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American School Counselor Association (2021). ASCA Student Standards: Mindsets and Behaviors for Student Success. Alexandria, VA.

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American School Counselor Association (2021). ASCA Student Standards: Mindsets and Behaviors for Student Success. Alexandria, VA.

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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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Today's blog post comes to us from one of our Family-Endorsed Providers, Carla Kenney, LMHC. She writes on the importance of both educators and family members noticing the possible signs of OCD in children. Thank you, Carla, for sharing your expertise with us at rtor.org. -Veronique Hoebeke, Associate Editor
Children say and do unusual things on occasion, or even quite often, but how do we know that it isn't just a quirky behavior or something more serious? How do we know if a child is struggling? If you are a teacher or school personnel, how would you know that those unusual behaviors you observe in your student may be something more, something that needs to be explored and possibly addressed?

Scenario:

Jonny is a 10-year-old boy attending the 5th grade. His academic performance is below average. He arrives tardy to school on most days and his parents report that he is "slow moving" and "not a morning person." Jonny's teachers notice that he asks the same questions over and over about his assignments as if he didn't understand and he spends a lot of time on his classwork. Sometimes his teachers see him erasing things repeatedly and starting over. He is often the last student to finish his work and he is falling behind academically. The other kids in class notice these behaviors too and sometimes make fun of him by calling him "slow poke." This makes Jonny more anxious and he gets more stuck on his school assignments. In addition, Jonny asks to use the bathroom multiple times each day. His visits to the bathroom are lengthy and when he leaves the bathroom his hands and wrists are visibly wet and red. The teacher is also noticing she is replenishing the soap and paper towels more frequently than usual in her classroom.

The above scenario describes a child struggling with Obsessive Compulsive Disorder (OCD) in the classroom environment. Many of these behaviors could be observed by onlookers as part of this child's character or disposition rather than something more serious, which could lead to an untreated illness that worsens and becomes more debilitating over time.

Understanding OCD

Before we can identify how OCD can manifest in the classroom we first need to understand it. According to statistics at least 1 in 100 children are diagnosed with OCD. This means that roughly about 8-10 kids in an average sized elementary school struggle with this illness. Research indicates that OCD is one of the most common psychiatric illnesses affecting children and adolescents.

OCD is an anxiety disorder that consists of obsessions and compulsions. Obsessions are unwanted thoughts, images, and urges that cause prominent distress. Compulsions are behaviors that are performed to help decrease the distress that the obsession has caused. Compulsions can be visible behaviors but they can also be mental acts that are not seen by others. These obsessions and compulsions are excessive and cause significant distress to the child and will often lead to avoidance behaviors. OCD is not pleasant and often a person who has OCD describes the illness as torturous and disabling.

Teachers and other school personnel spend a lot of time with children - often they see things that may go unnoticed at home therefore, it is important that they are aware of the many kinds of OCD symptoms. Sometimes OCD symptoms may mimic other illnesses.

How OCD Manifests Itself

While everyone experiences fears once in a while it is important to remember that these fears, worries and behaviors are excessive and cause significant and debilitating distress. Below are common obsessions and compulsions.

Common Obsessions

Contamination Obsessions: fear of dirt, germs, diseases, bodily wastes, sticky substances, chemicals, animals, insects and environmental contamination

Ordering Obsessions: need for symmetry, exactness, order, and perfectionism

Religious Obsessions & Morality Obsessions: fear of having bad thoughts and being punished for them, not following rules of religion or family values, losing control and doing bad things against religion, values, or society

Health Obsessions: fear about having a bad illness despite medical exams finding no evidence of an illness or having worries about being responsible for the well being of others

Aggressive Obsessions: fear of losing control and harming self or others

Sexual Obsessions: fear of losing control and acting out sexually, sexually harming others and thoughts about being homosexual, heterosexual, bisexual or other

Other kinds of obsessions

The need to know, seek out, confess, remember information that is useless

Fear of saying something wrong, not saying it a certain way, leaving out details

Worrying about losing things, making errors, forgetting information

Fear of saying certain words because something bad might happen

Fear of certain numbers, colors, objects, places

Common Compulsions

Cleaning and Washing Compulsions: hand washing, showering, bathing, teeth brushing, grooming, dressing, cleaning of house, space and objects

Checking Compulsions: checking to make sure no harm was done to self or others, that nothing terrible happened, that no mistakes were made

Repeating, Counting, and Ordering Compulsions: rereading, rewriting, repeating certain behaviors, doing things a certain number of times, counting items, counting while doing activities, arranging things a certain way

Health Compulsions: checking of the body to look for illness or injury, seeking out nurses, doctors and other medical professionals reassurance that everything is ok, seeking out medical tests, spending excessive amounts of time on the internet looking up medical information

Other kinds of compulsions

Mental rituals such as praying, counting, saying certain phrases

Excessive need to seek out reassurance from others

Excessive confessing about behaviors that are trivial

The need to touch, tap, rub items or people

Eating in a ritualistic way

As you can see, OCD symptoms can vary greatly. Not only can a person have multiple symptoms but symptoms can wax and wane over time in intensity as well as change altogether. For example, someone can have excessive worries about fears of getting sick and perform multiple washing compulsions and then these symptoms can lighten and a new obsession and set of new compulsions take center stage. These behaviors are often labeled as "odd" and much too often, a child will be misdiagnosed. As a result, they may end up getting ineffective treatment that only make their symptoms worse.

