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Bipolar: What is it?

People with bipolar disorder, also known as manic-depressive disorder, are afflicted with bouts of major depression and periods of mania-euphoria, poor judgment, and extreme risk-taking activity-in an often debilitating cycle. Onset usually occurs in mid-to-late adolescence, though there are cases in children. Bipolar disorder is treatable, but managing the episodes of depression and mania is a lifelong undertaking.

Until the revised DSM-5 came out, children who were chronically irritable and prone to severe tantrums were often diagnosed as bipolar, even though they did not experience the episodes of mania that define the disorder. These children are now diagnosed with disruptive mood dysregulation disorder.

Bipolar: What to Look For

Adolescents with bipolar disorder will show signs of both depression (prolonged sadness, lack of affect and interest in things they previously enjoyed, sleeping too much) and mania (periods of excitability or irritability, exaggerated self-confidence, even recklessness). For some, the onset of bipolar disorder is marked by a depressive episode; in others, it is a manic episode. Onset can also be a less severe, chronic form of depression called dysthymia or a milder form of mania called hypomania. The duration of and intervals between depressive and manic episodes are highly variable, particularly in younger people.

A young person might be having a manic episode if his personality seems to change drastically, he develops an inflated sense of his abilities, he displays grandiose thinking, he starts sleeping much less than he normally does, or he becomes extremely energetic, foolhardy, and voluble. Psychotic episodes-breaks from reality-can occur during both manic episodes and severe depressive episodes. During a manic episode, these can include impossible assessments-I can fly-or delusional thinking. For some, a psychotic episode is the first sign of the disorder.

Being on the lookout for symptoms of mania is particularly important if someone already has depressive symptoms. Bipolar disorder with an unnoticed manic component can be misdiagnosed as major depressive disorder, as people are much more likely to seek professional help when gripped by a depressive episode. When a manic episode hits, a sufferer is often elated, displays poor judgment, and cannot realize that his behavior is irrational. But depression and bipolar disorder are not the same thing and should be treated differently.

Bipolar: Risk Factors

Children with a family history are more likely to develop bipolar disorder.

Bipolar: Diagnosis

The standard for a diagnosis of bipolar disorder is the presence of a manic episode, though the vast majority will experience depression as part of the disorder.

A manic episode is a sustained period of "abnormally and persistently elevated, expansive, or irritable mood" in a distinct shift from normal functioning-not just "10 minutes of feeling super-good," as one clinician puts it, but a pattern of behavior. Some of the following symptoms are also usually present: grandiosity; decreased need for sleep; increased talkativeness; racing thoughts; scattered attention; drive to achieve goals; and risk-taking behavior. These symptoms must significantly interfere with normal activities-social life, school, work-or a psychotic episode must be present.

A teenager in a major depressive episode will display either depressed or irritable mood most of the time, or lose interest or pleasure in things he once enjoyed. In addition, he'll show some of the following symptoms: marked weight loss or gain; sleeping too much or too little; restlessness or lethargy; fatigue; feelings of hopelessness, helplessness, worthlessness, or excessive or inappropriate guilt; cloudy or indecisive thinking; and a preoccupation with death, plans of suicide, or an actual suicide attempt.

This section describes the most severe form of the condition, called bipolar I disorder. Some are also diagnosed with bipolar II disorder, in which less severe episodes of hypomania replace manic episodes.

Bipolar: Treatment

Medication is essential to the treatment of bipolar disorder, as is the involvement of the whole family. Psychotherapy can be of help in limiting and managing manic and depressive episodes and their consequences, which can severely affect a young person and all those around him. Even with an effective course of medication, people with bipolar can have "breakthroughs," or relapses, so a support network of family, friends, and professionals who monitor the young person's behavior is vital.

Psychotherapeutic: Bipolar is often treated with cognitive behavioral therapy in addition to medications. CBT helps children and adolescents with the disorder understand what triggers their episodes, how their thoughts influence their feelings, and how to control and manage them. Family therapy is often employed to engage parents and other family members in keeping track of symptoms and managing stress levels in the home, which can lead to episodes.

Some other therapies that have been shown to help include "prodrome detection," which encourages early detection and prevention of a budding episode, and social rhythm therapy, which uses a codified daily schedule to head off mania or depression.

Pharmacological: The first-line medication used to treat bipolar disorder is often a mood stabilizer. This class includes lithium and various anticonvulsants, which are generally effective at treating manic symptoms and lowering the frequency and severity of both manic and depressive episodes. A young person diagnosed with bipolar disorder might take lithium for the rest of his life. Other drugs can be prescribed to treat symptoms like psychosis (antipsychotics) or trouble sleeping (anti-anxiety drugs). If a mood stabilizer does not adequately address depressive symptoms, a doctor may prescribe an antidepressant, but will do so with extreme caution and almost always in conjunction with a mood stabilizer, as antidepressants can trigger a manic episode.

Many people with bipolar disorder take more than one medication and the medications can have complex interactions, leading to significant side effects if they are not effectively monitored by an experienced clinician.

Electroconvulsive Therapy: In some cases where medication and therapy aren't providing the hoped-for result, electroconvulsive therapy, or ECT may be considered. This is not the "shock therapy" of old; in ECT, the patient is anesthetized briefly while electrical current is passed through a part of the brain. This causes a seizure, though there are few, if any, external signs of a seizure, and no danger to the patient, who has also been given a muscle relaxant. ECT is rarely used in adolescents, and there is little information about its use in pre-pubertal children.

Bipolar: Other Concerns

Children and adolescents with bipolar disorder are at increased risk of committing suicide-the third leading cause of death among adolescents and young adults aged 15 to 24. Never ignore signs of suicidal behavior or ideation, which include: drastic changes in eating habits, sleep patterns, or personality; marked neglect of personal appearance; giving away personal belongings; sudden happiness after a period of depressed mood; and, of course, talk of suicide or of "going away" or "not being a problem anymore."

If you think your child or adolescent is suicidal, you can call the National Suicide Prevention Lifeline at 1-800-273-8255 or 911 if there is an emergency. Don't hesitate-the risk of suicide in children and adolescents is all too real.

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People with bipolar disorder, also known as manic-depressive disorder, are afflicted with bouts of major depression and periods of mania-euphoria, poor judgment, and extreme risk-taking activity-in an often debilitating cycle. Onset usually occurs in mid-to-late adolescence, though there are cases in children. Bipolar disorder is treatable, but managing the episodes of depression and mania is a lifelong undertaking.

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Depression is a psychiatric disorder that afflicts young people with chronic feelings of sadness or worthlessness-the defining characteristic of the disorder is that it robs a person of the capacity for pleasure. Unhappiness triggered by events is not uncommon in children, but it normally goes away when circumstances change.

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Schizophrenia is a disorder characterized by distorted perceptions of reality, including hallucinations, delusions and "disorganized" thinking and speech. Our guide explains the signs and symptoms of schizophrenia and how it's diagnosed and treated, usually in young adults.

Schizophrenia: What Is It?

Schizophrenia is a chronic psychiatric disorder characterized by distorted thinking, hallucinations, and/or delusions-called "positive" symptoms-and "negative" symptoms including social isolation and flat affect. Children with schizophrenia often experience paranoid delusions-seeing hostile intent where there isn't any-and their resulting behavior is misinterpreted as conduct disorder. They may believe other people can control their thoughts or read their minds, or believe that there are special messages for them in things like television shows or coincidences. While childhood schizophrenia is very uncommon, preliminary symptoms of the disorder can manifest in younger kids.

Schizophrenia: What to Look For

Children with schizophrenia may exhibit unusual thoughts and behavior. If your child has schizophrenia, he might express ideas that don't make sense, appear internally distracted, or perceive hostility in others where none is apparent. While it is common for young children to have imaginary friends, the voices that kids with schizophrenia hear are experienced as external, not internal, as if they're hearing someone else talking, or telling them what to do. Other signs include a child's belief that strangers know about him or are talking about him, or that the television is relaying special messages to him. For a child with schizophrenia, everyday tasks such as eating, bathing, attending school, and communicating coherently may become difficult, and he might withdraw from social interaction or appear to have little emotional range.

Schizophrenia: Risk Factors

Children who have a family history of schizophrenia are at higher risk for the disorder, though most kids who have a parent with schizophrenia never develop it. Pregnancy and birth complications are also linked to schizophrenia, though, again, the vast majority of children with these risk factors don't develop the disorder.

Schizophrenia: Diagnosis

The characteristic symptoms of schizophrenia include delusions, or beliefs held contrary to all evidence; hallucinations, or distortions in the perception of reality; disorganized or incoherent speech; and extremely disorganized or catatonic behavior (i.e. physical immobility or excessive mobility). Children with schizophrenia may display a lack of emotional responsiveness (called blunted or flattened affect), a lack of motivation (called avolition) and a lack of voluntary speech (called alogia). Other symptoms may include strange eating rituals, irritability, or inappropriate emotions. A child will be diagnosed with schizophrenia only if his symptoms interfere with age-appropriate activities, and have been in evidence for at least 6 months.

Schizophrenia is very difficult to diagnose because other psychiatric disorders (bipolar disorder, OCD, depression, even substance abuse) can generate similar symptoms if they manifest in psychosis. It is possible children with schizophrenia will be falsely diagnosed with conduct disorder because paranoia makes them respond in hostile or oppositional ways.

Schizophrenia: Treatment

The recommended treatment for schizophrenia, called Coordinated Specialty Care, involves a combination of services coordinated by a group of professionals working with the patient and the family. This treatment, within the first two to three years after a patient's initial psychotic episode, has been shown to decrease relapses of psychosis by more than 50 percent and prevent much of the disability associated with a psychotic illness.

Elements of the treatment include:

Low doses of antipsychotic medication

Cognitive behavioral therapy for psychosis (CBTp)

Family education and support

Educational and vocational rehabilitation

Unlike the old standard treatment for schizophrenia, which involved higher doses of medication and no follow-up after hospitalization, the goal of early treatment is not only to reduce psychotic symptoms, but also to help young people learn to manage them and to construct a support network to prevent relapse.

Related:

Schizophrenia: Risk For Other Disorders

Some children diagnosed with schizophrenia in fact have other disorders that manifest in psychosis, including obsessive-compulsive disorder and depression. And some develop other disorders as well, including OCD, panic disorder and post-traumatic stress disorder. Substance abuse is also a big problem for adolescents and young adults with schizophrenia, as it may drastically worsen their symptoms.

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Schizophrenia is a disorder characterized by distorted perceptions of reality, including hallucinations, delusions and "disorganized" thinking and speech. Our guide explains the signs and symptoms of schizophrenia and how it's diagnosed and treated, usually in young adults. Schizophrenia is a chronic psychiatric disorder characterized by distorted thinking, hallucinations, and/or delusions-called "positive" symptoms-and "negative" symptoms including social isolation and flat affect.

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Children with obsessive-compulsive disorder (OCD) are plagued by unwanted and stressful thoughts and fears that they try to alleviate by performing compulsive rituals like counting or washing their hands. This guide explains how OCD impacts children, how it's diagnosed and the most effective treatments.

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Children with obsessive-compulsive disorder (OCD) are plagued by unwanted and stressful thoughts and fears that they try to alleviate by performing compulsive rituals like counting or washing their hands. This guide explains how OCD impacts children, how it's diagnosed and the most effective treatments.

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Getting treatment for depression can feel daunting. Often the depression itself gets in the way. A child who is depressed might be feeling overwhelmed, tired and hopeless. They might also be unfairly blaming themselves or their circumstances for the way they feel. These are some of the characteristic symptoms and thoughts that accompany depression, and they can make it hard for someone who's depressed to speak up and ask for help, or believe concerned parents when they say treatment for depression can help them.

But treatment can really help children and adolescents struggling with depression, including several different kinds of therapy and medication that have all been proven to be effective. Research shows that the most effective treatment is a combination of therapy and medication.

Wendy Nash, MD, a child and adolescent psychiatrist, says she considers therapy "nearly a requirement" when she is prescribing medication for depression, explaining that the skills taught in therapy are essential. Part of the advantage with therapy is that the skills children learn will always stay with them.

What to expect from a clinician

Having a good relationship with your child's clinician is essential, because the more engaged and committed your child is in treatment, the more likely it is to be successful. A good clinician should make sure you understand the goals of treatment and make you feel like your questions are being taken seriously. You should also feel that you can be honest about how your child is doing.

Jill Emanuele, PhD, senior director of the Mood Disorders Center at the Child Mind Institute, says one of the first things she does with a new patient is try to establish a good rapport. "You get to know the person, you make them comfortable. You establish a safe space where you show them that you're listening and you care. Often enough we're the first person that's actually listening to them in a way they haven't experienced before, or have not experienced often."

If a person is resistant to treatment, Dr. Emanuele says she tries to address that. "Maybe they've had a difficult experience with therapy before, or they don't really trust adults, or perhaps they are shamed by their behavior or what they're feeling, and they don't want to show it to another person."

If your child hasn't received a formal diagnosis yet, his clinician should begin with an evaluation. This is to confirm that your child actually does have depression, and also to determine if they have another mental health or learning disorder as well. It isn't that uncommon for kids with undiagnosed anxiety, ADHD, learning disorders and other issues to develop depression. If your child has multiple disorders, then their treatment plan should include getting help for all of them.

Therapy for depression

There are different kinds of therapy that are considered "evidence-based" for treating depression, which means that they have been studied and clinically proven to be effective. Here is a breakdown of some of them:

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy is the gold standard therapy for treating children and adolescents with depression. CBT works by giving people skills to cope with symptoms like depressed mood and unhelpful thoughts (like "no one likes me" or "things will always be like this"). In CBT the child and their therapist collaborate to meet set goals, like catching those unhelpful thought patterns and improving problem-solving ability.

Central to the treatment is teaching kids that their thoughts, feelings and behaviors are all interconnected, so changing one of these points can change all three. For example, one technique called "behavioral activation" encourages them to participate in activities and then observe the effect it has on their mood. In Dr. Emanuele's words, "We set up a hierarchy of activities they can start to engage in. The idea is to get moving and active, so you not only get that physical momentum, but you also start to experience more positive thoughts from having success and interacting more with others."

Behavioral activation helps counter the isolation that teenagers with depression often experience, which can reinforce their depressed mood.

Dialectical behavior therapy (DBT)

For teenagers with more severe depression, dialectical behavior therapy can be helpful. DBT is a form of CBT that was adapted for people who have trouble managing very painful emotions, and may engage in risky behavior, self-harm like cutting, and suicidal thoughts or attempts.

To manage intense emotions, people participating in DBT learn to practice mindfulness (being fully present in the moment and focusing on one thing at a time, without judgment) and develop problem solving skills like tolerating distress, handling difficult situations in a healthy way and interacting more effectively with friends and family. DBT is a highly structured treatment that includes individual therapy and skills groups. DBT for adolescents includes sessions with parents and their child learning skills together.

Interpersonal psychotherapy (IPT)

Social relationships can sometimes influence and even maintain depression. When a person is depressed their relationships can also suffer. Interpersonal therapy works by addressing a child's relationships to make them more healthy and supportive. In this therapy children learn skills for better communicating their feelings and expectations, they build problem-solving skills for handling conflicts, and they learn to observe when their relationships might be impacting their mood.

IPT has been adapted for adolescents with depression to address common teen relationship concerns including romantic relationships and problems communicating with parents or peers. Called IPT-A, this specialized form of interpersonal therapy is typically a 12- to 16-week treatment. Parents will be asked to participate in some of the sessions.

Mindfulness-based cognitive therapy (MBCT)

While its efficacy is still being measured in adolescents, mindfulness-based cognitive therapy is another treatment that has been shown to work for young adults and adults with depression.

MBCT works by combining cognitive behavioral therapy (CBT) methods with mindfulness. Mindfulness teaches people to be fully present in the moment and observe their thoughts and feelings without judgment. This can help them interrupt undesirable thought patterns that can maintain or lead to a depressive episode, like being self-critical or fixating on negative things in ways that are not constructive.

MBCT was originally developed to help people with recurring episodes of depression, but it can also be used for treating a first episode of depression.

Medication treatment

Children and adolescents with depression can also benefit from medication, and clinicians often prescribe medication for more severe depression or when therapy alone isn't providing effective treatment.

Medications most often prescribed to treat depression are selective serotonin reuptake inhibitors (SSRIs) like Zoloft, Prozac and Lexapro, and serotonin-norepinephrine reuptake inhibitors (SNRIs) like Strattera and Cymbalta. These medications are also known as antidepressants. Your child's clinician may also prescribe an atypical antidepressant like Wellbutrin.

Dr. Nash says that sometimes young people (and their families) are worried about taking medication for depression. People often worry that medication will change their personality, or they will feel "drugged." They also worry that they might become addicted to the medication.

She takes these concerns seriously, and talks to patients and their families about what to expect. The right medication at the right dose won't make a child feel drugged and it won't change who he is, but it should help his symptoms of depression. She also explains that antidepressants are not addictive. "You don't have an urge to take them, or seek them out to the detriment of your relationships," she says. When it is time to stop taking antidepressants, it is uncommon for people to have ongoing symptoms of withdrawal if they taper off the medication carefully, and under the supervision of their doctor.

Dosage and side effects

It is rare for a person to stay on the same dose she is initially prescribed. Instead, doctors adjust dosage once every week or every two weeks in the beginning, as the medication builds up in the brain to reach an effective level. During this time your child's clinician will ask questions about how she is tolerating the medication, including side effects she might be experiencing.

"Most uncomfortable side effects will present early," says Dr. Nash. "I tell patients you might experience side effects before the desired effects." Clinicians should stay in touch with families during these first several weeks, monitoring how children are feeling and providing guidance because, as Dr. Nash says, "It can be a hard time for patients, who might feel headaches or insomnia, but not feel better yet." She says the side effects can go away after one to two weeks.

It can take a while for a patient to start feeling the full effect of an antidepressant medication. "The medication might start to work at two to four weeks, but you can still be feeling more benefit at six weeks further out," says Dr. Nash.

Monitoring for suicidal thinking

The Food and Drug Administration has issued a warning that children and adolescents taking some antidepressant medications may experience an increased risk of suicidal thoughts. Many studies have shown that the benefits of antidepressant medications outweigh the risks of going without treatment, so they are still prescribed to young people. To keep patients safe, a protocol has been developed for prescribing clinicians to help them closely monitor patients for any worsening in depression or emergence of suicidal thinking as they are adjusting to a new medication.

