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Sometimes anxiety is easy to identify - like when a child is feeling nervous before a test at school. Other times anxiety in the classroom can look like something else entirely - an upset stomach, disruptive or angry behavior, ADHD, or even a learning disorder.

There are many different kinds of anxiety, which is one of the reasons it can be hard to detect in the classroom. What they all have in common, says neurologist and former teacher Ken Schuster, PsyD, is that anxiety "tends to lock up the brain," making school hard for anxious kids.

Children can struggle with:

Separation anxiety: When children are worried about being separated from caregivers. These kids can have a hard time at school drop-offs and throughout the day.

Social anxiety: When children are excessively self-conscious, making it difficult for them to participate in class and socialize with peers.

Selective mutism: When children have a hard time speaking in some settings, like at school around the teacher.

Generalized anxiety: When children worry about a wide variety of everyday things. Kids with generalized anxiety often worry particularly about school performance and can struggle with perfectionism.

Obsessive-compulsive disorder: When children's minds are filled with unwanted and stressful thoughts. Kids with OCD try to alleviate their anxiety by performing compulsive rituals like counting or washing their hands.

Specific phobias: When children have an excessive and irrational fear of particular things, like being afraid of animals or storms.

Here are some tips for recognizing anxiety in kids at school, and what might be causing it.

Inattention and restlessness

When a child is squirming in his seat and not paying attention, we tend to think of ADHD, but anxiety could also be the cause. When kids are anxious in the classroom, they might have a hard time focusing on the lesson and ignoring the worried thoughts overtaking their brains. "Some kids might appear really 'on' at one point but then they can suddenly drift away, depending on what they're feeling anxious about," says Dr. Schuster. "That looks like inattention, and it is, but it's triggered by anxiety."

Attendance problems and clingy kids

It might look like truancy, but for kids for whom school is a big source of anxiety, refusing to go to school is also pretty common. School refusal rates tend to be higher after vacations or sick days, because kids have a harder time coming back after a few days away.

Going to school can also be a problem for kids who have trouble separating from their parents. Some amount of separation anxiety is normal, but when kids don't adjust to separation over time and their anxiety makes going to school difficult or even impossible, it becomes a real problem. Kids with separation anxiety may also feel compelled to use their phones throughout the day to check in with their parents.

Disruptive behavior

Acting out is another thing we might not associate with anxiety. But when a student is compulsively kicking the chair of the kid in front of him, or throws a tantrum whenever the schedule is ignored or a classmate isn't following the rules, anxiety may well be the cause. Similarly, kids who are feeling anxious might ask a lot of questions, including repetitive ones, because they are feeling worried and want reassurance.

Anxiety can also make kids aggressive. When children are feeling upset or threatened and don't know how to handle their feelings, their fight or flight response to protect themselves can kick in - and some kids are more likely to fight. They might attack another child or a teacher, throw things, or push over a desk because they're feeling out of control.

Trouble answering questions in class

Sometimes kids will do perfectly well on tests and homework, but when they're called on in class teachers hit a wall. There are several different reasons why this might happen.

"Back when I was teaching, I would notice that when I had to call on someone, or had to figure out who's turn it was to speak, it was like the anxious kid always tended to disappear," says Dr. Schuster. "The eager child is making eye contact, they're giving you some kind of physical presence in the room like 'Call on me, call on me!' " But when kids are anxious about answering questions in class, "they're going to break eye contact, they might look down, they might start writing something even though they're not really writing something. They're trying to break the connection with the teacher in order to avoid what's making them feel anxious."

If they do get called on, sometimes kids get so anxious that they freeze. They might have been paying attention to the lesson and they might even know the answer, but when they're called on their anxiety level becomes so heightened that they can't respond.

Frequent trips to the nurse

Anxiety can manifest in physical complaints, too. If a student is having unexplained headaches, nausea, stomachaches, or even vomiting, those could be symptoms of anxiety. So can a racing heart, sweaty palms, tense muscles, and being out of breath.

Problems in certain subjects

When a child starts doubting her abilities in a subject, anxiety can become a factor that gets in the way of her learning or showing what she knows. Sometimes this can be mistaken for a learning disorder when it's really just anxiety.

However anxiety can also go hand in hand with learning disorders. When kids start noticing that something is harder for them than the other kids, and that they are falling behind, they can understandably get anxious. The period before a learning disorder is diagnosed can be particularly stressful for kids.

Not turning in homework

When a student doesn't turn in her homework, it could be because she didn't do it, but it could also be because she is worried that it isn't good enough. Likewise, anxiety can lead to second guessing - an anxious child might erase his work over and over until there's a hole in the paper - and spending so much time on something that it never gets finished. We tend to think of perfectionism as a good thing, but when children are overly self-critical it can sabotage even the things they are trying their hardest at, like school work.

You might also notice that some anxious kids will start worrying about tests much earlier than their classmates and may begin dreading certain assignments, subjects, or even school itself.

Avoiding socializing or group work

Some kids will avoid or even refuse to participate in the things that make them anxious. This includes obvious anxiety triggers like giving presentations, but also things like gym class, eating in the cafeteria, and doing group work.

When kids start skipping things it might look to their teachers and peers like they are uninterested or underachieving, but the opposite might be true. Sometimes kids avoid things because they are afraid of making a mistake or being judged.

Dr. Schuster notes that when kids get anxious in social situations, sometimes they have a much easier time showing what they know when teachers engage them one-to-one, away from the group.

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How Does Anxiety Affect Kids in School? - Child Mind Institute

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Sometimes school anxiety is easy to identify - like when a child is feeling nervous before a test at school. Other times anxiety in the classroom can look like something else entirely - an upset stomach, disruptive or angry behavior, ADHD, or even a learning disorder.

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Back to School Anxiety - Child Mind Institute

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How to help kids manage anxiety at the start of a new school year, and make sure anxiety doesn’t cause disruptive behavior in the classroom

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by Karen Young

School anxiety is awful for children and heartwrenching for parents. It's so common, but it doesn't always look the same. Sometimes it will dress itself up as illness (headaches, tummy aches), sometimes as a tantrum or fierce defiance, and sometimes it looks exactly as you would expect.

School Anxiety. What it's not.

If I could write this across the sky, I would:

Separation anxiety and school anxiety have absolutely nothing to do with behaviour, defiance or poor parenting. Nothing at all.

Anyone who is tempted to tutt, judge, or suggest a toughening up of parents or children, don't. Hush and hold it in. The assumptions on which you've built your high ground are leading you astray. It's likely, anyway, that parents dealing with school anxiety have already tried the tough love thing, even if only out of desperation. It's understandable that they would. They'd try anything - parents are pretty amazing like that.

They are great parents, with great kids. If only being tougher was all it took they all would have done it yesterday and we'd be talking about something easier, like how to catch a unicorn - or something.

Why getting tough won't work.

School anxiety isn't a case of 'won't', it's a case of 'can't'. It's anxiety. It's a physiological response from a brain that thinks there's danger. Sometimes the anxiety is driven by the fear that something will happen to the absent parent. Sometimes it's not driven by anything in particular. Whether the danger is real or not is irrelevant. Many kids with anxiety would know somewhere inside them that there is nothing to worry about, but they're being driven by a brain that thinks there's a threat and acts as though it's true.

When this happens, the fight or flight response is triggered and the body is automatically surged with neurochemicals to deal with the threat. That's why anxiety can look like a tantrum (fight) or resistance (flight). It's the physiological, neurochemical response of a brain on high alert. It's hard enough to control your own brain when it's on high alert, let alone someone else's, however much that someone else wants to do the 'right' thing.

We humans are wired towards keeping ourselves safe above everything else. It's instinctive, automatic, and powerful. This is why tough love, punishment or negotiation just won't work. If you were in quicksand, no amount of any of that would keep you there while you got sucked under. You'd fight for your life at any cost. School is less dramatic than quicksand but to a brain and a body in fight or flight, it feels the same.

When you're dealing with an anxious child, you're dealing with a brain that will fight with warrior daring to keep him or her safe. It's not going to back down because of some tough words or tough consequences.

The good news is that there are powerful ways to turn this around. Let's talk about those.

But first ...

Before we go further, it's important to make sure that the anxiety isn't from bullying, friendship problems or problems with schoolwork that might need their own response. Teachers generally know what's going on so it's always worth having a chat to get a clearer idea of what you're dealing with. In many cases, there are no other issues at all. On paper, everything looks absolutely fine. That's anxiety for you.

Empower them.

Anxiety has a way of making people feel like they have no control. It's inexplicable and feels as though it comes from nowhere. Explaining to your kids how anxiety works will demystify what they're going through and take away some of the punch. It's powerful. Here are some ideas for how to explain it in a way they can understand:

Why does anxiety happen? The words.

Anxiety has a really good reason for being there. Your brain is great at protecting you. It's been practicing for millions of years and is brilliant at it. If it thinks there's something to worry about, it will instantly surge your body with fuel - oxygen, adrenaline, hormones - to make you strong, fast and powerful, kind of like a superhero. This is the fight or flight response and it comes from a part at the back of your brain called the amygdala. This part of your brain is small and shaped like an almond. It's like a fierce (but very kind) warrior and it's there to protect you.

Sometimes your brain gets a little overprotective. That's kind of understandable. You're pretty brilliant at a lot of things and the world needs you. Your brain is in charge of keeping you safe and it takes its job very seriously. It's a relief to know the 'keep me safe' switch in your brain is working. (Phew!)

When it thinks there's a threat, it doesn't stop to think about whether or not the threat is real - it's all action and not a lot of thought. In fact, the part of your brain that is able to think clearly, calm things down and make great decisions about what to do next, is sent 'offline' if the brain senses a threat. That can actually be really handy and is another clever way to keep you safe. If there's a real danger, like an out of control bus screaming towards you, you don't want your brain to keep you in the path while it figures out whether or not to get out of there.

When it comes to school, your brain can sometimes read it as a threat, even though it isn't. That's because school is a bit different to home - there are new people, different things and routines, you're away from your parents, sometimes it's noisy, and sometimes you don't really know what to expect. To a brain whose job it is to protect you, that can feel like a really big deal.

This is why the bad feelings you feel when you think about going to school can be so powerful. It's your brain telling your body to stay away from school because there could be something dangerous there. It might also be telling you that something could happen to the people you love if you aren't near them. Brains can be very convincing, but they're not always accurate.

Even if you know there's nothing to worry about, your brain won't always listen to that, and it will get your body ready to run for your life or fight for it. We're going to talk about how to deal with this, but first let's talk about what's happening up in that powerpack in your head.

Your brain and anxiety - what you need to know.

When your brain feels really strongly that it has to protect you (and remember, your brain doesn't care if the danger is real or not) the fight or flight part of your brain forces the thinking part of your brain to be quiet so that it can get on and deal with the danger. If your brain had a conversation, it would probably sound something like this:

The Thinking Part: Oh, we have school today. Cool. Let's do it.

The 'Fight or Flight' Part (the Amygdala): Yeah, no. That's not going to happen. You're going to be away from home and you don't really know what's happening today. It could be dangerous, so 'Thinking Part', you need to sit out while I check it out.

Thinking Part: Dude. It's school. There's not going to be anything dangerous. Maybe new or unfamiliar, but not dangerous. You need to calm down, okay? Chill.

Amygdala: Whoa! You seriously don't get it. If there's something bad - and I'm pretty sure there's a chance of that - then we're going to have to run for it or fight - but fighting can bring its own bag of trouble - so maybe run. Or maybe just stay away. Yep. Let's stay away. I'm trying to save a life here and you're kinda getting in my way.

Thinking Part: For a brain, you're not being very sensible. Think about it. It's school. It's teachers and other kid-sized humans and playgrounds and lunch and things. Nothing at all to worry about.

Amygdala: Gosh, you seriously don't get it. This could be deadly. You're getting my way man. I'm sending you offline for a bit while I check it out. Here have this - some oxygen, some adrenalin, some hormones. It's superhero fuel, but for you it will keep you quiet. Now, go to sleep. I've got this. I'm saving your life. You're welcome.

By now, the amygdala has surged your body with fuel to make you strong, fast and powerful in case you have to fight or flee. Of course, when it comes to school there's nothing to fight or flee but the thinking, good decision-making part of your brain is offline remember.

Why does anxiety feel the way it does?

When there's no need to fight or flee, there's nothing to burn off the superhero fuel that's racing through you, so it builds up. That fuel is perfectly safe, and in the right circumstances can be really helpful, but it can feel bad when it builds up. The feelings and emotions you have when you're anxious, or when it's time to say goodbye are all because of this buildup.

Here are some of the things you'll probably feel and why you'll feel them.

You might feel puffed or breathless. You might also feel the blood rush to your face and it might feel warm.
That's because your brain has told your body to stop using up oxygen on strong deep breaths, and to send it to your muscles so they can use it for energy to fight or run. To make this happen, your brain organises for your breathing to change from normal, strong breaths to fast little breaths. When you think about it, it's a pretty good way to save oxygen, even though it might not feel that great.
Your heart might feel like it's beating out of your chest. It might feel like you're having a heart attack.
This is because your heart is working hard to pump the fuel around your body so it can fight or flee. It's doing a great job, but it can feel a bit scary. It's nothing to worry about. It's just your heart doing exactly what a healthy heart does. You are definitely not having a heart attack. If you were, there would be other symptoms, including a pain in your chest that would be unbearable, not just uncomfortable.
You might feel dizzy or a bit confused.
This happens because there's nothing to fight or flee, so there's nothing to burn the fuel that's surging through your body. As the oxygen builds up, the carbon dioxide drops, making you feel dizzy and confused.
Your arms and legs might feel tense or wobbly.
Your brain is sending fuel to your arms (so they can fight) and to your legs (so they can run away).
You might feel a bit sweaty.
Your body does this to cool itself down. It doesn't want to overheat if it has to fight or flee.
You might feel like bursting into tears or your might feel really angry
This is the handy work of the amygdala - the part of the brain that triggers the fight or flight. It's also involved in emotions. It's in full control and it's working super hard. When it's highly active, you might get emotional or angry at all sorts of things or nothing at all. It's a really normal part of anxiety.
You might feel like you're going to vomit or you might actually vomit. You might get tummy aches or feel as though you have butterflies in your belly. Your mouth might also feel a little bit dry.
Everything that's happening in your body that isn't necessary in that moment for survival will shut down. One of these is your digestive system, which is the part of the body that gets the nutrients from food. That can wait, so it shuts down until the crisis (or what your brain thinks is a crisis - nobody said brains were always sensible!) is over. It's a great way to save energy, but it can make you feel sick. It's feels awful, but it definitely won't hurt you and it's definitely not a sign of anything worse going on inside you.
As you can see, there's a really good reason for every physical symptom. It's your brain doing a great job of what brains are meant to do - keep you alive.

This is why you might feel so strongly you that you can't go to school - because that's what your brain is telling you. It's why it might upset you when people tell you there's nothing to worry about. You kind of already know this, but your brain and your body aren't so convinced - your body is being driven by a brain that thinks it's under threat. This can feel scary, which is totally understandable.

Here's the thing though: Even though your brain is telling you there's danger, sometimes it might misread the situation. It happens to everyone from time to time but some brains will be a lot quicker to sense threat than others. There's nothing wrong with that. An anxious brain is just as healthy and strong and capable as a non-anxious brain. In fact, it's often even more capable, more creative and more sensitive to what's happening around it.

When your brain is reacting to things that aren't really a threat, what it actually needs is for you to come in and be the boss. Let's talk about how to do that.

