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Healthcare Toolbox

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Most children and parents will have some distress or upset - so how do I know when a child or family needs additional help?

Ask your patients (and their parents) about reactions and coping.

Listen for ongoing or severe traumatic stress symptoms.

Consider a referral for a more thorough evaluation with a mental health professional if:

Traumatic stress reactions are severe or prolonged (more than a month).

Traumatic stress reactions interfere with recovery or with returning to normal activities.

Consider: Is the child participating in daily activities to the extent possible given their medical condition? Are stress reactions interfering with treatment adherence? Are new fears or worries troubling the child or parent?

Steps for making a referral Effective mental health treatment for traumatic stress Online resources - help in finding a mental health professional Distinguishing between types of mental health professionals
Therapist Resource Guide: There are many ongoing stressors that children and families endure after diagnosis of an illness or an injury. This guide focuses specifically on medical traumatic stress and responses that children and families may have.

Steps for making a referral

Mention concerns you have identified.
Say something like: "I'm concerned that (you are / your child is) having these upsetting thoughts and feelings. It might be useful to talk with a specialist who can help your family more."

Involve child and family in making a plan.
Ask for their ideas about what is needed now
Say something like: "What issues or difficulties are impacting you / your family the most right now? What would help make things better?"

Ask for permission to offer advice. Present advice as range of possibilities; be sure to incorporate patient/family ideas

Say something like: "I have some suggestions that have helped other patients in the past in situations similar to yours. May I share them with you?"

Range of possibilities might include: patient education materials / websites; speaking with social worker, local clergy, school counselor; seeking out support group, referral to therapist / community mental health center.

Ask about their readiness to act on this now or in the future.
Say something like: "Is this (suggested plan) something you would be willing to do when you leave today, or if you need it next week...month?"

Ask about barriers to potential plans / referrals, and strategies to overcome barriers.
Say something like: "What kinds of things would interfere with following-up on this plan we just discussed? How can we work through this so you end up getting the help you need.?"

Involve the child and parent in setting the agenda*:*Adapted from Wissow et al. (2008)

Keep the door open.

If your patient or their parents are not quite ready to act on a suggested referral now, arrange to follow up to see how your patient is doing.

You might say: "I'd like to talk with you again in a few weeks to see how things are going."

Promote continuity of care.
If your care for this patient is ending, ask permission to communicate your concerns about traumatic stress reactions or risk factors to the child's primary care provider, or to other providers who will continue to take care of this patient.

Facilitating collaboration between pediatric health care and mental health providers: The American Academy of Pediatrics Task Force on Mental Health has developed tools to facilitate collaboration between pediatric health care providers and mental health professionals, including a Physician Referral and Feedback Form template

Effective mental health treatment for traumatic stress

There are very good and helpful treatments for children who continue to have traumatic stress symptoms.
What treatment approaches are effective?
Evidence-based treatments include cognitive-behavioral treatment approaches, and in particular Trauma-Focused Cognitive Behavior Therapy (TF-CBT).

Click here for a fact sheet about effective treatments for youth trauma from the National Child Traumatic Stress Network.

A recent article includes informative summaries of effective mental health treatments for child traumatic stress symptoms, and guidance for health care professionals:
Cohen, J, Kelleher, K, Mannarino, A.. Identifying, treating, and referring traumatized children: The role of pediatric providers. Archives of Pediatric and Adolescent Medicine 2008;162(5):447-452 How can I help parents find effective treatment for their child?
When helping parents find a counselor or therapist to help their child with traumatic stress symptoms, you might suggest that they ask prospective therapists questions such as:

Do you have experience working with children after trauma?

What is your approach to working with this type of problem?

What is your success rate?

How do you work with parents?

The National Child Traumatic Stress Network offers useful tips and information about finding a mental health professional to help children and their families after trauma.

Online resources - help in finding a mental health professional

The National Child Traumatic Stress Network (NCTSN) has trauma-trained, child mental health professionals and community-based treatment centers in 35 states in the US. For information about or referral to a NCTSN center near you, please go to the NCTSN Organizational Members site.
American Psychological Association - Psychologist Locator National Association of Social Workers - Find a Licensed Social Worker American Academy of Child and Adolescent Psychiatrists - Psychiatrist Finder Anxiety Disorders Association of America - Find a Therapist Sidran Institute Help Desk - Locate Trauma Resources ISTSS Clinician Directory - Find a Clinician, Counselor or Mental Health Professional
Distinguishing between types of mental health professionals

Psychologists are professionals who have earned a doctoral degree (Ph.D. or Psy.D.) after 4-6 years of graduate-level training in human behavior and development, psychological testing and evaluation, and psychotherapy. Psychologists are licensed by the state in which they practice.

Psychiatrists are physicians (M.D. or D.O.) who have completed medical school, plus additional advanced training in the evaluation and treatment of psychiatric disorders and emotional and behavioral problems. Psychiatrists are licensed by the state in which they practice. As medical doctors, psychiatrists can prescribe and monitor medications.

Clinical Social Workers are professionals who have earned a master's degree (M.S.W.) after 2-3 years of graduate training. Clinical Social Workers are licensed by the state in which they practice (LCSW or similar credential - varies by state).

Marriage and Family Therapists are professionals who have completed a master's degree (M.A. or M.S.) after 2-3 years of graduate training. Some Marriage and Family Therapists have completed a required amount of clinical hours and passed a state-administered examination to become licensed marriage and family therapist (LMFT).

Licensed Professional Counselors (LPC) & Licensed Mental Health Counselors (LMHC) are mental health professionals who have earned a master's degree (M.A. or M.S.) after 2-3 years of graduate training and have obtained a required amount of clinical experience and passed a state-administered licensing examination.

For more information on the training and credentialing of mental health professionals, see Mayo Clinic: Mental health providers.

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When and How to Refer for Mental Health Care

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Pediatric providers can follow specific steps to determine if and how to refer a child and familiy for further mental health services after a medically traumatic event. Providers can also become familiar with current evidence-based treatments and online resources for mental health services for traumatic stress.

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Addressing Mental Health in School Crisis Prevention & Response

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Addressing Mental Health in School Crisis Prevention & Response

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addressing mental health in school crisis prevention and response

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School Mental Health Referral Pathways Toolkit (SMHRP)

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School Mental Health Referral Pathways Toolkit (SMHRP)

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NITT-TA | Now Is The Time Technical Assistance Center

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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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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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Improving Education Outcomes for ALL Children

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Improving Education Outcomes for ALL Children

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"We initially chose IRIS because of the past experiences and their credible research-based, high-quality modules that align with specific areas of growth and need to support a state-directed corrective action plan in our region."

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"We initially chose IRIS because of the past experiences and their credible research-based, high-quality modules that align with specific areas of growth and need to support a state-directed corrective action plan in our region."

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21 Amazing Movies That Actually Understand Mental Illness

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While cinema often portrays people with mental illness as murderous, there are films out there that show mentally illness a little differently.

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Suffering in Silence: OCD in the School Setting

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Suffering in Silence: OCD in the School Setting

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OCD in School Setting Suffering in Silence

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BOOK: The ADHD Book of Lists : A Practical Guide for Helping Children and Teens with Attention Deficit Disorders

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BOOK: The ADHD Book of Lists : A Practical Guide for Helping Children and Teens with Attention Deficit Disorders

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Rief, Sandra F. 2015

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Oppositional Defiant Disorder A guide for parents

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BOOK: How to Reach and Teach Children and Teens with ADD/ADHD

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BOOK: How to Reach and Teach Children and Teens with ADD/ADHD

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Rief, Sandra F.

2016

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Early Development of Comorbidity Between ADHD and ODD

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Early Development of Comorbidity Between ADHD and ODD

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Journal of Abnormal Psychology

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Early Development of Comorbidity Between Symptoms of ADHD and ODD

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BOOK: Conduct and Oppositional Defiant Disorders : Epidemiology, Risk Factors, and Treatment

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BOOK: Conduct and Oppositional Defiant Disorders : Epidemiology, Risk Factors, and Treatment

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Essau, Cecilia

Date: 2003

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Also known as: Attention-deficit hyperactivity disorder (ADHD); attention deficit/hyperactivity disorder (ADHD); attention-deficit disorder (ADD)

Anatomy or system affected: Brain, nervous system, psychic-emotional system

Definition: A condition characterized by an inability to focus attention or to inhibit impulsive, hyperactive behavior; it is associated with behavior that results in poor performance in educational, social, or work settings. The disorder is typically diagnosed in childhood, but symptoms can persist into adulthood for some people.

Causes: Unknown, possibly genetic

Symptoms: Inattention, hyperactivity, impulsiveness, fidgeting

Duration: Chronic

Treatments: Behavioral therapy, counseling, medications
Causes and Symptoms
The prevalence of attention deficit hyperactivity disorder (ADHD) among the general population is difficult to determine, and depends largely on the diagnostic criteria used and the population studied. The American Psychiatric Association (APA), in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013), states that around 5 percent of children have ADHD, while data from the National Health Interview Survey (NHIS) for the years 2011-13 found that 9.5 percent of US children between ages four and seventeen had ever been diagnosed with ADHD, and a national parent survey conducted by the Centers for Disease Control and Prevention (CDC) in 2011-12 found that around 11 percent of children in the same age range had been diagnosed. A 2015 meta-analysis of 175 research studies found an estimated worldwide prevalence of 7.2 percent among children eighteen and under. Studies also indicate that somewhere between 3 and 5 percent of adults may have ADHD.

The causes of ADHD are unknown, although the fact that it often occurs in families suggests some degree of genetic inheritance. First-degree relatives of patients with ADHD are two to eight times more likely to develop ADHD than a person who has no first-degree relatives with ADHD. Boys are two times more likely to be affected than girls. ADHD is usually diagnosed when a child enters school, but it may be discovered earlier. According to the DSM-5, several of an individual's symptoms must be present prior to age twelve to merit a diagnosis of ADHD.

The pathophysiologic basis for ADHD is thought to be abnormalities in the dopaminergic and noradrenergic neurotransmission systems. Some genetic causes of ADHD that have been suggested include a possible mutation of the dopamine D4 receptor gene ( DRD4) or a phenotypic variation in the catechol-O-methyltransferase gene ( COMT). Other risk factors being explored include head injury before the age of two years; exposure to emotionally traumatic situations, such as abuse, neglect, or violence; and childhood exposure to environmental contaminants such as lead and organophosphate pesticides, substances such as alcohol and nicotine in utero, or secondhand smoke in childhood. Some studies have suggested that a high level of television viewing between the ages of one and three years may be modestly associated with ADHD. Other studies suggest that food dyes and preservatives such as artificial colors or sodium benzoate may increase hyperactivity. Other possible factors that may increase the risk of ADHD include maternal urinary tract infection during pregnancy, premature birth, complex congenital heart disease, fragile X syndrome, and Turner syndrome.

Individuals who do not have ADHD may at times display some of the symptoms of this disorder, but those who are diagnosed with ADHD must display symptoms most of the time and across multiple settings-in school, at home, and during other activities. According to the DSM-5, a child must display six or more ADHD symptoms for six months or longer to be diagnosed with the disorder, while adults must display five or more symptoms to be eligible for diagnosis. Prior to diagnosis, the referring pediatrician and specialist should rule out any undetected hearing or vision problems, any learning disabilities, undetected seizures, and anxiety and depression that may be causing ADHD-like symptoms.