Going off medication

To avoid a recurrence of depression, Dr. Nash says it is a good idea to stay on medication for at least a year after a child has stopped feeling any symptoms of depression. She also warns that it is important to think about the "optimal" time to stop taking medication. For example, it isn't a good idea to stop taking his medication right before the SATs or when he's going off to college.

To avoid unpleasant side effects, your child shouldn't stop taking medication cold turkey. Tapering off antidepressants gradually, with the guidance of a clinician who is monitoring him to make sure he is healthy, is important.

Family involvement

Both Dr. Nash and Dr. Emanuele emphasize that families should always be involved in the treatment of a child's depression. "Part of treatment, especially in the beginning, is to teach parents about depression and how therapy works, says Dr. Emanuele. "It's really important that parents understand the concepts behind the treatments so that they can coach their child, day-to-day, to use the skills that they're learning." Dr. Emanuele adds that parents often find that they benefit from learning the skills as well.

Clinicians can also be helpful in giving parents tips on interacting with a child with depression, which can sometimes be difficult. Children with depression might try to isolate themselves from family, or interpret even well-meaning parental concern as critical rather than loving. Knowing how to be supportive is important. Dr. Emanuele says that she helps parents develop a situation-specific plan to help them know when to lean in and when to back off. Clinicians can also give advice about fostering more positive interactions.

For parents who are struggling because of their child's illness, getting this support can be a big relief. And, of course, as soon as a child starts feeling better, her parents will start feeling better, too.

Frequently Asked Questions

What is the most effective way to treat adolescent depression?

What are the best medications to treat adolescent depression?

Is it important for parents to be involved in treating their adolescent's depression?

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Treatment for Depression - Child Mind Institute

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What parents need to know about treatment for depression, from different kinds of therapy and medication to finding a good clinician.

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Anorexia nervosa is an eating disorder characterized by severe weight loss, a significantly low body weight, intense fear of getting fat, and a distorted body image that drives an otherwise high-functioning person-usually a young woman-to starve herself. Anorexics keep themselves underweight by eating sparsely and infrequently, as well as purging-voiding food by induced vomiting, laxative use, etc.-and exercising intensely, often without recognizing that their actions are unhealthy or that their perceptions of their bodies are not normal.

Anorexia usually manifests during adolescence and is diagnosed overwhelmingly among females,though one in 10 of those diagnosed are male, and the actual prevalence could be higher as symptoms of starvation in young men are less obvious than in young women. Adolescents and young adults with anorexia are often high-achievers and perfectionists-successful in school and popular with peers-making it difficult for parents and other adults to see how troubled they are. But anorexia is an extremely serious condition-a life-threatening psychiatric disorder that, untreated, leads to fatal medical problems and a high rate of suicide. The earlier it is treated, the better the odds of the patient recovering, and avoiding future relapse.

Behavioral signs that a child might be anorexic include rejection of a healthy amount of food, dramatic dieting, compulsive exercise, and a gross overvaluing of shape and weight as components of her identity. Visible signs that she is starving herself include extreme weight loss, abnormal thinness, brittle nails, hair loss, constipation, irregular menstruation, and swelling. Still, in growing children and adolescents what constitutes a normal weight is very difficult to ascertain; a failure to keep up with normal growth and weight gain that might be perceived as being a "late bloomer" could be a sign of anorexia. But experts agree that the defining characteristic of anorexia is body image distortion-what the child sees in the mirror as unacceptably fat is, to anyone else, disturbingly thin.

Girls are more likely to have anorexia, as are children with a first-degree biological relative who has the disorder. Participating in activities that emphasize thinness, such as modeling and athletics, are a risk factor. Children with anxiety disorders or obsessional traits are also more likely to become anorexic.

The first step a professional will take towards a diagnosis of anorexia is an evaluation of the child's weight relative to the average for her age. If she consistently maintains a body weight 15% below average, whether by weight loss or failure to gain weight, a clinician will dig deeper, and try to find out if she is extremely troubled by weight gain or the prospect of being fat, even though she's so thin. He will look for evidence of an unrealistic body image or denial of the severity of her condition. Irregular periods can also be a factor in diagnosis. The diagnosis can be of restricting type (no purging) or binge eating/purging type (she uses self-induced vomiting or misuse of diuretics, laxatives, or enemas to keep her weight down).

Treatment for anorexia is psychotherapeutic and medical. No known medication can address the core symptoms of anorexia, though drugs are often prescribed to treat co-occurring symptoms.

Psychotherapeutic: While one-on-one cognitive behavioral therapy is often used for adults with anorexia, the most successful treatments for children and adolescents involve the whole family-intensive family therapy and education that enables parents and siblings to help a child with anorexia return to normal eating patterns. The first goal of any treatment is to restore your child to a healthy weight, and she should be immediately hospitalized for this purpose if she is in any medical danger. Milder cases respond well to family therapy; more severe cases require a hospital stay or a residential program. The disadvantage to residential programs is that patients tend to relapse when they are back at home, unless the family lifestyle has changed to make it incompatible with the dangerous behaviors. Treatment is more effective when the disorder is caught early, and the longer a child stays at a healthy weight, the less likely she is to relapse.

Pharmacological: Some drugs, particularly antidepressants, have been effective in treatment, but they are most often targeted at another condition the child might also have, such as depression or obsessive-compulsive disorder. Treating the co-occurring disorder can make the therapy for anorexia more successful.

Depression, anxiety disorders, obsessive-compulsive disorder, and substance abuse have been associated with the occurrence of anorexia.

The malnutrition associated with anorexia can create serious medical conditions, including anemia, kidney trouble, brittle bones, and hormone and electrolyte imbalances. At worst, it can be fatal: the havoc anorexia plays with the chemical balance in the body can cause the heart to shut down without notice, even in a young woman who does not appear to be dangerously thin. And the disorder can so impair social life, family connections, and personal development that suicide is a serious risk.

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Anorexia is characterized by severe weight loss, a dangerously low body weight, extreme exercise and a distorted body image. Our guide outlines how to spot the signs and symptoms of anorexia, guidelines for diagnosing the disorder and current treatment options.

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Bulimia is characterized by out-of-control eating offset by purging, fasting or extreme exercise designed to maintain weight. This guide to bulimia explores how the disorder is recognized, diagnosed and treated.

Bulimia: What Is It?

Bulimia nervosa is an eating disorder characterized by out-of-control eating offset by fasting, extreme exercise, or purging-voiding food by self-induced vomiting or other means. Children with bulimia, unlike those with anorexia, often maintain healthy weight-they can even be overweight-but the way they go about it is anything but healthy. Like anorexia, the vast majority of those diagnosed with bulimia are female, though actual prevalence in males is unknown. There is evidence that societal norms of appearance propagated through the media-the "beauty ideal"-could contribute to the prevalence of bulimia, which typically manifests in late adolescence or early adulthood.

Bulimia: What to Look For

A child with bulimia nervosa may well seem a healthy weight for her age, and appear to eat normally-bulimia is much harder to detect than anorexia, and secretiveness is a key facet of the disorder. But there are signs to look for. She may be dehydrated, and experience acid reflux from frequent vomiting, along with sore throats, swollen glands, and the deterioration of teeth due to contact with stomach acids. Sudden absences from the dinner table or routine trips to the bathroom right after eating are key signs. An unrealistic body image is also a possible sign of bulimia, as with anorexia. Bulimics often prefer to binge and purge in private.

Bulimia: Risk Factors

Children with weight concerns, low self-esteem, and depressive or anxious temperaments are more likely to develop bulimia, as are children who have been sexually or physically abused. Childhood obesity and early pubertal maturation also put children at risk. The disorder is more common among children with a family history of bulimia, and is much more common in girls.

Bulimia: Diagnosis

The key to diagnosing bulimia nervosa is whether a child is a binge eater, meaning that she consumes much more in a given period than average, and has a "sense of lack of control" during the binge episode, which is often described as a sort of "out-of-body" experience. The diagnosis also requires that she compensate for the binge episode inappropriately-self-induced vomiting, off-label use of laxatives or diuretics, fasting, or excessive exercise-and her self-image be dominated by her body weight and appearance. The biinging and compensating behavior must occur on average once a week for 3 months.

Bulimia: Treatment

Psychotherapeutic: Behavioral management is the first-line treatment for bulimia-professionals will address the dangerous and worrying purging behavior and ensure that a patient is healthy before moving on to more long-lasting interventions.

Cognitive behavioral therapy is employed to alter body image and eating habits by teaching patients how their thoughts turn into unwanted, even disturbing feelings and actions. CBT is effective in 50 to 60% of those treated. Interpersonal therapy, which focuses on how the child's relationships with others impact her feelings and actions, is also employed.

Pharmacological: If behavioral therapy does not yield the desired results, antidepressant medications-particularly selective serotonin reuptake inhibitors or SSRIs-can have positive results.

In addition, nutrition education may be necessary to convince someone with bulimia of the disastrous effects of her disorder, and may help her amend her behavior.

Bulimia: Other Concerns

Like anorexia, the unhealthy behaviors associated with bulimia can lead to severe medical problems and even death. Associated conditions include irregular heartbeat and heart failure, tooth decay, and severe digestive problems. Individuals with bulimia are also more likely than most to become dependent on alcohol and drugs, including those that they may use to purge.

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Bulimia is characterized by out-of-control eating offset by purging, fasting or extreme exercise designed to maintain weight. This guide to bulimia explores how the disorder is recognized, diagnosed and treated. Bulimia nervosa is an eating disorder characterized by out-of-control eating offset by fasting, extreme exercise, or purging-voiding food by self-induced vomiting or other means.

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While everyone may overeat occasionally, a child with binge eating disorder regularly consumes unusually large quantities of food in relatively short periods of time, with the feeling that her overeating is out of her control. Children or adolescents affected by the disorder overeat compulsively, often in secret and with great embarrassment or guilt. Binge eaters can be of normal weight, overweight, or obese. And unlike bulimia, binge eating does not involve "purging," or self-induced throwing up.

A child who has binge eating disorder is not necessarily overweight. Signs to look out for include eating unusually large quantities of food, eating when she is not hungry, eating rapidly, and feeling depressed, disgusted or ashamed about her eating habits. Children and adolescents who have the disorder will often hide their binge eating from those around them, making the symptoms particularly hard to detect. It is also common for those affected to lose and gain weight repeatedly, which is known as "yo-yo dieting."

The disorder may run in families, so a child with a family history of binge-eating disorder is more likely to develop it.

For a child to be diagnosed with binge eating disorder, she must repeatedly eat unusually large amounts of food in relatively short periods of time, and feel that those fixed periods of intense eating are beyond his or her control. To qualify for the disorder, at least three of the following factors must be present in a child's behavior: eating rapidly, eating to the point of uncomfortable fullness, eating when not hungry, eating in shame or in secret, and feeling disgusted, depressed or ashamed after eating. The behavior must occur at least twice a week for a period of six months. It does not, like bulimia, involve self-induced vomiting after overeating.

Treatments available for binge eating disorder include psychotherapy, medications, behavioral weight-loss programs and self-help strategies. The primary goal of treatment, to reduce or eliminate bingeing behavior, may go hand in hand with the goal of weight loss. However, not all children and adolescents with the disorder need to lose weight. Psychotherapy, cognitive behavioral therapy in particular, can help patients deal with the issues that may trigger binge eating, such as a negative body image, anxiety, or depression. Interpersonal psychotherapy may assist with binge eating that is triggered by difficult relationships with others, including family members. While there is no medication specifically to treat binge eating disorder, although there is some limited evidence to suggest that antidepressants and the anticonvulsant topiramate (Topamax) may be helpful in treatment of particularly resisitant cases.

Careful evaluation to rule out bulimia is important. The most common accompanying disorders are bipolar disorder, depressive disorders, anxiety disorders, and substance use disorders.

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While everyone may overeat occasionally, a child with binge eating disorder regularly consumes unusually large quantities of food in relatively short periods of time, with the feeling that her overeating is out of her control. Children or adolescents affected by the disorder overeat compulsively, often in secret and with great embarrassment or guilt.

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Anorexia Nervosa and Associated Disorders

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Anorexia Nervosa and Associated Disorders

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ANAD | Free Eating Disorder Support Groups & Services

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ANAD provides free, peer support services to anyone struggling with an eating disorder. Learn more about our Helpline, support groups & more!

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Families Empowered And Supporting Treatment for Eating Disorders (F.E.A.S.T.)

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Families Empowered And Supporting Treatment for Eating Disorders (F.E.A.S.T.)

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This community knows the hope and the tragedy of these dangerous brain disorders. We also know the heroic power of families: parents and siblings and sufferers and recovered people. We know the power of care giving, of loving support, of skilled clinicians, and of applying the emerging science to improve outcomes.

F.E.A.S.T. started back in 2007, formally, when we became a recognized nonprofit. Our volunteers and our board of directors formed originally from an online community of parents around the world connected by our common experience of loving and supporting sons and daughters who have suffered from eating disorders, and their siblings.

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F.E.A.S.T. - Support and resources for families affected by eating disorders

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This community knows the hope and the tragedy of these dangerous brain disorders. We also know the heroic power of families: parents and siblings and sufferers and recovered people. We know the power of care giving, of loving support, of skilled clinicians, and of applying the emerging science to improve outcomes.

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Eating Disorder Hope has put together a number of resources that complement getting professional help for eating disorders and can provide support for you and your loved ones.

Eating Disorder Support Groups

Eating Disorder Support Groups exist to provide women and men various types of help related to eating disorders. The help and support provided in these groups may consist of relevant information about eating disorders, relating personal experiences, forming social networks, and listening to and receiving others experiences. Two main types of eating disorder support groups are self-help support groups or therapist led support groups. Eating disorder support groups are a tangible way to share thoughts and feelings with other people who can understand and relate to what you might be going through. Support groups can be an invaluable component of successful eating disorder treatment.

Find eating disorder support groups in our directory.

Eating Disorder Recovery Tips and Self-Help

The journey of recovery is a continuous process and there is a lot you can do to help yourself outside of the therapist's office or within a treatment program. Because the process of recovering from an eating disorder is often strenuous, it is critical to develop effectual self-help skills. Learning how to cope in positive ways and efficiently manage your emotions will be valuable tools in maintaining your recovery. At Eating Disorder Hope, we recognize the importance of having the ability to self-help, so we have complied resources that will encourage you to grow in this area.

Read articles on eating disorder skills and recovery tips.

Stories of Hope - Inspirational Eating Disorder Stories

At times, the recovery journey can be exhausting and wearing, and seem never ending. It is at these times of discouragement, when perhaps you or a loved one fighting for freedom from an eating disorder, needs encouragement and hope the most. Reading the stories of women and men who have battled eating disorders and are doing well in recovery can inspire hope for your future and give confidence for the road ahead. While the road to recovery is not an easy one, it is the path that will ultimately lead to a life where you can truly thrive, and that is worth everything!

Read inspiring stories about eating disorder recovery.

Spirituality and Eating Disorders

Recovering from an eating disorder does not have to be done alone. Because of the difficult nature of the recovery journey, having spiritual fulfillment and belief in something greater than you can be a vital part of the healing processes. If you or someone you love is in recovery from an eating disorder, it may be uplifting to find faith in God and make Him a partner in your journey. Eating Disorder Hope is a Christian organization and is dedicated to promoting eating disorder recovery for individuals of all faith. Learn how making spirituality a part of your life can enhance your recovery process.

Learn more about eating disorders and spirituality.

Books on Eating Disorders

The vast amount of information available can be confusing and overwhelming. Having trusted and reliable resources can be important assets to you or your loved one if you are seeking greater understanding about eating disorders. Eating disorder books can provide deeper insight into the struggles that might be faced, the details about the recovery process, and answers about treatment questions. Learn more about how these eating disorder books can be a helpful resource to you.

Find eating disorder books to read in our guide.

Videos on Eating Disorders

Videos on eating disorders can be a great way to learn more about them and even provide insight that may help you identify signs that a loved on may be suffering from an eating disorder.

Find eating disorder videos.

More Resources for Eating Disorders Help & Information

There are many incredible eating disorder organizations and website dedicated to eating disorders treatment and recovery. We've put together a list of them for you.

Find external eating disorder help & treatment resources.

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Eating Disorder Recovery Tools & Support

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Eating Disorder Hope has put together a number of resources that complement getting professional help for eating disorders and can provide support for you and your loved ones. Eating Disorder Support Groups exist to provide women and men various types of help related to eating disorders.

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Guide Response Service Referral Process Guide

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Search for up-to-date data on all Missouri School Districts.

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Anxiety is one of the most common mental health challenges among children and teenagers. But it can be hard to tell when kids are feeling anxious.

Here are some of the most common signs that a child might be experiencing anxiety:

Worrying a lot: Kids with anxiety feel worry or fear that is out of proportion to what they're actually experiencing. These worries don't go away over time and get in the way of kids' normal lives. Some kids get anxious only in response to specific things, while others worry a lot in general.

Physical symptoms: Headaches, stomachaches, sweating and racing heart can all be signs of anxiety.

Avoiding certain situations: Depending on what makes them anxious, kids might avoid things that other kids enjoy or are comfortable doing. For example, kids with social anxiety might avoid playing with other kids or ask to stay home from school.

Difficulty concentrating: Anxious thoughts can distract kids from schoolwork and other tasks.

Trouble sleeping: Worrying can interfere with kids' sleep.

Disruptive behavior: Kids with anxiety sometimes lash out or act aggressive when they are overwhelmed by uncomfortable feelings.

Clinging to parents or caregivers: Children with anxiety may have trouble separating from their parents, and need lots of reassurance.

Being hard on themselves: Some anxious kids worry a lot about failing or looking bad in front of other people. They might have low self-esteem or say mean things about themselves.

There are several different anxiety disorders that kids can be diagnosed with. To learn more about the different kinds of anxiety that children and teenagers experience: https://childmind.org/article/what-are-the-different-kinds-of-anxiety/

Anxiety is usually very treatable. To learn more about treatment for anxiety in children and teenagers: https://childmind.org/article/behavioral-treatment-kids-anxiety/

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Anxiety is one of the most common mental health challenges among children and teenagers. But it can be hard to tell when kids are feeling anxious. Here are some of the most common signs that a child might be experiencing anxiety: Worrying a lot: Kids with anxiety feel worry or fear that is out of proportion to what they're actually experiencing.

