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When Is Anxiety Normal?

It's normal to feel anxious, nervous, or worried at times. Maybe you've felt anxious when you had to talk in front of a group. Or nervous before a tryout or a big test. Maybe you have felt anxious when you weren't sure your surroundings were safe. Or worried when a loved one was sick.

Most people have felt like this.

Anxious feelings can be uncomfortable - but they serve a purpose. They warn that something that matters to you is at stake. With anxious feelings, you might think, "I need to do well here." Or, "This counts - get ready." Or, "Be careful."

Anxiety sets off the body's fight-or-flight response. This is also called the stress response. It's a normal release of hormones that helps you gather the focus and energy you need for a challenge or possible threat. The fight-or-flight response causes the physical feelings that can happen with anxiety.

For example, when you're anxious, you might feel 'butterflies' in your stomach. Or you might have sweaty palms or shaky hands. You might notice your mouth is a little dry. Or your face feels a little warm. You might feel your breathing or heartbeat get faster. With anxiety, you might feel one - or a few - of these.

Feelings like these can help you do what you need to do. You can go ahead with the tryout or take the exam - even though you're nervous. You can check your surroundings to make sure you're safe. You can focus on what a loved one needs and plan how to help instead of getting caught up in the worry.

When you know that anxiety is normal for the situation, you can let go of focusing all your attention on the anxious thoughts and feelings. Instead, you can turn your attention to what you need to do. You don't need to do things to make anxiety 'go away.' You can take a breath and face the challenge. You'll find that anxiety fades on its own.

When Is Anxiety a Problem?

Some people feel anxiety that is too intense. It seems like more than they can cope with. Worries or fears take up too much of their time and energy. Some people might begin to avoid things that make them anxious. These things can be signs of an anxiety disorder.

If you feel like anxiety is too much, tell a parent, school counselor, or your doctor. There are treatments for anxiety disorders. The sooner you start getting help, the better you will feel.

Date reviewed: March 2022

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Anxiety is a natural part of life, and most of us experience it from time to time. Find out about normal anxiety and learn when anxiety can develop into a problem for some people.

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Overview

Teen depression is a serious mental health problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how your teenager thinks, feels and behaves, and it can cause emotional, functional and physical problems. Although depression can occur at any time in life, symptoms may be different between teens and adults.

Issues such as peer pressure, academic expectations and changing bodies can bring a lot of ups and downs for teens. But for some teens, the lows are more than just temporary feelings - they're a symptom of depression.

Teen depression isn't a weakness or something that can be overcome with willpower - it can have serious consequences and requires long-term treatment. For most teens, depression symptoms ease with treatment such as medication and psychological counseling.

Symptoms

Teen depression signs and symptoms include a change from the teenager's previous attitude and behavior that can cause significant distress and problems at school or home, in social activities, or in other areas of life.

Depression symptoms can vary in severity, but changes in your teen's emotions and behavior may include the examples below.

Emotional changes

Be alert for emotional changes, such as:

Feelings of sadness, which can include crying spells for no apparent reason

Frustration or feelings of anger, even over small matters

Feeling hopeless or empty

Irritable or annoyed mood

Loss of interest or pleasure in usual activities

Loss of interest in, or conflict with, family and friends

Low self-esteem

Feelings of worthlessness or guilt

Fixation on past failures or exaggerated self-blame or self-criticism

Extreme sensitivity to rejection or failure, and the need for excessive reassurance

Trouble thinking, concentrating, making decisions and remembering things

Ongoing sense that life and the future are grim and bleak

Frequent thoughts of death, dying or suicide

Behavioral changes

Watch for changes in behavior, such as:

Tiredness and loss of energy

Insomnia or sleeping too much

Changes in appetite - decreased appetite and weight loss, or increased cravings for food and weight gain

Use of alcohol or drugs

Agitation or restlessness - for example, pacing, hand-wringing or an inability to sit still

Slowed thinking, speaking or body movements

Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse

Social isolation

Poor school performance or frequent absences from school

Less attention to personal hygiene or appearance

Angry outbursts, disruptive or risky behavior, or other acting-out behaviors

Self-harm - for example, cutting or burning

Making a suicide plan or a suicide attempt

What's normal and what's not

It can be difficult to tell the difference between ups and downs that are just part of being a teenager and teen depression. Talk with your teen. Try to determine whether he or she seems capable of managing challenging feelings, or if life seems overwhelming.

When to see a doctor

If depression signs and symptoms continue, begin to interfere in your teen's life, or cause you to have concerns about suicide or your teen's safety, talk to a doctor or a mental health professional trained to work with adolescents. Your teen's family doctor or pediatrician is a good place to start. Or your teen's school may recommend someone.

Depression symptoms likely won't get better on their own - and they may get worse or lead to other problems if untreated. Depressed teenagers may be at risk of suicide, even if signs and symptoms don't appear to be severe.

If you're a teen and you think you may be depressed - or you have a friend who may be depressed - don't wait to get help. Talk to a health care provider such as your doctor or school nurse. Share your concerns with a parent, a close friend, a spiritual leader, a teacher or someone else you trust.

Symptoms

Suicide is often associated with depression. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

Call your mental health professional.

Contact a suicide hotline.

In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. The Spanish language phone line is 1-888-628-9454 (toll-free). Services are free and confidential.

Or contact a crisis service for teenagers in the U.S. called TXT 4 HELP: Text the word "safe" and your current location to 4HELP (44357) for immediate help, with the option for interactive texting.