1. Your anxiety isn't the enemy, so try not to fight it.

Remember that the amygdala that sets your anxiety in motion is like a fierce warrior that's trying to protect you. Even though it might be causing you trouble, it really doesn't mean to. If it could, it would hug you and walk one step in front of you to keep you safe. It can't do that, so instead it surges you with fuel to keep you strong, fast and powerful whenever it thinks you need it, and sometimes just in case. If you can put the thinking part of your brain (the pre-frontal cortex) back in control, it will stop the fuel surging through you and this will help you to feel better and braver. It really needs your help though because the only way it's going to be let back in control is if the amygdala thinks you're safe. That message needs to come from you.

2. Let your brain know, 'I've got this. You can stop worrying now.'

Luckily, there is a very cool thing your brain can do and it's called the relaxation response. You don't have to believe it works because it's programmed into your brain, like breathing, so it just does. But - it won't work until you flick the switch. The best way to do that is to breathe. Not just any breathing though - strong, deep breaths that come from your belly.

° in through your nose for three,

° pause,

° out through your mouth for three.

(Imagine that you have a hot cocoa in your hands and you're breathing in the delicious smell through your nose for three seconds, then blowing it cool for three seconds.)

When you do this, it's like a gorgeous massage for your amygdala. It totally relaxes it. It tells it that you're okay and that it can chill for a bit. When your amygdala is relaxed, something kind of wonderful happens. Your prefrontal cortex (the 'let's think about this' part of your brain) can take back control. The first thing that it does is to neutralise (get rid of) the fuel (oxygen, hormones, adrenalin). When that happens, the intense physical and emotional things you're feeling all start to settle down. You're back in control. Back to being the boss of your brain. It might not feel completely comfortable straight away, but it will be to a level that you can handle. Very soon after that, you'll feel as strong, brave and as awesome as ever.

3. Get really active for a couple of minutes or go for a walk.

Remember that the fuel surging through you is there to make you strong, fast and powerful. If you don't burn it up, it will build up, and that's when it feels bad. Walking or exercise will burn the fuel and stop the awful physical things you're feeling. If you can get sweaty for five minutes by running, skipping, jumping - anything - that will really help. Otherwise going for a brisk walk will also be a great thing to do.

4. Feel what's happening outside of yourself.

When you feel anxious, you become really aware of what's happening inside your body. Your brain also continues to worry itself silly by living in the future with a truck load of 'what if's'. Bring your brain back to the present by turning your attention to what's happening around you. Feel the ground beneath your feet. Touch your arms and feel the touch of your fingers against your sin. Feel your breath coming into you, and then going out. Feel the temperature. Hear the noises around you. You've got the idea.

5. Dear Me, This is what you need to know ...

When you're calm, and the thinking part of your brain is back in control, make a list of things you would like your amygdala to know. Then, use this as a reminder when you're feeling anxious about school. What would you say to someone if you saw them feeling the way you feel when it's time to go to school or say goodbye? These are the things that the thinking part of your brain would say to your amygdala if it was online when you were feeling anxious. Write it down and use it to remind your brain of what it needs to know when it starts to get you into fight or flight mode. Remember, you're the boss. Maybe it will look something like this:

Dear Me,

This is what you need to know ... you are completely okay. You're feeling like this because your brain thinks there's something to be scared of. It's trying to look after you, but it needs you need to be the boss.

You're brave. You're strong. And you're okay. Here's why:

♥ Your friend(s) are at school and they care about you.

♥ Your teacher is on your side and would never ever let anything happen to you.

♥ School is strengthening your brain, so it can be even more amazing.

♥ Today you're doing these fun things at school ... (even if it's just playing at lunch or eating something delicious - it all counts!).

♥ You're brave and you can handle school no matter what.

♥ In fact, you're probably one of the bravest ones there today because you feel really anxious - and you're doing it anyway.

♥ You only have to get through the next five minutes.

Go me. You're pretty awesome.

Love, Me.

6. Get organised.

Make a list of the things you need to do before you leave home to make your day goes smoothly. That way, you can remind yourself that things are under control, even if they feel like they aren't.

Breakfast eaten. (Gotta be strong).

Teeth brushed.

Uniform on.

Homework done.

Lunch packed.

Shoes on.

Bag packed.

Parents (or important adult) hugged.

'See ya later,' to pets - done.

'See ya later,' to sibling/s - done.

Hair - done. Lookin' fine.

Good to go.

7. Get some sleep.

When you sleep, your brain gets stronger and sorts out it's emotional worries. The more sleep you get, the better.

8. Have something lavender nearby.

Lavender oil calms a stressed out, hectic brain. Spray it around your room or have some ready when you need it by putting lavender oil on a tissue. Have a little smell when you need to feel calmer.

9. Anxiety and courage always exist together.

Anxiety means that you're doing something brave. It doesn't matter whether it's easy for other people or not. We all find different things hard or easy. If you're anxious, it's because your brain thinks there's something to worry about. It responds the same whether you're about to give a presentation or about to skydive. It doesn't matter what the thing is that's making you nervous, an anxious brain is a brave brain, an anxious body is a brave body, and an anxious person is always a brave person.

And finally ...

School anxiety never just swipes at one person. It's affects kids, parents, siblings and the teachers who also invest in the children in their care. One of the worst things about anxiety is the way it tends to show up without notice or a good reason. For kids (or anyone) who struggle with anxiety, it can feel like a barrelling - it comes from nowhere, makes no sense and has a mind of its own. The truth is, the mind that anxiety has is theirs, and when they can understand their own power, they can start to establish themselves firmly as the 'boss of their brain'. Understanding this will empower them, and will help them to draw on the strength, wisdom and courage that has been in them all along.

You might also like ...

'Hey Warrior' is the book I've written for children to help them understand anxiety and to find their 'brave'. It explains why anxiety feels the way it does, and it will teach them how they can 'be the boss of their brains' during anxiety, to feel calm. It's not always enough to tell kids what to do - they need to understand why it works. Hey Warrior does this, giving explanations in a fun, simple, way that helps things make sense in a, 'Oh so that's how that works!' kind of way, alongside gorgeous illustrations.

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How to Empower Your Child to Deal With School Anxiety - Hey Sigmund

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by Karen Young School anxiety is awful for children and heartwrenching for parents. It's so common, but it doesn't always look the same. Sometimes it will dress itself up as illness (headaches, tummy aches), sometimes as a tantrum or fierce defiance, and sometimes it looks exactly as you would expect.

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Children with anxiety or OCD are likely to exhibit symptoms in the school setting. For this reason, it's important to understand the signs and symptoms of Anxiety and OCD and to be able to differentiate between normal vs. abnormal behavior.

Anxiety in Kids

Everyone experiences anxiety at some point in their lives, from the very young to the very old. In school, students may get nervous during a fire drill, before a test or presentation, or when saying goodbye to their families in the morning. It is normal and common for students to get anxious in situations like these. When a student's anxiety starts to creep out of specific situations and into their everyday life, they might have an anxiety disorder.

Anxiety, as it relates to mental health conditions, is defined as chronic and/or generalized worry, fear, or nervousness that students express a lot of the time. In other words, the anxiety the student feels is not driven by specific situations - they feel anxious most of the time, regardless of what is happening in their life. In these cases, anxiety noticeably impacts a student's behavior in school and at home, their ability to participate in class, their learning, and/or their ability to perform assigned tasks.

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Anxiety Signs and Symptoms | Anxiety In The Classroom

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Children with anxiety or OCD are likely to exhibit symptoms in the school setting. For this reason, it's important to understand the signs and symptoms of Anxiety and OCD and to be able to differentiate between normal vs. abnormal behavior. Everyone experiences anxiety at some point in their lives, from the very young to the very old.

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National Association of School Psychologists (NASP)

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By Thomas J. Huberty, PhD, NCSP
Indiana University

Anxiety is one of the most common experiences of children and adults. It is a normal, adaptive reaction, as it creates a level of arousal and alertness to danger. The primary characteristic of anxiety is worry, which is fear that future events will have negative outcomes. Anxious children are much more likely than their peers to see minor events as potentially threatening. For example, giving a brief oral report might be slightly anxiety-producing for most children, but the anxious child is much more likely to believe that his or her performance will be a complete disaster.

Anxious children are likely to engage in a variety of avoidance behaviors to reduce exposure to threat. In the classroom, they may be withdrawn, not initiate interactions, select easy over difficult tasks, and avoid situations where they anticipate increased risk for failure. Socially, they may feel uncomfortable in new situations, not initiate conversations, or avoid group interactions. They worry about being evaluated socially and fear that others will view them negatively. Although there may be some basis for worry, it is usually out of proportion to the situation and is unrealistic. Either a real or imagined threat may be enough to trigger an anxiety reaction.

Defining Anxiety

From early childhood through adolescence, anxiety can be a normal reaction to stressful situations.

Infancy and Preschool
Anxiety first appears at about 7-8 months of age as stranger anxiety, when an infant becomes distressed in the presence of strangers. At about 12-15 months of age, toddlers show separation anxiety when parents are not nearby. Both of these reactions are typical and indicate that development is progressing as expected. In general, severe stranger and separation anxiety dissipate by the end of the second year of life. Anxiety at this age is primarily associated with fears of strangers, new situations, animals, the dark, loud noises, falling, and injury.

School Age
Up to about age 8, many causes of anxiety continue from preschool levels with a focus on specific, identifiable events. With age, sources of anxiety become more social and abstract, such as worrying about friends, social acceptance, the future, and coping with a move to a new school. Adolescents tend to become more worried about sexual, religious, and moral issues as they continue to develop. In the vast majority of cases, children and adolescents cope well with these situations and severe or chronic anxiety is not common.

Signs of Anxiety

Table 1 summarizes the major thinking/learning, behavioral, and physical signs of anxiety. Not all children will show all signs or show the same signs to the same degree, but a stable pattern that interferes with performance may be cause for concern.

The usual signs of anxiety differ between the anxious and nonanxious child primarily in degree, and may be shown in one or more of the following ways:

Excessive or atypical for age or developmental level

Inappropriate or excessive for the situation on a frequent basis

Have persisted for several weeks or months

Table 1. Signs of Anxiety

Anxiety Disorders

A child or adolescent may have an anxiety disorder if anxiety is a pattern causing persistent problems. Several types of anxiety disorders exist, impairing social, personal, or academic functioning. The frequency of anxiety disorders ranges from about 3% up to 20% of children and adolescents. In infancy and preschool children, anxiety disorders are infrequent. They most often start to emerge in early childhood and may persist into adulthood. The frequency of anxiety disorders in boys and girls is about the same during elementary school years, but differences between them emerge in adolescence, with girls being two to three times more likely to develop anxiety disorders. With a 10% frequency rate, a middle school class of 30 students could have as many as three students with an anxiety disorder and perhaps two of them would be girls.

Separation Anxiety Disorder (SAD)
SAD is the only anxiety disorder specific to children and is associated with fears about leaving familiar people, usually parents. In extreme situations, children might refuse to leave their home or not want to stay overnight with a friend. Sometimes, they may refuse to attend school, a pattern often termed "school phobia," although "school refusal" is more accurate. It is not unusual for preschool children to express separation anxiety, but persistent or extreme separation anxiety is atypical for school-aged children and may reflect concerns about family matters, safety, or fears of social rejection.

Generalized Anxiety Disorder (GAD)
GAD is associated with pervasive and high levels of anxiety across a variety of situations with no apparent events that trigger it. It is the most common childhood anxiety disorder and tends to persist to some degree into adulthood. These children often are described as "highstrung" and are often very concerned about doing things well; they may show perfectionist tendencies. The tendency to worry frequently about relatively minor things is a primary defining characteristic of GAD. Children with GAD tend to stay in a relatively high state of physical arousal and often appear stressed much of the time. GAD also tends to be chronic and does not dissipate over time without help, perhaps requiring professional intervention.

Posttraumatic Stress Disorder (PTSD)
PTSD is most often associated with distress as a result of a traumatic situation. The most common types of trauma in children are exposure to violent crime, auto accidents, home fires and injuries, natural disasters, domestic violence, physical and sexual abuse, and serious physical illnesses. Symptoms of PTSD include emotional numbing, avoidance, detachment from others, sleep difficulties, angry outbursts, reliving the experience through stressful memories, flashbacks, and concentration problems. Incidence rates for PTSD symptoms in traumatized children are as high as 20%, and the overall rate in children is about 3%, depending on the circumstances. Girls appear to have higher rates of PTSD than do boys.

Social Phobia
Children who have excessive fear and anxiety about being in social situations and being evaluated by others are experiencing social phobia. The fear of social situations is out of proportion to the actual situation, although some children may not be able to identify specific stressors. The typical age of onset is in adolescence or early adulthood, although shyness and social discomfort can be seen as early as 2 or 3 years of age. Typically, onset is gradual without obvious triggering events.

Causes of Anxiety Disorders

Considerable research has focused on genetic and environmental causes of anxiety. In general, there is a genetic contribution of about 30% in childhood anxiety disorders. It appears, however, that a general tendency toward anxiety is transmitted, rather than a predisposition for specific disorders. Biological influences include temperament, which is a fairly stable personality trait. Anxious children tend to have an inhibited, cautious, and tentative temperament that predisposes them to anxiety disorders. Some anxious children may have differences in certain parts of the brain that affect attention, concentration, and memory. Family factors appear to play an important role, especially from some mothers who overprotect their children, model anxious behavior, and prevent exposure to stressful situations.

Effects on School Performance
Highly anxious children tend to struggle with various demands of school and to be inattentive, perfectionistic, forgetful, or unwilling to participate due to concerns about failure or embarrassment. They may avoid difficult tasks, seek easy tasks, and not volunteer or readily participate in classroom activities. Because withdrawal is a typical response to avoid feeling anxious, anxious children may be perceived by teachers as unmotivated, lazy, or uninterested in school. In fact, the majority of these children want to do well and be involved, but the motivation to avoid feeling anxious is high.

Effects on Social Performance
Anxious children tend to withdraw socially to avoid experiencing anxiety, which leads to further problems of fitting in and making and sustaining friendships. Over time, more social problems and deficits may occur, making the situation worse. Avoidance and worry may offer short-term solutions but have cumulative negative effects and provide little long-term relief.

Interventions

If severe, anxiety problems may require professional help outside the school. Teachers and parents can ask some initial questions when determining what to do:

How typical is the anxiety for the child's age?

Does it tend to be situation-specific or pervasive across situations?

Are there any current events, changes, or circumstances that may help to explain the problem?

What effects on personal, social, and academic performance are evident?

What has been tried to help the situation?

What has helped and what has not helped?

School-Based Interventions
Some suggestions for the classroom include:

Establish predictable routines

Set clear and reasonable expectations

Break tasks into manageable units

Have specific evaluation criteria

Provide opportunities for practice and rehearsal

Pair anxious students with peers who are confident and supportive

Give special responsibilities

Give time to relax when anxiety becomes high

Reduce or avoid unexpected situations

Avoid punitive and negative attitudes

Reduce time constraints, if possible

Move the student to a quiet setting with fewer distractions

Home-Based Interventions
Because anxious children also tend to demonstrate these patterns at home, parents can do much to help. Some suggestions include:

Be consistent in how you handle problems and administer discipline.

Be patient and be prepared to listen.

Avoid being overly critical, disparaging, impatient, or cynical.

Maintain realistic, attainable goals and expectations for your child.

Do not communicate that perfection is expected or acceptable.

Maintain consistent but flexible routines for homework, chores, activities, etc.

Accept that mistakes are a normal part of growing up and that no one is expected to do everything equally well.

Praise and reinforce effort, even if success is less than expected. Practice and rehearse upcoming events, such as giving a speech or other performance.

Teach your child simple strategies to help with anxiety, such as organizing materials and time, developing small scripts of what to do and say to himself or herself when anxiety increases, and learning how to relax under stressful conditions.