The symptoms of ADHD are usually grouped into three main categories: inattention, hyperactivity, and impulsiveness. Individuals who have symptoms of inattention often make mistakes or do not pay close attention to details in school, social settings, or at work. They may have problems sustaining attention over time and frequently do not seem to listen when spoken to, especially in groups. Individuals with ADHD have difficulty following instructions and often fail to finish chores or schoolwork. They do not organize well and may have messy rooms and desks at school. They also frequently lose things necessary for school, work, or other activities. Because they have trouble sustaining attention, individuals with ADHD dislike tasks that require this skill and will try to avoid them. One of the key symptoms is distractibility, which means that people with ADHD are often paying attention to extraneous sights, sounds, smells, and thoughts rather than focusing on the task at hand. ADHD may also be characterized by forgetfulness in daily activities, despite numerous reminders about such common, everyday activities as dressing, hygiene, manners, and other behaviors. People with ADHD seem to have a poor sense of time; they are frequently late or think that they have more time to do a task than they really do.

Not all individuals with ADHD have symptoms of hyperactivity, but many have problems with fidgeting or squirming. It is common for these individuals to be constant talkers, often interrupting others. Other symptoms of hyperactivity include leaving their seat in school, work, or similar settings and moving around excessively in situations where they should be still. Some people with ADHD seem to be driven by a motor or are continuously on the go.

Individuals with ADHD may also have some symptoms of impulsiveness, such as blurting out answers before questions are completed. Another example of impulsiveness would be or intruding upon others in conversation or in some activity. They may also have difficulty standing in lines or waiting for their turn.

It is important to recognize that children with ADHD are not bad children who are hyperactive, impulsive, and/or inattentive on purpose. Rather, they are usually bright children who would like to behave better and to be more successful in school, in social life with peers, and in family affairs, but they simply cannot. One way to think about ADHD is to consider it a disorder of the ability to inhibit impulsive, off-task, or undesirable attention. Consequently, an individual with ADHD cannot separate important from unimportant stimuli and cannot sort appropriate from inappropriate responses to those stimuli. It is easy to understand how someone whose brain is trying to respond to a multitude of stimuli, rather than sorting stimuli into priorities for response, will have difficulty focusing and maintaining attention to the main task.

Individuals with ADHD may also have a short attention span, particularly for activities that are not fun or entertaining. They will be unable to concentrate because they will be distracted by peripheral stimuli. They may also have poor impulse control so that they seem to act on the spur of the moment. They may be hyperactive or clumsy, resulting in their being labeled "accident-prone." In fact, several cross-sectional studies have found that individuals with ADHD face an increased risk of injury compared to individuals without ADHD. They may also have problems completing tasks that require a lot of organization and planning-often first seen when the individual is in the third grade or beyond. They may display attention-demanding behavior and/or show resistant or overpowering social behaviors. Last, children with ADHD often act as if they were younger than they are, and "immaturity" is a frequent label. Along with this trait, they have wide mood swings and are seen as emotional.

Many experts think that ADHD may be related to problems with brain development. Studies have shown that the prefrontal cortex, striatum, and cerebellum in the brains of individuals with ADHD are less activated on functional magnetic resonance imaging (fMRI) than age-matched controls without ADHD. These regions of the brain are rich in dopaminergic and noradrenergic pathways and are associated with executive function. Other researchers have hypothesized that a developmental abnormality of the inferior frontal gyrus (cerebral cortex ridge) might cause the inhibition difficulties seen in ADHD.

Hyperactive symptoms may improve in adolescence, although adolescents with ADHD may continue to have problems with impulsive behavior and inattention. They may have considerable difficulty complying with rules and following directions. They may be poorly organized, causing problems with both starting projects and completing them. Adolescents with ADHD may have problems in school in spite of average or above-average potential. They may have poor self-esteem and a low frustration tolerance. Because of these and other factors related to ADHD, they may also be at greater risk of developing substance use problems and other mental health problems. ADHD may also persist into adulthood, in which case it is referred to as adult ADHD. The same diagnostic criteria apply, including the presence of the disorder since childhood.

Several other neurologic or psychiatric disorders have symptoms that can overlap with ADHD, so accurate diagnosis can be difficult. When an individual is suspected of having ADHD, he or she should have a thorough medical interview and a physical examination conducted by a physician familiar with child development, ADHD, and related conditions. A psychological evaluation to determine intelligence quotient (IQ) and areas of learning and performance strengths and weaknesses should be obtained. The evaluation should include an assessment for common coexisting conditions, such as learning disabilities. A thorough family history and a discussion of family problems such as divorce, violence, alcoholism, or drug abuse should be part of the evaluation, as symptoms of ADHD may arise after a significant and sudden change in a child's life. Conditions that may present similar symptoms to ADHD include psychological disturbances caused by abuse or neglect, bullying, social skills deficits, or an improper learning environment. Other conditions that might be found to exist along with ADHD, or to be the underlying cause of symptoms thought to be ADHD, include oppositional defiant disorder, conduct disorder (usually seen in older children), depression, anxiety, or a substance abuse disorder.

"Attention-deficit disorder (ADD) with or without hyperactivity" was first defined in the third edition of the APA's Diagnostic and Statistical Manual of Mental Disorders (1980), or DSM-III. Its definition has evolved since then. The name ADD was changed to ADHD in the revised edition of the DSM-III-R (1987). In 1998, the National Institutes of Health (NIH) held a Consensus Development Conference on the Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder. While most experts supported the ADHD diagnosis criteria, the final report noted a need for further research into the validity of the diagnosis. The DSM-5, published in 2013, updated the definition of ADHD to reflect the growing body of evidence that shows the condition can last beyond childhood in order to help clinicians diagnose and treat adults with ADHD. Approximately 50 percent of children with ADHD continue to have ADHD into adulthood.
Treatment and Therapy
Treatment and therapy for ADHD will usually begin with the diagnostic process. Generally, treatment will begin with some combination of counseling, education, and behavioral therapy. Behavioral therapy may be administered by a parent, teacher, or counselor. In some cases, family counseling may be indicated. This counseling may be help family members learn about ADHD. Parent training interventions may help to improve some symptoms of ADHD in children. Family counseling also may be recommended when family issues are thought to be related to the type or severity of symptoms that the child may be experiencing. For instance, if the family is undergoing a stressful event, such as a divorce, serious loss, or death, or other problems such as economic stress, then the symptoms of ADHD may worsen. Therefore, treatment may focus on trying to minimize the impact of such stressors on the child. In addition, neurofeedback may reduce inattentive behaviors and impulsivity.

If behavioral and nonpharmacologic interventions do not lead to improvement, and if there is a moderate to severe functional disturbance caused by ADHD, medications may be considered. Stimulants have the best evidence for the treatment of ADHD; stimulant medications include methylphenidate ( Ritalin), extended-release dexmethylphenidate (Focalin), and amphetamines ( Adderall). These medications are generally thought to be safe and effective, although they can have such adverse effects as headache, stomachache, mood changes, heart-rate changes, appetite suppression, and interference with falling asleep. All children receiving medication must be monitored at regular intervals by a physician.

Nonstimulant medications are the second-line pharmacological treatment of ADHD, especially if stimulant medications are ineffective or poorly tolerated. Other medications that may be used for ADHD include atomoxetine (Strattera), antidepressants such as desipramine or bupropion, and alpha-2 adrenergic agonists such as clonidine and extended-release guanfacine.

Costs and risks for adverse effects should be discussed with the physician who has made the diagnosis of ADHD before implementing any treatment, to ensure safety and a reasonable expectation of efficacy.
Perspective and Prospects
Attention deficit hyperactivity disorder remains controversial due to the subjective nature of its symptoms and the possible overdiagnosis and overtreatment of the disorder. Historically, experts have estimated that ADHD affects between 2 and 10 percent of the general population. However, in March 2013, the New York Times reported that data from the CDC showed that approximately 11 percent of children between the ages of four and seventeen have been diagnosed with ADHD, representing a 16 percent increase since 2007 and a 41 percent rise over the previous decade. This follows a general increase in rates of diagnosis beginning in the 1970s. ADHD experts caution against attributing the increase to a single factor, including misdiagnosis and increased pharmacological treatment of milder forms of the disorder.

Many experts also suggest that shifts in how ADHD is diagnosed, increasing tendencies to prescribe medications, and a rise in public awareness and media attention have all contributed to an increase in diagnoses, if not an increase in actual cases. These trends have also led some researchers to warn against overdiagnosis of ADHD, cautioning that not all children with high energy or difficulty focusing necessarily have the disorder, especially at very young ages. Some even challenge the concept of ADHD altogether, claiming that it is a case of applying a medical diagnosis to a range of behaviors that may go against social norms but have historically not been seen as a medical issue. Still, the majority of medical professionals do recognize ADHD as a legitimate condition, if one surrounded by continued controversies and misunderstandings.

For individuals with ADHD, the disorder is a real issue that can cause great harm and impairment if not recognized and managed correctly. Diagnosis should be based on family history, careful examination, and thorough psychological assessment. Treatment should always begin with behavioral interventions before medication.

Individuals with ADHD can share experiences and resources through organizations that assist families dealing with attention deficit hyperactivity disorder. The US organization Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) has state and local chapters helping individuals and families cope with the condition. CHADD chapters often have libraries and provide resources on ADHD management. The Learning Disabilities Association of America (LDA) also has state and local chapters helping schools and families cope with a wide range of learning disabilities, including ADHD.
Bibliography
Accardo, Pasquale J., et al., editors. Attention Deficits and Hyperactivity in Children and Adults: Diagnosis, Treatment, Management. 2nd ed., Marcel Dekker, 2000.

"Attention Deficit Hyperactivity Disorder." National Institute of Mental Health, National Institutes of Health, US Dept. of Health and Human Services, Mar. 2016, www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml. Accessed 6 Sept. 2017.

"Attention Deficit/Hyperactivity Disorder (ADHD)." Centers for Disease Control and Prevention, US Dept. of Health & Human Services, 18 July 2017, www.cdc.gov/ncbddd/adhd/index.html. Accessed 25 Sept. 2017.

Barkley, Russell A., editor. Attention-Deficit Hyperactivity Disorder: A Handbook for Treatment and Diagnosis. 4th ed., Guilford Press, 2015.

Breggin, Peter R. Talking Back to Ritalin: What Doctors Aren't Telling You about Stimulants and ADHD. Rev. ed., Da Capo Press, 2001.

Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed., American Psychiatric Association, 2013.

"General Prevalence." CHADD: The National Resource on ADHD, www.chadd.org/understanding-adhd/about-adhd/data-and-statistics/general-prevalence.aspx. Accessed 25 Sept. 2017.

McGough, James J. ADHD. Oxford UP, 2014.

Phelan, Thomas W. All About ADHD: A Family Resource for Helping Your Child Succeed with ADHD. Sourcebooks, 2017.

Quinn, Patricia O. AD/HD and the College Student: The Everything Guide to Your Most Urgent Questions. Magination Press, 2012.

