease the chance that children experience them. Learn about public health approaches to prevent these risks:

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Behavior or Conduct Problems in Children | CDC

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Children sometimes argue, are aggressive, or act angry or defiant around adults. A behavior disorder may be diagnosed when these disruptive behaviors are uncommon for the child's age at the time, persist over time, or are severe. Learn about behavior or conduct problems in children.

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Definition

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

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

Prevalence

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

Characteristics

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

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

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

Impact on Learning

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

Teaching Strategies

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

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

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

Assistive Technology

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

Organizations

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

American Academy of Child and Adolescent Psychiatry

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

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

Web: www.aacap.org

Center on Positive Behavioral Interventions and Supports

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

5262 University of Oregon
Eugene, OR 97403-5262

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

Center for Disability and Development

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

Council for Exceptional Children

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

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

Federation of Families for Children's Mental Health

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

1101 King Street, Suite 420
Alexandria, VA 22314

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

National Alliance for the Mentally Ill (NAMI)

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

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

Web: www.nami.org

Mental Health America

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

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

Web: www.nmha.org

National Mental Health Information Center

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

P.O. Box 42557
Washington, DC 20015

Web: www.mentalhealth.org

References

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

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

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

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

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Overview

Childhood schizophrenia is an uncommon but severe mental disorder in which children and teenagers interpret reality abnormally. Schizophrenia involves a range of problems with thinking (cognitive), behavior or emotions. It may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs your child's ability to function.

Childhood schizophrenia is essentially the same as schizophrenia in adults, but it starts early in life - generally in the teenage years - and has a profound impact on a child's behavior and development. With childhood schizophrenia, the early age of onset presents special challenges for diagnosis, treatment, education, and emotional and social development.

Schizophrenia is a chronic condition that requires lifelong treatment. Identifying and starting treatment for childhood schizophrenia as early as possible may significantly improve your child's long-term outcome.

Symptoms

Schizophrenia involves a range of problems with thinking, behavior or emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. The effect can be disabling.

In most people with schizophrenia, symptoms generally start in the mid- to late 20s, though it can start later, up to the mid-30s. Schizophrenia is considered early onset when it starts before the age of 18. Onset of schizophrenia in children younger than age 13 is extremely rare.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present. Schizophrenia can be difficult to recognize in the early phases.

Early signs and symptoms

Schizophrenia signs and symptoms in children and teenagers are similar to those in adults, but the condition may be more difficult to recognize in this age group.

Early signs and symptoms may include problems with thinking, behavior and emotions.

Thinking:

Problems with thinking and reasoning

Bizarre ideas or speech

Confusing dreams or television for reality

Behavior:

Withdrawal from friends and family

Trouble sleeping

Lack of motivation - for example, showing up as a drop in performance at school

Not meeting daily expectations, such as bathing or dressing

Bizarre behavior

Violent or aggressive behavior or agitation

Recreational drug or nicotine use

Emotions:

Irritability or depressed mood

Lack of emotion, or emotions inappropriate for the situation

Strange anxieties and fears

Excessive suspicion of others

Later signs and symptoms

As children with schizophrenia age, more typical signs and symptoms of the disorder begin to appear. Signs and symptoms may include:

Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; that certain gestures or comments are directed at you; that you have exceptional ability or fame; that another person is in love with you; or that a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.

Hallucinations. These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, hallucinations have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.

Disorganized thinking. Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.

Extremely disorganized or abnormal motor behavior. This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, which makes it hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.

Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion - doesn't make eye contact, doesn't change facial expressions, speaks in a monotone, or doesn't add hand or head movements that normally occur when speaking. Also, the person may avoid people and activities or lack the ability to experience pleasure.

Compared with schizophrenia symptoms in adults, children and teens may be:

Less likely to have delusions

More likely to have visual hallucinations

Symptoms may be difficult to interpret

When childhood schizophrenia begins early in life, symptoms may build up gradually. Early signs and symptoms may be so vague that you can't recognize what's wrong. Some early signs can be mistaken for typical development during early teen years, or they could be symptoms of other mental or physical conditions.

As time goes on, signs may become more severe and more noticeable. Eventually, your child may develop the symptoms of psychosis, including hallucinations, delusions and difficulty organizing thoughts. As thoughts become more disorganized, there's often a "break from reality" (psychosis) frequently requiring hospitalization and treatment with medication.

When to see a doctor

It can be difficult to know how to handle vague behavioral changes in your child. You may be afraid of rushing to conclusions that label your child with a mental illness. Your child's teacher or other school staff may alert you to changes in your child's behavior.

Seek medical care as soon as possible if you have concerns about your child's behavior or development.

Suicidal thoughts and behavior

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a child or teen who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with him or her. Call 911 or your local emergency number immediately. Or if you think you can do so safely, take your child to the nearest hospital emergency room.

Causes

It's not known what causes childhood schizophrenia, but it's thought that it develops in the same way as adult schizophrenia does. Researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder. It's not clear why schizophrenia starts so early in life for some and not for others.

Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they indicate that schizophrenia is a brain disease.

Risk factors

Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

Having a family history of schizophrenia

Increased immune system activation, such as from inflammation

Older age of the father

Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development

Taking mind-altering (psychoactive) drugs during teen years

Complications

Left untreated, childhood schizophrenia can result in severe emotional, behavioral and health problems. Complications associated with schizophrenia may occur in childhood or later, such as:

Suicide, suicide attempts and thoughts of suicide

Self-injury

Anxiety disorders, panic disorders and obsessive-compulsive disorder (OCD)

Depression

Abuse of alcohol or other drugs, including nicotine

Family conflicts

Inability to live independently, attend school or work

Social isolation

Health and medical problems

Being victimized

Legal and financial problems, and homelessness

Aggressive behavior, although uncommon

Prevention

Early identification and treatment may help get symptoms of childhood schizophrenia under control before serious complications develop. Early treatment is also crucial in helping limit psychotic episodes, which can be extremely frightening to a child and his or her parents. Ongoing treatment can help improve your child's long-term outlook.

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Childhood schizophrenia - Symptoms and causes

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Childhood schizophrenia is an uncommon but severe mental disorder in which children and teenagers interpret reality abnormally. Schizophrenia involves a range of problems with thinking (cognitive), behavior or emotions. It may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs your child's ability to function.

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Overview

What is childhood schizophrenia?

Childhood schizophrenia is a mental illness that affects children under the age of 13. It is also known as early-onset schizophrenia. Childhood schizophrenia is rare, and affects an estimated 0.4 percent of children.

Childhood schizophrenia may be hard to diagnose, especially in young children, because the symptoms are similar to those of other mental health conditions. These children may have other behavioral problems and difficulties with daily living.

Who is likely to have childhood schizophrenia?

Any child can develop early schizophrenia. Some risk factors increase a child's likelihood of developing this condition. These risks include:

Brain structure. Some people develop too few or too many connections between neurons (brain cells).

Family history of schizophrenia or other personality disorders

Father older than 30 years old at the time of conception

Genetic risk factors. Some people have changes to their genes. These changes can be inherited (passed down through families) or happen on their own.

Neurotransmitters that do not function correctly or do not function at all. Neurotransmitters are chemicals released by neurons that help control body systems and processes. With schizophrenia, the neurotransmitters dopamine or serotonin may not work as usual.

Symptoms and Causes

What causes childhood schizophrenia?

The exact causes of childhood schizophrenia are unknown. Schizophrenia tends to be hereditary (runs in families). Researchers have also found some other factors that may play a role in developing schizophrenia, including:

Complications during birth

Maternal malnutrition (the mother doesn't get the proper nutrition during pregnancy)

Mother is exposed to certain viruses while pregnant

What are the symptoms of childhood schizophrenia?

Childhood schizophrenia causes symptoms similar to schizophrenia in adults. In many cases, children who have schizophrenia first show social and developmental delays that occur with other conditions, including:

Disorganized behaviors, including inappropriate outbursts

Motor skill delays, including a delay in learning to walk

Poor attention span

Poor eye contact

Poor performance in school

Speech delays or other problems, such as echolalia (repeating noises or words spoken by other people)

What are positive, negative and cognitive symptoms of schizophrenia?

During the acute (active) phase of schizophrenia, children may show symptoms called positive, negative, and cognitive (thinking) symptoms.

Positive symptoms are psychotic behaviors. During psychosis, a person is not connected with reality. Positive symptoms may include:

Delusions (false or erroneous beliefs; for instance, that people are plotting against the person)

Hallucinations

Movement disorders (unusual movements or behaviors)

Thought disorders (unable to organize and control thinking)

Negative symptoms of childhood schizophrenia disrupt normal behaviors or emotions. Negative symptoms may include:

Speaking infrequently or not at all

Limited or no display of emotions

Feeling no pleasure in everyday life

Problems with starting or finishing activities

Isolation (avoiding friends and relatives)

Cognitive symptoms of childhood schizophrenia reflect changes in thinking or memory. These symptoms may include:

Being unable to understand information and make decisions

Poor attention span

Trouble focusing on a task

Diagnosis and Tests

How is childhood schizophrenia diagnosed?

Schizophrenia in children is difficult to diagnose. Many healthy, nonpsychotic children have hallucinations or delusions. For example, a young child may talk to an imaginary friend.

Also, other psychiatric illnesses can cause symptoms that may be mistaken for schizophrenia. These conditions include attention deficit hyperactivity disorder (ADHD), major depressive disorder, bipolar disorder and schizoaffective disorder.

No one test can tell whether a child has schizophrenia. To make a diagnosis, a doctor must rule out other diseases or conditions, and consider other psychiatric illnesses, developmental disorders or drug toxicity.

Doctors diagnose childhood schizophrenia with a combination of mental and physical tests. To check for physical causes, your doctor may use:

Magnetic resonance imaging (MRI): This test uses radio waves and strong magnetic fields to help doctors see whether there are any abnormalities in the brain.

Positron emission tomography (PET) and single photon emission computed tomography (SPECT): A radioactive chemical called a tracer is injected into the bloodstream to allow the doctor to see blood flow in the brain.

Management and Treatment

How is childhood schizophrenia treated?

Treatment for early schizophrenia depends on the child and the type and severity of symptoms. Treatment usually includes therapy and education for both patient and family. Depending on the child's age, the doctor may prescribe antipsychotic medications to help control symptoms.

In addition to medications, doctors often recommend social skills training and counseling for the child and family. Ongoing individual therapy helps children with schizophrenia learn coping skills. This support can help them maintain relationships and do well in school.

What complications are associated with childhood schizophrenia?

Childhood schizophrenia may cause difficulties throughout a child's life, and can affect learning, memory, relationships and productivity.

There is no cure for schizophrenia. Even when they are adults, these children will have various symptoms of the condition. They need continuous treatment to help them live a safe, productive life.

Prevention

Can childhood schizophrenia be prevented?

There is no way to prevent schizophrenia in children. You can lower your child's risk by avoiding known risk factors during pregnancy, such as malnutrition.

Outlook / Prognosis

What is the prognosis (outlook) for people who have childhood schizophrenia?

The outlook for children with schizophrenia depends on the severity of their symptoms. Many children affected by early schizophrenia have a poor prognosis. Early, ongoing treatment offers the best hope.

Living With

When should I call my doctor about schizophrenia in my child?

Speak with your doctor if your child begins to show any signs of social or developmental delays. In many cases, these signs are the first indications of early schizophrenia.

# data[].attributes.attachment_link.title
Childhood Schizophrenia: Causes, Symptoms, Diagnosis & Treatment

# data[].attributes.attachment_link.description
Childhood schizophrenia is a mental illness that affects children under the age of 13. It is also known as early-onset schizophrenia. Childhood schizophrenia is rare, and affects an estimated 0.4 percent of children. Childhood schizophrenia may be hard to diagnose, especially in young children, because the symptoms are similar to those of other mental health conditions.

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Missouri School Counselors and Counselors Educators. (2015). School counselor referral process guide.

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Mindsets and Behaviors for Student Success

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Mindsets and Behaviors for Student Success

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American School Counselor Association. (2021). ASCA student standards: Mindsets and behaviors for student success.

https://www.schoolcounselor.org/getmedia/7428a787-a452-4abb-afec-d78ec77870cd/Mindsets-Behaviors.pdf

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Section 261 of the Texas Family Code ( Tex. Fam. Code § 261.101)

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FAMILY CODE



TITLE 5. THE PARENT-CHILD RELATIONSHIP AND THE SUIT AFFECTING THE PARENT-CHILD RELATIONSHIP



SUBTITLE E. PROTECTION OF THE CHILD



CHAPTER 261. INVESTIGATION OF REPORT OF CHILD ABUSE OR NEGLECT



SUBCHAPTER A. GENERAL PROVISIONS



Sec. 261.001. DEFINITIONS. In this chapter:


(1) "Abuse" includes the following acts or omissions by a person:


(A) mental or emotional injury to a child that results in an observable and material impairment in the child's growth, development, or psychological functioning;


(B) causing or permitting the child to be in a situation in which the child sustains a mental or emotional injury that results in an observable and material impairment in the child's growth, development, or psychological functioning;


(C) physical injury that results in substantial harm to the child, or the genuine threat of substantial harm from physical injury to the child, including an injury that is at variance with the history or explanation given and excluding an accident or reasonable discipline by a parent, guardian, or managing or possessory conservator that does not expose the child to a substantial risk of harm;


(D) failure to make a reasonable effort to prevent an action by another person that results in physical injury that results in substantial harm to the child;


(E) sexual conduct harmful to a child's mental, emotional, or physical welfare, including conduct that constitutes the offense of continuous sexual abuse of young child or disabled individual under Section 21.02, Penal Code, indecency with a child under Section 21.11, Penal Code, sexual assault under Section 22.011, Penal Code, or aggravated sexual assault under Section 22.021, Penal Code;


(F) failure to make a reasonable effort to prevent sexual conduct harmful to a child;


(G) compelling or encouraging the child to engage in sexual conduct as defined by Section 43.01, Penal Code, including compelling or encouraging the child in a manner that constitutes an offense of trafficking of persons under Section 20A.02(a)(7) or (8), Penal Code, solicitation of prostitution under Section 43.021, Penal Code, or compelling prostitution under Section 43.05(a)(2), Penal Code;


(H) causing, permitting, encouraging, engaging in, or allowing the photographing, filming, or depicting of the child if the person knew or should have known that the resulting photograph, film, or depiction of the child is obscene as defined by Section 43.21, Penal Code, or pornographic;


(I) the current use by a person of a controlled substance as defined by Chapter 481, Health and Safety Code, in a manner or to the extent that the use results in physical, mental, or emotional injury to a child;


(J) causing, expressly permitting, or encouraging a child to use a controlled substance as defined by Chapter 481, Health and Safety Code;


(K) causing, permitting, encouraging, engaging in, or allowing a sexual performance by a child as defined by Section 43.25, Penal Code;


(L) knowingly causing, permitting, encouraging, engaging in, or allowing a child to be trafficked in a manner punishable as an offense under Section 20A.02(a)(5), (6), (7), or (8), Penal Code, or the failure to make a reasonable effort to prevent a child from being trafficked in a manner punishable as an offense under any of those sections; or


(M) forcing or coercing a child to enter into a marriage.


(2) "Department" means the Department of Family and Protective Services.


(3) "Exploitation" means the illegal or improper use of a child or of the resources of a child for monetary or personal benefit, profit, or gain by an employee, volunteer, or other individual working under the auspices of a facility or program as further described by rule or policy.