Do not treat feelings, questions, and statements about feeling anxious as silly or unimportant.

Often, reasoning is not effective in reducing anxiety. Do not criticize your child for not being able to respond to rational approaches.

Seek outside help if the problem persists and continues to interfere with daily activities.

Conclusion

Anxiety is a common problem affecting children and adolescents at home and school and can cause significant problems in personal, social, and academic performance. Often, it is not easy to identify, or it may be mistaken for another problem, such as attention deficits, low ability, or lack of motivation. Left unidentified and untreated, it can worsen over time, causing more problems into adolescence and adulthood. Parents and teachers can be major sources of support for anxious children, helping to reduce the negative effects of anxiety and encouraging progress.

Recommended Resources

Anxiety Disorders Association of America: http://www.adaa.org

Foa, E. B., & Andrews, L. W. (2006). If your adolescent has an anxiety disorder. New York: Oxford University Press.

Huberty, T. J. (2008). Best practices in school-based interventions for anxiety and depression. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology V (pp. 1473-1486). Bethesda, MD: National Association of School Psychologists.

Thomas J. Huberty, PhD, ABPP, NCSP, is Professor of School Psychology and Director of the School Psychology Program at Indiana University in Bloomington, IN. ©2010 National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814 (301) 657-0270.

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Anxiety & Anxiety Disorders in Children: Information for Parents

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Anxiety is one of the most common experiences of children and adults. It is a normal, adaptive reaction, as it creates a level of arousal and alertness to danger. The primary characteristic of anxiety is worry, which is fear that future events will have negative outcomes.

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American Counseling Association-Practice Briefs, (2014). https://www.counseling.org/knowledge-center/practice-briefs

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Buser, K. (2014). The school counselor's role in addressing eating disorder symptomatology among adolescents. https://www.counseling.org/Resources/Library/VISTAS/2012_Vol_1_67-104/2_2012-ACA-PDFs/Article_97.pdf

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Eating disorders are common among teens and kids, especially young women. Read about the warning signs, prevention strategies, and ways to help a child with an eating disorder.

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Eating disorders, such as anorexia nervosa and bulimia nervosa, are serious chronic conditions that are often underdiagnosed and not properly treated. These illnesses can be dangerous, so it is important for us to recognize signs and symptoms of disordered eating in order to get our kids the help they need for recovery.

On this week's On Call for All Kids, Sarah Stromberg, Ph.D., a licensed pediatric psychologist at Johns Hopkins All Children's Hospital who works closely with the Adolescent and Young Adult Clinic, is here to share some important information on this topic.

What is an eating disorder?

Eating disorders are complex medical illnesses that have serious physical, mental and psychosocial consequences as well as association with high mortality rates. Eating disorders involve an unhealthy relationship with food and cause significant interference with daily functioning. Some examples of eating disorders include anorexia nervosa, atypical anorexia nervosa, bulimia nervosa, binge eating disorder and avoidant restrictive food intake disorder (also known as ARFID).

What is atypical anorexia nervosa?

Atypical anorexia nervosa is a common eating disorder that is often overlooked or underdiagnosed because patients with atypical anorexia are in the normal weight range. Atypical anorexia is categorized by all of the same symptoms and risks as classic anorexia nervosa and is just as dangerous so we want to monitor individuals across the weight spectrum for disordered eating.

Eating disorders are considered both mental health disorders and medical illnesses. Therefore, someone suffering from an eating disorder should seek help from a medical professional and a mental health professional who specializes in treating eating disorders. It is also recommended to have a dietitian closely involved when a child or teen is struggling with an eating disorder.

What are some of the signs and symptoms of an eating disorder?

In anorexia nervosa or atypical anorexia nervosa, some of the most common signs are frequent comments about weight/appearance, skipping meals, eating small portions, refusal to eat high-sugar, high-fat foods, overall restrictive food intake and excessive exercise. Severe weight loss, fear of gaining weight and severe body image disturbances are also warning signs of anorexia.

What is bulimia nervosa?

Bulimia nervosa is categorized by a pattern of binge eating followed by the use of a compensatory behavior, such as purging, fasting, laxative or diuretic use, and excessive exercise to prevent weight gain.

What is binge eating disorder?

Binge eating disorder involves eating larger than normal portions of food in one sitting and inability to stop oneself from eating excessively large portions.

What is ARFID?

ARFID is an eating disorder categorized by significant aversion to food based on sensory characteristics (texture), lack of interest in eating, or concern about aversive consequences of eating such as stomach pain, vomiting or choking.

Other signs to look out for across eating disorders include hiding/sneaking food, calorie tracking and refusal to participate in social events involving food. As you can see, there are several different signs of eating disorders that indicate an individual may need an assessment by a professional.

What can happen if a child/teen starts to engage in disordered eating behaviors?

There are several medical and mental health consequences that can occur when children or teens start engaging in disordered eating behaviors. Medical concerns include rapid weight change, low heart rate, hormone changes, electrolyte shifting, fatigue, breathing problems, hair loss, blood pressure changes, heart rhythm abnormalities, fainting and even death. Mental health concerns that often occur in individuals with eating disorders include social isolation, loneliness, significant anxiety, withdrawal, depression and suicidal ideation.

What should you do if you or someone you know is suffering from an eating disorder?

Take these concerns seriously. Eating disorders can be a very sensitive topic, but reaching out to a trusted adult or professional is one of the most important steps toward recovery. Discussing it with your doctor or therapist will help you receive the right care, evaluation, diagnosis and treatment plan.

What should parents do at home to support their child or teen with an eating disorder?

Great question! It is important to remember that eating disorders are both medical and mental health disorders so it is incredibly difficult for children/teens to recover on their own. They need treatment and consistent support from their families. This means parents should not be afraid to closely monitor their child or teen's eating behaviors. Parents should be ensuring their child is eating a variety of foods and obtaining adequate nutrition each day.

Parents may have to use clever strategies to make sure their child is compliant with eating and not engaging in disordered eating behaviors. Remember to balance empathy and authoritativeness. As a parent it can be tempting to back off because arguments may happen around mealtime or because we feel the child/teen does not want help, but don't give in to the eating disorder.

Remember that your child did not choose to have an eating disorder. Your role as a parent or caregiver is to help your child fight the eating disorder. Parents and family are a critical component of recovery and should be closely involved in their child's treatment.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children's Hospital experts. Visit HopkinsAllChildrens.org/Stories each Monday for the latest report.

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Eating Disorders in Children and Adolescents

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Eating disorders, such as anorexia nervosa and bulimia nervosa, are serious chronic conditions that are often underdiagnosed and not properly treated. These illnesses can be dangerous, so it is important for us to recognize signs and symptoms of disordered eating in order to get our kids the help they need for recovery.

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What Is the Typical Onset of Eating Disorders in Young Children (12 and under)?

Children commonly experience food preference "phases", leading parents to consider initial changes in eating as "normal".

Because young children are smaller in stature and weight, smaller amounts of weight loss subsequent to food refusal can lead to sudden onset of eating disorder diagnoses.

By the time parents become aware of the significance of weight loss and disordered eating symptoms, changes in behavior and attitude can be profound.

What Are Typical Presentations of Eating Disorders in Young Children?

Most children with eating disorders have more atypical eating disorder symptoms. Presentations are often complex and patterns of food restriction are usually different from older patients. Common reasons for food refusal in children include:

Fear of getting "fat" related to seeing other peers teased at school

Fear of getting stomach aches or vomiting, choking

Aversion to tastes, smells and textures

Many children have pre-morbid anxiety symptoms which further impact their fears and disordered eating, while others may develop OCD-like behaviors which coincide with restriction and malnutrition. Children often present in behaviorally regressed states, displaying:

Severe tantrums

Physical aggression

Screaming

Excess movement

What Eating Disorders Diagnoses Are Commonly Seen in Young Children (Defined by DSM-5)?

Avoidant/ Restrictive Food Intake Disorder (ARFID): Lack of interest in food, limited diet due to sensory issues, or food refusal related to fears of aversive experiences (choking, vomiting)

Eating Disorder Not Elsewhere Classified (EDNEC): Dysregulated eating that does not fit all diagnostic criteria of AN, BN, or BED

Anorexia Nervosa (AN): Significantly low body weight, intense fear of gaining weight, distorted body image, and persistent behavior that interferes with weight gain. (Many children meet these criteria except fear of weight gain and/or distorted body image and are may be diagnosed with EDNEC)

How Are Eating Disorders in Younger Children Treated?

Family centered interventions are most effective in younger children. "Family Based Therapy (FBT) informed care is most appropriate, with parents taking charge of nutrition decisions and gaining skills in meal support and supervision and management of food avoidant behaviors and anxiety.

Medical monitoring by a pediatrician is critical. Severe eating disorders or medical instability may require higher levels of care. Consultation with dieticians can also be helpful if parents are uncertain about how to provide meals sufficient for weight restoration.

Does Treatment Differ From Treatment with Adolescents?

Because children developmentally lack cognitive abstraction, treatment is primarily behavioral and focuses on rewards and consequences related to ensuring adequate nutritional intake and management of maladaptive behaviors.

Prior to seeing improvement, periods of behavioral regression are common, including:

Refusal to eat solids necessitating a liquid supplement diet

Complete refusal of food and supplement requiring NG tube feeding

Increase in aggressive tantrums/outbursts

Increase in anxiety

Due to these issues, children often require longer stays in intensive treatment programs.

What Are Medical Complications of Childhood Eating Disorders?

Most medical complications resolve with stabilization of intake and weight restoration. Nutritional insufficiency during periods of development can slow growth and puberty, decrease bone density and cause structural and functional brain changes. Persistent malnutrition can lead to loss of growth potential and osteopenia in addition to other medical complications.

When Should Medical Hospitalization Be Considered?

Children have the best prognosis when diagnosis and treatment occur early in the course of illness to avoid medical morbidities. Unfortunately, hospitalization may be necessary.

Medical Guidelines for Hospitalization of Children with Eating Disorders:

<75% IBW, or ongoing weight loss despite intensive management

Heart rate <50 bpm daytime; <45 bpm nighttime

SBP <90 mmHg

Hypothermia T<96˚F

Arrhthymia including prolonged QTc

Electrolyte abnormalities

Intractable vomiting

How Do You Manage Barriers to Families Accepting Treatment Recommendations?

Parents vary in awareness of need for and readiness to receive treatment. Children typically do not recognize their symptoms as a problem and are often resistant to treatment.

Given the necessity of parental involvement in treatment, while considering parents' level of readiness and acceptance of treatment, evaluating teams should convey clinical information while developing rapport essential to facilitating acceptance of treatment recommendations.

Encourage parents to elaborate on their concerns to improve rapport and diminish resistance.

How Should Parents Approach Re-Feeding?

Parents must be prepared to prioritize the need to take control of all aspects of daily nutrition (planning, preparing, supervising meals and snacks). Families and patients should think of food as medicine or 'fuel to run the body'.

Just as medications are prescribed to be taken a certain number of times daily, nutrition "prescriptions" include eating a minimum of three meals and 2-3 snacks each day. This requires changes to home, work and school schedules.

How Many Calories Do Children Need to Restore Weight?

Guidelines suggest beginning with 200 to 300 calories above the patient's daily calorie intake. Most patients need to work up to at least 3000 calories each day to gain weight, while limiting activity until target weight is reached. Weight trends should be monitored closely until restoration to an appropriate weight for the child is reached and maintained.

Are Medications Used to Treat Eating Disorders?

No medications are approved for treatment of AN, ARFID or BED. Medication (often SSRI's) can be helpful for co-morbid conditions, such as depression, anxiety, and OCD. Fluoxetine is approved for the treatment of Bulimia Nervosa

Do Children With Eating Disorders Ever Recover?

Most young children who receive eating disorder treatment soon after onset and diagnosis have a good prognosis. Many patients restore weight, experience normalized eating and are able to return to normal daily activities. Ongoing parental involvement in meal planning and support, as well as behavioral management is necessary for long-term recovery.
What has been your experience with eating disorder recovery in children 12 and under? What types of support have you utilized in order to achieve success?
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

Last Updated & Reviewed by: Jacquelyn Ekern, MS, LPC, on December, 11 2014. Published on AddictionHope.com

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Eating Disorders in Children 12 and under

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Children commonly experience food preference "phases", leading parents to consider initial changes in eating as "normal". Because young children are smaller in stature and weight, smaller amounts of weight loss subsequent to food refusal can lead to sudden onset of eating disorder diagnoses.

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Historical underpinnings of bipolar disorder diagnostic criteria

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Working to deliver a better special education service

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OCD is like an unwelcome guest with bad manners. It moves into a mind - and it doesn't want to leave.
Students with OCD may appear to be daydreaming, distracted, disinterested, or even lazy. They may seem unfocused and unable to concentrate. But they are really very busy focusing on their nagging urges or confusing, stressful, and sometimes terrifying OCD thoughts and images. They may also be focused on completing rituals, either overtly or covertly, to relieve their distress.

While frustrating to educators, OCD may be torture for the students who have it. This disorder may be difficult to identify because its observable symptoms are similar to other conditions and mental disorders, and mental rituals cannot be observed. Symptoms in children and adolescents can change over time, and they tend to wax and wane for no apparent reason. School personnel who have a good understanding of the variety of behaviors that may signal OCD are better equipped to initiate a plan to assist the student.

The Effect of OCD on Academic Performance

Even very bright and motivated students can struggle with OCD. Although students with OCD typically have average to above-average intelligence levels, they may be unable to learn the same way others do because their focus is frequently on their obsessions or compulsions. Depending on the severity of the symptoms, some students find it difficult to learn and, for some, it's almost impossible to concentrate on and complete schoolwork.

Although they want to pay attention, participate in discussions or presentations, study, and complete homework, they feel compelled to respond to their obsessions or urges.

Students who have untreated OCD re likely to have a very difficult time concentrating in the classroom and completing homework assignments. They may experience overwhelming anxiety or strong urges, possibly describing the feeling of mounting anxiety or intensifying urges as if they were a rising volcano or a tea kettle about to boil - and relief comes when the pressure is released. Unfortunately, the release is usually a compulsive behavior that may be disruptive to learning and possibly to the classroom.

It may not be long before the student who has OCD falls behind and sees a drop in grades. In some cases, academic performance deteriorates abruptly and dramatically. And it may be nearly impossible to catch up unless a student can learn to manage the symptoms. For these reasons, it's important that school personnel take OCD seriously and work with the student and the family to provide support.

What Does OCD Look Like at School?

A student may enter a classroom at the beginning of the school year with a diagnosis of OCD, or the disorder may develop later. Whenever a student begins to falter - academically, socially, or emotionally - educators need to intervene. A proactive approach can make an impressive difference in a student's coping ability, academic performance, and interpersonal capabilities.

The first step is being aware of the behaviors that can signal OCD. The disorder includes a wide variety of symptoms in children and adolescents, which are not always obvious. It is important to keep in mind that OCD symptoms can look like other disorders, so it is critical that a mental health specialist trained in OCD and related disorders conduct a diagnostic assessment OCD can be confused for symptoms of ADHD and anxiety disorders, as well as acting out" or misbehavior not associated with a neurobiological disorder. Also, OCD changes in nature or scope from one set of obsessions and compulsions to another, with differing behaviors, and symptoms can worsen and or seem to disappear, often for no obvious reason.

Common Symptoms of OCD at School

Below are common OCD symptoms of children and adolescents in school.

