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Counseling Movies: Films that Illustrate Mental Health

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Counseling Movies: Films that Illustrate Mental Health

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Counseling Movies: Films that Illustrate Mental Health - Unseen Footprints

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Are you a counselor or studying to be one? Here are some counseling movies to check out that illustrate issues in mental health and how counselors are perceived in our society!

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ASCA Ethical Standards for School Counselors

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ASCA Ethical Standards for School Counselors

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School counselors face ethical and legal challenges every day. Whether you are new to the field or have been practicing for years, legal and ethical challenges can still throw you for a loop. From confidentiality issues to records maintenance, from duty of care to sexual harassment issues, a school counselor's legal and ethical questions can spring up from every corner.

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The Texas Model for Comprehensive School Counseling Programs

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The Texas Model for Comprehensive School Counseling Programs

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Center for Parent and Information Resources

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Center for Parent and Information Resources

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Finding the motivation to make positive lifestyle changes can be hard for anyone. For teenagers, it can be especially difficult when parents are the ones telling them to do it. But if they've fallen into unhealthy habits like vaping or alcohol abuse, change can be beneficial. Motivational interviewing is a form of therapy that creates a safe, non-judgmental environment for teens to establish their own goals and values and see how changing unhealthy behaviors can benefit them in the long run.

This series of articles comes from the Child Mind Institute, with most available in English and Spanish. Why might teens be resistant to therapy and how can parents and others to help them get the treatment they need? The articles explain how motivational interviewing can help teens gain the self-confidence to make important behavioral changes. To read more about motivational interviewing, and to connect with the articles in both English and Spanish, please visit CPIR's abstract.

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Center for Parent Information and Resources | Your Central Hub for Parent Centers Serving Families of Children With Disabilities

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Finding the motivation to make positive lifestyle changes can be hard for anyone. For teenagers, it can be especially difficult when parents are the ones telling them to do it. But if they've fallen into unhealthy habits like vaping or alcohol abuse, change can be beneficial.

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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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Mental Health Counseling - Counseling Outfitters

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Mental Health Counseling - Counseling Outfitters

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American Counseling Association (ACA) Practice Briefs

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American Counseling Association (ACA) Practice Briefs

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Brief research-based summaries of best practices, evidence-based practices, research-based approaches covering a wide variety of issues and topics.

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Fact Sheet for Parents with Children who have Mental Health challenges

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Fact Sheet for Parents with Children who have Mental Health challenges

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Our children's mental health fact sheets are free for your non-commercial use! The fact sheets include information on the most common mental health disorders in youth, as well as classroom strategies and additional resources.
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Our children's mental health fact sheets are free for your non-commercial use! The fact sheets include information on the most common mental health disorders in youth, as well as classroom strategies and additional resources. Any MACMH material used, copied or distributed may not be altered and the Minnesota Association for Children's Mental Health - MACMH [...]

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Lifetime Prevalence of Mental Disorders in US Adolescents

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Lifetime Prevalence of Mental Disorders in US Adolescents

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Dr. Kathleen Ries Merikangas, Ph.D, Ms. Jian-ping He, M.Sc., Dr. Marcy Burstein, Ph.D., Ms. Sonja A. Swanson, Sc.M., Dr. Shelli Avenevoli, Ph.D., Ms. Lihong Cui, M.Sc., Dr. Corina Benjet, Ph.D., Dr. Katholiki Georgiades, Ph.D., and Dr. Joel Swendsen, Ph.D.

Abstract

Objective

To present estimates of the lifetime prevalence of DSM-IV mental disorders with and without severe impairment, their comorbidity across broad classes of disorder, and their sociodemographic correlates.

Method

The National Comorbidity Survey-Adolescent Supplement NCS-A is a nationally representative face-to-face survey of 10,123 adolescents aged 13-18 years in the continental U.S. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview.

Results

Anxiety disorders were the most common condition (31.9%), followed by behavior disorders (19.1%), mood disorders (14.3%), and substance use disorders (11.4%), with approximately 40% of those with one class of disorder also meeting criteria for another class of lifetime disorder. The overall prevalence of disorders with severe impairment and/or distress was 22.2%; (11.2% with mood disorders; 8.3% with anxiety disorders; 9.6% behavior disorders). The median age of onset for disorder classes was earliest for anxiety (6 years), followed by 11 years for behavior, 13 years for mood, and 15 years for substance use disorders.

Conclusions

These findings provide the first prevalence data on a broad range of mental disorders in a nationally representative sample of U.S. adolescents. Approximately one in every 4-5 youth in the U.S. meets criteria for a mental disorder with severe impairment across their lifetime. The likelihood that common mental disorders in adults first emerge in childhood and adolescence highlights the need for a transition from the common focus on treatment of U.S. youth to that of prevention and early intervention.

Keywords: Epidemiology, adolescents, mental disorders, National Comorbidity Survey, correlates

INTRODUCTION

There has been tremendous growth in the field of child psychiatric epidemiology over the past two decades. The results of numerous community surveys in specific regions of the U.S. ⁻ have shown that about one in every three to four children suffers from a mental disorder and that about one in ten has a Serious Emotional Disturbance, ⁻ with few affected youth receiving adequate mental health care. However, there has been a lack of empirical data on the prevalence and distribution of a wide range of DSM-IV mental disorders from a nationally representative sample of children or adolescents. Such information is necessary to establish resource allocation priorities for prevention, treatment, and research.

Based on the recommendations of the landmark Surgeon General's Report on Mental Health and the recommendations of a subgroup of the National Institute of Mental Health (NIMH) National Advisory Mental Health Council, the NIMH established several research initiatives to address the lack of national statistics on mental health in children. Instruments for assessing mental health were added to two large national surveys including the Strengths and Difficulties Questionnaire (SDQ) to the National Health Interview Survey, and selected modules from the National Institute of Mental Health Diagnostic Interview Schedule for Children (DISC) Version 4 to the National Health and Nutrition Examination Survey. In addition to these measures, the National Comorbidity Survey Replication (NCS-R) was extended to assess a broad range of DSM-IV disorders in a nationally representative sample of youth aged 13-18 years, referred to as the National Comorbidity Survey Adolescent Supplement (NCS-A). ⁻

The goals of the present report are: (1) to present the lifetime prevalence estimates of mental disorders and the proportion of disorders that are associated with severe impairment in a nationally representative sample of U.S. adolescents; (2) to examine the magnitude of overlap in the major classes of mental disorders; and (3) to describe the individual and familial sociodemographic correlates of these disorders.

Method

Sample and Procedure

The NCS-A is a nationally representative, face-to-face survey of 10,123 adolescents aged 13-18 years in the continental US. The survey was administered by the professional interview staff of the Institute for Social Research at the University of Michigan. The NCS-A was carried out in a dual-frame sample that included a household sub-sample and a school sub-sample., , The overall NCS-A adolescent response rate combining the two sub-samples was 82.9%. Comparisons of sample and population distributions on census sociodemographic variables and the school sample on school characteristics revealed only minor differences that were corrected with post-stratification weighting.

One parent or parent surrogate of each participating adolescent was asked to complete a self-administered questionnaire (SAQ) that contained informant questions about the adolescent's mental health. The full SAQ was completed by 6,491 parents. These recruitment and consent procedures were approved by the Human Subjects Committees of both Harvard Medical School and the University of Michigan. Once the survey was completed, cases were weighted for variation in within-household probability of selection (in the household sub-sample) and for residual discrepancies between the sample and the US population on the basis of socio-demographic and geographic variables. These weighting procedures are discussed in more detail elsewhere., Socio-demographic variables assessed in the NCS-A include age (in years), sex, race/ethnicity, parent education, urbanicity, and marital status of parents. A poverty index ratio, based on family size and the ratio of family income to the family's poverty threshold level, (≤1.5 poor, ≤3, ≤6, and > 6) was also included.

presents the weighted socio-demographic characteristics of the study sample. About half of the sample was male (51.3%) and the mean age was 15.2 years, with a larger proportion of youth aged 13-14 years (36.2%), and approximately equal distributions of youth aged 15 (20.5%), 16 (21.0%), and 17-18 (22.3%) years. The sample was comprised of 65.6% non-Hispanic Whites, 15.1% non-Hispanic Blacks, and 14.4% Hispanics. In terms of family characteristics, 84.5% of the sample had parents who had completed at least high school, 14.7% had a poverty index ratio at 1.5 or lower, nearly half of the sample resided in a metropolitan area, and 78.6% had parents who were married or cohabiting.

Table 1

Measures

Diagnostic assessment

Details of the diagnostic and risk factor measures are described by Merikangas et al. Briefly, a modified version of the World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI), a fully structured interview administered by trained lay interviewers to generate DSM-IV diagnoses was administered to adolescents. Modifications to the CIDI involved enhancing the wording and appropriateness of the instrument for assessment of adolescents. Lifetime disorders assessed in the CIDI included mood disorders and episodes (major depressive disorder [MDD] or dysthymic disorder, bipolar I or II [BPD]), anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder [GAD], posttraumatic stress disorder [PTSD], separation anxiety disorder [SAD]), behavior disorders (attention deficit/hyperactivity disorder [ADHD], oppositional defiant disorder [ODD], and conduct disorder [CD]), substance use disorders (alcohol abuse/dependence, drug abuse/dependence), and eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder). Parents (or parent surrogates) were mailed a self-administered questionnaire (SAQ) in order to collect additional information on adolescent sociodemographic characteristics, developmental background, mental and physical health, and other family- and community-level factors. Parents who completed the SAQ provided full DSM-IV diagnostic information about MDD and dysthymic disorder, SAD, ADHD, ODD, and CD, whereas those completing the abbreviated SAQ only reported on ADHD. Based on prior research that has documented the value of supplemental parent reports, , information from both the parent and adolescent were combined for major depression and behavior problems and classified as positive if either informant endorsed the diagnostic criteria. Definitions of all psychiatric disorders adhered to DSM-IV criteria and diagnostic hierarchy rules were applied for every disorder, with the exception of oppositional defiant disorder and substance use disorders. Psychiatric disorders derived from the modified CIDI showed good concordance with a clinical reappraisal sub-sample.

Impairment criteria embedded in DSM-IV required endorsement of some/a lot/extreme level of impairment or moderate/severe/very severe level of symptom severity. In order to more clearly identify disorders that were clinically significant, our definition of severe lifetime disorders used higher thresholds of impairment that required endorsement of "a lot" or "extreme" impairment in daily activities, or "severe or very severe" distress. Severe emotional disorders required both distress and impairment to be present, and severe behavior disorders (ADHD, ODD, and CD) required endorsement of symptom criteria by both the parent and the adolescent.

Statistical Analysis

All statistical analyses were completed with the SUDAAN software package and utilize the Taylor series linearization method to take into account the complex survey design. Cross-tabulations were used to calculate prevalence and comorbidity. Logistic regression analysis was used to examine demographic correlates of prevalence; regression models included all sociodemographic variables simultaneously, and adjusted odds ratios are presented. Age-of-onset curves were generated using the Kaplan-Meier survival analysis method. Multivariate significance tests were calculated using Wald Chi-Square tests based on coefficient variance-covariance matrices that were adjusted for design effects using the Taylor series method. Statistical significance was based on two-sided design-based tests evaluated at a level of significance of 0.05.

Results

Lifetime Prevalence

presents the lifetime prevalence rates of DSM-IV mental disorders by sex, age group, total DSM-IV disorders and disorders with severe impairment. Mood disorders affected 14.3% of the total sample, corresponding to 11.7% who met criteria for MDD or dysthymia and 2.9% for BPD. Females were twice as likely to experience unipolar mood disorders as compared to males, and somewhat more likely to experience BPD. The prevalence of all mood disorders increased uniformly with age, with a nearly two-fold increase from the 13-14 year age group to the 17-18 year age group. Severe cases of mood disorder (11.2% of the total sample) represented 74.4% of all MDD or dysthymic disorders, and 89.7% of all cases of BPD. The sex-specific rates for severe disorders (not presented in the table) maintained the same general patterns as were observed for the overall prevalence rates.