Seek help from your primary care doctor or other health care provider.

Reach out to a close friend or loved one.

Contact a minister, spiritual leader or someone else in your faith community.

If a loved one or friend is in danger of attempting suicide or has made an attempt:

Make sure someone stays with that person.

Call 911 or your local emergency number immediately.

Or, if you can do so safely, take the person to the nearest hospital emergency room.

Never ignore comments or concerns about suicide. Always take action to get help.

Causes

It's not known exactly what causes depression, but a variety of issues may be involved. These include:

Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When these chemicals are abnormal or impaired, the function of nerve receptors and nerve systems changes, leading to depression.

Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression.

Inherited traits. Depression is more common in people whose blood relatives - such as a parent or grandparent - also have the condition.

Early childhood trauma. Traumatic events during childhood, such as physical or emotional abuse, or loss of a parent, may cause changes in the brain that increase the risk of depression.

Learned patterns of negative thinking. Teen depression may be linked to learning to feel helpless - rather than learning to feel capable of finding solutions for life's challenges.

Risk factors

Many factors increase the risk of developing or triggering teen depression, including:

Having issues that negatively impact self-esteem, such as obesity, peer problems, long-term bullying or academic problems

Having been the victim or witness of violence, such as physical or sexual abuse

Having other mental health conditions, such as bipolar disorder, an anxiety disorder, a personality disorder, anorexia or bulimia

Having a learning disability or attention-deficit/hyperactivity disorder (ADHD)

Having ongoing pain or a chronic physical illness such as cancer, diabetes or asthma

Having certain personality traits, such as low self-esteem or being overly dependent, self-critical or pessimistic

Abusing alcohol, nicotine or other drugs

Being gay, lesbian, bisexual or transgender in an unsupportive environment

Family history and issues with family or others may also increase your teenager's risk of depression, such as:

Having a parent, grandparent or other blood relative with depression, bipolar disorder or alcohol use problems

Having a family member who died by suicide

Having a family with major communication and relationship problems

Having experienced recent stressful life events, such as parental divorce, parental military service or the death of a loved one

Complications

Untreated depression can result in emotional, behavioral and health problems that affect every area of your teenager's life. Complications related to teen depression may include, for example:

Alcohol and drug misuse

Academic problems

Family conflicts and relationship difficulties

Suicide attempts or suicide

Prevention

There's no sure way to prevent depression. However, these strategies may help. Encourage your teenager to:

Take steps to control stress, increase resilience and boost self-esteem to help handle issues when they arise

Practice self-care, for example by creating a healthy sleep routine and using electronics responsibly and in moderation

Reach out for friendship and social support, especially in times of crisis

Get treatment at the earliest sign of a problem to help prevent depression from worsening

Maintain ongoing treatment, if recommended, even after symptoms let up, to help prevent a relapse of depression symptoms

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This serious mental health problem affects how your teenager thinks, feels and behaves, and can cause emotional, functional and physical problems.

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Overview

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).
Bipolar disorder care at Mayo Clinic
Symptoms

There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.

Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).

Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.

Cyclothymic disorder. You've had at least two years - or one year in children and teenagers - of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).

Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.

Mania and hypomania

Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.

Both a manic and a hypomanic episode include three or more of these symptoms:

Abnormally upbeat, jumpy or wired

Increased activity, energy or agitation

Exaggerated sense of well-being and self-confidence (euphoria)

Decreased need for sleep

Unusual talkativeness

Racing thoughts

Distractibility

Poor decision-making - for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episode

A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:

Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)

Marked loss of interest or feeling no pleasure in all - or almost all - activities

Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)

Either insomnia or sleeping too much

Either restlessness or slowed behavior

Fatigue or loss of energy

Feelings of worthlessness or excessive or inappropriate guilt

Decreased ability to think or concentrate, or indecisiveness

Thinking about, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Symptoms in children and teens

Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.

The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

When to see a doctor

Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need.

And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out - and perhaps in financial, legal or relationship trouble.

If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

Causes

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.

Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

Risk factors

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

Having a first-degree relative, such as a parent or sibling, with bipolar disorder

Periods of high stress, such as the death of a loved one or other traumatic event

Drug or alcohol abuse

Complications

Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:

Problems related to drug and alcohol use

Suicide or suicide attempts

Legal or financial problems

Damaged relationships

Poor work or school performance

Co-occurring conditions

If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include:

Anxiety disorders

Eating disorders

Attention-deficit/hyperactivity disorder (ADHD)

Alcohol or drug problems

Physical health problems, such as heart disease, thyroid problems, headaches or obesity

Prevention

There's no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.

If you've been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you're falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.

Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.

Take your medications exactly as directed. You may be tempted to stop treatment - but don't. Stopping your medication or reducing your dose on your own may cause withdrawal effects or your symptoms may worsen or return.

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Bipolar disorder causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

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Understanding teen depression

The teen years can be extremely tough and depression affects teenagers far more often than many of us realize. In fact, it's estimated that one in five adolescents from all walks of life will suffer from depression at some point during their teen years. However, while depression is highly treatable, most depressed teens never receive help.

Teen depression goes beyond moodiness. It's a serious health problem that impacts every aspect of a teen's life. Fortunately, it's treatable and parents can help. Your love, guidance, and support can go a long way toward helping your teen overcome depression and get their life back on track.

If you're a teen feeling depressed...

Is my teen depressed?

