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National Alliance on Mental Illness. (2022). Mental health by the numbers. https://www.nami.org/mhstats

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National Alliance on Mental Illness (2022).

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You Are Not Alone
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Millions of people are affected by mental illness each year. Across the country, many people just like you work, perform, create, compete, laugh, love and inspire every day.

22.8% of U.S. adults experienced mental illness in 2021 (57.8 million people). This represents 1 in 5 adults.

5.5% of U.S. adults experienced serious mental illness in 2021 (14.1 million people). This represents 1 in 20 adults.

16.5% of U.S. youth aged 6-17 experienced a mental health disorder in 2016 (7.7 million people)

7.6% of U.S. adults experienced a co-occurring substance use disorder and mental illness in 2021 (19.4 million people)

Annual prevalence of mental illness among U.S. adults, by demographic group:

Non-Hispanic Asian: 16.4%

Non-Hispanic Native Hawaiian or Other Pacific Islander: 18.1%

Non-Hispanic Black or African American: 21.4%

Hispanic or Latino: 20.7%

Non-Hispanic White: 23.9%

Non-Hispanic American Indian or Alaska Native: 26.6%

Non-Hispanic mixed/multiracial: 34.9%

Lesbian, Gay or Bisexual: 50.2%

Annual prevalence among U.S. adults, by condition:

Schizophrenia: <1%

Obsessive Compulsive Disorder: 1.2%

Borderline Personality Disorder: 1.4%

Bipolar Disorder: 2.8%

Posttraumatic Stress Disorder: 3.6%

Major Depressive Episode: 8.3%

Anxiety Disorders: 19.1%

Mental Health Care Matters
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47.2% of U.S. adults with mental illness received treatment in 2021

65.4% of U.S. adults with serious mental illness received treatment in 2021

50.6% of U.S. youth aged 6-17 with a mental health disorder received treatment in 2016

The average delay between onset of mental illness symptoms and treatment is 11 years

Annual treatment rates among U.S. adults with any mental illness, by demographic group:

Non-Hispanic Asian: 25.4%

Hispanic or Latino: 36.1%

Non-Hispanic Black or African American: 39.4%

Non-Hispanic White: 52.4%

Non-Hispanic mixed/multiracial: 52.2%

Male: 40%

Female: 51.7%

Lesbian, Gay or Bisexual: 55.6%

10.6% of U.S. adults with mental illness had no insurance coverage in 2021

11.9% of U.S. adults with serious mental illness had no insurance coverage in 2021

160 million people live in a designated Mental Health Professional Shortage Area

The Ripple Effect Of Mental Illness
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Having a mental illness can make it challenging to live everyday life and maintain recovery. Beyond the individual, these challenges ripple out through our families, our communities, and our world.

PERSON

People with depression have a 40% higher risk of developing cardiovascular and metabolic diseases than the general population. People with serious mental illness are nearly twice as likely to develop these conditions.

33.5% of U.S. adults with mental illness also experienced a substance use disorder in 2021 (19.4 million individuals)

The rate of unemployment is higher among U.S. adults who have mental illness (7.4%) compared to those who do not (4.6%)

High school students with significant symptoms of depression are more than twice as likely to drop out compared to their peers

Students aged 6-17 with mental, emotional or behavioral concerns are 3x more likely to repeat a grade.

FAMILY

At least 8.4 million people in the U.S. provide care to an adult with a mental or emotional health issue

Caregivers of adults with mental or emotional health issues spend an average of 32 hours per week providing unpaid care

COMMUNITY

21.1% of people experiencing homelessness in the U.S. have a serious mental health condition

Among people in the U.S. under age 18, depressive disorders are the most common cause of hospitalization (after excluding hospitalization relating to pregnancy and birth)

Among people in the U.S. aged 18-44, psychosis spectrum and mood disorders account for nearly 600,000 hospitalizations each year

19.7% of U.S. Veterans experienced a mental illness in 2020 (3.9 million people)

9.6% of Active Component service members in the U.S. military experienced a mental health or substance use condition in 2021

Across the U.S. economy, serious mental illness causes $193.2 billion in lost earnings each year

WORLD

Depression and anxiety disorders cost the global economy $1 trillion in lost productivity each year

Depression is a leading cause of disability worldwide

Common Warning Signs Of Mental Illness
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Diagnosing mental illness isn't a straightforward science. We can't test for it the same way we can test blood sugar levels for diabetes. Each condition has its own set of unique symptoms, though symptoms often overlap.

It's Okay To Talk About Suicide
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Thoughts of suicide can be frightening. But by reaching out for help or checking in with family and friends, we can avoid devastating outcomes.

Suicide is the 2nd leading cause of death among people aged 10-14 and the 3rd leading cause of death among those aged 15-24 in the U.S.

​Suicide is the 12th leading cause of death overall in the U.S.

46% of people who die by suicide had a diagnosed mental health condition

90% of people who die by suicide may have experienced symptoms of a mental health condition, according to interviews with family, friends and medical professionals (also known as psychological autopsy)

Annual prevalence of serious thoughts of suicide, high risk populations:

U.S. Adults: annual average 4.8%

Native Hawaiian/Other Pacific Islander: 7.4%

Mixed/Multiracial: 8.2%

American Indian/Alaska Native: 8.5%

Youth Populations

Young adults aged 18-25: 13%

High school students: 22%

LGBTQ youth: 45%

Lesbian, gay and bisexual youth are nearly 4x more likely to attempt suicide than straight youth

79% of people who die by suicide are male

Transgender adults are nearly 9x more likely to attempt suicide at some point in their lifetime compared to the general population

2020: Recognizing The Impact
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2020 was a year of challenges, marked by loss and the uncertainty of the COVID-19 pandemic.

We must recognize the significant impact of the pandemic on our mental health-and the importance of increasing access to timely and effective care for those who need it.

1 in 15 U.S adults experienced both a substance use disorder and mental illness

12+ million U.S adults had serious thoughts of suicide

1 in 5 U.S adults report that the pandemic had a significant negative impact on their mental health

Among people aged 12 and older who drink alcohol, 15% report increased drinking

Among people aged 12 and older who use drugs, 10% report increased use

Among U.S. adults who received mental health services:

26.3 million U.S adults received virtual mental health services in the past year

2020: Youth & Young Adults
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Youth and young adults experienced a unique set of challenges during the COVID-19 pandemic-isolation from peers, adapting to virtual learning, and changes to sleep habits and other routines.

We must recognize the significant impact of these experiences on young people's mental health-and the importance of providing the education, care and support they need.

Among U.S. adolescents (aged 12-17):

Among U.S. young adults (aged 18-25):

1 in 5 young people report that the pandemic had a significant negative impact on their mental health

1 in 10 people under age 18 experience a mental health condition following a COVID-19 diagnosis

Mental Illness And The Criminal Justice System
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People with mental illness deserve help, not handcuffs. Yet people with mental illness are overrepresented in our nation's jails and prisons. We need to reduce criminal justice system involvement and increase investments in mental health care.

CRIMINAL JUSTICE SYSTEM

About 2 million times each year, people with serious mental illness are booked into jails.

About 2 in 5 people who are incarcerated have a history of mental illness (37% in state and federal prisons and 44% held in local jails).

66% of women in prison reported having a history of mental illness, almost twice the percentage of men in prison.

Nearly one in four people shot and killed by police officers between 2015 and 2020 had a mental health condition.

Suicide is the leading cause of death for people held in local jails.

An estimated 4,000 people with serious mental illness are held in solitary confinement inside U.S. prisons.

COMMUNITIES

70% of youth in the juvenile justice system have a diagnosable mental health condition.

Youth in detention are 10 times more likely to suffer from psychosis than youth in the community.

About 50,000 veterans are held in local jails - 55% report experiencing a mental illness.

Among incarcerated people with a mental health condition, non-white individuals are more likely to go to solitary confinement, be injured, and stay longer in jail.

ACCESS TO CARE

About 3 in 5 people (63%) with a history of mental illness do not receive mental health treatment while incarcerated in state and federal prisons.

Less than half of people (45%) with a history of mental illness receive mental health treatment while held in local jails.

People who have healthcare coverage upon release from incarceration are more likely to engage in services that reduce recidivism.

Mental Health & Access To Care In Rural America
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People from all communities are affected by mental illness, but rural Americans often experience unique barriers to managing their mental health.

Among U.S. adults in nonmetropolitan areas, 2020:

21% experienced mental illness

6% experienced serious mental illness

13% experienced a substance use disorder

5% had serious thoughts of suicide

Access to Treatment is Severely Limited

25+ Million rural Americans live in a Mental Health Professional Shortage Area, where there are too few providers to meet demand

Some Populations Face Additional Challenges

53% of rural adults say the COVID-19 pandemic has affected their mental health

66% of farmers and farmworkers

71% of younger adults aged 18-34

Many rural states have a postpartum depression rate higher than the national average of 13%:

21% in Alabama

22% in Mississippi

23% in Arkansas

Rural youth are at an increased risk of suicide, but highly rural areas have fewer youth suicide prevention services

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Millions of people in the U.S. are affected by mental illness each year. It's important to measure how common mental illness is, so we can understand its physical, social and financial impact - and so we can show that no one is alone. These numbers are also powerful tools for raising public awareness, stigma-busting and [...]

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Center of Disease Control. (2022). Data and statistics on children's mental health. https://www.cdc.gov/childrensmentalhealth/data.html

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Centers for Disease Control and Prevention

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Mental health is an important part of children's overall health and well-being. Mental health includes children's mental, emotional, and behavioral well-being. It affects how children think, feel, and act. It also plays a role in how children handle stress, relate to others, and make healthy choices.

Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, causing distress and problems getting through the day. Among the more common mental disorders that can be diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD), anxiety, and behavior disorders.

There are different ways to assess mental health and mental disorders in children. CDC uses surveys, like the National Survey of Children's Health, to describe the presence of positive indicators of children's mental health and to understand the number of children with diagnosed mental disorders and whether they received treatment. In this type of survey, parents report on indicators of positive mental health for their child and report any diagnoses their child has received from a healthcare provider. The information on this page provides data about indicators of positive mental health in children and mental health disorders that are most common in children.