Obsession: Fears of germs or contamination
Compulsions
* Repeatedly washing hands, using antibacterial wipes or hand-sanitizer
* Protecting what is perceived as clean space -- personal desk, locker, or other property
* Avoiding touching surfaces that others may have touched, such as doorknobs, desks, shared supplies, lab tables or equipment, computer keyboards, paints, paste, soap, cafeteria trays, etc.
* Avoiding contact play or sports either because of a fear of catching a disease or fear of contaminating another student
* Avoiding the use of bathrooms
* Seeking reassurance that they or others are not sick or dirty
* Refusing to share items or supplies with others
* Refusing to eat in the cafeteria
* Avoiding certain products because they may contain poison, such as substances used in chemistry

Obsession: Fears that harm, illness, or death, will befall oneself or others; fear of causing harm to oneself or others, including violent or aggressive obsessions (Note: People with OCD who have violent or aggressive thoughts do not have a history of violence or act upon these urges or ideas.)
Compulsions
* Checking behavior, such as making sure doors or windows are locked or turning light switches on and off repeatedly
* Reading a paragraph over and over again to prevent harm from coming to a loved one, another person, or a pet.
* Asking the teacher for reassurance that the student is safe
* Avoiding leaving a perceived safe zone (classroom); avoiding going into unsafe zones (lunch or recess areas) or open spaces such as a gymnasium
* Unreasonable avoidance of peers, teachers, for fear of causing them harm

Obsession: Fears that harm, illness, or death, will befall oneself or others; fear of causing harm to oneself or others, including violent or aggressive obsessions ( Note: People with OCD who have violent or aggressive thoughts do not act upon these urges or ideas OR have a history of violence.)
Compulsions
* Checking behavior, such as making sure doors or windows are locked or turning light switches on and off repeatedly
* Reading a paragraph over and over again to prevent harm from coming to a loved one, another person, or a pet.
* Asking the teacher for reassurance that the student is "safe"
* Avoiding leaving a perceived "safe" zone (classroom); avoiding going into "unsafe" zones (lunch or recess areas) or open spaces such as a gymnasium
* Unreasonable avoidance of peers, teachers, for fear of causing them harm

Obsession: Fears, feelings, or urges related to numbers
Compulsions
* Counting, touching, or saying words a certain number of times due to believing in a magical significance to certain numbers or using those numbers to keep harm away; counting the number of steps between locations and having to start over if interrupted
* Touching objects a certain number of times; not being able to move on unless this touching has been accomplished
* Reading words or pages a certain number of times
* Going back and forth through doorways a certain number of times before it's OK to enter the room
* Avoiding using certain numbers that are perceived as unlucky or not safe; only using numbers that are perceived as safe or lucky. (math problems may be answered improperly, pages may not be read or pages may be numbered out of sequence )

Obsession: Fears, feelings, or urges related to discarding items because something bad will happen; feelings of incompleteness if something is discarded or the need document and preserve all life experiences; fears of contamination; need to buy items in multiples of a particular number; not discarding objects to avoid repetitive rituals such as washing or checking. (Note: This form of hoarding is related to the obsessions and compulsions of OCD and is distinct from hoarding disorder.)
Compulsions
* Saving scraps of paper, candy wrappers, bottle caps, broken items, or other useless items; inability to part with unneeded things
* Keeping books, toys, food, school papers, clothing, or other items for fear that they might be needed sometime in the future
* Buying every item in a store that one has touched (and therefore contaminated) to prevent others from being contaminated
* Accumulating items or objects in a particular area (desk drawer) because they are contaminated and cannot be touched
* Buying multiples of the same item (buying three of everything because it's a magic number)

Obsession: Scrupulosity, or the excessive fear of violating religious or moral rules
Compulsions
* Apologizing or confessing that something is wrong, such as breaking religious, classroom, or school rules
* Constantly seeking reassurance that a task has been completed right or perfectly; seeking affirmation that a mistake was not made
* Saying prayers a certain number of times; excessive praying to atone for being bad; repeatedly confessing perceived sins or bad behavior
* Repetitive praying, confessing to neutralize or undo bad thoughts, intrusive sexual thoughts, or visions of cursing or blaspheming in school or church
* Avoiding answering questions for fear of telling a lie

Obsession: Fears, feelings, or urges related to symmetry or order
Compulsions
* Constantly evening up books or other items on a shelf or desk; aligning edges to be even
* Rearranging items to be in a certain order, such as by color or alphabetical order
* Avoiding a room with square tiles because seeing the tiles would require tracing each of the edges visually
* Fears, feelings, or urges related to sexual content
* Seeking reassurance that one is not gay or lesbian, despite being heterosexual
* Excessive praying to atone for having inappropriate sexual thoughts or images
* Avoiding magazines, books, DVDs, websites, or other media for fear of seeing sexual content

Obsession: Excessive doubting or dread of uncertainty
Compulsions
* Constantly rechecking to see that everything is in a backpack or book bag
* Asking to leave the classroom to recheck a locker or its contents
* Avoiding a school locker to prevent checking the lock over and over again

Obsession: Fears, feelings, or urges related to having something just right or perfect
Compulsions
* Getting up and sitting down repeatedly at a desk, until feeling just right
* Repeatedly revising the way letters, words, or numbers are written to make them look just right; getting stuck rewriting the same letter or word
* Repeatedly filling in circles on answer sheets; getting stuck on one or two questions because too much time is spent carefully filling in the circles, erasing, refilling until it looks perfect
* Erasing and rewriting words over and over
* Extreme slowness with activities or school work until everything is just right
* Repeating various actions for no apparent reason
* Avoiding a hallway until walking in it until it feels just right

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OCD is like an unwelcome guest with bad manners. It moves into a mind - and it doesn't want to leave. Students with OCD may appear to be daydreaming, distracted, disinterested, or even lazy. They may seem unfocused and unable to concentrate.

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

Obsessions Common in Kids With OCD

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

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

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

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

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

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

Behaviors You Might See in Students With OCD

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

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

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

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

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

Behaviors Often Confused With Another Disorder

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

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

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

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

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

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

How to Help Students With OCD

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

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

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

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

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

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

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

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

How to Minimize Behavioral Problems

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

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

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

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

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

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

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares. Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry.

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Credit: Julius-Maximilians-Universität Würzburg, JMU

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

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

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

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

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

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

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

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

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

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

Provided by Julius-Maximilians-Universität Würzburg

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

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Child Mind Institute | Transforming Children’s Lives.

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The Child Mind Institute is an independent nonprofit dedicated to transforming the lives of children struggling with mental health and learning disorders.

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OCD, IDEA, and IEPs: How to Access Special Education Services for Children with OCD

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OCD, IDEA, and IEPs: How to Access Special Education Services for Children with OCD

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Obsessive compulsive disorder (OCD) can significantly affect a child's academic, social, and emotional functioning, which is collectively defined as his or her "educational performance" by the Individuals with Disabilities Education Act (IDEA). Fortunately, parents and educators can work together to address the educational needs of youth with OCD. In fact, schools are required by law to assist students with disabilities such as OCD. However, they may do so in different ways depending on the nature of the child's symptoms, his or her academic functioning, and the availability of resources.

The Individuals with Disabilities Education Act (IDEA)

The Individuals with Disabilities Education Act (IDEA) is a federal law in the United States that governs how states and federally funded public agencies provide early intervention, special education, and related services to children with disabilities. Although the law does not include OCD as a specific disability, children may be eligible to receive special education services through an "Other Health Impairment (OHI)" or "Emotional Disturbance (ED)" exception. Due to the way that state boards of education interpret IDEA, schools in some states may need a physician or psychologist to provide a recent medical report establishing a child's disability. Further information may need to be collected suggesting that commonly used treatment interventions were ineffective before a student is diagnosed with an OHI. To qualify to receive services for an ED exception, a student must display one or more of the following characteristics over a long period of time and to a significant degree that negatively affects his or her educational performance:

An inability to learn that cannot be explained by intellectual, sensory, motivational, lack of academic engagement, 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.

Additionally, a student's problematic behavior or emotional responses must be significantly different from age appropriate, cultural, or ethnic norms and data may be needed suggesting that commonly used research-based interventions were ineffective for consideration for an ED exception.

Any legal guardian can request an evaluation to determine if his or her child may benefit from special education services. However, a request does not guarantee that a comprehensive psychological and educational evaluation will be conducted. Under the 2004 reauthorization of IDEA, state departments of education now have several options to govern how school personnel should evaluate and address student needs. Because of problems with quickly and efficiently delivering special education services, the 2004 reauthorization of IDEA blurs the lines between assessment and intervention, which allows schools to simultaneously provide research-based intervention services and collect data on a student's response to these services.

Regarding the former, many schools now use a response-to-intervention (RtI) approach to determine students' disability status and provide supportive resources. This approach involves providing students with intervention services as soon as a problem is identified to fix the problem and avoid over-identifying students with disabilities. Therefore, under IDEA, students with OCD may receive services through RtI even though this is not yet a common practice or due to being diagnosed with having an OHI or ED exception. Additionally, following a gradual service delivery approach, students with OCD may initially receive services under a RtI framework but then receive additional special education supports if they fail to respond to research-based interventions.

It is important to note that "research-based interventions" provided during the RtI process or prior to evaluating a student for an exception differ from "well-established" and "probably effective" interventions as defined by the American Psychological Association's Task Force on Promotion and Dissemination of Psychological Procedures (1995), which includes cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) as a well-established treatment because of its excellent performance in properly designed research trials. In other words, the "research-based interventions" that the schools provide may not align with what OCD and psychology experts have found to be particularly effective for treating OCD in children. Research-based interventions that are commonly implemented in schools for students with OHI and ED exceptions may be behavioral in nature and have research-based support; however, they generally are not as rigorously evaluated as they should be. Therefore, it is unlikely that a student will receive CBT with ERP to treat his or her OCD symptoms at school.

Individualized Education Plan (IEP)

Once a student is diagnosed with an OHI or ED exception and becomes eligible to receive special education services, these services are then outlined in an Individualized Education Plan (IEP). An IEP describes how a student's disability influences his or her educational performance. Furthermore, it lists academic and behavioral goals and the academic/behavioral supports needed to help the child achieve these goals.

Legal guardians must be invited to participate on the IEP team, which generally includes the student's teacher, a special education teacher, a school administrator, a school psychologist, and other school personnel. A legal guardian also may invite others to attend IEP meetings such as a trusted associate, child advocate, or attorney. If a legal guardian does not agree with the IEP or the IEP team's decision regarding special education eligibility, he or she must be informed how he or she can challenge the decision.

Section 504 of the Rehabilitation Act

Section 504 of the Rehabilitation Act guarantees rights to people with disabilities. It aims to decrease discrimination and promote equal opportunities by requiring schools to provide reasonable accommodations (e.g., extra time on tests, use of computer-aided instruction) for children with disabilities. These accommodations can address temporary or chronic problems, and no diagnosis is needed for students to receive them. Thus, 504 accommodations can be implemented quickly and flexibly. However, in contrast to services provided under IDEA, school systems do not receive federal funding to provide 504 accommodations.

Children with OCD may be eligible to receive 504 accommodations if their symptoms significantly limit at least one major life activity (e.g., walking, speaking, learning, reading, writing, performing math calculations, working, self-care) as determined by a school-based team that usually includes the same individuals who sit on IEP teams. Section 504 requires the review of multiple sources of information provided by different individuals (e.g., school psychologist, parent, teacher) prior to providing accommodations.

Similar to IEPs associated with IDEA, eligible 504 students receive accommodations through an Individual Accommodation Plan (IAP). This plan simply lists specific accommodations and interventions that may help a student overcome his or her disability. These plans often list specific instructional materials that a student may need, modifications to tests or assignments, grading and assessment changes, and behavioral interventions.

Supporting and Accommodating Students with OCD

Some caregivers may believe that students with IEPs are automatically placed in a special education class, while children with IAP or 504 plans are allowed to remain in a general education classroom. However, this is not accurate. Although students with IAPs generally receive instruction in regular educational settings, students with IEPs may receive instruction in general and special education settings under the assumption that they will be served in the least restrictive setting possible.

Students who receive special education services under IDEA are automatically protected under Section 504 so there is no reason for them to have an IEP and an IAP. Generally, students who qualify for special education services under IDEA have more severe and intractable disabilities than students with 504 plans do. However, this is not always true, and students can transition back and forth between service delivery plans depending on their response to interventions and progress toward achieving IEP goals.

Similarities exist between the types of interventions and accommodations that can be provided for children with IEPs and IAPs. Common interventions and accommodations for children with OCD include but are not limited to the following:

Counseling (individual or group) (it will be important to determine if this type of therapy is specific to OCD or more supportive in nature)

Changes in the amount of time available to take tests

Changes in where tests will be taken

Provision of frequent breaks during instruction

Shortened assignments

A behavior improvement plan

Preferential seating

Transition plans

A special pass to use the restroom/office

However, members of IEP and IAP teams should carefully select accommodations and interventions that will help a student and not reinforce his or her OCD symptoms, especially if the child is in treatment with a mental health OCD specialist. For example, extra time on a test can cause a child with perfectionistic concerns to spend even more time fruitlessly erasing and rewriting his or her answers. Moreover, providing a seat cushion to a child with contamination obsessions could undermine effective treatment for the child's OCD. Therefore, in addition to including caregivers, it is important for school personnel to collaborate with a student's treatment providers when determining potential accommodations and interventions.

Discipline and Manifestation Determination

Students who have IAPs or 504 plans can be expelled from school if a behavior problem is not related to their disability. However, students with IEPs have the right to fair and appropriate educational programing under IDEA, even if they are expelled from school. In other words, schools are required to provide special education students with behavior problems with educational services in some capacity, whereas students who manifest similar problems and have an IAP - yet not an IEP - may not be eligible for these services. Therefore, students who have OCD, and a co-occuring exception as recognized by IDEA (e.g., autism, developmental delay, OHI, ED), as well as display significant behavior problems, may be better protected from being expelled if school personnel evaluate and diagnose them with the co-morbid disorder.

Summary

The Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act and the Americans with Disabilities Act allow children with OCD to receive intervention services and accommodations in school settings. Depending on a school-based team decision, students with OCD may be classified as having an Other Health Impairment (OHI) or and Emotional Disturbance (ED) exception and be provided with an Individualized Education Plan (IEP). Alternatively, they can receive services through Section 504 and provided with an Individual Accommodation Plan (IAP). Furthermore, schools also may decide to provide students with research-based interventions to see if they adequately respond to these interventions and do not need intensive supports or a special education diagnosis. However, schools are required to do something to help children with OCD if their symptoms negatively impact their educational performance.

In conclusion, schools are legally required to assist children with disabilities and include caregivers in the process. However, school personnel may be unfamiliar with OCD and unaware of steps they can take to better support affected children. Therefore, caregivers and mental health professionals should collaborate with members of school communities to ensure that children with OCD are adequately supported in school settings.
By Michael L. Sulkowski, PhD, & Eric A. Storch, PhD, University of South Florida

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OCD, IDEA, and IEPs: How to Access Special Education Services for Children with OCD - OCD in Kids

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Obsessive compulsive disorder (OCD) can significantly affect a child's academic, social, and emotional functioning, which is collectively defined as his or her "educational performance" by the Individuals with Disabilities Education Act (IDEA). Fortunately, parents and educators can work together to address the educational needs of youth with OCD.

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How does OCD Affect Children in the Classroom

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How does OCD Affect Children in the Classroom

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Obsessive Compulsive Disorder (OCD) is an anxiety disorder consisting of obsessions and compulsions, and it is one of the most common psychiatric illnesses affecting children and adolescents, with at least one out of 100 children receiving a diagnosis. The obsessions sufferers experience are unwanted thoughts, images, and urges that cause significant distress, while the compulsions are behaviors that are performed to help decrease the distress that the obsession has caused. Compulsions can be visible/observable behaviors or mental acts that are not seen by others.

