# data[].attributes.attachment_link.provider_name
Individuals with Disabilities Education Act

# data[].attributes.attachment_link.title
Sec. 300.8 (c) (4) - Individuals with Disabilities Education Act

# data[].attributes.attachment_link.description
(4) (i) Emotional disturbance means 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 f…

# data[].attributes.headline
What Parents Should Know About Treatment of Emotional Disorders in Preschool Children 

# data[].attributes.subject
What Parents Should Know About Treatment of Emotional Disorders in Preschool Children 

# data[].attributes.attachment_link.readable_text
Cite This Article

American Psychological Association. (2008, October 23). What parents should know about treatment of behavioral and emotional disorders in preschool children. https://www.apa.org/topics/children/treatment-behavioral-emotional-disorders-preschoolers

The number of children diagnosed with and treated for disruptive disorders including attention deficit/hyperactivity disorder (ADHD) has markedly increased over the last decade. Concurrent with this trend is a growing debate about the best way to treat such problems in children.

According to a study published in the Journal of the American Medical Association in February 2000, the number of preschool children receiving stimulants, antidepressants, and other psychiatric medications "rose drastically from 1991 to 1995." The study raised concerns about the increasing use of medications to manage ADHD disorders in young children because little is known about their safety and effectiveness for children of preschool ages. Few of these drugs, the study points out, are approved by the U.S. Food and Drug Administration for prescription to young children.

For parents, especially those parents of children who have been diagnosed with a behavioral or emotional disorder or those who suspect their children have been suffering from such a problem, these new concerns about the use of psychotropic medications present nagging dilemmas. How should a parent make decisions about what course of treatment is the best one for their child?

Appropriate assessment and diagnosis must come first

While all children develop at their own pace, there are developmentally appropriate stages through which children progress. It is important for parents, caregivers, and teachers to be aware of their children's growth and development and to watch for unusual behavioral changes or regressions. Every child will have an occasional "bad day," and it is appropriate for young children to have high energy levels. But, if your child is experiencing persistent problems that interrupt his or her participation in school or interaction with other children, or, if your child shows signs of social withdrawal, an inability to focus their attention, or is impulsive and unduly aggressive, it may be time for you to seek professional help to determine what is going on and how best to help your son or daughter.

As a general rule, it is time to consult a mental health provider if your child's behavior is age inappropriate; an ongoing pattern; and if it interferes with his or her learning, growth, and social development.

Teachers, school administrators, or primary care physicians may suggest that a child's behavior is problematic and that he or she could benefit from taking a psychotropic medication. However, a thorough evaluation and diagnosis by an appropriately trained and credentialed health professional should take place before any such decision is made. Among the providers who would do appropriate assessments of your child's behavior are child psychologists, pediatricians, pediatric neurologists, and child psychiatrists. These pediatric providers should also continue to work with the child, his or her family, and school to create a school and home-based treatment plan and monitor the child's progress over time. A "team" approach when treating a child is critical-the team members being the child's parents, pediatrician, psychologist, school-based counselors or psychologists, school administrators, and teachers.

Behavioral treatment can be an important part of the treatment plan

Treatment programs can take many forms and are best when specifically tailored for the child. They may include psychotherapy, including cognitive-behavior therapy or behavioral management training, parent education, social skills training, and family support services. If it is determined that your child needs medication in addition to the behaviorally-based treatment, it is often most effective if both types of treatment are employed together.

A variety of psychotropic drugs have proven to be very helpful in helping adults manage a number of psychiatric disorders, but few of these drugs have been tested for safety and effectiveness in preschool children. Depending on your child's diagnosis, behavioral, family, and school-based therapy programs should be considered first and given ample time to work, before the use of medications. Your child's specific diagnosis is critical to determining the best treatment plan. Research has shown that for a diagnosis of ADHD with a cooccurring emotional disorder, a combination of medication and behavioral therapy works best. For a diagnosis of ADHD only, medication-based treatment is often most effective. If your child is placed on a medication-based treatment, the ongoing monitoring of the medication's effects and effectiveness is critical.

More research is needed

The Food and Drug Administration will have approved any drug prescribed by a physician for clinical use, but not necessarily for use by preschool children. More research is needed to understand both the short and long-term effects of these drugs on children and their developing brains. In fact, the National Institute of Mental Health recently announced that it will invest more than $5 million in research on the use of Ritalin, behavioral therapy, and the combination of both interventions to treat attention deficit/hyperactivity disorder in preschool children.

# data[].attributes.attachment_link.title
What parents should know about treatment of behavioral and emotional disorders in preschool children

# data[].attributes.attachment_link.description
An overview of important factors in diagnosing and treating behavioral and emotional disorders in young children, as well as treatments such as psychotherapy and medication.

# data[].attributes.headline
Florida Dept of Education - Emotional/Behavioral Disability

# data[].attributes.subject
Florida Dept of Education - Emotional/Behavioral Disability

# data[].attributes.attachment_link.description
Definition A student with an emotional/behavioral disability has persistent (is not sufficiently responsive to implemented evidence based interventions) and c.

# data[].attributes.headline
IDEA Identification for Emotional Disturbances

# data[].attributes.subject
IDEA Identification for Emotional Disturbances

# data[].attributes.attachment_link.provider_name
Council for Children with Behavioral Disorders

# data[].attributes.attachment_link.title
Behavior Disorders: Definitions, Characteristics & Related Information

# data[].attributes.attachment_link.provider_name
National Institute of Mental Health (NIMH)

# data[].attributes.attachment_link.readable_text
What is anxiety?

Occasional anxiety is a normal part of life. Many people worry about things such as health, money, or family problems. But anxiety disorders involve more than temporary worry or fear. For people with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and various phobia-related disorders.

What are the signs and symptoms of anxiety?

What are the risk factors for anxiety?

How is anxiety treated?

How can I find a clinical trial for anxiety?

Where can I learn more about anxiety?

# data[].attributes.attachment_link.description
Learn about anxiety disorders, including signs and symptoms, types, risk factors, and potential treatments and therapies.

# data[].attributes.attachment_link.provider_name
Centers for Disease Control and Prevention

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

Oppositional Defiant Disorder

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

Examples of ODD behaviors include

Often being angry or losing one's temper

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

Often resentful or spiteful

Deliberately annoying others or becoming annoyed with others

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

Learn more about ODD
Conduct Disorder

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

Examples of CD behaviors include

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

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

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

Learn more about CD
Treatment for disruptive behavior disorders

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

Get help finding treatment

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

Managing Symptoms: Staying Healthy

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

Engaging in regular physical activity, including aerobic and vigorous exercise

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

Getting the recommended amount of sleep each night based on age

Strengthening relationships with family members

Prevention of disruptive behavior disorders

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

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

# data[].attributes.attachment_link.title
Behavior or Conduct Problems in Children | CDC

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

# data[].attributes.attachment_link.provider_name
National Institute of Mental Health (NIMH)

# data[].attributes.attachment_link.readable_text
What are eating disorders?

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

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

Who is at risk for eating disorders?

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

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

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

What are the common types of eating disorders?

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

What is anorexia nervosa?

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

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

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

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

Extremely restricted eating and/or intensive and excessive exercise

Extreme thinness (emaciation)

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

Intense fear of gaining weight

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

Denial of the seriousness of low body weight

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

Thinning of the bones (osteopenia or osteoporosis)

Mild anemia

Muscle wasting and weakness

Brittle hair and nails

Dry and yellowish skin

Growth of fine hair all over the body (lanugo)

Severe constipation

Low blood pressure

Slowed breathing and pulse

Damage to the structure and function of the heart

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

Lethargy, sluggishness, or feeling tired all the time

Infertility

Brain damage

Multiple organ failure

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

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

What is bulimia nervosa?

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

Chronically inflamed and sore throat

Swollen salivary glands in the neck and jaw area

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

Acid reflux disorder and other gastrointestinal problems

Intestinal distress and irritation from laxative abuse

Severe dehydration from purging

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

What is binge-eating disorder?

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

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

Eating rapidly during binge episodes

Eating even when full or not hungry

Eating until uncomfortably full

Eating alone or in secret to avoid embarrassment

Feeling distressed, ashamed, or guilty about eating

Frequently dieting, possibly without weight loss

What is avoidant restrictive food intake disorder?

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

Dramatic restriction of types or amount of food eaten

Lack of appetite or interest in food

Dramatic weight loss

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

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

How are eating disorders treated?

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

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

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

Restoring adequate nutrition

Bringing weight to a healthy level

Reducing excessive exercise

Stopping binge-purge and binge-eating behaviors

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

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

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

Are there clinical trials studying eating disorders?

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

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

Reprints

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

For More Information

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

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

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

# data[].attributes.attachment_link.title
What is OCD? | International OCD Foundation

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

# data[].attributes.attachment_link.readable_text
Psychosis (Schizophrenia)

Schizophrenia and other psychotic disorders are medical illnesses that result in strange or bizarre thinking, perceptions (sight, sound), behaviors, and emotions. Psychosis is a brain-based condition that is made better or worse by environmental factors - like drug use and stress. Children and youth who experience psychosis often say "something is not quite right" or can't tell if something is real or not real. It is an uncommon psychiatric illness in young children and is hard to recognize in its early phases.

The appearance of symptoms of psychosis before age 12 is rare (less than one-sixtieth as common as the adult-onset type), but studying these cases is important for understanding this disorder. For those who might develop psychotic disorders or schizophrenia as adults (adult-onset), it is not uncommon for them to start experiencing early warning signs during puberty or adolescence. The period of time when an adolescent experiences the early warning signs of psychosis is called prodrome. During this time, youth recognize that their experiences (hearing or seeing things that are not there) are strange or concerning. They may not easily admit these problems unless asked. Being aware of the early warning signs and offering support is crucial.

Childhood-onset - Most children with schizophrenia show delays in language and other functions long before their psychotic symptoms (hallucinations, delusions, and disordered thinking) appear. In the first years of life, about 30% of these children have transient symptoms of pervasive developmental disorder, such as rocking, posturing, and arm flapping. Childhood-onset of psychosis may present with poor motor development, such as unusual crawling, and children may be more anxious and disruptive compared to those with later onset.

It is especially important to pay attention to sudden changes in thoughts and behaviors. Keep in mind that the onset of several of the symptoms below, and not just any one change, indicates a problem that should be assessed. The symptoms below should not be due to recent substance use or another medical condition.

A quick and confidential way to determine if you may be experiencing psychosis is to take a mental health screening. A screening is not a diagnosis, but a way of understanding if your symptoms are having enough of an impact that you should seek help from a doctor or other professional. Take a psychosis screen here.

Early Warning Signs

Feeling like their brain is not working

Feeling like their mind or eyes are playing tricks on them

Seeing things and hearing voices that are not real

Hearing knocking, tapping, clicking or their named being called

Confused thoughts

Vivid and bizarre thoughts and ideas

Sudden and bizarre changes in emotions

Peculiar behavior that seem unusual

Increased sensitivity to light, sounds, smells or touch

Concept that people are "out to get them"

Fearfulness or suspicion that isn't warranted

Withdrawal from others

Severe problems in making and keeping friends

Difficulty speaking, writing, focusing or managing simple tasks

The behavior of children with this illness may change over time. Psychosis can develop gradually or suddenly. Children and youth may begin talking about strange fears and ideas. They may start to cling to parents or say things that do not make sense. Others who used to enjoy relationships with peers may become more shy or withdrawn or seem to be in their own world.

Treatment

Early diagnosis and medical treatment are important. It is especially important that children and youth with the problems and symptoms listed above receive a complete evaluation. These children may need individual treatment plans involving other professionals. A combination of medication and individual therapy, family therapy, and specialized programs (wraparound services, early psychosis treatment) is often necessary. Changes in life style (keeping stress low, taking fish oils), additional supports (therapy and school support) and psychiatric medication can be helpful for many of the symptoms and problems identified.

Making the choice about whether or not to use medications can be difficult. Second-generation (atypical) antipsychotic drugs are usually tried first because they may cause fewer side effects than standard drugs. Serious side effects of second-generation antispychotic drugs can include weight gain, diabetes and high chloresterol. Currently, the Food and Drug Administration approves the use of two second-generation drugs in children ages 13-17, Risperidone (Risperdal) and Aripiprazole (Abilify).

Parents need to ask their family physician or pediatrician to refer them to a child and adolescent psychiatrist who is specifically trained and skilled at evaluating, diagnosing, and treating children with schizophrenia.

To learn more visit:

Other Resources

National Association of Child and Adolescent Psychiatry
Schizophrenia in Children

Schizophrenia.com.
Childhood Schizophrenia and Bipolar Disorder Schizophrenia Medication Treatment

The Mayo Clinic - Childhood Schizophrenia Treatments and Drugs

National Institute of Mental Health,
Schizophrenia

National Alliance on Mental Illness - Early Onset Schizophrenia

NARSAD: The Mental Health Research Association
60 Cuttermill Rd, Suite 404
Great Neck, NY 11021
Toll-Free Number: (800) 829-8289
Fax Number: (516) 487-6930
Email Address: info@narsad.org
Website URL: www.narsad.org

National Schizophrenia Foundation
403 Seymour Ave. - Suite 202
Lansing, MI 48933
Phone Number: (517) 485-7168
Fax Number: (517) 485-7180
Email Address: inquiries@nsfoundation.org
Website URL: www.nsfoundation.org

# data[].attributes.attachment_link.title
Psychosis (Schizophrenia) in Children and Youth

# data[].attributes.attachment_link.description
Psychosis (Schizophrenia) Schizophrenia and other psychotic disorders are medical illnesses that result in strange or bizarre thinking, perceptions (sight, sound), behaviors, and emotions. Psychosis is a brain-based condition that is made better or worse by environmental factors - like drug use and stress.

# data[].attributes.headline
Emotional Disturbances Updated - Parent Resource

# data[].attributes.subject
Emotional Disturbances Updated - Parent Resource

# data[].attributes.attachment_link.readable_text
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

# data[].attributes.attachment_link.description
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.

# data[].attributes.headline
American Academy of Child & Adolescent Psychiatry Parent Resource

# data[].attributes.subject
American Academy of Child & Adolescent Psychiatry Parent Resource

# data[].attributes.attachment_link.readable_text
content_area

AACAP's Facts for Families provides concise up-to-date information on issues that affect children, teenagers, and their families.

Parents' Medication Guide

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

Included in this guide is new research on effective treatments for child and adolescent impairing emotional outbursts. The goal of the guide is to help parents make informed decisions about getting the best care for a child or adolescent with impairing emotional outbursts.

Rating Scales

ARI - Affective Reactivity Index

Emotion Dysregulation Inventory (EMO-I) - The Emotional Outburst Inventory (EMO-I) is a brief screening tool for irritability and severe emotional outbursts in youth.

RMOAS - Revised Modified Overt Aggression Scale-scale of severity of aggressive behavior on a weekly basis; has been used as an outcome measure for aggression treatment studies

More Resources

These apps can be helpful tools for people with emotion dysregulation. They should be used alongside comprehensive assessment and treatment from a trained mental health professional.

Taming Tantrums"Taming Tantrums" App - a collection of phrases to reduce tears and tantrums and increase cooperation in young children.

Grump MeterThe Grump Meter helps kids and adults recognize and name their emotions, prevent "losing their heads on red", and achieve calmer, more peaceful, and empathic interactions.

RegnaTales, a series of 6 mobile apps, was created in response to the above advantages of using mobile technology and serious games to increase access to treatment and enhance the motivation of children to learn skills. RegnaTales

T2 Mood Tracker
Mood Tracker allows users to monitor their moods on six pre-loaded scales (anxiety, stress, depression, brain injury, post-traumatic stress, general well-being). Custom scales can also be built.