Facts about mental health in U.S. children

National data on positive mental health indicators that describe mental, emotional, and behavioral well-being for children are limited. Based on the data we do have:

Facts about mental disorders in U.S. children

ADHD, anxiety problems, behavior problems, and depression are the most commonly diagnosed mental disorders in children. Estimates for ever having a diagnosis among children aged 3-17 years, in 2016-19, are given below.

ADHD 9.8% (approximately 6.0 million)

Anxiety 9.4% (approximately 5.8 million)

Behavior problems 8.9% (approximately 5.5 million)

Depression 4.4% (approximately 2.7 million)

Some of these conditions commonly occur together. For example, among children aged 3-17 years in 2016:

Having another mental disorder was most common in children with depression: about 3 in 4 children with depression also had anxiety (73.8%) and almost 1 in 2 had behavior problems (47.2%).

For children with anxiety, more than 1 in 3 also had behavior problems (37.9%) and about 1 in 3 also had depression (32.3%).

For children with behavior problems, more than 1 in 3 also had anxiety (36.6%) and about 1 in 5 also had depression (20.3%).

For adolescents, depression, substance use and suicide are important concerns. Among adolescents aged 12-17 years in 2018-2019 reporting on the past year:

Learn more about high-risk substance use among youth. Learn more about suicide.

Mental, behavioral, and developmental disorders begin in early childhood
1 in 6 U.S. children aged 2-8 years (17.4%) had a diagnosed mental, behavioral, or developmental disorder.

Prevalence of mental disorders change with age

Diagnoses of ADHD, anxiety, and depression become are more common with increased age.

Behavior problems are more common among children aged 6-11 years than younger or older children.

Adverse childhood events (ACEs) are associated with children's physical and mental health. In 2016-2019, among children aged 6-17 years:

Children who were discriminated against based on race or ethnicity had higher percentages of one or more physical health conditions (37.8% versus 27.1%), and one or more mental health conditions (28.9% versus 17.8%).

Racial/ethnic discrimination was almost seven times as common among children with three other ACEs compared to those with no other ACEs.

Note: The estimates reported on this page are based on parent report, using nationally representative surveys. This method has several limitations. It is not known to what extent children receive these diagnoses accurately. Estimates based on parent-reported diagnoses may match those based on medical records, but some children may also have mental disorders that have not been diagnosed, or receive diagnoses that may not be the best fit for their symptoms. Limited information on measuring children's mental health nationally is available.

Read more about children's mental health from a community study.

Access to mental health treatment

Early diagnosis and appropriate services for children and their families can make a difference in the lives of children with mental disorders. Access to providers who can offer services, including screening, referrals, and treatment, varies by location. CDC is working to learn more about access to behavioral health services and supports for children and their families.
View information by state describing the rates of different types of providers who can offer behavioral health services providers by county. Read a recent report describing shortages of services, barriers to treatment, and how integration of behavioral health care with pediatric primary care could address the issues. Read a policy brief on potential ways to increase access to mental health services for children in rural areas
Data sources for mental health and related conditions

There are many different datasets which include information on children's mental health and related conditions for children living in the United States.

Healthy People 2030
Healthy People 2030 sets data-driven national objectives to improve health and well-being over the next decade, including children's mental health and well-being.

National Survey of Family Growth (NSFG)
NSFG gathers information on family life, marriage and divorce, pregnancy, infertility, use of contraception, and general and reproductive health.

National Health and Nutrition Examination Survey (NHANES)
NHANES assesses health and nutritional status through interviews and physical examinations, and includes conditions, symptoms, and concerns associated with mental health and substance abuse, as well as the use and need for mental health services.

National Health Interview Survey (NHIS)
NHIS collects data on children's mental health, mental disorders, such as ADHD, autism spectrum disorder, depression and anxiety problems, and use and need for mental health services.

National Survey of Children's Health (NSCH)
NSCH examines the health of children, with emphasis on well-being, including medical homes, family interactions, the health of parents, school and after-school experiences, and safe neighborhoods. This survey was redesigned in 2016.

For previous versions of this survey, see also:
National Survey of Children's Health (NSCH 2003, 2007, 2011-12)
National Survey of Children with Special Healthcare Needs (NS-CSHCN 2001, 2005-6, 2009-10)

National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS-DATA)
NS-DATA collects information about children, 2-15 years old in 2011-2012, who had ever been diagnosed with ADHD and/or Tourette syndrome (TS), with the goal of better understanding diagnostic practices, level of impairment, and treatments for this group of children.

National Survey on Drug Use and Health (NSDUH)
NSDUH, administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides national- and state-level data on the use of tobacco, alcohol, and illicit drugs (including non-medical use of prescription drugs), as well as data on mental health in the United States.

National Vital Statistics System (NVSS)
NVSS contains vital statistics from the official records of live births, deaths, causes of death, marriages, divorces, and annulment recorded by states and independent registration areas

National Youth Tobacco Survey (NYTS)
NYTS is a nationally representative school-based survey on tobacco use by public school students enrolled in grades 6-12.

School Associated Violent Death Study (SAVD)
SAVD plays an important role in monitoring trends related to school-associated violent deaths (including suicide), identifying the factors that increase the risk, and assessing the effects of prevention efforts.

School Health Policies and Programs Study (SHPPS)
SHPPS is a national survey assessing school health policies and practices at the state, district, school, and classroom levels. Collected data includes mental health and social service policies.

Web-based Injury Statistics Query and Reporting System (WISQARS)
WISQARS is an interactive database system that provides customized reports of injury-related data.

Youth Risk Behavior Surveillance System (YRBSS)
The YRBSS monitors health-risk behaviors, including tobacco use, substance abuse, unintentional injuries and violence, sexual behaviors that contribute to unintended pregnancy, and sexually transmitted diseases.

References

1. Perou R, Bitsko RH, Blumberg SJ, Pastor P, Ghandour RM, Gfroerer JC, Hedden SL, Crosby AE, Visser SN, Schieve LA, Parks SE, Hall JE, Brody D, Simile CM, Thompson WW, Baio J, Avenevoli S, Kogan MD, Huang LN. Mental health surveillance among children - United States, 2005-2011. MMWR 2013;62(Suppl; May 16, 2013):1-35. [Read summary]

2. Bitsko RH, Claussen AH, Lichtstein J, Black LJ, Everett Jones S, Danielson MD, Hoenig JM, Davis Jack SP, Brody DJ, Gyawali S, Maenner MM, Warner M, Holland KM, Perou R, Crosby AE, Blumberg SJ, Avenevoli S, Kaminski JW, Ghandour RM. Surveillance of Children's Mental Health - United States, 2013 - 2019 MMWR, , 2022 / 71(Suppl-2);1-42. [Read article]

3. Ghandour RM, Sherman LJ, Vladutiu CJ, Ali MM, Lynch SE, Bitsko RH, Blumberg SJ. Prevalence and treatment of depression, anxiety, and conduct problems in U.S. children. The Journal of Pediatrics, 2018. Published online before print October 12, 2018 [Read summary]

4. Bitsko RH, Holbrook JR, Ghandour RM, Blumberg SJ, Visser SN, Perou R, Walkup J. Epidemiology and impact of healthcare provider diagnosed anxiety and depression among US children. Journal of Developmental and Behavioral Pediatrics. Published online before print April 24, 2018 [Read summary]

5. Cree RA, Bitsko RH, Robinson LR, Holbrook JR, Danielson ML, Smith DS, Kaminski JW, Kenney MK, Peacock G. Health care, family, and community factors associated with mental, behavioral, and developmental disorders and poverty among children aged 2-8 years - United States, 2016. MMWR, 2018;67(5):1377-1383. [Read article]

6. Hutchins HJ, Barry CM, Valentine V, Bacon S, Njai R, Claussen AH, Ghandour RM, Lebrun-Harris LA, Perkins K, Robinson LR (submitted). Perceived racial/ethnic discrimination, physical and mental health conditions in childhood, and the relative role of other adverse experiences. Adversity and Resilience Science published online May 23, 2022. [Read summary]

7. US Department of Health and Human Services Health Resources and Services Administration & Maternal and Child Health Bureau. Mental health: A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and National Institutes of Health, National Institute of Mental Health; 1999. [Read report]

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Data and Statistics on Children's Mental Health | CDC

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Read data highlights about children's mental health.

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Statistics on Mental Health in Adolescents

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Statistics on Mental Health in Adolescents

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CDC (2022)

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School Mental Health Referral Pathways Toolkit. (2015). Substance Abuse and Mental Health Services Administration.

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West Virginia Board of Education. (2015). Addressing Mental Health in School Crisis Prevention & Response.

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Missouri School Counselors and Counselor Educators. (2015). School counselor referral process guide.

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Crisis Response and Prevention; Mental Health

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Crisis Response and Prevention; Mental Health

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Definition

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

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

Prevalence

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

Characteristics

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

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

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

Impact on Learning

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

Teaching Strategies

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

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

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

Assistive Technology

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

Organizations

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

American Academy of Child and Adolescent Psychiatry

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

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

Web: www.aacap.org

Center on Positive Behavioral Interventions and Supports

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

5262 University of Oregon
Eugene, OR 97403-5262

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

Center for Disability and Development

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

Council for Exceptional Children

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

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

Federation of Families for Children's Mental Health

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

1101 King Street, Suite 420
Alexandria, VA 22314

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

National Alliance for the Mentally Ill (NAMI)

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

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

Web: www.nami.org

Mental Health America

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

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

Web: www.nmha.org

National Mental Health Information Center

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

P.O. Box 42557
Washington, DC 20015

Web: www.mentalhealth.org

References

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

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

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

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

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Overview

Obsessive-compulsive disorder (OCD) features a pattern of unwanted thoughts and fears known as obsessions. These obsessions lead you to do repetitive behaviors, also called compulsions. These obsessions and compulsions get in the way of daily activities and cause a lot of distress.

Ultimately, you feel driven to do compulsive acts to ease your stress. Even if you try to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads you to act based on ritual. This is the vicious cycle of OCD.

OCD often centers around certain themes, such as being overly fearful of getting contaminated by germs. To ease contamination fears, you may wash your hands over and over again until they're sore and chapped.

If you have OCD, you may be ashamed, embarrassed and frustrated about the condition. But treatment can be effective.