Table 2

Nearly one in three adolescents (31.9%) met criteria for an anxiety disorder, with rates for individual disorders ranging from 2.2% for GAD to 19.3% for specific phobia. All anxiety disorder subtypes were more frequent in females (the greatest sex difference being observed for PTSD). The aggregate category of any anxiety disorder was stable across age groups, but considerable variance was observed by disorder subtype. In particular, the prevalence of PTSD, panic disorder, social phobia and GAD showed modest but consistent increases with age. Severe anxiety disorders were present in 8.3% of the total sample, representing all individuals with panic disorder or agoraphobia, a moderate proportion of individuals with GAD (54.5%) or PTSD (30%), and only a small proportion of individuals with social phobia (14.3%), SAD (7.9%) and specific phobia (3.1%); yielding prevalence rates of 1.3% for social phobia, and 0.6% for SAD and specific phobia, respectively.

The prevalence of ADHD was 8.7%, with three times as many males being affected by this condition as females. The prevalence of severe ADHD was 4.2%, or approximately half of all cases in the sample. ODD was present in 12.6% of the sample (6.5% for severe cases) and 6.8% met criteria for CD (2.2% for severe cases). Although the rates of ADHD and ODD remained relatively stable by age group, rates of CD increased to a peak of 9.6% among the oldest adolescents.

Substance use disorders were present in 11.4% of the sample, corresponding to 8.9% of adolescents with drug abuse/dependence and 6.4% with alcohol abuse/dependence. These disorders were somewhat more frequent in males, and a five to eleven-fold increase in prevalence was observed across increasing age groups. The rates for severe substance use disorders were identical to those of the DSM-IV disorders because impairment criteria were embedded in the diagnostic definitions for these disorders. Concerning other conditions, 2.7% of adolescents had manifested eating disorders at some point in their lifetime. These disorders were more than twice as prevalent among females and demonstrated modest increases with age.

Finally, 49.5% of the total sample was affected by at least one class of disorder, but less than half had disorders with severe impairment (27.6%), and only 22.2% exclusive of substance use disorders. Approximately 20% of the sample (40% of all affected individuals) also met criteria for a disorder from at least one additional class. These comorbidity rates were similar for males and females. No age differences were observed for adolescents affected by one class of disorder, but comorbidity with additional classes strongly increased with age.

presents the age-specific incidence curves for each of the broad classes of lifetime mental disorder. Anxiety disorders occurred earliest with a steep slope beginning in early childhood, and leveling off after age 12. Risk was fairly low for mood and behavior disorders until early adolescence when it began to rise steadily. Substance use disorders appeared to have the latest age of onset with a steep increase in incidence after age 15. The estimated risk at age 18 was 17.6% for behavior disorders, 18.2% for mood disorders, 23.8% for substance use disorders, and 26.2% for anxiety disorders. The median age of disorder onset was 6 for anxiety disorders, 11 for behavior disorders, 13 for mood disorders, and 15 for substance use disorders (data not shown).

displays the proportion of adolescents affected by one or more broad classes of disorder among those with at least one DSM-IV disorder. A small majority of affected adolescents (61%) met criteria for disorders from one class only, with anxiety disorders being the most frequent condition to occur alone (35%) and smaller proportions having only behavior (14%), mood disorders (6%), or substance use disorders (6%). About one-quarter (25%) of adolescents affected by at least one class of disorder also met criteria for a disorder from one additional class, 11.0% were affected by three classes of disorders and 3% were affected by four classes of disorder.

Socio-demographic Correlates

presents the results of multivariate analyses of the association between individual and familial sociodemographic characteristics on classes of lifetime mental disorders in the adolescents. Mood and anxiety disorders were more prevalent among females in these multivariate analyses, whereas males had higher rates of behavior and substance use disorders. Rates of mood and substance use disorders were higher among older adolescents. There were few racial/ethnic differences in the major classes of mental disorders, with the exception of increased rates of anxiety disorders and lower rates of substance use disorder among non-Hispanic Black adolescents compared to non-Hispanic White adolescents, and higher rates of mood disorders among Hispanic adolescents compared to non-Hispanic Whites.

Table 3

With respect to parental characteristics, the prevalence rates of anxiety disorders, substance use disorders and behavior disorders were higher for respondents whose parents were divorced or separated relative to respondents of currently married or cohabitating parents. Rates of mood disorders were lower among children of parents who were never married compared to currently married or cohabitating parents. Parental poverty level and urbanicity were not associated with any of the classes of mental disorder. However, the most consistent association between parental characteristics and mental disorders in children emerged for parental education. Adolescents whose parents were not college graduates were at increased risk for all disorder classes.

The findings from multivariate analyses for these sociodemographic characteristics and classes of severe mental disorders (results not shown, but available upon request) were highly similar to those of all mental disorders, with limited exceptions. In particular, anxiety disorders were more prevalent in older adolescents, among 'other' ethnic minorities, among adolescents whose parents were not college graduates, and among adolescents whose parents were divorced or separated.

Two-way interactions for any significant main effects were tested for each class of disorder. After adjusting for family-wise experimental errors with a Bonferroni correction, no interactions were observed between individual and parental demographic correlates and anxiety or behavior disorders. There were four significant interactions for other disorders: (1) the prevalence of mood disorders was higher in White adolescents in homes with higher levels of parental education than that in Blacks and Hispanics; (2) rates of substance use disorders increased more dramatically with age for males than females; (3) sex differences in substance use disorders were largest for Blacks compared to other ethnic groups; and (4) increased rates of substance use disorders were observed among Hispanic adolescents whose parents were divorced, however, rates were decreased among Blacks whose parents were never married or divorced.

Discussion

These findings provide the first lifetime prevalence data on a broad range of mental disorders in a nationally representative sample of U.S. adolescents. The prevalence rates reported here closely approximate those of our nationally representative sample of adults using nearly identical methods, suggesting that the majority of mental disorders in adults emerge prior to adulthood. These rates are somewhat higher than those of prior studies, but within the ranges of estimates summarized in a meta-analysis of international community surveys of mental disorders in youth. In addition, the NCS-A provides a more comprehensive assessment of a wide range of DSM-IV disorders and subtypes than most previous studies. Despite the high prevalence rates, however, only about one in every four-to-five youths meet criteria for a lifetime mental disorder that is associated with severe role impairment and/or distress. The prevalence of severe emotional and behavior disorders is even higher than the most frequent major physical conditions in adolescence, including asthma or diabetes which have received widespread public health attention.

The finding that only about half of youth with a lifetime DSM-IV disorder report severe impairment confirms previous research demonstrating that a smaller proportion of youth with mental disorders actually have sufficiently severe distress or impairment to warrant immediate intervention. According to prior research, about one out of every ten youths with a current mental disorder fulfill criteria for Serious Emotional Disorder (SED) based on the Substance Abuse and Mental Health Services Administration (SAMSHA) definition (e.g., a mental health problem that has a drastic impact on a child's ability to function socially, academically, and emotionally). , While our study did not strictly assess all of the criteria for SED, our estimates of severe disorders were based on the full diagnostic criteria for DSM-IV disorders accompanied by severe impairment in major life roles.

Our data document the early onset of major classes of mental disorders. Among affected adolescents, 50% of disorders had their onset by age 6 for anxiety disorders, by age 11 for behavior disorders, by age 13 for mood disorders and by age 15 for substance use disorders. These findings closely approximate those of prospective studies of child and adolescent samples that have documented the incidence and progression of childhood mental disorders., ⁻ The early age of onset of anxiety has been well-established and our findings on specific subtypes of anxiety closely track those of prospective community-based research that reveal differential peak periods of onset of specific subtypes of anxiety. ⁻ Prospective studies have also shown that the average age of onset of major depression and dysthymia is between 11 and 14 years, with a steady increase in incidence across adolescence that continues through early adulthood. Our cross-sectional data reflect this increase with a near doubling of rates from 13-14 years (8.4%) to 17-18 years (15.4%). Also consistent with prior cross-sectional and prospective research, the median onset of behavior disorders is slightly earlier than that of mood disorders, with a later peak for conduct disorder than for oppositional defiant disorder. Finally, the later onset and steeper increase in rates of substance use disorders across adolescence has been repeatedly demonstrated, despite different prevalence periods and assessment methods.

About 40% of affected youth in the NCS-A reported more than one class of lifetime disorder, with mood disorders being the most likely to co-occur with other classes. Non-random patterns of comorbidity between discrete classes of mental disorders have been documented extensively in prior community samples of youth. ⁻ Future analyses of these data will investigate specific concurrent and prospective comorbidity patterns as well as their sociodemographic and clinical correlates.

In addition to providing prevalence estimates, the findings also confirm observations from previous U.S. and international investigations of adolescents concerning the association of sociodemographic characteristics and mental disorders. In particular, female adolescents were more likely than males to have mood and anxiety disorders, but less likely to have behavioral and substance use disorders. Non-Hispanic Blacks were less likely to have substance use disorders compared to Whites, a finding that is similar to prior community studies of adolescents and adults. The increased prevalence of mood and substance use disorders in older adolescents has also been observed in previous investigations, thus indicating the importance of prevention strategies for early and mid-adolescence. By contrast, the stability of certain anxiety and behavioral disorders across this same developmental period suggests that earlier interventions before puberty may be appropriate for many of these conditions.

The strong links between adolescent mental disorders and parental characteristics indicate the importance of the family context in the development of mental disorders. Our finding of a prominent effect of parental education on mental disorders has been well-documented for both child physical and mental health outcomes., Divorce was often associated with mental disorders in youth, particularly anxiety, behavior and substance use disorders. The mechanisms underlying the impact of non-intact homes on mental disorders in youth, including both biologic or genetic vulnerability, and indirect influences on disruptions in the home environment, warrant further study., , However, the significant interactions observed among several sociodemographic characteristics attest to the complexity of these associations. For example, increased rates of substance use disorders among Hispanic adolescents whose parents were divorced may reflect interactions of individual, familial and broader environmental influences that should be considered simultaneously in modeling the nature of risk and resilience in adolescent mental disorders., The lack of strong effects for some sociodemographic characteristics, such as poverty, may also be attributable to the multivariate statistical approach that adjusted for confounded variables.

The present findings should be interpreted in the context of several study-specific limitations. First, the cross-sectional nature of the survey limits our ability to document temporal ordering of mental disorders and putative risk and protective factors. Second, assessment of lifetime disorders is based on retrospective recall that is subject to numerous types of bias. Although we employed a number of methods to increase the validity of retrospective reports of age of onset, it is unlikely that we were able to completely correct for recall biases. A third limitation is that surrogate information was obtained only from one parent using a self-administered questionnaire rather than a direct interview, and only for a limited number of disorders assessed in the survey. The lack of prior evidence for integrating parent and child reports based on different modes of administration led us to apply an empirical approach based on previous research on cross-informant diagnostic estimates. In addition to study-specific limitations, a critical view is warranted concerning current diagnostic nomenclature more generally. Adolescence is a period of change and maturation in which emotional and behavioral difficulties may be common, and it is difficult to establish universally acceptable definitions of disorder or severity thresholds. The high comorbidity across classes of disorders also raises questions regarding the permeability of diagnostic categories and the plasticity of adolescent development. The pertinence of current and alternative developmentally-appropriate diagnostic criteria for adolescent mental disorders deserves careful attention and would benefit from continued debate.

Despite these limitations, our findings document the high prevalence of mental disorders in youth, and specify that just over one in four-to-five adolescents in the general population suffers from disorders that result in severe impairment. Considered with recent estimates indicating that the annual economic burden of mental disorders on the well-being of American youth and their families approaches a quarter of one trillion dollars, these findings underscore the key public health importance of mental health in American youth. The present data can inform and guide the development of priorities for future research and health policy by providing previously lacking prevalence estimates in a nationally representative sample of U.S. adolescents, as well as the individual, familial and environmental correlates of mental disorders. Prospective research is now needed to understand the risk factors for mental disorder onset in adolescence, as well as the predictors of the continuity of these disorders into adulthood.