Demonstrating the Six Steps of De-escalation

How to Communicate With Angry or Aggressive Kids

Self-Regulation Strategies for Kids: Expert Tips to Manage Outbursts

What To Do When Your Child Throws A Temper Tantrum

Tips During Tantrums

1. Keep cool

2. Model appropriate behavior

3. Contain a tantrum (in safe room)

4. Public place-remove child from store and return when calm

5. Take away the pay off (do not be trained by negative reinforcement)

@preschooltherapy
Best tip during tantrums: stay calm. Taking a breath can help you and your child. #tiktoktherapist #tantrum #parenting101 #edutok #toddlerparents
♬ bgm_track_0121_cinematic_moody_minimalist - Unknown
Teaching kids to deal with emotions
@preschooltherapy
Teaching kids to deal with emotions. #tiktoktherapist #childmentalhealth #tantrum #momsoftiktok #dadsoftiktok #teachersoftiktok
♬ UNDERWATER WONDERSCAPES (MASTER) - Frederic Bernard

# data[].attributes.attachment_link.keywords[]
irritability & emotional dysregulation resource center - parents families

# data[].attributes.attachment_link.description
Many children lose their temper or become frustrated and upset. Learning how to regulate emotions is a normal part of growing up. Some children and adolescents' outbursts that are impairing and extreme. Their outbursts may include verbal symptoms (su

# data[].attributes.headline
Child Mind Institute Family Resource Center

# data[].attributes.subject
Child Mind Institute Family Resource Center

# data[].attributes.attachment_link.title
Family Resource Center - Child Mind Institute

# data[].attributes.attachment_link.description
Find resources and information to help you support children who are struggling with mental health, behavior or learning challenges.

# data[].attributes.headline
Facts About: Students with ED a Vulnerable Population

# data[].attributes.subject
Facts About: Students with ED a Vulnerable Population

# data[].attributes.attachment_link.readable_text
The academic past of Nikolas Cruz, the accused mass shooter at Marjory Stoneman Douglas High School in Parkland, Fla., was littered with red flags suggesting serious emotional problems.

News outlets that have reviewed Cruz's disciplinary records and interviewed his teachers paint a picture of a young man prone to violent outbursts and fascinated with weapons. In high school, he spent time in a Broward County public school that specializes in serving students with emotional and behavioral disabilities. The Associated Press has reported that a high school resource officer who was also a sheriff's deputy and two school counselors recommended in September 2016 that Cruz be committed for mental evaluation under Florida's Baker Act. That law allows for involuntary commitment for mental health examination for at least three days.

The intense focus on Cruz's mental health history in the wake of the Feb. 14 school massacre has worried some of those who work directly with students who have mental health needs, such as those receiving special education for an "emotional disturbance," the official term used in federal special education law. The classification already carries a stigma, and those students already have some of the worst outcomes among students with disabilities.

Emotional disturbances, also called emotional/behavioral disabilities, are distinguished by their intensity and impact on school performance.

Students in special education for an emotional disturbance are not more likely than their peers to be school shooters. In an exhaustive examination of targeted school shootings between 1974 and 2000, the U.S. Secret Service and the U.S. Department of Education found that while perpetrators commonly described being bullied or persecuted and had thoughts of suicide, they generally did not have a history of mental health evaluations or diagnosis with a mental disorder.

But Cruz's known struggles in school have vaulted mental health to the front pages. And the tension between a school's responsibility to support students with mental health issues and the need to keep students from harm is now on full display.

Cruz received services both in traditional public school and in a specialized program. After a rocky re-entry to Stoneman Douglas, school officials recommended he return to the alternative placement. But he waived his right to special education services at age 18 with the support of his mother, Superintendent Robert Runcie told the Sun-Sentinel newspaper.

Runcie has ordered a full evaluation of Cruz's educational record.

"While we cannot undo this heartbreaking attack on our school community ... we can and must do what we can to understand the conditions that lead to such acts, in hopes of avoiding them here and elsewhere," Runcie said in a statement.

More than 335,000 students nationwide are identified as having an emotional disturbance. Here's some of what we know about this population:
Students with emotional disturbances are a small part of the population of students with disabilities.
About 6 percent of students with disabilities are classified as having an emotional disturbance nationally. In comparison, about 39 percent have a specific learning disability, such as dyslexia, and 17 percent have speech and language impairments.

But the numbers don't tell the full story. Emotional disorders can be a part of other disabilities; for example, a student with a learning disability could also be coping with anxiety or obsessive-compulsive disorder, both of which fall under the umbrella of "emotional disturbance."

And then there are students who may have all the features of an emotional disturbance, but are never identified as having a disability. The "emotional disturbance" label does not indicate that a student's problems are more severe than some other student who never gets that label.

"There's just a lot of randomness in who is able to get through that door," said Mark Weist, a professor at the University of South Carolina and founder of the Center for School Mental Health. "It depends on the school, it depends on the leadership."

Part of the concern is money, Weist said. Schools are legitimately concerned about how to pay for some services that students might need, so they enact "these artificial barriers to slow down the process."
Students with emotional disturbances face some of the steepest challenges of students in any disability group.
Students identified with emotional disturbances have lower graduation rates and higher dropout rates than other students in special education. They are more likely than other students with disabilities to face long-term suspension or expulsion.

In the 2016-17 school year, fewer than half of students in this disability category spent most of the day in a general education classroom. And while about 3 percent of students with disabilities overall were in separate schools, 13 percent of students with emotional disturbances were.

Students with disabilities in general, and behavioral disabilities in particular, are more likely than their peers in general education to be both the victims and perpetrators of bullying. Students with emotional disturbances also face high rates of self-harm.

One school known nationally for its work for students with emotional disabilities and autism is Centennial School, in Lehigh, Pa. The school serves students from elementary through high school who are placed there by several surrounding school districts. The school serves about 100 students each year, with the goal of returning them to their home setting.

Centennial has been profiled for its elimination of restraint, seclusion, and time-out rooms. Instead, the school has clear behavioral expectations and works under the assumption that students will need to be explicitly taught those expectations, as they would be taught math or English.

When students act out, "we treat those behavior errors as if they're an academic error," said Julie Fogt, the director of Centennial School. "We need to teach them a better way. We're not going to punish it out of them."
Students with emotional disturbances can be suspended or expelled.
Critics often single out special education students in discipline discussions, saying that the law makes it hard for schools to aggressively handle disruptions from students with disabilities.

Students with disabilities are frequently suspended and expelled, however. Federal data from the Education Department found that about 12 percent of students with disabilities faced that discipline, compared with 5 percent of students overall.

Within the universe of children and youth with disabilities, 25 percent of long-term suspensions and expulsions are of students with emotional disturbances, though they represent a fraction of the special education population.

"The notion that a kid can't be disciplined if they have special needs" is incorrect, said Mark Martin, an parent attorney based in Baltimore. "A principal can go ahead and do that." But once a suspension reaches more than 10 consecutive days, the law says that students with disabilities are entitled to a "manifestation determination" to see if the problem behavior is tied to his or her disability. Certain offenses, such as carrying a weapon, using or selling drugs, or causing injury, allow schools to unilaterally make the decision to remove a student from a school.

"A manifestation meeting is not a 'get-out-of-jail free' card," Martin said.

And expulsion carries its own risks, said Joseph Erardi, the former superintendent of schools in Newtown, Conn. He joined that district in 2014, two years after the deadly mass shooting that killed 20 students and six staff members at Sandy Hook Elementary School.

He led a group of superintendents who wrote a paper offering best practices for school leaders around mental-health issues in students.

"One of the greatest takeways is that social isolation at any point for a complex youngster is clearly an opportunity for that child to move into a more difficult space in his or her life," Erardi said. Expulsion of such a student is "extraordinarily counterproductive to the best interest of that child."
There are successful tools for working with these students. But help often comes late in a student's academic career.
A little over half, 52 percent, of students with emotional disturbances are 13 to 17 years old. For the special education population overall, it's 34 percent.

There's a couple of reasons behind that, said Sharon Hoover, an assistant professor of child and adolescent psychiatry at University of Maryland School of Medicine, and the co-director of the Center for School Mental Health. Some mental-health issues manifest themselves in adolescence, and some student problems aren't officially diagnosed until they're hard to ignore-and hard to treat.

But schools have developed ways to support students with mental health needs, Hoover said. One model used in Baltimore County, Md., brings community-based mental health providers directly into the schools so that they can provide counseling and other support services.

Having more trained counselors available, plus universal screening for mental health concerns "are not easy fixes, but they're the natural solutions," Hoover said.

"There are a lot of interventions that have demonstrated success," Hoover said, and they don't involve harsh discipline or arming teachers-suggestions coming from the White House. But in the immediate aftermath of a tragedy, those interventions can be forgotten, she said.

"We need to create conditions for kids to feel connected." she said.

# data[].attributes.attachment_link.title
Students With Emotional Disabilities: Facts About This Vulnerable Population

# data[].attributes.attachment_link.description
Advocates worry students with special education needs such as "emotional disturbance" may be stigmatized in light of the intense spotlight on accused Florida school shooter Nikolas Cruz's mental health history.

# data[].attributes.headline
9 Effective Teaching Strategies for Students with Emotional & Behavioral Disorders

# data[].attributes.subject
9 Effective Teaching Strategies for Students with Emotional & Behavioral Disorders

# data[].attributes.attachment_link.title
9 Effective Teaching Strategies for Students With Emotional and Behavioral Disorders

# data[].attributes.attachment_link.description
Children are the beacon of hope for our future. Their mental health and emotional well-being are the very foundation upon which future success and happiness are built.

# data[].attributes.headline
10 Ways to Support Students Who Are Emotionally Disturbed

# data[].attributes.subject
10 Ways to Support Students Who Are Emotionally Disturbed

# data[].attributes.attachment_link.title
10 Ways to Support Students Who Are Emotionally Disturbed

# data[].attributes.attachment_link.description
Find out how you can help your student achieve her full potential.

# data[].attributes.headline
Brief Overview of Emotional Disturbances

# data[].attributes.subject
Brief Overview of Emotional Disturbances

# data[].attributes.attachment_link.readable_text
Abstract

Mental health problems in children and adolescents include several types of emotional and behavioural disorders, including disruptive, depression, anxiety and pervasive developmental (autism) disorders, characterized as either internalizing or externalizing problems. Disruptive behavioural problems such as temper tantrums, attention deficit hyperactivity disorder, oppositional, defiant or conduct disorders are the commonest behavioural problems in preschool and school age children. The routine Paediatric clinic or Family Medicine/General Practitioner surgery presents with several desirable characteristics that make them ideal for providing effective mental health services to children and adolescents. DSM-5 and ICD-10 are the universally accepted standard criteria for the classification of mental and behaviour disorders in childhood and adults. The age and gender prevalence estimation of various childhood behavioural disorders are variable and difficult to compare worldwide. A review of relevant published literature was conducted, including published meta-analyses and national guidelines. We searched for articles indexed by Ovid, PubMed, PubMed Medical Central, CINAHL, EMBASE, Database of Abstracts and Reviews, and the Cochrane Database of Systematic reviews and other online sources. The searches were conducted using a combination of search expressions including "childhood", "behaviour", "disorders" or "problems". Childhood behaviour and emotional problems with their related disorders have significant negative impacts on the individual, the family and the society. They are commonly associated with poor academic, occupational, and psychosocial functioning. It is important for all healthcare professionals, especially the Paediatricians to be aware of the range of presentation, prevention and management of the common mental health problems in children and adolescents.

Keywords: Childhood behavioural disorders, Disruptive behaviour disorder, Conduct disorder, Challenging behaviour, Emotional disorder, Anxiety, Depression, Autism, Pervasive developmental disorders

Core tip: Mental health problems in children and young people (CYP) include several types of emotional and behavioural disorders, including disruptive, depression, anxiety and pervasive developmental (autism) disorders, characterized as either "internalizing" or "externalizing". The routine Paediatric or General Practitioner clinic present with several desirable characteristics that make them ideal for providing effective mental health services to CYP. Childhood mental health disorders have significant negative impacts on the individual, the family and the society. It is particularly important for all Paediatricians to be aware of the range of presentation, prevention and management of the common mental health problems in CYP.

INTRODUCTION

Mental health disorders (MHD) are very common in childhood and they include emotional-obsessive-compulsive disorder (OCD), anxiety, depression, disruptive (oppositional defiance disorder (ODD), conduct disorder (CD), attention deficit hyperactive disorder (ADHD) or developmental (speech/language delay, intellectual disability) disorders or pervasive (autistic spectrum) disorders[ 1]. Emotional and behavioural problems (EBP) or disorders (EBD) can also be classified as either "internalizing" (emotional disorders such as depression and anxiety) or "externalizing" (disruptive behaviours such as ADHD and CD). The terminologies of "problems" and "disorders" are interchangeably used throughout this article.

While low-intensity naughty, defiant and impulsive behaviour from time to time, losing one's temper, destruction of property, and deceitfulness/stealing in the preschool children are regarded as normal, extremely difficult and challenging behaviours outside the norm for the age and level of development, such as unpredictable, prolonged, and/or destructive tantrums and severe outbursts of temper loss are recognized as behaviour disorders. Community studies have identified that more than 80% of pre-schoolers have mild tantrums sometimes but a smaller proportion, less than 10% will have daily tantrums, regarded as normative misbehaviours at this age[ 2, 3]. Challenging behaviours and emotional difficulties are more likely to be recognized as "problems" rather than "disorders" during the first 2 years of life[ 4].

Emotional problems, such as anxiety, depression and post-traumatic stress disorder (PTSD) tend to occur in later childhood. They are often difficult to be recognised early by the parents or other carers as many children have not developed appropriate vocabulary and comprehension to express their emotions intelligibly[ 5]. Many clinicians and carers also find it difficult to distinguish between developmentally normal emotions ( e.g., fears, crying) from the severe and prolonged emotional distresses that should be regarded as disorders[ 6]. Emotional problems including disordered eating behaviour and low self-image are often associated with chronic medical disorders such as atopic dermatitis, obesity, diabetes and asthma, which lead to poor quality of life[ 7- 9].

Identification and management of mental health problems in primary care settings such as routine Paediatric clinic or Family Medicine/General Practitioner surgery are cost-effective because of their several desirable characteristics that make it acceptable to children and young people (CYP) ( e.g., no stigma, in local setting, and familiar providers). Several models to improve the delivery of mental health services in the Paediatric/Primary care settings have been recommended and evaluated recently, including coordination with external specialists, joint consultations, improved Mental Health training and more integrated on-site intervention with specialist collaboration[ 10, 11].

A review of relevant published literature was conducted, including published meta-analyses and national guidelines. We searched for articles indexed by Ovid, PubMed, PubMed Medical Central, CINAHL, the Cochrane Database of Systematic reviews and other online sources. The searches were conducted using a combination of search expressions including "childhood", "behaviour", "disorders" or "problems".

CLINICAL PRESENTATIONS OF CHILDHOOD BEHAVIOURAL AND EMOTIONAL DISORDERS

Various definitions for a wide range of childhood behavioural disorders are being used. The DSM-5[ 12] offers the commonest universally accepted standard criteria for the classification of mental and behaviour disorders. The ICD-10 is the alternative classification standard[ 13].

Challenging behaviours

Any abnormal pattern of behaviour which is above the expected norm for age and level of development can be described as "challenging behaviour". It has been defined as: "Culturally abnormal behaviour (s) of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy or behaviour which is likely to seriously limit or deny access to and use of ordinary community facilities"[ 14]. They can include self-injury, physical or verbal aggression, non-compliance, disruption of the environment, inappropriate vocalizations, and various stereotypies. These behaviours can impede learning, restrict access to normal activities and social opportunities, and require a considerable amount of both manpower and financial resources to manage effectively.

Many instances of challenging behaviour can be interpreted as ineffective coping strategies for a young person, with or without learning disability (LD) or impaired social and communication skills, trying to control what is going on around them. Young people with various disabilities, including LD, Autism, and other acquired neuro-behavioural disorders such as brain damage and post-infectious phenomena, may also use challenging behaviour for specific purposes, for example, for sensory stimulation, gaining attention of carers, avoiding demands or to express their limited communication skills[ 15]. People who have a diverse range of neurodevelopmental disorders are more likely to develop challenging behaviours[ 16].