While occasional bad moods or acting out is to be expected during the teenage years, depression is something different. The negative effects of teenage depression go far beyond a melancholy mood. Depression can destroy the essence of your teen's personality, causing an overwhelming sense of sadness, despair, or anger.

Many rebellious and unhealthy behaviors or attitudes in teenagers can be indications of depression. The following are some the ways in which teens "act out" in an attempt to cope with their emotional pain:

Persistent negative mood. Frequent crying due to an overwhelming sense of hopelessness is a common sign of depression. However, teens with depression may not necessarily appear sad. Instead, irritability, anger, and agitation may be the most prominent symptoms.

Problems at school. Depression can cause low energy and concentration difficulties. At school, this may lead to poor attendance, a drop in grades, or frustration with schoolwork in a formerly good student.

Loss of interest in activities. Outside of school, you might notice that your teen shows less enthusiasm for their favorite hobbies. They may quit a sports team or hobby, for example, or withdraw from family and friends.

Running away. Many depressed teens run away from home or talk about running away. Such attempts are usually a cry for help.

Drug and alcohol abuse. Teens may use alcohol or drugs in an attempt to self-medicate their depression. Unfortunately, substance abuse only makes things worse.

Low self-esteem. Depression can trigger and intensify feelings of ugliness, shame, failure, and unworthiness.

Smartphone addiction. Teens may go online to escape their problems, but excessive smartphone and Internet use only increases their isolation, making them more depressed.

Reckless behavior. Depressed teens may engage in dangerous or high-risk behaviors, such as reckless driving, binge drinking, and unsafe sex.
[Read: Help for Parents of Troubled Teens]
Violence. Some depressed teens-usually boys who are the victims of bullying -can become aggressive and violent.

Sudden changes in sleep and diet. Depressed teens may spend more time sleeping in bed than usual, or conversely, experience insomnia. You may also notice that your teen is eating more or less than normal.

While depression can cause tremendous pain for your teen-and disrupt everyday family life-there are plenty of things you can do to help your child start to feel better. The first step is to learn what teen depression looks like and what to do if you spot the warning signs.

Depression in teens vs. adults

Depression in teens can look very different from depression in adults. The following signs and symptoms are more common in teenagers than in their adult counterparts:

Irritable or angry mood. As noted, irritability, rather than sadness, is often the predominant mood in depressed teens. A depressed teenager may be grumpy, hostile, easily frustrated, or prone to angry outbursts.

Unexplained aches and pains. Depressed teens frequently complain about physical ailments such as headaches or stomachaches. If a thorough physical exam does not reveal a medical cause, these aches and pains may indicate depression.

Extreme sensitivity to criticism. Depressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure. This is a particular problem for "over-achievers."

Withdrawing from some, but not all people. While adults tend to isolate themselves when depressed, teenagers usually keep up at least some friendships. However, teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd.

Is it depression or teenage "growing pains"?

If you're unsure if your teen is depressed or just "being a teenager," consider how long the symptoms have been going on, how severe they are, and how different your teen is acting from their usual self. Hormones and stress can explain the occasional bout of teenage angst-but not continuous and unrelenting unhappiness, lethargy, or irritability.

Suicide warning signs in depressed teens

Seriously depressed teens, especially those who also abuse alcohol or drugs, often think about, speak of, or make attempts at suicide-and an alarming and increasing number are successful. So it's vital that you take any suicidal thoughts or behaviors very seriously. They're a cry for help from your teen.

Suicide warning signs to watch for

Talking or joking about committing suicide

Saying things like, "I'd be better off dead," "I wish I could disappear forever," or "There's no way out"

Speaking positively about death or romanticizing dying ("If I died, people might love me more")

Writing stories and poems about death, dying, or suicide

Engaging in reckless behavior or having a lot of accidents resulting in injury

Giving away prized possessions

Saying goodbye to friends and family as if for the last time

Seeking out weapons, pills, or other ways to kill themselves

Get help for a suicidal teen

Causes of teen depression

Biological factors, such as genes, can increase a teen's risk of developing depression. However, environmental and social conditions also have a role to play. The following factors may trigger or exacerbate symptoms of depression in your teen:

Bullying. Being bullied by peers can add stress to a teen's life and affect their self-esteem. This can, in turn, trigger feelings of intense helplessness and hopelessness.

Other mental and physical health conditions. Teen depression is associated with a number of other mental health problems, including eating disorders, self-injury, anxiety, ADHD, or a learning disorder. The struggles that accompany these conditions may lead a teen to feel unconfident and frustrated when it comes to academics and socializing. Similarly, physical disabilities or chronic illness can also play a role.

Past and present stressful experiences. Past trauma from violent or abusive situations can put teens at risk of depression as well as post-traumatic stress disorder (PTSD). Recent events, such as the loss of a loved one, can also trigger a depressed mood.

Lack of social support. Teens who feel unsupported by family or peers are at risk of depression. For example, a teen may be struggling with their sexual identity in a hostile or unaccepting environment.

Other causes of teen depression can include alcohol and drug abuse, family problems, and academic struggles. Depression can cause or worsen these issues as well, creating a cycle that needs to be broken.

Depression and social media use

Some studies draw a connection between teen depression and social media use. Teens that spend more time on social media tend to report higher rates of depression than their peers. Several explanations may explain this connection:

Online interactions may be emotionally unsatisfying or increase fear of missing out (FOMO). For example, your teen may see images of their peers enjoying time together and feel excluded.