Symptoms

Obsessive-compulsive disorder usually includes both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. You may or may not know that your obsessions and compulsions are beyond reason. But they take up a great deal of time, reduce your quality of life, and get in the way of your daily routines and responsibilities.

Obsession symptoms

OCD obsessions are lasting and unwanted thoughts that keeping coming back or urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by acting based on ritual. These obsessions usually intrude when you're trying to think of or do other things.

Obsessions often have themes, such as:

Fear of contamination or dirt.

Doubting and having a hard time dealing with uncertainty.

Needing things to be orderly and balanced.

Aggressive or horrific thoughts about losing control and harming yourself or others.

Unwanted thoughts, including aggression, or sexual or religious subjects.

Examples of obsession symptoms include:

Fear of being contaminated by touching objects others have touched.

Doubts that you've locked the door or turned off the stove.

Intense stress when objects aren't orderly or facing a certain way.

Images of driving your car into a crowd of people.

Thoughts about shouting obscenities or not acting the right way in public.

Unpleasant sexual images.

Staying away from situations that can cause obsessions, such as shaking hands.

Compulsion symptoms

OCD compulsions are repetitive behaviors that you feel driven to do. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. But taking part in the compulsions brings no pleasure and may offer only limited relief from anxiety.

You may make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are beyond reason and often don't relate to the issue they're intended to fix.

As with obsessions, compulsions usually have themes, such as:

Washing and cleaning.

Checking.

Counting.

Ordering.

Following a strict routine.

Demanding reassurance.

Examples of compulsion symptoms include:

Hand-washing until your skin becomes raw.

Checking doors over and over again to make sure they're locked.

Checking the stove over and over again to make sure it's off.

Counting in certain patterns.

Silently repeating a prayer, word or phrase.

Trying to replace a bad thought with a good thought.

Arranging your canned goods to face the same way.

Severity varies

OCD usually begins in the teen or young adult years, but it can start in childhood. Symptoms usually begin over time and tend to vary in how serious they are throughout life. The types of obsessions and compulsions you have also can change over time. Symptoms generally get worse when you are under greater stress, including times of transition and change. OCD, usually thought to be a lifelong disorder, can have mild to moderate symptoms or be so severe and time-consuming that it becomes disabling.

When to see a doctor

There's a difference between being a perfectionist - someone who needs flawless results or performance - and having OCD. OCD thoughts aren't simply excessive worries about real issues in your life or liking to have things clean or arranged in a specific way.

If your obsessions and compulsions affect your quality of life, see your doctor or mental health professional.

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Causes

The cause of obsessive-compulsive disorder isn't fully understood. Main theories include:

Biology. OCD may be due to changes in your body's natural chemistry or brain functions.

Genetics. OCD may have a genetic component, but specific genes have yet to be found.

Learning. Obsessive fears and compulsive behaviors can be learned from watching family members or learning them over time.

Risk factors

Factors that may raise the risk of causing obsessive-compulsive disorder include:

Family history. Having parents or other family members with the disorder can raise your risk of getting OCD.

Stressful life events. If you've gone through traumatic or stressful events, your risk may increase. This reaction may cause the intrusive thoughts, rituals and emotional distress seen in OCD.

Other mental health disorders. OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders.

Complications

Issues due to obsessive-compulsive disorder include:

Excessive time spent taking part in ritualistic behaviors.

Health issues, such as contact dermatitis from frequent hand-washing.

Having a hard time going to work or school or taking part in social activities.

Troubled relationships.

Poor quality of life.

Thoughts about suicide and behavior related to suicide.

Prevention

There's no sure way to prevent obsessive-compulsive disorder. However, getting treated as soon as possible may help keep OCD from getting worse and disrupting activities and your daily routine.

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Obsessive-compulsive disorder (OCD) - Symptoms and causes

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OCD features unwanted thoughts and fears, or obsessions. These obsessions lead to repetitive behaviors, also known as compulsions, that get in the way of daily activities.

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Overview

Somatic symptom disorder

Illness anxiety disorder, sometimes called hypochondriasis or health anxiety, is worrying excessively that you are or may become seriously ill. You may have no physical symptoms. Or you may believe that normal body sensations or minor symptoms are signs of severe illness, even though a thorough medical exam doesn't reveal a serious medical condition.

You may experience extreme anxiety that body sensations, such as muscle twitching or fatigue, are associated with a specific, serious illness. This excessive anxiety - rather than the physical symptom itself - results in severe distress that can disrupt your life.

Illness anxiety disorder is a long-term condition that can fluctuate in severity. It may increase with age or during times of stress. But psychological counseling (psychotherapy) and sometimes medication can help ease your worries.

Hypochondria

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, no longer includes hypochondriasis - also called hypochondria - as a diagnosis. Instead, people previously diagnosed with hypochondriasis may be diagnosed as having illness anxiety disorder, in which the focus of the fear and worry is on uncomfortable or unusual physical sensations being an indication of a serious medical condition.

On the other hand, somatic symptom disorder ― a related disorder ― involves focusing on the disabling nature of physical symptoms, such as pain or dizziness, without the worry that these symptoms represent a specific illness.

Symptoms

Symptoms of illness anxiety disorder involve preoccupation with the idea that you're seriously ill, based on normal body sensations (such as a noisy stomach) or minor signs (such as a minor rash). Signs and symptoms may include:

Being preoccupied with having or getting a serious disease or health condition

Worrying that minor symptoms or body sensations mean you have a serious illness

Being easily alarmed about your health status

Finding little or no reassurance from doctor visits or negative test results

Worrying excessively about a specific medical condition or your risk of developing a medical condition because it runs in your family

Having so much distress about possible illnesses that it's hard for you to function

Repeatedly checking your body for signs of illness or disease

Frequently making medical appointments for reassurance - or avoiding medical care for fear of being diagnosed with a serious illness

Avoiding people, places or activities for fear of health risks

Constantly talking about your health and possible illnesses

Frequently searching the internet for causes of symptoms or possible illnesses

When to see a doctor

Because symptoms can be related to health problems, it's important to be evaluated by your primary care provider if this hasn't already been done. If your provider believes that you may have illness anxiety disorder, he or she may refer you to a mental health professional.

Caring for a loved one

Significant health anxiety can cause real distress for the person, and reassurance isn't always helpful. Sometimes, providing reassurance can make things worse. This can be frustrating and cause stress on families and relationships. Encourage your loved one to consider a mental health referral to learn ways to cope with illness anxiety disorder.

Causes

The exact cause of illness anxiety disorder isn't clear, but these factors may play a role:

Beliefs. You may have a difficult time tolerating uncertainty over uncomfortable or unusual body sensations. This could lead you to misinterpret that all body sensations are serious, so you search for evidence to confirm that you have a serious disease.

Family. You may be more likely to have health anxiety if you had parents who worried too much about their own health or your health.

Past experience. You may have had experience with serious illness in childhood, so physical sensations may be frightening to you.

Risk factors

Illness anxiety disorder usually begins in early or middle adulthood and may get worse with age. Often for older individuals, health-related anxiety may focus on the fear of losing their memory.

Risk factors for illness anxiety disorder may include:

A time of major life stress

Threat of a serious illness that turns out not to be serious

History of abuse as a child

A serious childhood illness or a parent with a serious illness

Personality traits, such as having a tendency toward being a worrier

Excessive health-related internet use

Complications

Illness anxiety disorder may be associated with:

Relationship or family problems because excessive worrying can frustrate others

Work-related performance problems or excessive absences

Problems functioning in daily life, possibly even resulting in disability

Financial problems due to excessive health care visits and medical bills

Having another mental health disorder, such as somatic symptom disorder, other anxiety disorders, depression or a personality disorder

Prevention

Little is known about how to prevent illness anxiety disorder, but these suggestions may help.

If you have problems with anxiety, seek professional advice as soon as possible to help stop symptoms from getting worse and impairing your quality of life.

Learn to recognize when you're stressed and how this affects your body - and regularly practice stress management and relaxation techniques.

Stick with your treatment plan to help prevent relapses or worsening of symptoms.

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Illness anxiety disorder - Symptoms and causes

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Somatic symptom disorder Illness anxiety disorder, sometimes called hypochondriasis or health anxiety, is worrying excessively that you are or may become seriously ill. You may have no physical symptoms. Or you may believe that normal body sensations or minor symptoms are signs of severe illness, even though a thorough medical exam doesn't reveal a serious medical condition.

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Better Health Channel- Family and Friends

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Better Health Channel- Family and Friends

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Obsessive compulsive disorder (OCD) is characterised by recurring unwanted and intrusive thoughts, impulses and images (obsessions), as well as repetitive behavioural and mental rituals (compulsions).

It can be difficult, demanding and exhausting to live with a person who has OCD. Family members and friends may become deeply involved in the person's rituals and may have to assume responsibility and care for many daily activities that the person with OCD is unable to undertake. This can cause distress and disruption to all members of the family.

People with OCD are usually aware that their obsessions and compulsions are irrational and excessive, yet feel unable to control or resist them. OCD can take up many hours of a person's day and may severely affect work, study, and family and social relationships.

Understanding OCD can help

People with OCD often feel frustrated and distressed about their need to act compulsively. When family members and friends are more informed about OCD, it is easier to be supportive and understanding.

Many people with OCD experience intense fears of something terrible happening to themselves or others, have constant doubts about their behaviour, and frequently seek reassurance from others.

Common misconceptions include that OCD is caused by laziness, lack of willpower, bad parenting or trauma. Assumptions like these lead to blame and guilt. Many OCD behaviours that are irritating and demanding are actually symptoms of the condition.

There are many available that can help resolve misunderstandings and concerns about this disorder. These include , , and websites with information about specific aspects of OCD (such as , obsessional thinking and hyper-responsibility) and community resources such as telephone helplines and .

Offer support and understanding to people you know with OCD

It is important to communicate clearly that you understand the difference between the behavioural symptoms of OCD and the person: 'I know this is not you, this is your OCD.' This will help to diminish the person's feelings of guilt and low self-worth and reduce their levels of stress and anxiety. Other suggestions include:

Encourage the person to talk about the disorder so that you can learn how it affects them and how you can be more supportive, but don't engage in discussions about the logic of OCD as most people with OCD know their obsessions and compulsions are excessive and irrational.