Some environmental factors have been identified which are likely to increase the risk of challenging behaviour, including places offering limited opportunities for making choices, social interaction or meaningful occupation. Other adverse environments are characterized by limited sensory input or excessive noise, unresponsive or unpredictable carers, predisposition to neglect and abuse, and where physical health needs and pain are not promptly identified. For example, the rates of challenging behaviour in teenagers and people in their early 20s is 30%-40% in hospital settings, compared to 5% to 15% among children attending schools for those with severe LD[ 15].

Aggression is a common, yet complex, challenging behaviour, and a frequent indication for referral to child and adolescent Psychiatrists. It commonly begins in childhood, with more than 58% of preschool children demonstrating some aggressive behaviour[ 17]. Aggression has been linked to several risk factors, including individual temperaments; the effects of disturbed family dynamics; poor parenting practices; exposure to violence and the influence of attachment disorders. No single factor is sufficient to explain the development of aggressive behaviour[ 18]. Aggression is commonly diagnosed in association with other mental health problems including ADHD, CD, ODD, depression, head injury, mental retardation, autism, bipolar disorder, PTSD, or dyslexia[ 19].

Disruptive behaviour problems

Disruptive behaviour problems (DBP) include attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD). They constitute the commonest EBPs among CYP. Recent evidence suggests that DBPs should be regarded as a multidimensional phenotype rather than comprising distinct subgroups[ 20].

ADHD is the commonest neuro-behavioural disorder in children and adolescents, with prevalence ranging between 5% and 12% in the developed countries[ 21]. ADHD is characterized by levels of hyperactivity, impulsivity and inattention that are disproportionately excessive for the child's age and development[ 12]. The ICD-10[ 13] does not use the term "ADHD" but "hyperkinetic disorder", which is equivalent to severe ADHD. DSM-5 distinguishes between three subtypes of the disorder: predominantly hyperactive/impulsive, predominantly inattentive and combined types (Table ).

Table 1

Criteria

6 of 9 inattentive symptoms

6 of 9 hyperactivity/ impulsivity symptoms

Both criteria for (1) and (2)

Details

Fails to pay close attention to details or makes careless mistakes

Squirms and fidgets

Has difficulty sustaining attention

Can't stay seated

Does not appear to listen

Runs/climbs excessively

Struggles to follow through on instructions

Can't play/work quietly

Has difficulty with organization

"On the go"/"driven by a motor"

Avoids or dislikes tasks requiring a lot of thinking

Blurts out answers

Loses things

Is unable to wait for his turn

Is easily distracted

Intrudes/interrupts others

Talks excessively

Other criteria

Onset before age of 12, lasting more than 6 mo, symptoms pervasive in 2 or more settings, causing significant impairment of daily functioning o development

CD refers to severe behaviour problems (Table ), characterized by repetitive and persistent manifestations of serious aggressive or non-aggressive behaviours against people, animals or property such as being defiant, belligerent, destructive, threatening, physically cruel, deceitful, disobedient or dishonest, excessive fighting or bullying, fire-setting, stealing, repeated lying, intentional injury, forced sexual activity and frequent school truancy[ 13, 22]. Children with CD often have trouble understanding how other people think, sometimes described as being callous-unemotional. They may falsely misinterpret the intentions of other people as being mean. They may have immature language skills, lack the appropriate social skills to establish and maintain friendships, which aggravates their feelings of sadness, frustration and anger[ 12].

Table 2

A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 mo as evidenced by at least four out of 8 symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 mo from any of the categories below, with at least one criterion present in the past 6 mo

Aggression to people and animals: (1) Often bullies, threatens, or intimidates others; (2) Often initiates physical fights; (3) Has used a weapon that can cause serious physical harm to others ( e.g., a bat, brick, broken bottle, knife, gun); (4) Has been physically cruel to people; (5) Has been physically cruel to animals; (6) Has stolen while confronting a victim ( e.g., mugging, purse snatching, extortion, armed robbery); (7) Has forced someone into sexual activity

Angry/irritable mood: (1) Often loses temper; (2) Is often touchy or easily annoyed; (3) Is often angry and resentful

Argumentative/defiant behavior: (4) Often argues with authority figures or, for children and adolescents, with adults; (5) Often actively defies or refuses to comply with requests from authority figures or with rules; (6) Often deliberately annoys others; (7) Often blames others for his or her mistakes or misbehavior

Destruction of property: (8) Has deliberately engaged in fire setting with the intention of causing serious damage; (9) Has deliberately destroyed others' property (other than by fire setting)

Deceitfulness or theft: (10) Has broken into someone else's house, building, or car; (11) Often lies to obtain goods or favors or to avoid obligations ( i.e., "cons" others); (12) Has stolen items of nontrivial value without confronting a victim ( e.g., shoplifting, but without breaking and entering; forgery)

Vindictiveness: (8) Has been spiteful or vindictive at least twice within the past 6 mo

Serious violations of rules: (13) Often stays out at night despite parental prohibitions, beginning before age 13 yr; (14) Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period; (15) Is often truant from school, beginning before age 13 yr

Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from a behavior that is symptomatic and the behavior should occur at least once per week for at least 6 mo

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning

The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context ( e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning

If the individual is age 18 yr or older, criteria are not met for antisocial personality disorder

Specify whether: Childhood-onset type (prior to age 10 yr); Adolescent-onset type or Unspecified onset

Specify if: With limited prosocial emotions: Lack of remorse or guilt; Callous-lack of empathy; Unconcerned about performance or Shallow or deficient affect

Specify current severity: Mild; Moderate or Severe

The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder

ICD-10

It also requires the presence of three symptoms from the list of 15 (above), and duration of at least 6 mo. There are four divisions of conduct disorder: Socialised conduct disorder, unsocialised conduct disorder, conduct disorders confined to the family context and oppositional defiant disorder

Specify current severity: Mild; moderate or severe based on number of settings with symptoms shown

CD is the commonest reason for CYP referral for psychological and psychiatric treatment. Roughly 50% of all CYP with a MHD have a CD[ 23]. About 30%-75% of children with CD also have ADHD and 50% of them will also meet criteria for at least one other disorder including Mood, Anxiety, PTSD, Substance abuse, ADHD, learning problems, or thought disorders[ 24, 25]. Majority of boys have an onset of CD before the age of 10 years, while girls tend to present mainly between 14 and 16 years of age[ 26]. Most CYP with CD grow out of this disorder, but a minority become more dissocial or aggressive and develop antisocial personality disorder as adults.

ODD is considered to be the mildest and commonest of the DBPs, with prevalence estimates of 6%-9% for pre-schoolers and boys outnumbering girls by at least two to one[ 27]. CYP with ODD are typically openly hostile, negativistic, defiant, uncooperative, and irritable. They lose their tempers easily and are mean and spiteful towards others (Table ). They are mostly defiant towards authority figures, but they may also be hostile to their siblings or peers. This pattern of adversarial behaviour significantly negatively impact on their lives at home, school, and wider society, and seriously impairs all their relationships[ 28].

Emotional problems

Emotional problems in later childhood include panic disorder, generalized anxiety disorder (GAD), separation anxiety, social phobia, specific phobias, OCD and depression. Mild to moderate anxiety is a normal emotional response to many stressful life situations. Anxiety is regarded as a disorder when it is disproportionately excessive in severity in comparison to the gravity of the triggering circumstances, leading to abnormal disruption of daily routines. Panic disorder is characterized by panic attacks untriggered by external stimuli. GAD is characterized by generalized worry across multiple life domains. Separation anxiety disorder is characterized by fear related to actual or anticipated separation from a caregiver. Social anxiety disorder (also called social phobia), is characterized by fear of social situations where peers may negatively evaluate the person[ 12].

Common manifestations of Anxiety disorders include physical symptoms such as increased heart rate, shortness of breath, sweating, trembling, shaking, chest pain, abdominal discomfort and nausea[ 29]. Other symptoms include worries about things before they happen, constant concerns about family, school, friends, or activities, repetitive, unwanted thoughts (obsessions) or actions (compulsions), fears of embarrassment or making mistakes, low self-esteem and lack of self-confidence[ 30].

Depression often occurs in children under stress, experiencing loss, or having attentional, learning, conduct or anxiety disorders and other chronic physical ailments. It also tends to run in families[ 7- 9, 31]. Symptoms of depression are diverse and protean, often mimicking other physical and neurodevelopmental problems, including low mood, frequent sadness, tearfulness, crying, decreased interest or pleasure in almost all activities; or inability to enjoy previously favourite activities, hopelessness, persistent boredom; low energy, social isolation, poor communication, low self-esteem and guilt, feelings of worthlessness, extreme sensitivity to rejection or failure, increased irritability, agitation, anger, or hostility, difficulty with relationships, frequent complaints of physical illnesses such as headaches and stomach aches, frequent absences from school or poor performance in school, poor concentration, a major change in eating and/or sleeping patterns, weight loss or gain when not dieting, talk of or efforts to run away from home, thoughts or expressions of suicide or self-destructive behaviour[ 31].

Disruptive mood dysregulation disorder (DMDD) is a childhood disorder characterized by a pervasively irritable or angry mood recently added to DSM-5. The symptoms include frequent episodes of severe temper tantrums or aggression (more than three episodes a week) in combination with persistently negative mood between episodes, lasting for more than 12 mo in multiple settings, beginning after 6 years of age but before the child is 10 years old[ 32].

Autistic spectrum and pervasive development disorder

The definition of Autism has evolved over the years and has been broadened over time. DSM-IV-TR[ 33] and the ICD-10[ 13] defined the diagnostic category of pervasive developmental disorders (PDD) as the umbrella terminology used for a group of five disorders characterized by pervasive "qualitative abnormalities in reciprocal social interactions and in patterns of communication, and by a restricted, stereotyped, repetitive repertoire of interests and activities" affecting "the individual's functioning in all situations". These included autism, asperger syndrome, childhood disintegrative disorder (CDD), pervasive developmental disorder not otherwise specified (PDD-NOS) and Rett syndrome.

Autism and Asperger Syndrome are the most widely recognised and clinically diagnosed among this group of disorders. CDD is a term used to describe children who have had a period of normal development for the first 2-3 years before a relatively acute onset of regression and emergence of autistic symptoms. PDD-NOS was used, particularly in the United States, to describe individuals who have autistic symptoms, but do not meet the full criteria for Autism or Asperger's Syndrome, denote a milder version of Autism, or to describe atypical autism symptoms emerging after 30 mo of age, and autistic individuals with other co-morbid disorders[ 34].

The category of PDD has been removed from DSM-5[ 12] and replaced with Autism Spectrum disorders (ASD). ASD (Table ) is diagnosed primarily from clinical judgment usually by a multidisciplinary team, with minimal support from diagnostic instruments. Most individuals who received diagnosis based on the DSM-IV should still maintain their diagnosis under DSM-5, with some studies confirming that 91% to 100% of children with PDD diagnoses from the DSM-IV retained their diagnosis under the ASD category using the new DSM-5[ 35, 36], while a systematic review has found a slight decrease in the rate of ASD with DSM-5[ 37].

Table 3

Persistent deficits in social communication and social interaction across multiple contexts, as manifested by 3 out 3 of the following, currently or by history

Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions

Deficits in nonverbal communicative behaviours used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication

Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers

Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two out of 4 of the following, currently or by history

Stereotyped or repetitive motor movements, use of objects, or speech ( e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases)

Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior ( e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day)

Highly restricted, fixated interests that are abnormal in intensity or focus ( e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest)

Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment ( e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)

Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life)

Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

With or without accompanying intellectual impairment With or without accompanying language impairment

Associated with a known medical or genetic condition or environmental factor

Specify current severity based on social communication impairments and restricted, repetitive patterns of behavior

There are many intervention approaches and strategies, used alone or in combination, for supporting individuals with ASD. These interventions need to individualized and be closely tailored to the level of social and linguistic abilities, cultural background, family resources, learning style and degree of communication skills[ 38].

Various communication enhancement strategies have been designed to manage ASD[ 39], including augmentative and alternative communication (AAC), Facilitated Communication, computer-based instruction and video-based instruction (Table ). Several behavioural and psychological interventions (Table ) have also been used successfully in managing ASD children, including applied behaviour analysis (ABA) and functional communication training (FCT)[ 40].

Table 4

Augmentative and alternative communication

Supplements/replaces natural speech and/or writing with aided [ e.g., Picture Exchange Communication System, line drawings, Blissymbols, speech generating devices, and tangible objects] and/or unaided ( e.g., manual signs, gestures, and finger spelling) symbols

Effective in decreasing maladaptive or challenging behaviour such as aggression, self-injury and tantrums, promotes cognitive development and improves social communication

Scripts are often used to promote social interaction, initiate or sustain interaction

Table 5

ABA

Uses principles of learning theory to bring about meaningful and positive change in behaviour, to help individuals build a variety of skills ( e.g., communication, social skills, self-control, and self-monitoring) and help generalize these skills to other situations

Discrete trial training

A one-to-one instructional approach based on ABA to teach skills in small, incremental steps in a systematic, controlled fashion, documenting stepwise clearly identified antecedent and consequence ( e.g., reinforcement in the form of praise or tangible rewards) for desired behaviours

Anger management

Various strategies can be used to teach children how to recognise the signs of their growing frustration and learn a range of coping skills designed to defuse their anger and aggressive behaviour, teach them alternative ways to express anger, including relaxation techniques and stress management skills

Social (pragmatic) communication disorder

Social (pragmatic) communication disorder (SCD) is a new diagnosis included under Communication Disorders in the Neurodevelopmental Disorders section of the DSM-5[ 12]. It is characterized by persistent difficulties with using verbal and nonverbal communication for social purposes, which can interfere with interpersonal relationships, academic achievement and occupational performance, in the absence of restricted and repetitive interests and behaviours (Table ). Some authors consider that CYP with SCD present with similar but less severe restricted and repetitive interests and behaviours (RRIBs) characteristic of children on the autistic spectrum[ 41]. SCD is thought to occur more frequently in family members of individuals with autism[ 42].

Table 6

Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following

Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for social context

Impairment in the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language

Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction

Difficulties understanding what is not explicitly stated ( e.g., making inferences) and nonliteral or ambiguous meaning of language ( e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation)

The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination

The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities)

The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder

The term "pragmatic" has been used previously to describe the communication skills that are needed in normal social intercourse and the rules that govern routine interpersonal interactions, including ability to pay at least some attention to the other person in a conversation, take turns, not interrupting the other speaker unless there is a very good reason, match language and volume to the situation and the listener, etc[ 43]. Social and pragmatic deficit are known to also occur in diverse clinical populations, including ADHD, William's syndrome, CD, closed head injury and spina bifida/hydrocephalus[ 44].

Treatment modalities that have been used for supporting children with SCD are similar to those that have been used for several years in children with ASD (Tables and ). The first randomized controlled trial of social communication interventions designed primarily for children with SCD was reported in 2012[ 45]. The Social Communication Intervention Project ( http://www.psych-sci.manchester.ac.uk/scip/) targets development in social understanding and interaction, verbal and non-verbal pragmatic skills and language processing among children with SCD.

Pathological demand avoidance or Newson's syndrome

Pathological demand avoidance (PDA) or Newson's Syndrome is increasingly being accepted as part of the autism spectrum. PDA was first used in 2003[ 46] for describing some CYP with autistic symptoms who showed some challenging behaviours. It is characterized by exceptional levels of demand avoidance requested by others, due to high anxiety levels when the individuals feel that they are losing control. Avoidance strategies can range from simple refusal, distraction, giving excuses, delaying, arguing, suggesting alternatives and withdrawing into fantasy, to becoming physically incapacitated (with an explanation such as "my legs don't work") or selectively mute in many situations. If they feel threatened to comply, they may become verbally or physically aggressive, best described as a "panic attack", apparently intended to shock[ 46]. They tend to resort to "socially manipulative" behaviours. The outrageous acts and lack of concern for their behaviour appears to draw parallels with conduct problems (CP) and callous-unemotional traits (CUT), but reward-based techniques, effective with CP and CUT, seem not to work in people with PDA[ 47]. PDA is currently neither part of the DSM-5[ 12] nor the ICD-10[ 13].