Teens on social media may spend lots of time comparing their looks and their lives with those of their peers. This can damage self-esteem.

Spending time on social media may decrease the amount of time your teen spends being physically active or developing skills. Some studies show that a sedentary lifestyle can have a negative effect on mental health.

Too much time on social media may interfere with your teen's sleep routine, indirectly affecting their mood.

How to help a depressed teenager

Depression is very damaging when left untreated, so don't wait and hope that worrisome symptoms will go away. If you suspect that your teen is depressed, bring up your concerns in a loving, non-judgmental way. Even if you're unsure that depression is the issue, the troublesome behaviors and emotions you're seeing are signs of a problem that should be addressed.

Open up a dialogue by letting your teen know what specific depression symptoms you've noticed and why they worry you. Then ask your child to share what they're going through-and be ready and willing to truly listen. Hold back from asking a lot of questions (most teenagers don't like to feel patronized or crowded), but make it clear that you're ready and willing to provide whatever support they need.

How to communicate with a depressed teen

Focus on listening, not lecturing. Resist any urge to criticize or pass judgment once your teenager begins to talk. The important thing is that your child is communicating. You'll do the most good by simply letting your teen know that you're there for them, fully and unconditionally.

Be gentle but persistent. Don't give up if they shut you out at first. Talking about depression can be very tough for teens. Even if they want to, they may have a hard time expressing what they're feeling. Be respectful of your child's comfort level while still emphasizing your concern and willingness to listen.

Acknowledge their feelings. Don't try to talk your teen out of depression, even if their feelings or concerns appear silly or irrational to you. Well-meaning attempts to explain why "things aren't that bad" will just come across as if you don't take their emotions seriously. Simply acknowledging the pain and sadness they are experiencing can go a long way in making them feel understood and supported.

Trust your gut. If your teen claims nothing is wrong but has no explanation for what is causing the depressed behavior, you should trust your instincts. If your teen won't open up to you, consider turning to a trusted third party: a school counselor, favorite teacher, or a mental health professional. The important thing is to get them talking to someone.

Helping a depressed teen tip 1: Encourage social connection

Depressed teens tend to withdraw from their friends and the activities they used to enjoy. But isolation only makes depression worse, so do what you can to help your teen reconnect.

Make face time a priority. Set aside time each day to talk-time when you're focused totally on your teen, without distractions or trying to multi-task. The simple act of connecting face to face can play a big role in reducing your teen's depression. And remember: talking about depression or your teen's feelings will not make the situation worse, but your support can make all the difference in their recovery.

Combat social isolation. Do what you can to keep your teen connected to others. Encourage them to go out with friends or invite friends over. Participate in activities that involve other families and give your child an opportunity to meet and connect with other kids.

Try to reduce their social media use. Remind your teen that social media isn't an ideal substitute for face-to-face interactions. Encourage them to turn off their phone-or at least disable notifications-when socializing in person, focusing on work, or preparing for bed.

Get your teen involved. Suggest activities-such as sports, after-school clubs, or an art, dance, or music class-that take advantage of your teen's interests and talents. While your teen may lack motivation and interest at first, as they reengage with the world, they should start to feel better and regain their enthusiasm.

Promote volunteerism. Doing things for others is a powerful antidepressant and self-esteem booster. Help your teen find a cause they're interested in and that gives them a sense of purpose. If you volunteer with them, it can also be a good bonding experience.

Tip 2: Make physical health a priority

Physical and mental health are inextricably connected. Depression is exacerbated by inactivity, inadequate sleep, and poor nutrition. Unfortunately, teens are known for their unhealthy habits: staying up late, eating junk food, and spending hours on their phones and devices. But as a parent, you can combat these behaviors by establishing a healthy, supportive home environment.

Get your teen moving! Exercise is absolutely essential to mental health, so get your teen active-whatever it takes. Ideally, teens should be getting at least an hour of physical activity a day, but it needn't be boring or miserable. Think outside the box: walking the dog, dancing, shooting hoops, going for a hike, riding bikes, skateboarding-as long as they're moving, it's beneficial.

Set limits on screen time. Teens often go online to escape their problems, but when screen time goes up, physical activity and face time with friends goes down. Both are a recipe for worsening symptoms. Gently encourage your teen to take an occasional vacation from their devices or engage in family activities that don't involve screen time. You can also set an example by reducing your own time spent online.

Provide nutritious, balanced meals. Make sure your teen is getting the nutrition they need for optimum brain health and mood support: things like healthy fats, quality protein, and fresh produce. Eating a lot of sugary, starchy foods -the quick "pick me up" of many depressed teens-will only have a negative effect on their mood and energy.

Encourage plenty of sleep. Teens need more sleep than adults to function optimally-up to 9-10 hours per night. Make sure your teen isn't staying up until all hours at the expense of much-needed, mood-supporting rest.

Tip 3: Know when to seek professional help

Support and healthy lifestyle changes can make a world of difference for depressed teens, but it's not always enough. When depression is severe, don't hesitate to seek professional help from a mental health professional with advanced training and a strong background treating teens.

Involve your child in treatment choices

When choosing a specialist or pursuing treatment options, always get your teen's input. If you want your teen to be motivated and engaged in their treatment, don't ignore their preferences or make unilateral decisions. No one therapist is a miracle worker, and no one treatment works for everyone. If your child feels uncomfortable or is just not 'connecting' with the psychologist or psychiatrist, seek out a better fit.