"Those who suffer with OCD have excessive obsessions and compulsions that cause significant distress to the child and can affect their school performance, social success, and home life," explains Jill Fodstad, Ph.D., HSPP, BCBA-D, clinical psychology at Riley Hospital for Children at Indiana University Health. "For someone with OCD, these compulsions and obsessions are not pleasant, and they often want to stop them but may have an inability to do so on their own. OCD is not something can be turned on and off like a light switch. For most people who are living with OCD and are not actively receiving evidence-based care, they are unable to control their thoughts, urges, and impulses."

In a school setting, OCD symptoms may go unnoticed, especially depending the obsession, and as some are not entirely obvious to the naked eye. As teachers do not have in-depth training on mental health illnesses, many may dismiss these odd behaviors as a phase, or it could be misdiagnosed as something else, leading to ineffective treatment that often makes symptoms worse. Some common ways OCD may manifest in the classroom include:

Tardiness and/or absences from school

Disruptive behavior, meltdowns, tantrums, and rage-like episodes

Asking questions repeatedly or having difficulty completing work

Seeking reassurance

Rereading, rewriting, excessive erasing, or throwing paper out

Inability to complete work, procrastination

Frequent trips to use the bathroom or see the nurse

Avoidance of certain places, people, situations, or objects

Adjusting desk, contents of desk, locker or backpack, or other items in the classroom

Repeatedly doing the same thing (by number or by a "just right" feeling)

Difficulty transitioning from tasks, including entering or exiting rooms

"OCD can cause poor school performance as children may find it difficult to concentrate on school work due to the amount of attention focused on their obsessions and compulsions," notes Dr. Fodstad. "Essentially, the child spends so much time focusing on their obsessions or performing their compulsions that their attention to academic tasks is limited. This time spent on their OCD symptoms is also very exhausting for the child and can affect their sleep. These behaviors can take a heavy toll on a child's social environment with peers and can result in bullying by others - especially if their behavior is viewed as socially inappropriate or odd, and social isolation."

Often, parents are the first to notice symptoms. Dr. Fodstad urges parents to seek help from a mental health professional immediately for an accurate diagnosis and a proper treatment plan - a child will not simply outgrow OCD on their own. Parents should always notify school personnel so they are aware of the situation and can put supports in place.

"If school personnel are not alerted that there might be an issue, then difficulties the child may be experiencing due to OCD may be regarded as the child being 'naughty' or something else outside of what is actually going on," Dr. Fodstad cautions.

There is hope for children who suffer from OCD, especially when caught early. Research has shown that the best therapeutic outcomes typically involve a combination of medication and cognitive-behavioral therapy (CBT), which teaches children they are in charge, not OCD. Through CBT, they will face their fears slowly, in small steps, without giving in to the rituals. It is recommended that therapy be tried before medication, but those that have shown the best outcomes are serotonin reuptake inhibitors (SSRI's). However, it does take time to see a change in your child's symptoms - results may take up to 10 - 12 weeks for both therapy and medication.

If OCD symptoms upset your child and interfere with his or her everyday life, talk to your child's pediatrician or seek an evaluation with a qualified mental health professional such as a psychologist, psychiatrist or social worker. With proper therapy and a supportive environment at home and school, a child with OCD can achieve academic success.
OCD: Common Causes and Treatments
Causes:

While we still do not know the exact cause or causes of OCD, research has provided various theories:

Differences in the brain - dysfunction in the ability for the front part of the brain to communicate to deeper structures of the brain

Environmental influences - social support, exposure to trauma or abuse, significant life changes, substance abuse, living conditions/home life, general health and wellness

Genetics - multiple closely-related family members who have OCD symptoms could play a role, but this is not a guarantee that the child will develop OCD

Treatments:
It is recommended to try therapy prior to medication, and it should be noted that there is no one "best medicine" for treatment as the medicines affect each person differently.

Cognitive Behavioral Therapy (CBT) - teaches children with OCD that they can learn they are in charge, not OCD. They face their fears slowly in small steps, learning that their fears do not come true. Children learn to get used to the scary feeling, just like they might get used to cold water in the swimming pool.

Medicines that have shown the best outcomes are serotonin reuptake inhibitors (SSRI's), which target the brain structures that use serotonin.

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How Does OCD Affect Children In The Classroom?

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"Those who suffer with OCD have excessive obsessions and compulsions that cause significant distress to the child and can affect their school performance, social success, and home life," explains Jill Fodstad, Ph.D., HSPP, BCBA-D, clinical psychology at Riley Hospital for Children at Indiana...

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Applied Behavior Analysis Programs Guide

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Treatment of OCD with ABA

Applied behavior analysis (ABA) offers a variety of evidence-based strategies to assist in the treatment of OCD (obsessive-compulsive disorder). OCD may co-occur with other diagnoses, including conditions on the autism spectrum.

Obsessive-Compulsive Disorder (OCD) and Autism

According to Autism Speaks, OCD may occur more frequently among people with ASD than among others in the general population. About 2 percent of people in the general population have been diagnosed with OCD. Various studies have identified between 8 and 33 percent of people on the autism spectrum as being affected by OCD.

One important distinction between an OCD diagnosis and repetitive behaviors that are a feature of autism is how the person feels about their behaviors. Many people with ASD perform repetitive behaviors, but they are not bothered by them. In some cases, the behaviors may be comforting and enjoyable. An OCD diagnosis is related to compulsive behaviors which are considered undesirable and uncomfortable, like repetitive handwashing which causes raw, bleeding skin.

Some treatment plans for teens and adults with ASD who have symptoms of OCD may include treatments with anti-depressants. Clinical studies reported in the Journal of Depression and Anxiety in 2013 showed that some benefits from cognitive behavioral therapy (CBT) did reduce the severity of OCD symptoms in adults and young people on the autism spectrum.

Which Types of OCD Behaviors Can ABA Help to Moderate?

According to Melinda Smith, M.A., and Jeanne Segal, Ph.D. writing for Harvard Medical School's Helpguide, people with OCD can fall into five primary categories: washers, checkers, doubters and sinners, counters and arrangers, and hoarders. Different behaviors do show varying rates of success in treatment. Success rates with ABA techniques or cognitive-behavioral therapy (CBT) vary depending upon the type of behavior and co-occurring diagnoses, including autism, depression, or tics.

Is Hoarding a More Challenging OCD Behavior for Applied Behavioral Analysis?

Hoarding has been found to be more challenging to treat than other OCD categories. Behavioral analysis can be used to help identify what objects the person acquires, assist the person to practice sorting unnecessary items, and finally, develop methods to reward the hoarder when they can discard hoarded items.

Cognitive behavioral therapy (CBT) may be used to assist the hoarder to rethink their belief systems and deep attachment to unnecessary and sometimes dangerous or unhealthy things.

What do Applied Behavioral Analysts Need to Know About Obsessions and Compulsions?

Obsessive-compulsive disorder (OCD) is characterized by obsessions (thoughts) and compulsions (actions or behaviors).

Obsessions are considered to be more difficult to moderate using ABA techniques. Examples of obsessions include irrational fears such as germ-contaminated clothing or common items like faucets and doorknobs. Others with OCD may see the doctor and have a clear checkup, but leave the office thinking "the doctor must be wrong - I'm sure I have cancer."

Obsessions lead to anxiety and almost uncontrollable fears, such as making a mistake and work and being convinced you will be fired. People with OCD-related religious beliefs may become certain they will receive Divine punishment for any mistake. Because Applied Behavioral Analysis focuses on behaviors, working with obsessions can be more challenging than with compulsions, which are behaviors that are acted upon.

How Can Applied Behavioral Analysis Work With OCD

Focusing on OCD compulsive behaviors, ABAs can identify an antecedent stimulus, a behavior, and a consequence (ABC) to develop a treatment plan for specific compulsive behaviors. Using behavioral activation (BA), applied behavioral analysts can assist people with OCD to set goals to moderate their compulsive behaviors.

ABAs can assist the patient to recognize a trigger that could be the stimulus for the undesirable compulsive behavior. They can also intervene and assist in replacing the compulsive behavior with an alternative, less-stressful and harmful response.

Functional Analysis and OCD Behavioral Interventions

ABAs can develop interventions for OCD behaviors using functional analysis of the reasons why the patient is engaging in the behavior. Functional analysis can help the ABA to devise alternative interventions that will help the person with OCD to obtain the same or an improved social or internal result from a non-compulsive behavior. Functional analysis can also assist ABAs to change or disrupt conditions that lead to the performance of the compulsive behavior. A functional analysis will support a consequence-based or antecedent-based intervention.

Functional Communication Training and OCD Self-Harm

When a patient with OCD is causing harm to themselves, whether through excessive hand-washing or other similar behaviors, Functional Communication Training (FCT) has shown the ability to reduce harm and introduce more positive behaviors. FCT involves several approaches that help to teach the patient more appropriate responses to achieve a similar result to the harmful behavior. The FCT strategy also withdraws any potential reinforcements of self-harming behaviors.

Preparing for a Career Working With OCD as an Applied Behavioral Analyst

Most people who use applied behavioral analysis (ABA) to work with people with obsessive-compulsive disorder (OCD) are licensed therapists who possess at least a Master's Degree and who have also completed requirements for state licensing as behavioral therapists. ABA is an important tool for clinical psychologists, who possess a Ph.D. and have completed supervised internships in their field, including assisting in the treatment of patients with OCD.

Because there are a variety of approaches in treatment for OCD and co-occurring diagnoses such as autism spectrum disorders (ASD), preparation for a career should involve working with experienced professionals and treatment teams who are already in the field. An internship or supervised practicum working in a program that specializes in treating patients with OCD can assist in preparation before you incorporate ABA into your clinical practice.

Following completion of your education and licensing, you may apply to become a board-certified Behavioral Analyst (BCAB) from the Behavior Analyst Certification Board.

Further Reading on Applied Behavioral Analysis and OCD

National Institutes of Health's Clinical literature overview - Thorough examination and list of evidence-based behavioral interventions for repetitive behaviors among patients with autism.

HelpGuide for Obsessive-Compulsive Disorder (OCD) - Symptoms, behaviors, and treatment.

Child Mind Institute's behavioral therapy interventions - Benefits of OCD treatment in children from the Child Mind Institute.

Behavior Therapy Training Institute - Three-day and longer training courses for applied behavior analysts in working with OCD patients.

Another excellent resource:
Top 20 ABA Online Bachelor's Degree Programs
More Specialties:

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Applied Behavior Analysis in the Treatment of Obsessive Compulsive Disorder

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Applied behavior analysis (ABA) offers a variety of evidence-based strategies to assist in the treatment of OCD (obsessive-compulsive disorder). OCD may co-occur with other diagnoses, including conditions on the autism spectrum. According to Autism Speaks, OCD may occur more frequently among people with ASD than among others in the general population.

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Cognitive-behavioral therapy is a treatment for OCD that uses two scientifically based techniques to change a person's behavior and thoughts: exposure and response prevention (ERP) and cognitive therapy. CBT is conducted by a cognitive-behavioral therapist who has special training in treating OCD.

Most CBT treatment is conducted at a therapist's office once a week with exercises to practice at home between sessions. If your OCD is very severe, you might need more frequent sessions. Not all mental health professionals are trained in ERP therapy, so it's important to find one who is.

One key to knowing whether you have found an appropriate ERP therapist is if the therapist encourages you to engage in exposure exercises during your sessions in the office. This helps you engage in more exposures outside of the office. Simply speaking about doing them in the office is less effective than getting started with the actual exposures. The ultimate goal of therapy is to translate exposure to the real world, where you can resist your compulsions and where you can embrace uncertainty rather than fear it.

Exposure Therapy
The psychotherapy of choice for the treatment of OCD is exposure and response prevention (ERP), which is a form of CBT. In ERP therapy, people who have OCD are placed in situations where they are gradually exposed to their obsessions and asked not to perform the compulsions that usually ease their anxiety and distress. This is done at your pace; your therapist should never force you to do anything that you do not want to do.

The first step is for you to describe all of your obsessions and compulsions. Then you and the therapist will arrange them in a list, ordering them from things that don't bother you much to things that are the most frightening. Next, the therapist will ask you to face your fear of something on your list, starting with the easiest. Let's say you have an obsessive fear of germs in public places, and that fear is pretty low in how much it scares you. Your therapist will design a task for you that exposes you to that fear. Your task might for you to touch a public doorknob. Here's where the response-prevention part comes in. If your usual response is to wash your hands immediately after touching the doorknob, the therapist would ask you to wait before you wash your hands. As you repeat this exposure task, the therapist will ask you to wait longer and longer before washing your hands. Over time, this gradual exposure and delayed response would help you learn to control your fear of germs in public places without washing your hands.

It may seem weird, but this new way of confronting your fears directly will lead to fewer and less intense fears or obsessions about germs. Your brain learns that nothing bad happens when you stop performing compulsive rituals.

You'd probably feel very upset when you first touched the doorknob - maybe even feel a little panicked. But the body has a wonderful capacity for something called habituation, and anxiety will eventually lessen without doing anything but letting time pass. It's something like jumping into a pool of cold water. When you jump in, the water may feel very cold. But after a while, your body gets used to the cold, thanks to habituation, and you feel fine.

When your therapist helps you with exposures over a period of time, your anxiety shrinks until it is barely noticeable or even fades entirely. The therapist can then help you gain confidence and learn special skills to control the compulsions through a cognitive therapy.

Imaginal Exposure
For those who may be resistant to jumping right into real world situations, imaginal exposure (IE), sometimes referred to as visualization, can be a helpful way to alleviate enough anxiety to move willingly to ERP. With visualization, the therapist helps create a scenario that elicits the anxiety someone might experience in a routine situation. For someone who fears walking down a hallway in a way that diverts from their "perfect" pattern, the therapist may have them picture themselves walking in that divergent manner for several minutes every day and record their level of anxiety. As they habituates to the discomfort, with decreased anxiety over time, they are gradually desensitized to the feared situation, making them more willing to move the process to real life, and engage in the next step, ERP.

Habit Reversal Training
This intervention includes awareness training, introduction of a competing response, social support, positive reinforcement, and often relaxation techniques. Awareness training may be practicing the habit or tic in front of a mirror, focusing on the sensations of the body and specific muscles before and while engaging in the behavior, and identifying and recording when the habit or tic occurs. These techniques increase awareness of how and when the urges develop, making it more likely that an individual will be able to intervene and make a change.

That is where the competing response comes in, with the individual and therapist working together to find something similar to the movement or tic that is not noticeable to others. Someone with a vocal tic who learns awareness of the developing urge may practice tensing the muscles around their cheeks and mouth to ride out the urge and prevent the tic. Or someone with a compulsion to touch things symmetrically may be directed to tense the opposite arm, holding it tightly against their body, preventing them from completing the ritual.

This method of treatment takes time, diligent practice, and patience, as well as integrating relaxation skills prior to beginning. Also extremely critical to success is the support and positive reinforcement of family

Cognitive Therapy
When applied to treating OCD, cognitive therapy helps you understand that the brain is sending error messages. Your therapist will help you learn to recognize these messages and respond to them in new ways to help you control your obsessions and compulsions. Cognitive therapy focuses on the meanings we attach to certain experiences that we misinterpret. For example, if a friend passes you without acknowledgment, you might interpret her action incorrectly and think "Mary doesn't like me because she did not say hello." And you might believe your thought is very important or meaningful. Cognitive therapy helps you stand back from these thoughts, look at the evidence closely, and tell yourself something more realistic or accurate; in this case it might be, "Something is on Mary's mind, but I don't know what it is."