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3 Types of School Supports to Help Students with Mental Health Conditions

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There is hope for students with mental health needs as there are several ways to secure academic and behavioral support.

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Anxiety is one of the most common mental health challenges among children and teenagers. But it can be hard to tell when kids are feeling anxious.

Here are some of the most common signs that a child might be experiencing anxiety:

Worrying a lot: Kids with anxiety feel worry or fear that is out of proportion to what they're actually experiencing. These worries don't go away over time and get in the way of kids' normal lives. Some kids get anxious only in response to specific things, while others worry a lot in general.

Physical symptoms: Headaches, stomachaches, sweating and racing heart can all be signs of anxiety.

Avoiding certain situations: Depending on what makes them anxious, kids might avoid things that other kids enjoy or are comfortable doing. For example, kids with social anxiety might avoid playing with other kids or ask to stay home from school.

Difficulty concentrating: Anxious thoughts can distract kids from schoolwork and other tasks.

Trouble sleeping: Worrying can interfere with kids' sleep.

Disruptive behavior: Kids with anxiety sometimes lash out or act aggressive when they are overwhelmed by uncomfortable feelings.

Clinging to parents or caregivers: Children with anxiety may have trouble separating from their parents, and need lots of reassurance.

Being hard on themselves: Some anxious kids worry a lot about failing or looking bad in front of other people. They might have low self-esteem or say mean things about themselves.

There are several different anxiety disorders that kids can be diagnosed with. To learn more about the different kinds of anxiety that children and teenagers experience: https://childmind.org/article/what-are-the-different-kinds-of-anxiety/

Anxiety is usually very treatable. To learn more about treatment for anxiety in children and teenagers: https://childmind.org/article/behavioral-treatment-kids-anxiety/

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Anxiety is one of the most common mental health challenges among children and teenagers. But it can be hard to tell when kids are feeling anxious. Here are some of the most common signs that a child might be experiencing anxiety: Worrying a lot: Kids with anxiety feel worry or fear that is out of proportion to what they're actually experiencing.

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Whether your child already has a 504 plan or you've just started the process of getting one, it's natural to have questions. Does your child need an evaluation to get a 504 plan? How is a 504 plan different from an IEP ? Here, experts answer common questions about 504 plans.

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Whether your child already has a 504 plan or you've just started the process of getting one, it's natural to have questions. Does your child need an evaluation to get a 504 plan? How is a 504 plan different from an IEP ? Here, experts answer common questions about 504 plans.

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Social Anxiety: What Is It?

Children with social anxiety disorder struggle with excessive self-consciousness that goes beyond common shyness. Kids with social anxiety disorder worry so much about being judged negatively by others that they stop doing the things that they need (and want) to do for fear of embarrassing themselves.

Social anxiety disorder mostly affects adolescents, although it can also begin in childhood. Undiagnosed and untreated, it can lead to isolation and depression.
Related: What Is Social Anxiety?

Social Anxiety: What to Look For

Children with social anxiety disorder are extremely self-conscious about how they appear to others.

There are two main types of social anxiety disorder. The first focuses on performance, with kids worrying about things like speaking in public or trying out for a team. The second type involves social situations in general - not just situations when a child is in the spotlight. Kids with this type of social anxiety may fear things like going to school, eating in public, using public restrooms, meeting new people and even having conversations. Most people with more general social anxiety also experience anxiety about performing.

Children with social anxiety may experience physical symptoms such as shaking, sweating, flushing and shortness of breath. They may express their anxiety by asking, "What if I do something stupid?" or "What if I say the wrong thing?" Young children sometimes throw tantrums and cry when confronted with a situation that terrifies them. Children may experience anxiety symptoms well in advance of the situation they are worrying about.

Children with the disorder tend to start noticing symptoms between the ages of 8 and 15, but if they hide how they are feeling, parents might not realize anything is wrong for some time.

Social Anxiety: Risk Factors

Social anxiety disorder is more common in children who have a first-degree relative with the disorder. There seems to be a genetic component to this as well as an environmental component, such as socially anxious modeling by parents. Some children also have different traits that predispose them to developing social anxiety disorder, such as behavioral inhibition or fear of negative evaluation.

Related:
How to Avoid Passing Anxiety on to Your Kids

Social Anxiety: Diagnosis

Some amount of shyness is common to many people, and no one likes to be judged negatively. However, children with social anxiety disorder experience anxiety that is out of proportion to any potential judgment they could experience, and the anxiety that they experience is severe enough that it interferes with their ability to function socially. Children with social anxiety disorder will either actively avoid anxiety-inducing situations or suffer through them with intense distress. When their anxiety is triggered, they may experience panic reaction (shaking, sweating, shortness of breath) or, among young children, tantrums and crying.

To meet diagnostic criteria, the anxiety must occur in settings with peers and not just with adults, and must last for six months or more.

Some kids downplay their symptoms or even refuse to acknowledge them in an effort to avoid embarrassing scrutiny; as a result, the diagnosing clinician will often interview parents, teachers and other caregivers to more accurately understand symptoms.

Related:
Why Childhood Anxiety Often Goes Undetected (and the Consequences)

Social Anxiety: Treatment

Social anxiety disorder is treated either by behavioral therapy or a combination of behavioral therapy and medication. Children beginning a program of therapy and medication usually don't take medication for long.

Psychotherapeutic: Children with social anxiety disorder will benefit from cognitive behavioral therapy (or CBT), which is a kind of therapy that teaches kids how to overcome their fear and change anxious thought patterns. It also teaches kids coping skills that they can rely on when they are feeling anxious. Practicing social skills may also be part of treatment.

Pharmacological: Medications can alleviate symptoms of anxiety, which may make behavioral therapy more effective for some children. SSRIs, or selective serotonin reuptake inhibitors, have proven effective at managing some symptoms of social anxiety disorder. Medications called beta blockers may also be prescribed to curb the fear response and reduce physical symptoms of anxiety, such as palpitations and sweating.

Related:
Tips for Managing Social Anxiety

Social Anxiety: Risk For Other Disorders

Adolescents with social anxiety disorder may resort to using alcohol before attending a stressful event, which can give rise to substance abuse problems. Social anxiety disorder can also lead to depression if untreated. Some children with social anxiety disorder may also have a disorder called selective mutism.

FAQ

Will my child grow out of it?
Parents often wait to seek professional help because they assume a child is just being shy or will outgrow her fear. Unfortunately, social anxiety disorder rarely disappears if left untreated, and it often leads to social isolation, chronic anxiety and depression.

Do drugs help?
Yes, SSRIs can be used to successfully combat anxiety and make cognitive-behavioral therapy more effective. Beta-blockers may also be prescribed to treat the physical symptoms of fear, such as palpitations and nausea.

What causes it?
Experts are unsure about the root causes of social anxiety disorder, but it seems to have both genetic and environmental causes. People with social anxiety disorder often have heightened fear responses.

Should I avoid situations that stress my child?
Avoiding stressful situations will often make your child's anxiety and nervous anticipation even worse. Anxiety and stress are a normal part of life, and your child will benefit from learning how to manage her response.

Has my child been traumatized?
Children who have developed post-traumatic stress disorder may be more susceptible to social anxiety disorder. However, there is no direct relationship to trauma, and many diagnosed will have never experienced a seriously disturbing event.

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Children with social anxiety disorder struggle with excessive self-consciousness that goes beyond common shyness. Kids with social anxiety disorder worry so much about being judged negatively by others that they stop doing the things that they need (and want) to do for fear of embarrassing themselves.

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What is separation anxiety disorder?

Separation anxiety disorder is a mental health disorder that causes children to become extremely upset when they are separated from parents or caregivers. They worry that something bad will happen to their parents during the separation. It's normal for young kids to have some trouble separating, but this anxiety is more extreme. With separation anxiety disorder, fear and anxiety get in the way of normal life, like going to school or to playdates.

Symptoms of separation anxiety disorder usually show up in preschool and early elementary school. In rare cases it can show up later, like when a child starts middle school.

What are the symptoms of separation anxiety disorder?

The anxiety that children with separation anxiety disorder feel is much more than what is normal for their age.

Signs that a child might have separation anxiety disorder include:

Problems saying goodbye to parents

Fear that something bad will happen to a family member during separation

Tantrums when they have to leave parents or caregivers

Overwhelming need to know where parents are, and be in touch with them by phone or texting

Constantly following one parent around the house

Nightmares about bad things happening to family members

Younger children are mostly anxious at the time of separation. Older kids get anxious when they think about an upcoming separation.

How is separation anxiety disorder diagnosed?

A diagnosis of separation anxiety requires anxiety at being separated from parents or caregivers that is beyond what is considered normal for a child's age. The symptoms have to show up most of the time for at least four weeks and cause serious problems in the child's daily life.

How is separation anxiety disorder treated?

Treatment for separation anxiety disorder usually involves  cognitive behavioral therapy, or CBT. This is a treatment that helps children learn to understand and manage their fears. Exposure therapy, a specialized form of CBT, might also be used. Exposure therapy works by carefully exposing children to separation in small doses. This can help them feel less anxious over time.

When therapy is not enough, a child may be given medicine to lessen their symptoms and help make therapy more effective. The most common drug to treat separation anxiety disorder is an antidepressant medication called an SSRI. Occasionally anti-anxiety medications are used but they can be habit-forming.

This guide was last reviewed or updated on September 7, 2021.

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Quick Guide to Separation Anxiety Disorder - Child Mind Institute

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Download our free guide to separation anxiety disorder in children. Separation anxiety disorder is a mental health disorder that causes children to become extremely upset when they are separated from parents or caregivers. They worry that something bad will happen to their parents during the separation.

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Panic disorder is a condition characterized by repeated, unpredictable panic attacks that can cause feelings of impending death, heart attack-like symptoms, and a disconnection from reality. People having panic attacks often experience palpitations, shortness of breath, dizziness, among other physical symptoms, and an intense urge to flee the situation. The condition is rare in childhood, but often manifests in adolescence, when a teenager might make repeated trips to doctors and the emergency room before the psychiatric disorder is diagnosed. Attacks can happen at any time and may be triggered by a variety of cues; a key feature of panic disorder is that fear of an attack can trigger a fresh one. For this reason, many kids with panic disorder avoid the locations of previous episodes and other places where help would not be available or escape would be difficult-ie enclosed or crowded places. Cars, tunnels, bridges, and subways can all be worrying to a child with panic disorder. Some kids with the disorder will avoid leaving the house alone; extreme cases may even become housebound.

Panic disorder is characterized by the occurrence of panic attacks and deep distress about their possible return. These events are extremely stressful and frightening both for the person having the attack and those watching it happen. Should your child experience these events, she may describe heart attack-like symptoms, a sudden and overwhelming fear of death or losing control, a feeling that the world is unreal, and an intense desire to flee, as well as physical symptoms such as dizziness, nausea, sweating, and shortness of breath, among others. After an attack, which usually peaks within 10 minutes, children may be left with an intense fear of another attack. This can lead to avoidance of situations or activities she thinks might trigger another one, which in severe cases may limit her functioning.

A family history of anxiety disorders, bipolar disorder, and/or depression is a risk factor for the development of panic disorder. Respiratory problems like asthma also confer a risk, as does a history of panic-like episodes that don't meet the criteria for a panic attack.

A diagnosis of panic disorder often occurs only after medical explanations for signs and symptoms, as well as other psychiatric disorders-including OCD and PTSD-are exhausted. A professional will diagnose panic disorder if attacks are recurrent, and unexpected, and if one attack is followed in the ensuing months by other signs including: a preoccupation with the possibility of further attacks; fear of the effects of an attack, including the feeling of having a heart attack or "going crazy" and a considerable change from normal behavior following the attacks, such as avoiding places associated with them.

Treatment for panic disorder is often very successful and usually consists of a pharmacological and psychotherapeutic component.

Psychotherapy: A clinician will likely start cognitive behavioral therapy to begin reducing negative, avoidance-based behavior patterns. Another common form of treatment is exposure therapy, which counteracts anticipatory anxiety through gradual exposure to situations that are associated with attacks.

Pharmacological: Various classes of drugs may be prescribed to treat the effects of panic attacks, starting with antidepressants, which have proven effective. Benzodiazepines (Xanax, among others) are also used, though these drugs carry a risk of dependence.

People with panic disorder are also at risk for substance abuse, as well as depression.

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Panic disorder is a condition characterized by repeated, unpredictable panic attacks that can cause feelings of impending death, heart attack-like symptoms, and a disconnection from reality. People having panic attacks often experience palpitations, shortness of breath, dizziness, among other physical symptoms, and an intense urge to flee the situation.

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Post-traumatic stress disorder (PTSD) is a condition brought on by exposure to a traumatic event. While all children can be expected to be upset after a very disturbing experience-such as witnessing or being a victim of violence, physical or sexual abuse, a natural disaster, an accident, or extreme neglect-children with the disorder don't bounce back. They develop a pattern of behaviors that includes dreams about the event, play that reenacts the trauma, difficulty sleeping, irritability, and detachment. PTSD can develop months after the event, and may seem oddly disconnected from it. Though PTSD-like symptoms are common among children and adolescents exposed to trauma, the disorder is rare in young people.

Related
A Look at Acute Stress Disorder and PTSD

If a child has experienced a disturbing event or series of events, anxiety and some behavioral changes are a normal part of the coping process. PTSD might be considered if she becomes distant, recreates her trauma during playtime, regularly has nightmares about it, or experiences difficulty falling asleep. Young children may begin wetting the bed, become overly clingy with their parents, or even forget how to speak. Some children with the disorder will also develop separation anxiety disorder. Adolescents with PTSD may display self-destructive behavior and guilt.

Related

Signs of Trauma in Children
Acute Stress Disorder Basics

PTSD is brought on by closely witnessing or experiencing a traumatic event that puts the child or loved ones in danger of serious injury or death. Risk factors that a child exposed to a disturbing experience will develop the disorder include the severity and immediacy of the trauma, and prior exposure to trauma, neglect, or other childhood adversity. Strong social support in the aftermath of the event is a protective factor that can moderate the impact on the child.

For a child to be diagnosed with PTSD, she must have experienced a traumatic event either directly, by witnessing it happening to someone else, or by hearing of it happening to a close family member or friend. Since many children who are initially anxious and distressed in the aftermath of a disturbing event will recover in a healthy way without intervention, PTSD isn't diagnosed until a few months or longer after the initial trauma occurs, although symptoms may manifest earlier or even several years later.

A child who meets the criteria for PTSD shows symptoms commonly grouped in three areas: intrusive memories, such as bad dreams and play that reenact the event; avoidance and numbing, such as difficulty maintaining relationships, difficulty concentrating, and disinterest in formerly significant activities; and increased arousal, such as irritability, guilt, trouble sleeping, or fearful behavior. Children with the disorder often have stomachaches and headaches. The symptoms will cause significant impairment to ordinary functionality.

Many practitioners recommend a combination of behavioral therapy and medication. As some PTSD symptoms are often found in young people who don't develop the full disorder, a careful evaluation is necessary before a clinician decides how to intervene.

Behavioral: PTSD therapy sessions aim to create a safe and supportive environment for a child. Psychotherapy that helps children speak, draw, play, or write about their trauma has been successful. In other cases, a clinician might recommend behavior modification techniques and cognitive therapy to teach a child to cope with his or her fear instead of addressing the trauma directly. Therapy sessions for children almost always involve a parent, a family member, or another caregiver.

Pharmacological: Medication may be prescribed to help alleviate fear and anxiety, starting with antidepressants and anti-anxiety drugs. If a child has persistent bad dreams, a medication used to treat hypertension called Prazosin has proven effective in curbing them.

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Post-traumatic stress disorder (PTSD) is a condition brought on by exposure to a traumatic event. While all children can be expected to be upset after a very disturbing experience-such as witnessing or being a victim of violence, physical or sexual abuse, a natural disaster, an accident, or extreme neglect-children with the disorder don't bounce back.

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Ask Special Education Resources. (n.d.). IEP/504 plan parent informational handout. Retrieved July 20, 2021 from https://www.teacherspayteachers.com/Product/IEP504-Plan-Parent-Informational-Handout-4419029

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Is your child struggling with a mental health or learning disorder? The Child Mind Institute's guide for evaluating clinicians, treatments, quality care.

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

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

Children can struggle with:

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

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

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

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

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

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

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

Inattention and restlessness

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

Attendance problems and clingy kids

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

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

Disruptive behavior

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

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

Trouble answering questions in class

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

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

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

Frequent trips to the nurse

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

Problems in certain subjects

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

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

Not turning in homework

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

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

Avoiding socializing or group work

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

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

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

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

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

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Bender, Susan. (n.d.). Is it a modification or an accomodarion? (free visual).  Retrieved July 20, 2021 from https://www.teacherspayteachers.com/Product/Is-it-a-Modification-or-an-Accommodation-Free-Visual-4605904

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National Eating Disorders Association. (n.d.). Educator toolkit. Retrieved June 23, 2021

from https://www.nationaleatingdisorders.org/sites/default/files/nedaw18/2.%20EducatorToolkit%20-%20Copy.pdf

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The School Counselor and Student Mental Health

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Students' unmet mental health needs can be a significant obstacle to student academic, career and social/emotional development and even compromise school safety. Even so, most students in need do not receive adequate mental health supports (Centers for Disease Control and Prevention [CDC], 2013).

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NAMI Family Support Group | NAMI: National Alliance on Mental Illness

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Learn about NAMI Family Support Group, a peer-led support group for family members, caregivers and loved ones of individuals living with mental illness.

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NAMI Family Support Group is a peer-led support group for family members, caregivers and loved ones of individuals living with mental illness. Groups generally meet on a monthly basis but may meet weekly. The hallmark of a NAMI support group is leveraging the collective knowledge and experience of the other participants.

What You Should Expect

Meets monthly or weekly for 90-minute sessions free of charge.

Designed for loved ones (18 and over) of individuals living with mental illness.

Facilitated by a trained team of family members of individuals living with mental illness.

Confidential - share as much or as little personal information as you want.