Quinn, Patricia O., and Judith M. Stern. Putting On the Brakes: Understanding and Taking Control of Your ADD or ADHD. 3rd ed., Magination Press, 2012.

Ramsay, J. Russell. Nonmedication Treatments for Adult ADHD: Evaluating Impact on Daily Functioning and Well-Being. American Psychological Association, 2010.

Rief, Sandra F. The ADHD Book of Lists: A Practical Guide for Helping Children and Teens with Attention Deficit Disorders. 2nd ed., Jossey-Bass, 2015.

Schwarz, Alan, and Sarah Cohen. "ADHD Seen in 11% of US Children as Diagnoses Rise." The New York Times, 31 Mar. 2013, www.nytimes.com/2013/04/01/health/more-diagnoses-of-hyperactivity-causing-concern.html. Accessed 25 Sept. 2017.

Silva, Desiree, et al. "Environmental Risk Factors by Gender Associated with Attention-Deficit/Hyperactivity Disorder." Pediatrics, vol. 133, no. 1, 2014, doi:10.1542/peds.2013-1434. Accessed 6 Sept. 2017.

Steiner, Naomi J., et al. "In-School Neurofeedback Training for ADHD: Sustained Improvements from a Randomized Control Trial." Pediatrics, vol. 133, no. 3, 2014, doi:10.1542/peds.2013-2059. Accessed 6 Sept. 2017.

Thomas, Rae, et al. "Prevalence of Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis." Pediatrics, vol. 135, no. 4, 2015, doi:10.1542/peds.2014-3482. Accessed 6 Sept. 2017.

UK Adult ADHD Network et al. Handbook for Attention Deficit Hyperactivity Disorder in Adults. Springer Healthcare, 2013.

Van Dongen-Boomsma, Martine, et al. "A Randomized Placebo-Controlled Trial of Electroencephalographic (EEG) Neurofeedback in Children with Attention-Deficit/Hyperactivity Disorder." Journal of Clinical Psychiatry, vol. 74, no. 8, 2013, pp. 821-27.

"What Is ADHD?" KidsHealth, Nemours Foundation, July 2014, kidshealth.org/en/parents/adhd.html. Accessed 6 Sept. 2017.

Copyright of Magill's Medical Guide (Online Edition) is the property of Salem Press. The copyright in an individual article may be maintained by the author in certain cases. Content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. Source: Magill's Medical Guide (Online Edition), 2019, 5p
Item: 86193914

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Attention deficit hyperactivity disorder (ADHD)

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Also known as: Attention-deficit hyperactivity disorder (ADHD); attention deficit/hyperactivity disorder (ADHD); attention-deficit disorder (ADD) Anatomy or system affected: Brain, nervous system, psychic-emotional system Definition: A condition characterized by an inability to focus attention or to inhibit impulsive, hyperactive behavior; it is associated with behavior that results in poor performance in educational, social, or work settings.

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BOOK: ADHD in Schools 3rd Ed. Assessment & Intervention Strategies

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BOOK: ADHD in Schools 3rd Ed. Assessment & Intervention Strategies

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DuPaul, George J., Reid, Robert, Stoner, Gary D.

2014

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BOOK: ADHD Coaching A Guide for Mental Health Professionals

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BOOK: ADHD Coaching A Guide for Mental Health Professionals

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Prevatt, Frances F., Levrini, Abigail, American Psychological Association

Date: 2015

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BOOK: ADHD A guide to Understanding Symptoms, Causes Diagnosis, Treatment, and Changes Over Time in Children, Adolescents, and Adults

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BOOK: ADHD A guide to Understanding Symptoms, Causes Diagnosis, Treatment, and Changes Over Time in Children, Adolescents, and Adults

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Wender, Paul H., Tomb, David A.

2017

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Learning Disabilities Association of Texas
http://ldatx.org/

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Is it a modification or is it an accommodation(1)

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American Counseling Association

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Counseling Youth Who Have Bipolar Disorder

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Counseling Youth Who Have Bipolar Disorder

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American Counseling Association

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Counseling Youth who have Bipolar Disorder

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In a past term, some candidates expressed confusion as to when and if a student should be provided with an IEP or 504 services.

Andrew Lee (2019) explains that, "The Individuals with Disabilities Education Act (IDEA) requires schools to provide special education and related services to eligible students. But not every child with learning or attention issues qualifies. To be covered, a child’s school performance must be “adversely affected" (para 1).

Here are some other things you need to consider:

Just because a student receives a medical or outside diagnosis, they may or may not get an IEP.  There has to be an educational need.  So, for instance, a student may be autistic but extremely high-performing.  This student may not need an IEP.  There has to be proof of an educational need.  There are a lot of students out there with “diagnosed” emotional disturbances who do not show an educational need.  So, basically, a diagnosis does not automatically mean that a student needs an IEP.  A diagnosis PLUS an educational need equals a need for IEP and services under IDEA.

504 is much broader.  This is generally employed to cover kids who have some kind of need that might not be covered under official IDEA processes or that may be temporary—it can be as broad as kids who have asthma and need to have a management plan on file at the school all the way to kids who may not qualify under special ed but have needs to be addressed.  It could even cover a student who breaks his arm and needs to have his work transcribed or needs other services to fill his need while he is healing.

So remember, both bipolar and depression MAY warrant an IEP, but only if there is an educational need.

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At a glance

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

IDEA covers 13 disability categories.

Not every student who struggles in school qualifies.

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

1. Specific learning disability (SLD)

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

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

2. Other health impairment

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

3. Autism spectrum disorder (ASD)

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

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

5. Speech or language impairment

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

6. Visual impairment, including blindness

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

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

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

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

10. Orthopedic impairment

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

11. Intellectual disability

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

12. Traumatic brain injury

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

13. Multiple disabilities

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

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

Key takeaways

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

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

"Other health impairment" can cover ADHD.

About the author

About the author

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

Reviewed by

Reviewed by

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

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

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North Dakota Department of Public Instruction

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New York Lawyers for the Public Interest

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Students with Disabilities & Sec. 504 of Rehabilitation Act of 1973

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Students with Disabilities & Sec. 504 of Rehabilitation Act of 1973

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Pacer Center | Champions for Children with Disabilities

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Students with Disabilities and Section 504 of Rehabilitation Act of 1973

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Understood | For Learning and Attention Issues

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Both Individualized Education Programs (IEPs) and 504 plans can offer formal help for K-12 students who are struggling in school. They're similar in some ways but very different in others. This chart compares them side by side to help you understand the differences.

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.

To get an IEP, there are two requirements: 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. And 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.

To get a 504 plan, there are two requirements: A child has any disability. Section 504 covers a wide range of different struggles in school. And 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.

There are strict legal requirements about who participates. With a few exceptions, the entire IEP team must be present for IEP meetings. The team 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

* A school psychologist or other specialist who can interpret evaluation results

* A district representative with authority over special education services

The IEP sets learning goals and describes the services the school will provide. It's a written document. Here are some of the most important things the IEP must include:

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

* 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

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

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.

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

* Mediation

* Due process complaint

* Resolution session

* Civil lawsuit

* State complaint

* Lawsuit

And if you need help navigating special education law in your state, consider reaching out to your local Parent Training and Information Center. The people there can answer questions and give practical advice on issues specific to your area.

Do you want to learn more about how IEPs and 504 plans compare? Watch as an expert explains the differences between them.

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

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

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

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Individualized Education Programs (IEPs) and 504 plans are similar but different. See how they compare in what they provide and the processes and laws involved.

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Informing & Designing Education for all Learners

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Informing & Designing Education for all Learners

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Texas Council for Developmental Disabilities

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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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IDEA | Individuals with Disabilities Education Act

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IDEA | Individuals with Disabilities Education Act

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IDEA defines emotional disturbance as follows:
“…a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance:
(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors.
(B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.
(C) Inappropriate types of behavior or feelings under normal circumstances.
(D) A general pervasive mood of unhappiness or depression.
(E) A tendency to develop physical symptoms or fears associated with personal or school problems.”
As defined by IDEA, emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance.

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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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Bipolar Child Support

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The Bipolar Child

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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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International Bipolar Foundation

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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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Juvenile Bipolar Research Foundation

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The maximum amount of time allowed to pass between the parents' request and/or agreement to conduct the evaluation to the IEP development differs from state to state, but most regulations cite a time line somewhere between fifty and 120 days. (Note: In some states the meeting at which the IEP is written is called by the somewhat misleading phrase Admission, Review Dismissal meeting-the ARD meeting.)

Whatever it's called in your state, you will have a lot to prepare so that the meeting is productive and so that the school personnel understand the necessity of the accommodations. Being prepared will also ensure that the IEP is well written.

Parents must be prepared to educate the school team, develop a resource binder, rehearse the meeting beforehand, and decide who will be at the meeting with them (the child psychiatrist, an advocate, an educational lawyer).

Any written materials about early-onset bipolar disorder that you want the special education team at school to review (perhaps the article What is Juvenile Bipolar Disorder?) should be sent about two weeks before the scheduled meeting so that the IEP team will have time to digest the materials and better understand how to write the IEP. Few could skim and grasp the implications of this illness and construct an IEP in the hour or two allotted to the process without prior knowledge about the student's challenges and illness.

Preparing the Binder

The three-ring binder should carry a picture of your child on the front, his or her name and grade on the spine, and be divided into sections inside. These should include:

1. Important contacts and telephone numbers.

2. Reports or letters from the professionals working with your child. An example would be letters from the psychiatrist or therapist with any recommendations they have for your child's education.

3.Results you have from private assessments such as the neuropsychological testing. These test results should support your child's need for an IDEA classification.

4.The complete list of accommodations from this article.

5. The sample IEP from The Bipolar Child website. This sample IEP will help you with your input at the IEP meeting.

6.The Behavior/Symptom/Accommodation chart from this article is a visual aide to help the IEP team better understand how to interpret disruptive behaviors and recommend how to develop interventions which will reduce these unruly behaviors.

7.Examples of your child's work which exemplify areas of difficulty and areas of giftedness.

8. A copy of Jennifer Bollero's beautifully written and reasoned article called "Playing Hearts, Not Poker" available at the Harbor House Press Law site. No parent should leave home for an IEP meeting without reading or re-reading this article.

Educating the Team About Accommodations
That Will Benefit Your Child

Since a parent usually understands the illness and the side effects of the medications better than anyone, he or she should be ready to spell out a list of symptoms and medication side effects and proposed modifications in the academic schedule to accommodate the child's difficulties and to make the school day more productive and comfortable for the student.

Hopefully, by the time the education team sits down to write the IEP, the parents can provide the independent neuropsychological assessment which can pinpoint any specific learning disabilities, learning styles, and possible weaknesses in the domains of executive functions. (This neuropsychologist's report should make recommendations for the academic arena and these recommendations should be addressed in the IEP also.)