Cognitive therapy for OCD focuses on the experience of negative thoughts. While most people easily dismiss such thoughts (e.g., "That's a silly thing to think"), some people have certain beliefs that thoughts are always important. So instead of being able to just forget about these negative thoughts, their beliefs cause them to react differently and might make them think "I'm a bad person for having such a thought!" Research shows that believing that negative thoughts are important and attempting not to have "bad" thoughts actually produces the opposite effect.

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Cognitive-behavioral therapy is a treatment for OCD that uses two scientifically based techniques to change a person's behavior and thoughts: exposure and response prevention (ERP) and cognitive therapy. CBT is conducted by a cognitive-behavioral therapist who has special training in treating OCD.

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Classroom Accommodations for Teachers | Anxiety In The Classroom

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Classroom accommodations can help teachers and students with anxiety/OCD keep their studies on track as they work to manage their disorder(s). Find out which accommodations might be most useful for your student.

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OCD in children is an anxiety disorder characterized by unreasonable thoughts or fears that lead to certain repetitive behaviors. The goal of these behaviors is an attempt to reduce anxiety.

It is believed that this disorder affects 1% of children in the United States. The cause of OCD may be due to a chemical imbalance in the brain and often runs in families. Because a child with OCD can spend so much of their time performing ritualistic behaviors or dealing with obsessive thoughts, many of them qualify for special education services and have an individualized education plan (IEP). Children with mild OCD may qualify for a 504 plan instead, if a few accommodations will help them with their school day.

SYMPTOMS:

OCD in children is usually diagnosed by a psychologist, psychiatrist or physician. Because "quirky" behaviors are common in childhood, it is important for parents to remember that not all ritualistic behaviors or obsessive thoughts are OCD. We all have some degree of OCD type behaviors. In order for a child to be diagnosed with OCD, the anxiety is usually severe enough to interfere with daily life tasks including learning.

Examples of obsessive thoughts usually fall into one of these categories:

Washers: Fear of contamination and germs

Checkers: Fear of something bad happening to himself or herself or a loved one unless they check or touch something over and over again.

Counters and Arrangers: Obsessed with order and symmetry, often have superstitions, can spend a lot of time putting things in a "just right" position or place.

Hoarders: Fear if they throw something away, something bad will happen, or they feel overly attached to objects.

Obsessive thoughts cause severe anxiety, which is then reduced by the compulsive behavior.

Examples of compulsive behaviors include:

Excessive hand washing

Excessive teeth brushing or showering

Strict eating or bedtime rituals

Skin picking

Performing a ritual over and over, like locking a door, checking the closet, turning off the oven or light switch

Counting or sorting things into patterns

Touching objects a certain number of times

Re-arranging things to create order or putting things in a "just right" place

Refusal to part with anything and attaching sentimental value to senseless objects

TREATMENT:

Cognitive-behavioral therapy is usually the method of choice for OCD in children. Here, a therapist focuses on teaching the child to confront their fears and reduce anxiety without performing the ritual or behavior. There is also an overall emphasis on reducing catastrophic thinking.

Medications may also be prescribed. These usually include anti-depressants which can reduce overall anxiety. It should be noted that some studies have shown an increase in suicidal thoughts and/or behavior in children and adolescents who are prescribed anti-depressants so if you choose to have your child medicated, a physician should always closely monitor your child.

Natural remedies are on the rise and I always suggest trying a holistic approach to any mental illness, if possible. With my own child, I noticed a correlation in anxiety and OCE with stress, technology and sleep. I also have upped her vitamin intake and removed preservatives and other toxins. There are calming supplements and essential oils out there as well, but as always, use caution and do your research as some supplements can be harmful. In doing research, I was surprised to find that there is strong correlation between tics, Tourettes Syndrome and some OCD as many OCD behaviors like counting, are very "tic like" in nature. Trying remedies used for tic disorders may also be effective for OCD.

OCD and SPECIAL EDUCATION:

Because OCD symptoms can be severe enough to impact learning, some children with this disorder require modifications and accommodations to their school day. For children with mild symptoms and no other learning disabilities, a 504 plan can usually adequately implement accommodations. Examples of accommodations might include extra time with assignments or some sort of hall pass to a designated person on campus if the child is feeling anxious and needs a time out from their environment.

It is also important to have regular parent teacher conferences to ensure that the child's teachers understand that the child's inappropriate behaviors are part of a disorder. Here, teachers might be asked to use cues to help the child choose a more appropriate behavior or ignore the behavior instead of constantly correcting it or issuing a consequence.

OCD in children often also goes hand in hand with other learning disabilities and disorders. These can include autism spectrum disorders, and other learning disorders like If your child has been diagnosed with a learning disability along with OCD, it is important that the IEP address all of your child's needs. Social and emotional goals should be included in the IEP along with academic goals in order to assist with reducing anxiety and developing appropriate coping strategies.

If your child has recently been diagnosed with OCD, you should schedule a meeting with your school's student study team in order to create an educational plan or you can request that your child be evaluated for special education.

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OCD in Children: Obsessive Compulsive Disorder

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OCD in children is an anxiety disorder characterized by unreasonable thoughts or fears that lead to certain repetitive behaviors. The goal of these behaviors is an attempt to reduce anxiety. It is believed that this disorder affects 1% of children in the United States.

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Your students OCD or anxiety symptoms may qualify as a disability if they are severe enough that they impact his/her ability to learn. In these cases, the student who is in public school is eligible for a 504 Plan or an Individualized Education Plan (IEP). With a 504 or an IEP Plan, accommodations are made so that the student has access to the curriculum in the same way their peers do. As a teacher, you will most likely be involved in developing this plan, and in doing so, should consider the following.

504/IEP Plan: What Teachers Should Consider When Making Accommodations

Involve all Key Players - It is important to get input from everyone on the team (teachers, guidance counselors, parents, the student's outside therapist, and the student) when creating accommodations for OCD and/or Anxiety. Having the entire team involved increases the likelihood of developing an effective plan and having high "buy-in."

Operationalize the Plan - Accommodations should be clear and measurable to reduce confusion and increase consistency across teachers and classrooms. For example, instead of saying "The student will get extensions on writing assignments", the plan should state "The student will be given a one-day extension on all writing assignments when requested via email the day before the assignment is due."

Be Realistic - Accommodations should be practical for both the teacher and the student. It may be helpful for a student to get a study guide before each exam in every class, but it is unrealistic to expect this to happen every single time. Setting unrealistic goals leads to inconsistencies in plan implementation and frustration for everyone involved.

Collect Data - Gathering information about how accommodations are working is an important part of any plan. For example, tracking homework compliance, attendance, visits to the nurse, use of coping strategies, behavioral outbursts, etc. helps the team determine if the plan is effective or not. Hard data is more reliable and useful than individual opinion or recollections.

Not All Accommodations are Helpful - It is important to make sure that an accommodation is, indeed, helpful and does not exacerbate a student's symptoms. For example, if a student has checking or perfectionism then an accommodation of extra time on all tests may simply be providing more time for the student to ritualize. A more appropriate accommodation for these symptoms might be to have the test broken up into different sections or to have a test given orally.

Review Regularly - It is important to review plans regularly. In general, 504 plans and IEPs are reviewed annually, but it is wise to review plans more frequently, especially newly developed ones. The information collected (see above) ought to be reviewed and used to guide adjustments to the plan. Other factors that might warrant an adjustment to the plan are a change in symptom subtype and/or an increase in symptomatology.

Accommodations are not Treatment - Often times, school personnel or parents worry that the plan is "giving into anxiety" or "will become a crutch". It is important to remember that 504 Plans and IEPs are not treatment plans. They consist of accommodations that allow the anxious child to be able to learn as their non-anxious peers do -- to get them to the starting line, so to speak. Without them, anxiety can be so severe that it makes learning nearly impossible. The expectation is that accommodations will fade out as the child manages their symptoms more effectively.

Sample Accommodations for Anxiety or OCD:

Their are various accommodations that teachers can make for their students with anxiety or OCD in the classroom. Click the tabs below to view a list of sample accommodations for contamination fears, social anxiety, perfectionism, checking, and indecision/procrastination. For a comprehensive list of accommodation ideas, visit our page on Classroom Accommodations and Support Strategies.

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For Teachers - Sample 504s/IEPs | Anxiety In The Classroom

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Your students OCD or anxiety symptoms may qualify as a disability if they are severe enough that they impact his/her ability to learn. In these cases, the student who is in public school is eligible for a 504 Plan or an Individualized Education Plan (IEP).

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Obsessive Compulsive Disorder and the School Counselor 

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Obsessive Compulsive Disorder and the School Counselor 

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Wertlieb, E. (n.d). Obsessive compulsive disorder and the school counselor. https://files.eric.ed.gov/fulltext/EJ894799.pdf

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VISTAS Online is an innovative publication produced for ACA by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to provide a means of capturing the ideas, information and experiences generated by the annual ACA Conference and selected ACA Division Conferences. Papers on a program or practice that has been validated through research or experience may also be submitted. This digital collection of peer-reviewed articles is authored by counselors, for counselors. VISTAS Online contains the full text of over 900 proprietary counseling articles published from 2004 to 2017.

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

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VISTAS Online is an innovative publication produced for ACA by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to provide a means of capturing the ideas, information and experiences generated by the annual ACA Conference and selected ACA Division Conferences.

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"My heart is pounding. I feel like I can't breathe. My stomachs hurts. I don't want to be here at school. I know I shouldn't be worried about it, but I

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Identification and Management of Eating Disorders in Children and Adolescents

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Identification and Management of Eating Disorders in Children and Adolescents

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Texas Education Agency (2021). https://tea.texas.gov/sites/default/files/section-504.pdf

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What Teachers Should Know

Even the best-behaved students occasionally can be difficult. But kids and teens who display a continual pattern of tantrums, arguing, and angry or disruptive behavior toward teachers, parents, or other authority figures may have oppositional defiant disorder (ODD).

Students with ODD can be so uncooperative and combative that their behavior affects their ability to learn and get along with classmates and teachers. It can lead to poor school performance, anti-social behaviors, and poor impulse control.

ODD is more common in boys than girls. Signs of ODD generally develop during preschool years, and are almost always present before early teens.

Symptoms of ODD can be hard to distinguish from other mental health disorders. Children and teens with ODD may also have:

Behaviors associated with ODD can be mild, moderate, or severe and include:

negativity

being argumentative and defiant

disobedience

hostility toward authority figures

temper outbursts

angry and irritable mood

Students with ODD might need:

seating closer to the teacher to avoid disrupting other students

breaks from classroom activities when they feel overwhelmed

more time to complete assignments

to consult with a school counselor or psychologist

to visit the school nurse to take medication for coexisting conditions, such as ADHD

an individualized education program (IEP) if a learning disability is associated with their ODD

ODD treatment involves therapy, training to help build positive interactions, and sometimes medications to treat related mental health conditions.

What Teachers Can Do

It can be difficult to recognize the differences between a strong-willed or emotional student and one with ODD.

Post classroom rules and review them regularly. Have a plan in place to handle serious behavior problems. Students with ODD often are isolated and lack friends. They may be the targets of bullies or be seen as bullies.

Be sensitive to self-esteem issues. Provide feedback to your student with ODD in private, and avoid asking the student to perform difficult tasks in front of classmates. It can be helpful to praise positive behaviors, such as staying seated, not calling out, taking turns, and being respectful.

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Oppositional Defiant Disorder Factsheet (for Schools)

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Even the best-behaved students occasionally can be difficult. But kids and teens who display a continual pattern of tantrums, arguing, and angry or disruptive behavior toward teachers, parents, or other authority figures may have oppositional defiant disorder (ODD). Students with ODD can be so uncooperative and combative that their behavior affects their ability to learn and get along with classmates and teachers.

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Diffusing Defiance in the Classroom. Scholastics

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Diffusing Defiance in the Classroom. Scholastics

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By the time Antonio walked through the doors of Bronwyn Harris's third-grade classroom, he'd already secured a reputation as a troublemaker. Harris, a veteran teacher in Oakland, California, had worked with many troubled students, but she wasn't prepared for Antonio.

"He said 'no' sometimes before I even finished asking," Harris recalls. "Once, I said, 'Hey, you don't even know what I was going to ask you.' He said, 'It doesn't matter. No!' Another time, a kid tapped him on the shoulder, and Antonio turned around and attacked him, fists swinging."

Harris reached out to the boy's family and found out he had been diagnosed with oppositional defiant disorder. Harris had never heard of ODD before, but when she looked it up, she understood why she felt so stressed and helpless. According to the American Academy of Child and Adolescent Psychiatry, ODD is "a pattern of disobedient, hostile, and defiant behavior directed toward authority figures."

You may never encounter a student with an official diagnosis of ODD; experts say that somewhere between 1 and 16 percent of students are affected, but many are undiagnosed. Yet you'll almost certainly encounter opposition and defiance in the course of your career. (After all, defiance can be a part of normal development.) Here are some strategies for keeping the peace and creating a happier, healthier classroom community.

Establish realistic behavior targets.

Let's say you have a student who refuses to sit on the rug for story time, and instead throws a fit and leaves the room. First, identify the behavior you'd like to see. Be realistic: If the child is habitually leaving the room, simply staying put is a big step.

Then, collect some baseline data. How often is the child behaving in the desired way? Zero percent of the time? Twenty percent? Baseline data helps you set reasonable goals and track growth, says David Anderson, senior director of the ADHD and Disruptive Behavior Disorders Center at the Child Mind Institute. Work toward increasing the target behavior over a week, using a combination of positive reinforcement and consistent consequences. Don't expect magic, cautions Anderson. Behavior change is slow and takes practice.

Praise positive behavior.

Children who exhibit defiant behavior receive lots of negative attention. Shift the focus to the positive by giving specific feedback when you notice the child engaging in the target behavior. But note: Some of these kids are so used to negative feedback that positive feedback can make them feel insecure, says Raychelle Lohmann, a school counselor at Wake Young Men's Leadership Academy in Raleigh, North Carolina. "Be careful of suddenly putting them in the spotlight," she advises, as many react defensively. Depending on the student, it might be best to whisper a note of praise, or to talk to the student privately.

Wait before reacting.

Sometimes teachers unwittingly set the stage for defiance by assuming the worst about a child. "We may be so worried that the child will act out that we end up being overly coercive," Anderson says. "But many times, the child may not be planning on acting out." So take a deep breath and don't intervene unless necessary. You may be able to avoid a power struggle altogether-and be pleasantly surprised with positive behavior that you can praise instead.

Talk to your class.

Oppositional behavior affects the entire class, so it's important to acknowledge what's going on.

"One day when Antonio wasn't at school, I talked to the class about how different things are easy for different people, and how some people have an easier time controlling their feelings than others," Harris says. "The students responded really well and were [better] able to ignore Antonio's outbursts later."

Remember that students may not be as sensitive to disruptive behavior as adults are. "Kids are often more tolerant of what others are working on," Anderson says. He suggests teachers say, "We all have moments where we lose our cool or have difficulty following directions. That's something we as a class are working on, and our job is to help one another."

Enlist help.

Ask your school counselor for help. They can conduct a non-obtrusive observation of student behavior and teacher interactions, and provide tips to de-escalate behavior problems. They may also be willing to work with students individually. "Oftentimes, these kids just get mad, and they don't realize there's a sequence of steps that happens," Lohmann says. "I teach them how to identify triggers and what to do when they start feeling mad."

Rebecca Briscoe, a second-grade teacher at Harmony School of Exploration in Houston, also recommends establishing a relationship with your school's special education team, even if there's no IEP. "If a student is having an outburst and you can't deal with it, call them," she says. They can use their specialized tactics to calm things down, and may even be able to work with the child one-on-one while you teach the rest of the class.

Establish a system of emotional communication.