Though demand avoidance is a common characteristic of CYP with ASD, it becomes pathological when the levels are disproportionately excessive, and normal daily activities and relationships are negatively impaired. Unlike typically autistic children, people with PDA tend to have much better social communication and interaction skills, and are consequently able to use these abilities to their advantage. They often have highly developed social mimicry and role play, sometimes becoming different characters or personas. The people with PDA appear to retain a keen awareness of how to "push people's buttons", suggesting a level of social insight when compared to CYP with Autism. On the other hand, children with PDA exhibit higher levels of emotional symptoms compared to those with ASD or CD. They also often experience excessive mood swings and impulsivity. While the prevalence of ASD in boys is more than four times higher compared to that of girls, the risk of developing PDA appears to be the same for both boys and girls[ 47].

O'Nions et al[ 48] have recently reported on the development and preliminary validation of the "Extreme Demand Avoidance Questionnaire" (EDA-Q), designed to quantify PDA traits based on parent-reported information, with good sensitivity (0.80) and specificity (0.85). EDA-Q is available online (https:// www.pdasociety.org.uk/resources/extreme-demand-avoidance-questionnaire).

PREVALENCE OF BEHAVIOURAL AND EMOTIONAL DISORDERS IN CHILDHOOD

Accurate estimation of various childhood EBPs is difficult due to the problems of research methodologies relying on subjective assessments and varying definitions used. According to most studies, between 10% and 20% of CYP are affected annually by MHDs, and the rates are very similar across different racial and ethnic groups after controlling for income, resident status, education, and neighbourhood support. However, poverty and low socioeconomic status are risk factors that appear to increase the rate of MHDs across populations[ 49]. A 2001 WHO report [ 50] indicated the 6-mo prevalence rate for any MHD in CYP, up to age 17 years, to be 20.9%, with disruptive behaviour disorders (DBD) at 10.3%, second only to Anxiety disorders at 13%. About 5% of CYP in the general population suffer from Depression at any given point in time, which is more prevalent among girls (54%)[ 31, 51].

A previous British Child and Adolescent Mental Health (CAMH) survey carried out by the office of National Statistics (ONS) in 1999 and 2004, comprising 7977 interviews from parents, children and teachers, found the prevalence of MHD among CYP (aged 5-16 years) to be 6% for conduct problems, 4% for emotional problems (Depression or Anxiety) and 1.5% for Hyperkinetic disorders[ 51]. A similar survey in the United States between 2005 and 2011, the National survey of children's health (NSCH) involving 78042 households, indicated that 4.6% of CYP aged 3-17 years had a history DBD, with prevalence twice as high among boys as among girls (6.2% vs 3.0%), Anxiety (4.7%), Depression (3.9%), and ASD (1.1%)[ 24]. Reported prevalence rates for DMDD range from 0.8% to 3.3% with the highest rate in preschool children[ 52].

AETIOLOGY AND RISK FACTORS FOR CHILDREN'S BEHAVIOURAL AND EMOTIONAL DISORDERS

The exact causes of various childhood EBPs are unknown. Several studies have identified various combinations of genetic predisposition and adverse environmental factors that increase the risk of developing any of these disorders. These include perinatal, maternal, family, parenting, socio-economic and personal risk factors[ 53]. Table summarizes the evidence for various risk factors associated with development of childhood EBPs.

Table 7

Adverse family life

Dysfunctional families where domestic violence, poor parenting skills or substance abuse are a problem, lead to compromised psychological parental functioning, increased parental conflict, greater harsh, physical, and inconsistent discipline, less responsiveness to children's needs, and less supportive and involved parenting

Chronic stressors in children also lead to abnormal behaviour pattern of 'reactive responding' characterized by chronic vigilance, emotional reacting and sense of powerlessness

Physically aggressive behaviour rarely starts after age 5

Chronic irritability, temperament and anxiety symptoms before the age of 3 yr are predictive of later childhood anxiety, depression, oppositional defiant disorder and functional impairment

Children with intellectual disabilities are twice as likely to have behavioural disorders as normally developing children

Rate of challenging behaviour is 5% to 15% in schools for children with severe learning disabilities but is negligible in normal schools

Child's gender

Boys are much more likely than girls to suffer from several DBD while depression tends to predominantly affect more girls than boys

Unlike the male dominance in childhood ADHD and ASD, PDA tends to affect boys and girls equally

There is ample evidence supporting the genetic inheritability of many EBDs in CYP from their parents. From a prospective study of 209 parents along with their 331 biological offsprings, moderate inheritability ( r = 0.23, P < 0.001) between parental and offspring CD was found[ 74]. Anxiety seems to be transmissible from mothers to their preschool children, through both genetic factors and also through behaviour modelling and an anxious style of parenting[ 6].

A developmental taxonomy theory has been proposed by Patterson et al[ 75] to help understand the mechanisms underlying early onset and course of CPs. They described the vicious cycle of non-contingent parental responses to both prosocial and antisocial child behaviour leading to the inadvertent reinforcement of child behaviour problems. Parents' engagement in "coercive cycles" lead to children learning the functional value of their aversive behaviours ( e.g., physical aggression) for escape and avoidance from unwanted interactions, ultimately leading to the use of heightened aversive behaviours from both the child and parents to obtain social goals. This adverse child behavioural training combined with social rejection often lead to deviant peer affiliation and delinquency in adolescence[ 76].

NEUROBIOLOGY OF CHILDHOOD BEHAVIOURAL AND EMOTIONAL DISORDERS

Conflicting findings have been reported in the brain structural variations among CYP with EBPs using magnetic resonance imaging (MRI) studies. The most consistently reported structural abnormalities associated with the DBD include reduced grey matter volume (GMV) in the amygdala, frontal cortex, temporal lobes, and the anterior insula, which is involved in part of a network related to empathic concern for others. Reduced GMV along the superior temporal sulcus has also been found, particularly in girls[ 77]. A decreased overall mean cortical thickness, thinning of the cingulate and prefrontal cortices; and decreased grey matter density in different brain regions have been reported[ 78].

Subtle neurobiological changes in different parts of the brain of CYP with EBPs have been reported from many research studies of functional scans. Peculiar brain changes have been found in the hypothalamus, inferior and superior parietal lobes, right amygdala and anterior insula[ 79]. Functional MRI studies have demonstrated less activation in the temporal cortex in violent adult offenders[ 80] and in antisocial and psychopathic individuals[ 81] compared to non-aggressive offenders.

Reduced basal Hypothalamic-Pituitary-Adrenal (HPA) axis activity has been reported in relation to childhood DBDs and exposure to abuse and neglect[ 82]. It has been hypothesized that high levels of prenatal testosterone exposure appears to be part of the complex aetiology of EBDs, providing possible explanation for the higher prevalence in males for DBDs, by increasing susceptibility to toxic perinatal environments such as exposure to maternal nicotine and alcohol in pregnancy[ 83].

COMPLICATIONS OF CHILDHOOD BEHAVIOURAL AND EMOTIONAL DISORDERS

EBDs in childhood, if left untreated, may have negative short-term and long-term effects on an individual's personal, educational, family and later professional life. CD has been linked to failure to complete schooling, attaining poor school achievement, poor interpersonal relationships, particularly family breakup and divorce, and experience of long-term unemployment. DBPs in parents have been linked to the abuse of their offspring, thereby increasing their risk of developing CD[ 84, 85]. Children presenting with hyperactivity-inattention behaviours are more likely to have a more favourable educational outcome compared with those with aggression or oppositional behaviours[ 86, 87].

A high prevalence of sleep disturbances is associated with various childhood EBPs. Sleep problems in early childhood is associated with increased prevalence of later Anxiety disorders and ODD[ 88, 89].

Several studies have confirmed a strong relationship between early childhood EBPs and poor future long-term physical and mental health outcomes. Chronic irritability in preschool children, CD and ODD in older children each may be predictive of any current and lifetime Anxiety, Depression and DBDs in later childhood, Mania, Schizophrenia, OCD, major depressive disorder and panic disorder[ 84, 90- 92]. Individuals on the adolescent-onset CP path often consume more tobacco and illegal drugs and engage more often in risky sexual behaviour, self-harm, and have increased risk of PTSD, than individuals without childhood conduct problems. They also frequently experience parenting difficulties, including over-reactivity, lax and inconsistent discipline, child physical punishment and lower levels of parental warmth and sensitivity[ 74, 84, 93, 94]. Approximately 40%-50% of CYP with CD are at the risk of developing antisocial personality disorder in adulthood[ 84]. Other potential complications include adverse mental and physical health outcomes, social justice system involvement including incarceration, substance use and abuse, alcoholism, homelessness, poverty and domestic abuse[ 95, 96].

An analysis of several Scandinavian studies up to the 1980s has shown higher rates of violent death, estimated to be almost five times higher than expected among young people with previous MHD, with common associated predictive factors including behavioural problems, school problems, and co-morbid alcohol or drug abuse and criminality[ 97].

ASSESSMENT AND DIAGNOSIS OF CHILDHOOD BEHAVIOURAL AND EMOTIONAL DISORDERS

Assessment through detailed history taking as well as observation of a child's behaviour are indispensable sources of information required for clinical diagnosis of EBPs[ 1]. This should include general medical, developmental, family, social, educational and emotional history. Physical and neurological examination should include assessment of vision, hearing, dysmorphic features, neuro-cutaneous stigmata, motor skills and cognitive assessment. Condition-specific and generic observer feedback on screening rating scales and questionnaires can be used to complement direct clinical observations.

There is no single gold-standard diagnostic tool available for the diagnosis of EBDs, which largely depends on the clinical skills of an integrated collaboration of multi-professional experts. Diagnosis relies on interpretation of subjective multi-source feedback from parents or carers, teachers, peers, professional or other observers provided through a number of psychometric questionnaires or screening tools[ 98]. Significant discrepancies between various respondents are quite common and clinical diagnosis cannot rely on the psychometric tools alone. There is evidence from the literature suggesting that parents have a tendency to over-report symptoms of ODD and CD in children compared to the teachers[ 99].

There are several screening tools that are used for assessing the risk of MHD among CYP. The tools help to identify which individuals would require more in-depth clinical interventions[ 100]. Supplement material shows a list of common Mental Health screening and assessment tools, summarizing their psychometric testing properties, cultural considerations and costs. The commonest behaviour screening tools include the Behavioral and Emotional Screening System (BESS; ages 3-18 years), the Behavior Assessment System for Children-2 nd edition, Pediatric Symptom Checklist (PSC), the Ages and Stages Questionnaire-Social Emotional (ASQ-SE, Ages 0 to 5 years) and the Achenbach System of Empirically Based Assessment (ASEBA), for children aged 1.5 years through adulthood.

MANAGEMENT OF BEHAVIOURAL AND EMOTIONAL DISORDERS IN CHILDREN

Identification of appropriate treatment strategies depend on careful assessment of the prevailing symptoms, the family and caregiver's influences, wider socio-economic environment, the child's developmental level and physical health. It requires multi-level and multi-disciplinarian approaches that include professionals such as Psychologists, Psychiatrists, Behavioural Analysts, Nurses, Social care staff, Speech and language Therapists, Educational staff, Occupational Therapists, Physiotherapists, Paediatricians and Pharmacists. Use of pharmacotherapy is usually considered only in combination with psychological and other environmental interventions[ 15].

Holistic management strategies will include various combinations of several interventions such as child- and family-focused psychological strategies including Cognitive Behavioural Therapy (CBT), behavioural modification and social communication enhancement techniques, parenting skills training and psychopharmacology. These strategies can play significant roles in the management of children with a wide range of emotional, behavioural and social communication disorders. Effective alternative educational procedures also need to be implemented for the school age children and adolescents.

In early childhood, similar parenting strategies have been found useful to manage several apparently dissimilar EBPs ( e.g., infant feeding or sleeping problems, preschool tantrums, disruptive and various emotional problems). This may suggest there is a common maintaining mechanism, which is probably related to poor self-regulation skills, involving the ability to control impulses and expressions of emotion[ 101].

Several studies have confirmed the effectiveness of various psychological and pharmacologic therapies in the management of childhood EBDs. A meta-analysis of thirty-six controlled trials, involving 3042 children (mean sample age, 4.7 years), evaluating the effect of psychosocial treatments including parenting programmes on early DBPs, demonstrated large and sustained effects (Hedges'g = 0.82), with the largest effects for general externalizing symptoms and problems of oppositionality and non-compliance, and were weakest, relatively speaking, for problems of impulsivity and hyperactivity[ 102].

The treatment of CD among CYP with callous-unemotional traits is still at early stages of research. The mainstay of management for CDs includes individual behavioural or cognitive therapy, psychotherapy, family therapy and medications[ 103].

Parental skills training

Any challenging behaviour from CYP is likely to elicit persistent negative reactions from many parents, using ineffective controlling strategies and a decrease in positive responses[ 104]. There is evidence from published research that social-learning and behaviourally based parent training is capable of producing lasting improvement in children with callous-unemotional traits or CD, reducing externalizing problems for children with DBDs, leading to significant parent satisfaction, particularly when delivered early in childhood[ 84, 105- 107]. These interventions are typically delivered in a group format, one 2-h session per week for 4-18 wk, by trained leaders, with the focus on improving parenting skills to manage child behaviour, where parents typically learn to identify, define and observe problem behaviours in new ways, as well as learn strategies to prevent and respond to oppositional behaviour[ 108, 109].

Pooled estimates from a review of 37 randomised controlled studies identified a statistically significant improvement on several rating scales among children with CD up to the age of 18 years[ 23]. A previous meta-analysis of 24 studies confirmed that Parent-Child Interaction Therapy (PCIT) demonstrated significantly larger effect sizes for reducing negative parent behaviours, negative child behaviours, and caregiver reports of child behaviour problems than did most or all forms of Positive Parenting Programme (Triple P)[ 110]. A recent Cochrane review of 13 studies confirmed the efficacy and cost-effectiveness of group-based parenting interventions for alleviating child conduct problems, enhancing parental mental health and parenting skills, at least in the short term[ 111].

Differentiated educational strategies

Research has focused on identifying alternative educational strategies that can be used to improve learning opportunities for children presenting with challenging behaviours from various causes. Supportive school strategies for children with EBDs have traditionally focused on classroom management, social skills and anger management, but many researchers have more recently argued that academically-focused interventions may be most effective[ 112]. Traditional school policies of suspending or expelling children with EBD can be harmful to them. Researchers have developed "step-by-step" guidelines for teachers to guide them in the selection and implementation of evidence-based strategies that have been identified as effective in increasing levels of engagement and achievement by children with EBD, including peer-assisted learning procedures, class-wide peer tutoring, self-management interventions and tiered intervention systems - most notably Response to Intervention (RtI) and Positive Behavioural Interventions and Supports (PBIS)[ 113, 114].

There is increasing evidence to confirm that school-based interventions to address emerging DBPs produce significant reductions in both parent-, self- and teacher-reported internalizing and externalizing symptoms[ 114, 115].

Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) is an educational system designed for the management of children with Autism and related communication disorders[ 116, 117]. There is some evidence that TEACCH programmes also lead to some improvements in motor skills and cognitive measures[ 117].

Best practice management strategies for children with PDA are known to differ from those with Autism. Specific guidelines for children with PDA[ 118] have been published by the British institute for Learning Disabilities. Educational support for CYP with PDA relies on highly individualized strategies that allows them to feel in control. They would respond much better to more indirect and negotiative approaches. For example, "I wonder how we might..." is likely to be more effective than "Now let's get on with your work"[ 118].