We thought it would be helpful to divide the modifications into categories where parents and educators could see at a glance which symptoms the student has and which accommodations will have to be incorporated into the IEP. Four categories the IEP team should consider when developing an appropriate IEP for a student with a mood disorder are:

I. Symptoms caused by the mood disorder

II. Side effects of the medications used to treat the condition

III. Attention and organizational difficulties

IV. Specific learning disabilities

(Click here to view all the symptoms and accommodations)

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How to Prepare for the IEP Meeting - Juvenile Bipolar Research Foundation

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The maximum amount of time allowed to pass between the parents' request and/or agreement to conduct the evaluation to the IEP development differs from state to state, but most regulations cite a time line somewhere between fifty and 120 days. (Note: In some states the meeting at which the IEP is written is called by...

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Historical Underpinnings of Bipolar Disorder Diagnostic Criteria

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Historical Underpinnings of Bipolar Disorder Diagnostic Criteria

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Historical Underpinnings of Bipolar Disorder Diagnostic Criteria

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Hammen, Constance L., Gotlib, Ian H.

2014

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Meta-Analysis of Diagnoses and Symptoms
APA

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Magill’s Medical Guide (Online Edition), 2019. 6p.

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Salem Press Encyclopedia

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Type of psychology: Biological bases of behavior; psychopathology; psychotherapy

Bipolar disorder is a serious mental illness that is characterized by depressive and manic episodes. Advanced neurobiological research and assessment techniques have shown this disorder to have biochemical origins and a genetic element. Research indicates that stress may play a role in the precipitating recurrence of episodes. The main treatment interventions include lithium, mood-stabilizing anticonvulsants, antipsychotics, and psychotherapy.
Introduction
Although mood fluctuations are a normal part of life, individuals with bipolar disorder experience extreme mood changes. Bipolar disorder, or bipolar affective disorder (also called manic-depressive disorder), has been identified as a major psychiatric disorder characterized by dramatic mood and behavior changes. These changes, ranging from episodes of high euphoric moods to deep depression s, with accompanying behavioral and personality changes, are devastating to those with the disorder and perplexing to the loved ones of those affected. Prevalence rates have been estimated at about 1.6 (0.8 to 2.6) percent of the American population. The disorder is divided fairly equally between men and women.

Clinical psychiatry has been effective in providing biochemical intervention in the form of lithium carbonate to stabilize or modulate the ups and downs of this illness. However, lithium treatment has only been effective for approximately 70 percent of those administered the compound. Mood-stabilizing anticonvulsant medications, such as divalproex sodium (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal), are showing promise in helping some people with the disorder who were formerly referred to as lithium nonresponders. Antipsychotic medications are increasingly being prescribed to individuals with bipolar disorder. Psychotherapy is seen by most practitioners as a necessary adjunct to medication.
Symptoms
In the manic phase of a bipolar episode, individuals may experience inappropriately good moods, or "highs," or may become extremely irritable. During a manic phase, they may overcommit to work projects and meetings, social activities, and family responsibilities in the belief that they can accomplish anything; this is known as manic grandiosity. At times, psychotic symptoms such as delusions, severe paranoia, and hallucinations may accompany a manic episode. These symptoms may lead to a misdiagnosis of another psychotic disorder such as schizophrenia. Although it may be difficult to arrive at a differential diagnosis between schizophrenia and bipolar disorder when a person is acutely psychotic, a long-term view of the individual's symptoms and functioning can distinguish between the two disorders.

The initial episode of bipolar disorder is typically one of mania or elation, although in some people, a depressive episode may signal the beginning of the disorder. Episodes of bipolar disorder can recur rapidly-within hours or days-or may have a much slower recurrence rate, even of years. The duration of each episode, whether it is depression or mania, varies widely among individuals but normally remains fairly consistent for each individual.
Types
According to the Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (2013), the diagnostic manual of the American Psychiatric Association, there are several types of bipolar disorder. Bipolar disorder subtypes are categorized according to the extent of severity, the types of the symptoms, and the duration of the symptoms.

Bipolar I disorder is characterized by alternating periods of mania and depression. At times, severe bipolar disorder may be accompanied by psychotic symptoms such as delusions and hallucinations. For this reason, bipolar I disorder is also considered a psychotic disorder. The prevalence of bipolar I disorder is divided fairly equally between men and women. However, women report more episodes of depression than men and are more likely to be diagnosed with bipolar II disorder.

Bipolar II disorder is characterized by alternating episodes of a milder form of mania (known as hypomania) and depression. In bipolar II disorder, although there is an observable change in mood and functioning, the hypomanic episode causes less severe impairment than that seen in mania. It is very rare for an individual's diagnosis to change from bipolar II disorder to bipolar I disorder.

Cyclothymia is a form of bipolar disorder in which hypomania alternates with a low-level, chronic depressive state. Seasonal affective disorder (SAD) is characterized by alternating mood episodes that vary according to seasonal patterns; the mood changes are thought to be related to changes in the amount of sunlight and accompanying effects on the levels of hormone melatonin. In the Northern Hemisphere, the typical pattern is associated with manic symptoms in the spring and summer and depression in the fall and winter. Manic episodes often have a shorter duration than the depressive episodes. Bipolar disorder must be differentiated from depressive disorders, which include major depression (unipolar depression) and dysthymia, a milder but chronic form of depression. Children are diagnosed with bipolar disorder using the same criteria as adults.
Comorbidity
Many studies have reported that up to 65 percent of bipolar disorder patients have comorbid diagnoses, that is, they have at least one additional psychiatric diagnosis. The most frequent comorbid diagnoses among individuals with bipolar disorder are attention-deficit hyperactivity disorder (ADHD), substance use disorder, anxiety disorders (especially generalized anxiety disorder and panic disorder), and drug abuse. Comorbidity is important to note because bipolar disorder with comorbid diagnoses is associated with higher rates of suicidality, less favorable response to lithium, and poorer outcome.
Causes
The causes of bipolar disorder are not fully understood. However, family, twin, and adoption studies indicate that genetic factors play a major role. Approximately 80 percent of individuals with bipolar disorder have a biological relative with some form of mood disorder, whether bipolar disorder or depression. It is not uncommon to see families in which several generations are affected by bipolar disorder. Serotonin, norepinephrine, and dopamine, brain chemicals known as neurotransmitters that regulate mood, arousal, and energy, respectively, are thought to be altered in bipolar disorder.

One theory is that bipolar disorder is associated with dysregulation in brain regions that are implicated in emotion such as the amygdala and basal ganglia. This theory is supported by functional brain imaging studies that indicate that during cognitive or emotional tasks, people with bipolar I disorder show different patterns of activity in the amygdala. In terms of structural brain imaging, people with bipolar disorder also display differences in the volume of activity in certain regions such as the amygdala and basal ganglia.

A diathesis-stress model has been proposed for some psychosomatic disorders such as hypertension. This model has also been applied to bipolar disorder. In a diathesis-stress model, there is a susceptibility (the diathesis) for the disorder. An individual who has a diathesis is at risk for the disorder but may not show signs of the disorder unless there is sufficient stress. In this model, a genetic, structural, or biochemical predisposition toward the disorder (the bipolar diathesis) may lie dormant until stress triggers the emergence of the illness. The stress may be psychosocial, biological, neurochemical, or a combination of these factors.

A diathesis-stress model can also account for some of the recurrent episodes of mania in bipolar disorder. Investigators suggest that positive life events, such as the birth of a baby or a job promotion, as well as negative life events, such as divorce or the loss of a job, may trigger the onset of episodes in individuals with bipolar disorder. Stressful life events and the social rhythm disruptions that they cause can have adverse effects on a person's circadian rhythms. Circadian rhythms are normal biologic rhythms that govern such functions as sleeping and waking, body temperature, and oxygen consumption. Circadian rhythms affect hormonal levels and have significant effects on both emotional and physical well-being. For those reasons, many clinicians encourage individuals with bipolar disorder to work toward maintaining consistency in their social rhythms.

Investigators have compared the course of bipolar disorder to kindling, a process in which epileptic seizures increase the likelihood of further seizures. According to the kindling hypothesis, triggered mood episodes may leave the individual's brain in a sustained sensitized state that makes the person more vulnerable to further episodes. After a while, external factors are less necessary for a mood episode to be triggered. Episode sensitization may also account for rapid-cycling states, in which the individual shifts from depression to mania over the course of a few hours or days. Some individuals are diagnosed with a subtype of bipolar disorder known as rapid cycling bipolar disorder, which is defined as four or more episodes per year. Rapid cycling is characterized by poorer outcome.
Impact
The burden of bipolar disorder is considerable. In addition to experiencing functional impairment during illness episodes, many people with bipolar disorder experience ongoing functional impairment between episodes. In 2015, the World Health Organization (WHO) estimated that bipolar disorder affected almost 60 million people worldwide among adults between the ages of fifteen and forty-four. Bipolar disorder is associated with the highest rate of suicide out of all of the psychiatric disorders. According to Kay Redfield Jamison, one of the foremost experts on bipolar disorder, approximately 50 percent of people with bipolar disorder attempt suicide at least once during their lives. In one large-scale study, when asked to rate their perception of their well-being in terms of their culture, values, and how they live in relation to their goals, standards, and expectations (that is, their quality of life), individuals with bipolar disorder rated their quality of life lower than members of the general population did. Indeed, study findings suggest that quality-of-life ratings are poorer in bipolar disorder than they are in anxiety disorders and in depression, but better than they are compared with quality-of-life ratings in schizophrenia.

Organizations such as the National Alliance on Mental Illness (NAMI) and support groups such as the Depressive and Bipolar Support Alliance (DBSA) have provided a way for people with bipolar disorder to share their pain as well as to triumph over the illness. Many people have found comfort in knowing that others have suffered from the mood shifts, and they can draw strength from one another. Family members and friends can be the strongest supporters and advocates for those who have bipolar disorder or other psychiatric illnesses. Many patients have credited their families' constant, uncritical support, in addition to competent effective treatment including medications and psychotherapy, with helping them cope with the devastating effects of the illness. As many as 15 percent of those with bipolar disorder commit suicide; this reality makes early intervention, relapse prevention, and treatment of the disorder necessary to prevent such a tragic outcome.
Treatment Approaches
Medications have been developed to aid in correcting the biochemical imbalances thought to be part of bipolar disorder. Lithium carbonate is effective for approximately 70 percent of those who take it. Many brilliant and successful people have reportedly suffered from bipolar disorder and have been able to function successfully with competent and responsible treatment. Some people who have taken lithium for bipolar disorder, however, have complained that it robs them of their energy and creativity. They say that they actually miss the energy associated with manic phases of the illness. This perceived loss, some of it realistic, can be a factor in relapse associated with lithium noncompliance.

Other medications have been developed to help those individuals who are considered lithium nonresponders or who find the side effects of lithium intolerable. Anticonvulsant medications, such as divalproex sodium (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal), which have been found to have mood-stabilizing effects, are often prescribed to individuals with bipolar disorder. During the depressive phase of the disorder, electroconvulsive therapy (ECT) and lamotrigine (Lamictal) have also been administered to help restore the individual's mood to a normal level. Phototherapy is particularly useful for individuals who have SAD. Atypical antipsychotic medications such as risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel) have also been prescribed to individuals with bipolar I disorder for the treatment of mania.