Explore your options

Expect a discussion with the specialist you've chosen about depression treatment options for your teen. Talk therapy is often a good initial treatment for mild to moderate cases of depression. Over the course of therapy, your teen's depression may resolve. If it doesn't, medication may be warranted.
[Read: Finding a Therapist Who Can Help You Heal]
Unfortunately, some parents feel pushed into choosing antidepressant medication over other treatments that may be cost-prohibitive or time-intensive. However, unless your child is acting out dangerously or at risk for suicide (in which case medication and/or constant observation may be necessary), you have time to carefully weigh your options. In all cases, antidepressants are most effective when part of a broader treatment plan.

Medication comes with risks

Antidepressants were designed and tested on adults, so their impact on young, developing brains is not yet fully understood. Some researchers are concerned that exposure to drugs such as Prozac may interfere with normal brain development-particularly the way the brain manages stress and regulates emotion.

Antidepressants also come with risks and side effects of their own, including a number of safety concerns specific to children and young adults. They are also known to increase the risk of suicidal thinking and behavior in some teenagers and young adults. Teens with bipolar disorder, a family history of bipolar disorder, or a history of previous suicide attempts are particularly vulnerable.

The risk of suicide is highest during the first two months of antidepressant treatment. Teenagers on antidepressants should be closely monitored for any sign that the depression is getting worse.

Teens on antidepressants: Red flags to watch out for

Tip 4: Support your teen through depression treatment

As your depressed teenager goes through treatment, the most important thing you can do is to let them know that you're there to listen and offer support. Now more than ever, your teenager needs to know that they're valued, accepted, and cared for.

Be understanding. Living with a depressed teenager can be difficult and draining. At times, you may experience exhaustion, rejection, despair, aggravation, or any other number of negative emotions. During this trying time, it's important to remember that your child is not being difficult on purpose. Your teen is suffering, so do your best to be patient and understanding.

Stay involved in treatment. Make sure your teenager is following all treatment instructions, whether it's attending therapy or correctly taking any prescribed medication. Track changes in your teen's condition, and call the doctor if depression symptoms seem to be getting worse.
[Read: Depression Treatment]
Be patient. The road to your depressed teenager's recovery may be bumpy, so be patient. Rejoice in small victories and prepare for the occasional setback. Most importantly, don't judge yourself or compare your family to others. As long as you're doing your best to get your teen the necessary help, you're doing your job.

Tip 5: Take care of yourself (and the rest of the family)

As a parent, you may find yourself focusing all your energy and attention on your depressed teen and neglecting your own needs and the needs of other family members. However, it's extremely important that you continue to take care of yourself during this difficult time.

Above all, this means reaching out for much needed support. You can't do everything on your own so enlist the help of family and friends. Having your own support system in place will help you stay healthy and positive as you work to help your teen.
[Read: Helping Someone with Depression]
Don't bottle up your emotions. It's okay to feel overwhelmed, frustrated, helpless, or angry. Reach out to friends, join a support group, or see a therapist of your own. Talking about how you're feeling will help defuse the intensity.

Look after your health. The stress of your teen's depression can affect your own moods and emotions, so support your health and well-being by eating right, getting enough sleep, and making time for things you enjoy.

Be open with the family. Don't tiptoe around the issue of teen depression in an attempt to "protect" the other children. Kids know when something is wrong. When left in the dark, their imaginations will often jump to far worse conclusions. Be open about what is going on and invite your children to ask questions and share their feelings.

Remember the siblings. Depression in one child can cause stress or anxiety in other family members, so make sure "healthy" children are not ignored. Siblings may need special individual attention or professional help of their own to handle their feelings about the situation.

Avoid the blame game. It can be easy to blame yourself or another family member for your teen's depression, but it only adds to an already stressful situation. Furthermore, depression is normally caused by a number of factors, so it's unlikely-except in the case of abuse or neglect-that any loved one is "responsible."

Depression support, suicide prevention help

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Parent's Guide to Teen Depression - HelpGuide.org

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Learn what teen depression looks like in teens and what you can do to help your child.

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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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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.

Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry. These are called obsessions. To alleviate the anxiety caused by their obsessive thoughts, they perform repetitive, ritualized actions called compulsions. A child with OCD might need to line things up, touch things in a certain order when leaving the room or wash his hands repeatedly.

Obsessions Common in Kids With OCD

Contamination: Kids with this obsession are sometimes called "germaphobes." In schools, this plays out with kids worrying about other kids sneezing and coughing, touching things that might be dirty or getting sick in many different ways. This is the most common obsession seen in children.

Magical thinking: This is a kind of superstition, like "step on a crack, break your mother's back," taken to extremes. For example, kids might worry that their thoughts can cause someone to get hurt, or get sick. A child might think, "Unless my things are lined up in a certain way, mom will get in a car accident."

Catastrophizing: Some kids easily jump to the conclusion that something terrible has happened. For example, if her parents are five minutes late picking her up, a girl who is catastrophizing might tell herself that they've decided to abandon her.

Scrupulosity: This is when kids have obsessive worries about offending God or being blasphemous in some way.

What ifs: Kids may be plagued by a lot of different kinds of thoughts about bad things they could do. "What if I hurt someone? What if I stab someone? What if I kill someone?"

The "just right feeling": When OCD first develops, from about 6 to 9 years of age, kids may not know why they are doing something, but just that they need to do it until they get what we call the "just right feeling." So: "I'll line these things up until it just kind of feels right, and then I'll stop." And then over time - in the 9- to 12-year-old range - it evolves into magical thinking and becomes more superstitious in nature.