Text of subdivision as amended by Acts 2021, 87th Leg., R.S., Ch. 29 (H.B. 2536), Sec. 2



(4) "Neglect":


(A) includes:


(i) the leaving of a child in a situation where the child would be exposed to a substantial risk of physical or mental harm, without arranging for necessary care for the child, and the demonstration of an intent not to return by a parent, guardian, or managing or possessory conservator of the child;


(ii) the following acts or omissions by a person:


(a) placing a child in or failing to remove a child from a situation that a reasonable person would realize requires judgment or actions beyond the child's level of maturity, physical condition, or mental abilities and that results in bodily injury or a substantial risk of immediate harm to the child;


(b) failing to seek, obtain, or follow through with medical care for a child, with the failure resulting in or presenting a substantial risk of death, disfigurement, or bodily injury or with the failure resulting in an observable and material impairment to the growth, development, or functioning of the child;


(c) the failure to provide a child with food, clothing, or shelter necessary to sustain the life or health of the child, excluding failure caused primarily by financial inability unless relief services had been offered and refused;


(d) placing a child in or failing to remove the child from a situation in which the child would be exposed to a substantial risk of sexual conduct harmful to the child; or


(e) placing a child in or failing to remove the child from a situation in which the child would be exposed to acts or omissions that constitute abuse under Subdivision (1)(E), (F), (G), (H), or (K) committed against another child;


(iii) the failure by the person responsible for a child's care, custody, or welfare to permit the child to return to the child's home without arranging for the necessary care for the child after the child has been absent from the home for any reason, including having been in residential placement or having run away; or


(iv) a negligent act or omission by an employee, volunteer, or other individual working under the auspices of a facility or program, including failure to comply with an individual treatment plan, plan of care, or individualized service plan, that causes or may cause substantial emotional harm or physical injury to, or the death of, a child served by the facility or program as further described by rule or policy; and


(B) does not include:


(i) the refusal by a person responsible for a child's care, custody, or welfare to permit the child to remain in or return to the child's home resulting in the placement of the child in the conservatorship of the department if:


(a) the child has a severe emotional disturbance;


(b) the person's refusal is based solely on the person's inability to obtain mental health services necessary to protect the safety and well-being of the child; and


(c) the person has exhausted all reasonable means available to the person to obtain the mental health services described by Sub-subparagraph (b); or


(ii) a decision by a person responsible for a child's care, custody, or welfare to:


(a) obtain an opinion from more than one medical provider relating to the child's medical care;


(b) transfer the child's medical care to a new medical provider; or


(c) transfer the child to another health care facility.


Text of subdivision as amended by Acts 2021, 87th Leg., R.S., Ch. 8 (H.B. 567), Sec. 5



(4) "Neglect" means an act or failure to act by a person responsible for a child's care, custody, or welfare evidencing the person's blatant disregard for the consequences of the act or failure to act that results in harm to the child or that creates an immediate danger to the child's physical health or safety and:


(A) includes:


(i) the leaving of a child in a situation where the child would be exposed to an immediate danger of physical or mental harm, without arranging for necessary care for the child, and the demonstration of an intent not to return by a parent, guardian, or managing or possessory conservator of the child;


(ii) the following acts or omissions by a person:


(a) placing a child in or failing to remove a child from a situation that a reasonable person would realize requires judgment or actions beyond the child's level of maturity, physical condition, or mental abilities and that results in bodily injury or an immediate danger of harm to the child;


(b) failing to seek, obtain, or follow through with medical care for a child, with the failure resulting in or presenting an immediate danger of death, disfigurement, or bodily injury or with the failure resulting in an observable and material impairment to the growth, development, or functioning of the child;


(c) the failure to provide a child with food, clothing, or shelter necessary to sustain the life or health of the child, excluding failure caused primarily by financial inability unless relief services had been offered and refused;


(d) placing a child in or failing to remove the child from a situation in which the child would be exposed to an immediate danger of sexual conduct harmful to the child; or


(e) placing a child in or failing to remove the child from a situation in which the child would be exposed to acts or omissions that constitute abuse under Subdivision (1)(E), (F), (G), (H), or (K) committed against another child;


(iii) the failure by the person responsible for a child's care, custody, or welfare to permit the child to return to the child's home without arranging for the necessary care for the child after the child has been absent from the home for any reason, including having been in residential placement or having run away; or


(iv) a negligent act or omission by an employee, volunteer, or other individual working under the auspices of a facility or program, including failure to comply with an individual treatment plan, plan of care, or individualized service plan, that causes or may cause substantial emotional harm or physical injury to, or the death of, a child served by the facility or program as further described by rule or policy; and


(B) does not include:


(i) the refusal by a person responsible for a child's care, custody, or welfare to permit the child to remain in or return to the child's home resulting in the placement of the child in the conservatorship of the department if:


(a) the child has a severe emotional disturbance;


(b) the person's refusal is based solely on the person's inability to obtain mental health services necessary to protect the safety and well-being of the child; and


(c) the person has exhausted all reasonable means available to the person to obtain the mental health services described by Sub-subparagraph (b); or


(ii) allowing the child to engage in independent activities that are appropriate and typical for the child's level of maturity, physical condition, developmental abilities, or culture.


(5) "Person responsible for a child's care, custody, or welfare" means a person who traditionally is responsible for a child's care, custody, or welfare, including:


(A) a parent, guardian, managing or possessory conservator, or foster parent of the child;


(B) a member of the child's family or household as defined by Chapter 71;


(C) a person with whom the child's parent cohabits;


(D) school personnel or a volunteer at the child's school;


(E) personnel or a volunteer at a public or private child-care facility that provides services for the child or at a public or private residential institution or facility where the child resides; or


(F) an employee, volunteer, or other person working under the supervision of a licensed or unlicensed child-care facility, including a family home, residential child-care facility, employer-based day-care facility, or shelter day-care facility, as those terms are defined in Chapter 42, Human Resources Code.


(6) "Report" means a report that alleged or suspected abuse or neglect of a child has occurred or may occur.


(7) Repealed by Acts 2017, 85th Leg., R.S., Ch. 316 (H.B. 5), Sec. 36(1), eff. September 1, 2017.


(8) Repealed by Acts 2015, 84th Leg., R.S., Ch. 1, Sec. 1.203(4), eff. April 2, 2015.


(9) "Severe emotional disturbance" means a mental, behavioral, or emotional disorder of sufficient duration to result in functional impairment that substantially interferes with or limits a person's role or ability to function in family, school, or community activities.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 86, eff. Sept. 1, 1995; Acts 1997, 75th Leg., ch. 575, Sec. 10, eff. Sept. 1, 1997; Acts 1997, 75th Leg., ch. 1022, Sec. 63, eff. Sept. 1, 1997; Acts 1999, 76th Leg., ch. 62, Sec. 19.01(26), eff. Sept. 1, 1999; Acts 2001, 77th Leg., ch. 59, Sec. 1, eff. Sept. 1, 2001.


Amended by:


Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.11, eff. September 1, 2005.


Acts 2007, 80th Leg., R.S., Ch. 593 (H.B. 8), Sec. 3.32, eff. September 1, 2007.


Acts 2011, 82nd Leg., R.S., Ch. 1 (S.B. 24), Sec. 4.03, eff. September 1, 2011.


Acts 2013, 83rd Leg., R.S., Ch. 1142 (S.B. 44), Sec. 1, eff. September 1, 2013.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.120, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.203(4), eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 432 (S.B. 1889), Sec. 1, eff. September 1, 2015.


Acts 2015, 84th Leg., R.S., Ch. 1273 (S.B. 825), Sec. 4, eff. September 1, 2015.


Acts 2017, 85th Leg., R.S., Ch. 316 (H.B. 5), Sec. 36(1), eff. September 1, 2017.


Acts 2017, 85th Leg., R.S., Ch. 319 (S.B. 11), Sec. 7, eff. September 1, 2017.


Acts 2017, 85th Leg., R.S., Ch. 1136 (H.B. 249), Sec. 2, eff. September 1, 2017.


Acts 2021, 87th Leg., R.S., Ch. 8 (H.B. 567), Sec. 5, eff. September 1, 2021.


Acts 2021, 87th Leg., R.S., Ch. 29 (H.B. 2536), Sec. 2, eff. May 15, 2021.


Acts 2021, 87th Leg., R.S., Ch. 221 (H.B. 375), Sec. 2.18, eff. September 1, 2021.


Acts 2021, 87th Leg., R.S., Ch. 807 (H.B. 1540), Sec. 39, eff. September 1, 2021.


Sec. 261.002. CENTRAL REGISTRY. (a) The department shall establish and maintain a central registry of the names of individuals found by the department to have abused or neglected a child.


(b) The executive commissioner shall adopt rules necessary to carry out this section. The rules shall:


(1) prohibit the department from making a finding of abuse or neglect against a person in a case in which the department is named managing conservator of a child who has a severe emotional disturbance only because the child's family is unable to obtain mental health services for the child;


(2) establish guidelines for reviewing the records in the registry and removing those records in which the department was named managing conservator of a child who has a severe emotional disturbance only because the child's family was unable to obtain mental health services for the child;


(3) require the department to remove a person's name from the central registry maintained under this section not later than the 10th business day after the date the department receives notice that a finding of abuse and neglect against the person is overturned in:


(A) an administrative review or an appeal of the review conducted under Section 261.309(c);


(B) a review or an appeal of the review conducted by the office of consumer affairs of the department; or


(C) a hearing or an appeal conducted by the State Office of Administrative Hearings; and


(4) require the department to update any relevant department files to reflect an overturned finding of abuse or neglect against a person not later than the 10th business day after the date the finding is overturned in a review, hearing, or appeal described by Subdivision (3).


(c) The department may enter into agreements with other states to allow for the exchange of reports of child abuse and neglect in other states' central registry systems. The department shall use information obtained under this subsection in performing the background checks required under Section 42.056, Human Resources Code. The department shall cooperate with federal agencies and shall provide information and reports of child abuse and neglect to the appropriate federal agency that maintains the national registry for child abuse and neglect, if a national registry exists.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995.


Amended by:


Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.12, eff. September 1, 2005.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.121, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 432 (S.B. 1889), Sec. 2, eff. September 1, 2015.


Acts 2017, 85th Leg., R.S., Ch. 360 (H.B. 2849), Sec. 1, eff. September 1, 2017.


Sec. 261.003. APPLICATION TO STUDENTS IN SCHOOL FOR DEAF OR SCHOOL FOR BLIND AND VISUALLY IMPAIRED. This chapter applies to the investigation of a report of abuse or neglect of a student, without regard to the age of the student, in the Texas School for the Deaf or the Texas School for the Blind and Visually Impaired.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995.


Sec. 261.004. TRACKING OF RECURRENCE OF CHILD ABUSE OR NEGLECT REPORTS. (a) The department shall collect and monitor data regarding repeated reports of abuse or neglect:


(1) involving the same child, including reports of abuse or neglect of the child made while the child resided in other households and reports of abuse or neglect of the child by different alleged perpetrators made while the child resided in the same household; or


(2) by the same alleged perpetrator.


(b) In monitoring reports of abuse or neglect under Subsection (a), the department shall group together separate reports involving different children residing in the same household.


(c) The department shall consider any report collected under Subsection (a) involving any child or adult who is a part of a child's household when making case priority determinations or when conducting service or safety planning for the child or the child's family.


Added by Acts 2017, 85th Leg., R.S., Ch. 319 (S.B. 11), Sec. 8, eff. September 1, 2017.


Sec. 261.005. REFERENCE TO EXECUTIVE COMMISSIONER OR COMMISSION. In this chapter:


(1) a reference to the executive commissioner or the executive commissioner of the Health and Human Services Commission means the commissioner of the department; and


(2) a reference to the Health and Human Services Commission means the department.


Added by Acts 2017, 85th Leg., R.S., Ch. 316 (H.B. 5), Sec. 10, eff. September 1, 2017.


Redesignated from Family Code, Section 261.004 by Acts 2019, 86th Leg., R.S., Ch. 467 (H.B. 4170), Sec. 21.001(12), eff. September 1, 2019.


SUBCHAPTER B. REPORT OF ABUSE OR NEGLECT; IMMUNITIES



Sec. 261.101. PERSONS REQUIRED TO REPORT; TIME TO REPORT. (a) A person having reasonable cause to believe that a child's physical or mental health or welfare has been adversely affected by abuse or neglect by any person shall immediately make a report as provided by this subchapter.


(b) If a professional has reasonable cause to believe that a child has been abused or neglected or may be abused or neglected, or that a child is a victim of an offense under Section 21.11, Penal Code, and the professional has reasonable cause to believe that the child has been abused as defined by Section 261.001, the professional shall make a report not later than the 48th hour after the hour the professional first has reasonable cause to believe that the child has been or may be abused or neglected or is a victim of an offense under Section 21.11, Penal Code. A professional may not delegate to or rely on another person to make the report. In this subsection, "professional" means an individual who is licensed or certified by the state or who is an employee of a facility licensed, certified, or operated by the state and who, in the normal course of official duties or duties for which a license or certification is required, has direct contact with children. The term includes teachers, nurses, doctors, day-care employees, employees of a clinic or health care facility that provides reproductive services, juvenile probation officers, and juvenile detention or correctional officers.


(b-1) In addition to the duty to make a report under Subsection (a) or (b), a person or professional shall make a report in the manner required by Subsection (a) or (b), as applicable, if the person or professional has reasonable cause to believe that an adult was a victim of abuse or neglect as a child and the person or professional determines in good faith that disclosure of the information is necessary to protect the health and safety of:


(1) another child; or


(2) an elderly person or person with a disability as defined by Section 48.002, Human Resources Code.


(c) The requirement to report under this section applies without exception to an individual whose personal communications may otherwise be privileged, including an attorney, a member of the clergy, a medical practitioner, a social worker, a mental health professional, an employee or member of a board that licenses or certifies a professional, and an employee of a clinic or health care facility that provides reproductive services.


(d) Unless waived in writing by the person making the report, the identity of an individual making a report under this chapter is confidential and may be disclosed only:


(1) as provided by Section 261.201; or


(2) to a law enforcement officer for the purposes of conducting a criminal investigation of the report.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 87, eff. Sept. 1, 1995; Acts 1997, 75th Leg., ch. 162, Sec. 1, eff. Sept. 1, 1997; Acts 1997, 75th Leg., ch. 575, Sec. 11, eff. Sept. 1, 1997; Acts 1997, 75th Leg., ch. 1022, Sec. 65, eff. Sept. 1, 1997; Acts 1999, 76th Leg., ch. 62, Sec. 6.29, eff. Sept. 1, 1999; Acts 1999, 76th Leg., ch. 1150, Sec. 2, eff. Sept. 1, 1999; Acts 1999, 76th Leg., ch. 1390, Sec. 21, eff. Sept. 1, 1999; Acts 2001, 77th Leg., ch. 1420, Sec. 5.003, eff. Sept. 1, 2001.


Amended by:


Acts 2005, 79th Leg., Ch. 949 (H.B. 1575), Sec. 27, eff. September 1, 2005.


Acts 2013, 83rd Leg., R.S., Ch. 395 (S.B. 152), Sec. 4, eff. June 14, 2013.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.122, eff. April 2, 2015.


Acts 2017, 85th Leg., R.S., Ch. 1136 (H.B. 249), Sec. 3, eff. September 1, 2017.


Acts 2021, 87th Leg., R.S., Ch. 902 (H.B. 3379), Sec. 1, eff. September 1, 2021.


Sec. 261.102. MATTERS TO BE REPORTED. A report should reflect the reporter's belief that a child has been or may be abused or neglected or has died of abuse or neglect.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 88, eff. Sept. 1, 1995.


Sec. 261.103. REPORT MADE TO APPROPRIATE AGENCY.


(a) Except as provided by Subsections (b) and (c) and Section 261.405, a report shall be made to:


(1) any local or state law enforcement agency;


(2) the department; or


(3) the state agency that operates, licenses, certifies, or registers the facility in which the alleged abuse or neglect occurred.


(b) A report may be made to the Texas Juvenile Justice Department instead of the entities listed under Subsection (a) if the report is based on information provided by a child while under the supervision of the Texas Juvenile Justice Department concerning the child's alleged abuse of another child.


(c) Notwithstanding Subsection (a), a report, other than a report under Subsection (a)(3) or Section 261.405, must be made to the department if the alleged or suspected abuse or neglect involves a person responsible for the care, custody, or welfare of the child.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 89, eff. Sept. 1, 1995; Acts 1999, 76th Leg., ch. 1477, Sec. 24, eff. Sept. 1, 1999; Acts 2001, 77th Leg., ch. 1297, Sec. 46, eff. Sept. 1, 2001.