Child-focused psychological interventions

Cognitive behavioural therapy (CBT) is one of the most widely used non-pharmacologic treatments for individuals with emotional disorders, especially depression, and with individuals with behavioural problems including ASD[ 119]. CBT integrates a combination of both cognitive and behavioural learning principles to encourage desirable behaviour patterns. Research evidence from several trials[ 120] provide strong support for the effectiveness of cognitive-behavioural interventions among CYP with Anxiety and Depression. A recent study of child-focused CBT programme introduced at schools has shown that it produces significant improvement in disruptive behaviours among children[ 121].

Self-esteem building strategies can help many children with EBDs, who often experience repeated failures at school and in their interactions with others. These children could be encouraged to identify and excel in their particular talents (such as sports) to help build their self-esteem.

Behavioural modification and social communication enhancement strategies

Behavioural interventions and techniques are designed to reduce problem behaviours and teach functional alternative strategies using the basic principles of behaviour change. Most interventions are based on the principles of Applied Behaviour Analysis (ABA) which is grounded on behavioural learning theory. Table summarizes the common behavioural modification strategies for management of childhood EBDs.

Several strategies have been designed to help children acquire important social skills, such as how to have a conversation or play cooperatively with others, using social group settings and other platforms to teach peer interaction skills and promote socially appropriate behaviours and communication. There is ongoing research in the development of social communication treatment approaches[ 45]. Table summarizes common social communication enhancement strategies.

PSYCHOPHARMACOLOGY OF CHILDHOOD BEHAVIOURAL AND EMOTIONAL DISORDERS

Medications are often prescribed as part of a comprehensive plan for the management of childhood EBDs that includes other therapies. The greatest level of evidence for pharmacotherapy of childhood EBDs is available for their use in the management of childhood and adolescent ADHD. There is less evidence of any efficacy for medications in the management of other DBPs including ODD and CD. Table lists the common classes of medications used in the management of childhood EBD.

Table 8

Atypical antipsychotics

Aripiprazole, Clozapine, Olanzapine, Quetiapine, Risperidone, Ziprasidone

Low white blood cell count (Agranulocytosis - with Clozapine), Diabetes, Lipid abnormalities, Weight gain, Other medication-specific side effects

Selective Serotonin Reuptake Inhibitors

Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Sertraline

Headache, Nervousness, Nausea Insomnia, Weight Loss

Serotonin-norepinephrine reuptake inhibitor

Venlafaxine, Levomilnacipran, Duloxetine, Desvenlafaxine

Other antidepressants

Bupropion, Mirtazepine, Trazodone

Stimulants

Methylphenidate Immediate Release and Modified Release ( e.g., Concerta XL, Equasym XL), Dexamfetamines Immediate Release and Modified Release ( e.g., Lisdexamfetamine)

ADHD

Decreased appetite/ weight loss, Sleep problems, Jitteriness, restless, Headaches, Dry mouth, Dysphoria, feeling sad, Anxiety, Increased heart rate, Dizziness

Blood pressure and heart rate will be checked before treatment and periodically during treatment. Child's height and weight are monitored

Non-stimulants

Atomoxetine

Alpha-2 agonists

Clonidine, Guanfacine

Drowsiness, Dizziness, Sleepiness

Antihistamines

Hydroxyzine HCl, Hydroxyzine, Pamoate, Alimemazine

Sleepiness, Drowsiness, Dizziness, Dry mouth, Confusion, Blurred Vision, Balance problems, Heartburn

Psychostimulants (including different formulations of Methylphenidate and Dexamphetamines) remain the primary medication of choice for management of ADHD in CYP for more than 60 years. About 75% to 80% of children with ADHD will benefit from the use of psychostimulants. Non-stimulant therapy with Atomoxetine or alpha 2-adrenergic agonists (Clonidine and Guanfacine) are also effective second-line alternative options[ 133]. A recent analysis of 16 randomized trials and one meta-analysis, involving 2668 participants with ADHD, showed that both stimulant and non-stimulant medications led to clinically significant reductions in core symptoms with consistently high effect sizes. The psychosocial treatments alone combining behavioural, cognitive behavioural and skills training techniques demonstrated small- to medium-sized improvements for parent-rated ADHD symptoms, co-occurring emotional or behavioural symptoms and interpersonal functioning[ 134].

The use of pharmacological treatments for symptoms of ASD is common but challenging, as there are no medications that directly treat the social and language impairments present in individuals with ASD. The medications used most frequently include antipsychotics ( e.g., Risperidone) and Selective Serotonin Reuptake Inhibitors (SSRI) to treat mood and repetitive behaviour problems, and stimulants and other medications used to treat ADHD-related symptoms. The evidence base is good for using atypical antipsychotics to treat challenging and repetitive behaviours, but they also have significant side effects[ 119, 135]. Naltrexone is an opioid antagonist that has been shown from a systematic review (involving 155 children from 10 studies) to significantly improve symptoms of self-injury, irritability, restlessness and hyperactivity in autistic children, with minimal side effects and generally good tolerance, although long-term data are lacking[ 136].

Medication use in preschool children for control of ASD and ADHD symptoms is still largely controversial. Stimulant medications for treatment of ADHD are not uniformly licensed for pre-schoolers as there is limited available research evidence to confirm efficacy and safety. Moreover, the effectiveness of parenting interventions in this age group are comparable to the effects of using stimulant drugs among the older CYP[ 137, 138].

Research evidence from two systematic reviews and 20 randomized controlled trials has recently documented the efficacy of psychopharmacology in the management of childhood DBP. Psychostimulants have have been shown to have a moderate-to-large effect on oppositional behaviour, conduct problems, and aggression in youths with ADHD, with and without ODD or CD, while Atomoxetine has only a small effect. There is very-low-quality evidence that Clonidine and Guanfacine have a small-to-moderate effect on oppositional behaviour and conduct problems in youths with ADHD[ 139].

Other behavioural disorders in children could also be successfully treated by medications. Traditional and the newer atypical antipsychotics can be used for OCD, Depression, aggression and mood instability[ 140].

The commonest antidepressants in used in children are the SSRI and Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) medications as they work well and usually have fewer side effects compared to the older Tricyclic Antidepressants. Antidepressants can be used in the management of Major Depression, Anxiety, Seasonal Affective Disorder (SAD), OCD, PTSD and Social Anxiety. They may also be used to treat enuresis and pre-menstrual syndrome[ 141].

CONCLUSION

Childhood EBDs have significant negative impacts on the society, in the form of direct behavioural consequences and costs, and on the individual, in the form of poor academic, occupational and psychosocial functioning and on the family. The costs to society include the trauma, disruption and psychological problems caused to the victims of crime or aggression in homes, schools and communities, together with the financial costs of services to treat the affected individuals, including youth justice services, courts, prison services, social services, foster homes, psychiatric services, accident and emergency services, alcohol and drug misuse services, in addition to unemployment and other required state benefits[ 23].

Prevention and management of EBD is not easy and it requires an integrated multidisciplinary effort by healthcare providers at different levels to be involved in the assessment, prevention and management of affected individuals, and also to provide social, economic and psycho-emotional support to the affected families.

There is increasing evidence base for several psychosocial interventions but less so for pharmacological treatment apart from the use of stimulants for ADHD. Preventive measures that have been researched for controlling the risk of childhood emotional and behaviour problems include breastfeeding[ 142], avoiding second-hand smoke exposure in non-smoker youths [ 143] and intensive parenting interventions.

Footnotes

Conflict-of-interest statement: The author declares no conflict of interest for this article.

Manuscript source: Invited manuscript

Peer-review started: October 29, 2017

First decision: November 20, 2017

Article in press: December 5, 2017

Specialty type: Pediatrics

Country of origin: United Kingdom

Peer-review report classification

Grade A (Excellent): A, A

Grade B (Very good): 0

Grade C (Good): 0

Grade D (Fair): D

Grade E (Poor): 0

P- Reviewer: Ho RCM, Yellanthoor RB, Yucel O S- Editor: Ji FF L- Editor: A E- Editor: Li RF

References

6. Gardner F, Shaw DS. 2009. Behavioral Problems of Infancy and Preschool Children (0-5). Chapter 53 in Rutter's Child and Adolescent Psychiatry Fifth Edition. [ Google Scholar]

13. World Health Organization (WHO) International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Geneva Switzerland: World Health Organization, 1990. Available from: https://tinyurl.com/neayazp.

14. Emerson E. Cambridge University Press; 2001. Challenging Behaviour: Analysis and intervention in people with learning disabilities. 2nd edition; pp. 2-4. [ Google Scholar]

15. National Institute for Health and Clinical Excellence (NICE) Challenging behaviour and learning disabilities: Prevention and interventions for people with learning disabilities whose behaviour challenges. 2015. Available from: https://www.nice.org.uk/guidance/ng11.

21. National Institute for Health and Care Excellence (NICE) Attention deficit hyperactivity disorder: diagnosis and management. [updated 2008 Sept 24] Available from: https://www.nice.org.uk/guidance/cg72.

24. Centers for Disease Control and Prevention (CDC) Perou RH, Bitsko SJ, Blumberg P, Pastor RM, Ghandour JC, Gfoerer SL. Mental Health Surveillance among Children - United States 2005-2011. Morbidity and Mortality Weekly Report (MMWR) 2013;62(Suppl 2):1-35. Available from: [ https://www.cdc.gov/mmwr/pdf/other/su6202.pdf. [ PubMed] Google Scholar]

33. American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders 4th Edition. Washington (DC): APA; 2000. p. 866. [ Google Scholar]

43. Rapin I. Historical data. In Rapin I (Ed) Vol. 139. Preschool Children with Inadequate Communication: Developmental Language Disorder, Autism, Low IQ. Clinics in Developmental Medicine. Cambridge University Press, New York; 1996. pp. 57-97. [ Google Scholar]

62. McLoyd V. How money matters for children's socioemotional adjustment: Family processes and parental investment. Carlo G, Crockett L, Caranza M editors; Addressing youth health disparities in the twenty first century. Based on 57th Annual Nebraska Symposium on motivation. Springer; New York; In: Motivation and health. 2011. pp. 33-72. [ Google Scholar]

109. Funderburk BW, Eyberg SM. Parent-Child Interaction Therapy. In: History of Psychotherapy: Continuity and Change., editor. Norcross JC VandenBos GR Freedheim DK editors. 2nd ed. Washington DC: American Psychological Association; 2011. pp. 415-420. [ Google Scholar]

117. Warren Z, Veenstra-VanderWeele J, Stone W, Bruzek JL, Nahmias AS, Foss-Feig JH, Jerome RN, Krishnaswami S, Sathe NA, Glasser AM, et al. Therapies for Children With Autism Spectrum Disorders, 2011 [ Google Scholar]

# data[].attributes.attachment_link.title
Behavioural and emotional disorders in childhood: A brief overview for paediatricians

# data[].attributes.attachment_link.description
Mental health problems in children and adolescents include several types of emotional and behavioural disorders, including disruptive, depression, anxiety and pervasive developmental (autism) disorders, characterized as either internalizing or externalizing problems. Disruptive behavioural problems such as temper tantrums, attention deficit hyperactivity disorder, oppositional, defiant or conduct disorders are the commonest behavioural problems in preschool and school age children.

# data[].attributes.headline
How much do you know about ED (Emotional Disturbance)?

# data[].attributes.subject
How much do you know about ED (Emotional Disturbance)?

# data[].attributes.attachment_link.readable_text
"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."
Each school year students journey is like climbing stairs called success. To many, each step is an exciting and pleasant experience. But to some who are dealing with emotional disturbances, every step they take tells a different story. And no matter how they do reaching the top of the ladder is a challenge.

Under IDEA, the disability "emotional disturbance" is the 4th largest disability category. One in five children has a diagnosable, mental, emotional, or behavioral disorder. Children and youth identified as having an emotional disturbance represent 8.1% of all students ages 6-21 being served under IDEA (U.S. Department of Education, 2002). An emotional disturbance is more common in boys than in girls.

The federal term for "Emotional Disturbance" (ED) according to IDEA, is 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:

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

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

Inappropriate types of behavior or feelings under normal circumstances.

A general pervasive mood of unhappiness or depression.

A tendency to develop physical symptoms or fears associated with personal or school problems.

Children who are diagnosed with "schizophrenia" also fall under this term. This does not apply to children who are socially maladjusted unless it is determined that they have an emotional disturbance.
Symptoms of students with Emotional Disturbances:

Learning difficulties

Difficulties to focus or concentrate

Inability to build or maintain interpersonal relationships

Inappropriate types of behavior

Pervasive mood of unhappiness

Depression

Physical Symptoms of fears associated with personal or school problems

Emotional disturbance is an umbrella term that's used under IDEA to describe a wide range of different disorders and conditions. Anxiety disorders, conduct disorders, eating disorders, bipolar disorder, obsessive-compulsive disorder (OCD), psychiatric disorders - all are considered emotional disturbances. Yet each varies from the other in significant ways.

(Reference: education.com & specialeducationguide.com)

Students with an emotional disturbance have high dropout rates and even higher unemployment rates among those who do complete school. These students have the greatest risk of dropping out of school as compared to students in other disability categories. (Sutherland and Wehby, 2001)

Given those facts, schools can help students with ED through;

The physical environment:

Class seating arrangements should be considered and potentially harmful objects or substances should be kept away from easy access.

The student's proximity to teachers and teacher aides should also be considered, as well as where students sit with whom the child interacts negatively.

A "quiet spot" in the classroom may be useful for students with an emotional disturbance. The child may use this quiet spot to remove himself from a stressful situation to diffuse any negative emotions that could cause the situation to escalate.

Classroom materials:

Students with an emotional disturbance may benefit from using a self-monitoring checklist that allows them to check off activities after they are completed.

Because some children with emotional disturbances face increased anxiety in the school setting, having assignments broken into shorter segments can help students from becoming overwhelmed.

A checklist can also be used to aid students in self-monitoring behavior. Different behavior expectations can be placed in a chart organized by classroom subjects, and the teacher can tally the frequency of positive behaviors displayed by the student throughout the school day. As the child increases his or her tallies of positive behavior, teachers can provide positive reinforcement through classroom rewards.

Instruction and evaluations:

Teachers should scaffold instruction in a way that is accessible to all students, and they should facilitate a classroom community that is a welcoming and safe space.

Students with emotional disturbances may benefit from extended time during assessments and modified test questions to help minimize anxiety. The testing environment should also be distraction-free.

Talking to the child about coping with anxiety and encouraging the child to speak out about his or her needs can help the child learn more effective ways of managing his stress.

Help the child find a comfortable and quiet study space with minimal distractions to help the child increase the amount of time he or she spends being productive academically.

Breaking homework assignments into smaller pieces can help a child with emotional disturbances focus on the work he or she needs to complete rather than becoming overwhelmed by the overall workload.

Frequent breaks (every 20 minutes or as needed by the child) can also help decrease the child's anxiety about school work.

Positive reinforcement and praise during homework time can help the child increase his or her self-monitoring to stay on track with assignments.

Teachers play a vital role in helping emotionally disturbed students. They often serve as a guiding light in every step that their students have to take. However, no two students with ED are the same. And it makes a bit more challenging for any educators to deal with them. So here are some helpful tips and strategies to consider on how you can best help them, support their learning and encourage their well-being.

The educational programs for students with a serious emotional disturbance need to include attention to:

mastering academics

developing social skills

increasing self-awareness, self-esteem, and self-control

Career education (both academic and vocational programs) is also a major part of secondary education and should be a part of every adolescent's transition plan in his or her Individualized Education Program (IEP).