Behaviors You Might See in Students With OCD

Frequent requests to go to the bathroom: This could be to wash hands, if someone near the child was coughing or sneezing, or if she touched something that she perceives as contaminated. She could be washing items-pens, pencils, backpacks, books. It could also be an excuse to get out the classroom and just be away from everyone, and have some respite.

Constant reassurance-seeking: This takes the form of repetitive questions. "Are you sure that's the answer? Could you tell me again? Did you hear what I said?" Checking doors, windows, lockers, desks. Over and over and over again.

Getting stuck on tasks: Sometimes kids with OCD will need to finish something to completion, or understand it to completion, before they're able to move on. So if a child is working out what he did wrong on a math test, and the teacher says, "Now let's open the textbook and start a new chapter," he's not going to be able to shift gears.

Retracing: If a child leaves the classroom and worries that she left a pencil behind, she'll go back into the classroom and go to her desk and check. If she had a bad thought as she went through the doorway, she might have to "fix it" by going back through the doorway again saying a good word. If she had a bad thought when she went down a flight of stairs on the way to class, she might need to go back up that same stairway at the end of the period, even if it means being late to her next class.

Obsessive erasing: A child could be erasing a lot because the letters have to look perfect. Or he could have used a word that disturbs him. For example, if he has a fear of vomiting and he's written the word vomit, he might not be able to stand seeing that word, so he erases it. Kids start having erasers worn down to the metal. Teachers start to see holes in the paper. Words will be drawn over on the back of the page. A lot of different areas of writing become problematic.

Behaviors Often Confused With Another Disorder

Some behaviors associated with OCD are easy to confuse with ADHD, learning problems or being oppositional.

Distraction: If a child is busy thinking that if she doesn't turn the pen cap and count to four the right way then her mom is going to get sick, she's not going to be paying attention in class. And if her teacher calls on her to answer a question, her distraction might look like ADHD, but it isn't.

Slowness on exams, papers and tasks: Sometimes when kids take a long time, they're struggling with the perfectionism of needing to do things the right way. This could look like learning problems, or inattention, but it isn't.

Avoidance: Teachers might see a child who doesn't want to sit on the floor, or pick things up that touched the floor, or get his hands dirty in art class. He may avoid a lot of playground activities - kids with germ fears will view the playground the way some adults view the subway: it's gross. Why touch anything there?

Tapping and touching symmetrically: If a child sits down at her desk and she accidentally kicks the chair of the kid next to her with her right foot, she's going to have to then kick it with her left foot. That might look like somebody who's being oppositional, or somebody who's got too much energy, but actually it's OCD.

Complaints of anxiety and fatigue: There's one interesting theory that kids with OCD are smarter than other kids. And if you consider how much thinking they're doing, they're really using their brain more frequently than a lot of other kids are. But when that's coupled with a lot of anxiety, you can have a lot of fatigue. So it's common for kids with OCD to want to come home and take a nap after school.

How to Help Students With OCD

For children struggling with OCD, functioning in school can be complicated and very difficult. Here are some things you can do to help them, and the class as a whole, focus on learning:

Seating arrangement: If the school has noisy hallways, you might not want to have a child with OCD sit by the door. You might have her sit in the front, where she's less able to hear the noise and can stay more focused on her work. On the other hand, a child who has very observable symptoms, and doesn't want other kids to see her fidgeting with her hands, rocking or getting up a lot, might be better off closer to the door, toward the back of the room.

Extended time for tests and papers: If writing is a problem for a child who needs to find the perfect way to say something, he's going to need more time to finish those essay questions or papers.

Laptops for writing: If writing and rewriting/erasing is really problematic for a child, consider letting her use a laptop for taking notes, and having all assignments be typed instead of handwritten.

Private testing rooms: Research is quite clear that kids with OCD do better, are less overwhelmed and are more in control of their thoughts and their reactions if they're in a quiet place away from the other kids.

Skip reading out loud: Kids who feel they need to read perfectly may have to go back and reread sentences or whole paragraphs over and over to make sure they've got them right. So reading becomes a very laborious task, and reading in front of the class can become a nightmare. So if we know doing this is a problem for children, we can spare them.

Books on tape: If kids get so hung up reading that it takes forever, listening to the books can be a solution.

Break homework into chunks: If looking at a whole page of math makes kids feel overwhelmed and anxious - think of the potential for mistakes! - the problems can be broken up over four pages. It helps kids stay focused on doing the problems instead of worrying.

How to Minimize Behavioral Problems

Plan an escape route: Try working out a communication system so that if the student feels symptoms coming on, she can signal to you and leave the classroom, or go to a protected place in the classroom, without interrupting the class. It can prevent an embarrassing and disruptive blowup of symptoms in the classroom, and the other kids picking on or bullying her about it.

Be aware of triggering events: It's very important for teachers to know what kind of things might trigger the symptoms. Fatigue is a huge piece of OCD, and it can be exacerbated by medication. So it's important to know that if a child is drowsy in class, and maybe he's putting his head down, it's not because he's being oppositional or disrespectful, but because he's overwhelmed with fatigue.

Advance notice: Irritability and frustration are two of the longer-lasting things that kids with OCD are feeling on a daily basis. Changes in schedule can be very disruptive for a child with OCD, so it can be helpful for teachers to give advance notice of things. Kids who know what to expect are less likely to be thrown by the change.