Amended by:


Acts 2005, 79th Leg., Ch. 213 (H.B. 1970), Sec. 1, eff. September 1, 2005.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.123, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 734 (H.B. 1549), Sec. 80, eff. September 1, 2015.


Sec. 261.104. CONTENTS OF REPORT. The person making a report shall identify, if known:


(1) the name and address of the child;


(2) the name and address of the person responsible for the care, custody, or welfare of the child; and


(3) any other pertinent information concerning the alleged or suspected abuse or neglect.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 90, eff. Sept. 1, 1995.


Sec. 261.105. REFERRAL OF REPORT BY DEPARTMENT OR LAW ENFORCEMENT. (a) All reports received by a local or state law enforcement agency that allege abuse or neglect by a person responsible for a child's care, custody, or welfare shall be referred immediately to the department.


(b) The department shall immediately notify the appropriate state or local law enforcement agency of any report it receives, other than a report from a law enforcement agency, that concerns the suspected abuse or neglect of a child or death of a child from abuse or neglect.


(c) In addition to notifying a law enforcement agency, if the report relates to a child in a facility operated, licensed, certified, or registered by a state agency, the department shall refer the report to the agency for investigation.


(c-1) Notwithstanding Subsections (b) and (c), if a report under this section relates to a child with an intellectual disability receiving services in a state supported living center as defined by Section 531.002, Health and Safety Code, or the ICF-IID component of the Rio Grande State Center, the department shall proceed with the investigation of the report as provided by Section 261.404.


(d) If the department initiates an investigation and determines that the abuse or neglect does not involve a person responsible for the child's care, custody, or welfare, the department shall refer the report to a law enforcement agency for further investigation. If the department determines that the abuse or neglect involves an employee of a public or private elementary or secondary school, and that the child is a student at the school, the department shall orally notify the superintendent of the school district, the director of the open-enrollment charter school, or the chief executive officer of the private school in which the employee is employed about the investigation.


(e) In cooperation with the department, the Texas Juvenile Justice Department by rule shall adopt guidelines for identifying a report made to the Texas Juvenile Justice Department under Section 261.103(b) that is appropriate to refer to the department or a law enforcement agency for investigation. Guidelines adopted under this subsection must require the Texas Juvenile Justice Department to consider the severity and immediacy of the alleged abuse or neglect of the child victim.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1997, 75th Leg., ch. 1022, Sec. 66, eff. Sept. 1, 1997; Acts 1999, 76th Leg., ch. 1477, Sec. 25, eff. Sept. 1, 1999; Acts 2003, 78th Leg., ch. 374, Sec. 3, eff. June 18, 2003.


Amended by:


Acts 2009, 81st Leg., R.S., Ch. 284 (S.B. 643), Sec. 4, eff. June 11, 2009.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.124, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 734 (H.B. 1549), Sec. 81, eff. September 1, 2015.


Acts 2015, 84th Leg., R.S., Ch. 1167 (S.B. 821), Sec. 4, eff. September 1, 2015.


Acts 2019, 86th Leg., R.S., Ch. 987 (S.B. 1231), Sec. 1, eff. September 1, 2019.


Sec. 261.1055. NOTIFICATION OF DISTRICT ATTORNEYS. (a) A district attorney may inform the department that the district attorney wishes to receive notification of some or all reports of suspected abuse or neglect of children who were in the county at the time the report was made or who were in the county at the time of the alleged abuse or neglect.


(b) If the district attorney makes the notification under this section, the department shall, on receipt of a report of suspected abuse or neglect, immediately notify the district attorney as requested and the department shall forward a copy of the reports to the district attorney on request.


Added by Acts 1997, 75th Leg., ch. 1022, Sec. 67, eff. Sept. 1, 1997.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.125, eff. April 2, 2015.


Sec. 261.106. IMMUNITIES. (a) A person acting in good faith who reports or assists in the investigation of a report of alleged child abuse or neglect or who testifies or otherwise participates in a judicial proceeding arising from a report, petition, or investigation of alleged child abuse or neglect is immune from civil or criminal liability that might otherwise be incurred or imposed.


(b) Immunity from civil and criminal liability extends to an authorized volunteer of the department or a law enforcement officer who participates at the request of the department in an investigation of alleged or suspected abuse or neglect or in an action arising from an investigation if the person was acting in good faith and in the scope of the person's responsibilities.


(c) A person who reports the person's own abuse or neglect of a child or who acts in bad faith or with malicious purpose in reporting alleged child abuse or neglect is not immune from civil or criminal liability.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 91, eff. Sept. 1, 1995.


Sec. 261.107. FALSE REPORT; CRIMINAL PENALTY; CIVIL PENALTY. (a) A person commits an offense if, with the intent to deceive, the person knowingly makes a report as provided in this chapter that is false. An offense under this subsection is a state jail felony unless it is shown on the trial of the offense that the person has previously been convicted under this section, in which case the offense is a felony of the third degree.


(b) A finding by a court in a suit affecting the parent-child relationship that a report made under this chapter before or during the suit was false or lacking factual foundation may be grounds for the court to modify an order providing for possession of or access to the child who was the subject of the report by restricting further access to the child by the person who made the report.


(c) The appropriate county prosecuting attorney shall be responsible for the prosecution of an offense under this section.


(d) The court shall order a person who is convicted of an offense under Subsection (a) to pay any reasonable attorney's fees incurred by the person who was falsely accused of abuse or neglect in any proceeding relating to the false report.


(e) A person who engages in conduct described by Subsection (a) is liable to the state for a civil penalty of $1,000. The attorney general shall bring an action to recover a civil penalty authorized by this subsection.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 92, eff. Sept. 1, 1995; Acts 1997, 75th Leg., ch. 575, Sec. 2, eff. Sept. 1, 1997; Acts 1997, 75th Leg., ch. 1022, Sec. 68; Acts 1999, 76th Leg., ch. 62, Sec. 6.30, eff. Sept. 1, 1999.


Amended by:


Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.13, eff. September 1, 2005.


Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.14(a), eff. September 1, 2005.


Sec. 261.108. FRIVOLOUS CLAIMS AGAINST PERSON REPORTING. (a) In this section:


(1) "Claim" means an action or claim by a party, including a plaintiff, counterclaimant, cross-claimant, or third-party plaintiff, requesting recovery of damages.


(2) "Defendant" means a party against whom a claim is made.


(b) A court shall award a defendant reasonable attorney's fees and other expenses related to the defense of a claim filed against the defendant for damages or other relief arising from reporting or assisting in the investigation of a report under this chapter or participating in a judicial proceeding resulting from the report if:


(1) the court finds that the claim is frivolous, unreasonable, or without foundation because the defendant is immune from liability under Section 261.106; and


(2) the claim is dismissed or judgment is rendered for the defendant.


(c) To recover under this section, the defendant must, at any time after the filing of a claim, file a written motion stating that:


(1) the claim is frivolous, unreasonable, or without foundation because the defendant is immune from liability under Section 261.106; and


(2) the defendant requests the court to award reasonable attorney's fees and other expenses related to the defense of the claim.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995.


Sec. 261.109. FAILURE TO REPORT; PENALTY. (a) A person commits an offense if the person is required to make a report under Section 261.101(a) and knowingly fails to make a report as provided in this chapter.


(a-1) A person who is a professional as defined by Section 261.101(b) commits an offense if the person is required to make a report under Section 261.101(b) and knowingly fails to make a report as provided in this chapter.


(b) An offense under Subsection (a) is a Class A misdemeanor, except that the offense is a state jail felony if it is shown on the trial of the offense that the child was a person with an intellectual disability who resided in a state supported living center, the ICF-IID component of the Rio Grande State Center, or a facility licensed under Chapter 252, Health and Safety Code, and the actor knew that the child had suffered serious bodily injury as a result of the abuse or neglect.


(c) An offense under Subsection (a-1) is a Class A misdemeanor, except that the offense is a state jail felony if it is shown on the trial of the offense that the actor intended to conceal the abuse or neglect.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995.


Amended by:


Acts 2009, 81st Leg., R.S., Ch. 284 (S.B. 643), Sec. 5, eff. June 11, 2009.


Acts 2013, 83rd Leg., R.S., Ch. 290 (H.B. 1205), Sec. 1, eff. September 1, 2013.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.126, eff. April 2, 2015.


Sec. 261.110. EMPLOYER RETALIATION PROHIBITED. (a) In this section:


(1) "Adverse employment action" means an action that affects an employee's compensation, promotion, transfer, work assignment, or performance evaluation, or any other employment action that would dissuade a reasonable employee from making or supporting a report of abuse or neglect under Section 261.101.


(2) "Professional" has the meaning assigned by Section 261.101(b).


(b) An employer may not suspend or terminate the employment of, discriminate against, or take any other adverse employment action against a person who is a professional and who in good faith:


(1) reports child abuse or neglect to:


(A) the person's supervisor;


(B) an administrator of the facility where the person is employed;


(C) a state regulatory agency; or


(D) a law enforcement agency; or


(2) initiates or cooperates with an investigation or proceeding by a governmental entity relating to an allegation of child abuse or neglect.


(c) A person may sue for injunctive relief, damages, or both if, in violation of this section, the person:


(1) is suspended or terminated from the person's employment;


(2) is discriminated against; or


(3) suffers any other adverse employment action.


(d) A plaintiff who prevails in a suit under this section may recover:


(1) actual damages, including damages for mental anguish even if an injury other than mental anguish is not shown;


(2) exemplary damages under Chapter 41, Civil Practice and Remedies Code, if the employer is a private employer;


(3) court costs; and


(4) reasonable attorney's fees.


(e) In addition to amounts recovered under Subsection (d), a plaintiff who prevails in a suit under this section is entitled to:


(1) reinstatement to the person's former position or a position that is comparable in terms of compensation, benefits, and other conditions of employment;


(2) reinstatement of any fringe benefits and seniority rights lost because of the suspension, termination, or discrimination; and


(3) compensation for wages lost during the period of suspension or termination.


(f) A public employee who alleges a violation of this section may sue the employing state or local governmental entity for the relief provided for by this section. Sovereign immunity is waived and abolished to the extent of liability created by this section. A person having a claim under this section may sue a governmental unit for damages allowed by this section.


(g) In a suit under this section against an employing state or local governmental entity, a plaintiff may not recover compensatory damages for future pecuniary losses, emotional pain, suffering, inconvenience, mental anguish, loss of enjoyment of life, and other nonpecuniary losses in an amount that exceeds:


(1) $50,000, if the employing state or local governmental entity has fewer than 101 employees in each of 20 or more calendar weeks in the calendar year in which the suit is filed or in the preceding year;


(2) $100,000, if the employing state or local governmental entity has more than 100 and fewer than 201 employees in each of 20 or more calendar weeks in the calendar year in which the suit is filed or in the preceding year;


(3) $200,000, if the employing state or local governmental entity has more than 200 and fewer than 501 employees in each of 20 or more calendar weeks in the calendar year in which the suit is filed or in the preceding year; and


(4) $250,000, if the employing state or local governmental entity has more than 500 employees in each of 20 or more calendar weeks in the calendar year in which the suit is filed or in the preceding year.


(h) If more than one subdivision of Subsection (g) applies to an employing state or local governmental entity, the amount of monetary damages that may be recovered from the entity in a suit brought under this section is governed by the applicable provision that provides the highest damage award.


(i) A plaintiff suing under this section has the burden of proof, except that there is a rebuttable presumption that the plaintiff's employment was suspended or terminated or that the plaintiff was otherwise discriminated against for reporting abuse or neglect if the suspension, termination, or discrimination occurs before the 61st day after the date on which the person made a report in good faith.


(j) A suit under this section may be brought in a district or county court of the county in which:


(1) the plaintiff was employed by the defendant; or


(2) the defendant conducts business.


(k) It is an affirmative defense to a suit under Subsection (b) that an employer would have taken the action against the employee that forms the basis of the suit based solely on information, observation, or evidence that is not related to the fact that the employee reported child abuse or neglect or initiated or cooperated with an investigation or proceeding relating to an allegation of child abuse or neglect.


(l) A public employee who has a cause of action under Chapter 554, Government Code, based on conduct described by Subsection (b) may not bring an action based on that conduct under this section.


(m) This section does not apply to a person who reports the person's own abuse or neglect of a child or who initiates or cooperates with an investigation or proceeding by a governmental entity relating to an allegation of the person's own abuse or neglect of a child.


Added by Acts 2001, 77th Leg., ch. 896, Sec. 1, eff. Sept. 1, 2001.


Amended by:


Acts 2019, 86th Leg., R.S., Ch. 218 (H.B. 621), Sec. 1, eff. September 1, 2019.


Sec. 261.111. REFUSAL OF PSYCHIATRIC OR PSYCHOLOGICAL TREATMENT OF CHILD. (a) In this section, "psychotropic medication" has the meaning assigned by Section 266.001.


(b) The refusal of a parent, guardian, or managing or possessory conservator of a child to administer or consent to the administration of a psychotropic medication to the child, or to consent to any other psychiatric or psychological treatment of the child, does not by itself constitute neglect of the child unless the refusal to consent:


(1) presents a substantial risk of death, disfigurement, or bodily injury to the child; or


(2) has resulted in an observable and material impairment to the growth, development, or functioning of the child.


Added by Acts 2003, 78th Leg., ch. 1008, Sec. 3, eff. June 20, 2003.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.127, eff. April 2, 2015.


SUBCHAPTER C. CONFIDENTIALITY AND PRIVILEGED COMMUNICATION



Sec. 261.201. CONFIDENTIALITY AND DISCLOSURE OF INFORMATION. (a) Except as provided by Section 261.203, the following information is confidential, is not subject to public release under Chapter 552, Government Code, and may be disclosed only for purposes consistent with this code and applicable federal or state law or under rules adopted by an investigating agency:


(1) a report of alleged or suspected abuse or neglect made under this chapter and the identity of the person making the report; and


(2) except as otherwise provided in this section, the files, reports, records, communications, audiotapes, videotapes, and working papers used or developed in an investigation under this chapter or in providing services as a result of an investigation.


(b) A court may order the disclosure of information that is confidential under this section if:


(1) a motion has been filed with the court requesting the release of the information;


(2) a notice of hearing has been served on the investigating agency and all other interested parties; and


(3) after hearing and an in camera review of the requested information, the court determines that the disclosure of the requested information is:


(A) essential to the administration of justice; and


(B) not likely to endanger the life or safety of:


(i) a child who is the subject of the report of alleged or suspected abuse or neglect;


(ii) a person who makes a report of alleged or suspected abuse or neglect; or


(iii) any other person who participates in an investigation of reported abuse or neglect or who provides care for the child.


(b-1) On a motion of one of the parties in a contested case before an administrative law judge relating to the license or certification of a professional, as defined by Section 261.101(b), or an educator, as defined by Section 5.001, Education Code, the administrative law judge may order the disclosure of information that is confidential under this section that relates to the matter before the administrative law judge after a hearing for which notice is provided as required by Subsection (b)(2) and making the review and determination required by Subsection (b)(3). Before the department may release information under this subsection, the department must edit the information to protect the confidentiality of the identity of any person who makes a report of abuse or neglect.


(c) In addition to Subsection (b), a court, on its own motion, may order disclosure of information that is confidential under this section if:


(1) the order is rendered at a hearing for which all parties have been given notice;


(2) the court finds that disclosure of the information is:


(A) essential to the administration of justice; and


(B) not likely to endanger the life or safety of:


(i) a child who is the subject of the report of alleged or suspected abuse or neglect;


(ii) a person who makes a report of alleged or suspected abuse or neglect; or


(iii) any other person who participates in an investigation of reported abuse or neglect or who provides care for the child; and


(3) the order is reduced to writing or made on the record in open court.


(d) The adoptive parents of a child who was the subject of an investigation and an adult who was the subject of an investigation as a child are entitled to examine and make copies of any report, record, working paper, or other information in the possession, custody, or control of the state that pertains to the history of the child. The department may edit the documents to protect the identity of the biological parents and any other person whose identity is confidential, unless this information is already known to the adoptive parents or is readily available through other sources, including the court records of a suit to terminate the parent-child relationship under Chapter 161.