Does not recommend or endorse any medications or other medical therapies for your family member.

Guided by Principles of Support.

Why You Should Attend

Reinforcement in an environment of sincere, uncritical acceptance

At each meeting, you review the Group Guidelines and Principles of Support and update the group on the current events in your life, then spend the bulk of the meeting in group discussion, or 'group work'. The group addresses urgent issues of its members and participants share their learned experience, or 'group wisdom'. As a participant, your voice is heard, and you can contribute to a dynamic that encourages empathy, productive discussion and a sense of community.

Tools for caring for yourself and for your loved one

The support group can offer you practical advice on addressing issues related to mental illness and your loved one. It also gives you the appropriate space to have your personal needs met so that you can provide the best possible care for your family member. Taking time to voice your experiences and to hear from others may help you develop your inner reserves of strength. You may gain confidence in your ability to cope with your family member's mental illness as well as local knowledge on how to best access needed services for your family member.

The Principles of Support

We will see the individual first, not the illness.

We recognize that mental illnesses are medical illnesses that may have environmental triggers.

We understand that mental illnesses are traumatic events.

We aim for better coping skills.

We find strength in sharing experiences.

We reject stigma and do not tolerate discrimination.

We won't judge anyone's pain as less than our own.

We forgive ourselves and reject guilt.

We embrace humor as healthy.

We accept we cannot solve all problems.

We expect a better future in a realistic way.

We will never give up hope.

What Others Say About NAMI Family Support Group

"Using the [NAMI] support group model is so essential to the success of our family support groups. As a group, the collective wisdom covered a lot of possibilities towards the issues."

"The most beneficial thing for me was that I am not alone. I found the NAMI Family Support Group at the time I really needed it!"

Find a Support Group

Contact your local NAMI Affiliate to find out about upcoming programs.

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NAMI Family Support Group is a peer-led support group for family members, caregivers and loved ones of individuals living with mental illness. Groups generally meet on a monthly basis but may meet weekly. The hallmark of a NAMI support group is leveraging the collective knowledge and experience of the other participants.

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Children with attention-deficit hyperactivity disorder (ADHD) find it unusually difficult to concentrate on tasks, to pay attention, to sit still and to control impulsive behavior. Our guide to ADHD offers information on symptoms, diagnosis and treatment options for ADHD.

ADHD: What Is It?

Attention-deficit hyperactivity disorder, or ADHD, is a persistent pattern of inattention and/or hyperactivity and impulsivity that exceeds the typical range for a child's age and interferes significantly with his functioning. ADHD makes it unusually difficult for kids to concentrate on tasks, to pay attention, to sit still, and to control impulsive behavior. While some children exhibit mostly inattentive behaviors and others predominantly hyperactive and impulsive, the majority of those with ADHD have a combination of both.

ADHD: What to Look For

ADHD behaviors usually become apparent when a child is between 3 and 6 years of age. Hyperactive or impulsive behaviors, which are often noticed first, include fidgeting, an inability to sit still, excess energy, verbal outbursts, extreme impatience, talking incessantly, and interrupting others. The inattentive behaviors often become noticeable only when a child enters school. He might be easily distracted, have difficulty following instructions, be unusually forgetful, struggle with organizing tasks, avoid things that involve mental exertion, and appear oblivious to what's going on around him.

Boys are diagnosed with ADHD much more frequently than girls, at a rate of about 2 to 1, though girls experience the disorder differently.

ADHD: Risk Factors

Children with a first-degree biological relative who has ADHD are more likely to develop the disorder.

ADHD: Diagnosis

Because symptoms of ADHD can also reflect other disorders, such as anxiety or depression or trauma, a professional diagnosing your child must carefully rule out other possible reasons for a child's behavior.

A child should be diagnosed with ADHD only if he exhibits a variety of inattentive or impulsive behaviors, at a level that is abnormal for children his age, over an extended period and in multiple settings-at home and at school, for instance. The behavior must be interfering significantly with schoolwork or social interaction. A trained clinician will make the diagnosis only after a thorough examination of the child and collecting information from several people who have observed your child, including parents, teachers, and other adults. To qualify for the diagnosis, symptoms must have been present before the age of 12.

ADHD: Treatment

Treatment for ADHD is usually a combination of behavioral therapy and medication.

Psychotherapeutic: A variety of behavioral and psychotherapeutic methods have proven successful in managing the symptoms of ADHD. Parent-child interaction therapy, which focuses on teaching parents how to cultivate desired behaviors while minimizing the impulsive or inattentive ones, is often used effectively. Parent training is another that uses the family to address the symptoms, while cognitive behavioral therapy teaches a child to control his behaviors by understanding how his thoughts and feelings influence them. Close consultation with your child's teachers can help him succeed despite his disorder. Tools such as a daily report card that targets desired behaviors can be effective. Social skills training may help him behave more appropriately with other children, and family therapy can help parents and siblings manage the stress created by the ADHD child's needs and behavior.

Pharmacological: The most common medications prescribed for ADHD are psychostimulants. The two most widely used are known, generically, as methylphenidate and dextroamphetamine, which go by brand names like Ritalin and Adderall. What these drugs stimulate is the brain's production of certain neurotransmitters that seem to activate the brain's centers of attention and impulse control. They serve to focus the attention and curb the impulsivity and hyperactivity of kids with ADHD. Stimulant medications can have significant side effects, such as headaches, loss of appetite, and trouble sleeping. Some children are prescribed other, non-stimulant drugs approved for treatment of ADHD if the side effects of stimulants are troublesome or excessive.

Many children will outgrow their diagnosis by the time they reach young adulthood, as symptoms wane or disappear. Others continue to have symptoms that are seriously impairing as adults. Inattentive and impulsive symptoms are more likely to persist into adulthood than motor hyperactivity.

ADHD: Risk For Other Disorders

Children with ADHD are often diagnosed with oppositional defiant disorder, anxiety or depressive disorders. Tourette's syndrome, which can cause tics and spontaneous and inappropriate utterances, also appears in conjunction with ADHD. Any course of treatment for a child with ADHD will be more effective if all of the co-occurring conditions are addressed.

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Children with attention-deficit hyperactivity disorder (ADHD) find it unusually difficult to concentrate on tasks, to pay attention, to sit still and to control impulsive behavior. Our guide to ADHD offers information on symptoms, diagnosis and treatment options for ADHD.

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

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

What is oppositional defiant disorder?

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

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

Being unusually angry and irritable

Frequently losing their temper

Being easily annoyed

Arguing with authority figures

Refusing to follow rules

Deliberately annoying people

Blaming others for mistakes

Being vindictive

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

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

Parenting under fire

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

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

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

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

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

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

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

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

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

ADHD and other risk factors

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

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

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

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

Why treatment is important

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

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

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

What treatment for ODD looks like

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

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

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

Parent-Child Interaction Therapy (PCIT)

Parent Management Training (PMT)

Defiant Teens

Positive Parenting Program (Triple P)

The Incredible Years

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

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

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

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

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

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares.

What is conduct disorder?

Conduct disorder is a mental health condition that can affect children and teenagers. Kids who have conduct disorder seem to enjoy hurting people and doing bad things. They are unkind and often violent, and they don't care about other people's feelings. This behavior goes beyond normal teasing, bullying, or acting out.

Extreme bullying, hurting animals, and lying for no reason are all signs of conduct disorder. In younger kids, conduct disorder starts with pushing, hitting and biting. In older kids, conduct disorder can come with more extreme violent behavior and crimes like stealing, destroying things and setting fires.

All kids act out sometimes, so conduct disorder is only diagnosed when this extreme behavior shows up over a long period of time and isn't caused by the child's environment.

What are the symptoms of conduct disorder?

Symptoms of conduct disorder include:

Not caring about social norms of good behavior

Ignoring the rights and feelings of other people

Enjoying causing harm, lying or manipulating people

Committing physical or sexual violence

Hurting animals

In younger kids: lying for no real reason, stealing for the fun of it, and extreme bullying

In older kids: picking fights, lying, cheating, stealing, destroying property, and physically or emotionally abusing others

How is conduct disorder diagnosed?

Conduct disorder is different from just bad behavior or acting out, which most kids do at some point. Kids must show symptoms of conduct disorder for several months at a time to be diagnosed. Before diagnosing a child with conduct disorder, a professional will also try to figure out if their extreme behavior could be a reaction to problems at home. To be diagnosed, a child's enjoyment of causing pain must seem to come from something inside them.

What are the risk factors for conduct disorder?

Several things put kids at higher risk of developing conduct disorder:

Having a parent or sibling with conduct disorder

Having a biological parent who abuses alcohol or has depression, ADHD, bipolar disorder, or schizophrenia

Experiencing abuse or neglect

Being bullied or having friends who encourage negative behavior

How is conduct disorder treated?

Conduct disorder is hard to treat but treatment can work if the child's family, friends and teachers get involved. Treatment works better if it starts when the child is young.

In therapy for conduct disorder, the child learns healthier ways to interact with others. At the same time, the child's family and support system learn ways to communicate with the child. Children with conduct disorder usually stay in psychotherapy or behavioral therapy for a long time.

In younger children, therapy for conduct disorder usually involves teaching parents how to encourage good behavior. In adolescents, therapy may also focus on the child's relationships with friends, other kids, and adults at school (like teachers and principals).

There is no medication specifically for conduct disorder. But kids with conduct disorder sometimes have other disorders as well, like depression or bipolar disorder. Treating those other disorders with medication can help therapy for conduct disorder work better.

This guide was last reviewed or updated on February 23, 2023.

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Quick Guide to Conduct Disorder - Child Mind Institute

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares. Conduct disorder is a mental health condition that can affect children and teenagers. Kids who have conduct disorder seem to enjoy hurting people and doing bad things.

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What Is ADHD?

Attention-deficit hyperactivity disorder, or ADHD, is a condition that makes it unusually difficult for children to concentrate, to pay attention, to sit still, to follow directions, and to control impulsive behavior. While all young children are at times distractible, restless, and oblivious to parents' and teachers' instructions, kids with ADHD behave this way much more often than other children their age. And their inability to settle down, focus, and follow through on tasks in age-appropriate ways makes it very hard for them to do what's expected of them at school. It can also lead to conflict at home and difficulty getting along with peers.

ADHD Symptoms

Symptoms of ADHD are divided into two groups: inattentive behaviors and hyperactive and impulsive behaviors.

Inattentive symptoms of ADHD:

Makes careless mistakes

Is easily distracted

Doesn't seem to be listening when spoken to directly

Has difficulty following instructions

Has trouble organizing

Avoids or dislikes sustained effort

Is forgetful, always losing things

Hyperactive or impulsive symptoms of ADHD:

Fidgeting or squirming, trouble staying in one place or waiting his turn

Excessive running and climbing

Trouble playing quietly

Extreme impatience

Always seems to be "on the go" or "driven by a motor"

Excessive talking or interrupting, blurting out answers

Some children exhibit only the first group ADHD of symptoms, and some exhibit only the latter. But the majority of those with an ADHD diagnosis have a combination of both, which can make it very difficult for them to function in school, and in other activities, and can create a lot of conflict at home.

How Are ADD and ADHD Different?

ADD, or attention-deficit disorder, is an older term for the disorder we now call ADHD, or attention-deficit hyperactivity disorder. It was called ADD up until 1987, when the word "hyperactivity" was added. Some people still use the old term, ADD, out of habit, or because it's a more familiar term than ADHD. Some use it to refer to kids with ADHD who aren't hyperactive.

Can a Child Who's Not Hyperactive Have ADHD?

Yes. Kids who have trouble focusing but are not unusually restless or impulsive have a more inattentive type ADHD. They tend to be diagnosed later because they are less prone to disruptive or problematic behavior that comes to the attention of teachers and parents. But kids who have inattentive symptoms may start to struggle in the middle of elementary school, when it becomes increasingly difficult for them to keep up.

Why Can Kids With ADHD Concentrate on Some Things? What Is ADHD Hyperfocus?

While ADHD is called an attention deficit disorder, experts say what's really disordered is the child's ability to control and direct what he's paying attention to. So many kids with ADHD are perfectly capable of intense focus on things that are very exciting to them, like video games, but they can't maintain that kind of focus on things that aren't immediately rewarding, like schoolwork or putting on their shoes or going to bed.

That intense concentration, sometimes called hyperfocus, is also the reason kids with ADHD often get upset when asked to stop doing something they are engaged in, like a favorite activity at school or playing a video game. They have what experts call an inability to "attention switch," which can cause a lot of conflicts with adults.

And speaking of video games: Because they are constantly stimulating and rewarding, experts say they can induce a kind of trance state in a child who has trouble regulating her attention. In that case, it's less a matter of hyperfocus than what one calls "screen suck."

What Is Executive Functioning?

Executive functions are the self-regulating skills that we all use to accomplish tasks, from getting dressed to doing homework. They include:

Planning

Organizing time and materials

Making decisions

Shifting from one situation to another

Controlling emotions

Learning from past mistakes

Most kids with ADHD have deficits in some executive functions, though not all children with executive function issues have ADHD.

Does ADHD Affect Kids Outside of School?

Yes. Their inattention and impulsivity also affects their friendships, extra-curricular activities, and family life. They may have trouble making and keeping friends because they interrupt constantly, and are prone to blowing up when they don't get their way. It's not uncommon for children with severe ADHD to be blackballed from playdates because they can't be counted on to behave. Kids with ADHD may have trouble playing on teams because they find it hard to focus and follow the rules.

At home, they may find themselves on a collision course with parents and siblings because they don't follow instruction, are impulsive, and melt down when they are asked to transition from some activity they enjoy to mealtime, homework time, or bedtime.

By the time kids with ADHD reach adolescence, their impulsivity can be dangerous, making them prone to car accidents, unsafe sex, and other risky behaviors.

Why Are Kids With ADHD Often Defiant or Demonstrate Disruptive Behavior?

Defiance and emotional outbursts are very common in kids with ADHD, though they are not, themselves, symptoms of ADHD.

Kids who have ADHD tend to become defiant when they are expected to do things that are hard for them, especially when it means stopping something that's pleasurable-like playing a video game. So things like homework, going to bed, getting dressed, and coming to dinner can become battlegrounds. These situations are difficult for them to tolerate because of inherit deficits in paying attention, tolerating a boring situation, reining in impulses, transitioning from a fun activity, and controlling their activity level. Since these situations are really challenging for them, they may try to avoid them. Unfortunately when it comes to ADHD parenting, the avoidance strategies that these kids typically use are disruptive behavior, tantrums, arguing, defiance, and power struggles.

Can You Grow Out of ADHD?

ADHD symptoms change as children get older, and it's estimated that about a third of children who are diagnosed with the attention-deficit hyperactivity disorder will no longer meet the criteria by the time they reach young adulthood.

In general, hyperactivity declines as kids move through elementary school, and inattention becomes the primary problem for them as the schoolwork they are expected to do becomes more demanding and their parents and teachers are not so closely supervising their activities. In adolescence, impulsivity also becomes a big concern, as it leads to car accidents, unsafe sex, and other risky behavior.

Children who are most likely to have ADHD that continues into adulthood are those whose symptoms are very severe in childhood, and those who also have another psychiatric disorder, like depression or anxiety.

ADHD Diagnosis

When is ADHD diagnosed?
Because the symptoms of ADHD can also be the result of other issues, such as anxiety, depression, or trauma, a professional diagnosing your child should carefully rule out other possible reasons for his behavior.

A child should receive an ADHD diagnosis only if he exhibits a variety of inattentive or impulsive behaviors

At a level that is abnormal for children his age

Over an extended period

In more than one setting-both at home and at school, for instance.
These behaviors must also be interfering significantly with schoolwork or social interaction.

How is an ADHD diagnosis done?
To make an accurate diagnosis, a clinician should collect information from several people who have observed your child, including you, other caregivers, and teachers.

Parents and teachers should be asked to fill out a rating scale, such as the SNAP, the Child Behavior Checklist, or Connor's Checklist, to capture an accurate assessment of the frequency of symptoms over a period of time. A child may be given a test called a Continuous Performance Test, which rates her ability to complete a repetitive task over a period of time and can give a more complex picture of her ADHD symptoms.

A child should not be diagnosed with ADHD just based on a parent's or teacher's report that she is overly active or distracted.

Who can diagnose ADHD?
ADHD can be diagnosed by any doctor or mental health professional, including:

Pediatricians

Psychiatrists

Clinical psychologists

Social workers

School psychologists

But in the majority of cases, only medical doctors like psychiatrists can prescribe medication to treat it. (Some states allow psychologists to prescribe, and nurse practitioners and physician's assistants often can, as well.) The overwhelming majority of ADHD diagnoses are made by pediatricians, though parents should be aware that many pediatricians don't have advanced training in psychiatric disorders, and an ADHD diagnosis should not be made in a quick office visit, based solely on a report that a child is having trouble concentrating in school. Inattention can be caused by other things, and giving a child ADHD medication won't address his problems if he doesn't have ADHD.

ADHD Medication Treatment

What is the most effective ADHD treatment?
Research shows that a combined approach of medication and behavioral therapy is the most effective treatment.

For moderate to severe cases of ADHD the first line of treatment is usually medication. ADHD medications called psychostimulants, which increase the amount of certain chemicals in the brain, help children focus and curb impulsivity and hyperactivity.

Behavioral therapies help kids rein in impulsive behavior and be better organized.

What are the kinds of stimulant medications for ADHD?
If a child has ADHD, studies show there's an over 80% chance that he will respond to stimulant medication with a significant reduction in symptoms.
There are two main classes of stimulant medications:

Methylphenidate-based medications
Ritalin, Methylin, Concerta, Metadate, Daytrana Patch

Dextroamphetamine-based medications
Adderall, Vyvanse, Dexedrine

Of the children who respond to stimulants, half will respond equally well to both groups of medications, and the other half will respond better to one or the other. There are many different release formulas for stimulant medications, which make them effective for different periods of time.

Immediate-release formulas
are effective for about 4 hours

Extended-release formulas
last as long as 14 hours.

Within the extended-release group, medications vary in the doses they deliver morning and afternoon. Some deliver 50 percent in the first half of the day and 50 percent in the second; others deliver just 30 percent in the first half and 70 percent in the second.