Children with OCD are often teased and bullied because of their symptoms. Kids feel very uncomfortable about their rituals, knowing that they're being watched. It can be helpful to educate the whole class about what's going on, especially if a child is going to be in the same school for a number of years, and it can inspire a surprising amount of support from other children.

Peer understanding program: A peer understanding program includes a presentation in the classroom that explains (with the child participating) what OCD is. The child might say, "Listen, I have OCD. It's an anxiety disorder. It makes me think that my hands are dirty and I have to wash my hands a lot, so if you see me getting up and going to the sink to wash my hands, that's why." Psychologists can role-play with the teacher and child ahead of time, to anticipate questions his classmates might ask, and how to answer them.

A buddy system: A buddy is like a peer coach who sits next to the child and prompts him to keep up with note taking and staying on task. It can be great for the buddy, to foster a sense of confidence and pride and to be able to help someone in need, and great for fostering friendship.

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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. Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry.

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This ecample is a general overview, please contact local school for their process.

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At a glance

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

IDEA covers 13 disability categories.

Not every student who struggles in school qualifies.

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

1. Specific learning disability (SLD)

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

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

2. Other health impairment

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

3. Autism spectrum disorder (ASD)

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

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

5. Speech or language impairment

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

6. Visual impairment, including blindness

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

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

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

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

10. Orthopedic impairment

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

11. Intellectual disability

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

12. Traumatic brain injury

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

13. Multiple disabilities

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

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

Key takeaways

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

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

"Other health impairment" can cover ADHD.

About the author

About the author

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

Reviewed by

Reviewed by

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

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See a list of the 13 IDEA disability categories. Find out which disabilities can qualify kids for special education.

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Overview

You might hear people talking about panic attacks and anxiety attacks like they're the same thing. They're different conditions though.

Panic attacks come on suddenly and involve intense and often overwhelming fear. They're accompanied by frightening physical symptoms, such as a racing heartbeat, shortness of breath, or nausea.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes panic attacks, and categorizes them as unexpected or expected.

Unexpected panic attacks occur without an obvious cause. Expected panic attacks are cued by external stressors, such as phobias. Panic attacks can happen to anyone, but having more than one may be a sign of panic disorder.

Anxiety attacks aren't recognized in the DSM-5. The DSM-5 does, however, define anxiety as a feature of a number of common psychiatric disorders.

Symptoms of anxiety include worry, distress, and fear. Anxiety is usually related to the anticipation of a stressful situation, experience, or event. It may come on gradually.

The lack of diagnostic recognition of anxiety attacks means that the signs and symptoms are open to interpretation.

That is, a person may describe having an "anxiety attack" and have symptoms that another has never experienced despite indicating that they too have had an "anxiety attack."

Read on to find out more about the differences between panic attacks and anxiety.

Panic and anxiety attacks may feel similar, and they share a lot of emotional and physical symptoms.

You can experience both an anxiety and a panic attack at the same time.

For instance, you might experience anxiety while worrying about a potentially stressful situation, such as an important presentation at work. When the situation arrives, anxiety may culminate in a panic attack.

Unexpected panic attacks have no clear external triggers. Expected panic attacks and anxiety can be triggered by similar things. Some common triggers include:

Anxiety and panic attacks have similar risk factors. These include:

experiencing trauma or witnessing traumatic events, either as a child or as an adult

experiencing a stressful life event, such as the death of a loved one or a divorce

experiencing ongoing stress and worries, such as work responsibilities, conflict in your family, or financial woes

living with a chronic health condition or life-threatening illness

having an anxious personality

having another mental health disorder, such as depression

having close family members who also have anxiety or panic disorders

using drugs or alcohol

People who experience anxiety are at an increased risk of experiencing panic attacks. However, having anxiety doesn't mean you will experience a panic attack.

Doctors can't diagnose anxiety attacks, but they can diagnose:

anxiety symptoms

anxiety disorders

panic attacks

panic disorders

Your doctor will ask you about your symptoms and conduct tests to rule out other health conditions with similar symptoms, such as heart disease or thyroid problems.

To get a diagnosis, your doctor may conduct:

You should speak to your doctor or another mental health professional to find out what you can do to both prevent and treat anxiety- and panic-related symptoms. Having a treatment plan and sticking to it when an attack strikes can help you feel like you're in control.

If you feel an anxiety or panic attack coming on, try the following:

Take slow deep breaths. When you feel your breath quickening, focus your attention on each inhale and exhale. Feel your stomach fill with air as you inhale. Count down from four as you exhale. Repeat until your breathing slows.

Recognize and accept what you're experiencing. If you've already experienced an anxiety or panic attack, you know that it can be incredibly frightening. Remind yourself that the symptoms will pass and you'll be alright.

Practice mindfulness. Mindfulness-based interventions are increasingly used to treat anxiety and panic disorders. Mindfulness is a technique that can help you ground your thoughts in the present. You can practice mindfulness by actively observing thoughts and sensations without reacting to them.

Use relaxation techniques. Relaxation techniques include guided imagery, aromatherapy, and muscle relaxation. If you're experiencing symptoms of anxiety or a panic attack, try doing things that you find relaxing. Close your eyes, take a bath, or use lavender, which has relaxing effects.

Lifestyle changes

The following lifestyle changes can help you prevent anxiety and panic attacks, as well as reduce the severity of symptoms when an attack occurs:

Reduce and manage sources of stress in your life.