(e) Before placing a child who was the subject of an investigation, the department shall notify the prospective adoptive parents of their right to examine any report, record, working paper, or other information in the possession, custody, or control of the department that pertains to the history of the child.


(f) The department shall provide prospective adoptive parents an opportunity to examine information under this section as early as practicable before placing a child.


(f-1) The department shall provide to a relative or other individual with whom a child is placed any information the department considers necessary to ensure that the relative or other individual is prepared to meet the needs of the child. The information required by this subsection may include information related to any abuse or neglect suffered by the child.


(g) Notwithstanding Subsection (b), the department, on request and subject to department rule, shall provide to the parent, managing conservator, or other legal representative of a child who is the subject of reported abuse or neglect information concerning the reported abuse or neglect that would otherwise be confidential under this section if the department has edited the information to protect the confidentiality of the identity of the person who made the report and any other person whose life or safety may be endangered by the disclosure.


(h) This section does not apply to an investigation of child abuse or neglect in a home or facility regulated under Chapter 42, Human Resources Code.


(i) Notwithstanding Subsection (a), the Texas Juvenile Justice Department shall release a report of alleged or suspected abuse or neglect made under this chapter if:


(1) the report relates to a report of abuse or neglect involving a child committed to the Texas Juvenile Justice Department during the period that the child is committed to that department; and


(2) the Texas Juvenile Justice Department is not prohibited by Chapter 552, Government Code, or other law from disclosing the report.


(j) The Texas Juvenile Justice Department shall edit any report disclosed under Subsection (i) to protect the identity of:


(1) a child who is the subject of the report of alleged or suspected abuse or neglect;


(2) the person who made the report; and


(3) any other person whose life or safety may be endangered by the disclosure.


(k) Notwithstanding Subsection (a), an investigating agency, other than the department or the Texas Juvenile Justice Department, on request, shall provide to the parent, managing conservator, or other legal representative of a child who is the subject of reported abuse or neglect, or to the child if the child is at least 18 years of age, information concerning the reported abuse or neglect that would otherwise be confidential under this section. The investigating agency shall withhold information under this subsection if the parent, managing conservator, or other legal representative of the child requesting the information is alleged to have committed the abuse or neglect.


(l) Before a child or a parent, managing conservator, or other legal representative of a child may inspect or copy a record or file concerning the child under Subsection (k), the custodian of the record or file must redact:


(1) any personally identifiable information about a victim or witness under 18 years of age unless that victim or witness is:


(A) the child who is the subject of the report; or


(B) another child of the parent, managing conservator, or other legal representative requesting the information;


(2) any information that is excepted from required disclosure under Chapter 552, Government Code, or other law; and


(3) the identity of the person who made the report.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 93, eff. Sept. 1, 1995; Acts 1997, 75th Leg., ch. 575, Sec. 12, eff. Sept. 1, 1997; Acts 1997, 75th Leg., ch. 1022, Sec. 69, eff. Sept. 1, 1997; Acts 1999, 76th Leg., ch. 1150, Sec. 3, eff. Sept. 1, 1999; Acts 1999, 76th Leg., ch. 1390, Sec. 22, eff. Sept. 1, 1999; Acts 2003, 78th Leg., ch. 68, Sec. 2, eff. Sept. 1, 2003.


Amended by:


Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.15, eff. September 1, 2005.


Acts 2007, 80th Leg., R.S., Ch. 263 (S.B. 103), Sec. 12, eff. June 8, 2007.


Acts 2009, 81st Leg., R.S., Ch. 713 (H.B. 2876), Sec. 1, eff. June 19, 2009.


Acts 2009, 81st Leg., R.S., Ch. 779 (S.B. 1050), Sec. 1, eff. September 1, 2009.


Acts 2009, 81st Leg., R.S., Ch. 1377 (S.B. 1182), Sec. 13, eff. September 1, 2009.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.128, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 734 (H.B. 1549), Sec. 82, eff. September 1, 2015.


Sec. 261.202. PRIVILEGED COMMUNICATION. In a proceeding regarding the abuse or neglect of a child, evidence may not be excluded on the ground of privileged communication except in the case of communications between an attorney and client.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995.


Sec. 261.203. INFORMATION RELATING TO CHILD FATALITY. (a) Not later than the fifth day after the date the department receives a request for information about a child fatality with respect to which the department is conducting an investigation of alleged abuse or neglect, the department shall release:


(1) the age and sex of the child;


(2) the date of death;


(3) whether the state was the managing conservator of the child at the time of the child's death; and


(4) whether the child resided with the child's parent, managing conservator, guardian, or other person entitled to possession of the child at the time of the child's death.


(b) If, after a child abuse or neglect investigation described by Subsection (a) is completed, the department determines a child's death or a child's near fatality was caused by abuse or neglect, the department on request shall promptly release investigation information not prohibited from release under federal law, including the following information:


(1) the information described by Subsection (a), if not previously released to the person requesting the information;


(2) information on whether a child's death or near fatality:


(A) was determined by the department to be attributable to abuse or neglect; or


(B) resulted in a criminal investigation or the filing of criminal charges if known at the time the investigation is completed;


(3) for cases in which the child's death or near fatality occurred while the child was living with the child's parent, managing conservator, guardian, or other person entitled to possession of the child:


(A) a summary of any previous reports of abuse or neglect of the child or another child made while the child was living with that parent, managing conservator, guardian, or other person entitled to possession of the child;


(B) the disposition of any report under Paragraph (A);


(C) a description of any services, including family-based safety services, that were provided or offered by the department to the child or the child's family as a result of any report under Paragraph (A) and whether the services were accepted or declined; and


(D) the results of any risk or safety assessment completed by the department relating to the child; and


(4) for a case in which the child's death or near fatality occurred while the child was in substitute care with the department or with a residential child-care provider regulated under Chapter 42, Human Resources Code, the following information:


(A) the date the substitute care provider with whom the child was residing at the time of death or near fatality was licensed or verified;


(B) a summary of any previous reports of abuse or neglect investigated by the department relating to the substitute care provider, including the disposition of any investigation resulting from a report;


(C) any reported licensing violations, including notice of any action taken by the department regarding a violation; and


(D) records of any training completed by the substitute care provider while the child was placed with the provider.


(c) If the department is unable to release the information required by Subsection (b) before the 11th day after the date the department receives a request for the information or the date the investigation of the child fatality is completed, whichever is later, the department shall inform the person requesting the information of the date the department will release the information.


(d) Repealed by Acts 2015, 84th Leg., R.S., Ch. 944 , Sec. 86(7), eff. September 1, 2015.


(e) Before the department releases any information under Subsection (b), the department shall redact from the records any information the release of which would:


(1) identify:


(A) the individual who reported the abuse or neglect; or


(B) any other individual other than the deceased child or an alleged perpetrator of the abuse or neglect;


(2) jeopardize an ongoing criminal investigation or prosecution;


(3) endanger the life or safety of any individual; or


(4) violate other state or federal law.


(f) The executive commissioner of the Health and Human Services Commission shall adopt rules to implement this section.


Added by Acts 2009, 81st Leg., R.S., Ch. 779 (S.B. 1050), Sec. 2, eff. September 1, 2009.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 253 (S.B. 949), Sec. 1, eff. September 1, 2015.


Acts 2015, 84th Leg., R.S., Ch. 944 (S.B. 206), Sec. 86(7), eff. September 1, 2015.


Sec. 261.204. ANNUAL CHILD FATALITY REPORT. (a) Not later than March 1 of each year, the department shall publish an aggregated report using information compiled from each child fatality investigation for which the department made a finding regarding abuse or neglect, including cases in which the department determined the fatality was not the result of abuse or neglect. The report must protect the identity of individuals involved and contain the following information:


(1) the age and sex of the child and the county in which the fatality occurred;


(2) whether the state was the managing conservator of the child or whether the child resided with the child's parent, managing conservator, guardian, or other person entitled to the possession of the child at the time of the fatality;


(3) the relationship to the child of the individual alleged to have abused or neglected the child, if any;


(4) the number of any department abuse or neglect investigations involving the child or the individual alleged to have abused or neglected the child during the two years preceding the date of the fatality and the results of the investigations;


(5) whether the department offered family-based safety services or conservatorship services to the child or family;


(6) the types of abuse and neglect alleged in the reported investigations, if any; and


(7) any trends identified in the investigations contained in the report.


(b) The report published under Subsection (a) must:


(1) accurately represent all abuse-related and neglect-related child fatalities in this state, including child fatalities investigated under Subchapter F, Chapter 264, and other child fatalities investigated by the department; and


(2) aggregate the fatalities by investigative findings and case disposition, including the following dispositions:


(A) abuse and neglect ruled out;


(B) unable to determine cause of death;


(C) reason to believe abuse or neglect occurred;


(D) reason to believe abuse or neglect contributed to child's death;


(E) unable to complete review; and


(F) administrative closure.


(c) The department may release additional information in the annual report if the release of the information is not prohibited by state or federal law.


(d) The department shall post the annual report on the department's Internet website and otherwise make the report available to the public.


(e) The executive commissioner of the Health and Human Services Commission may adopt rules to implement this section.


(f) At least once every 10 years, the department shall use the information reported under this section to provide guidance for possible department policy changes.


Added by Acts 2015, 84th Leg., R.S., Ch. 253 (S.B. 949), Sec. 2, eff. September 1, 2015.


Amended by:


Acts 2017, 85th Leg., R.S., Ch. 822 (H.B. 1549), Sec. 1, eff. September 1, 2017.


SUBCHAPTER D. INVESTIGATIONS



Sec. 261.301. INVESTIGATION OF REPORT. (a) With assistance from the appropriate state or local law enforcement agency as provided by this section, the department shall make a prompt and thorough investigation of a report of child abuse or neglect allegedly committed by a person responsible for a child's care, custody, or welfare. The investigation shall be conducted without regard to any pending suit affecting the parent-child relationship.


(b) A state agency shall investigate a report that alleges abuse, neglect, or exploitation occurred in a facility operated, licensed, certified, or registered by that agency as provided by Subchapter E. In conducting an investigation for a facility operated, licensed, certified, registered, or listed by the department, the department shall perform the investigation as provided by:


(1) Subchapter E; and


(2) the Human Resources Code.


(c) The department is not required to investigate a report that alleges child abuse, neglect, or exploitation by a person other than a person responsible for a child's care, custody, or welfare. The appropriate state or local law enforcement agency shall investigate that report if the agency determines an investigation should be conducted.


(d) The executive commissioner shall by rule assign priorities and prescribe investigative procedures for investigations based on the severity and immediacy of the alleged harm to the child. The primary purpose of the investigation shall be the protection of the child. The rules must require the department, subject to the availability of funds, to:


(1) immediately respond to a report of abuse and neglect that involves circumstances in which the death of the child or substantial bodily harm to the child would result unless the department immediately intervenes;


(2) respond within 24 hours to a report of abuse and neglect that is assigned the highest priority, other than a report described by Subdivision (1); and


(3) respond within 72 hours to a report of abuse and neglect that is assigned the second highest priority.


(e) As necessary to provide for the protection of the child, the department shall determine:


(1) the nature, extent, and cause of the abuse or neglect;


(2) the identity of the person responsible for the abuse or neglect;


(3) the names and conditions of the other children in the home;


(4) an evaluation of the parents or persons responsible for the care of the child;


(5) the adequacy of the home environment;


(6) the relationship of the child to the persons responsible for the care, custody, or welfare of the child; and


(7) all other pertinent data.


(f) An investigation of a report to the department that alleges that a child has been or may be the victim of conduct that constitutes a criminal offense that poses an immediate risk of physical or sexual abuse of a child that could result in the death of or serious harm to the child shall be conducted jointly by a peace officer, as defined by Article 2.12, Code of Criminal Procedure, from the appropriate local law enforcement agency and the department or the agency responsible for conducting an investigation under Subchapter E.


(g) The inability or unwillingness of a local law enforcement agency to conduct a joint investigation under this section does not constitute grounds to prevent or prohibit the department from performing its duties under this subtitle. The department shall document any instance in which a law enforcement agency is unable or unwilling to conduct a joint investigation under this section.


(h) The department and the appropriate local law enforcement agency shall conduct an investigation, other than an investigation under Subchapter E, as provided by this section and Article 2.27, Code of Criminal Procedure, if the investigation is of a report that alleges that a child has been or may be the victim of conduct that constitutes a criminal offense that poses an immediate risk of physical or sexual abuse of a child that could result in the death of or serious harm to the child. Immediately on receipt of a report described by this subsection, the department shall notify the appropriate local law enforcement agency of the report.


(i) If at any time during an investigation of a report of child abuse or neglect to which the department has assigned the highest priority the department is unable to locate the child who is the subject of the report of abuse or neglect or the child's family, the department shall notify the Department of Public Safety that the location of the child and the child's family is unknown. If the Department of Public Safety locates the child and the child's family, the Department of Public Safety shall notify the department of the location of the child and the child's family.


(j) In geographic areas with demonstrated need, the department shall designate employees to serve specifically as investigators and responders for after-hours reports of child abuse or neglect.


(k) In an investigation of a report of abuse or neglect allegedly committed by a person responsible for a child's care, custody, or welfare, the department shall determine whether the person is an active duty member of the United States armed forces or the spouse of a member on active duty. If the department determines the person is an active duty member of the United States armed forces or the spouse of a member on active duty, the department shall notify the United States Department of Defense Family Advocacy Program at the closest active duty military installation of the investigation.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 94, eff. Sept. 1, 1995; Acts 1995, 74th Leg., ch. 943, Sec. 2, eff. Sept. 1, 1995; Acts 1997, 75th Leg., ch. 1022, Sec. 70, eff. Sept. 1, 1997; Acts 1997, 75th Leg., ch. 1137, Sec. 1, eff. Sept. 1, 1997; Acts 1999, 76th Leg., ch. 1150, Sec. 4, eff. Sept. 1, 1999; Acts 1999, 76th Leg., ch. 1390, Sec. 23, eff. Sept. 1, 1999; Acts 2003, 78th Leg., ch. 867, Sec. 1, eff. Sept. 1, 2003.


Amended by:


Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.16(a), eff. September 1, 2005.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.129, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 1056 (H.B. 2053), Sec. 1, eff. September 1, 2015.


Acts 2017, 85th Leg., R.S., Ch. 319 (S.B. 11), Sec. 9, eff. September 1, 2017.


Acts 2017, 85th Leg., R.S., Ch. 356 (H.B. 2124), Sec. 1, eff. September 1, 2017.


Acts 2017, 85th Leg., R.S., Ch. 822 (H.B. 1549), Sec. 2, eff. September 1, 2017.


Acts 2017, 85th Leg., R.S., Ch. 1136 (H.B. 249), Sec. 4, eff. September 1, 2017.


Acts 2019, 86th Leg., R.S., Ch. 467 (H.B. 4170), Sec. 21.001(13), eff. September 1, 2019.


Sec. 261.3011. JOINT INVESTIGATION GUIDELINES AND TRAINING. (a) The department shall, in consultation with the appropriate law enforcement agencies, develop guidelines and protocols for joint investigations by the department and the law enforcement agency under Section 261.301. The guidelines and protocols must:


(1) clarify the respective roles of the department and law enforcement agency in conducting the investigation;


(2) require that mutual child protective services and law enforcement training and agreements be implemented by both entities to ensure the integrity and best outcomes of joint investigations; and


(3) incorporate the use of forensic methods in determining the occurrence of child abuse and neglect.


(b) The department shall collaborate with law enforcement agencies to provide to department investigators and law enforcement officers responsible for investigating reports of abuse and neglect joint training relating to methods to effectively conduct joint investigations under Section 261.301. The training must include information on interviewing techniques, evidence gathering, and testifying in court for criminal investigations, as well as instruction on rights provided by the Fourth Amendment to the United States Constitution.