Cognitive behavior therapy is a form of therapy that addresses an individual's beliefs, assumptions, and behaviors to improve that person's emotional responses and health. Interpersonal social rhythms therapy encourages individuals to achieve and maintain stable routines, emphasizing the link between regular routines and moods, whereas the interpersonal component of the therapy focuses on the interpersonal issues that arise in individuals' lives. Psychotherapy, especially cognitive behavior therapy or interpersonal social rhythm therapy, is viewed by most practitioners as a necessary adjunct to medication. Indeed, psychotherapy has been found to assist individuals with bipolar disorder in maintaining medication compliance.

Local mental health associations are able to recommend psychiatric treatment by board-certified psychiatrists and licensed psychologists who specialize in the treatment of mood disorders. Often, temporary hospitalization is necessary for complete diagnostic assessment, initial mood stabilization and intensive treatment, medication adjustment, or monitoring of an individual who feels suicidal.
Bibliography
Bengesser, Susanne, and Eva Reininghaus. Genetics of Bipolar Disorder. Frankfurt: PL Academic Research, 2013. Print.

Fountoulakis, Konstanthos N. Bipolar Disorder : An Evidence-based Guide to Manic Depression. Heidelberg: Springer, 2015. Print.

Goodwin, Frederick K., and Kay R. Jamison. Manic Depressive Illness. 2nd ed. New York: Oxford UP, 2007. Print.

Jamison, Kay R. An Unquiet Mind. New York: Knopf, 1995. Print.

Miklowitz, David J. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know. New York: Guilford, 2002. Print.

Miklowitz, David J., and Sheri E. Johnson. "The Psychopathology and Treatment of Bipolar Disorder." Annual Review of Clinical Psychology 2 (2006): 199-235. Print.

Moore, Nickolas B. Bipolar Disorder: Symptoms, Management, and Risk Factors. New York: Nova Biomedical, 2013. Print.

Yatham, Lakshmi N., and Vivek Kusumakar, eds. Bipolar Disorder: A Clinician's Guide to Treatment Management. 2nd ed. New York: Brunner-Routledge, 2009. Print.

Yildiz, Aysegul, et al. The Bipolar Book: History, Neurobiology, and Treatment. New York: Oxford UP, 2015. Print.

Copyright of Salem Press Encyclopedia of Health is the property of Salem Press. The copyright in an individual article may be maintained by the author in certain cases. Content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. Source: Salem Press Encyclopedia of Health, 2018, 4p
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Type of psychology: Biological bases of behavior; psychopathology; psychotherapy Bipolar disorder is a serious mental illness that is characterized by depressive and manic episodes. Advanced neurobiological research and assessment techniques have shown this disorder to have biochemical origins and a genetic element. Research indicates that stress may play a role in the precipitating recurrence of episodes.

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Bipolar: Life Between two Extremes | Video

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Bipolar: Life Between two Extremes | Video

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Angelo State University - Library Online Resources

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Unauthorized use is prohibited; Usage may be subject to security testing and monitoring; Misuse is subject to criminal prosecution; No expectation of privacy except as otherwise provided by applicable privacy laws.

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A Closer Examination of Bipolar Disorder in School-age Children

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A Closer Examination of Bipolar Disorder in School-age Children

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ASCA | Professional School Counseling

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A closer examination of bipolar disorder in school age children

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BOOK: Helping People with Eating Disorders

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BOOK: Helping People with Eating Disorders

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Palmer, Robert L.

2015

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Detection, Management, and Consulting with Professionals

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Eating Issues in Schools Detection Mgmt and Consulting with professionals

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Prevention Strategies for School Counselors

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Eating Issues and Body Image Distortion article

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Abraham, Suzanne

Date: 2016

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Waller, Glen
2010

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National Eating Disorders Association

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Students with Anxiety: The Role of the School Counselor

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Students with Anxiety: The Role of the School Counselor

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GSCA Journal

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Assessment of Risk Factors of onset Anxiety Disorders in Children & Adolescents

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Assessment of Risk Factors of onset Anxiety Disorders in Children & Adolescents

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Public Health and Management Article

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Assessment of the Risk Factors Involved in the Onset of Anxiety Disorders in Children and Adolescents Article

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Horwitz, Allan V.

2013

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Test Anxiety Intervention for Children & Adolescents

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Test Anxiety Intervention for Children & Adolescents

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Psychology in the Schools | Article

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Test Anxiety Interventions for Children and Adolescents article

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BOOK: Handbook of School Mental Health: Research, Training, Practice, and Policy

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BOOK: Handbook of School Mental Health: Research, Training, Practice, and Policy

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Weist, Mark D., Lever, Nancy A., Bradshaw, Catherine P., Owens, Julie Sarno

2014

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American Counseling Assoc. Article

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Counseling Persons with Disabilities article

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Education for families & educators

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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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Links updated, November 2021
This information in Spanish

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

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

anxiety disorders;

bipolar disorder (sometimes called manic-depression);

conduct disorders;

eating disorders;

obsessive-compulsive disorder (OCD); and

psychotic disorders.

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

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

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

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

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

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

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

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

Characteristics

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

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

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

Hyperactivity (short attention span, impulsiveness);

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

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

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

Learning difficulties (academically performing below grade level).

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

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

Causes

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

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

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

Frequency

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

Help for School-Aged Children

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

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

A Look at Specific Emotional Disturbances

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

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

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

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

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

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

Conduct Disorder

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

aggression to people and animals;

destruction of property;

deceitfulness, lying, or stealing; or

truancy or other serious violations of rules. (15)

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

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

family therapy;

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

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

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

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

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

According to the National Eating Disorders Association:

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

Obsessive-Compulsive Disorder

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

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

therapist trained in behavior therapy;

Cognitive Behavior Therapy (CBT);

medication (usually an antidepressant). (23)

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

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

More about School

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

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

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

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

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

Other Considerations

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

The Importance of Support

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

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

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

Resources of More Information

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

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

Anxiety Disorders

Autism

Bipolar Disorder

Conduct Disorder

Depression

Oppositional Defiant Disorder

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

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

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

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

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

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

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

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

National Eating Disorders Association
1.800.931.2237 | www.nationaleatingdisorders.org

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

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

References

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

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

5 | Ibid.

7 | Ibid.

11 | Ibid.

13 | Ibid.

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

15 | Ibid.

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

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

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Info for parents 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. 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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BOOK: The School Counseling and School Social Work Treatment Planner

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BOOK: The School Counseling and School Social Work Treatment Planner

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Knapp, Sarah Edison, Dimmitt, Catherine L., Jongsma, Arthur E.

2014

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Ellen Braaten, ed.
Thousand Oaks, CA: SAGE
2018. 1818 pp. 4 vols.

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Angelo State University - Library Online Resources

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Unauthorized use is prohibited; Usage may be subject to security testing and monitoring; Misuse is subject to criminal prosecution; No expectation of privacy except as otherwise provided by applicable privacy laws.

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School Referral Patterns Among Adolescents

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School Referral Patterns Among Adolescents

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School Referral Patterns Among Adolescents with Serious ED Enrolled in Sustems of Care Article

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Case Study of an Alternative School for Students with Emotional Disturbances

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Out of sight, out of mind case study article

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Mindfulness for students classified with emotional/behavioral disorders

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Mindfulness for students classified with emotional/behavioral disorders

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article

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Mindfulness for Students Classified with Emotional Behavioral Disorders

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BOOK: DSM-5 Made Easy The Clinician's Guide to Diagnosis

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BOOK: DSM-5 Made Easy The Clinician's Guide to Diagnosis

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Morrison, James

2014

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Tobin, Renée Margaret, House, Alvin E.
2016

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Dziegielewski, Sophia F.
2015

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Title IX / Sex Discrimination and Sexual Assault

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The University of Central Missouri (UCM) believes that all students should have the opportunity to learn in an educational environment free from discrimination. Sexual harassment of students, including sexual violence and other forms of sexual misconduct, interferes with this right and will not be tolerated.

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No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.

-Title IX of the Education Amendments of 1972

Angelo State University is committed to providing and strengthening an educational, working, and living environment where students, faculty, staff, and visitors are free from sex discrimination of any kind. In accordance with Title VII, Title IX, the Violence Against Women Act (VAWA), the Campus Sexual Violence Elimination Act (SaVE), and other federal and state law, the University prohibits discrimination based on sex and other types of Sexual Misconduct.

Prohibited Conduct

Sexual Misconduct is a broad term encompassing all forms of gender-based harassment or discrimination and unwelcome behavior of a sexual nature. The term includes sexual harassment, nonconsensual sexual contact, nonconsensual sexual intercourse, sexual assault, sexual exploitation, stalking, public indecency, interpersonal violence, sexual violence, and any other misconduct based on sex. While sexual orientation and gender identity are not explicitly protected categories under state or federal law, it is the University's policy not to discriminate in employment, admission, or use of programs, activities, facilities, or services on this basis. Discriminatory behavior is prohibited regardless of the manner in which it is exhibited, whether verbally, in writing, by actions, or electronically displayed or conveyed.

Behaviors & Examples of Behaviors Covered by ASU's Sexual Misconduct Policy

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No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.

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Teaching Adolescents with Emotional Disturbances

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Teaching Adolescents with Emotional Disturbances

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Beating Your Eating Disorders: A Cognitive Behavior Self-Help Guide for Adult Sufferers and Their Carers

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Beating Your Eating Disorders: A Cognitive Behavior Self-Help Guide for Adult Sufferers and Their Carers

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By Glen Waller, 2010

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Angelo State University - Library Online Resources

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Unauthorized use is prohibited; Usage may be subject to security testing and monitoring; Misuse is subject to criminal prosecution; No expectation of privacy except as otherwise provided by applicable privacy laws.

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Eating Disorders Prezi Presentation

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Dysfunctional Behaviors | Eating Disorders

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Corina N. Villarreal EDG 6327 | Dysfunctional Behaviors Angelo State University Eating Disorders Educating Collegiate Staff on Awareness, Prevention, & Support -- To educate college staff, educators, and counselors on eating disorders. -- To provide information on the prevention

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Understanding Dysfunctional Behavior Patterns in Your Family

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Understanding Dysfunctional Behavior Patterns in Your Family

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Brown University Counseling and Psychological Services

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Appropriate & Inappropriate Activities for School Counselors

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Appropriate & Inappropriate Activities for School Counselors

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ASU

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What mental health professionals do in schools

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What mental health professionals do in schools

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Webinar: Compassion Fatigue in School Counselors: Caring for the Caregivers

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Mod 3 EthicalStandards for School Counselors

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The ASAP® course catalog has been published and includes information on all our standards-based ASAP® course modules, as well as the ASAP® assessments, workbooks, case studies and academies. Download the ASAP Catalog today!

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The ASAP® course catalog has been published and includes information on all our standards-based ASAP® course modules, as well as the ASAP® assessments, workbooks, case studies and academies. Download the ASAP Catalog today!

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Case Study Videos

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Case Studies for Higher Education Leaders Leading in Tough Times Workbook

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Occasionally in life we can get so overwhelmed with all of the things we have to do in order to get to the future and reach our goals (whilst avoiding the present moment). Or maybe we have faulty thoughts or distortions playing in our mind, saying we are not "good enough" to be the person we would like to be.

One thing I know from my own life and the things I have completed (from being a professional athlete to going to university or learning yoga) is that we only ever have this moment and can take one step or moment at a time.