Encourage the person to seek professional help. OCD is generally not a condition that will go away without treatment. You can assist in locating an experienced therapist and offer to be involved in their treatment program. If the OCD has involved you or other family or friends extensively in rituals and avoidance behaviours, you will need to know the best ways to modify your involvement so that the treatment can be as effective as possible.

Encourage discussion about OCD as a common and treatable anxiety condition that is nothing to be embarrassed or ashamed of. Support the person with OCD to share their experiences with family and friends - this will help to break the secrecy about OCD.

Acknowledge improvements, however small, and encourage the person to reward themselves for their progress.

Try to be patient and maintain a non-judgemental attitude - this will support the person to focus their efforts on recovery rather than dealing with anger and resentment.

If their motivation wanes and they consider stopping treatment, remind them of the gains they have made.

Don't reinforce obsessive compulsive behaviours

Families and friends often get involved in OCD behaviours. It may seem like the only way to reduce the distress that the person with OCD is experiencing. You may feel that it is easier to keep things functioning if you can quickly comply with their request, rather than dealing with the protracted anxiety, tears, or arguments that may arise if you don't do what is asked.

Helping a person with OCD with their rituals, responding to requests for reassurance or undertaking tasks that they want to avoid, are all behaviour patterns that maintain OCD and may create an obstacle to the person's recovery.

It can be very difficult to reduce this type of involvement in a person's OCD, especially if it has been going on for a long time. It is important to 'normalise' family or household routines and refuse to participate in reinforcing OCD behaviours. This should be done in a gradual way and preferably as part of a cognitive behavioural treatment program.

Suddenly stopping all involvement in a person's OCD could trigger overwhelming distress for the person with OCD and lead to increased symptoms, high agitation, anxiety and depression.

Some suggestions include:

Talk openly about behaviours that impact on household routines and time. Plan ways in which family and friends can gradually reduce their participation in the person's rituals and explain the reasons for doing this. Encourage the person with OCD to be a part of decision making about how this is achieved. Set realistic goals together and talk about ways to ensure that everyone will abide by the plan.

If the person with OCD is in treatment, offer to attend a session with them so that you can seek advice about how you can best support their treatment program.

Try to maintain normal household routines whenever possible.

Focus on strengthening family and social connections, and reinforce a sense of stability by maintaining positive traditions and occasions - celebrate birthdays and anniversaries, or have regular family dinners. Reinforce positive communication and behaviours (such as sharing, hugs and helping each other) and keep up family activities such as going to the footy, or taking the dog to the park.

Reach out for support and help for yourself

If you live with someone with OCD, it is likely you will need some support and help for yourself. Over time, OCD in the family or household can lead to everyone feeling isolated and alone. It is important to maintain your connections and supports among your extended family and friends.

If these support networks are limited or unable to meet your needs, consider seeking out supports in the community. Suggestions include:

Contact a telephone helpline for families and carers of people with OCD and anxiety conditions, such as the Tel, 1300 269 438.

Attend a support group for families and friends in similar situations.

Attend education and skills groups for carers of people with OCD.

Seek out information or workshops on stress management, relaxation and mindfulness meditation, and healthy living.

If your physical or emotional health is suffering, seek professional help for yourself - short-term counselling and support can be found through your GP, local community health centre, or a private psychologist.

Take time out for yourself whenever possible and try to maintain hobbies and outside interests.

When the person who has OCD refuses treatment

A person who has OCD may be reluctant to seek professional help. They may have fears such as:

the stigma associated with mental illness

the possibility of being found to be really 'mad' or 'crazy'

having to give up their compulsions - they may feel that the behaviours are necessary to their survival and that it would be impossible to stop them

becoming addicted to medications

'failing' at the therapy

appearing weak because they can't deal with their problem on their own.

Suggestions for supporting the person with OCD include:

Offer reassurance that OCD is a recognised and treatable illness.

Assist them to be fully informed about effective treatments, including medication and psychological therapy. Information about available options can help alleviate many of the fears that people with OCD have about treatment, such as: how the treatments work, what is expected of the person, how long it should take, what self-management strategies can improve recovery, and how these treatments have helped others with OCD.

Encourage them to seek treatment from a professional who is experienced in treating OCD. Fears and worries about treatment may be exacerbated if the person with OCD is exposed to an incompetent or inappropriate treatment service.

Don't try to bully or ridicule a person with OCD into getting treatment - strong-arm tactics won't work and will only increase their feelings of powerlessness and failure.

Emphasise that knowing when to seek help is actually a sign of strength, not weakness.

Seek advice from professionals and support groups on your own, if necessary.

Sometimes, despite your best efforts, you have to accept there's nothing more you can do to encourage the person to seek help - in this case, you need to find avenues of support and strength for yourself.

If you think the person is in danger of harming themselves or someone else, call your doctor, local mental health service crisis assessment team or the police (dial 000).

Where to get help

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Obsessive compulsive disorder - family and friends

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Obsessive compulsive disorder (OCD) is characterised by recurring unwanted and intrusive thoughts, impulses and images (obsessions), as well as repetitive behavioural and mental rituals (compulsions). It can be difficult, demanding and exhausting to live with a person who has OCD.

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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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504- Protecting Students with Disabilities 

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504- Protecting Students with Disabilities 

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Introduction | Interrelationship of IDEA and Section 504 | Protected Students | Evaluation | Placement |
Procedural Safeguards | Terminology

This document is a revised version of a document originally developed by the Chicago Office of the Office for Civil Rights (OCR) in the U.S. Department of Education (ED) to clarify the requirements of Section 504 of the Rehabilitation Act of 1973, as amended (Section 504) in the area of public elementary and secondary education. The primary purpose of these revisions is to incorporate information about the Americans with Disabilities Act Amendments Act of 2008 (Amendments Act), effective January 1, 2009, which amended the Americans with Disabilities Act of 1990 (ADA) and included a conforming amendment to the Rehabilitation Act of 1973 that affects the meaning of disability in Section 504. The Amendments Act broadens the interpretation of disability. The Amendments Act does not require ED to amend its Section 504 regulations. ED's Section 504 regulations as currently written are valid and OCR is enforcing them consistent with the Amendments Act. In addition, OCR is currently evaluating the impact of the Amendments Act on OCR's enforcement responsibilities under Section 504 and Title II of the ADA, including whether any changes in regulations, guidance, or other publications are appropriate. The revisions to this Frequently Asked Questions document do not address the effects, if any, on Section 504 and Title II of the amendments to the regulations implementing the Individuals with Disabilities Education Act (IDEA) that were published in the Federal Register at 73 Fed. Reg. 73006 (December 1, 2008).
INTRODUCTION
An important responsibility of the Office for Civil Rights (OCR) is to eliminate discrimination on the basis of disability against students with disabilities. OCR receives numerous complaints and inquiries in the area of elementary and secondary education involving Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. § 794 (Section 504). Most of these concern identification of students who are protected by Section 504 and the means to obtain an appropriate education for such students.

Section 504 is a federal law designed to protect the rights of individuals with disabilities in programs and activities that receive Federal financial assistance from the U.S. Department of Education (ED). Section 504 provides: "No otherwise qualified individual with a disability in the United States . . . shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance . . . ."

OCR enforces Section 504 in programs and activities that receive Federal financial assistance from ED. Recipients of this Federal financial assistance include public school districts, institutions of higher education, and other state and local education agencies. The regulations implementing Section 504 in the context of educational institutions appear at 34 C.F.R. Part 104.

The Section 504 regulations require a school district to provide a "free appropriate public education" (FAPE) to each qualified student with a disability who is in the school district's jurisdiction, regardless of the nature or severity of the disability. Under Section 504, FAPE consists of the provision of regular or special education and related aids and services designed to meet the student's individual educational needs as adequately as the needs of nondisabled students are met.

This resource document clarifies pertinent requirements of Section 504.

For additional information, please contact the Office for Civil Rights.
INTERRELATIONSHIP OF IDEA AND SECTION 504 1. What is the jurisdiction of the Office for Civil Rights (OCR), the Office of Special Education and Rehabilitative Services (OSERS) and state departments of education/instruction regarding educational services to students with disabilities?
OCR, a component of the U.S. Department of Education, enforces Section 504 of the Rehabilitation Act of 1973, as amended, (Section 504) a civil rights statute which prohibits discrimination against individuals with disabilities. OCR also enforces Title II of the Americans with Disabilities Act of 1990 (Title II), which extends this prohibition against discrimination to the full range of state and local government services, programs, and activities (including public schools) regardless of whether they receive any Federal financial assistance. The Americans with Disabilities Act Amendments Act of 2008 (Amendments Act), effective January 1, 2009, amended the Americans with Disabilities Act of 1990 (ADA) and included a conforming amendment to the Rehabilitation Act of 1973 (Rehabilitation Act) that affects the meaning of disability in Section 504. The standards adopted by the ADA were designed not to restrict the rights or remedies available under Section 504. The Title II regulations applicable to free appropriate public education issues do not provide greater protection than applicable Section 504 regulations. This guidance focuses primarily on Section 504.

Section 504 prohibits discrimination on the basis of disability in programs or activities that receive Federal financial assistance from the U.S. Department of Education. Title II prohibits discrimination on the basis of disability by state and local governments. The Office of Special Education and Rehabilitative Services (OSERS), also a component of the U.S. Department of Education, administers the Individuals with Disabilities Education Act (IDEA), a statute which funds special education programs. Each state educational agency is responsible for administering IDEA within the state and distributing the funds for special education programs. IDEA is a grant statute and attaches many specific conditions to the receipt of Federal IDEA funds. Section 504 and the ADA are antidiscrimination laws and do not provide any type of funding.

2. How does OCR get involved in disability issues within a school district?

OCR receives complaints from parents, students or advocates, conducts agency initiated compliance reviews, and provides technical assistance to school districts, parents or advocates.

3. Where can a school district, parent, or student get information on Section 504 or find out information about OCR's interpretation of Section 504 and Title II?

OCR provides technical assistance to school districts, parents, and students upon request. Additionally, regulations and publicly issued policy guidance is available on OCR's website, at http://www.ed.gov/policy/rights/guid/ocr/disability.html.
4. What services are available for students with disabilities under Section 504?
Section 504 requires recipients to provide to students with disabilities appropriate educational services designed to meet the individual needs of such students to the same extent as the needs of students without disabilities are met. An appropriate education for a student with a disability under the Section 504 regulations could consist of education in regular classrooms, education in regular classes with supplementary services, and/or special education and related services.