Acknowledgments

The National Comorbidity Survey Adolescent Supplement (NCS-A) and the larger program of related NCS surveys are supported by the National Institute of Mental Health (U01-MH60220) and the National Institute of Drug Abuse (R01 DA016558) with supplemental support from Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust. The NCS-A was carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative.

This work was supported by the Intramural Research Program of the National Institute of Mental Health. The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or U.S. Government.

Footnotes

Disclosure: Drs. Merikangas, Burstein, Avenevoli, Benjet, Georgiades, and Swendsen, and Ms. He, Ms. Swanson, and Ms. Cui report no biomedical financial interests or potential conflicts of interest.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Contributor Information

Dr. Kathleen Ries Merikangas, Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health.

Ms. Jian-ping He, Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health.

Dr. Marcy Burstein, Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health.

Ms. Sonja A. Swanson, Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health.

Dr. Shelli Avenevoli, Division of Developmental Translational Research, National Institute of Mental Health.

Ms. Lihong Cui, Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health.

Dr. Corina Benjet, National Institute of Psychiatry Ramón de la Fuente, Mexico.

Dr. Katholiki Georgiades, McMaster University.

Dr. Joel Swendsen, National Scientific Research Center (CNRS), Bordeaux, France.

References

1. Costello E, Mustillo S, Keeler G, Angold A. Prevalence of psychiatric disorders in childhood and adolescence. In: Levin B, Petrila J, hennessy K, editors. Mental Health Services: A Public Health Perspective. Oxford: 2004. pp. 111-128. [ Google Scholar]

12. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: Substance Abuse and Mental Health Services Administration: Center for Mental Health Services; 1999. [ Google Scholar]

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Lifetime Prevalence of Mental Disorders in US Adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A)

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Dr. Kathleen Ries Merikangas, Ph.D, Ms. Jian-ping He, M.Sc., Dr. Marcy Burstein, Ph.D., Ms. Sonja A. Swanson, Sc.M., Dr. Shelli Avenevoli, Ph.D., Ms. Lihong Cui, M.Sc., Dr. Corina Benjet, Ph.D., Dr. Katholiki Georgiades, Ph.D., and Dr. Joel Swendsen, Ph.D.

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How to help a child with an anxiety disorder - The New Yok Times

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How to help a child with an anxiety disorder - The New Yok Times

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety.

Credit... Getty Images

By

Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York. Anxiety may be missed because it doesn't necessarily declare itself with attention-getting disruptive behaviors; in fact, symptoms may keep some children quiet and inhibited, though in other children, alternatively, anxiety may be misunderstood as oppositional behavior.

Adults may also assume that anxiety in a child is just a phase to be outgrown. A certain amount of anxiety is a normal aspect of development for young children - consider separation anxiety, for example - and it can even be protective, since children need to learn to keep themselves safe and anticipate certain kinds of dangers. But when worrying or avoiding possible threats gets in the way of a child's functioning or a child's enjoyment, it should be a signal to parents that help is needed, not just watching and waiting, not arranging the child's life to avoid the occasions of anxiety.

Kathleen Merikangas, the senior investigator and chief of the Genetic Epidemiology Research Branch at the National Institute of Mental Health, said, "To me, anxiety is one of the most underrecognized or under-treated conditions of childhood and adolescence." These children can get missed, she said, because they may seem to be functioning well; many don't have the kinds of developmental problems or attention issues that draw attention in school, though they may be suffering.

Consider the child whose anxiety about speaking in public gets in the way of participating in class. The child may be silent out of a fear of being laughed at or otherwise rejected, Dr. Merikangas said, but to the teacher, it may look like the child is just not interested. Environmental modifications can really help these children thrive in school, she said; for example, working in small groups with children they know.

The new report, released in September, summarizes the evidence that early temperament in children predicts their later behavior patterns around anxiety; toddlers who show what are called "behaviorally inhibited" behaviors, which parents are likely to perceive as extreme shyness, or anxiety around new people, are more likely to develop social anxiety later on. That doesn't mean that shyness is pathological (as with all varieties of temperament, there's a wide range of function), but it does suggest how important it is to help a child with this temperament who develops difficulties.

The tendency toward anxiety - and toward some specific forms of anxiety, like phobias - may persist throughout childhood and adolescence and into adulthood. And anxiety is closely tied to depression, Dr. Merikangas said. Although there have been reports that anxiety rates among American teenagers have soared, she cited evidence that the international rates of the underlying disorders had stayed consistent from 1998 to 2013; there is no global "epidemic" of clinical anxiety disorders, she said.

But with rates of suicide and suicidal ideation on the rise, it's particularly important to provide information to schools and to parents about recognizing anxiety and getting children help.

Dr. Harold Koplewicz, the president of the Child Mind Institute, said that when anxiety disorders in children are left untreated, anxiety can inhibit their lives, making standard daily activities difficult, from attending school to sleeping in their own beds, and lead to many extra visits to the school nurse or the pediatrician.

But beyond that, he said, "people underestimate that this is a gateway disorder." If children don't get help with these disorders, they may be at risk to develop other mental health problems; the child with severe separation anxiety may develop panic disorder, he said; the child with untreated general anxiety may be at greater risk for depression.

Dr. Merikangas was a co-investigator on a national study of mental disorders in adolescents, which has shown both that anxiety disorders were the most common mental health problems in adolescents in the United States, and also the problems that showed up earliest in those children's lives - the mean age of onset for anxiety disorders was 6. But many adolescents had never received treatment. That makes it essential to get the word out, Dr. Merikangas said, that anxiety is "one of the most treatable symptoms and syndromes, we can really change their lives with minimal intervention."

"All these disorders are remarkably treatable," Dr. Koplewicz said. There are highly effective behavioral and psychosocial therapies, including cognitive behavioral therapies, to help children cope with the demands of daily life. For children who don't respond to psychosocial therapies, he said, medications can be added.

But perhaps because anxiety is a normal response, parents often believe that even severe and disabling anxiety symptoms are just a phase, and on average, there is a two-year lag between the time children develop anxiety and the time they get help. "It's bad for these children's brains," he said. "Having your brain's thermostat miss-set is not good for your brain."

"Anxiety can manifest itself along a continuum," said Rachel Busman, the senior director of the anxiety disorders center at the Child Mind Institute. The report shows that there is some overlap with physical illnesses, such as chronic headaches or stomach aches, often coordinated with school. "That could be a kid's way of saying, 'I'm anxious,'" she said.

And when a child who is having a lot of difficulty with separation gets into the classroom, Dr. Busman said, that child may start throwing things, or running and hiding, and that "bad behavior" may represent the fight or flight response of anxiety. "We've also seen kids who have intense social anxiety and their way of managing it is to be class clown," she said.

Treating children with anxiety always means working with their parents. Jerry Bubrick, senior clinical psychologist at the anxiety disorders center of the Child Mind Institute, said that when children are little, it's normal for parents to operate in "fix-it mode," blocking the staircase so a toddler doesn't tumble down, averting problems before they happen.

As children get older, parents normally pull back, helping children find solutions of their own. "But anxious parents of anxious children remain in fix-it mode," he said, helping their children avoid the situations that make them anxious. Therapy involves exposing children to those situations and helping them develop strategies to manage them; with treatment, Dr. Bubrick said, parents can "let the child experience the anxiety and learn to tolerate and overcome it on their own."

"If you see things you're not sure about, talk to the preschool, talk to the pediatrician, be open to the idea that maybe there is anxiety," even in a young child, Dr. Busman said. Separation anxiety can be a problem even in children who are able to go to school, she said. Parents should pay attention if a child can't be left with a babysitter, a child can't sleep alone at home."These are the kids, they go into the bathroom, and they're like, are you still there?" she said. "We do see really young anxious children."

"If your child is suffering distress and dysfunction, reach out to your pediatrician," Dr. Koplewicz said. When you get to a mental health professional, "make sure you ask the right questions," he said, including asking whether that person has specific experience with treating anxiety and how long the treatment is expected to take.

"You want a professional who understands what they're doing and can explain to you what they're doing."

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How to Help a Child With an Anxiety Disorder

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety. By Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York.

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Inside Higher Ed | Higher Education News, Events and Jobs

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More than half of the college students who visited their campus counseling centers during the 2015-16 academic year reported symptoms of anxiety, according to a survey by the Association for University and College Counseling Center Directors.

This marks the seventh year in a row that anxiety has been the top complaint among students seeking mental health services. This year, 51 percent of students who visited a counseling center reported having anxiety, followed by depression (41 percent), relationship concerns (34 percent) and suicidal ideation (20.5 percent). Many students reported experiencing multiple conditions at once.

Since 2009, when anxiety overtook depression as the No. 1 concern among college students, the number of students experiencing anxiety has steadily increased.

This survey was conducted between September 2015 and August 2016. In total, 529 counseling center directors representing that many institutions responded to the survey, with an even split between public and private institutions. The majority of respondents came from four-year colleges, but community colleges, professional schools and art schools were also included.

In an effort to reflect the makeup of their student bodies, counseling centers have diversified their clinical staff members. Of new hires, 62.2 percent are white, 15.3 percent black, 7.5 percent Latino and 10 percent Asian. This compares to current clinical staff, who are 70.9 percent white, 10.1 percent black, 7.3 percent Latino and 7.9 percent Asian.

"Student populations have become more diverse," said Micky Sharma, president of the AUCCCD and director of counseling and consultation services at Ohio State University. "Counseling services work to create a staff that represents their student bodies."

At Ohio State, for example, the counseling center now offers clinical services in nine different languages to meet the needs of their international students, who make up about 12 percent of the student body, Sharma said.

Regardless of race, ethnicity, gender or sexual orientation, "anyone could show up with anxiety or depression or a relationship issue," Sharma said. "A university counseling center is charged with providing help for everybody."

Another key finding in the survey is that 41.6 percent of counseling centers hired additional staff members in the last academic year, compared to about 26 percent in 2011 and 36 percent in 2016.

College counseling centers continue to grow to match the demands of their students, according to David Reetz, the lead researcher and coordinator for the 2016 survey and director of counseling and psychological services at the Rochester Institute of Technology.

"More students are seeking services because we continue to be more and more aware that a student's health and well-being have a lot to do with their success in their academic programs and the quality of their student life experience," Reetz said.

In fact, of the students surveyed, about 72 percent who used counseling services said it helped their academic performance in some way.

As more students continue to seek out mental health services and campus counseling centers try to keep up with new hires, the question of student wait times becomes key.

For the first time, this year's survey asked counseling center directors about average wait times for students based on the number of business days between when the appointment was scheduled and when it occurred.

The survey team found that, on average, students waited between six and eight business days for counseling services. However, as might be expected, institutions with a lower ratio of professional staff to students saw shorter wait times.

Reetz noted that the wait-time average is a "tricky number," given that some students opt to schedule their first appointment farther out to accommodate their own schedules.

"Students don't necessarily want to be seen right away," Reetz said, adding that, generally, "the more staff a center has, the shorter that wait time is between initial contact and first appointment."

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Anxiety and depression are the primary concerns for students seeking counseling services

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Survey of campus counseling centers finds increased demand for services, as well as additional positions and more diversity in hiring.

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Risk Factors for Anxiety Disorder - Journal Article from Acta Medica Transilvanica

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Risk Factors for Anxiety Disorder - Journal Article from Acta Medica Transilvanica

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Risk Factors for Anxiety Disroders in Children

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Anxiety is a normal reaction to stress - your mind and body's natural response to events that are threatening. A certain amount of worry and anxiety is normal for everyone - in fact, it can help you focus on an upcoming deadline or presentation, or cope with a tense situation. But when anxiety is severe, symptoms continue for several weeks, and it leads to an excessive, irrational dread of everyday situations that interferes with normal activities, it crosses the line to crippling disorder.