Finding the right dose
Since different children metabolize medication in different ways, the goal is to find the formula that delivers an effective dose over a desirable period of time for your child. Getting the right dosage for a particular child takes several weeks of trial. The clinician normally increases the dosage gradually until it becomes effective. If your child experiences undesirable side effects, it may mean that the dosage is too high, or the medication isn't right for her.

It's important to note that some children respond differently to the two different stimulants used in these medications-methylphenidate and dextroamphetamine. Changing from one to the other, or even to a different release formula of the same basic medicine, can help reduce or eliminate side effects.

Once an effective dosage is established, your child should be monitored periodically to make sure it's still meeting her needs as she grows.

Side effects of stimulant medications
Stimulant medications can be very effective in reducing symptoms of ADHD, but some kids do experience adverse side effects. They include:

Sleep issues
If medication is interfering with a child's sleep, it's because the medication is still active at bedtime.
If he's taking a short-acting formula, it may mean that he is taking a second or third dose too late in the day. If he's taking medication that lasts 12 or 14 hours, it may help to try one that's not quite as long-acting. Sleep issues caused by the medication tend to get better over time, so it's worth giving kids four to six weeks to see if they adjust. Trouble going to sleep may also be caused by kids being too stimulated at bedtime.

Are there non-stimulant medications for ADHD?
There are two types of medications that aren't stimulants that can help alleviate symptoms of ADHD. They are useful for kids who don't respond to stimulant medica-tions, or who experience adverse side effects from them.

Atomoxetine (sold as Strattera) is in a class of drugs called norepinephrine reuptake inhibitors.
Norepinephrine is a natural substance in the brain that is needed to control behavior.

Clonidine (Catapres, Nexicon) and guanfacine (Tenex) are called alpha-adrenergic agonists.
These medications were developed to lower high blood pressure, but at the doses given to kids for ADHD they rarely affect blood pressure.Both clonidine and guanfacine come in a 24-hour-release version (Kapvay and Intuniv), and they are sometimes used to treat tics.

Finally, omega fatty acids can also be helpful for ADHD, though not as helpful as stimulants or these other medications.

Should children stop taking ADHD medication during holidays and the summer?
Since children with ADHD don't need to perform academically during the summer or on extended holidays, parents sometimes seize the opportunity to take kids off their regular medication regimen, especially if they are experiencing side effects. Other parents avoid an interruption, fearing that their children's behavioral problems will rebound.

One reason to stay with treatment year-round is that ADHD doesn't only affect a child's performance in school. During the summer, children still have to get along with family and friends and function effectively in group activities like sports and camp.

However, if you are concerned that taking a stimulant medication may be slowing your child's growth, a summer break can allow him to catch up. And if you are concerned that he is underweight due to suppressed appetite, a summer without medication can help him put on some pounds.
For more on the pros and cons of a drug holiday, click here.

Behavioral Treatment for ADHD

What are the behavioral treatments for ADHD?
Behavior therapies do not eliminate the core symptoms of ADHD, but they can be very helpful in teaching children to manage them better. For example, children who have trouble finishing things and staying organized can learn techniques for completing tasks, keeping track of assignments, and getting their schoolwork done.

There's also a kind of behavior therapy for ADHD called parent training that can help reduce behavior problems that stem from ADHD in children. Parent-child interaction therapy and other forms of parent training teach parents how to work with their kids to cultivate good behaviors while minimizing impulsive or inattentive ones. Stimulated by more positive reinforcement, kids who have been out of control can learn to rein in their behavior and enjoy more rewarding relationships with parents and teachers.

As children get older, they often begin working more one-on-one with clinicians to strengthen their organizational skills and develop effective behavioral plans.

When a child is old enough, cognitive behavioral therapy can help teach her to control her behaviors by understanding how her thoughts and feelings influence them.
For more on behavioral therapy for kids with ADHD click here.
What can we do to help kids strengthen executive functions?
To bolster kids with weak skills in these areas, learning specialists teach a mix of specific strategies and alternative learning styles that complement or enhance a child's particular abilities.

With elementary school children, the educational specialist usually works with parents and kids together, to establish routines and tools to use to get work done successfully and with minimal conflict. For instance:

Checklists can be useful for anything from getting out of the house on time in the morning to doing homework after school to the bedtime routine. Since the steps necessary for completing a task often aren't obvious to kids with ADHD, defining them clearly ahead of time, and posting them prominently, makes a task less daunting and more achievable.
For more information on adolescents with ADHD, click here.
Assigning a time limit for each step, particularly if it is a bigger, longer-term project, helps kids manage their time and avoid underestimating how long it will take to do something.

Using a planner is essential for kids with ADHD who struggle to remember things like homework assignments.

A rewards chart at home, as well as at school, can help motivate kids who are easily distracted and struggle to acquire new skills.

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Parents Guide to ADHD in Children | Child Mind Institute

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Attention-deficit hyperactivity disorder, or ADHD, is a condition that makes it unusually difficult for children to concentrate, to pay attention, to sit still, to follow directions, and to control impulsive behavior. While all young children are at times distractible, restless, and oblivious to parents' and teachers' instructions, kids with ADHD behave this way much more often than other children their age.

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Attention-deficit hyperactivity disorder, or ADHD, is a condition that makes it unusually difficult for children to concentrate, sit still, follow directions and control impulsive behavior. This guide focuses on what educators need to know about teaching kids with ADHD: how it affects children in the classroom - girls as well as boys - and how we teachers can help kids with the disorder succeed in school.

Teaching Kids With ADHD

Many children with ADHD show signs of the attention disorder before they reach school age. But it's in school, when they are having trouble meeting expectations for kids in their grade, that most are referred for diagnosis.

That's why it's important that educators be well-informed about the attention deficit hyperactivity disorder - able to recognize children who might be struggling with ADHD, but also aware that the symptoms and behaviors associated with ADHD may also have other possible explanations.

ADHD Symptoms

There are three kinds of behavior involved in ADHD: inattention, hyperactivity and impulsivity. Of course all young children occasionally have trouble paying attention to teachers and parents, staying in their seats and waiting their turn. Kids should only be diagnosed with ADHD if their behavior is much more extreme in these areas than other kids their age.

These symptoms of ADHD are divided into two groups - inattentive and hyperactive-impulsive. Some children exhibit mostly inattentive behaviors, and others, predominantly hyperactive-impulsive. But the majority of those with ADHD have a combination of both, which can make it very difficult for them to function well in school.

Here are behaviors signs of ADHD you might observe in school in those two categories.

Inattentive Symptoms of ADHD:

Makes careless mistakes in schoolwork, overlooks details

Is easily distracted or sidetracked

Has difficulty following instructions

Doesn't seem to be listening when spoken to directly

Has trouble organizing tasks and possessions

Often fails to finish work in school or chores in the classroom

Often avoids or resists tasks that require sustained mental effort, including doing homework

Often loses homework assignments, books, jackets, backpacks, sports equipment

Hyperactive or Impulsive Symptoms of ADHD:

Often fidgets or squirms

Has trouble staying in his seat

Runs and climbs where it's inappropriate

Has trouble playing quietly

Is extremely impatient, can't wait for his turn

Always seems to be "on the go" or "driven by a motor"

Talks excessively

Blurts out answers before a question is completed

Interrupts or intrudes on others' conversations, activities, possessions

ADHD Behavior and Serious Impairment

It's important to keep in mind that not every high-energy or impulsive child has ADHD. Children are diagnosed with ADHD only if they demonstrate these symptoms so often that they are causing real difficulty in at least two settings - i.e., at school and at home. And the pattern that's causing them serious impairment must persist for at least six months.

The Difference Between ADD and ADHD

ADD, or attention-deficit disorder, is an older term for the disorder we now call ADHD, or attention-deficit hyperactivity disorder. It was called ADD up until 1987, when the word "hyperactivity" was added. Some people still use the old term, ADD, out of habit, or because it's a more familiar term than ADHD. Some use it to refer to kids with ADHD who aren't hyperactive.

Why Age Is Crucial in ADHD Diagnosis

Within any given classroom, there is an age range of students that spans almost a year, and a year can make a big difference in a child's ability to self-regulate. That's why it's important when teaching kids with ADHD and when considering a child's behavior, to compare it to other children the same age - not to the range of kids in his class or grade.

Two studies in the last few years concluded that kids who are youngest in their class are disproportionately diagnosed with ADHD. A Michigan study found that kindergarteners who are the youngest in their grade are 60 percent more likely to be diagnosed with ADHD than the oldest in their grade. And it doesn't affect just kindergarteners: a North Carolina study found that in fifth and eighth grade, the youngest children were almost twice as likely as the oldest to be prescribed medication for ADHD.

Why Are Some Kids With ADHD Prone to Disruptive Behavior?

Defiance and emotional outbursts are not themselves symptoms of ADHD, but kids with ADHD are at higher risk for developing these behaviors. Some kids who have ADHD tend to become frustrated and overwhelmed by demands placed on them that they cannot consistently fulfill, because of inherent deficits in paying attention, reining in impulses and controlling their activity level.

Making transitions from one activity to another can be particularly difficult for kids with ADHD in the classroom, especially when they involve stopping some activity they find more stimulating than what comes next. Clinicians call it an inability to "attention switch," and it can result in children disrupting the class or acting out.

Other Causes for Behaviors That Look Like ADHD

A child who can't seem to sit still, who blurts out answers in class without raising his hand, who doesn't finish his homework, who seems to be daydreaming when the teacher gives instructions - these actions are associated with ADHD behavior, but they can also be a result of other factors, from anxiety to trauma to just being younger than most of the kids in the class, and hence a little less mature.

That's why it's important for teachers and parents both to be aware of other things that could be influencing a child's behavior.

Inattention: A child who is inattentive could be distracted by a worrisome or painful situation at home, or because she's being bullied on the playground, and recess is coming up. If a child with OCD doesn't know the answer to the question, it looks like he wasn't paying attention, but it's really because he was distracted by obsessions. When a child seems to be looking everywhere but at the pages of the book she is supposed to be reading, another possible cause is that she has a learning disorder.

Hyperactivity: If a child is fidgeting when she's supposed to be reading, she could have sensory issues that are making her uncomfortable, or a learning issue that is causing her great frustration. And if she bolts from her chair, it could be because she is ashamed that she doesn't seem to be able to do what the other kids can do, and intent on covering that fact up.

Impulsivity: Anxiety is another condition, often hidden, that can cause kids to be unable to follow rules or wait their turn, or to lash out when they are upset.

Gender Differences in ADHD: How are Girls Different From Boys?

The stereotype of ADHD is boys disrupting the classroom by jumping up from their seats, getting in other kids' business or blurting out answers without raising their hands. But girls get ADHD too, and they tend to be diagnosed much later because their symptoms are more subtle.

More of them have only the inattentive symptoms of ADHD, and they get written off as dreamy or ditzy.

If they have the hyperactive-impulsive symptoms they are more likely to be seen as pushy, hyper-talkative or overemotional.

Impulsive girls may have trouble being socially appropriate and struggle to make and keep friends.

They often work so hard to compensate for their weaknesses that they are able to hide their challenges.

The growing awareness, as they get older, that they have to work much harder than their peers without ADHD is very damaging to their self-esteem.

Girls who are chronically hard on themselves about their mistakes may be struggling with thoughts that they're stupid or broken.

What Are Executive Functions?

Executive functions are the self-regulating skills that we all use to accomplish tasks,
from getting dressed to doing homework. They include:

Planning

Organizing time and materials

Making decisions

Shifting from one situation to another

Controlling emotions

Learning from past mistakes

Most kids with ADHD have deficits in some executive functions, though not all children with executive function issues have ADHD.

How Can Teachers Help Kids With ADHD?

Children with ADHD in the classroom who have trouble complying with rules and completing tasks can benefit from a daily report card system that sets positive behavioral goals and rewards to reinforce the behavior when they meet those goals.

The desired behaviors might be for the child to remain seated, to finish schoolwork, to raise his hand before speaking. The child receives points for successfully meeting goals, and his parents receive a daily behavior report card, enabling them to further to reinforce positive behavior in school with praise and prizes earned.

This system allows teachers to focus on what the child is doing well - rather than what he isn't doing well. It can bolster his self-esteem and help him feel positive about school.

Commonly Used Medications for ADHD

Many children with ADHD are prescribed stimulant medication to help reduce their symptoms. There are two main classes of stimulant ADHD medications:

Methylphenidate-based medications: Ritalin, Methylin, Concerta, Metadate, Daytrana Patch, Ritalin LA

Dextroamphetamine-based medications: Adderall, Vyvanse, Dexedrine, Focalin

There are also many different release formulas for stimulant medications, which make them effective for different periods of time:

Immediate-release formulas are effective for about four to six hours.

Extended-release formulas last as long as nine to twelve hours.

Children taking immediate-release formulas are often given medication in the middle of the school day by a school nurse. The goal is to maintain an effective dose during the school day but have the ADHD medication out of the child's system by bedtime, to facilitate sleep.

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Attention-deficit hyperactivity disorder, or ADHD, is a condition that makes it unusually difficult for children to concentrate, sit still, follow directions and control impulsive behavior. This guide focuses on what educators need to know about teaching kids with ADHD: how it affects children in the classroom - girls as well as boys - and how we teachers can help kids with the disorder succeed in school.

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Substance Abuse and Mental Health Services Administration (SAMHSA)

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Substance Abuse and Mental Health Services Administration (SAMHSA)

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Substance Abuse and Mental Health Services Administration

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Frequently Asked Questions - What is SAMHSA’s National Helpline?

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares.

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

Obsessions Common in Kids With OCD

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

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

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

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

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

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

Behaviors You Might See in Students With OCD

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

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

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

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

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

Behaviors Often Confused With Another Disorder

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

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

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

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

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

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

How to Help Students With OCD

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

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

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

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

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

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

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

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

How to Minimize Behavioral Problems

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

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

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

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

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

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

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

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Depression and Bipolar  Support Alliance

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Depression and Bipolar  Support Alliance

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Finding out your child has received a mood disorder diagnosis can be overwhelming. Being equipped with tools, information, and resources will help you find the best treatment options and outcomes for your child.

Introduction to Caregiving

Being a parent or a caregiver to a young person can be both rewarding and challenging. Caregiving can become even more challenging if you find out your child has received a mood disorder diagnosis. At DBSA, we know that children who live with a mood disorder diagnosis have the potential to lead fulfilling and meaningful lives. For caregivers who are supporting young people with a mental health condition, being equipped with tools, information, and resources will assist you in finding the best way to help your young person and care for yourself throughout the process. The resources in this section will guide you through understanding how to talk to your young person about mental health conditions, provide helpful tips on finding a treatment team, and working with educators, as well as information on planning for safety. This section will also review the very important topic of self-care for caregivers.

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For Parents and Caregivers: Depression and Bipolar Disorders in Children and Teens

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Finding out your child has received a mood disorder diagnosis can be overwhelming. Being equipped with tools, information, and resources will help you find the best treatment options and outcomes for your child. Being a parent or a caregiver to a young person can be both rewarding and challenging.

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Stewart, Kori. (2021). Mood disorder resources & support. Retrieved July 20, 2021 from https://www.canva.com/design/DAEi9689Mjo/ZDfiy0CgpLGJ-NJHynZ1Ug/edit?utm_content=DAEi9689Mjo&utm_campaign=designshare&utm_medium=link2&utm_source=sharebutton

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From a hedgehog too anxious to go ice skating to a puppy who can't make his letters come out right, children's books address many emotional, behavioral and learning challenges kids face. These books help kids name and understand feelings and experiences they may be struggling with. At the Child Mind Institute we've contacted publishers all over to call in popular children's books about mental health and learning disorders and other common challenges, like dealing with painful experiences and coping with strong emotions. We included books for kids up to 12, from picture books to be read with preschoolers to chapter books for independent reading by older children. Our clinicians read them all and picked the best in each category, based on how helpful they found them. Here you will see descriptions of 77 books we like, and we hope you will find useful.

Popular children's books about abuse and establishing boundaries.

Written by Zach and Kimberly King, illustrated by Sue Rama
Popular children's books about ADHD with emphasis on why it shouldn't define them.

Written by Jeanne Kraus, illustrated by Whitney Martin
Cory tells readers about himself in this picture book with black-and-white illustrations. Cory says that sometimes kids make fun of him and he isn't sure why. "Sometimes my whole body falls off the chair!" But readers also learn that Cory has persevered, concentrating in karate class, making friends at bowling club, and helping other kids with math. The important parting message: "Nobody needs to be good at everything. But I found out that I am good at a lot of things." Ages 6-11. Published by Magination Press.

Written by Mari Schuh, illustrated by Isabel
In a warm and friendly way, Annabelle, a real girl from Long Island, New York, explains how ADHD affects her. She talks about symptoms, medication, and helpful strategies. She reassures readers that "ADHD doesn't stop me from doing most things." For instance, Annabelle is a Girl Scout and loves to swim and run. "The book has good visuals too," adds an expert from the Child Mind Institute. A Spanish language version is also available. Ages 6-9. Published by Amicus.

Popular children's books on anxiety and how they can take charge of their fears.

Written by Alex Boniello and April Lavalle, illustrated by James Kwan
A story of a kid robot who sometimes gets "the zaps" provides a clever way to introduce the concept of anxiety to kids, as well as ways to manage it. "This playful story is perfect for families looking to start open conversations about anxiety with their children while also normalizing the sensation of other emotions that come along with it," says an expert from the Child Mind Institute. Ages 4-8. Published by Harry N. Abrams.

Written by Imogen Harrison
Through mazes, craft projects, and dozens of other fun exercises, kids learn how to let go of worries and remain calm. "The book will help children develop emotional awareness and recognize their feelings and how they experience them," says an expert from the Child Mind Institute. "From here, a wide range of practical coping strategies can be tried out, practiced, and mastered." The Calming Sparkle Jar project is especially fun. Ages 8-12. Published by Sky Pony Press.

Written by Elly Swartz
Autumn has been struggling since her best friend moved away and her dad went to Ecuador with the Peace Corps. Trying not to let her social anxiety stop her from doing something new, she applies to be the secret voice of the school newspaper's advice column - and she gets the job! When her friends write in for advice, Autumn is pushed outside her comfort zone. The book provides good examples of social anxiety-related thoughts, feeling embarrassed, words-getting-stuck syndrome, and a good theme of being brave," says an expert from the Child Mind Institute. Ages 10-14. Published by Delacorte Press.