Support the student's inclusion. - Emotional disturbances, by their very nature, can make it difficult for people to build or maintain satisfactory interpersonal relationships. You can support the student with an emotional disturbance in subtle but meaningful ways, especially during group work, cooperative learning activities, peer interactions, and team projects. There may also be times to let the student work alone, take a break, or have a hall pass for some quiet time apart.

Set clear behavioral rules and expectations for the entire class. - Students with emotional disturbances are frequently the targets (rather than the initiators) of other students' misbehaviors. Having a stated, explicit classroom management plan provides a solid structure by which both teacher and students can address inappropriate behavior, understand consequences, and develop a shared approach to behavior in class and toward one another. This IRIS training module may help you set up such a plan.

Recognize the student's accomplishments. - Some students benefit from working toward a tangible goal on an hourly, daily, or weekly basis. With a bonus points system, students earn points that can be saved up and cashed in for rewards at a later time. When designing a point system for students with emotional disturbance and behavioral problems, it is important to design the task and its time frame to fit the points. If the payoff is too far into the future, the student may give up on the task. Students may also be encouraged to record their progress on a chart or record sheet that enables them to see their progress toward the goal.

Encourage organization and routine. - Teach students to keep track of their assignments, grades, and targeted behaviors using reminders such as assignment sheets, daily schedules, and to-do lists. Help students manage their time by establishing routines for making transitions between lessons, getting and putting away materials, and requesting assistance. Students can have cue cards on their desk or notebook to serve as visual cues for transition steps. Provide time-management reminders, such as 10-, 5-, or 2-minute warnings before clean-up time, to establish time limitations for completing work.

Accommodation/Differentiation Strategies

Extend the amount of time that a student is given to complete a particular task.

Break down assignments into smaller ones. As students finish each mini-assignment, build in reinforcement for task completion. Wait to distribute the next assignment until students have been successful with the current one.

Reduce the number of practice items that a student must complete, once the student has demonstrated mastery.

Follow low-interest activities with high-interest activities so that students get breaks from difficult or less interesting activities from time to time.

Plan short review lessons or readiness activities to help orient the student to a particular learning task.

(Reference: elementaryemotionaldisturbance.com)

(Read full article here: theeducatorsroom.com)

Teaching Students with Emotional Disturbances: 8 Tips for Teachers

1. Learn more about the student's specific mental health disturbance.

2. Learn more about the student's strengths, too.

3. Remember, they're kids first.

4. Support the student's inclusion.

5. Set clear behavioral rules and expectations for the entire class.

6. Provide accommodations.

7. Join the student's IEP team and help shape his or her special education program.

8. Communicate with the student's parents.

(Access explanations and more info here: myschoolpsychology.com)

More Emotional Disturbances Helpful and Informative Links for Educators and Parents:

We are not affiliated with any educators or bloggers mentioned in this article. But we admire their advocacies in guiding parents and educators help emotionally disturbed students. We believe that with your conscious determination paired with sensible heart and viable strategies, reaching the top of the ladder of success is possible with ease for students with ED. And for sure your "extraordinary" effort will make a huge difference in their lives that they will be so grateful for a lifetime!

"A caring teacher can be a child's salvation against all odds," (Larrivee, 2009).

Other Useful Resources:
Special Ed Teacher jobs

# data[].attributes.attachment_link.title
How much do you know ED (Emotional Disturbance)?

# data[].attributes.attachment_link.description
"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."

# data[].attributes.headline
Tips for Parents Who Have Children with Emotional Disturbance

# data[].attributes.subject
Tips for Parents Who Have Children with Emotional Disturbance

# data[].attributes.headline
Emotional Disorder: Symptoms, Diagnosis & Treatment

# data[].attributes.subject
Emotional Disorder: Symptoms, Diagnosis & Treatment

# data[].attributes.attachment_link.readable_text
The term "emotional disorders" usually refers to mental health conditions like mood disorders.

When people use the term emotional disorders, they're usually talking about mental health conditions that affect your mood. Mood disorders, also called affective disorders, include conditions like clinical depression and bipolar disorder.

According to the American Psychological Association's Dictionary of Psychology, emotional disorders include psychological disorders where people have "maladjustive emotional reactions that are inappropriate or disproportionate to their cause."

When used loosely, the term can refer to any mental health condition.

Emotional or mood disorders can be treated, often through talk therapy and medications. If you have an emotional disorder, it's possible to heal and feel better.

In clinical settings, the term "mood disorder" is used more often than the term "emotional disorder."

Common emotional disorders include:

Common depressive disorders include:

Anxiety disorders aren't considered mood disorders, although they can affect mood and often occur alongside the mood disorders mentioned above.

Obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) aren't considered mood disorders.

The symptoms of emotional disorders vary based on the individual and their specific disorder, and not everybody with an emotional disorder will have the same symptoms and experience.

You can generally divide the symptoms of emotional disorders into two groups:

depressive symptoms, which occur in depressive disorders, bipolar disorder, and PMDD

mania symptoms, which occur during manic and hypomanic episodes in bipolar disorder

Depressive symptoms include:

Symptoms of hypomanic or manic episodes include:

It's important to note that these symptoms can also point to another condition (in other words, not an emotional disorder). For example, some depressive symptoms are common in people with PTSD.

Although the causes of mood disorders aren't entirely understood, there are a number of factors that seem to increase your risk of developing a mood disorder, according to .

The risk factors for emotional disorders include:

Brain function: The structure and chemistry of your brain may play a role in whether you develop a mood disorder.

Genetics: You're more likely to develop an emotional disorder if a close blood relative has the same disorder.

Hormones: Recent notes that increased levels of thyroid-stimulating hormone are associated with depression. Hormones also may play a role in the development of perinatal or postnatal depression, as well as PMDD.

Physical health: Certain physical health conditions, such as cancer, HIV, and hypothyroidism, can increase your risk.

Substance use: The use (and misuse) of certain substances, including amphetamines, cocaine, procarbazine, and steroids, can cause symptoms similar to mood disorders.

Traumatic life experiences: Trauma, although usually associated with PTSD, can also cause or trigger mood disorders.

Emotional disorders are diagnosed by mental health professionals, such as psychiatrists, nurse psychotherapists, or psychologists. A general practitioner may also make a diagnosis, although they might refer you to a mental health specialist first.

Your clinician might ask about your current symptoms, medical history, and family history. They may use certain questionnaires to assess your mental health. If your symptoms fit the diagnostic criteria for a certain condition, you might be diagnosed with the disorder.

You don't need a diagnosis before you approach a therapist. It's possible to receive talk therapy even if you haven't been diagnosed with a disorder.

Emotional disorders can be treated. The treatment course you take will depend on your condition.

Psychotherapy

Also known as talk therapy, psychotherapy can be helpful for people with mood disorders.

Talk therapy can help you identify and change unhealthy patterns in your thoughts, behaviors, and emotions. You can use therapy as a space to explore and process your feelings in a constructive, healthy way.

Many different types of therapy are used to treat emotional disorders. Some of the most common types of therapy include:

Talk therapy is done with a qualified, licensed mental health professional, such as a clinical social worker, psychologist, or psychiatrist.

Medication

In some cases, certain medications - such as antidepressants or mood stabilizers - can significantly benefit people with emotional disorders.

Common medications for emotional disorders include:

If you don't feel that your medication is helping, discuss it with a mental health professional, as they may help you find alternatives. Stopping your medication without guidance and supervision can lead to unwanted complications.

Alternative treatments

In some cases, your doctor may suggest alternative treatments, such as.

These treatments can be helpful, especially if you have treatment-resistant depression or bipolar disorder (in other words, conventional medication and therapy only improve your condition very slightly).

Emotional disorders can be challenging to live with, but they are treatable. It's possible to live a full, successful, happy life while living with an emotional disorder.

Some people respond to treatments more quickly than others, and in some cases, it might take time to find a treatment plan that works for you. Generally, emotional disorders require long-term treatment.

If you think you have an emotional disorder or mood disorder, a good first step is to speak with a doctor or therapist. They can help you take steps toward feeling better.

We've compiled a list of Mental Health Resources for people who are looking for mental health support. The article includes some guidance on finding lower cost and free counseling and support.
Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa. She's passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information.

# data[].attributes.attachment_link.description
When people use the term emotional disorders, they're usually talking about mental health conditions that affect your mood.

# data[].attributes.headline
Classroom Accommodations for Students with Emotional & Behavior Disorders

# data[].attributes.subject
Classroom Accommodations for Students with Emotional & Behavior Disorders

# data[].attributes.attachment_link.readable_text
If you're a special education teacher working with students who have emotional and behavioral disorders, you know that accommodations are key to helping them succeed. But what accommodations are best for these students? In this blog post, you will learn about accommodations for students with emotional and behavioral disorders (EBD) that have proven to be effective for students.

Remember, it is extremely important to collect data on what accommodations are suitable for each student. It is oftentimes trial and error to determine what are the most effective strategies for each student. This is not an exhaustive list but rather ideas and suggestions for the first phase of the process in deciding how to help students succeed.

ENCOURAGE POSITIVE BEHAVIORS

One of the most important accommodations for students with EBD is to provide them with a positive and structured environment. This means discouraging negative behavior while rewarding appropriate behavior. Some ways to do this include setting clear rules and expectations, providing positive reinforcement when students display good behavior, and using a token economy system to reward positive behaviors.

ACCOMMODATIONS FOR STUDENTS WITH EMOTIONAL AND BEHAVIORAL DISORDERS-PARTICIPATING IN CLASS

Another important accommodation for students with EBD is to encourage them to participate in class. This means giving them opportunities to answer questions, offer their opinions, work with their peers, and complete assignments.

Examples of accommodations and modifications are:

providing clear instructions

breaking down tasks into smaller steps

offer choices when able

give students extra time to complete assignments.

Making class participation an effective part of normal circumstances, will shift students' focus off their disability, and increase their tendency to strive for better grades.

PROVIDE PROPER ASSIGNMENTS

It's important to give students with EBD assignments that are within their abilities and that match their educational level. Additionally, the types of accommodations in their IEP and individualized education program can be provided to help these students succeed.

Some examples of accommodations that have been found to be effective for students with EBD include:

- Testing accommodations such as extended time on tests, and small group testing environment

-Use of a calculator on math tests and homework

-Extended time on assignments that are in the general education curriculum

- Movement breaks as needed: use a pass system for breaks

- Offer choices: for example, students can demonstrate comprehension of a subject by handing in a traditional paper, video, or poster, etc.

- Preferential seating arrangements

- Frequent check-ins with the teacher

- Alternative seating such as wiggle cushions or exercise ball seating

ENSURE ACCOUNTABILITY - ACCOMMODATIONS FOR STUDENTS WITH EMOTIONAL AND BEHAVIORAL DISORDERS

It's important for students with EBD to be held accountable for their behavior and actions. This means making sure they understand the consequences of their choices. Some ways to do this include:

- Having clear rules and expectations in place

- Providing immediate feedback to the student

-Use non-verbal cues or a code word to communicate inappropriate behavior

- Encouraging the student to take ownership of their actions

- Imposing consequences for severe inappropriate types of behavior

ENCOURAGE STUDENTS WITH EMOTIONAL AND BEHAVIORAL DISORDERS TO PARTICIPATE IN SOCIAL ACTIVITIES

Many students with EBD struggle with social interactions. It can be helpful to encourage them to participate in social activities, such as lunchtime groups, class discussions, or extracurricular activities. This can help them to develop their social skills and make friends. With satisfactory interpersonal relationships in hand, students can hope to avoid a general pervasive mood of unhappiness.

Accommodations or modifications for social skills could possibly include:

small group work

lunch time with small number of peers

Seat the student close to a positive role model

provide additional personal space between desks

partnering with a peer to encourage social skills.

WORK WITH COLLEAGUES, COUNSELORS, OR PSYCHOLOGISTS

If you are having difficulty managing a student with EBD, don't hesitate to ask for help from your colleagues or school administration. There are many resources available to help educators support students with EBD. If a student's emotional or behavioral problems are causing intense difficulty in the classroom, it may be necessary to seek help from a counselor or school psychologist.

Counselors or psychologists can provide interventions, therapy, and guidance to help the student deal with their emotions and behavior. They might also be able to give students the peace of mind they need to focus on their academic subjects.

ACCOMMODATIONS FOR STUDENTS WITH EMOTIONAL AND BEHAVIORAL DISORDERS-CALM ENVIRONMENT AND SCHOOL ROUTINES

There are a few things that can be done in the classroom to help accommodate students with emotional and behavioral disorders. One of the most important is to create a calm and organized environment cutting down on emotional disturbances. This can be done by:

- Putting up calming decorations, such as pictures of nature or peaceful scenes

-Providing a calm classroom environment - Keep the classroom quiet during higher-level learning.

-Offering a calming corner in the classroom or hallway

- Keeping noise levels down

- Having a predictable schedule

-Noise cancelling headphones

-Dim lighting

- Having clear rules and expectations

- Providing structure and routine

-Use visual supports to reinforce the predictability of the routine

ACCOMMODATIONS FOR STUDENTS WITH ANXIETY DISORDERS

Students with anxiety disorders can often find it difficult to focus in the classroom. Accommodations that may be helpful for students with this diagnosis include:

- Allowing them to take breaks as needed

- Giving them more time to complete tasks

-Weight daily work higher than tests of test anxiety is present

- Helping them prepare for tests and assignments

- Encouraging them to participate in social activities

- Putting them in a designated seat away from distractions

-Provide organizers for lockers/desk to help with predictability

- Using calming decorations, such as pictures of nature or peaceful scenes.

Read more about writing and students with anxiety here.

ACCOMMODATIONS FOR STUDENTS WITH EMOTIONAL AND BEHAVIORAL DISORDERS-AUTISM SPECTRUM

Students with autism spectrum disorders often have difficulty with communication and social interaction. This is by no means an extensive list but help to provide basic suggestions. Accommodations that may be helpful for these students include:

- Preferential seating

- Allowing them to take breaks as needed

- Encouraging them to be social with their peers

-Helping them learn and identify their sensory needs

- Using visual supports to aid with communication, directions, and routine.

Read more on accommodations and students with autism.

ACCOMMODATIONS FOR STUDENTS WITH DEPRESSION

Students with depression often have low energy levels and difficulty concentrating. It can have a profound effect on a person's thoughts, emotions, and behavior. Accommodations that may be helpful for these students include:

- Allowing them to take downtime when necessary

- Encouraging them to talk and interact with peers

- Helping them with schoolwork and studying for tests

- Giving them longer periods of time to complete tasks

- Breaking assignments down into simpler steps

-Recognizing when health factors or physical symptoms may be causing an inability to focus.

- Self-monitoring checklists to stay on task

ACCOMMODATIONS FOR STUDENTS WITH EMOTIONAL AND BEHAVIORAL DISORDERS- BIPOLAR DISORDER

Students with bipolar disorder can experience extreme mood swings, from mania to depression that can cause many school problems and conduct disorders. Students may feel intensely happy, and then quickly feel very depressed. Accommodations that may be helpful for these students include:

- Preferential seating

-Reduced workload during difficult times

- Allowing them to take a pause if the classroom environment is too much

-Encouraging positive behavior and social activities with peers

- Breaking tasks down into small, manageable steps

-Organizational supports

- Monitoring the variables in their moods and adjusting their accommodations as needed.

Accommodations can be an important tool in helping students with emotional and behavioral disorders succeed in the classroom. By understanding the condition and implementing appropriate accommodations, it is possible to create a learning environment that meets the student's needs.

LEARNING TO KNOW WHICH ACCOMMODATIONS TO CHOOSE

Learn more about the difference between accommodations and modifications here.
5 Different Ways to Use Accommodations in the Classroom 504 Accommodations for ADHD
Most importantly, teach your students how to learn about their strengths, challenges and accommodations to empower them to live a more independent life at school, home and the workplace. You can follow this 10 step process starting today with the Self-Advocacy for Students Workbook.