Added by Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.17, eff. September 1, 2005.


Sec. 261.3013. CASE CLOSURE AGREEMENTS PROHIBITED. (a) Except as provided by Subsection (b), on closing a case, the department may not enter into a written agreement with a child's parent or another adult with whom the child resides that requires the parent or other adult to take certain actions after the case is closed to ensure the child's safety.


(b) This section does not apply to an agreement that is entered into by a parent or other adult:


(1) following the removal of a child and that is subject to the approval of a court with continuing jurisdiction over the child;


(2) as a result of the person's participation in family group conferencing; or


(3) as part of a formal case closure plan agreed to by the person who will continue to care for a child as a result of a parental child safety placement.


(c) The department shall develop policies to guide caseworkers in the development of case closure agreements authorized under Subsections (b)(2) and (3).


Added by Acts 2011, 82nd Leg., R.S., Ch. 598 (S.B. 218), Sec. 1, eff. September 1, 2011.


Sec. 261.3015. ALTERNATIVE RESPONSE SYSTEM. (a) In assigning priorities and prescribing investigative procedures based on the severity and immediacy of the alleged harm to a child under Section 261.301(d), the department shall establish an alternative response system to allow the department to make the most effective use of resources to investigate and respond to reported cases of abuse and neglect.


(b) Notwithstanding Section 261.301, the department may, in accordance with this section and department rules, conduct an alternative response to a report of abuse or neglect if the report does not:


(1) allege sexual abuse of a child;


(2) allege abuse or neglect that caused the death of a child; or


(3) indicate a risk of serious physical injury or immediate serious harm to a child.


(c) The department may administratively close a reported case of abuse or neglect without completing the investigation or alternative response and without providing services or making a referral to another entity for assistance if the department determines, after contacting a professional or other credible source, that the child's safety can be assured without further investigation, response, services, or assistance.


(d) In determining how to classify a reported case of abuse or neglect under the alternative response system, the child's safety is the primary concern. The classification of a case may be changed as warranted by the circumstances.


(e) An alternative response to a report of abuse or neglect must include:


(1) a safety assessment of the child who is the subject of the report;


(2) an assessment of the child's family; and


(3) in collaboration with the child's family, identification of any necessary and appropriate service or support to reduce the risk of future harm to the child.


(f) An alternative response to a report of abuse or neglect may not include a formal determination of whether the alleged abuse or neglect occurred.


(g) The department may implement the alternative response in one or more of the department's administrative regions before implementing the system statewide. The department shall study the results of the system in the regions where the system has been implemented in determining the method by which to implement the system statewide.


Added by Acts 1997, 75th Leg., ch. 1022, Sec. 71, eff. Sept. 1, 1997.


Amended by:


Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.19(a), eff. September 1, 2005.


Acts 2013, 83rd Leg., R.S., Ch. 420 (S.B. 423), Sec. 1, eff. September 1, 2013.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.130, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.131, eff. April 2, 2015.


Sec. 261.3016. TRAINING OF PERSONNEL RECEIVING REPORTS OF ABUSE AND NEGLECT. The department shall develop, in cooperation with local law enforcement officials and the Commission on State Emergency Communications, a training program for department personnel who receive reports of abuse and neglect. The training program must include information on:


(1) the proper methods of screening reports of abuse and neglect; and


(2) ways to determine the seriousness of a report, including determining whether a report alleges circumstances that could result in the death of or serious harm to a child or whether the report is less serious in nature.


Added by Acts 2005, 79th Leg., Ch. 54 (H.B. 801), Sec. 1, eff. September 1, 2005.


Added by Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.20, eff. September 1, 2005.


Sec. 261.3017. CONSULTATION WITH PHYSICIAN NETWORKS AND SYSTEMS REGARDING CERTAIN MEDICAL CONDITIONS. (a) In this section:


(1) "Network" means the Forensic Assessment Center Network.


(2) "System" means the entities that receive grants under the Texas Medical Child Abuse Resources and Education System (MEDCARES) authorized by Chapter 1001, Health and Safety Code.


(b) Any agreement between the department and the network or between the Department of State Health Services and the system to provide assistance in connection with abuse and neglect investigations conducted by the department must require the network and the system to have the ability to obtain consultations with physicians licensed to practice medicine in this state and board certified in the relevant field or specialty, including radiologists, geneticists, orthopedists, and endocrinologists, to diagnose and treat certain unique health conditions, including:


(1) rickets;


(2) Ehlers-Danlos Syndrome;


(3) osteogenesis imperfecta;


(4) vitamin D deficiency; and


(5) other medical conditions that mimic child maltreatment or increase the risk of misdiagnosis of child maltreatment.


(c) During an abuse or neglect investigation authorized by this subchapter or an assessment provided under Subsection (b), the department shall refer the child's case for a specialty consultation if:


(1) the department determines the child requires a specialty consultation with a physician;


(2) the child's primary care physician or other primary health care provider who provided health care or treatment or otherwise evaluated the child recommends a specialty consultation; or


(3) the child's parent or legal guardian or, if represented by an attorney, the attorney of the parent or legal guardian requests a specialty consultation.


(c-1) For a case in which a specialty consultation is required by Subsection (c), the department shall refer the case to a physician who:


(1) is licensed to practice medicine in this state under Subtitle B, Title 3, Occupations Code;


(2) is board certified in a field or specialty relevant to diagnosing and treating the conditions described by Subsection (b); and


(3) was not involved with the report of suspected abuse or neglect.


(c-2) Before referring a child's case under Subsection (c), the department shall provide to the child's parent or legal guardian or, if represented by an attorney, the attorney of the parent or legal guardian written notice of the name, contact information, and credentials of the specialist. The parent, legal guardian, or attorney, as applicable, may object to the proposed referral and request referral to another specialist. The department and the parent, legal guardian, or attorney, as applicable, shall collaborate in good faith to select an acceptable specialist from the proposed specialists; however the department may refer the child's case to a specialist over the objection of the parent, legal guardian, or attorney.


(d) In providing assessments to the department as provided by Subsection (b), the network and the system must use a blind peer review process to resolve cases where physicians in the network or system disagree in the assessment of the causes of a child's injuries or in the presence of a condition listed under Subsection (b).


(e) This section may not be construed to prohibit a child's parent or legal guardian or, if represented by an attorney, the attorney of the parent or legal guardian from otherwise obtaining an alternative opinion at the parent's, legal guardian's, or attorney's, as applicable, own initiative and expense. The department shall accept and consider an alternative opinion obtained and provided under this section and shall document its analysis and determinations regarding the opinion.


Added by Acts 2017, 85th Leg., R.S., Ch. 502 (H.B. 2848), Sec. 1, eff. September 1, 2017.


Amended by:


Acts 2021, 87th Leg., R.S., Ch. 1047 (S.B. 1578), Sec. 1, eff. September 1, 2021.


For expiration of this section, see Subsection (d).



Sec. 261.30171. FORENSIC ASSESSMENT CENTER NETWORK EVALUATION. (a) In this section, "network" means the Forensic Assessment Center Network.


(b) The department, with the assistance of the Supreme Court of Texas Children's Commission, shall:


(1) evaluate the department's use of the network; and


(2) develop joint recommendations to improve:


(A) the evaluation of agreements between the department and the network; and


(B) the best practices for using assessments provided by the network in connection with abuse and neglect investigations conducted by the department.


(c) Not later than September 1, 2022, the department shall prepare and submit to the legislature a written report containing the department's findings and recommendations under Subsection (b) and any recommendations for legislative or other action.


(d) This section expires September 1, 2023.


Added by Acts 2021, 87th Leg., R.S., Ch. 1047 (S.B. 1578), Sec. 2, eff. September 1, 2021.


Sec. 261.30175. MITIGATION OF PROVIDER CONFLICTS IN ABUSE OR NEGLECT INVESTIGATION CONSULTATIONS. (a) In this section:


(1) "Forensic assessment" means a medical examination, psychosocial evaluation, medical case review, specialty evaluation, or other forensic evaluation service conducted by a physician under Section 261.3017 in connection with any investigation of a suspected case of abuse or neglect for the primary purpose of providing the department, law enforcement, or the court with expert advice, recommendations, or testimony on the case.


(2) "Health care practitioner" means an individual licensed, certified, or otherwise authorized to administer health care services in the ordinary course of business or professional practice. The term includes a physician, medical student, resident physician, child abuse fellow, advanced practice registered nurse, nurse, and physician assistant.


(3) "Network" has the meaning assigned by Section 261.3017.


(4) "System" has the meaning assigned by Section 261.3017.


(b) A health care practitioner who reports suspected abuse or neglect of a child may not provide forensic assessment services in connection with an investigation resulting from the report. This subsection applies regardless of whether the practitioner is a member of the network or system.


(c) When referring a case for forensic assessment, the department shall refer the case to a physician authorized to practice medicine in this state under Subtitle B, Title 3, Occupations Code, who was not involved with the report of suspected abuse or neglect.


(d) This section may not be construed to:


(1) prohibit the department from interviewing the health care practitioner in the practitioner's capacity as a principal or collateral source; or


(2) otherwise restrict the department's ability to conduct an investigation as provided by this subchapter.


Added by Acts 2021, 87th Leg., R.S., Ch. 1047 (S.B. 1578), Sec. 3, eff. September 1, 2021.


Sec. 261.3018. ABBREVIATED INVESTIGATION AND ADMINISTRATIVE CLOSURE OF CERTAIN CASES. (a) A department caseworker may refer a reported case of child abuse or neglect to a department supervisor for abbreviated investigation or administrative closure at any time before the 60th day after the date the report is received if:


(1) there is no prior report of abuse or neglect of the child who is the subject of the report;


(2) the department has not received an additional report of abuse or neglect of the child following the initial report;


(3) after contacting a professional or other credible source, the caseworker determines that the child's safety can be assured without further investigation, response, services, or assistance; and


(4) the caseworker determines that no abuse or neglect occurred.


(b) A department supervisor shall review each reported case of child abuse or neglect that has remained open for more than 60 days and administratively close the case if:


(1) the supervisor determines that:


(A) the circumstances described by Subsections (a)(1)-(4) exist; and


(B) closing the case would not expose the child to an undue risk of harm; and


(2) the department director grants approval for the administrative closure of the case.


(c) A department supervisor may reassign a reported case of child abuse or neglect that does not qualify for abbreviated investigation or administrative closure under Subsection (a) or (b) to a different department caseworker if the supervisor determines that reassignment would allow the department to make the most effective use of resources to investigate and respond to reported cases of abuse or neglect.


(d) The executive commissioner shall adopt rules necessary to implement this section.


(e) In this section, "professional" means an individual who is licensed or certified by the state or who is an employee of a facility licensed, certified, or operated by the state and who, in the normal course of official duties or duties for which a license or certification is required, has direct contact with children. The term includes teachers, nurses, doctors, day-care employees, employees of a clinic or health care facility that provides reproductive services, juvenile probation officers, and juvenile detention or correctional officers.


Added by Acts 2017, 85th Leg., R.S., Ch. 523 (S.B. 190), Sec. 1, eff. June 9, 2017.


Redesignated from Family Code, Section 261.3017 by Acts 2019, 86th Leg., R.S., Ch. 467 (H.B. 4170), Sec. 21.001(14), eff. September 1, 2019.


Sec. 261.302. CONDUCT OF INVESTIGATION. (a) The investigation may include:


(1) a visit to the child's home, unless the alleged abuse or neglect can be confirmed or clearly ruled out without a home visit; and


(2) an interview with and examination of the subject child, which may include a medical, psychological, or psychiatric examination.


(b) The interview with and examination of the child may:


(1) be conducted at any reasonable time and place, including the child's home or the child's school;


(2) include the presence of persons the department determines are necessary; and


(3) include transporting the child for purposes relating to the interview or investigation.


(b-1) Before the department may transport a child as provided by Subsection (b)(3), the department shall attempt to notify the parent or other person having custody of the child of the transport.


(c) The investigation may include an interview with the child's parents and an interview with and medical, psychological, or psychiatric examination of any child in the home.


(d) If, before an investigation is completed, the investigating agency believes that the immediate removal of a child from the child's home is necessary to protect the child from further abuse or neglect, the investigating agency shall file a petition or take other action under Chapter 262 to provide for the temporary care and protection of the child.


(e) An interview with a child in which the allegations of the current investigation are discussed and that is conducted by the department during the investigation stage shall be audiotaped or videotaped unless:


(1) the recording equipment malfunctions and the malfunction is not the result of a failure to maintain the equipment or bring adequate supplies for the equipment;


(2) the child is unwilling to allow the interview to be recorded after the department makes a reasonable effort consistent with the child's age and development and the circumstances of the case to convince the child to allow the recording; or


(3) due to circumstances that could not have been reasonably foreseen or prevented by the department, the department does not have the necessary recording equipment because the department employee conducting the interview does not ordinarily conduct interviews.


(e-1) An interview with a child alleged to be a victim of physical abuse or sexual abuse conducted by an investigating agency other than the department shall be audiotaped or videotaped unless the investigating agency determines that good cause exists for not audiotaping or videotaping the interview in accordance with rules of the agency. Good cause may include, but is not limited to, such considerations as the age of the child and the nature and seriousness of the allegations under investigation. Nothing in this subsection shall be construed as prohibiting the investigating agency from audiotaping or videotaping an interview of a child on any case for which such audiotaping or videotaping is not required under this subsection. The fact that the investigating agency failed to audiotape or videotape an interview is admissible at the trial of the offense that is the subject of the interview.


(f) A person commits an offense if the person is notified of the time of the transport of a child by the department and the location from which the transport is initiated and the person is present at the location when the transport is initiated and attempts to interfere with the department's investigation. An offense under this subsection is a Class B misdemeanor. It is an exception to the application of this subsection that the department requested the person to be present at the site of the transport.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 95, eff. Sept. 1, 1995; Acts 1997, 75th Leg., ch. 575, Sec. 13, 14, eff. Sept. 1, 1997; Acts 1997, 75th Leg., ch. 1022, Sec. 73, eff. Sept. 1, 1997.


Amended by:


Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.21, eff. September 1, 2005.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.132, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 944 (S.B. 206), Sec. 19, eff. September 1, 2015.


Sec. 261.3021. CASEWORK DOCUMENTATION AND MANAGEMENT. Subject to the appropriation of money, the department shall identify critical investigation actions that impact child safety and require department caseworkers to document those actions in a child's case file not later than the day after the action occurs.


Added by Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.22, eff. September 1, 2005.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 944 (S.B. 206), Sec. 20, eff. September 1, 2015.


Sec. 261.3022. CHILD SAFETY CHECK ALERT LIST. (a) The Department of Public Safety of the State of Texas shall maintain a child safety check alert list as part of the Texas Crime Information Center to help locate a child or the child's family for purposes of:


(1) investigating a report of child abuse or neglect;


(2) providing protective services to a family receiving family-based support services; or


(3) providing protective services to the family of a child in the managing conservatorship of the department.


(b) If the department is unable to locate a child or the child's family for a purpose described by Subsection (a) after the department has attempted to locate the child for not more than 20 days, the department shall notify the Texas Department of Public Safety that the department is unable to locate the child or the child's family. The notice must include the information required by Subsections (c)(1)-(10).


(c) On receipt of the notice from the department, the Texas Department of Public Safety shall notify the Texas Crime Information Center to place the child and the child's family on a child safety check alert list. The alert list must include the following information if known or readily available:


(1) the name, sex, race, date of birth, any known identifying numbers, including social security number and driver's license number, and personal descriptions of the family member alleged to have abused or neglected a child according to the report the department is attempting to investigate;


(2) the name, sex, race, date of birth, any known identifying numbers, including social security number and driver's license number, and personal descriptions of any parent, managing conservator, or guardian of the child who cannot be located for the purposes described by Subsection (a);


(3) the name, sex, race, date of birth, any known identifying numbers, including social security number and driver's license number, and personal descriptions of the child who is the subject of the report or is receiving services described by Subsection (a)(2) or (3);


(4) if applicable, a code identifying the type of child abuse or neglect alleged or determined to have been committed against the child;


(5) the family's last known address;


(6) any known description of the motor vehicle, including the vehicle's make, color, style of body, model year, and vehicle identification number, in which the child is suspected to be transported;


(7) the case number assigned by the department;


(8) the department's dedicated law-enforcement telephone number for statewide intake;


(9) the date and time when and the location where the child was last seen; and


(10) any other information required for an entry as established by the center.