I wonder what life would be like if we enjoyed the journey more and remembered this? Would we slow down, take time out to reflect to find out what is important to us and then have the courage to follow those dreams remembering that we can only ever take one step at a time?

20 Quotes to Inspire You to Take Small Simple Steps Each Day

I hope the following 20 quotes inspire you to take small steps each day and create the life or love you are searching for -

1. "You need to be content with small steps. That's all life is. Small steps that you take every day so when you look back down the road it all adds up and you know you covered some distance." ~ Katie Kacvinsky

2. "Great things are not done by impulse, but by a series of small things brought together." ~ Vincent Van Gogh

3. "Each step you take reveals a new horizon. You have taken the first step today. Now, I challenge you to take another." ~ Dan Poynter

4. "It is better to take many small steps in the right direction than to make a great leap forward only to stumble backward." ~ Old Chinese Proverb

5. "Success is the sum of small efforts, repeated day in and day out." ~ Robert Collier

6. "Habit is habit and not to be flung out of the window by any man, but coaxed downstairs a step at a time." ~ Mark Twain

7. "Be not afraid of growing slowly, be afraid only of standing still." ~ Chinese Proverb

8. "It's the little details that are vital. Little things make big things happen." ~ John Wooden

9. "Take small steps every day and one day you will get there." ~ Unknown

10. "Have a bias toward action - let's see something happen now. You can break that big plan into small steps and take the first step right away." ~ Indira Ghandi

11. "I long to accomplish a great and noble task; but it is my chief duty to accomplish small tasks as if they were great and noble." ~ Helen Keller

12. "The man who removes a mountain begins by carrying away small stones." ~ Chinese Proverb

13. "It does not matter how slowly you go so long as you do not stop" ~ Confucius

14. "Do small things with great love." ~ Mother Theresa

15. "Don't judge each day by the harvest you reap, but by the seeds you plant." ~ Robert Louis Stevenson

16. "The journey of a thousand miles begins with one step." ~ Lao Tzu

17. "Big things have small beginnings." ~ Promethus

18. "The secret of getting ahead is getting started. The secret of getting started is breaking you complex overwhelming tasks into small manageable tasks, and then starting on the first one." ~ Mark Twain

19. "One may walk over the highest mountain one step at a time." ~ John Wanamaker

20. "The key to realizing a dream is to focus not on success but on significance - and then even the small steps and little victories along your path with take on greater meaning." ~ Oprah Winfrey

Reflection -

Which quote did you like the best?

What steps are you inspired to take now to live your dream life?

If you are ready to reclaim your courage and take the next step towards freedom and opening your heart, why not join our Toolkit?

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20 Quotes to Inspire You to Take Small Simple Steps Each Day

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Occasionally in life we can get so overwhelmed with all of the things we have to do in order to get to the future and reach our goals (whilst avoiding the present moment). Or maybe we have faulty thoughts or distortions playing in our mind, saying we are not "good enough" to be the person we would like to be.

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Perceptions of School Counselors and School Counseling Programs and the Transforming School Counseling Initiatives 

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Perceptions of School Counselors and School Counseling Programs and the Transforming School Counseling Initiatives 

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Perceptions of School Counselors and School Principals about the National Standards for School Counseling Programs and the Transforming School Counseling Initiative on JSTOR

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In a national survey, members from the American School Counselor Association, the National Association of Secondary School Principals, and the National Associat...

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Counseling Role-Play

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Example

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8 Characteristics of Effective School Leaders

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8 Characteristics of Effective School Leaders

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Classmates Resource :)

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Trying to pin down what makes an effective school leader can be a little like trying to eat soup with a fork, but a group of academics has come up with what looks like a pretty good list.

I reported earlier this month on a study by experts at the Institute of Education (IoE) in London into the turnaround of schools in one of the city's poorest boroughs, from the worst performing in England to among the best in the world.

Not surprisingly, the researchers identified the quality of leadership as one of the key factors driving the transformation, in line with many previous studies into school improvement, such as Kenneth Leithwood and Karen Seashore-Louis' influential 2011 Linking Leadership to Student Learning.

But the IoE academics - professors David Woods and Chris Husbands and Dr Chris Brown - went further. Through a study of reports by school inspectors, they came up with a set of characteristics shared by successful school leaders that I thought was worth sharing.

1. They have consistent, high expectations and are very ambitious for the success of their pupils.

2. They constantly demonstrate that disadvantage need not be a barrier to achievement.

3. They focus relentlessly on improving teaching and learning with very effective professional development of all staff.

4. They are expert at assessment and the tracking of pupil progress with appropriate support and intervention based upon a detailed knowledge of individual pupils.

5. They are highly inclusive, having complete regard for the progress and personal development of every pupil.

6. They develop individual students through promoting rich opportunities for learning both within and out of the classroom.

7. They cultivate a range of partnerships particularly with parents, business and the community to support pupil learning and progress.

8. They are robust and rigorous in terms of self-evaluation and data analysis with clear strategies for improvement.

Although this list was drawn up with particular reference to schools in difficult circumstances, they appear to readily translate into different contexts. What is particularly heartening is that there is also considerable overlap with qualities of leadership identified by one of England's most respected school principals.

Sir David Carter is chief executive of the Cabot Learning Federation, a group of 11 schools based in and around Bristol. Many of the schools joined the federation after they were identified as in need of improvement, and Sir David was knighted earlier this year for services to education.

When I interviewed him last month for an article on superheads - principals skilled in turning around struggling schools - he spoke about the need to work relentlessly on behalf of pupils (3), having a clear and consistent vision (1) and working closely with the community the school serves (7).

He also adds other qualities, some perhaps implicit in the IoE list, but all crucial to the successful school leadership. Among these was the ability to balance strategic and operational roles, and the ability to manage change and understand how it works.

Another is talent spotting. Sir David invests a huge amount of time in making the right appointments and in getting people in the right roles.

Effective principals also need to have a high level of emotional intelligence and interpersonal skills. Often, the power of school leaders is vested in their capacity to persuade and influence, rather than to direct. "You have to take people with you, you can't be bullish," Sir David says. "You have got to build collaboration and get people to work together."

Finally, Sir David identifies a sense of moral purpose. While this may be of most significance in disadvantaged areas, the desire to get the best for all children is something every principal should possess. "I don't know many who don't have that," Sir David adds.

Of course, every school leader will have a different list. Many will echo these characteristics, many will emphasise different aspects and some will add their own characteristics. But this list - plus Sir David's additions - seems to offer a set of core qualities.

The next question - and one to which I hope to return in a future article - is whether it is reasonable to expect to find them all in one person, and whether the increasingly onerous requirements of the job are off-putting for people who are eminently suitable to lead our schools.

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The Eight Characteristics Of Effective School Leaders

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Trying to pin down what makes an effective school leader can be a little like trying to eat soup with a fork, but a group of academics has come up with what looks like a pretty good list.

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Classmates Resource :)

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"Everything can be taken from a man but the last of human freedoms - the ability to choose one's attitude in a given set of circumstances, to choose one's way." Viktor Frankl, "Man's Search for Meaning."

Controlling Emotions in the Workplace

We've all been in one of "those" situations before. You know... when your favorite project is canceled after weeks of hard work; when a customer snaps at you unfairly; when your best friend (and co-worker) is laid off suddenly; or your boss assigns you more work when you're already overloaded.

In your personal life, your reaction to stressful situations like these might be to start shouting, or to go hide in a corner and feel sorry for yourself for a while. But at work, these types of behavior could seriously harm your professional reputation, as well as your productivity.

Stressful situations are all too common in a workplace that's facing budget cuts, staff layoffs, and department changes. It may become harder and harder to manage your emotions under these circumstances, but it's even more important for you to do so.

After all, if management is forced into making more layoffs, they may choose to keep those who can handle their emotions, and work well under pressure. No matter what the situation is, you're always free to choose how you react to it.

So, how can you become better at handling your emotions, and "choosing" your reactions to bad situations? In this article, we look at the most common negative emotions experienced in the workplace - and how you can manage them productively.

Why are we focusing only on negative emotions? Well, most people don't need strategies for managing their positive emotions. After all, feelings of joy, excitement, compassion, or optimism usually don't affect others in a negative way. As long as you share positive emotions constructively and professionally, they're great to have in the workplace!

Common Negative Emotions at Work

In 1997, Bond University professor of management Cynthia Fisher conducted a study called " Emotions at Work: What Do People Feel, and How Should We Measure It?"

According to Fisher's research, the most common negative emotions experienced in the workplace are as follows:

Frustration/irritation.

Worry/nervousness.

Anger/aggravation.

Dislike.

Disappointment/unhappiness.

From " Emotions at Work: What Do People Feel and How Should we Measure it?" by Cynthia D. Fisher. School of Business Discussion Paper; No. 63, February 1997. © Copyright Cynthia D. Fisher and the School of Business, Bond University.

How to Manage Emotions at Work

Below are different strategies you can use to help you deal with each of these negative emotions.

Frustration/Irritation

Frustration usually occurs when you feel stuck or trapped, or unable to move forward in some way. It could be caused by a colleague blocking your favorite project, a boss who is too disorganized to get to your meeting on time, or simply being on hold on the phone for a long time.

Whatever the reason, it's important to deal with feelings of frustration quickly, because they can easily lead to more negative emotions, such as anger.

Here are some suggestions for dealing with frustration:

Stop and evaluate - One of the best things you can do is mentally stop yourself, and look at the situation. Ask yourself why you feel frustrated. Write it down, and be specific. Then think of one positive thing about your current situation. For instance, if your boss is late for your meeting, then you have more time to prepare. Or, you could use this time to relax a little.

Find something positive about the situation - Thinking about a positive aspect of your situation often makes you look at things in a different way. This small change in your thinking can improve your mood. When it's people who are causing your frustration, they're probably not doing it deliberately to annoy you. And if it's a thing that's bothering you - well, it's certainly not personal! Don't get mad, just move on.

Remember the last time you felt frustrated - The last time you were frustrated about something, the situation probably worked out just fine after a while, right? Your feelings of frustration or irritation probably didn't do much to solve the problem then, which means they're not doing anything for you right now.

Worry/Nervousness

With all the fear and anxiety that comes with increasing numbers of layoffs, it's no wonder that many people worry about their jobs. But this worry can easily get out of control, if you allow it, and this can impact not only your mental health, but also your productivity, and your willingness to take risks at work.

Try these tips to deal with worrying:

Don't surround yourself with worry and anxiety - For example, if co-workers gather in the break room to gossip and talk about job cuts, then don't go there and worry with everyone else. Worrying tends to lead to more worrying, and that isn't good for anyone.

Try deep-breathing exercises - This helps to slow your breathing and your heart rate. For a guide to trying it for yourself, read our article on Physical Relaxation Techniques.

Focus on how to improve the situation - If you fear being laid off, and you sit there and worry, that probably won't help you keep your job. Instead, why not brainstorm ways to bring in more business, and show how valuable you are to the company?

When you're worried and nervous about something, it can dent your self-confidence. Read our article on Building Self-Confidence to make sure this doesn't happen. Also, don't let your worries get in the way of being appropriately assertive.