Anxiety disorders are serious illnesses of the brain. When they are not treated, anxiety disorders can negatively affect a person's personal relationships or ability to work or study. In the most severe cases, they can make even regular and daily activities such as shopping, cooking or going outside incredibly difficult. Further, anxiety disorders can lead to low self-esteem, substance abuse, and isolation from one's friends and family.

People with anxiety disorders perceive more threats, which sends their bodies' natural "fight or flight" mechanism into overdrive. This response can prompt a genuine physical reaction to everyday people, places or things. They believe danger lurks around every corner, and that something terrible will happen if certain things aren't done a certain way. This leaves them in a constant state of feeling keyed-up and on edge.

Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders last at least six months and can get worse if they are not treated. Anxiety symptoms are real and nothing to be ashamed of. What's more, they can be treated effectively.

Signs and Symptoms

Individuals who suffer from anxiety disorders frequently experience severe symptoms that make them feel extremely uncomfortable, helpless and out-of-control. Symptoms include:

Constant worry

Fear or confusion

Thoughts that don't go away

Avoidance of people, places or things

Muscle tension

Physical weakness

Poor memory

Sweating

Trembling

Restlessness, inability to relax

Difficulty concentrating

Shortness of breath

Lightheadedness

Rapid or irregular heartbeat

Upset stomach

Aches and pains

There are three major types of anxiety disorders: Generalized Anxiety Disorder (GAD) Panic Disorder Social Anxiety Disorder / Social Phobia
Each anxiety disorder has different symptoms, but they all revolve around excessive, irrational fear and dread. Other recognized anxiety disorders include separation anxiety, specific phobias, and substance/medication-induced anxiety disorder.

How Common are Anxiety Disorders? Approximately 40 million American adults - about 18 percent of the population age 18 and older - are affected by anxiety disorders in a given year. Anxiety disorders also affect one in eight children. Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse.

Diagnosis

An anxiety disorder may be diagnosed if a person has an inappropriate response to a situation, cannot control their response, and the anxiety inhibits their ability to function for more than six months. As with all types of illness, a physician must be seen to provide a proper diagnosis. After ruling out other illnesses, the doctor may recommend seeing a mental health professional, such as a psychiatrist.

Treatment

Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help people with anxiety disorders lead productive, fulfilling lives. In general, individuals are treated with medication, specific types of psychotherapy or a combination of the two. Some people may respond to treatment after a few weeks or months, while others may need more than a year. Treatment may be complicated if people have more than one anxiety disorder or if they suffer from other co-existing conditions. This is why treatment must be tailored specifically for each individual.

Co-occurring Conditions

Anxiety disorders commonly occur along with other mental or physical illnesses, including depression and alcohol or substance abuse. Even though some drugs make people feel less anxious when they are high, anxiety becomes even worse when the drugs wear off. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder.
Find help for anxiety now
National Institute of Mental Health

National Alliance on Mental Illness

The Kim Foundation

Anxiety Disorders Association of America
Helpful links: http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml http://www.nimh.nih.gov/health/publications/anxiety-disorders-listing.shtml http://www.nami.org/Template.cfm?Section=By_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=142543 http://www.nami.org/factsheets/anxietydisorders_factsheet.pdf http://www.psychologytoday.com/basics/anxiety http://psychcentral.com/disorders/anxiety/ http://www.adaa.org/living-with-anxiety http://www.adaa.org/living-with-anxiety/children
Anxiety Disorders Association of America - http://www.adaa.org/

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (GAD) is characterized by persistent, excessive and unrealistic worry about everyday things. People with the disorder experience chronic, exaggerated worry and tension. They often expect the worst, even when there is no apparent reason for concern. They anticipate disaster and are overly concerned about money, health, family, work or other issues. Other times, the source of the worry is hard to pinpoint.

Sometimes just the thought of getting through the day triggers anxiety. Individuals affected don't know how to stop the worry cycle and feel it is beyond their control, even though they usually realize that their anxiety is more intense than the situation warrants - that it's irrational. Yet the anxiety is frequently sufficient to also cause fatigue, headaches, nausea and other physical symptoms.

In contrast to those with other anxiety disorders, people with GAD don't typically avoid certain situations as a result of their disorder. When their anxiety level is mild, they can function in social settings and the workforce. However, if severe, GAD can be debilitating, making even the most routine daily activities seem overwhelming.

How Common is Generalized Anxiety Disorder?

GAD affects 6.8 million adults, or 3.1% of the U.S. population, in any given year. The disorder comes on gradually and can begin anytime within the life cycle. Most often, it appears in childhood or adolescence, but can begin in adulthood, too. According to the Anxiety and Depression Association of America, women are twice as likely to be affected. In addition, GAD often occurs in the relatives of affected individuals. Evidence suggests that biological factors, family background and life experiences, particularly stressful ones, all play a role.

Signs and Symptoms

People with generalized anxiety disorder are consumed with worry every day, potentially all day. This disrupts social activities and interferes with work, school or family. What's more, they seem irritable, on-edge and unable to relax. They frequently have trouble falling or staying asleep, so they're tired all the time. They have a hard time concentrating - or their mind goes blank.

The emotional pain is compounded by physical symptoms, notably trembling, twitching, headaches, muscle tension or unexplained pains. Those afflicted with GAD are prone to sweating or hot flashes, upset stomachs and frequent trips to the bathroom. They may feel lightheaded or out-of-breath, or as though they have a lump in their throat. Many individuals with GAD even startle more easily than other people.

Treatment

Like other anxiety disorders, GAD is treatable. Cognitive-behavioral therapy is effective for many people, helping them to identify, understand and modify faulty thinking and behavior patterns. This enables people with GAD learn to control their worry. They may also take medication. Anti-anxiety medications and antidepressants are commonly prescribed to treat GAD. In addition, a GAD treatment plan may incorporate relaxation techniques, meditation, yoga, exercise and other alternative treatments

Co-occurring Conditions

Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone; co-occurring conditions must also be treated with appropriate therapies.
Get Help With Generalized Anxiety Disorder Now Helpful links: http://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml http://psychcentral.com/disorders/generalized-anxiety-disorder-symptoms/
Panic Disorder

Characterized by "panic attacks," panic disorder results in sudden feelings of terror that can strike anytime, anywhere, repeatedly and often without warning - even while asleep. While most attacks average a couple of minutes, occasionally they can go on for up to 10 minutes. In rare cases, they may last an hour or more. These episodes of intense fear are accompanied by physical symptoms such as chest pain, heart palpitations, breathlessness, dizziness or intestinal distress. Panic disorder drives more people to seek medical attention than any other anxiety disorder.

Some people with this disorder experience unrealistic worry and live in fear of having more panic attacks. They become very ashamed and self-conscious, and avoid places where they have previously had an attack. They may be unable to work, drive, go to school, shop for groceries, see friends, or conduct activities of daily living. Approximately one-third of individuals who suffer from panic disorder become so consumed with fear that they cannot leave their homes or other safe surroundings, a condition known as agoraphobia. The good news is that early treatment of panic disorder can often stop the progression to agoraphobia. In fact, most people with panic disorder get better with treatment.

How Common is Panic Disorder?

Panic disorder strikes between 3 and 6 million Americans, and is twice as common in women as in men. It can appear at any age - in children or in the elderly - but most often it begins in young adults. Sometimes it starts when a person is under a lot of stress. Not everyone who experiences panic attacks will develop panic disorder; many people have a single panic attack but never have another. For those who do have panic disorder, though, it's important to seek treatment. Untreated, the disorder can become very disabling.

Signs and Symptoms

Panic attacks are characterized by the following symptoms:

A racing or pounding heart, or palpitations

Chest pain or discomfort

Trembling or shaking

Shortness of breath or a sensation of being smothered

A choking feeling

Chills, hot flashes or sweating

Nausea or abdominal distress

Feeling faint, unsteady or woozy

Numbness or a tingling sensation

A sense of being detached from oneself or unreality

Fears of losing control or impending doom

Fear of dying

Diagnosis

Panic disorder may be diagnosed in people who experience panic attacks, fixate on the fear of having another attack, and who significantly change their behavior as a result. Not surprisingly, the symptoms of panic disorder, such as elevated heart rate, feeling faint, shortness of breath, and sweating, are often mistaken for signs of a heart attack or other life-threatening medical conditions. Therefore, someone with panic disorder may not be diagnosed until medical tests are conducted to rule out other serious illnesses.

Co-occurring Conditions

Panic disorder is often accompanied by other conditions such as depression or substance abuse. Individuals with panic disorder may self-medicate with drugs or alcohol in hopes of coping with or preventing symptoms. The disorder can also trigger phobias - such as fears of places or situations where panic attacks have occurred. If a panic attack struck while someone was on an airplane, he or she may develop a flying phobia.

Treatment

Typically, panic disorder is treated with medication, psychotherapy or a combination of the two. Cognitive-behavioral therapy (CBT) has proven particularly useful for treating panic disorder. It teaches patients to see their panic attacks in a different way and shows them how to reduce their anxiety. Most patients show significant progress after just a few weeks of therapy. Relapses may occur, but they can be treated effectively.

Physicians may also prescribe medication to help relieve symptoms. Anti-anxiety medications and antidepressants are most commonly prescribed for panic disorder.
Find help for panic disorder now Helpful links http://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms/index.shtml http://www.psychologytoday.com/conditions/panic-disorder?tab=Treatments
Social Anxiety Disorder (Social Phobia)

Social Anxiety Disorder (also known as social phobia) is a strong fear of being judged by others and of being embarrassed. This fear can be so strong that it gets in the way of work, school or doing other everyday things. People with social anxiety disorder often have an irrational fear of being humiliated in public for "saying something stupid," or "not knowing what to say."

Everyone has felt anxious or embarrassed at one time or another. Meeting new people or giving a public speech can make anyone nervous. But people with social anxiety disorder worry about these and other things for weeks before they happen.

Those affected are afraid of doing common things in front of other people. For example, they might be afraid to sign a check in front of a cashier at the grocery store; eat or drink in front of other people; or use a public restroom. Most of these individuals know that their fear is excessive, but they can't control it. So they avoid going to places or events where they think they might have to do something that will embarrass them.

For some, social anxiety is a problem only in specific situations. For example, they may be extremely fearful of talking to a salesperson or speaking in public. Others can have symptoms in almost any social setting, and around anyone except their own family. They can literally feel sick from fear where most people see no threat. Children with social anxiety are prone to clinging behavior, tantrums and even mutism.

How Common is Social Anxiety Disorder?

Social phobia affects about 15 million American adults. Women and men are equally likely to develop the disorder, which usually begins in childhood or early adolescence.

Signs and Symptoms

People with social phobia tend to:

Be very anxious about being with other people and have a hard time talking to them, even though they wish they could

Be very self-conscious in front of other people and feel embarrassed

Be very afraid that other people will judge them

Worry for days or weeks before an event where other people will be

Stay away from places where there are other people

Have a hard time making and keeping friends

Physical symptoms of social anxiety disorder may mirror panic attacks. These can include blushing, sweating profusely, trembling, nausea or other abdominal distress, rapid heartbeat, shortness of breath, dizziness and headaches. Afflicted adults may experience feelings of detachment and loss of self-control in social situations. As a result, individuals struggling with this disorder may have few or no social or romantic relationships, making them feel powerless, alone or even ashamed.

Co-Occurring Conditions

Social phobia is often accompanied by other anxiety disorders or depression. Substance abuse may develop if people try to self-medicate their anxiety.

Treatment

Most people with a diagnosed social phobia condition require professional treatment to overcome it.

Social phobia is generally treated with psychotherapy, medication or a combination of the two. Cognitive behavior therapy (CBT) is especially useful for treating social phobia. It teaches individuals different ways of thinking, behaving and reacting to situations that help them feel less anxious and fearful. It can also help people learn and practice social skills. The most commonly prescribed medications for social phobia are anti-anxiety medications and antidepressants.
Find help for social anxiety disorder now Helpful links http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml http://www.adaa.org/understanding-anxiety/social-anxiety-disorder http://www.nami.org/Template.cfm?Section=By_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=142543

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Anxiety Disorders (General, Panic and Social)

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Anxiety is a normal reaction to stress - your mind and body's natural response to events that are threatening. A certain amount of worry and anxiety is normal for everyone - in fact, it can help you focus on an upcoming deadline or presentation, or cope with a tense situation.