Added by Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.22, eff. September 1, 2005.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1056 (H.B. 2053), Sec. 2, eff. September 1, 2015.


Acts 2015, 84th Leg., R.S., Ch. 1202 (S.B. 1406), Sec. 1, eff. September 1, 2015.


Sec. 261.3023. LAW ENFORCEMENT RESPONSE TO CHILD SAFETY CHECK ALERT. If a law enforcement officer encounters a child or other person listed on the Texas Crime Information Center's child safety check alert list, the law enforcement officer shall follow the procedures described by Article 2.272, Code of Criminal Procedure.


Added by Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.22, eff. September 1, 2005.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1056 (H.B. 2053), Sec. 3, eff. September 1, 2015.


Acts 2015, 84th Leg., R.S., Ch. 1202 (S.B. 1406), Sec. 2, eff. September 1, 2015.


Reenacted and amended by Acts 2017, 85th Leg., R.S., Ch. 324 (S.B. 1488), Sec. 7.006, eff. September 1, 2017.


Sec. 261.3024. REMOVAL FROM CHILD SAFETY CHECK ALERT LIST. (a) A law enforcement officer who locates a child listed on the Texas Crime Information Center's child safety check alert list shall report that the child has been located in the manner prescribed by Article 2.272, Code of Criminal Procedure.


(b) If the department locates a child who has been placed on the child safety check alert list established under Section 261.3022 through a means other than information reported to the department by a law enforcement officer under Article 2.272, Code of Criminal Procedure, the department shall report to the Texas Crime Information Center that the child has been located.


(c) On receipt of notice that a child has been located, the Texas Crime Information Center shall remove the child and the child's family from the child safety check alert list.


Added by Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.22, eff. September 1, 2005.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1056 (H.B. 2053), Sec. 4, eff. September 1, 2015.


Acts 2015, 84th Leg., R.S., Ch. 1202 (S.B. 1406), Sec. 3, eff. September 1, 2015.


Acts 2017, 85th Leg., R.S., Ch. 324 (S.B. 1488), Sec. 7.007, eff. September 1, 2017.


Sec. 261.3027. NOTICE OF RIGHT TO RECORD INTERVIEW. (a) Before conducting an interview with an alleged perpetrator, the department shall inform the person orally and in writing that:


(1) the person may create an audio or video recording of the interview but may not record the interview in any other manner;


(2) any audio or video recording made by the person may be subject to subpoena under a court order; and


(3) the person may request and receive a copy of the department's current recording policy.


(b) The department shall document in the case file that the department provided the notice required by Subsection (a).


(c) The department shall provide two copies of the written notice to be signed by the person. The department shall provide one signed notice to the person and retain the other signed notice in the case file.


(d) An audio or video recording of the department's interview with an alleged perpetrator may not be posted on an Internet website in a manner that could identify a party involved in the interview.


Added by Acts 2021, 87th Leg., R.S., Ch. 789 (H.B. 135), Sec. 1, eff. September 1, 2021.


Sec. 261.303. INTERFERENCE WITH INVESTIGATION; COURT ORDER. (a) A person may not interfere with an investigation of a report of child abuse or neglect conducted by the department.


(b) If admission to the home, school, or any place where the child may be cannot be obtained, then for good cause shown the court having family law jurisdiction shall order the parent, the person responsible for the care of the children, or the person in charge of any place where the child may be to allow entrance for the interview, examination, and investigation.


(c) If a parent or person responsible for the child's care does not consent to release of the child's prior medical, psychological, or psychiatric records or to a medical, psychological, or psychiatric examination of the child that is requested by the department, the court having family law jurisdiction shall, for good cause shown, order the records to be released or the examination to be made at the times and places designated by the court.


(d) A person, including a medical facility, that makes a report under Subchapter B shall release to the department, as part of the required report under Section 261.103, records that directly relate to the suspected abuse or neglect without requiring parental consent or a court order. If a child is transferred from a reporting medical facility to another medical facility to treat the injury or condition that formed the basis for the original report, the transferee medical facility shall, at the department's request, release to the department records relating to the injury or condition without requiring parental consent or a court order.


(e) A person, including a utility company, that has confidential locating or identifying information regarding a family that is the subject of an investigation under this chapter shall release that information to the department on request. The release of information to the department as required by this subsection by a person, including a utility company, is not subject to Section 552.352, Government Code, or any other law providing liability for the release of confidential information.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 96, eff. Sept. 1, 1995; Acts 1999, 76th Leg., ch. 1150, Sec. 5, eff. Sept. 1, 1999; Acts 1999, 76th Leg., ch. 1390, Sec. 24, eff. Sept. 1, 1999.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1406 (S.B. 758), Sec. 6, eff. September 1, 2007.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.133, eff. April 2, 2015.


Sec. 261.3031. FAILURE TO COOPERATE WITH INVESTIGATION; DEPARTMENT RESPONSE. (a) If a parent or other person refuses to cooperate with the department's investigation of the alleged abuse or neglect of a child and the refusal poses a risk to the child's safety, the department shall seek assistance from the appropriate attorney with responsibility for representing the department as provided by Section 264.009 to obtain a court order as described by Section 261.303.


(b) A person's failure to report to an agency authorized to investigate abuse or neglect of a child within a reasonable time after receiving proper notice constitutes a refusal by the person to cooperate with the department's investigation. A summons may be issued to locate the person.


Added by Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.23, eff. September 1, 2005.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1406 (S.B. 758), Sec. 7, eff. September 1, 2007.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.134, eff. April 2, 2015.


Sec. 261.3032. INTERFERENCE WITH INVESTIGATION; CRIMINAL PENALTY. (a) A person commits an offense if, with the intent to interfere with the department's investigation of a report of abuse or neglect of a child, the person relocates the person's residence, either temporarily or permanently, without notifying the department of the address of the person's new residence or conceals the child and the person's relocation or concealment interferes with the department's investigation.


(b) An offense under this section is a Class B misdemeanor.


(c) If conduct that constitutes an offense under this section also constitutes an offense under any other law, the actor may be prosecuted under this section or the other law.


Added by Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.24, eff. September 1, 2005.


Sec. 261.304. INVESTIGATION OF ANONYMOUS REPORT. (a) If the department receives an anonymous report of child abuse or neglect by a person responsible for a child's care, custody, or welfare, the department shall conduct a preliminary investigation to determine whether there is any evidence to corroborate the report.


(b) An investigation under this section may include a visit to the child's home, unless the alleged abuse or neglect can be confirmed or clearly ruled out without a home visit, an interview with and examination of the child, and an interview with the child's parents. In addition, the department may interview any other person the department believes may have relevant information.


(c) Unless the department determines that there is some evidence to corroborate the report of abuse, the department may not conduct the thorough investigation required by this chapter or take any action against the person accused of abuse.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995.


Amended by:


Acts 2017, 85th Leg., R.S., Ch. 416 (S.B. 1063), Sec. 1, eff. September 1, 2017.


Sec. 261.305. ACCESS TO MENTAL HEALTH RECORDS. (a) An investigation may include an inquiry into the possibility that a parent or a person responsible for the care of a child who is the subject of a report under Subchapter B has a history of medical or mental illness.


(b) If the parent or person does not consent to an examination or allow the department to have access to medical or mental health records requested by the department, the court having family law jurisdiction, for good cause shown, shall order the examination to be made or that the department be permitted to have access to the records under terms and conditions prescribed by the court.


(c) If the court determines that the parent or person is indigent, the court shall appoint an attorney to represent the parent or person at the hearing. The fees for the appointed attorney shall be paid as provided by Chapter 107.


(d) A parent or person responsible for the child's care is entitled to notice and a hearing when the department seeks a court order to allow a medical, psychological, or psychiatric examination or access to medical or mental health records.


(e) This access does not constitute a waiver of confidentiality.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1997, 75th Leg., ch. 575, Sec. 15, eff. Sept. 1, 1997; Acts 1999, 76th Leg., ch. 1150, Sec. 6, eff. Sept. 1, 1999; Acts 1999, 76th Leg., ch. 1390, Sec. 25, eff. Sept. 1, 1999.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.135, eff. April 2, 2015.


Sec. 261.306. REMOVAL OF CHILD FROM STATE. (a) If the department has reason to believe that a person responsible for the care, custody, or welfare of the child may remove the child from the state before the investigation is completed, the department may file an application for a temporary restraining order in a district court without regard to continuing jurisdiction of the child as provided in Chapter 155.


(b) The court may render a temporary restraining order prohibiting the person from removing the child from the state pending completion of the investigation if the court:


(1) finds that the department has probable cause to conduct the investigation; and


(2) has reason to believe that the person may remove the child from the state.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.136, eff. April 2, 2015.


Sec. 261.307. INFORMATION RELATING TO INVESTIGATION PROCEDURE AND CHILD PLACEMENT RESOURCES. (a) As soon as possible after initiating an investigation of a parent or other person having legal custody of a child, the department shall provide to the person:


(1) a summary that:


(A) is brief and easily understood;


(B) is written in a language that the person understands, or if the person is illiterate, is read to the person in a language that the person understands; and


(C) contains the following information:


(i) the department's procedures for conducting an investigation of alleged child abuse or neglect, including:


(a) a description of the circumstances under which the department would request to remove the child from the home through the judicial system; and


(b) an explanation that the law requires the department to refer all reports of alleged child abuse or neglect to a law enforcement agency for a separate determination of whether a criminal violation occurred;


(ii) the person's right to file a complaint with the department or to request a review of the findings made by the department in the investigation;


(iii) the person's right to review all records of the investigation unless the review would jeopardize an ongoing criminal investigation or the child's safety;


(iv) the person's right to seek legal counsel;


(v) references to the statutory and regulatory provisions governing child abuse and neglect and how the person may obtain copies of those provisions; and


(vi) the process the person may use to acquire access to the child if the child is removed from the home;


(2) if the department determines that removal of the child may be warranted, a proposed child placement resources form that:


(A) instructs the parent or other person having legal custody of the child to:


(i) complete and return the form to the department or agency;


(ii) identify in the form at least three individuals who could be relative caregivers or designated caregivers, as those terms are defined by Section 264.751;


(iii) ask the child in a developmentally appropriate manner to identify any adult, particularly an adult residing in the child's community, who could be a relative caregiver or designated caregiver for the child; and


(iv) list on the form the name of each individual identified by the child as a potential relative caregiver or designated caregiver; and


(B) informs the parent or other person of a location that is available to the parent or other person to submit the information in the form 24 hours a day either in person or by facsimile machine or e-mail; and


(3) an informational manual required by Section 261.3071.


(b) The child placement resources form described by Subsection (a)(2) must include information on the periods of time by which the department must complete a background check.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995.


Amended by:


Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.25(a), eff. September 1, 2005.


Acts 2019, 86th Leg., R.S., Ch. 1294 (H.B. 3390), Sec. 3, eff. June 14, 2019.


Acts 2019, 86th Leg., R.S., Ch. 1294 (H.B. 3390), Sec. 4, eff. June 14, 2019.


Sec. 261.3071. INFORMATIONAL MANUALS. (a) In this section:


(1) "Designated caregiver" and "relative caregiver" have the meanings assigned those terms by Section 264.751.


(2) "Voluntary caregiver" means a person who voluntarily agrees to provide temporary care for a child:


(A) who is the subject of an investigation by the department or whose parent, managing conservator, possessory conservator, guardian, caretaker, or custodian is receiving family-based safety services from the department;


(B) who is not in the conservatorship of the department; and


(C) who is placed in the care of the person by the parent or other person having legal custody of the child.


(b) The department shall develop and publish informational manuals that provide information for:


(1) a parent or other person having custody of a child who is the subject of an investigation under this chapter;


(2) a person who is selected by the department to be the child's relative or designated caregiver; and


(3) a voluntary caregiver.


(c) Information provided in the manuals must be in both English and Spanish and must include, as appropriate:


(1) useful indexes of information such as telephone numbers;


(2) the information required to be provided under Section 261.307(a)(1);


(3) information describing the rights and duties of a relative or designated caregiver;


(4) information regarding:


(A) the relative and other designated caregiver program under Subchapter I, Chapter 264, and the option for the relative or other designated caregiver to become verified by a licensed child-placing agency to operate an agency foster home, if applicable; and


(B) the permanency care assistance program under Subchapter K, Chapter 264; and


(5) information regarding the role of a voluntary caregiver, including information on how to obtain any documentation necessary to provide for a child's needs.


Added by Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.26, eff. September 1, 2005.


Amended by:


Acts 2009, 81st Leg., R.S., Ch. 825 (S.B. 1723), Sec. 1, eff. June 19, 2009.


Acts 2019, 86th Leg., R.S., Ch. 375 (H.B. 1884), Sec. 1, eff. September 1, 2019.


Sec. 261.308. SUBMISSION OF INVESTIGATION REPORT. (a) The department shall make a complete written report of the investigation.


(b) Repealed by Acts 2015, 84th Leg., R.S., Ch. 944 , Sec. 86(9), eff. September 1, 2015.


(c) Repealed by Acts 2015, 84th Leg., R.S., Ch. 944 , Sec. 86(9), eff. September 1, 2015.


(d) The department shall release information regarding a person alleged to have committed abuse or neglect to persons who have control over the person's access to children, including, as appropriate, the Texas Education Agency, the State Board for Educator Certification, the local school board or the school's governing body, the superintendent of the school district, the public school principal or director, the director of the open-enrollment charter school, or the chief executive officer of the private school if the department determines that:


(1) the person alleged to have committed abuse or neglect poses a substantial and immediate risk of harm to one or more children outside the family of a child who is the subject of the investigation; and


(2) the release of the information is necessary to assist in protecting one or more children from the person alleged to have committed abuse or neglect.


(e) On request, the department shall release information about a person alleged to have committed abuse or neglect to the State Board for Educator Certification if the board has a reasonable basis for believing that the information is necessary to assist the board in protecting children from the person alleged to have committed abuse or neglect.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 97, eff. Sept. 1, 1995.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1372 (S.B. 9), Sec. 13, eff. June 15, 2007.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.137, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 944 (S.B. 206), Sec. 86(9), eff. September 1, 2015.


Acts 2019, 86th Leg., R.S., Ch. 987 (S.B. 1231), Sec. 2, eff. September 1, 2019.


Sec. 261.309. REVIEW OF DEPARTMENT INVESTIGATIONS. (a) The executive commissioner shall by rule establish policies and procedures to resolve complaints relating to and conduct reviews of child abuse or neglect investigations conducted by the department.


(b) If a person under investigation for allegedly abusing or neglecting a child requests clarification of the status of the person's case or files a complaint relating to the conduct of the department's staff or to department policy, the department shall conduct an informal review to clarify the person's status or resolve the complaint. The division of the department responsible for investigating complaints shall conduct the informal review as soon as possible but not later than the 14th day after the date the request or complaint is received.


(c) If, after the department's investigation, the person who is alleged to have abused or neglected a child disputes the department's determination of whether child abuse or neglect occurred, the person may request an administrative review of the findings. A department employee in administration who was not involved in or did not directly supervise the investigation shall conduct the review. The review must sustain, alter, or reverse the department's original findings in the investigation.


(d) The department employee shall conduct the review prescribed by Subsection (c) as soon as possible but not later than the 45th day after the date the department receives the request, unless the department has good cause for extending the deadline. If a civil or criminal court proceeding or an ongoing criminal investigation relating to the alleged abuse or neglect investigated by the department is pending, the department may postpone the review until the court proceeding is completed.


(e) A person is not required to exhaust the remedies provided by this section before pursuing a judicial remedy provided by law.