Learn how to identify and stop negative thoughts.

Get regular, moderate exercise.

Practice meditation or yoga.

Eat a balanced diet.

Join a support group for people with anxiety or panic attacks.

Limit your consumption of alcohol, drugs, and caffeine.

Speak to your doctor about other treatments for anxiety and panic attacks. Some common treatments include psychotherapy or medication, including:

antidepressants

antianxiety drugs

benzodiazepines

Oftentimes, your doctor will recommend a combination of treatments. You may also need to alter your treatment plan over time.

Panic attacks and anxiety attacks aren't the same. Though these terms are often used interchangeably, only panic attacks are identified in the DSM-5.

Anxiety and panic attacks have similar symptoms, causes, and risk factors. However, panic attacks tend to be more intense and are often accompanied by more severe physical symptoms.

You should contact a doctor if anxiety- or panic-related symptoms are affecting your everyday life.

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What's the Difference Between a Panic Attack and an Anxiety Attack?

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Overview You might hear people talking about panic attacks and anxiety attacks like they're the same thing. They're different conditions though. Panic attacks come on suddenly and involve intense and often overwhelming fear. They're accompanied by frightening physical symptoms, such as a racing heartbeat, shortness of breath, or nausea.

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Links updated, November 2021
This information in Spanish

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

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

anxiety disorders;

bipolar disorder (sometimes called manic-depression);

conduct disorders;

eating disorders;

obsessive-compulsive disorder (OCD); and

psychotic disorders.

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

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

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

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

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

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

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

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

Characteristics

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

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

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

Hyperactivity (short attention span, impulsiveness);

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

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

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

Learning difficulties (academically performing below grade level).

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

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

Causes

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

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

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

Frequency

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

Help for School-Aged Children

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

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

A Look at Specific Emotional Disturbances

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

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

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

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

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

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

Conduct Disorder

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

aggression to people and animals;

destruction of property;

deceitfulness, lying, or stealing; or

truancy or other serious violations of rules. (15)

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

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

family therapy;

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

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

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

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

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

According to the National Eating Disorders Association:

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

Obsessive-Compulsive Disorder

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

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

therapist trained in behavior therapy;

Cognitive Behavior Therapy (CBT);

medication (usually an antidepressant). (23)

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

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

More about School

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

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

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

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

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

Other Considerations

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

The Importance of Support

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

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

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

Resources of More Information

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

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

Anxiety Disorders

Autism

Bipolar Disorder

Conduct Disorder

Depression

Oppositional Defiant Disorder

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

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

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

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

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

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

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

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

National Eating Disorders Association
1.800.931.2237 | www.nationaleatingdisorders.org

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

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

References

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

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

5 | Ibid.

7 | Ibid.

11 | Ibid.

13 | Ibid.

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

15 | Ibid.

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

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

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Here's a quick video that summarizes emotional disturbances.

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Students with Emotional Disturbance in the regular education classroom can be a challenge to support. I have collected some good articles and tools in this post as a way to adopt the right mindset to prepare to differentiate to this special population. My best advice in finding the most success is to stay curious and build relationships with; the student, the parents, the special education team.

Start here and read this article from National Dissemination for Children with Disabilities (NICHCY) ...print and revisit: Teaching Students with Emotional Disturbances: 8 Tips for Teachers

Then if you like lists to remind and/ or inform your practice this is a helpful link from DoLearn: ED Strategies

Reasons why Emotional Disturbance occurs:

ASCD has some good insights from this article and below is a good chart to consider for your students showing behaviors in your classroom.

What Emotional Disturbance looks like-

Some emotional problems you can see-others you cannot. If a student has internalized her emotional problems, for example, she may become withdrawn or depressed, and the teacher may not be aware of the student's distress. If a student has externalized emotional problems, however, the teacher is likely to know. This student puts emotions on display and may become disruptive, even antagonistic, in class. It's important, therefore, that teachers know the early warning signs for both kinds of emotional problems.

A student may have internalized emotional problems if he

Appears isolated from peers.

Seems overly dependent on others.

Is moody.

Exhibits feelings of helplessness.

Shows an interest in cults.

Has an inordinate attraction to fantasy.

Is apathetic.

Is a bully victim.

Is frequently absent because of illness.

Cries inappropriately and too often.

Abuses himself.

A student may have externalized emotional problems if she

Becomes a chronic discipline problem.

Exhibits a lack of empathy or compassion.

Has temper tantrums.

Is truant often.

Experiences poor academic performance.

Has conflicts with authority figures.

Bullies others.

Damages the property of others.

Becomes noncompliant.

Becomes impulsive.

Becomes aggressive.

Source: Compiled from Gresham, F. M., MacMillan, D. L., & Bocian, K. (1996). "Behavioral earthquakes": Low-frequency salient behavioral events that differentiate students at risk of behavior disorders. Behavioral Disorders 21(4), 277-292.

Behavior Intervention Plans can help to proactively address the issues that are happening in your classroom. Engage with your School Psychologist in fully understanding the plan and don't hesitate to ask for clarity and/ or strategies that may be challenging to implement in your particular classroom.

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Emotional Disturbance a starting point for Teachers

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Students with Emotional Disturbance in the regular education classroom can be a challenge to support. I have collected some good articles and tools in this post as a way to adopt the right mindset to prepare to differentiate to this special population. My best advice in finding the most success is to stay curious and...