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School Counselor's Role in Addressing Eating Disorders

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School Counselor's Role in Addressing Eating Disorders

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Eating Issues in Schools: Detection, Management, and Consultation with Allied Professionals

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Eating Issues in Schools: Detection, Management, and Consultation with Allied Professionals

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The National Council for Mental Wellbeing

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The National Council for Mental Wellbeing

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It Takes GRIT to Help Kids with Mental Illness

Mental illnesses and addictions affect individuals, children and families year round, and our work to address them is never ending. We invite you to join us to raise awareness of children's mental health during Children's Mental Health Awareness Week.

View & SHARE the infographic:

GET THE FACTS:

The Child Mind Institute compiled a report on the state of children's mental health across America. Its Speak Up for Kids campaign reveals that more than 17 million children have had a diagnosable mental health disorder, but most will not receive treatment.

hear from the experts:

The National Council released a new video series on GRIT featuring insight from Ben Shapiro, Dr. Harold Koplewicz, Dr. John Kane and Dr. Mary McKay.

Part 2: Resilience

Part 3: Identification

Part 4: Treatment

Review Our Webinars:

The SAMHSA-HRSA Center for Integrated Health Solutions presented "Consultation for Kids: Models of Psychiatric Consultation in Pediatric Primary Care" on May 4 to review how a busy clinician can effectively tap into psychiatric consultation to provide high quality mental health care. View the presentation online.

Learn how Youth Mental Health First Aid can help teachers, school administration, coaches and faith leaders recognize early signs of mental illness and substance use, provide support in possible crises and refer young people to professional help. View the "Using Youth Mental Health First Aid to Foster GRIT" presentation and recording online.

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Children's Mental Health - The National Council

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It Takes GRIT to Help Kids with Mental Illness Mental illnesses and addictions affect individuals, children and families year round, and our work to address them is never ending. We invite you to join us to raise awareness of children's mental health during Children's Mental Health Awareness Week.

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At a glance

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

IDEA covers 13 disability categories.

Not every student who struggles in school qualifies.

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

1. Specific learning disability (SLD)

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

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

2. Other health impairment

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

3. Autism spectrum disorder (ASD)

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

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

5. Speech or language impairment

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

6. Visual impairment, including blindness

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

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

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

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

10. Orthopedic impairment

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

11. Intellectual disability

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

12. Traumatic brain injury

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

13. Multiple disabilities

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

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

Key takeaways

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

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

"Other health impairment" can cover ADHD.

About the author

About the author

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

Reviewed by

Reviewed by

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

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The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education services to eligible students. IDEA covers 13 disability categories. Not every student who struggles in school qualifies. The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education and related services to eligible students.

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Individuals with Disabilities Education Act

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Individuals with Disabilities Education Act (IDEA)

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The U.S. Department of Education’s Individuals with Disabilities Education Act website brings together department and grantee IDEA information and resources. The IDEA makes available a free appropriate public education to and ensures special education and related services to eligible children with disabilities.

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NYC Department of Education - 504 Accommodations

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NYC Department of Education - 504 Accommodations

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Summary

Section 504 of The Rehabilitation Act requires public schools to offer services and accommodations for eligible students with disabilities. These services help students with special health needs fully take part in school.

Your child may be eligible for health services, educational accommodations, or both.

Health services are for students who need to take medicine (like insulin) or receive a special nursing treatment at school. Find out more on our Health Services page:

Educational accommodations are for students who need building, classroom or testing accommodations. For example, students with trouble hearing may need to be seated close to the blackboard. Other students may need breaks, or extra time to take tests. For these accommodations, please submit the Request for Section 504 Accommodations, Medical Review for 504 Accommodations and the HIPAA form (provided below) to your school's 504 Coordinator:

Return completed forms to your school's 504 Coordinator. Any medication or medical treatment forms will go to the school nurse/medical professional in the building. For Educational Accommodations, the 504 Coordinator will contact you to schedule a meeting within 30 days of your initial request. At the meeting, the school's 504 Team will review your request and other relevant information about your child. The 504 team will decide if your child is eligible for accommodations. They will also decide which accommodations are most appropriate.

Eligibility

Students qualify for 504 Accommodations if:

1. They have a physical or mental impairment, and do not have an IEP.

2. The impairment substantially limits at least one major life activity.

Physical or Mental Impairments

Some examples of physical or mental impairments are physical disabilities, health conditions, mental disorders, and learning disabilities.

Short term impairments (like a broken leg) may qualify a student for 504 accommodations. This depends on the type of the impairment, how long it lasts, and how severe it is.

Episodic impairments (like asthma) may qualify a student for 504 accommodations. Students are qualified if the impairment substantially limits a major life activity when it is active.

Examples of Major Life Activities:
Caring for oneself, communicating, bending, breathing, doing tasks with one's hands, eating, focusing, hearing, learning, lifting, reading, seeing, sleeping, speaking, standing, thinking, walking, working.

Does your child have an impairment that prevents him from doing any of the life activities listed above? If so, your child may qualify for accommodations under Section 504. Once the correct forms are submitted to the school, each student case is reviewed individually.

Paraprofessionals

Paraprofessionals ("paras") help students with physical and mental disabilities. Paras work with students to make sure their learning and health needs are met at school. Paras work in the classroom, under the general supervision of a certified teacher.

Can a Para Help My Child?

Paras can provide your child with extra teaching support if they have a mental disability. Some examples of qualifying disabilities are attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), dyslexia and depression.

Paras can also help your child if they have a physical or medical disability. Some examples of qualifying disabilities are asthma, diabetes, cancer, HIV/AIDs, limited eyesight and severe allergies. Under the guidance of the school nurse, a para can check for signs and symptoms of a specific disease, help students with disabilities eat and move, and help students get to the school nurse.

To Apply For a Para

Fill out the 504 Accommodations form with HIPAA Consent for Parents:

Have your child's health care provider fill out the Medical Review for 504 Accommodations:

Bring the completed form to your child's school.

The request will be reviewed by an Office of School Health physician. Your school will contact you about next steps.

Medicine at School Resources

If your child needs to take medicine at school, make sure to also bring a completed Medication Administration Form to your school. Learn more about how to apply for medicine at school on our Health Services page:

Questions?

Please reach out to the 504 Coordinator and Health Director for your child's school.

Testing and Classroom Accommodations

Classroom accommodations are changes to the classroom setting so that students with disabilities may fully participate in school. For example, students with trouble hearing or seeing might be seated close to the blackboard. Other students may need to use the school elevator, assistive technology devices or special furniture. Some students may receive extra breaks, or longer time for activities.

What are Testing Accommodations?

Testing accommodations are changes to the way tests are given, or to testing format. Some students with disabilities may need these changes to be able to show their understanding of class material. The testing changes are to prevent students' test results from being affected by their disabilities. Testing accommodations do not change the skills or content that tests measure.

Method of Presentation
Examples: Test directions or questions may be read, repeated and explained by school staff. Tests may be also be given in braille.

Method of Response
Examples: Students may use assistive technology devices. Students may write answers directly in answer booklets, or type their answers using a computer.

Test Timing
Examples: Students may receive breaks or have more time to take tests.

Test Setting
Examples: Students may take tests in separate locations, in a small group, or with special lighting or furniture.

There are four types of testing accommodations. They are:

How do I apply for Testing and Classroom Accommodations?

Follow these steps if your child has a disability but does not already have an individualized education plan (IEP).

Fill out the 504 Accommodations form with HIPAA Consent for Parents.

Have your child's health care provider fill out the Medical Review for 504 Accommodations.

Bring the completed forms to your child's school.

Your school will contact you with the results of the review.

Transportation Accommodation

Your child may be eligible for student transportation to and from school by yellow bus or Metro Card. Your child may be eligible if they are within a certain age range, and a distance range from the school. Check the Office of Pupil Transportation to see if your child is eligible for a yellow bus or Metro Card.

If your child does not meet the age and distance ranges for general education transportation, but has a medical condition where they require transportation, you may apply for a transportation accommodation.

If your child is approved for a transportation accommodation, they will get a bus ride to school even if they do not meet the general education age and distance requirements.

How to apply for a Transportation Accommodation:

Learn how to apply for a transportation accommodation on the Office of Pupil Transportation website. Bring completed forms to your child's school.

Questions?

Please contact your school's 504 Coordinator.

Home Instruction

Home instruction students receive one-on-one instruction at home from a licensed teacher.

Students in grades K - 6 receive 5 weekly hours of instruction.

Students in grades 7 - 12 receive 10 weekly hours of instruction.

Your school will provide your home instruction curriculum.

Home instruction is an interim program that does not grant diplomas.

An adult chaperone must be present during home instruction lessons.

Home instruction is a program to prevent students from falling behind in classes during a long-term absence. If your child will be out of school for at least 4 weeks because of a serious emotional or medical condition, your child may be eligible for home instruction. If you are a student who is a parent, you may be eligible for home instruction if your child has a medical condition and cannot attend day care or the LYFE Program (Living for the Young Family through Education).

How to apply for Home Instruction:

Notify your school's guidance counselor and school of your child's situation. Go to the Home Instruction website to learn how to apply.

Questions?

Next Steps and Review Process

Educational Accommodations Meeting

Your child's application will be reviewed at a 504 meeting. The 504 meeting is attended by people who know your child's abilities. They understand the information that is being reviewed and know the types of accommodations that may meet your child's needs. Parents are always invited to take part in the meeting.

Talk about your child's abilities and skills. (Your child's teacher or guidance counselor may attend.)

Interpret reports or evaluations. (The school social worker or nurse may attend.)

Share information about the accommodations that may meet your child's needs. (The 504 Coordinator may attend.)

The 504 meeting must include at least two people who can:

What Information is Reviewed at the Meeting?

The 504 team will review information that describes your child's abilities and needs. The information will come from a few different sources. The team may review your child's tests, observations, work samples, report cards, and medical records. This will help the team understand your child's abilities, achievement, behaviors, and health needs. Parents and school staff may bring any information they believe best describes the child's abilities and needs.

Diagnosis and Suggestions from Your Child's Doctor

Your child's doctor must complete the Medical Review for 504 Accommodations. The doctor may suggest that the school provide certain accommodations. The 504 Team will decide if the suggested accommodations are appropriate, and how to provide them at school.

How is Eligibility Determined?

The 504 Team will consider if your child's impairment substantially limits a major life activity. They will make this decision based on information reviewed at the meeting. The 504 Team will consider if your child's impairment has a significant impact on your child's performance or participation in school.

Can my child get Related Services with a 504 Plan?

No. Your child can not get related services through a 504 plan. Examples of related services are physical therapy, speech therapy, and counseling services. If your child appears to need any of these services, the 504 Team will refer your child to the school or district Committee on Special Education.

504 Plans and Medical Accommodations

Example 1: a student with diabetes checks his insulin levels two times per day in the nurse's office. He does not need any other supports or accommodations.
This student does not need a 504 Plan.

Example 2: a student with diabetes needs to take insulin at certain times during the school day. This overlaps with class time, so she sometimes needs to do make-up work. She also needs to take bathroom breaks, and have access to snacks.
This student does need 504 Plan.

Not all students who need health services at school need a 504 Plan. If your child's health service does not affect his ability to fully take part in school, then he does not need a 504 plan.

Yearly Review of Accommodations

504 Plans must be renewed each year by the 504 Team. This typically occurs at the end of each school year. During the yearly renewal, your child's 504 Plan may be changed as needed.

If your child's impairment continues to substantially limit your child's participation in school, your child will remain eligible for accommodations. If it is decided that your child's impairment no longer substantially limits his or her ability in a major life activity, your child is no longer eligible for accommodations (the 504 Plan is ended).