5. Does OCR examine individual placement or other educational decisions for students with disabilities?

Except in extraordinary circumstances, OCR does not review the result of individual placement or other educational decisions so long as the school district complies with the procedural requirements of Section 504 relating to identification and location of students with disabilities, evaluation of such students, and due process. Accordingly, OCR generally will not evaluate the content of a Section 504 plan or of an individualized education program (IEP); rather, any disagreement can be resolved through a due process hearing. The hearing would be conducted under Section 504 or the IDEA, whichever is applicable.

OCR will examine procedures by which school districts identify and evaluate students with disabilities and the procedural safeguards which those school districts provide students. OCR will also examine incidents in which students with disabilities are allegedly subjected to treatment which is different from the treatment to which similarly situated students without disabilities are subjected. Such incidents may involve the unwarranted exclusion of disabled students from educational programs and services.

6. What protections does OCR provide against retaliation?

Retaliatory acts are prohibited. A recipient is prohibited from intimidating, threatening, coercing, or discriminating against any individual for the purpose of interfering with any right or privilege secured by Section 504.

7. Does OCR mediate complaints?

OCR does not engage in formal mediation. However, OCR may offer to facilitate mediation, referred to as "Early Complaint Resolution," to resolve a complaint filed under Section 504. This approach brings the parties together so that they may discuss possible resolution of the complaint immediately. If both parties are willing to utilize this approach, OCR will work with the parties to facilitate resolution by providing each an understanding of pertinent legal standards and possible remedies. An agreement reached between the parties is not monitored by OCR.

8. What does noncompliance with Section 504 mean?

A school district is out of compliance when it is violating any provision of the Section 504 statute or regulations.

9. What sanctions can OCR impose on a school district that is out of compliance?

OCR initially attempts to bring the school district into voluntary compliance through negotiation of a corrective action agreement. If OCR is unable to achieve voluntary compliance, OCR will initiate enforcement action. OCR may: (1) initiate administrative proceedings to terminate Department of Education financial assistance to the recipient; or (2) refer the case to the Department of Justice for judicial proceedings.

10. Who has ultimate authority to enforce Section 504?

In the educational context, OCR has been given administrative authority to enforce Section 504. Section 504 is a Federal statute that may be enforced through the Department's administrative process or through the Federal court system. In addition, a person may at any time file a private lawsuit against a school district. The Section 504 regulations do not contain a requirement that a person file a complaint with OCR and exhaust his or her administrative remedies before filing a private lawsuit.
STUDENTS PROTECTED UNDER SECTION 504
Section 504 covers qualified students with disabilities who attend schools receiving Federal financial assistance. To be protected under Section 504, a student must be determined to: (1) have a physical or mental impairment that substantially limits one or more major life activities; or (2) have a record of such an impairment; or (3) be regarded as having such an impairment. Section 504 requires that school districts provide a free appropriate public education (FAPE) to qualified students in their jurisdictions who have a physical or mental impairment that substantially limits one or more major life activities.

11. What is a physical or mental impairment that substantially limits a major life activity?

The determination of whether a student has a physical or mental impairment that substantially limits a major life activity must be made on the basis of an individual inquiry. The Section 504 regulatory provision at 34 C.F.R. 104.3(j)(2)(i) defines a physical or mental impairment as any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive; digestive; genito-urinary; hemic and lymphatic; skin; and endocrine; or any mental or psychological disorder, such as intellectual disabilities, organic brain syndrome, emotional or mental illness, and specific learning disabilities. The regulatory provision does not set forth an exhaustive list of specific diseases and conditions that may constitute physical or mental impairments because of the difficulty of ensuring the comprehensiveness of such a list.

Major life activities, as defined in the Section 504 regulations at 34 C.F.R. 104.3(j)(2)(ii), include functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working. This list is not exhaustive. Other functions can be major life activities for purposes of Section 504. In the Amendments Act (see FAQ 1), Congress provided additional examples of general activities that are major life activities, including eating, sleeping, standing, lifting, bending, reading, concentrating, thinking, and communicating. Congress also provided a non-exhaustive list of examples of "major bodily functions" that are major life activities, such as the functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions. The Section 504 regulatory provision, though not as comprehensive as the Amendments Act, is still valid - the Section 504 regulatory provision's list of examples of major life activities is not exclusive, and an activity or function not specifically listed in the Section 504 regulatory provision can nonetheless be a major life activity.

12. Does the meaning of the phrase "qualified student with a disability" differ on the basis of a student's educational level, i.e., elementary and secondary versus postsecondary?

Yes. At the elementary and secondary educational level, a "qualified student with a disability" is a student with a disability who is: of an age at which students without disabilities are provided elementary and secondary educational services; of an age at which it is mandatory under state law to provide elementary and secondary educational services to students with disabilities; or a student to whom a state is required to provide a free appropriate public education under the Individuals with Disabilities Education Act (IDEA).

At the postsecondary educational level, a qualified student with a disability is a student with a disability who meets the academic and technical standards requisite for admission or participation in the institution's educational program or activity.

13. Does the nature of services to which a student is entitled under Section 504 differ by educational level?

Yes. Public elementary and secondary recipients are required to provide a free appropriate public education to qualified students with disabilities. Such an education consists of regular or special education and related aids and services designed to meet the individual educational needs of students with disabilities as adequately as the needs of students without disabilities are met.

At the postsecondary level, the recipient is required to provide students with appropriate academic adjustments and auxiliary aids and services that are necessary to afford an individual with a disability an equal opportunity to participate in a school's program. Recipients are not required to make adjustments or provide aids or services that would result in a fundamental alteration of a recipient's program or impose an undue burden.

14. Once a student is identified as eligible for services under Section 504, is that student always entitled to such services?

Yes, as long as the student remains eligible. The protections of Section 504 extend only to individuals who meet the regulatory definition of a person with a disability. If a recipient school district re-evaluates a student in accordance with the Section 504 regulatory provision at 34 C.F.R. 104.35 and determines that the student's mental or physical impairment no longer substantially limits his/her ability to learn or any other major life activity, the student is no longer eligible for services under Section 504.

15. Are current illegal users of drugs excluded from protection under Section 504?

Generally, yes. Section 504 excludes from the definition of a student with a disability, and from Section 504 protection, any student who is currently engaging in the illegal use of drugs when a covered entity acts on the basis of such use. (There are exceptions for persons in rehabilitation programs who are no longer engaging in the illegal use of drugs).

16. Are current users of alcohol excluded from protection under Section 504?

No. Section 504's definition of a student with a disability does not exclude users of alcohol. However, Section 504 allows schools to take disciplinary action against students with disabilities using drugs or alcohol to the same extent as students without disabilities.
EVALUATION
At the elementary and secondary school level, determining whether a child is a qualified disabled student under Section 504 begins with the evaluation process. Section 504 requires the use of evaluation procedures that ensure that children are not misclassified, unnecessarily labeled as having a disability, or incorrectly placed, based on inappropriate selection, administration, or interpretation of evaluation materials.

17. What is an appropriate evaluation under Section 504?

Recipient school districts must establish standards and procedures for initial evaluations and periodic re-evaluations of students who need or are believed to need special education and/or related services because of disability. The Section 504 regulatory provision at 34 C.F.R. 104.35(b) requires school districts to individually evaluate a student before classifying the student as having a disability or providing the student with special education. Tests used for this purpose must be selected and administered so as best to ensure that the test results accurately reflect the student's aptitude or achievement or other factor being measured rather than reflect the student's disability, except where those are the factors being measured. Section 504 also requires that tests and other evaluation materials include those tailored to evaluate the specific areas of educational need and not merely those designed to provide a single intelligence quotient. The tests and other evaluation materials must be validated for the specific purpose for which they are used and appropriately administered by trained personnel.

18. How much is enough information to document that a student has a disability?

At the elementary and secondary education level, the amount of information required is determined by the multi-disciplinary committee gathered to evaluate the student. The committee should include persons knowledgeable about the student, the meaning of the evaluation data, and the placement options. The committee members must determine if they have enough information to make a knowledgeable decision as to whether or not the student has a disability. The Section 504 regulatory provision at 34 C.F.R. 104.35(c) requires that school districts draw from a variety of sources in the evaluation process so that the possibility of error is minimized. The information obtained from all such sources must be documented and all significant factors related to the student's learning process must be considered. These sources and factors may include aptitude and achievement tests, teacher recommendations, physical condition, social and cultural background, and adaptive behavior. In evaluating a student suspected of having a disability, it is unacceptable to rely on presumptions and stereotypes regarding persons with disabilities or classes of such persons. Compliance with the IDEA regarding the group of persons present when an evaluation or placement decision is made is satisfactory under Section 504.

19. What process should a school district use to identify students eligible for services under Section 504? Is it the same process as that employed in identifying students eligible for services under the IDEA?

School districts may use the same process to evaluate the needs of students under Section 504 as they use to evaluate the needs of students under the IDEA. If school districts choose to adopt a separate process for evaluating the needs of students under Section 504, they must follow the requirements for evaluation specified in the Section 504 regulatory provision at 34 C.F.R. 104.35.

20. May school districts consider "mitigating measures" used by a student in determining whether the student has a disability under Section 504?

No. As of January 1, 2009, school districts, in determining whether a student has a physical or mental impairment that substantially limits that student in a major life activity, must not consider the ameliorating effects of any mitigating measures that student is using. This is a change from prior law. Before January 1, 2009, school districts had to consider a student's use of mitigating measures in determining whether that student had a physical or mental impairment that substantially limited that student in a major life activity. In the Amendments Act (see FAQ 1), however, Congress specified that the ameliorative effects of mitigating measures must not be considered in determining if a person is an individual with a disability.

Congress did not define the term "mitigating measures" but rather provided a non-exhaustive list of "mitigating measures." The mitigating measures are as follows: medication; medical supplies, equipment or appliances; low-vision devices (which do not include ordinary eyeglasses or contact lenses); prosthetics (including limbs and devices); hearing aids and cochlear implants or other implantable hearing devices; mobility devices; oxygen therapy equipment and supplies; use of assistive technology; reasonable accommodations or auxiliary aids or services; and learned behavioral or adaptive neurological modifications.