Written and illustrated by Andi Green
In this whimsical rhyming book, Wince, the monster of worries, learns that the more he worries, the more the pesky WorryBug grows. Eventually the WorryBug grows so big that it can't be ignored, and Wince knows he needs to do something. The book does a good job of illustrating how anxiety can become overwhelming and teaches kids how they can take charge of their anxiety. Ages 3-8. Published by Monsters in My Head.

Written by Danielle Marie Price, illustrated by Nana Gonzales
One day, Ellie was feeling too grumpy to eat pancakes. Her mom says, "That happens sometimes" and gets a yoga mat out of the closet. Ellie and her mom do various yoga poses and breathing exercises. Then it's pancake time! "A good introduction to mindfulness and yoga, this book highlights how trying something new can improve feelings," says an expert from the Child Mind Institute. Ages 4-8. Published by Warren Publishing

Written by Nicole C. Kear, illustrated by Tracy Dockray
Seven-year-old Veronica wants to help her classmate Maya conquer her fear of bugs, which is preventing her from playing at recess. Veronica comes up with a step-by-step plan that starts with drawing a spider. "Showing gradual exposure to anxieties is a great approach," says an expert at the Child Mind Institute. Ages 7-10. Published by Imprint.

Written by Marcus Stroman with Samantha Thornhill
Stroman, a pitcher for the Chicago Cubs, drew on some of his childhood experiences to write this fast-paced novel. Marcus wants to be the greatest pitcher of all time, and his dad pushes him hard to achieve his goals. But Marcus doesn't believe in himself as much as his family does. Constant teasing about being short for his age begins to affect his game. Marcus's mom takes him to see a mental health coach. "Marcus shares how he copes with the aftermath of divorce, very different parenting styles, bullying, and pressure from his dad and himself to excel as a young baseball pitcher," says an expert from the Child Mind Institute. "Realistic and practical strategies to challenge and change negative thoughts and to practice mindfulness are woven into the narrative." The verdict: It will grip the reader from start to finish! Ages 8-14. Published by Aladdin.

In this helpful story to read before the first day of school, a cat detective gives her classmates smart advice about how to overcome their anxieties. For instance, when a fellow student tells Hattie that he's nervous about standing up in front of the class, she pulls a squishy ball out of her Worry Detective Tool Belt. Hattie uses her toolkit to playfully demonstrate useful strategies like "movement activities, tensing and releasing muscles, coping self-talk, and mindful breathing," says an expert from the Child Mind Institute. Ages 4-8. Published by Viking Books for Young Readers.

Written and illustrated by Jo Rooks
A cute hedgehog turns down ice-skating and playing in the snow with his animal friends because of his worries. "What if he had forgotten how to skate? He could fall and hurt himself." When Hector receives a fun invitation to the Winter Forest Party, he hesitates for a while, and then realizes that he has to be brave. "It's an adorable story," says an expert at the Child Mind Institute. "I like that Hector does a little more, and then a little more, and so on." Ages 4-8. Published by Magination Press.

By Jayneen Sanders, illustrated by Stephanie Fizer Coleman
Anxious about school, soccer practice, and monsters under his bed, baby bear worried day and night, despite his family telling him to stop worrying. But when his mom began encouraging him to talk about and even draw out his worries, the feelings began to subside. "I like that the book emphasizes the importance of sharing your thoughts and feelings," says an expert at the Child Mind Institute. Another plus: The book suggests questions that you can ask your child as you're reading together. Ages 6-10. Published by Educate2Empower Publishing.

Written by Victoria M. Sanchez, illustrated by Jess Golden
In this new picture book, Pilar lives and breathes ballet - she even does pliés while brushing her teeth. But auditioning for the winter ballet performance makes her feel scared, and she almost doesn't go. By using smart coping techniques, like positive thinking and talking with her friends, she's able to overcome her fears. Bravo! Ages 4-8. Published by Albert Whitman & Company.

Written and illustrated by Tom Percival
This brilliantly illustrated story stands out for helping kids visualize anxiety and see how it grows. While playing at the park, Ruby discovers a worry - it's depicted as a yellow blob with googly eyes that starts out small but gets bigger and bigger. Eventually, it stops her from doing the things she loves and she can't stop thinking about it. But when she sees a boy sitting on a park bench next to a worry of his own, she starts to talk to him. Then both of their worries begin to fade. "Kids can easily identify with the images and simple storyline," says an expert from the Child Mind Institute. Another notes that the story helps kids realize that everyone worries sometimes and encourages them to talk about their feelings. Ages 4-8. Published by Bloomsbury Children's Books.

Written by Alberto Soler and Concepción Roger, illustrated by Nuria Albes a

Published exclusively in Spanish, this book focuses on a girl who begins to feel anxious. "It contains a great metaphor for anxiety - a knot in the stomach - and provides ways to talk back to the anxiety bully in all of us," says an expert at the Child Mind Institute. Ages 4-8. Published by B De Blok.
Written by Dawn Huebner, illustrated by Bonnie Matthews

Popular children's books about autism and related disorders.
Written by Nancy Carlson and Armond Isaak, illustrated by Nancy Carlson

Co-written by a boy with Asperger's, this picture book "gives a simple understanding of why children with Asperger's struggle to attend parties, and talks about the importance of learning flexibility," says an expert at the Child Mind Institute. (For more about the term Asperger's and its relationship to autism, see our guide to autism terminology.) Readers may relate to Armond's fear of balloons popping and not being able to think of anything to say. In the end, Armond admits to his mom that the party was hard, but he's glad he went. Ages 4-8. Published by Free Spirit Publishing.
Written by Alison Green Myers

For Axel, who has autism, the sudden changes that a tornado brings are extra hard to handle. The storm damages Axel's house and his beloved eagle's nest. His dad comes back home to help with the damage. "The book provides a great depiction of complicated and changing family dynamics," says an expert from the Child Mind Institute. "It features multiple autistic characters and discusses needs related to sensory and information processing." Readers who are especially interested in birds, animals, or nature will enjoy this story. Ages 9-12. Published by Dutton Children's Books.
Written by Elana K. Arnold, illustrated by Charles Santoso

On the surface, it's a sweet boy-wants-pet story. Bixby's (aka Bat's) mom is a veterinarian, and she brings home a baby skunk that he desperately wants to keep. But readers with autism may relate to chatter about itchy and uncomfortable clothes, sticking with routines, and only having friends who are grown-ups. "It does a wonderful job of describing the day-to-day experience of high-functioning children with ASD," says an expert at the Child Mind Institute. Ages 6-10. Published by Walden Pond Press.
Written by Meg Eden Kuyatt

Inspired by the author's own childhood experiences on the autism spectrum, this novel in verse (poetry) explores what it's like for a 12-year-old who has to keep her feelings locked inside. She usually follows the rules for "being normal," until one day she can't hold it together anymore. Although tough at first, it's the turning point that puts her on a path to celebrate her differences rather than hiding them. "I loved this book," says an expert from the Child Mind Institute. "It's a beautiful story about family relationships, support, and how to communicate with people you love but can't completely relate to. It emphasizes compassion and has a great discussion about the ways that social norms help and hurt." Ages 8-12. Published by Scholastic Press.

Henry, a boy on the autism spectrum, forgets to raise his hand in school and offends his classmate Daisy by using her Latin plant name, Leucanthemum vulgare. While his fellow students sometimes find him odd or annoying, a field trip to the local botanical garden allows Henry's knowledge to shine and his classmates are wowed. "This beautifully illustrated book normalizes the common challenges of neurodiverse children," says an expert from the Child Mind Institute. "It also highlights that a special interest can be a source of peer connection." Ages 4-8. Published by Orca Book Publishers.
Written by Phil Bildner, illustrated by Tim Probert

Popular children's books on body image, eating disorders, and the importance of body positivity.
Written by Nabela Noor, illustrated by Nabi H. Ali

Diversity advocate and mom Nabela Noor writes a moving story about a young Bangladeshi girl who wonders if there is something wrong with the way she looks. Her worries begin after she hears her mom, dad, and sister being critical of their own weight. At dinner, the girl tells her family that she wants to go on a diet, too. Surprised by her comment, the family discusses what beauty means. "The story has a wonderful message about looking internally for beauty, watching the things we say in front of others, and sharing kindness with the world," says an expert from the Child Mind Institute. Ages 4-8. Published by Simon & Schuster Books for Young Readers.
Written and illustrated by Maggie Edkins Willis

With realistic-sounding dialogue and brilliant illustrations, this graphic novel deftly conveys the impact of eating disorders on two sisters and their family. At first, the older sister is diagnosed with anorexia nervosa. Eventually the younger sister struggles with body image too. "The book presents digestible conversations about eating disorder development, treatment, and its relevance in middle and high school settings," says an expert from the Child Mind Institute. It also presents healthy strategies to avoid disordered eating, such as surrounding yourself with positive friends rather than those who criticize your body. Ages 10-14. Published by Roaring Brook Press.
Written by Lisa Fipps

In this critically acclaimed novel in verse (poetry), Ellie has been bullied about her weight since she was five years old. She made "Fat Girl Rules" that she follows, including not eating in public. With a strong support network - a friend, her father, and a therapist - will she be able to put the Fat Girl Rules behind her and show the world her fabulous self? "Highlighting the importance of body positivity, this book shows the impact that therapy can have on helping someone handle difficult emotions and developing skills to voice their needs and opinions to others," says an expert from the Child Mind Institute. Ages 10-14. Published by Nancy Paulsen Books.
Written by Alyson Gerber

In seventh grade, Sarah starts to feel slower on the basketball court. Her body is changing - and she doesn't like it one bit. She begins skipping meals and her discomfort with her body grows. "The book presents a nuanced take on disordered eating behaviors, including a mother's role in a child's eating and relationship with food," says an expert from the Child Mind Institute. Ages 8-12. Published by Scholastic Inc.
Written by Jen Petro-Roy

The author sprinkles her personal experiences with an eating disorder into this well-organized self-help book. "It offers guidance and practical tools for those struggling with disordered eating and negative body image," says an expert from the Child Mind Institute. The chapters on perfectionism, selfie culture, and clothing sizes are especially interesting. Action items include creating a self-soothing tool kit and creating a list of people you admire. Ages 9-14. Published by Feiwel & Friends.

Popular children's books that cover bullying and show ways to respond to it.
Written by Hope Gilchrist, illustrated by Zoe Jordon

Toby makes his friends laugh when he teases a classmate over his weird clothes. He's just trying to be funny and he isn't beating anyone up, so he can't be a bully - can he? This independently published paperback helps children recognize when teasing crosses the line into bullying. Ages 6-9. Published by CreateSpace Independent Publishing Platform.
Written and illustrated by Kevin Henkes

This sweet story prepares kids for how short-lived teasing can be. On the first day of school, Victoria picks on Chrysanthemum because she has the same name as a flower, and Chrysanthemum wilts under the ridicule. Then the students learn that a teacher has a similar name, and all of a sudden Chrysanthemum is cool. Ages 4-8. Published by Mulberry Books.
Written by Julia Cook, illustrated by Anita DuFalla

Particularly good for an anxious or literal child, this rhyming book helps distinguish between teasing and bullying. "There are two types of teasing: the nice and the mean," Cook writes. "You think that everyone's against you, but it's not like it seems." Readers will learn strategies for responding to both good-natured teasing and bullying. Ages 5-10. Published by Boys Town Press.
Written by Lisa Yee

In a fast-paced chapter book that will appeal to reluctant readers, Marley thinks seventh grade will be boring until he draws attention from the school bully. Digger pushes Marley down in the hallway, and the drama unfolds. "It's a very relatable story for kids who feel like outsiders," says an expert at the Child Mind Institute. Bonus: If your child is a fan of Star Wars, there are loads of references. Ages 8-12. Published by Arthur A. Levine Books.
Written by R.J. Palacio

Popular children's books about depression and handling complex emotions.

Kids and parents alike will find helpful messages in this story about a boy who feels too sad to get out of bed. The boy's parents and younger sibling try to cheer him up with jokes, silly faces, and toys. But, ultimately, it takes a lot of waiting and love. "Young children will find it helpful to see images of someone who is sad being supported and not rushed to come out of sadness," says an expert from the Child Mind Institute. "Plus, for parents, the story models how to validate and sit with discomfort instead of trying to fix the situation for their children." An author's note from Tomlinson, a psychologist, is directed to parents. Ages 4-8. Published by Kokila.
Written by Anna Lazowski, illustrated by Penny Neville-Lee

Sadness and other big emotions take the form of a dark cloud, a ball of worries, and a swirl of fog in this lyrical book about childhood depression. The cloud usually follows as Abigail goes about her activities, but sometimes she's able to leave it behind. At the beach, for instance, she traps it in a sandcastle and goes for ice cream. "The illustrations really help the story come to life and provide an easier way for young kids who may not have the vocabulary to describe their emotions," says an expert from the Child Mind Institute. "The images of the character embracing her cloud and finding enough distance from it to see light and joy are heartwarming and provide hope." Ages 4-8. Published by Kids Can Press.
Written by Diane Guerrero with Erica Moroz

An actress on TV shows such as Orange Is the New Black, Guerrero shares the heartbreaking story of her Colombian parents being deported when she was 14. She also reveals how she battled depression, and had suicidal thoughts in her early 20s. "I wanted so badly to prove that I could take care of myself. That I didn't need anyone. That I was grown-up," she writes. "By the time I admitted to myself that I did still need others, I had pushed away the people I loved." Ages 12+. Published by Henry Holt and Co.
Written and illustrated by Eva Eland

Portraying sadness as a visitor that you shouldn't be afraid of, this book makes it easier for kids to imagine the emotion as something outside themselves. When sadness arrives, the main character still reads, plays, and decides sadness doesn't want to stay indoors. "The idea of continuing to do things with sadness is important," says an expert from the Child Mind Institute. "It's something that's with the child, but doesn't define them." Ages 3-8. Published by Random House Books for Young Readers.

Popular children's books about dyslexia, self-esteem, and positive messages about hard work.
Aaron Slater, Illustrator

In this best-selling rhyming book, Aaron wants to be a storyteller, but he's having trouble putting a single word down on a piece of paper. Then he realizes his strength is his imagination. "The book shows that reading struggles are not rooted in lack of interest, motivation, or intelligence," says an expert from the Child Mind Institute. "You can feel the character's pain and joy as he finds a way to express himself." This book is printed in a dyslexia-friendly font. Ages 4-8. Published by Harry N. Abrams.
Written and illustrated by Claire Alexander

This sweet picture book follows Stan, a puppy, and his animal classmates. Stan's letters come out "back to front and upside down, and some didn't look like letters at all," but he's afraid to ask his teacher for help because he thinks the other kids will laugh at him. When he finally does, he learns that with help - and lots of practice - he can succeed. "The book sends the positive message that things will get better with a bit of hard work," says an expert at the Child Mind Institute. Ages 4-8. Published by Eerdmans Books for Young Readers.
Written by Gavin Newsom with Ruby Shamir, illustrated by Alexandra Thompson

Ben, a star baseball player, is frustrated that he's not learning to read as easily as his classmates, especially Emma, who carries around big books. But everything isn't as it seems. "A sweet and simple story that provides encouragement and normalization to struggling readers, with an emphasis on reinforcing effort, practice, and hard work," says an expert from the Child Mind Institute. One of the best parts: the letter at the end from California governor and the book's author, Gavin Newsom, who calls his dyslexia a gift. Ages 5-9. Published by Philomel Books.
Written by Lynda Mullaly Hunt

Popular children's books on feelings and managing complex emotions.