Parent Communications

Schools will communicate with you about NYC DOE Section 504 policies. All schools post and share the Notice of Non-Discrimination under Section 504

If you are approved for a 504 plan, you will also receive:

A Notice of Eligibility and 504 Plan. The 504 plan will tell you which accommodations your school recommends for your child. You will have ten days to review and agree to the 504 plan. If you do not agree with your school's decision, talk to your school's Field Support Center Health Director. Contact information will be provided by the school.

An Annual Notice of Reauthorization. This letter will tell you the steps that you must take to have your child's 504 plan renewed for the next school year.

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Section 504 of The Rehabilitation Act requires public schools to offer services and accommodations for eligible students with disabilities. These services help students with special health needs fully take part in school. Your child may be eligible for health services, educational accommodations, or both.

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Students with Disabilities & Section 504 of the Rehabilitation Act of 1973

Section 504 of the Rehabilitation Act of 1973 (commonly referred to as Section 504) is a federal law designed to protect the rights of individuals with disabilities in programs and activities that receive federal financial assistance. Those programs include public school districts, institutions of higher education, and other state and local education agencies. To qualify under Section 504, a student must have a disability and that disability must limit a major life function. The Americans with Disabilities Act Amendments of 2008 (ADA) broadened the definition of disability in the ADA as well as in Section 504.

How does Section 504 define disability and major life functions?

Under Section 504, disability is defined broadly. A student is determined to have a disability if he or she has a physical or mental impairment affecting a body system.

This impairment or disability must substantially limit one or more major life activities. These activities include such things as walking, seeing, hearing, speaking, breathing, learning, working, caring for oneself, performing manual tasks, eating, sleeping, standing, lifting, bending, reading, concentrating, thinking, communicating, and more.

When determining whether a student has a physical or mental impairment, the school district must not consider the improvement of a disability caused by a "mitigating measure" such as medication, hearing aids, prosthetics, mobility devices, or other means. The language on mitigating measures was added in the ADA Amendments Act of 2008.

Does Section 504 require schools to do evaluations?

Yes. The school must conduct an evaluation to determine if the student has a disability as defined under this act. Based on documented information from varied sources, decisions must be made by a group of school personnel who are knowledgeable about the child, the meaning of the data, and the placement options.

Section 504 Flow Chart

How does a school determine if a child is eligible for services either under IDEA, the Individuals with Disabilities Education Act, or under Section 504? The adapted Minnesota Department of Education chart below gives you an idea of how the two processes work.

Does the disability substantially limit one or more major life activities? Under Section 504, disability is defined broadly. A student is determined to have a disability if he or she has a physical or mental impairment affecting a body system. The Code of Federal Regulations (CFR) defines a physical or mental impairment as "any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive; digestive; genitourinary; hemic and lymphatic; skin; and endocrine; or any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities."

This impairment or disability must substantially limit one or more major life activities. These activities include such things as walking, seeing, hearing, speaking, breathing, learning, working, caring for oneself, performing manual tasks, eating, sleeping, standing, lifting, bending, reading, concentrating, thinking, communicating, and more. The legislation also states that the school district must not consider the improvement caused by a "mitigating measure" such as medication, hearing aids, prosthetics, mobility devices, or other means when determining whether a student has a physical or mental impairment.

Determine an education plan comparable to that provided to non-disabled students: School districts are required to provide students with disabilities appropriate educational services designed to meet the individual needs of students as adequately as the needs of students without disabilities are met.

Accommodations: When a child is determined to be eligible for services under Section 504, the school must eliminate barriers to his or her access to full participation in school activities, including the general education curriculum. Barriers often are eliminated by providing accommodations to the student. Accommodations must give the child meaningful equal opportunities, consider his or her functional limitations, and offer different ways to show what he or she knows. Examples of accommodations include testing in a quiet room, preferential seating, digital textbooks, tailored homework assignments, or a sign language interpreter for a track meet.

What happens if my child is eligible?

Section 504 requires a school district to provide a free appropriate public education (FAPE) to each eligible student in its jurisdiction, regardless of the nature or severity of the disability. Under Section 504, an appropriate education for a student with a disability could consist of education in a regular classroom, education in a regular classroom with supplementary services, or special education and related services. A child who has a disability but does not qualify for special education services under the Individuals with Disabilities Education Act (IDEA) may still be entitled to services or accommodations under Section 504.

The school must provide a plan for providing reasonable accommodations and other services so a child may participate fully in the school setting. Parents are usually invited to a meeting where the plan is developed. Putting the plan in writing is an effective way to document what services the school will be providing.

What are accommodations under Section 504?

When the school determines that a child is eligible for services under Section 504, the school must eliminate barriers to his or her access to full participation in school activities, including the general education curriculum. The school can often eliminate barriers by providing accommodations for a student. Accommodations must give the child meaningful equal opportunities, consider his or her functional limitations, and offer alternative methods of performance. Examples of accommodations include testing in a quiet room, preferential seating, digital textbooks, tailored homework assignments, and a sign language interpreter for a track meet.

What responsibilities do schools have under Section 504?

To provide assurance that they do not discriminate, schools must designate an employee to ensure compliance, provide grievance procedures, identify and locate all children with disabilities who receive education within the district, and provide notice of the district's Section 504 responsibilities and procedural safeguards to parents.

The district also must give parents a copy of procedural safeguards within the school district. Procedural safeguards include the parents' right to:

receive notice of action regarding identification, evaluation, and placement of their child with a disability

review records

request an impartial hearing

have a review procedure

Did you find this helpful?

Learn more

To learn more about this subject or to request a Section 504 evaluation, parents are encouraged to call their school district's Section 504 coordinator. Parents may also request a copy of the district's 504 policy including grievance procedures if they do not agree with the district's implementation of Section 504.

What if there appears to be a violation of Section 504?

Section 504 complaints in Minnesota are investigated by:

Office for Civil Rights/Chicago
U.S. Department of Education
Citigroup Center, Suite 1475
500 W. Madison St.
Chicago, IL 60661-4544

Phone: 312-730-1560

TDD: 312-730-1609 or 1-877-521-2172

Fax: 312-730-1576

Email: [email protected]

Additional Resource - Print Version

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Section 504 of the Rehabilitation Act of 1973 - PACER Center

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Section 504 of the Rehabilitation Act of 1973 (commonly referred to as Section 504) is a federal law designed to protect the rights of individuals with disabilities in programs and activities that receive federal financial assistance. Those programs include public school districts, institutions of higher education, and other state and local education agencies.

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Basic Description

A blueprint or plan for a child's special education experience at school.

A blueprint or plan for how the school will provide support and remove barriers for a student with a disability.

What It Does

Provides individualized special education and related services to meet a child's unique needs.

Provides services and changes to the learning environment to enable students to learn alongside their peers.

As with an IEP, a 504 plan is provided at no cost to families.

These services are provided at no cost to families.

What Law Applies

The Individuals with Disabilities Education Act (IDEA)

Section 504 of the Rehabilitation Act of 1973

This is a federal civil rights law to stop discrimination against people with disabilities.

This is a federal special education law for children with disabilities.

Who's Eligible

To get an IEP, there are two requirements:

To get a 504 plan, there are two requirements:

1. A child has any disability. Section 504 covers a wide range of different struggles in school.

2. The disability must interfere with the child's ability to learn in a general education classroom.

Section 504 has a broader definition of a disability than IDEA. (It says a disability must substantially limit one or more basic life activities. This can include learning, reading, communicating, and thinking.) That's why a child who doesn't qualify for an IEP might still be able to get a 504 plan.

1. A child has one or more of the 13 disabilities listed in IDEA. The law lists specific challenges, like learning disabilities, ADHD, autism, and others.

2. The disability must affect the child's educational performance and/or ability to learn and benefit from the general education curriculum. The child must need specialized instruction to make progress in school.

Independent Educational Evaluation

Families can ask the school district to pay for an independent educational evaluation (IEE) by an outside expert. The district doesn't have to agree.

Doesn't allow families to ask for an IEE. As with an IEP evaluation, families can always pay for an outside evaluation themselves.

Families can always pay for an outside evaluation themselves, but the district may not give it much weight.

Who Creates It

There are strict legal requirements about who participates. An IEP is created by an IEP team that must include:

The rules about who's on the 504 team are less specific than they are for an IEP.

A 504 plan is created by a team of people who are familiar with the child and who understand the evaluation data and special services options. This might include:

The child's parent or caregiver

General and special education teachers

The school principal

The child's parent or caregiver

At least one of the child's general education teachers

At least one special education teacher

School psychologist or other specialist who can interpret evaluation results

A district representative with authority over special education services

With a few exceptions, the entire team must be present for IEP meetings.

What's in It

The IEP sets learning goals and describes the services the school will provide. It's a written document.

There is no standard 504 plan. Unlike an IEP, a 504 plan doesn't have to be a written document.

A 504 plan generally includes the following:

Specific accommodations, supports, or services for the child

Names of who will provide each service

Name of the person responsible for ensuring the plan is implemented

Here are some of the most important things the IEP must include:

The child's present levels of academic and functional performance-how the child is currently doing in school

Annual education goals for the child and how the school will track progress

The services the child will get-this may include special education, related, supplementary, and extended school year services

The timing of services-when they start, how often they occur, and how long they last

Any accommodations-changes to the child's learning environment

Any modifications-changes to what the child is expected to learn or know

How the child will participate in standardized tests

How the child will be included in general education classes and school activities

Notice

When the school wants to change a child's services or placement, it has to tell families in writing before the change. This is called prior written notice. Notice is also required for any IEP meetings and evaluations.

The school must notify families about an evaluation or a "significant change" in placement. Notice doesn't have to be in writing, but most schools do so anyway.

Families also have "stay put" rights to keep services in place while there's a disagreement about the IEP.

Consent

A parent or caregiver must consent in writing for the school to evaluate a child. They must also consent in writing before the school can provide the services in an IEP.

A parent or caregiver's consent is required for the school district to evaluate a child.

How Often It's Reviewed and Revised

The IEP team must review the IEP at least once a year.

The rules vary by state. Generally, a 504 plan is reviewed each year and a reevaluation is done every three years or when needed.

The child must be reevaluated every three years to determine whether services are still needed.

How to Resolve Disputes

IDEA gives families several ways to resolve disputes (usually in this order):

Section 504 gives families several options for resolving disagreements with the school:

Mediation

Alternative dispute resolution

Impartial hearing

Complaint to the Office for Civil Rights (OCR)

Lawsuit

Funding/Costs

Students receive these services at no charge.

Students receive these services at no charge.

States do not receive extra funding for students with 504 plans. But the federal government can take funding away from programs (including schools) that don't meet their legal duty to serve kids with disabilities.

IDEA funds can't be used to serve students with 504 plans.

States receive additional funding for students with IEPs.

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IEP vs. 504 Plan: What's the Difference?

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Basic Description A blueprint or plan for a child's special education experience at school. A blueprint or plan for how the school will provide support and remove barriers for a student with a disability. What It Does Provides individualized special education and related services to meet a child's unique needs.

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Definition

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

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

Prevalence

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

Characteristics

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

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

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

Impact on Learning

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

Teaching Strategies

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

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

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

Assistive Technology

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

Organizations

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

American Academy of Child and Adolescent Psychiatry

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

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

Web: www.aacap.org

Center on Positive Behavioral Interventions and Supports

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

5262 University of Oregon
Eugene, OR 97403-5262

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

Center for Disability and Development

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

Council for Exceptional Children

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

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

Federation of Families for Children's Mental Health

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

1101 King Street, Suite 420
Alexandria, VA 22314

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

National Alliance for the Mentally Ill (NAMI)

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

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

Web: www.nami.org

Mental Health America

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

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

Web: www.nmha.org

National Mental Health Information Center

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

P.O. Box 42557
Washington, DC 20015

Web: www.mentalhealth.org

References

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

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

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

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

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Each child is an individual with different social, emotional, and academic strengths and weaknesses. Therefore, their educational needs may vary from one season or school year to the next.