Congress created one exception to the mitigating measures analysis. The ameliorative effects of the mitigating measures of ordinary eyeglasses or contact lenses shall be considered in determining if an impairment substantially limits a major life activity. "Ordinary eyeglasses or contact lenses" are lenses that are intended to fully correct visual acuity or eliminate refractive error, whereas "low-vision devices" (listed above) are devices that magnify, enhance, or otherwise augment a visual image.

21. Does OCR endorse a single formula or scale that measures substantial limitation?

No. The determination of substantial limitation must be made on a case-by-case basis with respect to each individual student. The Section 504 regulatory provision at 34 C.F.R. 104.35 (c) requires that a group of knowledgeable persons draw upon information from a variety of sources in making this determination.

22. Are there any impairments which automatically mean that a student has a disability under Section 504?

No. An impairment in and of itself is not a disability. The impairment must substantially limit one or more major life activities in order to be considered a disability under Section 504.

23. Can a medical diagnosis suffice as an evaluation for the purpose of providing FAPE?

No. A physician's medical diagnosis may be considered among other sources in evaluating a student with an impairment or believed to have an impairment which substantially limits a major life activity. Other sources to be considered, along with the medical diagnosis, include aptitude and achievement tests, teacher recommendations, physical condition, social and cultural background, and adaptive behavior. As noted in FAQ 22, the Section 504 regulations require school districts to draw upon a variety of sources in interpreting evaluation data and making placement decisions.

24. Does a medical diagnosis of an illness automatically mean a student can receive services under Section 504?

No. A medical diagnosis of an illness does not automatically mean a student can receive servicesunder Section 504. The illness must cause a substantial limitation on the student's ability to learn or another major life activity. For example, a student who has a physical or mental impairment would not be considered a student in need of services under Section 504 if the impairment does not in any way limit the student's ability to learn or other major life activity, or only results in some minor limitation in that regard.

25. How should a recipient school district handle an outside independent evaluation? Do all data brought to a multi-disciplinary committee need to be considered and given equal weight?

The results of an outside independent evaluation may be one of many sources to consider. Multi-disciplinary committees must draw from a variety of sources in the evaluation process so that the possibility of error is minimized. All significant factors related to the subject student's learning process must be considered. These sources and factors include aptitude and achievement tests, teacher recommendations, physical condition, social and cultural background, and adaptive behavior, among others. Information from all sources must be documented and considered by knowledgeable committee members. The weight of the information is determined by the committee given the student's individual circumstances.

26. What should a recipient school district do if a parent refuses to consent to an initial evaluation under the Individuals with Disabilities Education Act (IDEA), but demands a Section 504 plan for a student without further evaluation?

A school district must evaluate a student prior to providing services under Section 504. Section 504 requires informed parental permission for initial evaluations. If a parent refuses consent for an initial evaluation and a recipient school district suspects a student has a disability, the IDEA and Section 504 provide that school districts may use due process hearing procedures to seek to override the parents' denial of consent.

27. Who in the evaluation process makes the ultimate decision regarding a student's eligibility for services under Section 504?

The Section 504 regulatory provision at 34 C.F.R.104.35 (c) (3) requires that school districts ensure that the determination that a student is eligible for special education and/or related aids and services be made by a group of persons, including persons knowledgeable about the meaning of the evaluation data and knowledgeable about the placement options. If a parent disagrees with the determination, he or she may request a due process hearing.

28. Once a student is identified as eligible for services under Section 504, is there an annual or triennial review requirement? If so, what is the appropriate process to be used? Or is it appropriate to keep the same Section 504 plan in place indefinitely after a student has been identified?

Periodic re-evaluation is required. This may be conducted in accordance with the IDEA regulations, which require re-evaluation at three-year intervals (unless the parent and public agency agree that re-evaluation is unnecessary) or more frequently if conditions warrant, or if the child's parent or teacher requests a re-evaluation, but not more than once a year (unless the parent and public agency agree otherwise).

29. Is a Section 504 re-evaluation similar to an IDEA re-evaluation? How often should it be done?

Yes. Section 504 specifies that re-evaluations in accordance with the IDEA is one means of compliance with Section 504. The Section 504 regulations require that re-evaluations be conducted periodically. Section 504 also requires a school district to conduct a re-evaluation prior to a significant change of placement. OCR considers an exclusion from the educational program of more than 10 school days a significant change of placement. OCR would also consider transferring a student from one type of program to another or terminating or significantly reducing a related service a significant change in placement.

30. What is reasonable justification for referring a student for evaluation for services under Section 504?

School districts may always use regular education intervention strategies to assist students with difficulties in school. Section 504 requires recipient school districts to refer a student for an evaluation for possible special education or related aids and services or modification to regular education if the student, because of disability, needs or is believed to need such services.

31. A student is receiving services that the school district maintains are necessary under Section 504 in order to provide the student with an appropriate education. The student's parent no longer wants the student to receive those services. If the parent wishes to withdraw the student from a Section 504 plan, what can the school district do to ensure continuation of services?

The school district may initiate a Section 504 due process hearing to resolve the dispute if the district believes the student needs the services in order to receive an appropriate education.

32. A student has a disability referenced in the IDEA, but does not require special education services. Is such a student eligible for services under Section 504?

The student may be eligible for services under Section 504. The school district must determine whether the student has an impairment which substantially limits his or her ability to learn or another major life activity and, if so, make an individualized determination of the child's educational needs for regular or special education or related aids or services. For example, such a student may receive adjustments in the regular classroom.

33. How should a recipient school district view a temporary impairment?

A temporary impairment does not constitute a disability for purposes of Section 504 unless its severity is such that it results in a substantial limitation of one or more major life activities for an extended period of time. The issue of whether a temporary impairment is substantial enough to be a disability must be resolved on a case-by-case basis, taking into consideration both the duration (or expected duration) of the impairment and the extent to which it actually limits a major life activity of the affected individual.

In the Amendments Act (see FAQ 1), Congress clarified that an individual is not "regarded as" an individual with a disability if the impairment is transitory and minor. A transitory impairment is an impairment with an actual or expected duration of 6 months or less.
34. Is an impairment that is episodic or in remission a disability under Section 504?
Yes, under certain circumstances. In the Amendments Act (see FAQ 1), Congress clarified that an impairment that is episodic or in remission is a disability if it would substantially limit a major life activity when active. A student with such an impairment is entitled to a free appropriate public education under Section 504.
PLACEMENT
Once a student is identified as being eligible for regular or special education and related aids or services, a decision must be made regarding the type of services the student needs.

35. If a student is eligible for services under both the IDEA and Section 504, must a school district develop both an individualized education program (IEP) under the IDEA and a Section 504 plan under Section 504?

No. If a student is eligible under IDEA, he or she must have an IEP. Under the Section 504 regulations, one way to meet Section 504 requirements for a free appropriate public education is to implement an IEP.

36. Must a school district develop a Section 504 plan for a student who either "has a record of disability" or is "regarded as disabled"?

No. In public elementary and secondary schools, unless a student actually has an impairment that substantially limits a major life activity, the mere fact that a student has a "record of" or is "regarded as" disabled is insufficient, in itself, to trigger those Section 504 protections that require the provision of a free appropriate public education (FAPE). This is consistent with the Amendments Act (see FAQ 1), in which Congress clarified that an individual who meets the definition of disability solely by virtue of being "regarded as" disabled is not entitled to reasonable accommodations or the reasonable modification of policies, practices or procedures. The phrases "has a record of disability" and "is regarded as disabled" are meant to reach the situation in which a student either does not currently have or never had a disability, but is treated by others as such.

As noted in FAQ 34, in the Amendments Act (see FAQ 1), Congress clarified that an individual is not "regarded as" an individual with a disability if the impairment is transitory and minor. A transitory impairment is an impairment with an actual or expected duration of 6 months or less.

37. What is the receiving school district's responsibility under Section 504 toward a student with a Section 504 plan who transfers from another district?

If a student with a disability transfers to a district from another school district with a Section 504 plan, the receiving district should review the plan and supporting documentation. If a group of persons at the receiving school district, including persons knowledgeable about the meaning of the evaluation data and knowledgeable about the placement options determines that the plan is appropriate, the district is required to implement the plan. If the district determines that the plan is inappropriate, the district is to evaluate the student consistent with the Section 504 procedures at 34 C.F.R. 104.35 and determine which educational program is appropriate for the student. There is no Section 504 bar to the receiving school district honoring the previous IEP during the interim period. Information about IDEA requirements when a student transfers is available from the Office of Special Education and Rehabilitative Services at http://idea.ed.gov/explore/view/p/%2Croot%2Cdynamic%2CQaCorner%2C3%2C

40. What are the responsibilities of regular education teachers with respect to implementation of Section 504 plans? What are the consequences if the district fails to implement the plans?

Regular education teachers must implement the provisions of Section 504 plans when those plans govern the teachers' treatment of students for whom they are responsible. If the teachers fail to implement the plans, such failure can cause the school district to be in noncompliance with Section 504.

41. What is the difference between a regular education intervention plan and a Section 504 plan?

A regular education intervention plan is appropriate for a student who does not have a disability or is not suspected of having a disability but may be facing challenges in school. School districts vary in how they address performance problems of regular education students. Some districts employ teams at individual schools, commonly referred to as "building teams." These teams are designed to provide regular education classroom teachers with instructional support and strategies for helping students in need of assistance. These teams are typically composed of regular and special education teachers who provide ideas to classroom teachers on methods for helping students experiencing academic or behavioral problems. The team usually records its ideas in a written regular education intervention plan. The team meets with an affected student's classroom teacher(s) and recommends strategies to address the student's problems within the regular education environment. The team then follows the responsible teacher(s) to determine whether the student's performance or behavior has improved. In addition to building teams, districts may utilize other regular education intervention methods, including before-school and after-school programs, tutoring programs, and mentoring programs.
PROCEDURAL SAFEGUARDS
Public elementary and secondary schools must employ procedural safeguards regarding the identification, evaluation, or educational placement of persons who, because of disability, need or are believed to need special instruction or related services.