(f) This section does not provide for a review of an order rendered by a court.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.138, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 944 (S.B. 206), Sec. 21, eff. September 1, 2015.


Sec. 261.3091. NOTICE OF RIGHT TO REQUEST ADMINISTRATIVE REVIEW. (a) Before conducting an interview with an alleged perpetrator, the department shall notify the person in writing that the person may request an administrative review of the department's findings under Section 261.309. The person shall sign the written notice to acknowledge receipt of the notice.


(b) The department shall document in the case file that the department provided the notice required by Subsection (a).


Added by Acts 2021, 87th Leg., R.S., Ch. 789 (H.B. 135), Sec. 2, eff. September 1, 2021.


Sec. 261.310. INVESTIGATION STANDARDS. (a) The executive commissioner shall by rule develop and adopt standards for persons who investigate suspected child abuse or neglect at the state or local level. The standards shall encourage professionalism and consistency in the investigation of suspected child abuse or neglect.


(b) The standards must provide for a minimum number of hours of annual professional training for interviewers and investigators of suspected child abuse or neglect.


(c) Repealed by Acts 2015, 84th Leg., R.S., Ch. 944 , Sec. 86(10), eff. September 1, 2015.


(d) The standards shall:


(1) recommend that videotaped and audiotaped interviews be uninterrupted;


(2) recommend a maximum number of interviews with and examinations of a suspected victim;


(3) provide procedures to preserve evidence, including the original recordings of the intake telephone calls, original notes, videotapes, and audiotapes, for one year; and


(4) provide that an investigator of suspected child abuse or neglect make a reasonable effort to locate and inform each parent of a child of any report of abuse or neglect relating to the child.


(e) The department, in conjunction with the Department of Public Safety, shall provide to the department's residential child-care facility licensing investigators advanced training in investigative protocols and techniques.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995.


Amended by:


Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.27, eff. September 1, 2005.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.139, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 944 (S.B. 206), Sec. 86(10), eff. September 1, 2015.


Sec. 261.311. NOTICE OF REPORT. (a) When during an investigation of a report of suspected child abuse or neglect a representative of the department conducts an interview with or an examination of a child, the department shall make a reasonable effort before 24 hours after the time of the interview or examination to notify each parent of the child and the child's legal guardian, if one has been appointed, of the nature of the allegation and of the fact that the interview or examination was conducted.


(b) If a report of suspected child abuse or neglect is administratively closed by the department as a result of a preliminary investigation that did not include an interview or examination of the child, the department shall make a reasonable effort before the expiration of 24 hours after the time the investigation is closed to notify each parent and legal guardian of the child of the disposition of the investigation.


(c) The notice required by Subsection (a) or (b) is not required if the department or agency determines that the notice is likely to endanger the safety of the child who is the subject of the report, the person who made the report, or any other person who participates in the investigation of the report.


(d) The notice required by Subsection (a) or (b) may be delayed at the request of a law enforcement agency if notification during the required time would interfere with an ongoing criminal investigation.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1997, 75th Leg., ch. 1022, Sec. 74, eff. Sept. 1, 1997.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.140, eff. April 2, 2015.


Sec. 261.312. REVIEW TEAMS; OFFENSE. (a) The department shall establish review teams to evaluate department casework and decision-making related to investigations by the department of child abuse or neglect. The department may create one or more review teams for each region of the department for child protective services. A review team is a citizen review panel or a similar entity for the purposes of federal law relating to a state's child protection standards.


(b) A review team consists of at least five members who serve staggered two-year terms. Review team members are appointed by the commissioner of the department and consist of volunteers who live in and are broadly representative of the region in which the review team is established and have expertise in the prevention and treatment of child abuse and neglect. At least two members of a review team must be parents who have not been convicted of or indicted for an offense involving child abuse or neglect, have not been determined by the department to have engaged in child abuse or neglect, and are not under investigation by the department for child abuse or neglect. A member of a review team is a department volunteer for the purposes of Section 411.114, Government Code.


(c) A review team conducting a review of an investigation may conduct the review by examining the facts of the case as outlined by the department caseworker and law enforcement personnel. A review team member acting in the member's official capacity may receive information made confidential under Section 40.005, Human Resources Code, or Section 261.201.


(d) A review team shall report to the department the results of the team's review of an investigation. The review team's report may not include confidential information. The findings contained in a review team's report are subject to disclosure under Chapter 552, Government Code. This section does not require a law enforcement agency to divulge information to a review team that the agency believes would compromise an ongoing criminal case, investigation, or proceeding.


(e) A member of a review team commits an offense if the member discloses confidential information. An offense under this subsection is a Class C misdemeanor.


Added by Acts 1995, 74th Leg., ch. 943, Sec. 3, eff. Sept. 1, 1995. Amended by Acts 1997, 75th Leg., ch. 575, Sec. 16, eff. Sept. 1, 1997.


Amended by:


Acts 2009, 81st Leg., R.S., Ch. 1372 (S.B. 939), Sec. 3, eff. June 19, 2009.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.141, eff. April 2, 2015.


Sec. 261.3125. CHILD SAFETY SPECIALISTS. (a) The department shall employ in each of the department's administrative regions at least one child safety specialist. The job responsibilities of the child safety specialist must focus on child abuse and neglect investigation issues, including reports of child abuse required by Section 261.101, to achieve a greater compliance with that section, and on assessing and improving the effectiveness of the department in providing for the protection of children in the region.


(b) The duties of a child safety specialist must include the duty to:


(1) conduct staff reviews and evaluations of cases determined to involve a high risk to the health or safety of a child, including cases of abuse reported under Section 261.101, to ensure that risk assessment tools are fully and correctly used;


(2) review and evaluate cases in which there have been multiple referrals to the department of child abuse or neglect involving the same family, child, or person alleged to have committed the abuse or neglect; and


(3) approve decisions and assessments related to investigations of cases of child abuse or neglect that involve a high risk to the health or safety of a child.


Added by Acts 1999, 76th Leg., ch. 1490, Sec. 1, eff. Sept. 1, 1999.


Amended by:


Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.29, eff. September 1, 2005.


Sec. 261.3126. COLOCATION OF INVESTIGATORS. (a) In each county, to the extent possible, the department and the local law enforcement agencies that investigate child abuse in the county shall colocate in the same offices investigators from the department and the law enforcement agencies to improve the efficiency of child abuse investigations. With approval of the local children's advocacy center and its partner agencies, in each county in which a children's advocacy center established under Section 264.402 is located, the department shall attempt to locate investigators from the department and county and municipal law enforcement agencies at the center.


(b) A law enforcement agency is not required to comply with the colocation requirements of this section if the law enforcement agency does not have a full-time peace officer solely assigned to investigate reports of child abuse and neglect.


(c) If a county does not have a children's advocacy center, the department shall work with the local community to encourage one as provided by Section 264.402.


Added by Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.30, eff. September 1, 2005.


Sec. 261.314. TESTING. (a) The department shall provide testing as necessary for the welfare of a child who the department believes, after an investigation under this chapter, has been sexually abused, including human immunodeficiency virus (HIV) testing of a child who was abused in a manner by which HIV may be transmitted.


(b) Except as provided by Subsection (c), the results of a test under this section are confidential.


(c) If requested, the department shall report the results of a test under this section to:


(1) a court having jurisdiction of a proceeding involving the child or a proceeding involving a person suspected of abusing the child;


(2) a person responsible for the care and custody of the child as a foster parent; and


(3) a person seeking to adopt the child.


Added by Acts 1995, 74th Leg., ch. 943, Sec. 7, eff. Sept. 1, 1995.


Sec. 261.315. REMOVAL OF CERTAIN INVESTIGATION INFORMATION FROM RECORDS. (a) At the conclusion of an investigation in which the department determines that the person alleged to have abused or neglected a child did not commit abuse or neglect, the department shall notify the person of the person's right to request the department to remove information about the person's alleged role in the abuse or neglect report from the department's records.


(b) On request under Subsection (a) by a person whom the department has determined did not commit abuse or neglect, the department shall remove information from the department's records concerning the person's alleged role in the abuse or neglect report.


(c) The executive commissioner shall adopt rules necessary to administer this section.


Added by Acts 1997, 75th Leg., ch. 1022, Sec. 75, eff. Sept. 1, 1997.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.142, eff. April 2, 2015.


Sec. 261.316. EXEMPTION FROM FEES FOR MEDICAL RECORDS. The department is exempt from the payment of a fee otherwise required or authorized by law to obtain a medical record from a hospital or health care provider if the request for a record is made in the course of an investigation by the department.


Added by Acts 1997, 75th Leg., ch. 575, Sec. 17, eff. Sept. 1, 1997. Renumbered from Sec. 261.315 by Acts 1999, 76th Leg., ch. 62, Sec. 19.01(27), eff. Sept. 1, 1999.


SUBCHAPTER E. INVESTIGATIONS OF ABUSE, NEGLECT, OR EXPLOITATION IN CERTAIN FACILITIES



Sec. 261.401. AGENCY INVESTIGATION.


(a) Repealed by Acts 2017, 85th Leg., R.S., Ch. 1136 (H.B. 249), Sec. 14, and Acts 2017, 85th Leg., R.S., Ch. 319 (S.B. 11), Sec. 32, eff. September 1, 2017.


(b) Except as provided by Section 261.404 of this code and Section 531.02013(1)(D), Government Code, a state agency that operates, licenses, certifies, registers, or lists a facility in which children are located or provides oversight of a program that serves children shall make a prompt, thorough investigation of a report that a child has been or may be abused, neglected, or exploited in the facility or program. The primary purpose of the investigation shall be the protection of the child.


(c) A state agency shall adopt rules relating to the investigation and resolution of reports received as provided by this subchapter. The executive commissioner shall review and approve the rules of agencies other than the Texas Department of Criminal Justice or the Texas Juvenile Justice Department to ensure that those agencies implement appropriate standards for the conduct of investigations and that uniformity exists among agencies in the investigation and resolution of reports.


(d) The Texas School for the Blind and Visually Impaired and the Texas School for the Deaf shall adopt policies relating to the investigation and resolution of reports received as provided by this subchapter. The executive commissioner shall review and approve the policies to ensure that the Texas School for the Blind and Visually Impaired and the Texas School for the Deaf adopt those policies in a manner consistent with the minimum standards adopted by the executive commissioner under Section 261.407.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 98, eff. Sept. 1, 1995; Acts 2001, 77th Leg., ch. 355, Sec. 2, eff. Sept. 1, 2001.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 908 (H.B. 2884), Sec. 29, eff. September 1, 2007.


Acts 2009, 81st Leg., R.S., Ch. 284 (S.B. 643), Sec. 6, eff. June 11, 2009.


Acts 2009, 81st Leg., R.S., Ch. 720 (S.B. 68), Sec. 18, eff. September 1, 2009.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.143, eff. April 2, 2015.


Acts 2017, 85th Leg., R.S., Ch. 319 (S.B. 11), Sec. 10, eff. September 1, 2017.


Acts 2017, 85th Leg., R.S., Ch. 319 (S.B. 11), Sec. 32, eff. September 1, 2017.


Acts 2017, 85th Leg., R.S., Ch. 1136 (H.B. 249), Sec. 5, eff. September 1, 2017.


Acts 2017, 85th Leg., R.S., Ch. 1136 (H.B. 249), Sec. 14, eff. September 1, 2017.


Sec. 261.402. INVESTIGATIVE REPORTS. (a) A state agency shall prepare and keep on file a complete written report of each investigation conducted by the agency under this subchapter.


(b) A state agency shall immediately notify the appropriate state or local law enforcement agency of any report the agency receives, other than a report from a law enforcement agency, that concerns the suspected abuse, neglect, or exploitation of a child or the death of a child from abuse or neglect. If the state agency finds evidence indicating that a child may have been abused, neglected, or exploited, the agency shall report the evidence to the appropriate law enforcement agency.


(c) A state agency that licenses, certifies, or registers a facility in which children are located shall compile, maintain, and make available statistics on the incidence in the facility of child abuse, neglect, and exploitation that is investigated by the agency.


(d) A state agency shall compile, maintain, and make available statistics on the incidence of child abuse, neglect, and exploitation in a facility operated by the state agency.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 1995, 74th Leg., ch. 751, Sec. 99, eff. Sept. 1, 1995; Acts 2001, 77th Leg., ch. 355, Sec. 3, eff. Sept. 1, 2001.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.144, eff. April 2, 2015.


Sec. 261.403. COMPLAINTS. (a) If a state agency receives a complaint relating to an investigation conducted by the agency concerning a facility operated by that agency in which children are located, the agency shall refer the complaint to the agency's governing body.


(b) The governing body of a state agency that operates a facility in which children are located shall ensure that the procedure for investigating abuse, neglect, and exploitation allegations and inquiries in the agency's facility is periodically reviewed under the agency's internal audit program required by Chapter 2102, Government Code.


Added by Acts 1995, 74th Leg., ch. 20, Sec. 1, eff. April 20, 1995. Amended by Acts 2001, 77th Leg., ch. 355, Sec. 4, eff. Sept. 1, 2001.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.145, eff. April 2, 2015.


Sec. 261.404. INVESTIGATIONS REGARDING CERTAIN CHILDREN RECEIVING SERVICES FROM CERTAIN PROVIDERS.


(a) The department shall investigate a report of abuse, neglect, or exploitation of a child receiving services from a provider, as those terms are defined by Section 48.251, Human Resources Code, or as otherwise defined by rule. The department shall also investigate, under Subchapter F, Chapter 48, Human Resources Code, a report of abuse, neglect, or exploitation of a child receiving services from an officer, employee, agent, contractor, or subcontractor of a home and community support services agency licensed under Chapter 142, Health and Safety Code, if the officer, employee, agent, contractor, or subcontractor is or may be the person alleged to have committed the abuse, neglect, or exploitation.


(a-1) For an investigation of a child living in a residence owned, operated, or controlled by a provider of services under the home and community-based services waiver program described by Section 534.001(11)(B), Government Code, the department, in accordance with Subchapter E, Chapter 48, Human Resources Code, may provide emergency protective services necessary to immediately protect the child from serious physical harm or death and, if necessary, obtain an emergency order for protective services under Section 48.208, Human Resources Code.


(a-2) For an investigation of a child living in a residence owned, operated, or controlled by a provider of services under the home and community-based services waiver program described by Section 534.001(11)(B), Government Code, regardless of whether the child is receiving services under that waiver program from the provider, the department shall provide protective services to the child in accordance with Subchapter E, Chapter 48, Human Resources Code.


(a-3) For purposes of this section, Subchapters E and F, Chapter 48, Human Resources Code, apply to an investigation of a child and to the provision of protective services to that child in the same manner those subchapters apply to an investigation of an elderly person or person with a disability and the provision of protective services to that person.


(b) The department shall investigate the report under rules developed by the executive commissioner.


(c) If a report under this section relates to a child with an intellectual disability receiving services in a state supported living center or the ICF-IID component of the Rio Grande State Center, the department shall, within one hour of receiving the report, notify the facility in which the child is receiving services of the allegations in the report.


(d) If during the course of the department's investigation of reported abuse, neglect, or exploitation a caseworker of the department or the caseworker's supervisor has cause to believe that a child with an intellectual disability described by Subsection (c) has been abused, neglected, or exploited by another person in a manner that constitutes a criminal offense under any law, including Section 22.04, Penal Code, the caseworker shall immediately notify the Health and Human Services Commission's office of inspector general and promptly provide the commission's office of inspector general with a copy of the department's investigation report.


(e) The definitions of "abuse" and "neglect" prescribed by Section 261.001 do not apply to an investigation under this section.


(f) Repealed by Acts 2015, 84th Leg., R.S., Ch. 1272 , Sec. 19(1), and Ch. 860 , Sec. 15(1), effective September 1, 2015


Added by Acts 1995, 74th Leg., ch. 751, Sec. 100, eff. Sept. 1, 1995. Amended by Acts 1999, 76th Leg., ch. 907, Sec. 39, eff. Sept. 1, 1999.