Empower your students by working out a system of communication that allows them to let you know when they're nearly at the end of their rope. Try a 1-10 scale, with 10 standing for "everything is wonderful" and 1 representing the worst. To keep it private, try having your student pass you a card, or give an agreed-upon non-verbal signal.

If a child indicates he's having a bad day, it's best to keep things low key. Some good alternatives for high-stress days include allowing the student to read quietly, to work off some energy in the gym or other part of the school, or to visit a counselor.

Make a contract.

Behavioral contracts can work well for middle school students, but only if they are involved in problem solving and help identify both target behaviors and rewards and consequences.

First, keep expectations reasonable: "If a student isn't doing any homework, they're more likely to start doing part of it rather than all of it," says Anderson, who advises a future-oriented rather than a punitive approach. "You might point out that they have a free period where they could ask for some homework support, or you could ask them if there are ways they can structure their environment at home to be free of distraction."

Take specific and measured action.

General guidelines-such as keeping a GPA above 2.0 to play sports-aren't helpful for many kids. Create specific action plans that detail the steps students need to take, supports, and scheduled check-ins.

Involving a student's family may or may not be helpful. Often, families are overwhelmed and exhausted. When defiance is a problem in the classroom, it's best to let the school or district psychologist take the lead in setting up parent-teacher meetings.

Understand students' challenges.

"These kids can push every button a teacher has," Lohmann says. And the all-too-human reaction to constant defiance are feelings of dislike and frustration. Yet, it's important to step back. "You've got to understand they're still children," Lohmann says. "Step into their shoes and think about what it would be like to feel that level of anger and frustration constantly, to not have a lot of friends. Then, you can start to develop a relationship with the child," she continues. "And we know that if these kids start to trust their teachers and really believe their teachers are there for them, these children will start to work with them."
Click Here to Subscribe to Scholastic Teacher Magazine Photo: Adam Chinitz

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Defusing Defiance in the Classroom | Scholastic

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By the time Antonio walked through the doors of Bronwyn Harris's third-grade classroom, he'd already secured a reputation as a troublemaker. Harris, a veteran teacher in Oakland, California, had worked with many troubled students, but she wasn't prepared for Antonio. "He said 'no' sometimes before I even finished asking," Harris recalls.

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When parents start googling behavior issues, one phrase tends to jump out: oppositional defiant disorder. It's easy to see why. "The words 'oppositional' and 'defiant' show up in parents' vocabulary fairly frequently," says Dr. David Anderson, director of the ADHD and Behavior Disorders Center at the Child Mind Institute. "It's one of the more aptly named diagnoses that exists."

Whether your child has oppositional defiant disorder (or ODD) or not, learning about the disorder can be helpful. That's because the behavior management strategies used in treatment are evidence-based techniques that all parents will benefit from knowing.

What is oppositional defiant disorder?

It is normal for children to be oppositional and defiant at least some of the time. In fact, it's a sign of healthy development. So when does a child have oppositional defiant disorder? The diagnosis should not be given, for example, to a toddler who has just discovered that her new favorite word is "no."

ODD is typically diagnosed around early elementary school ages and stops being diagnosed around adolescence. Kids who have ODD have a well-established pattern of behavior problems. Symptoms include:

Being unusually angry and irritable

Frequently losing their temper

Being easily annoyed

Arguing with authority figures

Refusing to follow rules

Deliberately annoying people

Blaming others for mistakes

Being vindictive

All children can have these symptoms from time to time. What distinguishes ODD from normal oppositional behavior is how severe it is, and how long it has been going on for. A child with ODD will have had extreme behavior issues for at least six months.

Another hallmark of ODD is the toll it takes on family relationships. Regular daily frustrations - ignored commands, arguments, explosive outbursts - build up over time, and these negative interactions damage the parent-child bond and reinforce hostile patterns of behavior.

Parenting under fire

"Kids who have behavioral issues push parents towards the extremes," says Dr. Anderson. "They push parents to become permissive and they push parents to become hyper-coercive in the hope that a larger amount of control will get the kid to listen."

Neither of these extremes make for ideal parenting. It is never a parent's intention to reinforce bad behavior, and we often don't realize when we're doing it. Here are two common scenarios:

1. You tell your child to stop playing a game and get ready for bed. He ignores your first two requests. By the third time you ask, you're so mad that you yell.

2. You tell your child to stop playing a game and get ready for bed. He throws a tantrum because he wants to keep playing. You don't want him to be so worked up before bedtime, so you back down and say he can play for another ten minutes - but then he has to go to bed.

In the first scenario, your child learns that yelling is an acceptable way to get a message across. More subtly, he might also be learning that he can continue ignoring those first few requests - when you escalate the situation is when he knows you're serious.

In the second scenario, your child has learned that throwing a tantrum might give him something that he wants, so he'll be more likely to do it again in the future.

Both of these scenarios can set families up for future conflicts, and the more they are repeated the more they become familiar patterns of behavior that are harder to break out of. Your child doesn't have to have ODD for these scenarios to happen, but repeated negative interactions like these make diagnosing a behavior disorder much more likely.

And just like parents aren't necessarily to blame, neither are the kids, says Dr. Anderson. "Through no conscious effort of the child, he learns through hundreds of trials that this is a way to continue getting what he wants."

This also explains why kids who have ODD might act out more at home. Dr. Anderson notes, "Kids who have ODD are likely to be more oppositional with people they know well, partly because the pathways are so well worn. Whereas in a place like school, where a kid has less control in general over their environment, the types of behaviors that are common to ODD may not pay off as much."

ADHD and other risk factors

There is a very high overlap in kids who have ADHD who are also diagnosed with ODD. Depending on the study, the overlap could be 30 to 50 percent of kids with ADHD also have ODD.

Dr. Anderson explains the connection like this: "Kids with ADHD are biologically loaded to be distractible, to be impulsive, to have difficulty staying in one place for a little while. So kids with ADHD start off doing things that parents perceive as off limits. And then when those kids get negative feedback they start to become even more negatively oriented towards adults." These repeated patterns of negative interactions can lead to developing ODD.

But another pathway into developing ODD has more to do with a child's temperament and might be apparent early on. Children who had a lot of difficulty soothing themselves as toddlers and continue to struggle with an age-appropriate ability to control their emotions in the face of disappointment or frustration can sometimes develop ODD. The adults in their environment might be more inclined to accommodate their demands in order to keep the family functioning as harmoniously as possible.

Kids who have experienced a lot of life stress and trauma are also more likely to develop ODD.

Why treatment is important

It's important to get treatment to improve the parent-child relationship, which is crucial to the health and happiness of the entire household. It is also important for your child's future. Some children will grow out of oppositional defiant disorder, but others will continue to have behavior issues, which could lead to peer rejection and difficulty forming healthy relationships, not to mention continued family discord.

They'll also be less likely to achieve their potential. If something doesn't go their way, they might think it's anyone's fault but theirs. Dr. Anderson says they might also "retreat to the places where they know they can get what they want. That might mean that they try even less, push even more on the people who are closest to them, who they actually care about the most, causing even more frayed relationships."

A small percentage of kids with ODD go on to develop something called conduct disorder, which is a more severe behavior disorder that includes criminal acts like stealing, setting fires and hurting people. Getting treatment sooner rather than later improves a child's trajectory.

What treatment for ODD looks like

Parents play a key role in treatment for oppositional defiant disorder. This might be surprising, since children are the ones given the diagnosis, but in ODD the parent-child relationship needs to be repaired, which means both parties need to make changes to get back on track.

All programs have certain goals in common, like helping parents find the middle ground between being too authoritative and too permissive. A behavioral therapist helps parents learn how to train their child's behavior through setting clear expectations, praising kids when they follow through and using effective consequences when they don't. Parents also learn to use these strategies consistently - one reason why behavior management strategies sometimes don't work is because parents try different, conflicting techniques, or don't stick to one program long enough to see gains. Parents and children will also learn problem solving skills they can rely on when they run into issues.

Parent training programs might include sessions with parents and children working together, or just parents alone. Some different programs include:

Parent-Child Interaction Therapy (PCIT)

Parent Management Training (PMT)

Defiant Teens

Positive Parenting Program (Triple P)

The Incredible Years

Clinicians might also recommend social skills training to help improve your child's peer relationships or cognitive behavioral therapy if she is struggling with anxiety or depression.

There is no FDA-approved medication for ODD, but medications are sometimes used as an adjunct to behavioral therapy. Anti-psychotic medications like Abilify (aripiprazole) and Risperdal (risperidone), which have been shown to reduce aggression and irritability, are frequently used in cases where a child is at risk of being removed from the school or home. Stimulant medication may be used if a child has excessive impulsivity, including those who have an ADHD diagnosis. Antidepressants (SSRIs) may be helpful if a child has underlying depression or anxiety.

Regardless of the treatment plan your therapist recommends, parents will need to provide a lot of encouragement. "Make no mistake, kids do not often just suddenly wake up with the insight that they wish their behavior was better and then ask all the adults in their life how they can change," warns Dr. Anderson. "They'll stick with whatever behavior is working for them, even if it's not working that well."

But once the family dynamic begins to change, and kids (and parents) begin to feel more confident in their ability to get along, everyone will be a lot happier.

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When parents start googling behavior issues, one phrase tends to jump out: oppositional defiant disorder. It's easy to see why. "The words 'oppositional' and 'defiant' show up in parents' vocabulary fairly frequently," says Dr. David Anderson, director of the ADHD and Behavior Disorders Center at the Child Mind Institute.

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What Teachers Need to Know About Students with ODD. 

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What Teachers Need to Know About Students with ODD. 

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Third grade teacher Ms. Kim is really struggling with her student Aiden. Every day, he argues over simple things, seemingly just for the sake of causing trouble. He refuses to take responsibility for his behavior, even when caught in the act. And today, Aiden tore up a fellow student's art project after that student wouldn't let him use their red marker. His parents say he's the same at home. A school counselor finally suggests that many of these behaviors line up with the symptoms of ODD in kids-oppositional defiant disorder.

What is ODD?

Image: TES Resources

Oppositional defiant disorder, commonly known as ODD, is a behavioral disorder in which children are-as the name suggests-defiant to the degree that it interferes with their daily lives. The DSM-5, published by the American Psychiatric Association, defines it as a pattern of angry, vindictive, argumentative, and defiant behavior that lasts at least six months.

In an article on Headteacher Update, Dr. Nicola Davies sums it up this way: "The goal of a student with oppositional defiant disorder (ODD) is to gain and maintain control by testing authority to the limit, breaking rules, and provoking and prolonging arguments. In the classroom, this can be distracting for both the teacher and other students."

Between 2% and 16% of the population may have ODD, and we're not entirely sure of the causes. Scientists believe it could be genetic, environmental, biological, or a mix of all three. It's diagnosed more often in younger boys than girls, though by their teen years, both seem to be equally affected. It co-occurs in many kids with ADHD, with some studies indicating up to 50% of students with ADHD also have ODD.

What does ODD in kids look like?

Image: ACOAS

We all know that kids of a certain age, especially toddlers and teenagers, are pretty much always arguing and defying. In fact, those can be appropriate behaviors at those ages, as kids test the world around them and learn how it works.

However, ODD is a whole lot more than that, to the point where students with ODD disrupt their own lives and often the lives of everyone around them. Kids with ODD push the limits of defiance far beyond reason. Their problem behavior is much more extreme than that of their peers, and it happens much more often.

Defiance and arguing

Most kids go through a phase where "no" is their favorite word, but for students with ODD, that phase never ends. They question everything, all the time, and consistently refuse to comply with rules and requests. Their need for argument may lead them to deliberately annoy others in an attempt to create conflict. However, they usually refuse to take responsibility for their mistakes or behaviors, blaming others for everything.

Anger and irritability

These are the kids who seem angry all the time and fly off the handle at the slightest provocation. Their overreactions may devolve into temper tantrums, not just occasionally but frequently. Therefore, every conversation you have with them seems to be a struggle.

Vindictiveness

The ongoing anger of kids with ODD can lead to vindictiveness and a need for revenge. They are spiteful and retaliatory, holding grudges and demanding punishment for others.

Not surprisingly, these behaviors cause students with ODD to struggle both at home and in school. It's hard for them to make friends, and their schoolwork often suffers too. They may become depressed or anxious, or develop conduct or substance abuse disorders as they grow older. Early identification and treatment are vital to helping these kids.

How can teachers help kids with ODD?

It's vital that teachers and parents work together to help students with ODD. The experienced teachers in the WeAreTeachers Helpline group on Facebook suggest trying these methods at school and at home. Find more ideas at Pathway 2 Success.

Be consistent

"Instead of arguing, repeat your words and consequences," says Brandy T. "I use trigger words that I often repeat so the student knows I mean business. If a student tries to argue, I simply say either 'not now,' 'later,' or 'fix the issue!' The student then knows they can go to their chill-out space if they need to calm down."

Give them space to reset

Kids with ODD can learn to recognize when they're feeling overwhelmed and getting ready to challenge or defy. Giving them a safe space to calm down and rethink their choices can be beneficial. Calm-down corners have become popular in classrooms for this very reason. "Put out books, coloring, LEGO bricks, etc., in a place where they can go on their own when they feel like they need a break," says Tobey G. "Often immediately after activities with a lot of stimulation, these kids need a safe space to calm down. Let them decide if and when they need to excuse themselves."

Give them choices

Kids with ODD are looking for control. Rather than letting them drive the situation, you can give them a feeling of control while maintaining control yourself. "Always give choices," advises Holli A. "State your choices-then walk away. Give the student time to process and decide which choice to make. If they don't like the choices, don't engage. When they try to argue, repeat the choices, and walk away again. If the student still will not choose, they do not get to participate in their preferred activity."

As in other situations, it pays to stay consistent in your classroom rules and discipline. "After I give choices, I always reinforce the classroom rules and procedures and follow up with an appropriate consequence," says Kristel R. "You cannot falter; stick to your rules and follow through."

Offer positive reinforcement and appropriate rewards

Kids with ODD often respond to positive behavior reinforcement. It's helpful to offer them a chance to earn certain privileges, rather than taking those privileges away as punishment. For instance, give them the ability to earn screen time when they promptly do as they're asked, instead of threatening to take away screens when they defy.

When using a reward system, make sure that it is appropriate and isn't perceived as manipulation. Leslie L. uses a behavior tracking system and a reward system where students can turn in points for an incentive (iPad time, lunch with a teacher, etc.). "I also build breaks right into their schedule," adds Leslie. "And I try to be as patient and understanding as I possibly can."

Teacher Erica M. also uses a point system checklist with options A and B. If they do each one, they earn "points" for an incentive, which often is iPad time during the last 15 minutes of class. "Find an interest and use that to your advantage!" Erica says.

Avoid power struggles

Most teachers agreed: Stay out of those winless power struggles. As Kris W. said, "Pick your battles. A student of mine corrects me all the time, whether I am wrong or not. I answer back, 'OK, let's double-check that.' If I made a mistake, I correct it, and we move on; if he's wrong, I silently let him figure it out."

Make personal connections

Often kids with ODD are looking for a relationship with a teacher who can help them deal with problems on their own instead of making them stand out in a negative way. Building a connection with them will help get to the root of the behavior.

"Almost all of my students have ODD, and I have a great relationship with most of them," says Kendra J. "Find out what they are interested in and have conversations on their level during breaks." Allow them to set goals and decide together what the consequences will be if they don't meet the goal.

Carol H. says, "Find something at the student's interest level. I once had a middle school girl who hated all of her teachers and was out of control. She would curse at adults and peers, scratch, bite, and refuse to complete work. I found out she played soccer for a travel team. So did my son. A few weeks into the school year, she had a game adjacent to my son's, and I was able to watch her play. It changed everything. She is a freshman in college now, and we still keep in touch."