It is critical to determine what accommodations work for each student using data collection and feedback. Research indicates that this is often highly imprecise. The information can be presented differently, responses can change, the environment can be altered, time constraints can be eliminated and specialized tools/technology can help! Take the time to determine what is the best options for each individual student.

# data[].attributes.attachment_link.title
Accommodations for Students with Emotional and Behavioral Disorders

# data[].attributes.attachment_link.description
Learn about accommodations for students with emotional and behavioral disorders (EBD) that have proven to be effective for students.

# data[].attributes.headline
Substance Abuse and Mental Health Services Administration Parent and Caregiver Resources

# data[].attributes.subject
Substance Abuse and Mental Health Services Administration Parent and Caregiver Resources

# data[].attributes.attachment_link.readable_text
Talking to children about mental illness can be an opportunity for parents and caregivers to provide their children with information, support, and guidance. Mental illness in children can be hard for parents and caregivers to identify. As a result, many children who could benefit from treatment don't get the help they need. It's important to know what to watch for and how to get help.

If you have questions or comments, you can contact ACF and SAMHSA at ParentCaregiverTraining@samhsa.hhs.gov.

SAMHSA Resources

Early Childhood Mental Health Programs - SAMHSA funds these programs that promote and support the health and wellness of young children and their families.

MentalHealth.gov - Provides users with information on a variety of mental health issues, including potential signs of mental illness, ways to seek help for mental health challenges, and videos that feature individual stories of mental illness, hope, and recovery.

National Child Traumatic Stress Initiative (NCTSI) - SAMHSA's NCTSI improves treatment and services for children, adolescents, and families who have experienced traumatic events.

School and Campus Health - SAMHSA supports efforts to promote mental health and substance use prevention in schools and on campuses and to provide safe learning environments.

"Talk. They Hear You."® Campaign - SAMHSA's national substance use prevention campaign helps parents and caregivers, educators, and community members get informed, be prepared, and take action.

Federal Resources

ACF & Behavioral Health - ACF is a division of the Department of Health & Human Services that promotes the economic and social well-being of families, children, individuals and communities. The ACF behavioral health webpage includes a section specifically for parents and caregivers.

Centers for Disease Control and Prevention (CDC) - From birth to 5 years, your child should reach milestones in how he plays, learns, speaks, acts and moves. Track your child's development and act early if you have a concern.

CDC - Adverse Childhood Experiences (ACEs) - Adverse childhood experiences (ACEs) can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. CDC works to understand ACEs and prevent them.

National Institute of Mental Health (NIMH) - The National Institute of Mental Health (NIMH) offers authoritative information about mental disorders, a range of related topics, and the latest mental health research.

Embrace, Encourage, & Engage: Family and Caregiver Access to Child and Youth Mental Health Resources Webinar

On March 22, 2023, the ACF and SAMHSA resources training (1 hour, 18 minutes) provided parents and caregivers with tools and skills to support their children.
Embrace, Encourage, & Engage: Family & Caregiver Access to Child & Youth Mental Health Resources presentation (PDF | 3.5 KB)
Additional Resources

American Academy of Child & Adolescent Psychiatry - AACAP Resource Centers empower consumers through patient education. Each AACAP Resource Center contains consumer-friendly definitions, answers to frequently asked questions, clinical resources, expert videos, and abstracts from the JAACAP, Scientific Proceedings and Facts for Families relevant to each disorder.

American Psychiatric Association - The premier psychiatric organization that advances mental health as part of general health and well-being.

Child Mind Institute - Find information to help you support children who are struggling with mental health, behavior or learning challenges.

Mental Health America - Programs and initiatives fulfill its mission of promoting mental health and preventing mental illness through advocacy, education, research and services.

National Alliance on Mental Illness (NAMI) - NAMI provides advocacy, education, support and public awareness so that all individuals and families affected by mental illness can build better lives.

National Center for Transgender Equality - Advocates to change policies and society to increase understanding and acceptance of transgender people. In the nation's capital and throughout the country, NCTE works to replace disrespect, discrimination, and violence with empathy, opportunity, and justice.

The National Child Traumatic Stress Network (NCTSN) - The National Child Traumatic Stress Network (NCTSN) raises the standard of care and increase access to services for children and families who experience or witness traumatic events. This unique network of frontline providers, family members, researchers, and national partners is committed to changing the course of children's lives by improving their care and moving scientific gains quickly into practice across the U.S.

National Federation of Families - The National Federation works to develop and implement policies, legislation, funding mechanisms, and service systems that utilize the strengths of families. Its emphasis on advocacy offers families a voice in the formation of national policy, services and supports for their children with mental health needs and substance use challenges across the lifespan.

Trans Lifeline - Connects trans people to the community support and resources they need to survive and thrive.

Trans Student Educational Resources - A youth-led organization dedicated to transforming the educational environment for trans and gender non-conforming students through advocacy and empowerment. Founded in 2011, it is the only national organization led by trans youth.

Trauma & Grief Center Virtual Learning Library - Meadows Mental Health Policy Institute - The Trauma and Grief (TAG) Center's Virtual Learning Library offers free webinars and resources focusing on childhood trauma and grief to key audiences: parents and caregivers, mental health clinicians, educators, health care providers, law enforcement, and other professionals working with children and adolescents who have experienced trauma and loss.

YOUTH M.O.V.E. - A youth led national organization that works as a diverse collective to unite the voices and causes of youth while raising awareness around youth issues. We will advocate for youth rights and voice in mental health and the other systems that serve them, for the purpose of empowering youth to be equal partners in the process of change. Includes many resources and opportunities for involvement.

# data[].attributes.attachment_link.description
Talking to children about mental illness can be an opportunity for parents and caregivers to provide their children with information, support, and guidance. Mental illness in children can be hard for parents and caregivers to identify. As a result, many children who could benefit from treatment don't get the help they need.

# data[].attributes.attachment_link.readable_text
Parents should be aware of the following characteristics and behaviors seen in children who have emotional disturbance: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 2003-2004 school year, more than 484,000 children and youth with emotional disturbance received these services to address their individual needs related to emotional disturbance. (

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);

Learning difficulties (academically performing below grade level).

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

There is no particular age at which it is discovered that students have emotional disturbance because emotional disturbance is influenced by factors such as family, culture, and school, in addition to genetic, biological and neurological factors. However, teachers are often among the first to suspect that a student may have an undiagnosed emotional disturbance. ( Child Rights - Services 2) They may notice a student's ongoing problems with interpersonal relationships, for example, or signs of unreasonable anger, an eating disorder, or self-injurious behavior. It's also not uncommon for teachers to refer such students for evaluation, to see that they are connected with the systems of supports and services that can be genuinely helpful, even life-changing. 8)

You have the option of asking your school to evaluate your child to determine if he/she is eligible for special education and related services provided under IDEA. This evaluation is free of charge in public schools. However, the school does not have to evaluate your child just because you have asked. The school may not think your child has a disability or needs special education. In this case, the school may refuse to evaluate your child. It must let you know this decision in writing, as well as why it has refused. This is called giving you prior written notice. (For more information about prior written notice, see NICHCY's Q&A on Parent Participation, available online at: www.nichcy.org/schoolage/qa-series-on-idea/qa2)

If the school refuses to evaluate your child, there are two things you can do immediately:

Ask the school system for information about its special education policies, as well as parent rights to disagree with decisions made by the school system. These materials should describe the steps parents can take to appeal a school system's decision.

Get in touch with your state's Parent Training and Information (PTI) center. The PTI is an excellent resource for parents to learn more about special education, their rights and responsibilities, and the law. The PTI can tell you what steps to take next to find help for your child. Visit NICHCY's website to identify how to contact your PTI. This information appears on our State Resource Sheet for your state, under "Organizations Especially for Parents." You'll find our state sheets online at:http://www.nichcy.org/families-community/states/

Your child's school may also be concerned about how your child is learning and developing. If the school thinks that your child may have a disability, then it must evaluate your child at no cost to you. The school must ask your permission and receive your written consent before it may evaluate your child. Once you provide that consent, the evaluation must be conducted within 60 days (or within the timeframe the state has established).
During evaluation, it is your right to be included in the team evaluating your child. Also, individuals (invited by you or the school) who have knowledge or special expertise about your child can be included in the evaluation team.
Parent Rights - Eligibility & Refusal/Appeal Not Eligible:
Teaching Students with Severe Emotional and Behavioral Disorders: Best Practices Guide to Intervention

This resource has best practices for the classroom with suggestions for teachers, parents, and students to try.

http://www.k12.wa.us/SpecialEd/Families/pubdocs/bestpractices.pdf
If the eligibility team decides that your child is not eligibile for special education, the school system must tell you this in writing and explain why your child has been found "not eligible." Under IDEA, you must also be given information about what you can do if you disagree with this decision.

Read the information the school system gives you. Make sure it includes information about how to appeal the school system's decision. If that information is not in the materials the school gives you, ask the school for it. IDEA includes many different mechanisms for resolving disagreements, including mediation. The school is required to tell you what those mechanisms are and how to use them.

Also get in touch with your state's Parent Training and Information (PTI) center. The PTI can tell you what steps to take next. Your PTI is listed on NICHCY's State Resource Sheet for your state under "Organizations Especially for Parents"-available online at: www.nichcy.org/families-community/states/

If your child is found eligible for special education and related services and you disagree with that decision, or if you do not want your child to receive special education and related services, you have the right to decline these services for your child. The school may provide your child with special education and related services only if you agree. Also, you may cancel special education and related services for your child at any time.

It is important to note, however, that if you decline or cancel special education for your child and later change your mind, the evaluation process must be repeated.

To locate systems of support in your community or state, visit the organizations 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. Support Groups & More Resources

LD Online, a leading website on learning disabilities and ADHD has a forum page for Emotional Disturbance on which individuals can pose or answer questions about students who might be emotionally disturbed. More specifically, this forum focuses on behavior, social skills, and self esteem. - http://www.ldonline.org/xarbb/topic/9799

Questions Asked by Parents about Special Education Services - http://nichcy.org/publications/lg1

Parent Advocacy Coalition for Educational Rights (PACER) Center - PACER is a non-profit statewide organization created to improve and expand opportunities that enhance the quality of life for children and young adults with disabilities and their families. PACER offers a variety of programs that provide assistance for children with disabilities from birth to adulthood, and for students and schools. PACER also offers technical assistance to parent centers locally and nationwide. PACER's goal is to make parents informed consumers for the welfare of their children by providing them with knowledge of their rights and responsibilities as parents, and about laws and other resources pertaining to their special needs children and their roles as parents. - http://www.pacer.org/

Emotional disturbance. (n.d.). Retrieved from http://nichcy.org/disability/specific/emotionaldisturbance
Questions often asked by parents about special education services. (n.d.). Retrieved from http://nichcy.org/publications/lg1

# data[].attributes.headline
Medications Used For Behavioral & Emotional Disorders

# data[].attributes.subject
Medications Used For Behavioral & Emotional Disorders

# data[].attributes.attachment_link.readable_text
A new treatment protocol may give practitioners a comprehensive, flexible way to treat patients with a variety of disorders, including depression, anxiety and phobias, said anxiety-disorders expert David H. Barlow, PhD, at a plenary session during APA's Annual Convention.

"The protocol takes three or four basic concepts that seem to be present in all of our successful treatments for these emotional disorders and puts them together as a single, unified, transdiagnostic set of principles that clinicians could adapt to anyone sitting in front of them," said Barlow, professor of psychology and director emeritus at the Center for Anxiety and Related Disorders at Boston University.

Barlow and colleagues are finishing a four-year National Institute of Mental Health study testing the treatment's efficacy.

The protocol incorporates three strands of research, Barlow said:

Changes in our understanding of how exposure therapy works. Research now finds that it's more effective to "expose" people to their actual emotional experience - which helps them better accept their emotional life and develop more positive ways of regulating their emotions - than merely to subject them to externally aversive conditions that may temporarily arouse those emotions without attending to how they are processing that experience.

New findings that demonstrate how emotional patterns and responses affect regions of the brain. For instance, brain-imaging studies show that cognitive reappraisal and other emotion-regulation techniques modulate the response of both the amygdala and prefrontal cortices in ways that reduce negative emotions, increase positive emotions, or both, he said.

Further research from Barlow's lab based on findings from emotion science shows that people with any of these emotional disorders experience their emotions in similar ways. In essence, they enter a downward spiral in which they can't accept an initial negative emotion such as anger, depression or fear; they try to suppress or get rid of the emotion; and they have trouble regulating and letting go of the emotion. By contrast, healthy controls are better able to accept, let go of and move on from their negative emotions, he noted.

The new protocol is designed as seven modules that incorporate key elements of that research, as well as principles of change - mechanisms that research shows help people scale barriers to change, Barlow said. Module topics include psychoeducation; motivational enhancement to aid treatment engagement; emotional awareness training; cognitive appraisal and reappraisal; modifying emotion-driven behaviors and emotional avoidance; internal somatic and situational exposure; relapse prevention; and present-focused emotional awareness training.

The protocol is a move toward giving practitioners greater treatment flexibility than manuals allow, Barlow noted.

"Instead of studying treatments as some sort of fixed pattern, practitioners will have principles they can flexibly apply to a variety of different emotional disorders," he said.

The treatment plan also aims to simplify what practitioners have to learn, he noted.

"Instead of having to master, say, 12 different treatment manuals, you'd just have to master one," he said. "The idea is to create a protocol that's easy to disseminate and is much more user-friendly for psychologists."

Tori DeAngelis is a writer in Syracuse, N.Y.

# data[].attributes.attachment_link.description
Research suggests that a single protocol can successfully treat all anxiety and mood disorders.

# data[].attributes.headline
Treating Disruptive Behavior Disorders in Children and Teens

# data[].attributes.subject
Treating Disruptive Behavior Disorders in Children and Teens

# data[].attributes.attachment_link.readable_text
Is This Information Right for Me?

This information is for you if:

A health care professional* said your child or teen has a disruptive behavior disorder, such as oppositional defiant disorder, conduct disorder, or intermittent explosive disorder.

Your child or teen is younger than age 18. The information in this summary is from research on children and teens under age 18.

* Your health care professional may include your child's or teen's primary care physician, pediatrician, psychologist, psychiatrist, licensed social worker-counselor, nurse practitioner, or physician assistant.

What will this summary tell me?

This summary will answer these questions:

What are disruptive behavior disorders (DBDs)?

How are DBDs treated?

Psychosocial treatment (treatment with a trained therapist)

Medicines

What have researchers found about treatments for DBDs?

What are possible side effects of medicines for DBDs?

What should I talk about with my child's or teen's health care professional?

Note: The information in this summary is for children or teens who have a DBD. A child or teen may also have attention deficit hyperactivity disorder (ADHD) with a DBD. This summary is not for children or teens who only have ADHD.

What is the source of this information?

This information comes from a research report that was funded by the Agency for Healthcare Research and Quality, a Federal Government agency.

Researchers looked at 84 studies published between 1994 and June 2014. Health care professionals, researchers, experts, and the public gave feedback on the report before it was published.

Understanding Your Child's or Teen's Condition

What are disruptive behavior disorders (DBDs)?

DBDs are disorders in which children or teens have trouble controlling their emotions and behavior. Their behavior may be very defiant, and they may strongly conflict with authority figures. Their actions may be aggressive and destructive. All children have mild behavior problems now and then, but DBDs are more severe and continue over time.

DBDs can start when a child is young. Children or teens with a DBD who do not receive treatment often have serious behavior problems at home, at school, or both. They are also more likely to have problems with alcohol or drug use and violent or criminal behavior as they get older.

Examples of DBDs include oppositional defiant disorder, conduct disorder, and intermittent explosive disorder.

Oppositional Defiant Disorder

Children or teens with this disorder may have an angry or irritable mood much of the time. They may argue often and refuse to obey parents, caregivers, teachers, or others. They may also want to hurt someone they think has harmed them.