Amended by:


Acts 2009, 81st Leg., R.S., Ch. 284 (S.B. 643), Sec. 7, eff. June 11, 2009.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.146, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 860 (S.B. 1880), Sec. 11, eff. September 1, 2015.


Acts 2015, 84th Leg., R.S., Ch. 860 (S.B. 1880), Sec. 12, eff. September 1, 2015.


Acts 2015, 84th Leg., R.S., Ch. 860 (S.B. 1880), Sec. 15(1), eff. September 1, 2015.


Acts 2015, 84th Leg., R.S., Ch. 1272 (S.B. 760), Sec. 1, eff. September 1, 2015.


Acts 2015, 84th Leg., R.S., Ch. 1272 (S.B. 760), Sec. 2, eff. September 1, 2015.


Acts 2015, 84th Leg., R.S., Ch. 1272 (S.B. 760), Sec. 19(1), eff. September 1, 2015.


Sec. 261.405. INVESTIGATIONS IN JUVENILE JUSTICE PROGRAMS AND FACILITIES. (a) Notwithstanding Section 261.001, in this section:


(1) "Abuse" means an intentional, knowing, or reckless act or omission by an employee, volunteer, or other individual working under the auspices of a facility or program that causes or may cause emotional harm or physical injury to, or the death of, a child served by the facility or program as further described by rule or policy.


(2) "Exploitation" means the illegal or improper use of a child or of the resources of a child for monetary or personal benefit, profit, or gain by an employee, volunteer, or other individual working under the auspices of a facility or program as further described by rule or policy.


(3) "Juvenile justice facility" means a facility operated wholly or partly by the juvenile board, by another governmental unit, or by a private vendor under a contract with the juvenile board, county, or other governmental unit that serves juveniles under juvenile court jurisdiction. The term includes:


(A) a public or private juvenile pre-adjudication secure detention facility, including a holdover facility;


(B) a public or private juvenile post-adjudication secure correctional facility except for a facility operated solely for children committed to the Texas Juvenile Justice Department; and


(C) a public or private non-secure juvenile post-adjudication residential treatment facility that is not licensed by the Department of Family and Protective Services or the Department of State Health Services.


(4) "Juvenile justice program" means a program or department operated wholly or partly by the juvenile board or by a private vendor under a contract with a juvenile board that serves juveniles under juvenile court jurisdiction. The term includes:


(A) a juvenile justice alternative education program;


(B) a non-residential program that serves juvenile offenders under the jurisdiction of the juvenile court; and


(C) a juvenile probation department.


(5) "Neglect" means a negligent act or omission by an employee, volunteer, or other individual working under the auspices of a facility or program, including failure to comply with an individual treatment plan, plan of care, or individualized service plan, that causes or may cause substantial emotional harm or physical injury to, or the death of, a child served by the facility or program as further described by rule or policy.


(b) A report of alleged abuse, neglect, or exploitation in any juvenile justice program or facility shall be made to the Texas Juvenile Justice Department and a local law enforcement agency for investigation.


(c) The Texas Juvenile Justice Department shall make a prompt, thorough investigation as provided by this chapter if that department receives a report of alleged abuse, neglect, or exploitation in any juvenile justice program or facility. The primary purpose of the investigation shall be the protection of the child.


(d) In an investigation required under this section, the investigating agency shall have access to medical and mental health records as provided by Subchapter D.


(e) As soon as practicable after a child is taken into custody or placed in a juvenile justice facility or juvenile justice program, the facility or program shall provide the child's parents with:


(1) information regarding the reporting of suspected abuse, neglect, or exploitation of a child in a juvenile justice facility or juvenile justice program to the Texas Juvenile Justice Department; and


(2) the Texas Juvenile Justice Department's toll-free number for this reporting.


Added by Acts 1995, 74th Leg., ch. 751, Sec. 100, eff. Sept. 1, 1995. Amended by Acts 1997, 75th Leg., ch. 162, Sec. 2; Acts 1997, 75th Leg., ch. 1374, Sec. 8, eff. Sept. 1, 1997; Acts 1999, 76th Leg., ch. 1150, Sec. 7, eff. Sept. 1, 1999; Acts 1999, 76th Leg., ch. 1390, Sec. 26, eff. Sept. 1, 1999; Acts 1999, 76th Leg., ch. 1477, Sec. 26, eff. Sept. 1, 1999; Acts 2001, 77th Leg., ch. 1297, Sec. 47, eff. Sept. 1, 2001; Acts 2003, 78th Leg., ch. 283, Sec. 29, eff. Sept. 1, 2003.


Amended by:


Acts 2005, 79th Leg., Ch. 949 (H.B. 1575), Sec. 28, eff. September 1, 2005.


Acts 2007, 80th Leg., R.S., Ch. 908 (H.B. 2884), Sec. 30, eff. September 1, 2007.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.147, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 734 (H.B. 1549), Sec. 83, eff. September 1, 2015.


Acts 2017, 85th Leg., R.S., Ch. 319 (S.B. 11), Sec. 11, eff. September 1, 2017.


Acts 2017, 85th Leg., R.S., Ch. 1136 (H.B. 249), Sec. 6, eff. September 1, 2017.


Sec. 261.406. INVESTIGATIONS IN SCHOOLS. (a) On receipt of a report of alleged or suspected abuse or neglect of a child in a public or private school, the department shall perform an investigation as provided by this chapter.


(b) The department shall send a copy of the completed report of the department's investigation to the Texas Education Agency or, in the case of a private school, the school's chief executive officer. On request, the department shall provide a copy of the completed report of the department's investigation to the State Board for Educator Certification, the local school board or the school's governing body, the superintendent of the school district, the public school principal or director, or the chief executive officer of the private school, unless the principal, director, or chief executive officer is alleged to have committed the abuse or neglect, for appropriate action. On request, the department shall provide a copy of the report of investigation to the parent, managing conservator, or legal guardian of a child who is the subject of the investigation and to the person alleged to have committed the abuse or neglect. The report of investigation shall be edited to protect the identity of the persons who made the report of abuse or neglect. Except as otherwise provided by this subsection, Section 261.201(b) applies to the release of the report relating to the investigation of abuse or neglect under this section and to the identity of the person who made the report of abuse or neglect.


(c) Nothing in this section may prevent a law enforcement agency from conducting an investigation of a report made under this section.


(d) The executive commissioner shall adopt rules necessary to implement this section.


Added by Acts 1995, 74th Leg., ch. 751, Sec. 100, eff. Sept. 1, 1995. Amended by Acts 1997, 75th Leg., ch. 575, Sec. 18, eff. Sept. 1, 1997; Acts 1999, 76th Leg., ch. 1150, Sec. 8, eff. Sept. 1, 1999; Acts 1999, 76th Leg., ch. 1390, Sec. 27, eff. Sept. 1, 1999.


Amended by:


Acts 2005, 79th Leg., Ch. 213 (H.B. 1970), Sec. 2, eff. September 1, 2005.


Acts 2007, 80th Leg., R.S., Ch. 1372 (S.B. 9), Sec. 14, eff. June 15, 2007.


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.148, eff. April 2, 2015.


Acts 2015, 84th Leg., R.S., Ch. 944 (S.B. 206), Sec. 22, eff. September 1, 2015.


Acts 2019, 86th Leg., R.S., Ch. 987 (S.B. 1231), Sec. 3, eff. September 1, 2019.


Sec. 261.407. MINIMUM STANDARDS. (a) The executive commissioner by rule shall adopt minimum standards for the investigation under Section 261.401 of suspected child abuse, neglect, or exploitation in a facility.


(b) A rule or policy adopted by a state agency or institution under Section 261.401 must be consistent with the minimum standards adopted by the executive commissioner.


(c) This section does not apply to a facility under the jurisdiction of the Texas Department of Criminal Justice or the Texas Juvenile Justice Department.


Added by Acts 2001, 77th Leg., ch. 355, Sec. 5, eff. Sept. 1, 2001.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.149, eff. April 2, 2015.


Sec. 261.408. INFORMATION COLLECTION. (a) The executive commissioner by rule shall adopt uniform procedures for collecting information under Section 261.401, including procedures for collecting information on deaths that occur in facilities.


(b) The department shall receive and compile information on investigations in facilities. An agency submitting information to the department is responsible for ensuring the timeliness, accuracy, completeness, and retention of the agency's reports.


(c) This section does not apply to a facility under the jurisdiction of the Texas Department of Criminal Justice or the Texas Juvenile Justice Department.


Added by Acts 2001, 77th Leg., ch. 355, Sec. 5, eff. Sept. 1, 2001.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 1.150, eff. April 2, 2015.


Sec. 261.409. INVESTIGATIONS IN FACILITIES UNDER TEXAS JUVENILE JUSTICE DEPARTMENT JURISDICTION. The board of the Texas Juvenile Justice Department by rule shall adopt standards for:


(1) the investigation under Section 261.401 of suspected child abuse, neglect, or exploitation in a facility under the jurisdiction of the Texas Juvenile Justice Department; and


(2) compiling information on those investigations.


Added by Acts 2001, 77th Leg., ch. 355, Sec. 6, eff. Sept. 1, 2001.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 734 (H.B. 1549), Sec. 84, eff. September 1, 2015.


Sec. 261.410. REPORT OF ABUSE BY OTHER CHILDREN. (a) In this section:


(1) "Physical abuse" means:


(A) physical injury that results in substantial harm to the child requiring emergency medical treatment and excluding an accident or reasonable discipline by a parent, guardian, or managing or possessory conservator that does not expose the child to a substantial risk of harm; or


(B) failure to make a reasonable effort to prevent an action by another person that results in physical injury that results in substantial harm to the child.


(2) "Sexual abuse" means:


(A) sexual conduct harmful to a child's mental, emotional, or physical welfare; or


(B) failure to make a reasonable effort to prevent sexual conduct harmful to a child.


(b) An agency that operates, licenses, certifies, or registers a facility shall require a residential child-care facility to report each incident of physical or sexual abuse committed by a child against another child.


(c) Using information received under Subsection (b), the agency that operates, licenses, certifies, or registers a facility shall, subject to the availability of funds, compile a report that includes information:


(1) regarding the number of cases of physical and sexual abuse committed by a child against another child;


(2) identifying the residential child-care facility;


(3) regarding the date each allegation of abuse was made;


(4) regarding the date each investigation was started and concluded;


(5) regarding the findings and results of each investigation; and


(6) regarding the number of children involved in each incident investigated.


Added by Acts 2005, 79th Leg., Ch. 268 (S.B. 6), Sec. 1.31, eff. September 1, 2005.


SUBCHAPTER F. PROTECTIVE ORDER IN CERTAIN CASES OF ABUSE OR NEGLECT



Sec. 261.501. FILING APPLICATION FOR PROTECTIVE ORDER IN CERTAIN CASES OF ABUSE OR NEGLECT. The department may file an application for a protective order for a child's protection under this subchapter on the department's own initiative or jointly with a parent, relative, or caregiver of the child who requests the filing of the application if the department:


(1) has temporary managing conservatorship of the child;


(2) determines that:


(A) the child:


(i) is a victim of abuse or neglect; or


(ii) has a history of being abused or neglected; and


(B) there is a threat of:


(i) immediate or continued abuse or neglect to the child;


(ii) someone illegally taking the child from the home in which the child is placed;


(iii) behavior that poses a threat to the caregiver with whom the child is placed; or


(iv) someone committing an act of violence against the child or the child's caregiver; and


(3) is not otherwise authorized to apply for a protective order for the child's protection under Chapter 82.


Added by Acts 2017, 85th Leg., R.S., Ch. 317 (H.B. 7), Sec. 14, eff. September 1, 2017.


Sec. 261.502. CERTIFICATION OF FINDINGS. (a) In making the application under this subchapter, the department must certify that:


(1) the department has diligently searched for and:


(A) was unable to locate the child's parent, legal guardian, or custodian, other than the respondent to the application; or


(B) located and provided notice of the proposed application to the child's parent, legal guardian, or custodian, other than the respondent to the application; and


(2) if applicable, the relative or caregiver who is jointly filing the petition, or with whom the child would reside following an entry of the protective order, has not abused or neglected the child and does not have a history of abuse or neglect.


(b) An application for a temporary ex parte order under Section 261.503 may be filed without making the findings required by Subsection (a) if the department certifies that the department believes there is an immediate danger of abuse or neglect to the child.


Added by Acts 2017, 85th Leg., R.S., Ch. 317 (H.B. 7), Sec. 14, eff. September 1, 2017.


Sec. 261.503. TEMPORARY EX PARTE ORDER. If the court finds from the information contained in an application for a protective order that there is an immediate danger of abuse or neglect to the child, the court, without further notice to the respondent and without a hearing, may enter a temporary ex parte order for the protection of the child.


Added by Acts 2017, 85th Leg., R.S., Ch. 317 (H.B. 7), Sec. 14, eff. September 1, 2017.


Sec. 261.504. REQUIRED FINDINGS; ISSUANCE OF PROTECTIVE ORDER. (a) At the close of a hearing on an application for a protective order under this subchapter, the court shall find whether there are reasonable grounds to believe that:


(1) the child:


(A) is a victim of abuse or neglect; or


(B) has a history of being abused or neglected; and


(2) there is a threat of:


(A) immediate or continued abuse or neglect to the child;


(B) someone illegally taking the child from the home in which the child is placed;


(C) behavior that poses a threat to the caregiver with whom the child is placed; or


(D) someone committing an act of violence against the child or the child's caregiver.


(a-1) In making a determination whether the child is or has been a victim of abuse or neglect, the court shall consider the opinion of a medical professional obtained by an individual against whom a protective order is sought.


(b) If the court makes an affirmative finding under Subsection (a), the court shall issue a protective order that includes a statement of that finding.


Added by Acts 2017, 85th Leg., R.S., Ch. 317 (H.B. 7), Sec. 14, eff. September 1, 2017.


Amended by:


Acts 2021, 87th Leg., R.S., Ch. 1047 (S.B. 1578), Sec. 4, eff. September 1, 2021.


Sec. 261.505. APPLICATION OF OTHER LAW. To the extent applicable, except as otherwise provided by this subchapter, Title 4 applies to a protective order issued under this subchapter.


Added by Acts 2017, 85th Leg., R.S., Ch. 317 (H.B. 7), Sec. 14, eff. September 1, 2017.

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FAMILY CODE CHAPTER 261. INVESTIGATION OF REPORT OF CHILD ABUSE OR NEGLECT

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FAMILY CODE TITLE 5. THE PARENT-CHILD RELATIONSHIP AND THE SUIT AFFECTING THE PARENT-CHILD RELATIONSHIP SUBTITLE E. PROTECTION OF THE CHILD CHAPTER 261. INVESTIGATION OF REPORT OF CHILD ABUSE OR NEGLECT SUBCHAPTER A. GENERAL PROVISIONS Sec. 261.001. DEFINITIONS.

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Australian Government Response Ability Initiative. (2015). Attention deficit hyperactivity disorder. http://responseability.org

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Home - ADDA - Attention Deficit Disorder Association

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

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

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

1. Emotional and Behavior Disorders (EBD)

2. Emotional Conflict (EC)

3. Serious Emotional Disturbance (SED)

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

General Strategies

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

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

Teacher Presentation

Laboratory

Group Interaction and Discussion

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

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

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

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

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

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

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

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

Reading

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

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

2. Reading in group or with others.

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

4. Demonstrating appropriate reading

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

Research

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

2. Use appropriate laboratory and field strategies.

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

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

Field Experiences

1. Use appropriate general strategies.

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

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

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

5. Use a buddy system.

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

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

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

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

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

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

Testing

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

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

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

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

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

Organizations

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

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

Resources

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

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

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

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Resource Guide for Bipolar and Depressive Disorders

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Resource Guide for Bipolar and Depressive Disorders

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Azle ISD Resource Guide Bipolar and Depressive Disorders

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Student Crisis Intervention - Westwood Protocol Flow Chart

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Teacher Flow Chart for Student Issues - Sheet1 (1)

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Sendable Understanding Trauma and its Impact NCSSLE

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Trauma Informed Teaching and Learning During a Global Health Crisis