Anger Management at Work

Out-of-control anger is perhaps the most destructive emotion that people experience in the workplace. It's also the emotion that most of us don't handle very well. If you have trouble managing your temper at work, then learning to control it is one of the best things you can do if you want to keep your job.

Try these suggestions to control your anger:

Watch for early signs of anger - Only you know the danger signs when anger is building, so learn to recognize them when they begin. Stopping your anger early is key. Remember, you can choose how you react in a situation. Just because your first instinct is to become angry doesn't mean it's the correct response.

If you start to get angry, stop what you're doing - Close your eyes, and practice the deep-breathing exercise we described earlier. This interrupts your angry thoughts, and it helps put you back on a more positive path.

Picture yourself when you're angry - If you imagine how you look and behave while you're angry, it gives you some perspective on the situation. For instance, if you're about to shout at your co-worker, imagine how you would look. Is your face red? Are you waving your arms around? Would you want to work with someone like that? Probably not.

To find out more about managing your anger at work, take our self-test How Good Is Your Anger Management? Also, read Dealing with Unfair Criticism and Anger Management.

Dislike

We've probably all had to work with someone we don't like. But it's important to be professional, no matter what.

Here are some ideas for working with people you dislike:

Be respectful - If you have to work with someone you don't get along with, then it's time to set aside your pride and ego. Treat the person with courtesy and respect, as you would treat anyone else. Just because this person behaves in an unprofessional manner, that doesn't mean you should as well.

Be assertive - If the other person is rude and unprofessional, then firmly explain that you refuse to be treated that way, and calmly leave the situation. Remember, set the example.

To learn more about handling dislike in the workplace, please see our articles on Working With People You Don't Like, Dealing With Difficult People and Egos at Work.

Disappointment/Unhappiness

Dealing with disappointment or unhappiness at work can be difficult. Of all the emotions you might feel at work, these are the most likely to impact your productivity. If you've just suffered a major disappointment, your energy will probably be low, you might be afraid to take another risk, and all of that may hold you back from achieving.

Here are some proactive steps you can take to cope with disappointment and unhappiness:

Look at your mindset - Take a moment to realize that things won't always go your way. If they did, life would be a straight road instead of one with hills and valleys, ups and downs, right? And it's the hills and valleys that often make life so interesting.

Adjust your goal - If you're disappointed that you didn't reach a goal, that doesn't mean the goal is no longer reachable. Keep the goal, but make a small change - for example, delay the deadline. Our Back On Track article provides practical steps for recovering from a major career setback.

Record your thoughts - Write down exactly what is making you unhappy. Is it a co-worker? Is it your job? Do you have too much to do? Once you identify the problem, start brainstorming ways to solve it or work around it. Remember, you always have the power to change your situation.

Frequently Asked Questions

What is a "worry log"?

If you find that worries are churning around inside your mind, write them down in a notebook or "worry log," and then schedule a time to deal with them. Before that time, you can forget about these worries, knowing that you'll deal with them. When it comes to the time you've scheduled, conduct a proper risk analysis around these things, and take whatever actions are necessary to mitigate any risks.
How do you use "deep breathing"?
Here's a simple technique to try. Breathe in slowly through your nose for five seconds, then breathe out slowly through your mouth for five seconds. Focus on your breathing, and nothing else. Do this at least five times, and see whether it has a positive impact on how you feel.
Does smiling help?
Strange as it may sound, forcing a smile onto your face can often make you feel happier (this is one of the strange ways in which we humans are "wired.") Try it - you may be surprised!

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Managing Your Emotions at Work - Controlling Your Feelings... Before They Control You

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Learn how to manage your emotions at work constructively, whether you experience frustration, irritation, worry, anger, dislike or unhappiness.

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How to copyright your graduate school work.

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Copyright Act - Copyright Alliance, Create Innovate Protect

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Copyright Law of the United States. The U.S. Copyright Act is the basis for copyright law in the United States. In the table below you will find the text of the U.S. Copyright Act, which can

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Individual Counseling

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In this module, you will learn about the process of terminating the counseling relationship. When any relationship ends, including a counseling relationship, there are many emotions that those individuals involved in the relationship may experience. The Termination Stage is the final stage of counseling, but is just as important as the initial phase of counseling. How you close your counseling relationship can have a significant impact on your client's view of his or her experience in counseling and the likelihood of their practicing what has been learned in counseling after sessions have concluded.

As Masters students, you will participate in Practicum and Internship placements that will provide you with the opportunity to establish, cultivate and terminate effective counseling relationships with many individuals. Termination of these relationships often proves to be one of the more difficult aspects of training for students because the duration of your relationship with clients is determined more by the timing of your academic semester than by the needs of the client and the achievement of mutually determined goals. Termination is often required before you or the client feel ready (forced-termination). This somewhat artificial aspect that is inherent in the training process can lead to a myriad of emotions for both counselor and client that must be acknowledged and worked through by both individuals.

**In some cases, the "end" of counseling is not always the end, and follow-up is deemed appropriate by the counselor and client to serve as a check to see if change has been maintained and to allow for clients to revisit old issues or work on new issues at a later date. For the purpose of this module, it is assumed that follow-up is not an option for counselors-in-training who are participating in temporary counseling placements.

In This Module

Moving Toward Termination of Therapy

Ideally, termination occurs when the goals that are mutually agreed upon by the counselor and client have been achieved, or the problem for which a client has entered into counseling has become more manageable or is resolved. However, as Masters students, you will learn during your Practicum experience that it is relatively unlikely that you will have been able to work through all of the stages of counseling with your clients during the span of one semester, especially when you may only be at your site one or two days a week. Oftentimes, it can take the majority of your time at the site to establish a trusting connection with clients so that they are willing to open up to you about their issues. You may have resistant clients who are mandated to see you, or clients who volunteer to engage in the process with you but who bring so many concerns with them that it is difficult to decipher what needs to take precedence. Getting them to a point at which they are comfortable with you might bring you close to the end of the semester, at which point you are already thinking about having to end the relationship you have worked so hard to establish.

Termination is the final stage of the counseling process but is not something that should be broached during your last (or next to last) session with a client. Doing so does not allow for the proper amount of time for counselor and client to process what termination means, how the client will handle the conclusion of the counseling relationship, and what follow-up contact or transitioning needs to happen for the client. Termination should be among the first topics that you and your client discuss. Kramer (1990) clearly articulates this when he writes: "The therapist must be clear from the first contact, unless there are mitigating circumstances, that the intent of treatment is to help the (client) function without the therapist." As a counselor, you are ethically bound to communicate to your client how long you will be available to counsel them, to discuss openly the timeline of your relationship, and to make appropriate referrals or recommendations at the conclusion of your relationship. It is a stage of counseling that clients need to be prepared for and counselors need to address early on in the counseling process to avoid abandonment.

Here are some helpful guidelines for effectively moving your clients toward termination:

Remind clients of the approaching ending of the sessions with you. This should be done at least 2-3 sessions prior to the final one. This provides you an opportunity to ask clients to talk about relationships that have ended in their past, how they have ended, and how that might affect the end of this counseling relationship. You can also ask clients what they would like to focus on during their remaining time with you. A question to ask prior to the final one, which may help to prepare clients for the reality of the end, is "If this were our last meeting, how would that be for you?"

If you and your client are not limited to a certain number of sessions, you have the option of spacing out your last few meetings. This is a good way to wean your client of the relationship and foster in them a sense of confidence in their ability to handle things without seeing you on a weekly basis before the relationship abruptly ends.

Review the progress that you and the client have made during your sessions. Very often, clients will forget the advances they have made, or neglect to give themselves credit for their accomplishments. Doing this with them can instill confidence and provide them with a positive perspective on what counseling helped them to do. Ask your clients what they learned, what they intend to do with what they have learned, what they found helpful about their sessions and how they felt about their participation in the process.

Allow clients to talk about their feelings surrounding termination. They will likely have many emotions to work through and time should be spent acknowledging and processing them.

Be aware of your own feelings surrounding the termination process. It is normal to feel many emotions when ending a relationship with your clients. Acknowledge your feelings, your ambivalence about termination, etc. Always keep in mind that your ultimate goal as a counselor is to "put yourself out of business." If you are good at what you do, people will not need to continue to see you for help. They will have the tools to help themselves.

If possible, have an open-door policy. Once termination has ended, clients may want to return a few months or years later to refocus or to "check-in". This is often impossible in the training setting, but something to keep in mind for your professional career.

Review the tools and skills that clients have acquired through the counseling process. These tools will be critical in helping clients be self-sufficient in handling problems that might have previously brought them to counseling. If there are additional resources that you feel your client would benefit from for continued personal growth, make appropriate referrals and make your client aware of them.

Types of Termination

Forced-Termination

Definition: Forced-termination is termination of the counseling relationship before the work of therapy has been fully accomplished. This will be the most common type of termination that you will face as a Masters student. As a counselor in training, your clients are individuals who have typically been seeing someone else. You are given what you could call a rotation during which you take over as their counselor, and upon your departure, the individual is transitioned back to his or her regular therapist. In some situations, you may meet with clients who are not receiving services because there are simply not enough professionals to offer service to meet the needs of the site. In these situations, transition may not always be possible.

Anticipated Reactions: Clients typically feel anger toward the counselor, perceiving the end of the counseling relationship as abandonment. This may occur even if you make termination a topic of conversation throughout your counseling sessions. It is most likely to occur if you do not mention termination until very close to your intended departure from the relationship. Clients may feel anxious at the thought of having to handle things on their own without the support they have found in your relationship. Other reactions from clients might include sadness at losing a relationship upon which they have come to depend, or indifference at the end of the relationship. These emotions are oftentimes easier or more comfortable to express that anger or separation anxiety. Always keep in mind that how other relationships in the client's past have ended will very likely affect his or her reaction to the end of your counseling relationship. Unresolved issues surrounding past relationships can be played out in the termination process, but if you handle the process ethically, sensitively, and honestly, you are in a wonderful position to provide your client with a healthy end to a productive relationship that they can look back on positively and feel comfortable with.

Counselors also experience many emotions when forced-termination occurs. Guilt is a very common emotion for counselors to feel when they initiate the termination stage. Forced-termination, by its very definition, means that the counseling relationship is ending prematurely. After spending so much time encouraging your client to be trusting, open and honest, one must now abruptly sever that connection. This can leave counselors feeling as though they are abandoning their clients just as good progress could have been made, and can lead to a sense of feeling responsible for whatever might happen to the client as a result of the end of the relationship. For many counselors, a sense of frustration exists at not having "finished the job" or achieved the goals set out by the counselor and client. Counselors-in-training often struggle with a sense of omnipotence, or the feeling that they are the only one who can understand or help the client. On the other hand, it is normal to feel a sense of impotence, or the feeling that the relationship was not at all helpful to the client and that the client will be helped more effectively by a different therapist. When working with a client for only a short period of time, it can be difficult to see if any progress was made, especially if the client is not communicating any improvements to the counselor. In such cases, it is important for counselors to work to become comfortable with that feeling of "not knowing." It may not be for some time that a client himself realizes if and how a counselor has been of help. And as a counselor, you may never know. Counselors may feel a sense of loss and sadness at not being able to see their clients anymore, and other may feel a sense of relief. This relief often leads to guilt about being glad to move on from the counseling situation. It is very important to acknowledge your own feelings as you proceed through the termination stage of counseling.