Conduct Disorder

Children or teens with this disorder may act aggressively toward people, animals, or both. They may bully or threaten someone, start physical fights, use weapons, hurt animals, or force sexual activity on others. They may also destroy property by fire or other means, lie often, or steal. They may stay out late at night, skip school, or run away from home. They may also lack compassion and not feel guilty about harming others.

Intermittent Explosive Disorder

Children or teens with this disorder may have outbursts of aggressive, violent behavior or shouting. They may have extreme temper tantrums and may start physical fights. They often overreact to situations in extreme ways and do not think about consequences. Outbursts happen with little or no warning. They usually last for 30 minutes or less. After the outburst, the child or teen may feel sorry or embarrassed.

How common are DBDs? What causes them?

DBDs are one of the most common types of behavioral disorders in children and teens.

Out of every 100 children in the United States, about 3 of them have a DBD.

More boys than girls have a DBD.

DBDs are more common among children aged 12 years and older.

The cause of DBDs is not known. Things that increase the risk for a DBD include:

Child abuse or neglect

A traumatic life experience, such as sexual abuse or violence

A family history of DBDs

Having a child or teen with a DBD can be very stressful for parents, caregivers, and the whole family. But, there are treatments that may help.

Understanding Your Options

How are DBDs treated?

To treat your child's or teen's DBD, your health care professional may recommend psychosocial treatment (treatment with a trained therapist). If needed, your child's or teen's health care professional may also suggest taking a medicine with the psychosocial treatment.

Each child or teen responds differently to different treatments. You may need to try several treatments before finding one that is right for your child or teen.

Psychosocial Treatment

Psychosocial treatment can help improve interactions between you and your child or teen. This is done through programs in which parents and their child or teen meet with a trained therapist. It is important for parents and caregivers to be involved in the treatment.

Some programs focus only on parent training. Other programs also work with the child or teen, the whole family together, or with the child's or teen's teachers.

Parent and child training programs are sometimes done in groups. Sessions usually last 1 to 2 hours and are held each week for 8 to 18 weeks. The programs usually charge a fee. Your insurance may cover some of the costs.

Parent Programs

These programs can help you:

Respond in a positive way when your child asks for help or wants attention

Choose realistic goals for your child

Better monitor your child's behavior

Learn more effective parenting skills

Have more confidence in being able to handle situations

Reduce your stress

The programs help support you and can teach you specific ways to help change your child's behavior without shouting, threatening, or using physical punishment. You can learn to:

Set clear rules

Stay calm when asking your child to do something

Make sure your instructions are clear and right for your child's age

Explain the consequences of disruptive behavior to your child

Respond to disruptive behavior with things such as quiet time or a time-out

You can also learn ways to help support your child and:

Improve your child's social skills

Help your child build friendships

Help your child learn how to control his or her emotions

Teach your child problem-solving skills

Help your child learn to be independent

Child Programs

These programs can help children:

Feel more positive about themselves and their family

Strengthen their social, communication, and problem-solving skills

Better communicate feelings and manage anger

Practice good behaviors

Teen Programs

For teens, a trained therapist may meet with parents and also with the whole family together. The therapist may look for patterns in the way family members interact that could cause tension and problems. The therapist can then help your family learn new ways to communicate to avoid conflict.

The therapist can help you learn how to:

Be more involved with your teen

Set clear rules and consequences for breaking the rules

Improve your leadership, communication, and problem- solving skills

Support your teen

Teacher Programs

These programs can help teachers learn how to:

Manage behavior in the classroom

Improve students' social and emotional skills

Work with parents and keep them involved

What have researchers found about medicines for DBDs?

Programs that work with:

Do the programs improve disruptive behavior in preschool-age children?

Do the programs improve disruptive behavior in school-age children?

Do the programs improve disruptive behavior in teens?

* More research is needed to know this for sure.

Medicines

Medicines are usually given to children or teens with a DBD only if psychosocial treatment alone does not help enough. Medicines are usually taken together with psychosocial treatment.

Several types of medicines have been used to treat DBDs (see the chart on the next page). These medicines cannot cure DBDs. They are used to reduce symptoms and improve quality of life. The medicines work by changing the way certain chemicals act in the brain.

Medicines work differently in different children or teens. You may have to try several medicines to find one that works for your child or teen.

Note: The U.S. Food and Drug Administration (FDA) approves medicines for certain uses. Health care professionals often prescribe medicines for conditions other than their FDA-approved uses.

What have researchers found about medicines to treat DBDs?

Medicine

About the Medicine

FDA Approval in Children

Researchers found that in children and teens:

ADHD = attention deficit hyperactivity disorder; FDA = U.S. Food and Drug Administration
*More research is needed to know this for sure.
† More research is needed to know how well antipsychotics work in the long term (for longer than 6 months).

Stimulants
Examples include:

Mixed amphetamine salts (Adderall®, Adderall XR®)

Methylphenidate (Concerta®, Focalin®, Focalin XR®, Metadate CD®, Metadate ER®, Methylin®, Methylin ER®, Ritalin®, Ritalin LA®, Ritalin SR®)

Stimulants are approved by the FDA to treat ADHD.

Some health care professionals also use them to treat DBDs.

Stimulants can be short acting (work for 4 to 6 hours) or long acting (work for 8 to 12 hours).

Approved for children aged 6 and older

Stimulants may improve disruptive behavior.*

Nonstimulant ADHD medicines

Atomoxetine (Strattera®)

Guanfacine ER (Intuniv®)

Atomoxetine (Strattera®) and guanfacine ER (Intuniv®) are approved by the FDA to treat ADHD.

Some health care professionals also use them to treat DBDs.

Approved for children aged 6 and older

Atomoxetine and guanfacine ER improve disruptive behavior.

Anticonvulsant medicine
Divalproex (Depakene®, Depakote®, Depakote ER®)

The anticonvulsant medicine divalproex (Depakene®, Depakote®, Depakote ER®) is approved by the FDA to treat seizures.

Some health care professionals also use it to treat DBDs.

Approved for use in children, but should be used with extreme caution in children under the age of 2

Divalproex may improve aggression.*

Antipsychotics
Examples include:

Aripiprazole (Abilify®)

Risperidone (Risperdal®)

Ziprasidone (Geodon®)

Antipsychotics are approved by the FDA to treat people with psychosis (a type of mental illness).

Some health care professionals also use antipsychotics to treat DBDs. Taking these medicines does not mean your child or teen has a psychosis.

Approved for children aged 6 and older

Antipsychotics improve disruptive behavior in the short term. †

What are possible side effects of medicines to treat DBDs?

The FDA lists these possible side effects for medicines to treat DBDs. Just because side effects are possible does not mean your child or teen will have them.

Possible Side Effects of Medicines to Treat DBDs

Type of Medicine

Medicine Name(s)

Possible Side Effects

Warnings

Stimulants

Mixed amphetamine salts (Adderall®, Adderall XR®)

Methylphenidate (Concerta®, Focalin®, Focalin XR®, Metadate CD®, Metadate ER®, Methylin®, Methylin ER®, Ritalin®, Ritalin LA®, Ritalin SR®)

Stomach ache

Decreased appetite

Weight loss

Trouble falling asleep

Headache

Nausea and vomiting

Increased heart rate

Nervousness

Worsened tic (uncontrollable movement)

Blurred vision and other vision problems

Stimulants may cause serious side effects that affect the heart. These medicines may not be safe in children or teens with a history of severe heart problems. Children or teens who have heart problems and take a stimulant should be monitored closely by their doctor.

Stimulants can be habit forming. Your child or teen should never take more of the medicine than your doctor has prescribed.

Stimulants may cause growth problems in children.The height and weight of children taking a stimulant should be monitored by their doctor.

Nonstimulant ADHD Medicines

Atomoxetine (Strattera®)

Nausea and vomiting

Decreased appetite

Feeling tired or sleepy

Stomach ache

Atomoxetine may increase the risk of suicidal thoughts and behaviors in children and teens.

Atomoxetine may cause growth problems in children. The height and weight of children taking this medicine should be monitored by their doctor.

Guanfacine ER should not be stopped suddenly, because this can increase blood pressure.

Atomoxetine and guanfacine ER may cause serious side effects that affect the heart. These medicines may not be safe in children or teens with a history of severe heart problems. Children or teens who have heart problems and take atomoxetine or guanfacine ER should be monitored closely by their doctor.

Guanfacine ER (Intuniv®)

Low blood pressure

Slow heart rate

Feeling tired or sleepy

Nausea and vomiting

Stomach ache

Trouble falling asleep

Irritability

Dizziness

Dry mouth

Anticonvulsant Medicine

Divalproex (Depakene®, Depakote®, Depakote ER®)

Divalproex may increase the risk of suicidal thoughts or behaviors.

Divalproex can cause life-threatening liver and pancreas problems. Children under the age of 2 years are at higher risk for these problems.

Antipsychotics

Uncontrollable movements, such as tics and tremors

Feeling tired or sleepy

Nausea and vomiting

Blurred vision or other vision problems

Changes in appetite (increase or decrease)

Weight gain

Extra saliva or drooling

Cold symptoms (stuffy nose and sore throat)

Aripiprazole may increase the risk of suicidal thoughts in children and teens taking antidepressant medicines.

Antipsychotics can cause a possibly life-threatening reaction called "neuroleptic malignant syndrome,"although this is rare. Symptoms include a high fever, sweating, changes in blood pressure, and muscle stiffness.

Making a Decision

What should I think about when deciding about treatment?

There are several things to think about when deciding which treatment may help your child or teen. As your child or teen grows and develops, his or her treatment may need to be changed. You will need to continue to work with your child's or teen's health care professional over time.

You may want to talk with your child's or teen's health care professional about:

Psychosocial treatment programs

Whether a medicine may help your child or teen

The possible risks of the medicine

Ask your child's or teen's health care professional

How might psychosocial treatment help my child or teen?

How do I sign up for a psychosocial treatment program? Which program do you recommend? Why?

How often would I meet with a therapist and for how long? Would my child or teen meet with the therapist as well?

Would the therapist interact with our whole family or with my child's or teen's teachers?

How will we know if my child or teen may need medicine?

If my child or teen needs medicine, which medicine might be best?

How long would my child or teen need to take the medicine?

What are the risks of taking the medicine?

How will I know if my child or teen is having a serious side effect? What should I watch for, and when should I call you?

How long might it take for my child's or teen's treatment to start helping?

Are there local support groups that could help me?

Source

The information in this summary comes from Epstein R, Fonnesbeck C, Williamson E, Kuhn T, Lindegren ML, Rizzone K, Krishnaswami S, Sathe N, Ficzere CH, Ness GL, Wright GW, Raj M, Potter S, McPheeters M. Psychosocial and Pharmacologic Interventions for Disruptive Behavior in Children and Adolescents. Comparative Effectiveness Review No. 154. (Prepared by the Vanderbilt University Evidence-based Practice Center under Contract No. 290-2012-00009-I.) AHRQ Publication No. 15(16)- EHC019-EF. Rockville, MD: Agency for Healthcare Research and Quality; October 2015.

Additional information came from MedlinePlus.gov, a service of the National Library of Medicine and the National Institutes of Health.

This summary was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX. It was written by Amelia Williamson Smith, M.S., Frank Domino, M.D., and Michael Fordis, M.D. Parents and caregivers of children or teens with a disruptive behavior disorder gave feedback on this summary.

# data[].attributes.attachment_link.title
Treating Disruptive Behavior Disorders in Children and Teens

# data[].attributes.attachment_link.description
Is This Information Right for Me? This information is for you if: A health care professional* said your child or teen has a disruptive behavior disorder, such as oppositional defiant disorder, conduct disorder, or intermittent explosive disorder. Your child or teen is younger than age 18.

# data[].attributes.headline
Innovative Treatment for Children with Serious Emotional Disturbances

# data[].attributes.subject
Innovative Treatment for Children with Serious Emotional Disturbances

# data[].attributes.attachment_link.readable_text
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Abstract

This article describes the development, implementation, and preliminary evaluation of a school-based Intensive Mental Health Program (IMHP) for 50 children (42 boys, 8 girls) with severe, early-onset, serious emotional disturbances (SED). Eighty-four percent of the children showed clinically significant improvement in overall functioning as measured by the Child and Adolescent Functional Assessment Scale (CAFAS). Child functioning at home and school, behavior toward others, regulation of moods and emotions, self-harm, and problems in thinking improved significantly. Results provide initial support for the IMHP as a promising approach to serving the needs of children with SED.

PubMed Disclaimer

Similar articles

Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder.

Klassen AF, Miller A, Fine S. Klassen AF, et al. Pediatrics. 2004 Nov;114(5):e541-7. doi: 10.1542/peds.2004-0844. Pediatrics. 2004. PMID: 15520087

A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder.

Foy JM, Earls MF. Foy JM, et al. Pediatrics. 2005 Jan;115(1):e97-104. doi: 10.1542/peds.2004-0953. Pediatrics. 2005. PMID: 15629972

Assessing the quality of healthcare provided to children.

Mangione-Smith R, McGlynn EA. Mangione-Smith R, et al. Health Serv Res. 1998 Oct;33(4 Pt 2):1059-90. Health Serv Res. 1998. PMID: 9776949 Free PMC article. Review.

# data[].attributes.attachment_link.keywords[]
health services needs and demand / statistics & numerical data

# data[].attributes.attachment_link.keywords[]
mental health services / organization & administration*

# data[].attributes.attachment_link.keywords[]
school health services / organization & administration*

# data[].attributes.attachment_link.keywords[]
self-injurious behavior / prevention & control

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.attachment_link.title
Innovative treatment for children with serious emotional disturbance: preliminary outcomes for a school-based intensive mental health program - PubMed

# data[].attributes.attachment_link.description
This article describes the development, implementation, and preliminary evaluation of a school-based Intensive Mental Health Program (IMHP) for 50 children (42 boys, 8 girls) with severe, early-onset, serious emotional disturbances (SED). Eighty-four percent of the children showed clinically signifi ...

# data[].attributes.headline
National Association of Special Education Teachers 

# data[].attributes.subject
National Association of Special Education Teachers 

# data[].attributes.attachment_link.description
Some of these files may require Adobe Reader for PDF files. These files are noted as PDF at the end of the site explanation. If you do not have Adobe Reader you can download it for free.

# data[].attributes.body
Local resources and support for Mental Health

# data[].attributes.attachment_link.readable_text
Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act, and helps determine how we handle stress, relate to others, and make choices. Mental health is intimately connected with physical health and lays the foundation for positive growth. Mental health not only affects an individual, it also impacts families and communities.

Resources for Assistance
Florida Resources

211 - Thousands of caring, local experts are available to help, 24/7. Calls to 211 are confidential and can be anonymous.

Hope for Healing - Hope for Healing navigates the many ways Floridians can access help for mental health and substance abuse.

Resiliency and Mental Health - Resources for children provided by the Florida Department of Education.

Mental Health and Substance Abuse - The Florida Department of Children and Families provides crisis support resources to locate verified social services providers for things like food, housing, transit, healthcare, legal aid, and more.

Childrens Mental Health - Coordinated network of community-based services and supports that is family-driven to produce individualized, evidence-based, culturally and linguistically competent outcomes that improve the lives of children and their families.

National Resources

988 Suicide and Crisis Lifeline - The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones. Call or text 988 for help.

Find Support - The Substance Abuse and Mental Health Services Administration (SAMHSA) provides resources for issues with mental health, drugs, or alcohol.

Support Positive Mental Health

Getting professional help - if you feel depressed seek help from a professional.

Connecting with others - try a weekly check-in.

Staying positive - read daily positive affirmation.

Getting physically active - take a walk during breaks or times of stress.

Helping others - volunteer to help others in need.

Getting enough sleep - drink a cup of tea or listen to soft music.

If you or someone you care about is having thoughts of harming themselves or in emotional distress, call or text 988 immediately.
Informational Materials

DOH Mental Health Handout - The handout is available in two languages, with English on the front side and Español/Spanish on the back side.