42. Must a recipient school district obtain parental consent prior to conducting an initial evaluation?

Yes. OCR has interpreted Section 504 to require districts to obtain parental permission for initial evaluations. If a district suspects a student needs or is believed to need special instruction or related services and parental consent is withheld, the IDEA and Section 504 provide that districts may use due process hearing procedures to seek to override the parents' denial of consent for an initial evaluation.

43. If so, in what form is consent required?

Section 504 is silent on the form of parental consent required. OCR has accepted written consent as compliance. IDEA as well as many state laws also require written consent prior to initiating an evaluation.

44. What can a recipient school district do if a parent withholds consent for a student to secure services under Section 504 after a student is determined eligible for services?

Section 504 neither prohibits nor requires a school district to initiate a due process hearing to override a parental refusal to consent with respect to the initial provision of special education and related services. Nonetheless, school districts should consider that IDEA no longer permits school districts to initiate a due process hearing to override a parental refusal to consent to the initial provision of services.

45. What procedural safeguards are required under Section 504?

Recipient school districts are required to establish and implement procedural safeguards that include notice, an opportunity for parents to review relevant records, an impartial hearing with opportunity for participation by the student's parents or guardian, representation by counsel and a review procedure.
46. What is a recipient school district's responsibility under Section 504 to provide information to parents and students about its evaluation and placement process?
Section 504 requires districts to provide notice to parents explaining any evaluation and placement decisions affecting their children and explaining the parents' right to review educational records and appeal any decision regarding evaluation and placement through an impartial hearing.

47. Is there a mediation requirement under Section 504?

No.
TERMINOLOGY
The following terms may be confusing and/or are frequently used incorrectly in the elementary and secondary school context.

Equal access: equal opportunity of a qualified person with a disability to participate in or benefit from educational aid, benefits, or services

Free appropriate public education (FAPE): a term used in the elementary and secondary school context; for purposes of Section 504, refers to the provision of regular or special education and related aids and services that are designed to meet individual educational needs of students with disabilities as adequately as the needs of students without disabilities are met and is based upon adherence to procedures that satisfy the Section 504 requirements pertaining to educational setting, evaluation and placement, and procedural safeguards

Placement: a term used in the elementary and secondary school context; refers to regular and/or special educational program in which a student receives educational and/or related services

Reasonable accommodation: a term used in the employment context to refer to modifications or adjustments employers make to a job application process, the work environment, the manner or circumstances under which the position held or desired is customarily performed, or that enable a covered entity's employee with a disability to enjoy equal benefits and privileges of employment; this term is sometimes used incorrectly to refer to related aids and services in the elementary and secondary school context or to refer to academic adjustments, reasonable modifications, and auxiliary aids and services in the postsecondary school context

Reasonable modifications: under a regulatory provision implementing Title II of the ADA, public entities are required to make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity

Related services: a term used in the elementary and secondary school context to refer to developmental, corrective, and other supportive services, including psychological, counseling and medical diagnostic services and transportation

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special education; disabilities; disability discrimination; fape; free appropriate public education

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Frequently Asked Questions about Section 504 requirements for the education by school districts of students with disabilities

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Individuals with Disabilities Education Act

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The Individuals with Disabilities Education Act (IDEA) is a law that makes available a free appropriate public education to eligible children with disabilities throughout the nation and ensures special education and related services to those children.

The IDEA governs how states and public agencies provide early intervention, special education, and related services to more than 8 million (as of school year 2022-23) eligible infants, toddlers, children, and youth with disabilities.

Infants and toddlers, birth through age 2, with disabilities and their families receive early intervention services under IDEA Part C. Children and youth ages 3 through 21 receive special education and related services under IDEA Part B.

Additionally, the IDEA authorizes:

Formula grants to states to support special education and related services and early intervention services.

Discretionary grants to state educational agencies, institutions of higher education, and other nonprofit organizations to support research, demonstrations, technical assistance and dissemination, technology development, personnel preparation and development, and parent-training and -information centers.

Congress reauthorized the IDEA in 2004 and most recently amended the IDEA through Public Law 114-95, the Every Student Succeeds Act, in December 2015.

In the law, Congress states:

Disability is a natural part of the human experience and in no way diminishes the right of individuals to participate in or contribute to society. Improving educational results for children with disabilities is an essential element of our national policy of ensuring equality of opportunity, full participation, independent living, and economic self-sufficiency for individuals with disabilities.

Other Laws for Children with Disabilities

The U.S. Department of Education's Office for Civil Rights (OCR) provides additional resources of interest for individuals with disabilities and their families.

OCR does not enforce the IDEA; however, OCR does enforce the Rehabilitation Act of 1973, Section 504 and Americans with Disabilities Act of 1990, Title II rights of IDEA-eligible students with disabilities.

To learn more, visit the OCR's Frequently Asked Questions About Section 504 and the Education of Children with Disabilities.

Visit OCR's website for additional resources.

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About IDEA - Individuals with Disabilities Education Act

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The IDEA is a law that makes available a free appropriate public education to eligible children with disabilities throughout the nation and ensures special education and related services to those children.

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Up to 65% of adults with bipolar disorder experienced symptoms prior to the age of 18. So while the condition is often associated with adults, kids of any age can have bipolar disorder.﻿﻿

Childhood-onset bipolar is associated with a more severe course of illness compared to people who don't begin to experience symptoms until adulthood. Early intervention can be the key to getting symptoms under control.﻿﻿

Even if you know an adult with bipolar disorder-or you have been diagnosed with it yourself-it might not look the same in a teenager.

Teens tend to be more irritable than elated during manic episodes and their depressive episodes may involve more complaints of physical symptoms other than sadness.

When to Seek Help

Children and adolescents with bipolar disorder experience severe mood and behavior changes that are extreme and represent a major change from their typical mood and behavior. It might be difficult to know when the symptoms are severe enough to warrant evaluation and, potentially, diagnosis, so consider these three basic factors: functioning, feeling, and family.﻿﻿

Here are some questions to ask yourself about your child's functioning:

Are the problem behaviors of your child interfering with his daily functioning?

Is she able to play with other children her age?

Is he able to attend school regularly?

Do the demands of her difficulties outweigh the needs of other members of the family, maybe including you?

Here are some questions to ask yourself about your child's feelings:

Does your child feel like there is something wrong with him?

Does she feel overwhelmed handling normal activities other kids her age engage in?

Does your child worry about things other kids don't even think about?

Is there a history of mental illness in your child's family?

If you've said YES to questions in at least two of the three items above (functioning, feeling, and family), you're probably curious about the specific symptoms of bipolar disorder. Experts disagree about the exact symptoms that may appear in childhood and adolescent bipolar disorder because they appear to manifest differently than the symptoms of adults, but some of these symptoms may include:﻿﻿

Separation anxiety

Rages & explosive temper tantrums (lasting up to several hours)

Marked irritability

Oppositional behavior

Frequent mood swings

Distractibility

Hyperactivity

Getting involved in many projects or activities at once

More energy than normal

Less need for sleep

Impulsivity

Restlessness/ fidgetiness

Silliness, goofiness, giddiness

Racing thoughts

Aggressive behavior

Grandiosity

Risk-taking behaviors

Depressed mood

Low self-esteem

Difficulty getting up in the morning

Night terrors

Rapid or pressured speech

Thoughts of death or suicide

If you think your child may have bipolar disorder (or any other mental health issue), talk to his physician. Schedule an appointment to discuss your concerns.

A physician may refer you to a mental health treatment provider for a complete evaluation. A mental health expert will likely want to interview you and your child to get a full picture of the signs and symptoms.

There isn't a lab test that identifies bipolar disorder.﻿﻿

Sometimes other conditions such as depression or ADHD have similar presentations; so it's important to offer as much information as you can about your child's mood, sleep patterns, energy level, history, and behavior to help rule out other possibilities.

Bipolar disorder must be managed throughout a person's life.﻿﻿ Treatment may require adjustments over time. Your teen's treatment team may recommend:

Medication: A psychiatrist may prescribe medication to stabilize your child's mood. It's important to monitor your child's medication and be on the lookout for side effects. Finding the right medication and the right dosage may take some time as there isn't a single medication that works best for everyone with bipolar disorder.﻿﻿

Talk therapy: A therapist may educate your child about bipolar and may offer coping strategies to help manage the symptoms. Therapy often includes family members. Family therapy may address relationship issues, behavior management problems, or strategies to help the entire family cope with a child's mental illness.﻿﻿

A psychiatric hospitalization may be required at one time or another if a child poses an acute safety risk. A serious suicide attempt, thoughts of suicide with a clear plan, self-injury, or psychosis are just a few of the possible reasons a child with bipolar disorder may need to stay in a hospital.﻿﻿

Treatment works best when the child, parents, doctors, therapists, and other treatment providers work together as a team. So it's important to attend your teen's appointments, ask questions, communicate with other treatment providers, and continue to educate yourself about your child's mental health needs.﻿﻿

A therapist or psychiatrist may request that you log your teen's moods, sleep patterns, or behavior. Charting your child's progress can help treatment providers determine how well therapy or medications are working to keep your child's moods stable.﻿﻿

Risks With Teens

Teens are already prone to risky behavior, but that risk is multiplied when the teenager also has bipolar disorder. Keep an eye out for substance abuse, such as drinking or taking drugs, as well as suicidal behavior.﻿﻿

The risk for suicide in people with bipolar disorder is among the highest for all psychiatric disorders.﻿﻿

Studies show that between 25 and 60% of adults with bipolar make at least one suicide attempt over the course of their lives and between 8 and 19% of individuals with bipolar disorder die from suicide.﻿﻿

Studies have found that 72 percent of adolescents with bipolar disorder acknowledge thinking about suicide at one point or another. Research shows teens with both bipolar I and bipolar II are at an elevated risk for suicide.

If your teen has been diagnosed with bipolar disorder, take the risk of suicide seriously. Work with your teen's treatment providers to assess your teen's risks and to develop a safety plan.

Co-Morbid Conditions

Many children with bipolar disorder have an additional mental illness, addiction, or behavior disorder. Some research has estimated that between 60 to 90% of youth with bipolar disorder may have attention deficit hyperactivity disorder as well.﻿﻿

Anxiety disorders, substance use, and disruptive behavior disorders are among the other most common issues children with bipolar disorder may experience.﻿﻿

Support at School

It's important to work with your child's school if he's been diagnosed with bipolar disorder. School officials can assist with a plan that will best support your child's education.