Especially useful for kids who have trouble verbalizing their emotions, this story demonstrates that feelings aren't always visible to others. During various stressful situations, ranging from playing goalie for the first time to starting at a new school, the book illustrates the wild swings of emotions a boy experiences. One minute there's a roller coaster screaming through his ribs, the next he's in a cave full of bats. "It also provides great examples of when those emotions may surface and models calming strategies," says an expert from the Child Mind Institute. Ages 4-8. Published by Free Spirit Publishing.
Written and illustrated by Barney Saltzberg

This short rhyming book with expressive cartoon-like illustrations will help validate the big feelings of toddlers and preschoolers. A young cat, who doesn't want to be cheered up, questions "Why do I have to be happy?" before insisting that he wants to be mad for a while and throwing himself on the floor. "The book includes great analogies, such as describing anger as 'feeling like a crocodile,'" says an expert from the Child Mind Institute. "I also appreciated that it's not about getting rid of the emotion, but managing it with strategies like alone time and talking to someone." Ages 3-5. Published by Orchard Books.
Written by Jo Witek, illustrated by Christine Roussey

In this sturdy book with beautiful heart-shaped cutouts, a girl explains that her heart is full of feelings. Each spread focuses on a different emotion, such as happiness, bravery, and fear. The descriptions of the feelings are particularly engaging: "Some days my heart feels as heavy as an elephant. There's a dark cloud over my head and tears fall like rain. This is when my heart is sad." Ages 3-6. Published by Harry N. Abrams.
Written by Dr. Seuss, illustrated by Steve Johnson and Lou Fancher

This little-known Dr. Seuss story gives young kids a groundwork for describing their feelings, normalizing the experience of having multiple emotions. Bonus: It will also help toddlers and preschoolers learn colors. Ages 3-5. Published by Knopf Books for Young Readers.
Written by Poppy O'Neill

Packed with 45 self-help activities that most kids as young as age eight or nine can complete on their own, this workbook could serve as a great addition to therapy or a stand-alone resource. Activities include breathing exercises, a gratitude journal, and a positivity scavenger hunt. "The book contains practical and accessible interventions that many children could benefit from," says an expert from the Child Mind Institute. "The information is presented in an easy-to-understand and fun format. Overall, it's a self-help book that kids will enjoy." Ages 8-12. Published by Sky Pony Press.
Written by Gibson Frazier, illustrated by Micah Player

This must-read for children who have trouble with impulse control highlights a clever technique to help manage behavior. Dash says he knows right from wrong, but that doesn't stop him from blowing out the candles on his friend's birthday cake and breaking his grandma's cookie platter. "In the story, Dash learns a grounding exercise that helps him stop and relax before he takes action," says an expert from the Child Mind Institute. When Dash is tempted to fly a paper airplane in class, "the reader is able to see the difference that the grounding exercise makes with his choice." Bonus: Dash's dad takes him to fly paper airplanes after school, highlighting that there's an appropriate place for the behavior. Ages 4-8. Published by G.P. Putnam's Sons Books for Young Readers.
Written and illustrated by Keith Negley

The witty illustrations in this book may be even more powerful than the text. Kids will see various "tough guys" showing emotion. An astronaut in space holds a picture of his family. A wrestler cries in the locker room. A tattooed biker regrets running over a squirrel. The final image of a father and son is particularly heartwarming. Ages 3-6. Published by Flying Eye Books.
Written and illustrated by Molly Bang

Popular children's books about grief, loss, and learning to heal.
Written by Steffanie Lorig and Rosalie Frankel

This 40-plus-page activity book uses writing and drawing to help kids work through their emotions. Activities include creating a "Circle of Strength" and using a calendar to express feelings on different days. "I use this book in therapy for grieving children and find it to be extremely effective," says an expert at the Child Mind Institute. Ages 6-10. Published by Art With Heart.
Written by Pat Thomas, illustrated by Lesley Harker

This book explains, in realistic but reassuring language, why people die and how hard it can be to say goodbye. The real genius: "What About You?" boxes scattered throughout the book that contain questions you can ask children. "I particularly like that it normalizes the sad feelings around death," says an expert at the Child Mind Institute. Ages 4-8. Published by B.E.S. Publishing.
Written by Patrice Karst, illustrated by Joanne Lew-Vriethoff

This companion book to The Invisible String focuses on the death of a pet. When Zach's beloved dog dies, he's sad and angry. Zach's friend Emily tells him, "When pets aren't here anymore, an invisible leash connects our hearts to each other forever." Although skeptical at first, Zach begins to feel his dog's presence. The concept of an invisible string "is a mental and visual way to recall positive memories," says an expert from the Child Mind Institute. Ages 4-9. Published by Little, Brown Books for Young Readers.
Written by Patrice Karst, illustrated by Joanne Lew-Vriethoff

This bestselling picture book introduces little ones to the concept of an invisible link between people, even when they're separated. In the story, a mom explains to her children that there is a "very special string made of love" that connects them to everyone they love. "When you're at school and you miss me, your love travels all the way along the string until I feel a tug on my heart," Karst writes. The story continues with explaining how far the string reaches - to a submarine captain in the ocean, a dancer in France, and even to a beloved relative in heaven. Ages 3-8. Published by Little, Brown Books for Young Readers.
Written by Holly Thompson, illustrated by Ashley Crowley

After Kai's dad died, the boy's grief manifests itself in many ways, from crying to throwing a fit to feeling flat and robotic. "The story line shows the change from struggling to recovering, and emphasizes using support networks," says an expert at the Child Mind Institute. Ages 4-8. Published by Albert Whitman & Company.

In this tender tale about the loss of a pet, a black cloud forms over the head of a girl whose beloved dog, Pumpkin, has recently died. She cries so hard that she feels like there's soap in her eyes and an octopus has wrapped itself around her heart. Then she dreams that Pumpkin licks the soap from her eyes and barks at the octopus. That's when she realizes that Pumpkin will always be with her. "This book ties physical symptoms to grief and discusses always having the memories," says an expert at the Child Mind Institute. This book is available in both English and Spanish language versions. Ages 4-8. Published by NuboOcho.

Following a fire at their castle home, a girl in a red cape and her fox navigate an arduous and frightening journey before reaching a bright future. Stunning illustrations and short, rhyming text convey a powerful lesson. "For children at different stages of grief, this book includes a message of hope that after the pain, things will get better," says an expert from the Child Mind Institute. Ages 3-7. Published by Candlewick Press.
Written and illustrated by Laurie Krasny Brown and Marc Brown

Popular children's books on finding identity and appreciating differences.
Written and illustrated by Michael Hall

Popular children's books on neglect and how caregivers should act.

Written by Lauren H. Kerstain, illustrated by Natalia Moore A licensed social worker crafts a compelling and authentic story about what it feels like for a child who has lived in a lot of foster homes. When Calvin moves in with Maggie, he doesn't want to unpack his suitcase or get a goodnight hug. He accidentally breaks things multiple times, testing Maggie's patience. But she always responds with kindness and wise advice. The ending is heartwarming. "This book provides an example of building a warm relationship with a caregiver while honoring a relationship with a biological parent," says an expert from the Child Mind Institute. Ages 4-9. Published by Magination Press.
Written by Susan Farber Straus, PhD, illustrated by Claire Keay

Written and illustrated by Beth Richey and Paula Wood

In a calm, reassuring tone, two trauma therapists explain the things that children should be able to count on from the grown-ups they belong to -basic needs, such as food, a home, schooling, safety, and love. Sometimes the adults can't provide these things, the book notes, and the kids need to be cared from by someone else. Soothing illustrations of animal characters help put children at ease, and they are assured that they deserve to have everything they need to be healthy and happy. "Using direct, child-friendly language, the book is particularly helpful for kids who see Children Protective Service workers or lawyers," says an expert from the Child Mind Institute. Ages 4-8.Published by Warren Publishing.

Popular children's books on OCD and related disorders.
Written by Elly Swartz

In this moving chapter book, 12-year-old Molly Nathan struggles with undiagnosed obsessive-compulsive disorder as she navigates middle school friendships and life without her mom, who has temporarily relocated for a job. Early on, many of Molly's OCD tendencies - like organizing takeout menus alphabetically and looking for the patterns in phone numbers - are casually woven into a story line that focuses on her desire to win the poetry slam so her mom will come home for the banquet. But, as time passes, her OCD worsens: "I used to just wash my hands, and then I started washing my hands a lot, and now I scrub them raw," Swartz writes. When Molly becomes fixated on counting, her dad takes her to a doctor who provides her diagnosis. Ages 9-14. Published by Farrar, Straus and Giroux.
Written and illustrated by Veronica Agarwal and Lee Durfey-Lavoie

Maggie, a sixth grader, tries to live up to her older sister's achievements in this graphic novel that spotlights anxiety and obsessive-compulsive disorder. When she comes home from school, Maggie goes through a ritual of switching the lights on and off. She also rolls a 20-sided die to help her make decisions. Although she resists therapy at first, she eventually goes. "Maggie comes to terms with her behavior, puts a name to it, and copes with it," says an expert from the Child Mind Institute. References to Dungeons and Dragons as well as anime help engage reluctant readers. Ages 8-12. Published by Random House Graphic.
Written by Holly L. Niner, illustrated by Greg Swearingen

Before he goes to sleep, Kevin asks his mom the same questions over and over and lines things up neatly so "his mind doesn't get sweaty." By the end of the story, Kevin's OCD has improved thanks to therapy and medication. Ages 7-12. Published by Albert Whitman & Comp a ny.
Written by Wesley King

This YA book combines a coming-of-age tale with a mystery novel. The protagonist is 13-year-old Daniel, who hides his "zaps" - rearranging cups into geometric patterns, tying his shoes a lot, and counting things - from other kids at school and at football practice. Written in the first person, "this book does an excellent job of describing the stigma and has a very accurate description of how obsessions and compulsions take hold," says an expert at the Child Mind Institute. Eventually, Daniel discovers that he has OCD, moves toward self-acceptance, and helps a friend solve a mystery. Ages 12+. Published by Simon & Schuster/Paula Wiseman Books.
Written by Aureen Pinto Wagner, PhD, illustrated by Paul A. Jutton

Popular children's books on self-esteem and celebrating our differences.
Written by Allia Zobel Nolan, illustrated by Miki Sakamoto

This collection of six stories, published exclusively in Spanish, is designed to increase a child's self-esteem. "The book has great visuals and provides suggestions for parents and teachers," says an expert at the Child Mind Institute. Ages 7-9. Published by Beascoa.

Popular children's books on selective mutism and learning to speak in public.
Written by Dr. Melissa Giglio and Daisy Geddes Illustrated by Ira Baykovsk

This sweet, rhymed story is about a little girl who is lively and boisterous at home but freezes up and can't speak when she's at the playground or at school. Her parents encourage her to try "brave talking" and she practices until her confidence swells and her words flow. "It introduces facing fears by taking small steps and illustrates how it takes practice to build brave muscles," says a selective mutism expert from the Child Mind Institute. Ages 4-8. Published by Brave Mighty Minds.
Written and illustrated by Elaheh Bos

Written by Julie Mensh Graham

This tells the story of a turtle with selective mutism whose friends are patient and take the time to interact with her without putting pressure on her to speak. "This gives her a chance to relax and get comfortable enough to use her brave voice," notes a Child Mind Institute expert. "Helpful strategies for kids with SM, as well as for their family and friends, are woven into the narrative."Ages 3 and up. Published by Nightingale Books

Popular children's books on sensory processing and finding courage.
Written by Sally J. Pla, illustrated by Steve Wolfhard

Popular children's books on tourette's syndrome and related disorders.
Written by Ellie Terry

Toggling between verse and prose, this book is written from the points of view of two students: Calli, who has Tourette's Syndrome, and her classmate Jinsong. Most students tease and reject Calli because of her tics. "I walk into the boys' locker room, and all I hear is: 'The new girl wears old clothes. The new girl rolls her eyes. The new girl makes creepy sounds with her throat," says Jinsong. "It's all true. But somehow it feels wrong to hear them say it." Readers will be satisfied by the end of the story when Calli begins to stand up for herself and find confidence, says an expert at the Child Mind Institute. Ages 8-12. Published by Square Fish.
Written by Dusti Bowling

Popular children's books covering trauma and helping children understand traumatic experiences.
Written by Margaret M. Holmes, illustrated by Cary Pillo

When Sherman, a raccoon, saw something that upset him, he became nervous, didn't sleep well, and felt sad. "Through Sherman, the book explains the symptoms of post-traumatic stress disorder in simple terms that young children can understand," says an expert at the Child Mind Institute. "The book also covers the importance of talking about traumatic things to help feel better." Another plus: The story doesn't specify exactly what happened to Sherman, so the book could be useful in many situations. Ages 5-9. Published by Magination Press.
By Kimberly Brubaker Bradley

During World War II, 10-year-old Ava escapes her traumatic life with her mom and goes to the countryside, where she learns to ride a pony and read. But in the country she is still struggling with post-traumatic stress disorder; for instance, going into a bomb shelter reminds her of being locked in a kitchen cabinet in her mom's apartment. Because of some mature language and themes, it's better read with your child. Ages 9-12. Published by Puffin Books.
Written and illustrated by Beth Richey and Paula Wood

Two social workers team up on this book for children who have experienced physical abuse. Using cute illustrations of animals, the book explains that it's not okay for a grown-up to hurt a child, no matter what the child has done. It also acknowledges that children may have conflicting feelings about the person who hurt them. "The book uses direct and child-friendly language," says an expert from the Child Mind Institute. "It also does a good job explaining what abuse means." Ages 4-8. Published by Warren Publishing.

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77 Children's Books About Mental Health - Child Mind Institute

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Explore our favorite children's books on everything from ADHD to trauma. Help your kids understand the emotional and learning challenges they may be experiencing.

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Children with OCD have intrusive thoughts and worries that make them extremely anxious, and they develop rituals they feel compelled to perform to keep those anxieties at bay. This guide explains the often confusing behaviors that can be associated with OCD, and the treatments most effective for hel…

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Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD)

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Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD)

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CHADD - Improving the lives of people affected by ADHD

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Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) is the nation’s leading nonprofit organization serving people affected by ADHD.

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Anxiety & Depression Association of America

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Anxiety & Depression Association of America

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ADAA Online Support Group | Anxiety and Depression Association of America, ADAA

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ADAA’s four free online peer-to-peer communities for people suffering from mental health disorders provides a safe space for support, sharing experiences, and connecting with others.

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1. CBT Activity: Think-Feel-Act Triangle

The Think-Feel-Act Triangle is a classic CBT activity that you can use over and over again. It is a simple visual that helps students break apart their thoughts, feelings and behaviors, and begin to see how those are connected.

When using it, have the student write down a difficult situation in the center of the triangle. At each corner of the triangle, write down what the student thought, felt, and how they acted.

To show them how these three elements are connected, change one of them and talk about how that might change the others. For example, if you change a negative thought to one that is more realistic, you may then feel different and then you may act different.

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7 CBT Activities You Can Use in School Counseling

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1. CBT Activity: Think-Feel-Act Triangle The Think-Feel-Act Triangle is a classic CBT activity that you can use over and over again. It is a simple visual that helps students break apart their thoughts, feelings and behaviors, and begin to see how those are connected.

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Counselor Chelsey | Simple School Counseling Ideas

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Childhood anxiety is on the rise. If you been a counselor for a while, you may be seeing more anxious students than ever before. It can be challenging to know just what to say or do to give students the support they need. By adding these activities to your next small group, you will help your students understand what anxiety is, how they can recognize it, and what they can do about it.

1- Define What Anxiety Is

Worry is a normal feeling. Kids may feel worried about many things - like going to a new school, or a relative that is sick. Many students, though, might not know how to tell whether or not their worry is normal. Taking time to explain to students what worry is and when it's normal can help students learn to handle their worry in a positive way. By teaching students about what worry and anxiety are, we can empower them to get support when they need it.

In my personal life, I have struggled with anxiety my entire life. However, I didn't know it until I was in my early 20's. Because I didn't know what anxiety was, or what was normal, my anxiety went untreated for a long time.

I love to start off my worry and anxiety small groups with an activity to help students learn the difference between anxiety and normal worries. To start, I explain that although worry is a common and normal experience, it can sometimes turn into anxiety. I then explain anxiety as worries that are intense, frequent, might not seem logical, or include physical symptoms such as quick breathing or a stomachache.

Then, once students know the difference between worry and anxiety, I give them scenarios (or have them come up with their own) and ask them to share whether they think it is worry or anxiety. This is a helpful exercise because it gives students practice in understanding what is a normal worry and what is anxiety.

2- Talk About Anxiety And The Brain

One of the scary parts of worry and anxiety for kids is that they don't understand what is happening in their brain or body. They feel like they can't control their thoughts or the bodily sensations that they are having. This feeling of fear and uncertainty can make their anxiety even worse.

By educating students about what is happening in their brains and bodies when they feel anxious, students can better understand their own feelings. They are then less likely to be anxious about being anxious. Thankfully, there are several YouTube videos explaining the science behind anxiety that are perfect to use in your anxiety small group counseling lessons. Here are two of my favorite videos to use:

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Worry and Anxiety Small Group Activities For Kids - Counselor Chelsey | Simple School Counseling Ideas

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Use these worry and anxiety small group activities for kids to support anxious students at your school. Students will learn what anxiety is, the science behind it, and how they can recognize and cope with their anxiety.

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Even without having the everyday worries of an adult, children experience debilitating anxiety in your classroom. While anxiety does not affect children's academic ability, it does impact their ability to learn. Creating anxiety management activities for kids is easy and fun for both you and your students.

As teachers and counselors, we need to help our students succeed in the classroom. And if they are experiencing anxiety, there are a few things we can do to make things easier for them throughout their time at school.

It's important to remember that our goal is to help children manage their anxiety, and cope with it when it has been triggered, not necessarily identify triggers for the students.

The following anxiety management activities for kids will help your students manage in and out of the classroom:

Anxiety is often brought on by a fear, or worry, trigger. Perhaps a looming test is causing the student stress, and anxiety. Bringing your students back to the present moment gets them out of their minds, and helps them detach from worry.

One way to do this is to help them learn how to practice mindfulness in the classroom with an activity like bubble breathing - a deep breathing activity with elements of visualization. You can do this without the mess by using make believe bubbles.

Belly Breathing is another way to bring students back to the moment. Teach them to breathe from their stomach rather than from their chest. They can test this by placing one hand on the belly and the other on the chest. Have them close their eyes and redirect their breathing to the belly so that the belly is moving up and down, not the chest.

Children with anxiety, whether chronic or test-related, can benefit from having something else to focus on. Knowing they have a worry box at the ready can soothe anxious minds. These may include slime, fidget spinners, special music, or anything else that might give them a different focus.

In the classroom, each student can create their own boxes out of a tissue box, decorate it, and bring their favorite things to keep within it. You can also use a smaller plastic container to create a mini kit that will fit in their desk. They can refer to the Worry Escape Box if they start to experience extreme anxiety in the classroom.

Journaling is another excellent way for children to release their anxiety. Teaching your students to write their worries on paper while imaging negative feelings leaving their body and remaining on the paper is a way to teach visualization techniques to youngsters.

If students aren't writing yet, drawing can be another excellent visualization technique. Splashing colors and making shapes is not only an active physical outlet but also a great tool for stress relief.

Along with writing and drawing, students can go one step further by tearing up the worry they've expressed on paper, and throwing it in the trash. This exercise allows children to visualize the burden of the worry being detached from themselves, and gone forever.

Sometimes anxiety is socially triggered in students, and at times, it can become paralyzing for students to remain amongst the rest of the class. In extreme cases, it can be beneficial to have a quiet place to retreat to when students need to recharge.

A Calm Down Corner can be a tent in a separate area of the classroom, a space in the nurse's office, or even just a new desk to sit at. Just make sure the students don't feel isolated or alienated in this quiet space. Instead, they should benefit from the quiet time and never feel alone. It should always be their choice to enter the Calm Down corner .

Setting up a safe space for a student to retreat to in times of extreme anxiety may help him or her bring themselves back into a more manageable state of mind.

You can equip this area with earmuffs, headphones, books, and puzzles.

Escape rooms for the classroom are a hit amongst students. They provide engaging skill-building activities in real-time and encourage the development of problem-solving skills.

As teachers and counselors, we know students who engage in lessons learn the best, and escape rooms are an excellent way to get students to invest in the learning process.

Check out this one that is ready to print and go.

These anxiety management activities for kids are both fun and useful in and out of the classroom. Children with anxiety may feel overwhelmed and, at times, paralyzed with fear. But if we help students learn to identify anxiety, and manage it at the onset, they will be better equipped as they progress in their education...and throughout their lives.

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6 Anxiety Management Activites for Kids - The Counseling Teacher

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Even without having the everyday worries of an adult, children experience debilitating anxiety in your classroom. While anxiety does not affect children's academic ability, it does impact their ability to learn. Creating anxiety management activities for kids is easy and fun for both you and your students.