Client-Initiated Termination

Definition: Client-Initiated Termination can occur in a number of situations. A client may initiate termination when it is determined that the goals that he or she set out to accomplish have been adequately met, or when he or she feels that problematic symptoms have been reduced or eliminated. If the counselor agrees that goals have been met and the timing for termination is appropriate, termination can be a comfortable, pleasing experience for all involved. There may still be a sense of loss at not seeing the client on a regular basis, but this is often outweighed by a sense of happiness in knowing that the relationship was positive and productive and helped the client make progress.

Anticipated Reactions: In some cases, clients may initiate termination of the relationship if they do not feel comfortable with the counselor or do not feel that they are ready to fully engage in the counseling process. In such cases, counselors often feel a sense of insecurity in their ability to effectively connect with and counsel clients, guilt about "losing a client", and possibly relief at being rid of a relationship that they were uncomfortable with. In this case, it is very important for counselors to process their own feelings about the end of the relationship and how it might affect future interactions with clients.

Counselor-Initiated Termination

Definition: Counselor-Initiated Termination can occur when the counselor sees that the client has made progress toward achieving goals, notices a reduction in or elimination of symptoms, sees that the client has gained enough insight to deal with future recurring symptoms and has resolved transference issues, and determines that the client has the ability to work, enjoy life and play. Once the counselor has determined that there is little left to continue working on in therapy, it is time to introduce the reality of termination to the client. Counselor-initiated termination is also your ethical duty as a counselor if you determine "an inability to provide professional service" to your client. If this is the case, it is your responsibility to make appropriate referrals and to obtain the professional training that would enable you to work with similar clients effectively in the future.

Anticipated Reactions: Sometimes, clients will resist the termination process. After all, they have enjoyed success, in part, due to a relationship with their counselor. Ending that relationship can be frightening. The client may insist that more time is needed to work on the issue(s). A plethora of additional problems may suddenly arise, and sessions may be missed in an attempt to draw out the process or avoid termination. The client may become suddenly angry at the mention of termination in order to create distance between client and counselor, and, in some cases, the client may prematurely end therapy of his or her own volition.

Counselors may also resist the process. If a client has enjoyed success, in which you have played a part, it is easy to want to maintain that relationship. As a counselor, you are receiving positive feedback, feeling needed and appreciated, all of which provides you with confidence and a sense of self-worth. Letting go of that to allow your client to function independently can be difficult. It is important to recognize the positive work you do as a counselor, but this should not lead to your maintaining a relationship that is no longer serving the client.

It is important to remind you that not all clients will exhibit the emotions outlined as "typical." You must understand your clients' reactions to termination in relation to their overall experience in the counseling relationship, taking care to acknowledge cultural and historical influences. For example, an Asian client is far less likely to exhibit anger and separation anxiety at termination than a client of European origin might be. This caveat is simply to remind you to pay appropriate attention to factors that might influence how your clients react or appear to react to the termination stage.

Termination of Group Counseling

Many of the same skills necessary for termination of individual counseling relationships are necessary for terminating counseling groups. Group leaders must be aware of their own timeline for the group, communicate that timeline to group members and know when to initiate the termination stage. Very often groups will have a set number of sessions, so the conclusion of the counseling relationship can be anticipated. This, however, does not necessarily make the process of termination any easier on group members.

As in termination of individual counseling, there may be feelings of sadness or anxiety over the ending of the group. Participants often become reliant on the group for support and advice and can be fearful at the reality of that support being removed. Once termination has been introduced, members may pull back, or disengage themselves slightly from the process in an effort to protect themselves from the emotions surrounding termination.

Some of the things that group leaders can do to increase the chances of ending a group successfully include:

Reinforcing the progress that was made during the course of the group.

Offering suggestions to group members about ways in which they can successfully incorporate what they have learned into their daily lives.

Helping group participants brainstorm and anticipate problems that may arise when the group has concluded.

Allowing time for constructive feedback from group members. This includes feedback for the leader as well as feedback for other group members.

Assisting participants in processing their feelings about termination and helping them resolve any unfinished business.

Educating participants about additional resources that are available to them as supports once the group has ended.

Making oneself available should the need for individual counseling or consultation with group members arise.

Tips for Successful Termination

To increase the likelihood of successful termination with your clients, take heed of the following suggestions:

Discuss termination with your clients early on in the counseling process.

Establish clear goals with your clients so that progress toward those goals can be recognized and completion of those goals is apparent.

Respect your client's desire to terminate if it is client-initiated, but be confident in expressing concerns if you feel termination may be premature.

Keep your relationship professional and do not let it stray into the realm of friendship.

Communicate to your clients that they can return if need be.

Help clients to review the success they have had in counseling.

Allow clients to discuss feelings of loss surrounding termination and process your own feelings surrounding the process, as well.

Helping the Helper Deal with Termination

As counselors-in-training, you are in the unique position to be able to utilize your site supervisors and on-campus supervisors and professors as resources when dealing with the issues surrounding termination. As you have read above, counselors deal with many emotions as the counseling relationship ends, and these emotions must be acknowledged and worked through. Supervisors are there to provide you a place to communicate your feelings about ending your relationships, about the discomforts of closure and the feelings you will experience about your own abilities as you leave counseling relationships behind. This is often one of the most difficult stages of training for students who are struggling to feel competent while feeling completely overwhelmed.

It is also important for you to discuss your experiences surrounding termination with your peers. You will find that you are not alone in feeling the way you do about ending your relationships with clients, and this camaraderie can make a world of difference when you are in the infancy of becoming effective helpers.

The Value of Feedback

Eliciting feedback can also help counselors through the termination process. As discussed earlier, counselors do not always know if they have been effective in helping a client, especially if the relationship was forced to an end by the close of a school semester. One way to make termination a reality and offer clients the chance to give feedback and reflect on their experience with you is to have them fill out some kind of informal evaluation. This will be done to some extent when you and your clients discuss terminating your relationship, but offering an opportunity for clients to express things concretely on paper for you both to keep can be a good way to summarize the experience for you both. If you are so inclined, you could document the progress you have seen in your clients and offer that written expression to them for their future reference and reminder.

Sample Feedback Form Questions

For each of the statements below, circle the option (Never, Sometimes, Usually, or Always) that is closest to how you feel.

1. I feel like (your name here) really listens to me and understands what I am saying.

2. I feel comfortable and safe when I meet with (your name here). I feel like she cares.

3. I feel like meeting with (your name here) has helped me sort out some of my feelings.

For each of the statements below, circle the option (I disagree, I'm not sure if it helped, It helped a little, or It helped a lot) that is closest to how you feel.

1. I feel like meeting with (your name here) has helped me talk about my feelings.

2. I look forward to seeing (your name here) and talking about what is going on in my life.

Additional questions:

1. What do you like about coming in to talk with (your name here)?

2. Is there anything you don't like so much about coming to talk to (your name here)?

3. How do you feel about (your name here) leaving and not meeting with him/her anymore?

4. What, if anything, will you miss about your time with (your name here)?

5. Do you have any additional feedback about your time with (your name here)?

Positive Endings to the Counseling Relationship

One thing that is often appropriate to do for clients, particularly if you are at a school setting, is to leave clients with something material that will remind them of your relationship and the successes they experienced as a result of engaging in that relationship. There are many creative ways to do this.

Below you will find two suggestions for concluding individual counseling relationships:

Marbles

Purchase a bag of marbles, filled with swirls that make each one different. You could give each client a marble and communicate how they, like the marble, are unique and special. They can keep this marble with them to serve as a reminder that someone thinks of them that way and as a reminder of their positive relationship with you and the progress they made.

Survival Kit

Using a box, a Ziploc bag, or any other container you choose, select various items that represent something about that client, or a lesson that the client learned through the counseling process. For example, a Life Saver candy could represent the people for the client has been a "life saver" in the past. A rubber band could serve as a reminder of the importance of being flexible. A toothpick could remind your client not to pick on him or herself for the little things. A Band-Aid could represent the need to take time to heal wounds. A stick of Carefree gum could remind your client to take time out to play and enjoy life. You get the drift. You can get creative with your Survival Kit and it is a great way to leave your client with something tangible that reminds them of you, and reinforces the skills you have worked on with them throughout your relationship. Can you think of other keepsakes that would be appropriate for you to give to your clients?

Below are descriptions of two creative ways to provide closure during a final group counseling session:

Anonymous Notecards

One fantastic method I have seen used to conclude a group has been the use of notecards passed around the room and filled out by group participants. Each person is given a blank notecard. They write their name across the top and pass it to the person sitting to their right. That person then writes something that they learned about or from the person to their left. They could also write what they think of that person, as long is it is something constructive and/or positive. Once they are done, they pass the card to the right and that person writes their comments on it. By the time the card makes its way around the circle, the owner of the card has received feedback from everyone in the group but does not necessarily know who wrote what comment. He or she is then asked to read aloud the statements that others in the group chose to write about them. This is a wonderful way to help group members hear and own the positive things about themselves that others recognize in them after sharing the group experience. The cards are for them to take with them as a reminder of the process.

Connections

This is a great way to provide visual representation of how each person in a group has an effect on everyone else in the group. Take a ball of string or yarn, large enough that it can be tossed from person to person to create a web. Have everyone stand in a circle and give one person the yarn. They are to hold on to one end of the yarn and offer up something about what they learned in the group or from a particular group member. Once they have made their statement, they hold on to the one end of the yarn and toss the ball to a fellow group member across from them. They make a comment about something they learn, hold on to the yarn so that they are creating a line between themselves and the person who threw the yarn to them, and they then toss the ball to another member across from them. Each member makes a statement and tosses the ball to a fellow participant, all the while holding on to the piece of yarn that comes from the person who went before them. Once everyone has spoken, you will see that a huge web has been created that symbolizes the connection that group members make with one another through the group counseling process. This is an excellent way to show how everyone is connected, affects one another, and how the things that each member brought to the experience have sustained the group.

Additional Resources

ACA Code of Ethics: Termination and Referral (A.11.)

Theory and Practice of Counseling and Psychotherapy by Gerald Corey. 2001.

Becoming A Helper by Marianne Schneider Corey and Gerald Corey. 1998.

Practice Issues for the Beginning Counselor by Harold Hackney. 2000.

The World of the Counselor: An Introduction to the Counseling Profession by Ed Neukrug. 1999.

Ethnicity & Family Therapy, 2e, Edited by Monica McGoldrick, Joe Giordano and John K. Pearce. 1996.

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Termination of Counseling | Syracuse University School of Education

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In this module, you will learn about the process of terminating the counseling relationship. When any relationship ends, including a counseling relationship, there are many emotions that those individuals involved in the relationship may experience. The Termination Stage is the final stage of counseling, but is just as important as the initial phase of counseling.

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Developing an Effective Command Philosophy

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Grad School: Leadership 6363

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Developing an Effective Command Philosophy

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Creating your own leadership philosophy

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Leadership Lessons Creating Your Own Leadership Philosophy

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Why you should have a Leadership Philosophy

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