In the first section of our chapter, "School: A Child's World Beyond Home" we cover the legal evolution of the Individual with Disabilities Educational Act (IDEA 2004) and advise a parent how to initiate an Individual Education Plan (IEP), prepare for the IEP meeting (including rehearsal strategies), and locate educational consultants and attorneys.

But the more we talked to people in preparation for this chapter, the more we came to understand that both parents and educators were confused about the construction of an IEP for a student struggling with a bipolar disorder. A model IEP-one that specifically addresses the seasonal variations in mood, energy, attention, motivation, and behavior, as well as one that addresses the frequently co-occurring executive function deficits, needed to be developed.

Therefore, we asked special education advocate, Anne Marie Smith, M. Ed., from Agawam, Massachusetts, to construct an IEP that might provide guidelines for educating a middle school student throughout the school year.

With the hope that the following information is helpful to parents and educators alike, we excerpt the following from The Bipolar Child (pages 305-311.) Also see pages 295-303 in the book for a highly focused and very comprehensive list of accommodations, modifications, and special services that can be incorporated into an IEP.
From The Bipolar Child by Demitri Papolos, M.D. and Janice Papolos (Broadway Books, 2006). All rights reserved.

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Bipolar Children Individual Education Plan (IEP) Model

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Each child is an individual with different social, emotional, and academic strengths and weaknesses. Therefore, their educational needs may vary from one season or school year to the next.

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Not all students who have disabilities require specialized instruction. For students with disabilities who do require specialized instruction in the United States, the IDEA controls the procedural requirements and an IEP is developed. "Special education" under IDEA means the child has been identified as having unique educational needs related to his/her disability and is entitled to an Individualized Education Program (IEP) to meet these needs.

The IDEA process is more involved than that of Section 504 of the Rehabilitation Act. The IDEA requires that measurable growth and progress towards written goals and objectives be documented.

For students with disabilities who do not require specialized instruction but need the assurance that they will receive equal access to public education and services, a document is created to outline their specific accessibility requirements. Section 504 is a federal civil rights law. The purpose of Section 504 is to protect persons with disabilities against discrimination for reasons related to their disabilities.

While students with a 504 plan do not require specialized instruction, and specific goals and objectives are not necessarily outlines nor is data tracked, the plan should be reviewed annually to ensure that the student is receiving the most effective accommodations for his/her specific circumstances.

Unlike IDEA, Section 504 does not guarantee that a child with a disability will receive an individualized educational program that is designed to meet the child's individual educational needs. Rather, it guarantees that accommodations will be made relative to their specific medical needs.

Eligibility for protections under Section 504 depends on the child in question having a physical or mental impairment which must substantially limit at least one major life activity. Major life activities include walking, seeing, hearing, speaking, breathing, learning, reading, writing, performing math calculations, working, caring for oneself, and performing manual tasks. Section 504 requires an evaluation that draws information from a variety of sources.

A child who receives Section 504 protections has fewer rights than the child who receives special education services under the IDEA. The child who receives special education services under the IDEA is automatically protected under Section 504.

Section 504 is designed to guarantee that children with disabilities will not be discriminated against. It is also important to understand that if your child does not qualify for special education services under IDEA, your child does not have the procedural protections that are available under the IDEA.

Under Section 504, the child with a disability may receive accommodations and modifications that are not available to children who are not disabled. These accommodations and modifications are also available under IDEA. For example; accommodations could include, but not be limited to, such things as:

Tests taken in a separate location with time limits waived or extended.

The use of a word processor due to fine motor, visual motor deficits.

Shortened assignments.

Standardized tests answers written directly in the test booklet and transferred onto answer sheet by teacher or assistant.

Class notes provided rather than having the student copy from the chalkboard or overhead.

Allowing the child to leave the classroom 2 to 3 minutes early to avoid crowded hallways.

Preferential seating in the classroom.

Provision of a daily assignment sheet to be filled out by the student and verified by the teacher for accuracy. The parent could then check to make sure that all the work is accomplished. This would assist with homework prioritizing and management.

Please note: These are simply examples. All or none of these may be suitable for your child.

Students with bipolar disorder may or may not have a need for specialized instruction provided within an IEP. For some students, simply being granted accommodations that make allowance for the side effects of medications, related anxiety issues, or results of mood changes is sufficient.

Students with bipolar disorder who are well-controlled on medication may or may not be plagued by racing thoughts, distracting thoughts, an inability to concentrate, decreased energy; all of which will require modifications in the teaching environment or instructional strategies.

For other students, the side effects of medications may be significant enough to require changes in instruction provided or curriculum modifications. Some of the common side effects of medications include: tremors (trembling of hands), blurred vision, loss of coordination, slurred speech, sedation, ataxia (unsteady movement), dizziness, seizures. Some students with bipolar disorder may also have one of a number of other disabilities that impacts their access to the general education curriculum; such as vision or hearing impairment, learning disability, processing problems, or other disability. The co-morbidity rates of ADHD, anxiety disorder, conduct disorder, oppositional-defiant disorder and learning disabilities in students with bipolar disorder tell us that we should explore all avenues available to meet the educational needs of our children.

The following accommodations are meant to serve as a resource for parents unsure of what possibilities exist:

Students on some medications may need:

increased access to water, unlimited access to restrooms (particularly students taking Lithium)

decreased reading assignments or having books on tape or computer screen-reading due to blurred vision

modified school arrival, shortened day, scheduling of core content during the student's most alert time, reducing homework and extending deadlines, providing notes, allowing longer or more frequent breaks, allowing exercise or other movement due to sleep impairment or to sedation of medications

provision of notes and listening guides, work monitoring, extended time on assignments, extra set of books for home use, breaking assignments into more manageable pieces, use of checklists, providing written instructions and/or other visual cues, use of word banks on fill-in types of tests and other modifications that aid retrieval/memory, testing in a separate room, or extended test time, use of multiple choice formats, use of oral exams rather than written demands, use of noise-canceling headsets, - all for impaired concentration, memory

reducing or discontinuing homework may be necessary for some students due to difficulties with concentration, sleep patterns, mood irritability. For these students it may be necessary to schedule a resource room period at the beginning of the day to get assignments ready for the day, or at the end of the day to complete assignments before leaving school

preferential seating can be used to help with vision, focus, reduce visual or auditory distraction, allow for discrete monitoring

and while a 504 plan will simply list the type of accommodation needed and the reasons for it/them, an IEP must contain objectives that are written with specific criteria; such as -Given a grade level reading assignment of 1 chapter with 4 comprehension questions, (name) will answer the questions with 60/70/80% accuracy. Or given an assignment containing 5 long division problems, (name) will complete 3/4/5 problems at 80% accuracy.

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Accommodations for Students with Bipolar Disorder and Related Disabilities - International Bipolar Foundation

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Error! You must specify a value for the Video ID, Width, Height and Anchor parameters to use this shortcode! Not all students who have disabilities require specialized instruction. For students with disabilities who do require specialized instruction in the United States, the IDEA controls the procedural requirements and an IEP is developed.

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JBRF - Juvenile Bipolar Research Foundation

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JBRF - Juvenile Bipolar Research Foundation

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The Clinician's Pathway Program (CPP) and its assessment tools, the CBQ and JJ, were developed by Dr. Demitri Papolos. By clicking the links below you will leave www.jbrf.org and be redirected to the research site that contains the CPP and the CBQ & JJ assessments. If you have any questions or concerns regarding these tools please direct them to Dr. Papolos's system administrator at CPP@drpapolos.com To Set Up a New CPP Account To Access an Existing CPP Account
Scoring for assessments within the CPP is a fee-based service offered by the private practice of Demitri Papolos, M.D.; this service is independent of JBRF but may be accessed through the JBRF website. Dr. Papolos developed the CBQ & JJ measures and their automated scoring report with the support of JBRF. Questions and/or concerns with regard to the scored report should be addressed to CPP@drpapolos.com

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JBRF - Juvenile Bipolar Research Foundation

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The Clinician's Pathway Program (CPP) and its assessment tools, the CBQ and JJ, were developed by Dr. Demitri Papolos. By clicking the links below you will leave www.jbrf.org and be redirected to the research site that contains the CPP and the CBQ & JJ assessments.

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Historical Underpinnings of Bipolar Disorder

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Historical Underpinnings of Bipolar Disorder

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Historical Underpinning of Bipolar Disorder

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Behavioral disorders also known as conduct disorders are one of the most common forms of disability among children and young adults and is the most frequently cited reason for referral to mental health services. The appearance of behavioral disorders is increasing dramatically in our K-12 classrooms. As a result, their presence severely constrains the ability of the school systems to educate students effectively. The prevalence of behavioral problems among children and young adults is substantial. Many surveys indicate that behavioral disorders vary among young adults, ranging from 2 and 6 percent among K-12 students. This percentage translates into 1.3 to 3.8 million cases of behavioral disorders among the school and pre-college population.

Behavior disorders have also been referred to in a variety of different terminologies, including but not limited to:

1. Emotional and Behavior Disorders (EBD)

2. Emotional Conflict (EC)

3. Serious Emotional Disturbance (SED)

Behavioral disorders become apparent when the student displays a repetitive and impact persistent pattern of behavior that results in the significant disruption of other students. Such disturbances may cause significant impairments in academic, social, and or occupational functioning. Among the characteristics of a behavioral disorder among children and adolescents are:

General Strategies

Multidisciplinary educational teams, including parents, must design programs to meet the individual behavioral and academic needs of identified SED students. Most students can benefit from supportive treatments provided in general education programs. For others, at least temporary placements in special education classrooms, schools, or institutional programs may be appropriate.

Special education programs usually attempt to provide a structured environment where students experience a high degree of success; rules and routines are predictable; and students are consistently rewarded for appropriate behavior. Behavior management techniques, such as positive reinforcement, token economies, contracting, and time-out, which rely on direct measurement and monitoring of behavioral change, are commonly used in SED programs. The assessment and systematic teaching of social skills through modeling, discussion, and rehearsal are frequently used to help students increase control over their behavior and improve their relations with others. In addition, supportive therapies involving music, art, exercise, and relaxation techniques, as well as affective education, individual, and group counseling are sometimes employed to improve self-understanding, self-esteem, and self-control. The following are strategies that may be effective with students with EBD:

Teacher Presentation

Laboratory

Group Interaction and Discussion

1. Acknowledge the contributions of the student with an emotional disorder.

2. Call for responses and participation commensurate with the student's socialization skills.

3. As the student's comfort level rises and when a safe topic is available, encourage the student to be a group spokesperson.

4. Along with the student, devise a contingency plan in which inappropriate forms of response are replaced by appropriate ones.

5. Gradually increase the challenges in the student's participation in group exercises while providing increased positive reinforcement.

6. Help the student to feel as though he or she has something worthwhile to contribute to the discussion.

7. Some students may experience considerable strain in social adjustment in a group context. It may be necessary to work gradually toward group activities. One can devise a strategy of progressing from spectatorship to one-to-one instruction and eventually to small group discussion.

8. Should monitor carefully to ensure that the nondisabled students do not dominate the discussion or detract in any way from the successful performance of the student with the behavioral disorder.

Reading

1. It is necessary to target specific pro-social behaviors for appropriate instruction and assessment to occur such as:

1. Taking turns, working with partner, following directions.

2. Reading in group or with others.

3. Increasing positive relationships by means of awards when they read appropriately.

4. Demonstrating appropriate reading

2. Instructional strategies involving self-control, self-reinforcement, self-monitoring, self-management, problem solving, cognitive behavior modification, and metacognitive skills should be focused on teaching students reading skills

Research

1. Review and discuss with the student the steps involved in a research activity. Think about which step(s) may be difficult for the specific functional limitations of the student and jointly devise accommodations for that student.