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Oppositional Defiant Disorder (ODD) Resources - MACMH

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American Academy of Child and Adolescent Psychiatry (AACAP) www.aacap.org National Institute of Mental Health (NIMH) www.nimh.nih.gov

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Educator Guidelines for Meeting & Referring Students with Eating Disorders

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Educator Guidelines for Meeting & Referring Students with Eating Disorders

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Stewart, Kori. (2021) Understanding eating disorders. Retrieved July 20, 2021 from https://www.canva.com/design/DAEiK-1oGMI/6UeJzNAQdRuQTepsnUJBZw/edit?utm_content=DAEiK-1oGMI&utm_campaign=designshare&utm_medium=link2&utm_source=sharebutton

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Counselor Chelsey | Simple School Counseling Ideas

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It Doesn't Have To Be Complicated

As a counselor, I have always loved doing super creative and engaging lessons. I want the kids to have so. much. fun.

And you know what? There's a place for that.

But sometimes, you don't need a 45 minute lesson with 10 moving parts. Sometimes there's a school assembly in 10 minutes, half the class is out sick, and you're not feeling great yourself. And that's okay.

Just because a lesson isn't complicated doesn't mean it isn't effective. Each of these 10 self esteem videos are less than five minutes, but have the power to really impact your students and how they see themselves.

Because they are so short and easy, you can easily add them into what you're already doing.

Simple ways to use them:

Morning meetings

As a way to begin or end your self esteem lessons

Post them on your school website or school counseling page

During morning announcements done via video

When you have 5 minutes that you're not sure how to fill

So, choose a few of your favorite and help your students become more confident in who they are.

Self Esteem Videos For Grades K-2

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Self Esteem Videos For Elementary School

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These 10 self esteem videos for elementary school students will help kids learn about how to be confident and how to build their self esteem. Students will learn to celebrate themselves and what makes them unique.

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Self-Esteem Team is a fun game that will promote body confidence for kids! Across three levels, Self-Esteem Team will explore the amazing things your body can do, as well as what can happen when you become a kindness superstar by stopping teasing & bullying, and when you make friends with different people.

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As is the case with parent training, the techniques used to manage ADHD in the classroom have been used for some time and are considered effective. Many teachers who have had training in classroom management are quite expert in developing and implementing programs for students with ADHD. However, because the majority of children with ADHD are not enrolled in special education services, their teachers will most often be regular education teachers who may know little about ADHD or behavior modification and will need assistance in learning and implementing the necessary programs.

There are many widely available handbooks, texts and training programs that teach classroom behavior management skills to teachers. Most of these programs are designed for regular or special education classroom teachers who also receive training and guidance from school support staff or outside consultants. Parents of children with ADHD should work closely with the teacher to support efforts in implementing classroom programs.

Managing teenagers with ADHD in school is different from managing children with ADHD. Teenagers need to be more involved in goal planning and implementation of interventions than do children. For example, teachers expect teenagers to be more responsible for belongings and assignments. They may expect students to write assignments in weekly planners rather than receive a daily report card. Organizational strategies and study skills, therefore, need to be taught to the adolescent with ADHD. Parent involvement with the school, however, is as important at the middle and high school levels as it is in elementary school. Parents will often work with guidance counselors rather than individual teachers so that the guidance counselor can coordinate intervention among the teachers.

The following list includes typical classroom behavioral management procedures. They are arranged in order from mildest and least restrictive to more intensive and most restrictive procedures. Some of these programs may be included in 504 plans or Individualized Educational Programs for children with ADHD. Typically, an intervention is individualized and consists of several components based on the child's needs, classroom resources, and the teacher's skills and preferences.

1. Classroom rules and structure

Use classroom rules such as:

Be respectful of others

Obey adults

Work quietly

Stay in assigned seat/area

Use materials appropriately

Raise hand to speak or ask for help

Stay on task and complete assignments

Post the rules and review them before each class until learned

Make rules objective and measurable

Tailor the number of rules to developmental level

Establish a predictable environment

Enhance children's organization (folders/charts for work)

Evaluate rule-following and give feedback/consequences consistently

Tailor the frequency of feedback to developmental level

2. Praise for appropriate behaviors and choosing battles carefully

Ignore mild inappropriate behaviors that are not reinforced by peer attention

Use at least five times as many praises as negative comments

Use commands/reprimands to cue positive comments for children who are behaving appropriately-that is, find children who can be praised each time a reprimand or command is given to a child who is misbehaving

3. Appropriate commands and reprimands

Use clear, specific commands

Give private reprimands at the child's desk as much as possible

Reprimands should be brief, clear, neutral in tone and as immediate as possible

4. Individual accommodations and structure for the child

Structure the classroom to maximize the child's success

Place the student's desk near the teacher to facilitate monitoring

Enlist a peer to help the student copy assignments from the board

Break assignments into small chunks

Give frequent and immediate feedback

Require corrections before new work is given

5. Proactive interventions to increase academic performance
Such interventions can prevent problematic behavior from occurring and can be implemented by individuals other than the classroom teacher, such as peers or a classroom aide. When disruptive behavior is not the primary problem, these academic interventions can improve behavior significantly.

Focus on increasing completion and accuracy of work

Offer task choices

Provide peer tutoring

Consider computer-assisted instruction

6. "When...then" contingencies (withdrawing rewards or privileges in response to inappropriate behavior)
Examples include recess time contingent upon completion of work, staying after school to complete work, assigning less desirable work prior to more desirable assignments, and requiring assignment completion in study hall before allowing free time.

7. Daily school-home report card
This tool allows parents and teacher to communicate regularly, identifying, monitoring and changing classroom problems. It is inexpensive and minimal teacher time is required.

Teachers determine the individualized target behaviors

Teachers evaluate targets at school and send the report card home with the child

Parents provide home-based rewards; more rewards for better performance and fewer for lesser performance

Teachers continually monitor and make adjustments to targets and criteria as behavior improves or new problems develop

Use the report card with other behavioral components such as commands, praise, rules, and academic programs

8. Behavior chart and/or reward and consequence program (point or token system)

Establish target behaviors and ensure that the child knows the behaviors and goals (e.g., list on index card taped to desk)

Establish rewards for exhibiting target behaviors

Monitor the child and give feedback

Reward young children immediately

Use points, tokens or stars that can later be exchanged for rewards

9. Class wide interventions and group contingencies
Such interventions encourage children to help one another because everyone can be rewarded. There is also potential for improvement in the behavior of the entire class.

Establish goals for the class as well as the individual

Establish rewards for appropriate behavior that any student can earn (e.g., class lottery, jelly bean jar, wacky bucks)

Establish a class reward system in which the entire class (or subset of the class) earns rewards based on class functioning as a whole (e.g, Good Behavior Game) or the functioning of the student with ADHD

Tailor frequency of rewards and consequences to developmental level

10. Time out
The child is removed, either in the classroom or to the office, from the ongoing activity for a few minutes (less for younger children and more for older) when he or she misbehaves.

11. Schoolwide programs
Such programs, which include schoolwide discipline plans, can be structured to minimize the problems experienced by children with ADHD, while at the same time help manage the behavior of all students in a school.

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As is the case with parent training, the techniques used to manage ADHD in the classroom have been used for some time and are considered effective. Many teachers who have had training in classroom management are quite expert in developing and implementing programs for students with ADHD.

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Classroom Management

Good classroom managers have efficient classrooms that meet the educational and psychological needs of their students. Classrooms are structured so that rules and routines are well known by the students and consistently followed. Transitions among lessons and activities are smooth. The teacher is able to give the impression that the he or she is aware of all activities by students in the classroom.Teachers with good classroom management skills meet the educational and personality needs of their students, regardless of their students' abilities and special needs. Student misbehavior especially misbehavior related to ADHD symptoms, can be prevented by careful attention to the following:

the physical environment of the classroom (including minimizing distracting classroom displays)

establishing and practicing with the students rules and procedures for routines and classroom tasks

organizing lesson plans and instruction in a way that minimizes interruptions

increasing teacher awareness in the classroom by letting students know you are aware of their actions at all times

Accommodations are intended to help students with ADHD learn the same information as other students. They are changes to the structures and/or the environment that provide support to help students access the curriculum. Accommodations work best when they are tailored for the individual needs of the student based on the severity and symptoms of their ADHD and any other co-occurring conditions. It is important to observe the student to see which accommodations are effective - and effectiveness of accommodations can change over time. Students can also be enlisted in figuring out what helps them the most. This will also ensure that the accommodations are seen as support instead of punishment. Teachers, parents, and students should partner together to address needs and supports.

The Diagnostic and Statistical Manual, Fifth Edition lists two categories of symptoms of ADHD-inattentive and hyperactive-impulsive. Students may have only one type, or they may have both types of symptoms. The accommodations that are appropriate for each student depend on the symptoms and on how much they impact the student.

Social Skills

Accommodating ADHD in the Classroom
ADHD: Inattentive Symptoms
Students with inattentive symptoms are easily distracted and have trouble focusing. Everything competes for their attention. They often struggle to follow through with instructions and have difficulty with organization.

To help students with managing inattentive symptoms, the following accommodations can be effective:

Seating the student in an area with fewer distractions where he or she can focus on the lesson. For example, near the teacher's desk, away from windows and the doorway, or in another area that has few distractions.

Seating the student next to positive role models, peers who are less likely to provide distractions and can help them stay on task.

Breaking long assignments into smaller parts. This allows students to see both the start and end of the task.

Making sure all assignments are clear and provided in writing in addition to giving them out loud.

Checking with the student before they complete an assignment to see if they heard and understood instructions. Ask them to repeat it back to verify understanding.

Allowing them to take tests in a different room, one that is quiet and has few distractions. Or using aids such as headphones or privacy boards to create quiet spaces in the classroom.

Giving more time to complete assignments, projects, and tests.

Using a timer or alarm to help with time management.

Providing breaks. Depending on the student, these could include stretching, walking to the board to complete a task, or handing out assignments or materials.

Limiting repetitive assignments, particularly those the students has already mastered, or tasks that are too far above the student's level. Students are most able to pay attention to tasks that present some challenge but are within their current learning zone.

Making sure that the student has the opportunity for physical activities because active movement increases the ability to focus. Recess should never be taken away as a punishment for misbehavior.

Providing tools to help with organization, such as different colored folders, a notebook with dividers, or a homework assignment book.

Using computers or tablets for work. Computers are visually stimulating and allow for more engagement and also help students organize their thoughts.

ADHD: Hyperactive-Impulsive Symptoms
Students with hyperactive-impulsive symptoms move a lot. They fidget, squirm, and have difficulty staying seated. They often talk excessively, blurt out answers, and have trouble taking turns.

To help students manage their hyperactive-impulsive symptoms, the following accommodations can be effective:

Seating the student in an area of the room where there will be the least disruption. This might be towards either side of the classroom rather than the center.

Allowing for the student to move around. You could allow the student to do their work while standing, sitting on the floor, or moving between desks.

Pairing the student with a peer who is a good role model and can model appropriate behavior.

Providing activity breaks. Depending on the student, these could include stretching, walking to the board to complete a task, or handing out assignments or materials.

Ignoring minor misbehavior.

Allowing the student to move or fidget in a non-distracting manner. They might tap their foot in the air or rotate their pen back and forth in their hands. Asking the student to offer suggestions is always a great way to get more ideas.

Allowing them to take tests in a different room. One that is quiet, has few distractions, and lets them move around without interrupting other students.

Praising when they exhibit appropriate behavior such as raising their hands and waiting to be called.

Limiting repetitive assignments, particularly those the students has already mastered, or tasks that are too far above the student's level. Fidgeting is often a symptom of boredom or overstimulation.

Making sure that the student has the opportunity for physical activities. Recess should never be taken away as a punishment for misbehavior.

Using a speaking stick or other object that gets passed around during class discussions as a cue to indicate whose turn it is to speak.

ADHD: combined symptoms
Many students with ADHD show a combination of inattention and hyperactive-impulsive behaviors. You can use a combination of accommodations from both lists. One of the best ways to identify which accommodations might work best is to observe the student's natural behavior.

Some sample behaviors and accommodations include:

Constantly moving in their seat

Try giving them options for how they can do their work and provide breaks.

Attention wavers, but when focused blurts out answers

Try consistent praise for raising their hands and seating them in an area with minimal distractions.

Has trouble completing assignments and tests in the allotted time because of distractions

Try an alternative test setting or breaking up assignments and tests into smaller sections. Allow extra time to complete tests.

Taps a pen constantly that is distracting to other students

Let the student know privately that tapping their pen is a distraction. Ask them if they have other suggestion for how they could focus. You might offer that they could wave their pen in the air, wiggle it between their fingers, or replace the pen with a soft object to tap that won't make noise.

References
Barkley, R. (2008). Classroom Accommodations for Children with ADHD. ADHD Report.

Dendy, C., Durheim, M., & Ellison, A. (2006). CHADD Educator's Manual. Lynchburg, VA: Progress Printing.

Parker, H. (2012). Accommodations Help Students with Attention Deficit Disorders. A.D.D. WareHouse.

Zentall, S. (2006). ADHD and Education Foundations, Characteristics, Methods, and Collaboration. Upper Saddle River, NJ: Pearson Education.

Chaban, P., McAuley, T., & Tannock, R. (2009). ADHD and Social-Emotional Abilities. www.AboutKidsHealth.ca.

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Classroom Management Good classroom managers have efficient classrooms that meet the educational and psychological needs of their students. Classrooms are structured so that rules and routines are well known by the students and consistently followed. Transitions among lessons and activities are smooth. The teacher is able to give the impression that the he or she...

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Mylemarks, (2016). Positive self-talk (anxiety). Retrieved July 20, 2021 from http://www.mylemarks.com/uploads/4/7/0/1/47012219/s815775378408561442_p284_i4_w640.png

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TES Resources. (n.d.). Oppositional defiant disorder. Retrieved July 20, 2021 from https://www.weareteachers.com/students-with-odd/

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Pathways2Success. (n.d.). Strategies for oppositional kids. Retrieved July 20, 2021 from https://www.weareteachers.com/students-with-odd/

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Anxiety is a normal part of childhood, but anxiety disorders can cause kids to perform poorly in school and/or miss out on typical social experiences because of fear. The Anxiety and Depression Association of America says that one in eight children has an anxiety disorder, so chances are you have more than one student who struggles with this issue.

Literature can be a great springboard for discussing ways to cope. With that in mind, we've rounded up some of the most recommended books for kids with anxiety. Please note, however, that reading about characters with anxiety may be triggering for certain students. We always recommend reaching out to a child's parents or your school counselor for further guidance.
Just a heads up, WeAreTeachers may collect a share of sales from the links on this page. We only recommend items our team loves!
Wemberly is a mouse who worries about everything, but her biggest fear is the first day of school. Kids will relate to Wemberly's fears and learn with her as she overcomes them.

As Mae's first day of school approaches, her anxiety builds, but then she meets Rosie and Ms. Pearl, who are equally nervous. This reassuring narrative shows kids the power of expressing fears and conquering them with support from others.

Several typical childhood fears, including fear of the dark, dogs, starting school, and getting lost, are illustrated in this book that encourages kids to address and think through their fears to a solution.

4. Noni Is Nervous by Heather Hartt-Sussman (Pre-K-2)

Noni is nervous about lots of things, but she is particularly anxious about her first day of school. This picture book about managing fears will comfort children who are contemplating a new experience.

Mr. Hartwell tries to convince a nervous Sarah to come out from under her covers and attend her first day of school. When she overcomes her fear and arrives at school, readers realize that Sarah Jane Hartwell is the new teacher. Kids will appreciate the joke and be reassured that they are not alone in their first-day jitters.

6. Is a Worry Worrying You? by Ferida Wolff and Harriet May Savitz (Pre-K-2)

Different hypothetical situations invite kids to think about creative ways to solve worrying problems. This book is a good way to start a conversation with kids about how to rethink reactions to their fears.

Although this workbook was developed to help children on the autism spectrum recognize and handle anxious emotions, it is appropriate for any young child who experiences anxiety.

8. Black Dog by Levi Pinfold (1-4)

When a huge dog appears outside the Hope family's house, they're all terrified except for Small, the youngest, who chases the rapidly shrinking dog until her courage has shrunk the dog to a normal, not scary size. This book will remind students that facing fears can help minimize them.

Engaging, encouraging, and easy to follow, this book helps kids develop actionable ways to manage anxiety and will empower them to work toward change.

Sixth grader Stanley struggles with anxiety, which prevents him from making friends, trying new things, and participating in a comics trivia scavenger hunt. Whether they suffer anxiety themselves or not, readers will cheer for Stanley and will come away with some coping strategies for dealing with their own stresses.

11. Sidetracked by Diana Harmon Asher (4-7)

With debilitating phobias of everything from hard-boiled eggs to gargoyles, Joseph struggles to make friends at school. But when his seventh grade teacher compels him to join the school track team, he makes an unlikely friend and finds himself off the sidelines for the first time.

This checklist helps kids narrow down what they are anxious about and know that they are not alone in their feelings.

Written by a therapist who has firsthand experience with anxiety, this is a great book for teens to help them understand the underlying causes of their anxiety and work on practical steps they can take to manage it.

This easy-to-read book offers practical strategies to help teens overcome all kinds of anxiety-inducing scenarios by recognizing and silencing the "monkey mind," or the primitive, instinctual part of the brain.

Beginning with relaxation and moving through more complex strategies, each step in this book builds a layered approach to managing anxiety. The final chapters stress the importance of proper nutrition, exercise, sleep, and the possible need for medication.
Are there other books for kids with anxiety that you would recommend? Come and share in our WeAreTeachers HELPLINE group on Facebook. Plus, check out 50 books to help teach kids social-emotional skills.

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15 Books That May Help Kids With Anxiety

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Anxiety is a normal part of childhood, but anxiety disorders can cause kids to perform poorly in school and/or miss out on typical social experiences because of fear. The Anxiety and Depression Association of America says that one in eight children has an anxiety disorder, so chances are you have more than one student who struggles with this issue.

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Therapist Aid. (n.d.). OCD treatment oveview. Retrieved July 20, 2021 from https://www.therapistaid.com/therapy-guide/ocd-treatment-overview