Your child's academic needs will depend on his symptoms and his academic issues. If he exhibits behavior problems at school, the teachers may create a behavior plan that will use appropriate disciplinary action.

If he struggles academically, the school may provide services to help ensure he is able to get an education. The school may be able to offer things such as a modified schedule or a hall pass that lets your teen visit the guidance counselor whenever necessary. Encourage your child to participate in meetings to talk about how the school could support his education as well.

Support at Home

Bipolar disorder affects the entire family so it's important to work together to help your child manage the symptoms.

Learn as much as you can about bipolar disorder and the latest treatment options-and make sure other family members learn about it too. It's important for siblings to understand what to expect.

Hold regular conversations with your child about treatment and treatment-related issues. There's a good chance that at some point your child won't want to take medication or attend therapy. Validate her feelings and talk about the importance of following doctors' recommendations.

It's important to take care of yourself as well. Coping with the challenges of raising a child with bipolar disorder can be stressful. Consider joining a support group for parents with teens with bipolar disorder (or mental illness in general). Connecting with other parents may help you gain emotional support as well as practical advice about how to support your child.

A Word From Verywell

It is common for children to experience some of the symptoms listed above, and it doesn't necessarily mean they have bipolar disorder.

If your child is having difficulty with daily functioning or if your child is struggling with feeling normal- especially over an extended period of time-an evaluation by a psychiatrist may be warranted. An unbiased, professional opinion could bring you some peace of mind and perhaps a few new parenting skills. Talk to your pediatrician and seek out advice for your precious one so that you are not carrying your worries or concerns alone.

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Up to 65% of adults with bipolar disorder experienced symptoms prior to the age of 18. So while the condition is often associated with adults, kids of any age can have bipolar disorder.﻿﻿ Childhood-onset bipolar is associated with a more severe course of illness compared to people who don't begin to experience symptoms until adulthood.

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©2022 Child Mind Institute, Inc., a tax-exempt charitable organization (tax identification number 80-0478843) under Section 501(c)(3) of the Internal Revenue Code. All rights reserved.

The Child Mind Institute Family Resource Center was made possible by a generous grant from the Morgan Stanley Foundation.
Created by Constructive.

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You searched for eating disorders - Child Mind Institute

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Addressing Anxiety in School Settings: Information for Counselors

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Addressing Anxiety in School Settings: Information for Counselors

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Centers for Disease Control and Prevention

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Research on children's mental health in the community

Project to Learn About Youth - Mental Health

The Project to Learn About Youth - Mental Health (PLAY-MH) analyzed information collected from four communities. The focus was to study attention-deficit/hyperactivity disorder (ADHD) and other externalizing and internalizing disorders, as well as tic disorders in school-aged children. The purpose was to learn more about public health prevention and intervention strategies to support children's health and development.

Study questions included:

What percentage of children in the community had one or more externalizing, internalizing, or tic disorders?

How frequently did these disorders appear together?

What types of treatment were children receiving in their communities?

This project used the same methodology as the original Project to Learn about ADHD in Youth (PLAY) project. Read more about the original study approach here.

Other research

Read more about research on

CDC and partner agencies are working to understand the prevalence of mental disorders in children and how they impact their lives. Currently, it is not known exactly how many children have any mental disorder, or how often different disorders occur together, because no national dataset is available that looks at all mental, emotional, or behavioral disorders together.

Research on prevalence

Using different data sources

Healthcare providers, public health researchers, educators, and policy makers can get information about the prevalence of children's mental health disorders from a variety of sources. Data sources, such as national surveys, community-based studies, and administrative claims data (like healthcare insurance claims), use different study methods and provide different types of information, each with advantages and disadvantages. Advantages and disadvantages for different data sources include the following:

National surveys have large sample sizes that are needed to create estimates at the national and state levels. However, they also generally use a parent's report of the child's diagnosis, which means that the healthcare provider has to give an accurate diagnosis and the parent has to accurately remember what it was.

Community-based studies offer the opportunity to observe children's symptoms, which means that even children who have not been diagnosed or do not have the right diagnosis could be found. However, these studies are typically done in small geographic areas, so findings are not necessarily the same in other communities.

Administrative claims are typically very large datasets with information on diagnosis and treatment directly from the providers, which allows tracking changes over time. Because they are recorded for billing purposes, diagnoses or services that would not be reimbursed from the specific health insurance might not be recorded in the data.

Using different sources of data together provides more information because it is possible to describe the following:

Children with a diagnosed condition compared to children who have the same symptoms, but are not diagnosed

Differences between populations with or without health insurance

How estimates for mental health disorders change over time

Read more about using different data sources.external icon
National data on children's mental health

A comprehensive report from the Centers for Disease Control and Prevention (CDC), Mental Health Surveillance Among Children -United States, 2005-2011, described federal efforts on monitoring mental disorders, and presented estimates of the number of children with specific mental disorders. The report was developed in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSAexternal icon ), the National Institute of Mental Health (NIMHexternal icon ), and the Health Resources and Services Administration (HRSAexternal icon ). The report is an important step towards better understanding these disorders and the impact they have on children. This is the first report to describe the number of U.S. children aged 3-17 years who have specific mental disorders, compiling information from different data sources covering the period 2005-2011. You can read a summary of the findings here.

The goal is now to build on the strengths of federal agencies serving children with mental disorders to:

Develop better ways to document how many children have these disorders,

Better understand the impacts of mental disorders,

Inform needs for treatment and intervention strategies, and

Promote the mental health of children.

This report is an important step on the road to recognizing the impact of childhood mental disorders and developing a public health approach to address children's mental health.

Reference

Holbrook JR, Bitsko RB, Danielson ML, Visser SN. Interpreting the Prevalence of Mental Disorders in Children: Tribulation and Triangulation. Health Promotion Practice. Published online November 15, 2016 https://www.ncbi.nlm.nih.gov/pubmed/27852820external icon .

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Project to Learn About Youth - Mental Health The Project to Learn About Youth - Mental Health (PLAY-MH) analyzed information collected from four communities. The focus was to study attention-deficit/hyperactivity disorder (ADHD) and other externalizing and internalizing disorders, as well as tic disorders in school-aged children.

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Centers for Disease Control and Prevention

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Learn about different types of mental disorders in children, including symptoms, treatment, and what can be done to prevent them.

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Centers for Disease Control and Prevention

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Being mentally healthy during childhood means reaching developmental and emotional milestones and learning healthy social skills and how to cope when there are problems. Mentally healthy children have a positive quality of life and can function well at home, in school, and in their communities.

Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, which cause distress and problems getting through the day. Many children occasionally experience fears and worries or display disruptive behaviors. If symptoms are serious and persistent and interfere with school, home, or play activities, the child may be diagnosed with a mental disorder.

Mental health is not simply the absence of a mental disorder. Children who don't have a mental disorder might differ in how well they are doing, and children who have the same diagnosed mental disorder might differ in their strengths and weaknesses in how they are developing and coping, and in their quality of life. Mental health as a continuum and the identification of specific mental disorders are both ways to understand how well children are doing.

What are common childhood mental disorders?

Among the more common mental disorders that can be diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD), anxiety (fears or worries), and behavior disorders.

Learn more about childhood mental disorders, symptoms, and treatment.

Other childhood disorders and concerns that affect how children learn, behave, or handle their emotions can include learning and developmental disabilities, autism, and risk factors like substance use and self-harm.

Read more about related conditions.

What are the symptoms of childhood mental disorders?

Symptoms of mental disorders change over time as a child grows, and may include difficulties with how a child plays, learns, speaks, and acts, or how the child handles their emotions. Symptoms often start in early childhood, although some disorders may develop during the teenage years. The diagnosis is often made in the school years and sometimes earlier; however, some children with a mental disorder may not be recognized or diagnosed as having one.

Can childhood mental disorders be treated?

Childhood mental disorders can be treated and managed. There are many treatment options based on the best and most current medical evidence. Parents and doctors should work closely with everyone involved in the child's treatment-teachers, coaches, therapists, and other family members. Taking advantage of all the resources available will help parents, health professionals, and educators guide the child towards success. Early diagnosis and appropriate services for children and their families can make a difference in the lives of children with mental disorders.

Get help finding treatment

If you have concerns about a child, you can use these resources to help you find a healthcare provider familiar with treatment options.

Who is affected?

Childhood mental disorders affect many children and families. Boys and girls of all ages and ethnic/racial backgrounds and living in all regions of the United States experience mental disorders. Based on the National Research Council and Institute of Medicine report, which gathered findings from previous studies, it is estimated that in 2007, 13-20% of children living in the United States (up to 1 out of 5 children) experienced a mental disorder in a given year, costing individuals, families, and society an estimated $247 billion per year.

What is the impact of mental disorders in children?

Mental health is important to overall health. Mental disorders are chronic health conditions-conditions that last a long time and often don't go away completely-that can continue through the lifespan. Without early diagnosis and treatment, children with mental disorders can have problems at home, in school, and in forming friendships. Mental disorders can also interfere with a child's healthy development, causing problems that can continue into adulthood.

Public health includes mental health

Supporting children's mental health also includes making sure children meet developmental milestones, understanding what to do when there is a concern, supporting positive parenting strategies, and improving access to care.

CDC works with partner agencies to better understand mental health and mental disorders and the impact they have on children.
Read more about research on children's mental health.
What you can do

Parents: You know your child best. Talk to your child's healthcare professional if you have concerns about the way your child behaves at home, in school, or with friends.

Youth: It is just as important to take care of your mental health as it is to take care of your physical health. If you are angry, worried or sad, don't be afraid to talk about your feelings and reach out to a trusted friend or adult.

Healthcare professionals: Early diagnosis and appropriate treatment based on updated guidelines are very important. There are resources available to help diagnose and treat children's mental disorders.

Teachers/school administrators: Early identification is important so that children can get the help they need. Work with families and healthcare professionals if you have concerns about the mental health of a child in your school.

Resources

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Learn more about mental health, mental disorders, treatments, prevention, and public health research on children's mental health.

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Inside Higher Ed | Higher Education News, Events and Jobs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Child Mind Institute | Transforming Children’s Lives.

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