2. Use appropriate laboratory and field strategies.

3. Depending on the site of the research check the previous two sections.

4. Show clear examples of what the students should expect as an outcome of their research.

Field Experiences

1. Use appropriate general strategies.

2. Consider alternate activities/exercises that can be utilized with less difficulty for the student, but has the same or similar learning objectives.

3. In field activities acknowledge the contributions and assistance of the student with an emotional disorder.

4. Help the student to feel as though he or she has something worthwhile to contribute to the field trip.

5. Use a buddy system.

6. Gradually increase the challenges in the student's participation in field exercises while providing increased positive reinforcement.

7. Group participation in field activities is highly desirable because it enhances social contacts.

8. Make the student with the behavioral disorder become one of the field trip leader of an activity which can often reduce their disorder.

9. Special efforts should be made to get students with behavioral disorders to interact with other students.

10. You should encourage students to practice field skills during their free hours.

11. Every effort should be made to arouse the interest of such students in activities, so they will learn to perform the activities with success and pleasure with appropriate behaviors.

Testing

1. Be sensitive to the student's reactions to the various aspects of assessment.

2. For each student, accumulate in his or her portfolio several examples of work (quizzes, assignments, projects) that demonstrate knowledge of the subject matter or the unit of study.

3. Make special arrangements for the student with an emotional disorder according to what their special needs are and that they do not compromise the integrity of the testing situation.

4. Stay on top of student progress through informal assessment, don't wait until it's too late to discover that there is a problem.

5. Provide private room/smaller group setting/alternative test site (with proctor present); alternatively screens to block out distractions.

Organizations

Council for Exceptional Children-Council for Children with Behavior Disorders (CCBD)
The Council for Children with Behavioral Disorders (CCBD) is dedicated to supporting the professional development and enhancing the expertise of those who work on behalf of children with challenging behavior and their families. It is a division of the Council for Exceptional Children (CEC).

CCBD Foundation
The CCBD Foundation was founded in 1997 by the Council for Children with Behavioral Disorders (CCBD), to support its mission of improving the education of children and youth with emotional or behavioral disorders (EBD).

Resources

Council for Exceptional Children (Behavior Disorders/Emotional Disturbance)
The Council for Exceptional Children (CEC) page on EBD. The Council for Exceptional Children (CEC) is the largest international professional organization dedicated to improving the educational success of individuals with disabilities and/or gifts and talents.

BehaviorDisorder.org
The site offers information on behavior disorders, conduct disorders, and other behavior problems.

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Behavioral disorders also known as conduct disorders are one of the most common forms of disability among children and young adults and is the most frequently cited reason for referral to mental health services. The appearance of behavioral disorders is increasing dramatically in our K-12 classrooms. As a result, their presence severely constrains the ability of the school systems to educate students effectively.

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Be You provides educators with knowledge, tools and resources to create positive, inclusive and responsive learning communities where every child, young person, educator and family is empowered to achieve their best possible mental health.

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Attention deficit hyperactivity disorder (ADHD) is a condition in which characterized by inattention, hyperactivity and impulsivity. ADHD is most commonly diagnosed in young people. An estimated 17 have ADHD. While ADHD is usually diagnosed in childhood, it does not only affect children. An estimated 8.8% of children aged 4- 4.4% of adults aged 18-44 have ADHD.

With treatment, people with ADHD can be successful in school, work and lead productive lives. Researchers are using new tools such as brain imaging to better understand the condition and to find more effective ways to treat and prevent ADHD.

Symptoms

While some behaviors associated with ADHD are "normal" and not a cause for concern to most people, someone with ADHD will have trouble controlling these behaviors and will show them much more frequently and for longer than 6 months.

Signs of inattention include:

Becoming easily distracted, and jumping from activity to activity.

Becoming bored with a task quickly.

Difficulty focusing attention or completing a single task or activity.

Trouble completing or turning in homework assignments.

Losing things such as school supplies or toys.

Not listening or paying attention when spoken to.

Daydreaming or wandering with lack of motivation.

Difficulty processing information quickly.

Struggling to follow directions.

Signs of hyperactivity include:

Fidgeting and squirming, having trouble sitting still.

Non-stop talking.

Touching or playing with everything.

Difficulty doing quiet tasks or activities.

Signs of impulsivity include:

Impatience.

Acting without regard for consequences, blurting things out.

Difficulty taking turns, waiting or sharing.

Interrupting others.

Causes

There are several factors believed to contribute to ADHD:

Genetics. Research shows that genes may be a large contributor to ADHD. ADHD often runs in families and some trends in specific brain areas that contribute to attention.

Environmental factors. Studies show a link between cigarette smoking and alcohol use during pregnancy and children who have ADHD. Exposure to lead as a child has also been shown to increase the likelihood of ADHD in children.

Diagnosis

ADHD occurs in both children and adults, but is most often and diagnosed in childhood. Getting a diagnosis for ADHD can sometimes be difficult because the symptoms of ADHD are similar to typical behavior in most young children. Teachers are often the first to notice ADHD symptoms because they see children in a learning environment with peers every day.

There is no one single test that can diagnose a child with ADHD, so meet with a doctor or mental health professional to gather all the necessary information to make a diagnosis. The goal is to rule out any outside causes for symptoms, such as environmental changes, difficulty in school, medical problems and ensure that a child is otherwise healthy.

Treatment

ADHD is managed and treated in several ways:

including stimulants, nonstimulants and antidepressants

Behavioral therapy

Self-management, education programs and assistance through schools or work or alternative treatment approaches

Related Conditions

Around two-thirds of children with ADHD also have another condition. Many adults are also impacted by the symptoms of another condition. Common conditions associated with ADHD include the following.

Symptoms from other conditions make treating ADHD more difficult. Talking to a skilled professional to help establish an accurate diagnosis can help increase the effectiveness of treatment.

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Attention deficit hyperactivity disorder (ADHD) is a condition in which characterized by inattention, hyperactivity and impulsivity. ADHD is most commonly diagnosed in young people. An estimated 17 have ADHD. While ADHD is usually diagnosed in childhood, it does not only affect children. An estimated 8.8% of children aged 4- 4.4% of adults aged 18-44 have ADHD.

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Conduct Disorder

"Conduct disorder" refers to a group of repetitive and persistent behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules, respecting the rights of others, showing empathy, and behaving in a socially acceptable way. They are often viewed by other children, adults and social agencies as "bad" or delinquent, rather than mentally ill. Many factors may lead to a child developing conduct disorder, including brain damage, child abuse or neglect, genetic vulnerability, school failure, and traumatic life experiences.

Children or adolescents with conduct disorder may exhibit some of the following behaviors:

Aggression to people and animals

bullies, threatens or intimidates others

delights in being cruel and mean to others

starts physical fights

has used a weapon that could cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife or gun)

is physically cruel to people or animals

steals from a victim while hurting them

forces someone into sexual activity

shows no genuine remorse after an aggressive episode

Destruction of Property

Deceitfulness, lying, or stealing

has broken into someone else's building, house, or car

lies to obtain goods, or favors or to avoid obligations

steals items without confronting a victim (e.g. shoplifting, but without breaking and entering)

Serious violations of rules

often stays out at night despite parental objections

runs away from home

often stays away from

Children who exhibit these behaviors should receive a comprehensive evaluation by an experience mental health professional. Many children with a conduct disorder may have coexisting conditions such as mood disorders, anxiety, PTSD, substance abuse, ADHD, learning problems, or thought disorders which can also be treated. Research shows that youngsters with conduct disorder are likely to have ongoing problems if they and their families do not receive early and comprehensive treatment. Without treatment, many youngsters with conduct disorder are unable to adapt to the demands of adulthood and continue to have problems with relationships and holding a job.

Treatment of children with conduct disorder can be complex and challenging. Treatment can be provided in a variety of different settings depending on the severity of the behaviors. Adding to the challenge of treatment are the child's uncooperative attitude, fear and distrust of adults. In developing a comprehensive treatment plan, a child and adolescent psychiatrist may use information from the child, family, teachers, community (including the legal system) and other medical specialties to understand the causes of the disorder.

Behavior therapy and psychotherapy are usually necessary to help the child appropriately express and control anger. Special education may be needed for youngsters with learning disabilities. Parents often need expert help to develop and carry out special management and educational programs in the home and at school. Home-based treatment programs such as Multisystemic Therapy (MST) are effective for helping both the child and family.

Treatment may also include medication in some youngsters who may have difficulty paying attention, impulse problems, or depression.

Treatment is rarely brief since establishing new attitudes and behavior patterns takes time. However, early treatment offers a child a better chance for considerable improvement and hope for a more successful future.

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Conduct Disorder "Conduct disorder" refers to a group of repetitive and persistent behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules, respecting the rights of others, showing empathy, and behaving in a socially acceptable way.

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Home - ADDA - Attention Deficit Disorder Association

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Empowering adults with adhd to live their best lives A Different Brain Requires a Different Approach Whether you're newly diagnosed, wondering if you have ADHD, or simply ready to take charge of your life - we're here to help. Have ...

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National Council for Special Education (NCSE)

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National Council for Special Education (NCSE)

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Oppositional Defiant Disorder is, in my book, a red flag. It is an indication that there is something else going on. I have never... seen a kid that meets criteria for ODD and did not meet criteria for some other diagnosis. It is as if the oppositional and defiant behavior is a coping strategy for dealing with other issues. Or a poorly functional reaction to other issues that are NOT being dealt with.

ODD is a psychiatric disorder, the definite causes of which are unknown, although biological and environmental factors may have a role to play. The hallmark of ODD is a recurrent pattern of negative, defiant, disobedient and hostile behaviour towards authoritative figures in particular that continues for at least six months, during which four or more of the following are present:

often loses temper

often argues with adults

often actively defies/refuses to comply with adults' requests or rules

often deliberately annoys people

often puts the blame for own mistakes or behaviour on others

often is easily upset or annoyed by others

often is angry and resentful

often is spiteful and vindictive

The disturbance in behaviour causes clinically significant impairment in social, academic and/or occupational functioning. Students with ODD possess a 'counter-will': the more pressure one applies the greater the opposition. Actions are premeditated and often the student may want confrontation. Typically, in the school situation the student with ODD will be aggressive and will purposefully bother and irritate others.

It is exceptionally rare for a student to present with ODD alone: usually students have other neuropsychiatric disorders such as attention deficit hyperactivity disorder (ADHD), depression, conduct disorder (CD) and bipolar disorder. Students may also present with Tourette syndrome or other special educational needs.

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Oppositional Defiant Disorder is, in my book, a red flag. It is an indication that there is something else going on. I have never... seen a kid that meets criteria for ODD and did not meet criteria for some other diagnosis. It is as if the oppositional and defiant behavior is a coping strategy for dealing with other issues.

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Oppositional Defiant Disorder: A Guide for Parents

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Oppositional Defiant Disorder: A Guide for Parents

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Oppositional Defiant Disorder

No. 72; Reviewed January 2019

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

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

Symptoms of ODD may include:

Frequent temper tantrums

Excessive arguing with adults

Often questioning rules

Active defiance and refusal to comply with adult requests and rules

Deliberate attempts to annoy or upset people

Blaming others for his or her mistakes or misbehavior

Often being touchy or easily annoyed by others

Frequent anger and resentment

Mean and hateful talking when upset

Spiteful attitude and revenge seeking

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

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

Treatment of ODD may include:

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

Individual Psychotherapy to develop more effective anger management

Family Psychotherapy to improve communication and mutual understanding

Cognitive Problem-Solving Skills Training and Therapies to decrease negativity

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

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

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

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

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

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

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

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

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

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

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

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National Institute of Mental Health (NIMH)

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Overview

Obsessive-compulsive disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts ("obsessions") and/or behaviors ("compulsions") that he or she feels the urge to repeat over and over.

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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Obsessive-compulsive disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts ("obsessions") and/or behaviors ("compulsions") that he or she feels the urge to repeat over and over. Signs and Symptoms Risk Factors Treatments and Therapies Join a Study

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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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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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