Find ODD Resources

This is just an overview of what students with ODD are facing. Educate yourself about the condition to find more ways to understand and help these kids in your classroom.

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Books

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Have more questions about kids with ODD? Come share your thoughts and ask for advice in the WeAreTeachers Helpline Facebook group.

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What Teachers Need To Know About Students With ODD

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What is ODD in kids, and how can teachers help their students with ODD? Learn what oppositional defiant disorder looks like in the classroom.

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"I don't want to go to school!" It's an age-old complaint from children, but a growing body of research suggests that it can signal a deeper problem: school anxiety. This fear affects 2 to 5 percent of school-age children, according to the Anxiety and Depression Association of America (ADAA). And the pandemic certainly hasn't made things easier. After months of distance learning and limited social interactions, children must readjust to the classroom setting-and this can be daunting.

So how do you know whether your child's protests are a ploy to avoid an uncomfortable situation or a genuine cry for help? Read on for more about the causes and symptoms of school anxiety, with tips for making drop-off easier.

School Anxiety in Daycare

Causes: Around 8 months, many children develop separation anxiety, which causes them to scream and cry whenever their caregiver isn't around. This anxiety coincides with a new intellectual skill called object permanence: the ability to remember objects and specific people that aren't present, according to pediatrician Alan Greene, M.D., FAAP. In other words, your baby starts calling up mental pictures of you when you aren't there-and they miss your warmth, comfort, and familiarity. Young children also don't have a sense of time, so they don't understand whether you'll be gone for an hour or two days.

Signs and Symptoms: Babies and toddlers may scream and cling during drop-off-but they'll usually stop once you're out of sight.

How to Handle It: Dr. Greene suggests preparing your child with "separation" games, such as peek-a-boo, which reinforce that you'll always return after leaving. You can also begin introducing small doses of separation into your little one's life- a visit to an aunt's house or a day with Grandma. According to Elizabeth Berger, M.D., a child and adolescent psychiatrist, "Little by little, your child will become more comfortable with spending time away with you, because she knows that you will return when you said that you would and because she had a good time even when you were gone."

When it's time for daycare drop-off, "goodbyes should be brief, affectionate, and with a clear statement that you will be back," Dr. Greene says. Don't draw out the leaving process, since it can make the experience more traumatic for a child. Also avoid sneaking out without saying goodbye; your little one might feel that they can't trust you. Finally, Dr. Greene suggests bringing a stuffed animal, blanket, or other comforting object to the daycare center.

School Anxiety in Preschoolers

Causes: "School" is an abstract concept to a kid who's never been before. The unfamiliar people and routines can be scary for them. Some preschoolers might also have lingering separation anxiety, but this is completely normal-it simply means that a child has a strong attachment to a caregiver.

Signs and Symptoms: Usually, kids with school anxiety will show a range of stress- or anxiety-related symptoms. Preschoolers might talk about their fear of school and ask for repeated reassurance: "Can you stay at school with me?" "Do I have to go?" They may also complain about stomachaches or headaches, or they'll throw tantrums when you're ready to leave.

How to Handle It: If your child is going into preschool, take them on a tour a few days beforehand, recommends Sucheta Connolly, M.D., a child psychiatrist and director of the Pediatric Stress and Anxiety Disorders Clinic at the University of Illinois in Chicago, which treats children as young as 2. Talk openly and excitedly to your child about their upcoming routine. If they tend to have trouble with new social situations, arrange for playdates with some new classmates before school begins.

Also consider role-playing at home. Many children are cognitively ready for school but struggle to assert themselves socially. Use puppets, dolls, or stuffed animals to act out social situations that make them anxious, such as meeting the teacher for the first time.

When the first day comes, it's sometimes best to tell your child that you will stay for a few minutes to help them feel settled. Give them a little memento to put in their pocket that reminds them of you, so they can take it out if they feel sad. If you think the problem is serious, you might speak privately with the teacher. Many children are a bit weepy at first, but most of them cheer up in a few minutes.

You can also reward children for taking positive steps toward independence. For example, put a sticker on your kid's chart every day they attend school without tears or clinging, and when they earn a certain number of stickers, take them on a special outing.

School Anxiety in Elementary Students

Causes: School anxiety in elementary students has many different causes. For starters, the child might be stressed by the demands of the classroom. "Our society is expecting more and more from our kids at younger ages," says Dr. Connolly. "And not all of them can handle it."

Along those lines, the student may have undiagnosed learning disability, adds Dr. Connolly. If they have difficulty with a certain subject- but the teachers aren't aware or think the student simply isn't trying-the kid can fret about school.

Other factors, including generalized anxiety disorder (GAD) and social anxiety, can also make school seem scary. Children with GAD suffer excessive worry about everyday things- academic performance, being away from parents, etc. Kids with social anxiety often feel intensely scrutinized and worry that they'll do something embarrassing. Some are fearful of speaking in front of the class, while others have trouble even walking up to the blackboard.

Signs and Symptoms: Children might have physical symptoms (headaches, nausea, diarrhea, difficulty sleeping, etc.) that appear before the school day, according to the ADAA. Some will develop school refusal-a fear so intense that they can't be coaxed into the school bus or the building. If they manage to get to school, they may cry, complain of aches and pains, and can't be consoled by the teacher.

It's important to note that children with school anxiety struggle every day of school. It's not something they have one day but not the next.

How to Handle It: Always have recurrent physical symptoms checked out by a pediatrician to rule out medical problems. But assuming kids are physically healthy, parents need to be firm about not allowing them to miss school. Acknowledge that they feel scared, but reiterate that nervousness doesn't mean they won't enjoy themselves. Remind them of new situations they've dealt with, such as sleeping at Grandma's house for the first time without you, and how it ended up fine.

It's also important to rule out problems at school or home. Ask your child and their teacher if something upsetting happened, such as bullying or teasing. Events at home-a move, a divorce, the death of a family pet, etc.-might also be causing these negative feelings. Dealing with these issues accordingly might relieve some negative symptoms.

If the school anxiety doesn't ease for several weeks, or if it affects your child's everyday life, have them evaluated by a mental health professional who specializes in working with kids. School anxiety is not a psychiatric diagnosis, but it may be a symptom of an anxiety disorder. Treatment usually begins with cognitive behavioral therapy, which teaches relaxation and coping skills and can result in improved behavior over several months. Doctors may also prescribe medication for severe cases. Work with the expert and your child's teacher to help your child feel more comfortable in the classroom.

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School Anxiety in Children: Causes, Signs, and What to Do

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"I don't want to go to school!" It's an age-old complaint from children, but a growing body of research suggests that it can signal a deeper problem: school anxiety. This fear affects 2 to 5 percent of school-age children, according to the Anxiety and Depression Association of America (ADAA).

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Children with anxiety or OCD are likely to exhibit symptoms in the school setting. For this reason, it's important to understand the signs and symptoms of Anxiety and OCD and to be able to differentiate between normal vs. abnormal behavior.

Anxiety in Kids

Everyone experiences anxiety at some point in their lives, from the very young to the very old. In school, students may get nervous during a fire drill, before a test or presentation, or when saying goodbye to their families in the morning. It is normal and common for students to get anxious in situations like these. When a student's anxiety starts to creep out of specific situations and into their everyday life, they might have an anxiety disorder.

Anxiety, as it relates to mental health conditions, is defined as chronic and/or generalized worry, fear, or nervousness that students express a lot of the time. In other words, the anxiety the student feels is not driven by specific situations - they feel anxious most of the time, regardless of what is happening in their life. In these cases, anxiety noticeably impacts a student's behavior in school and at home, their ability to participate in class, their learning, and/or their ability to perform assigned tasks.

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Anxiety Signs and Symptoms | Anxiety In The Classroom

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Children with anxiety or OCD are likely to exhibit symptoms in the school setting. For this reason, it's important to understand the signs and symptoms of Anxiety and OCD and to be able to differentiate between normal vs. abnormal behavior. Everyone experiences anxiety at some point in their lives, from the very young to the very old.

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Many adolescents and teenagers today face eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder. Because of the severity of these mental illnesses, professional treatment and interventions are necessary and crucial to prevent worsening of symptoms.

Research has found that more adolescents and teenagers are impacted by eating disorders than type 2 diabetes, with restrictive eating disorders occurring more commonly than other chronic illnesses [1].

The most effective treatment approaches include multidisciplinary treatment and sometimes hospitalization.

Eating Disorder Treatment for Teenagers

The level of care needed for eating disorder treatment may vary according to the severity of the illness. Teenagers who are experiencing medical/psychiatric instability related to the eating disorder will typically require treatment at a more acute level of care, such as inpatient hospitalization and/or residential treatment.

Eating disorders that are less severe may possibly be managed at an intensive outpatient or outpatient level of care. When assessing the most appropriate level of care for treatment, it is important to follow the professional recommendations given by eating disorder specialists in order to maximize treatment efforts.

Many teenagers may be resistant to treatment due to fear of missing out on social activities or even falling behind in school. For a student who is involved in many activities or even in a transition for college preparation, the decision to take a break to prioritize eating disorder treatment can be difficult to make.

Stressing the importance of treatment as a gateway to a hopeful future is often necessary when encouraging a teenager toward eating disorder treatment. If falling behind in school is a concern, it may be helpful to appropriately address this issue with academic advisors and devise a plan for staying on course.

Academic Options During Treatment

When considering academic options during eating disorder treatment, it is necessary to keep priorities in check.

A teenager or adolescent who is severely impacted by an eating disorder is likely facing many challenges keeping up with their academics as it is, as cognition often malfunctions due to lack of proper nutrition.

Many students with eating disorders may already be struggling in school, have a decreased ability to concentrate, focus, and process information, and be less able to perform tasks compared to their peers without eating disorders [2].

Deficiencies in both macro and micronutrients can lead to an overall diminished ability to be a successful student in school, both academically and socially.

During the early phases of eating disorder treatment, particularly when establishing medical and psychiatric stability, it may not be appropriate to incorporate any form of academic school work.

The recovery process is often overwhelming for a teenager or adolescent, and allowing room to just focus on healing can eliminate any unnecessary stress or pressure.

There may come a point in the recovery process when it is appropriate for the student to revisit academic work, at a pace that is suitable to their recovery and treatment efforts. This should be collaboratively discussed and planned with their treatment team and school academic advisors.

Keeping Recovery a Priority

Because of the severity and chronicity of eating disorders, treatment may extend much longer than anticipated. It is important to take the necessary and recommended steps to improve prognosis and make a full recovery, when possible.

If an extended leave from school is possible, it is important to determine what steps should be taken to help a student make up any missed work under the guidance of both treatment professionals and academic advisors. In many cases, when a student has reached a certain point in their treatment, incorporating some form of "home study" or academic work with a qualified tutor can support a student's effort to catch up with missed schooling.

Overall, when a student's health is prioritized and necessary steps are taken for treatment, a teenager is enabled to have a much brighter future that allows them the opportunity to thrive. Research has found that individuals who seek out early intervention for treatment within the first one to three years of the onset of the illness have a significantly improved chance for recovery [3].

While it is difficult to miss out on many enjoyable and important aspects of life due to eating disorder treatment, seeking out professional care is a vital step toward ensuring that one's life can be lived to its fullest potential.
About the Author: Crystal Karges, MS, RDN, IBCLC is a Contributing Writer for Eating Disorder Hope. Crystal is a Masters-level Registered Dietitian Nutritionist (RDN) with a specialty focus in eating disorders, maternal/child health and wellness, and intuitive eating. Combining clinical experience with a love of social media and writing. References: As a Certified Intuitive Eating Counselor, Crystal has dedicated her career to helping others establish a healthy relationship with food and body through her work with EDH and nutrition private practice. The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals. We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
[1]: Leora Pinhas, MD, FRCPC, et al. Incidence and age-specific presentation of restrictive eating disorders in children. 2011;165(10):895-899. Accessed 8 June 2017 Arch Pediatr Adolesc Med.
[2]: Bulimia Guide, "Impact of Eating DIsorders on Cognitive Abilities and Functioning in School", http://www.bulimiaguide.org/summary/detail.aspx?doc_id=9480&hide=1 [3]: David Herzog, et al. Mortality in eating disorders: a descriptive study. International Journal of Eating Disorders
July 2000 28(1):20-6

Published on July 12, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on July 12, 2017.
Published on EatingDisorderHope.com

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Teenagers & Eating Disorder Treatment: Keeping Up in School

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Many adolescents and teenagers today face eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder. Because of the severity of these mental illnesses, professional treatment and interventions are necessary and crucial to prevent worsening of symptoms. Research has found that more adolescents and teenagers are impacted by eating disorders than type 2 diabetes, with restrictive eating disorders occurring more commonly than other chronic illnesses [1].

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Lean sports such as running, swimming, wrestling, gymnastics and dance are sports that are judged on appearances and body shape and tend to have higher rates of eating disorders, but no sport is immune to an eating disorder. Athletics can be a great way to learn teamwork, self-discipline, mindfulness and the development of the importance of physical activity in daily living and therefore it is important that parents, teachers, coaches and athletes alike keep in mind these goals when competing in sports.

The relationship of a coach with an athlete can be especially important when trying to prevent an eating disorder. The athlete is influenced by the coach's motivation, their body image, and their relationship with the team, the training, and their competitiveness. Athletes and coaches spend a significant amount of time together during the week, especially if the coach is also one of the athlete's teachers. The coach or teacher can have a substantial influence on an athlete's beliefs, perceptions, and behaviors.

The relationship between motivation, conflict, and performance has also been shown to increase or decrease disordered eating in athletes. If the conflict is high between the coach and athlete, and there is little support then typically the athlete may begin to show signs of disordered eating. Additionally, if there is a performance-centered or judgment based environment, there is often a higher rate of disordered eating among athletes.

Teaching about mindfulness and body positivity in schools

Research at middle schools and high schools have shown that engaging in prevention programs like mindful eating can help in preventing eating disorders.

Middle school programs that incorporate mindfulness also work to integrate reframing techniques to help youth reframe their thoughts with the use of dietetics and food science teachers. Studies have shown that eating disorders are deeply rooted in past trauma, low self esteem, unhealthy coping skills, and poor interpersonal relationships and therefore developing a positive body image and high self esteem is important, especially in school-aged children and adolescents. Some schools bring in short-term prevention programs or leadership training such as The Body Positive, Girls on the Run and Girls in the Know that explore healthy lifestyles, body image, and self-care education. Professional therapists, dietitians, and physicians in local communities that volunteer their time to these organizations often lead these educational programs. Other programs have guest speakers who are recovering from an eating disorder and share their personal story.

Taking preventative steps in the classroom and on the field

Another way to prevent unhealthy social atmospheres is to change the conversations from performance and appearance driven to team and quality driven.

When coaches and teachers start to focus on the team or class as a whole, talents of the person, as well as performance, it enhances the student's or athlete's self-confidence and self-worth.

Inviting dietitians to talk at schools on a regular basis about nourishment for the athlete's body, mindful eating practices, and self-care are important for all students regardless of the age or if they are in athletics.

Being able to have the student and athlete focus all of their senses on how their body is feeling, what emotions they are sensing, and how their food tastes is a great tool to use in preventing disordered eating patterns.

Engaging a school counselor or a therapist to work with a student in school or on the team or the team as a whole can help with prevention efforts. School therapists can offer educational sessions on healthy versus unhealthy eating behaviors, and provide one-on-one counseling.

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How Teachers and Coaches can Help in Preventing Eating Disorders

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Lean sports such as running, swimming, wrestling, gymnastics and dance are sports that are judged on appearances and body shape and tend to have higher rates of eating disorders, but no sport is immune to an eating disorder.