How OCD Is Missed

OCD symptoms can go unnoticed for several reasons. Teachers are not clinicians and have not had in-depth training on mental health illnesses and how they can present in the school environment. Also, many clinicians are not fully aware of the various faces of OCD and these "odd" behaviors are often dismissed as a phase the child may be going through. Children may also have trouble articulating what they are feeling or thinking or simply may lack self-awareness. Other children may be insightful about their thoughts and behaviors but choose to conceal their symptoms to ensure better social acceptance.

Some common manifestations of OCD in the classroom

Tardiness and/or absences from school

Disruptive behavior, meltdowns, tantrums and rage-like episodes

Asking questions repeatedly or having difficulty with completing work

Seeking reassurance

Rereading, rewriting, excessive erasing or throwing paper out

Inability to complete work, procrastination

Frequent trips to use the bathroom or nurse

Avoidance of certain places, people, situations, objects

Red, raw, and chapped looking hands and arms

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

Repeatedly doing things (by number or by a "just right" feeling)

Difficulty transitioning from tasks, including entering or exiting rooms

Wearing the same clothing

Eating rituals

It is important that these behaviors be addressed as they can interfere with learning and affect a child's ability to concentrate, think and process information.

How OCD Affects the Student

Attention can be limited because the student is focused on their obsessions. This can be very exhausting for the child and can affect sleep. These behaviors in school can also take a heavy toll on social interactions with peers and may result in bullying by other students and isolation. Both can lead to depression.

Any teacher or school personnel who have concerns about a student having OCD should communicate it to the appropriate person and continue to monitor and document behaviors. In most cases the person to report these observations to are school psychologists, therapists/clinicians, adjustment counselors, or guidance counselors. Usually these professionals have in-depth training about mental illness and can investigate more by talking with the child, the child's teachers, and his or her parents. If a diagnosis of OCD is likely, then a referral to a treatment provider who specializes in the treatment of OCD should be made. It is important that if there is a diagnosis of OCD then communication between the outside treatment provider and school personnel should take place to help determine the best actions to help the student while in the school environment.

Teachers and school personnel who are educated about OCD can play an important role in the identification of this often-debilitating illness. Early detection is possible and can lead to effective treatment before symptoms worsen. This can help the child avoid years of unnecessary suffering. Understanding OCD and other related disorders can provide support that is crucial for a child's ability to function successfully in the classroom.

There are many online resources about OCD. The International OCD Foundation has specific information for educators and school personnel to provide guidance and support. In addition, there are a few books that are also very helpful. Please visit iocdf.org for a list of books that are recommended.
Carla Kenney, LMHC
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Understanding & Identifying OCD in the Classroom

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Today's blog post comes to us from one of our Family-Endorsed Providers, Carla Kenney, LMHC. She writes on the importance of both educators and family members noticing the possible signs of OCD in children. Thank you, Carla, for sharing your expertise with us at rtor.org.

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

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

The Effect of OCD on Academic Performance

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

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

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

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

What Does OCD Look Like at School?

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

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

Common Symptoms of OCD at School

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

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

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

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

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

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

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

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

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

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

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

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What Is OCD?

Obsessive-compulsive disorder (OCD) causes upsetting thoughts called obsessions. It also causes the urge to do behaviors called compulsions (also called rituals). Kids and teens with OCD get stuck in a stressful cycle of these thoughts, anxiety, and rituals.

If you think your child has OCD, start with a visit to your child's doctor or mental health provider. They can check for OCD or for other problems that could be the cause of your child's symptoms.

How Is OCD Treated?

Treatment for OCD is a type of cognitive behavioral therapy (CBT). In therapy, kids learn coping and calming skills for anxiety. They learn how to safely face fears without doing rituals.

Along with therapy, doctors may give medicines for OCD to some kids. For kids who need medicines, doctors give SSRIs (selective serotonin reuptake inhibitors). These include Zoloft®, Prozac®, and Luvox®.

Treatment works best when a parent or caregiver goes to therapy with their child. That way, they can learn how to coach their child through OCD symptoms, help their child practice skills they learn in therapy, and offer daily support.

What Signs Might Parents Notice?

Obsessions

These are stressful thoughts that come to mind over and over. A child with OCD doesn't want to think about these things. But they feel they can't stop.

Parents may notice obsessions as intense fears or worries. Kids with OCD may feel unusually upset about:

germs, dirt, illness, injury, or harm

whether someone could get sick, hurt, or die

things that seem wrong, or out of place

whether bad thoughts might come true

things that are not straight, even, or arranged "just right"

Compulsions (Rituals)

These are behaviors a child will do, trying to feel better. To the child, rituals seem like the way to stop thoughts and relieve fears. They seem like a way to keep bad things from happening.

Parents may notice that kids:

touch, tap, or step in unusual ways

arrange things over and over

repeat words, phrases, or questions

have many doubts, and trouble making choices

wash or clean more than needed

take a long time to do things - like get dressed, shower, eat, do homework

Kids may involve parents in rituals. And at first, parents may not realize that something is a ritual. For example, a child with OCD might ask for reassurance over and over. Or a child may insist a parent say or do something a set number of times, or in a set way.

Kids and teens with OCD can have obsessions, compulsions, or both.

Feelings

OCD symptoms are hard on kids. Rituals may seem to give them some relief at first. But rituals multiply. They start to take more time and energy. Kids have little left for things they enjoy. OCD thoughts, feelings, and rituals become a stressful cycle. This can make it hard to focus in school, have fun with friends, get to sleep, or relax.

Kids may seem:

anxious, worried

frustrated, irritable

sad, tired

upset when they can't do a ritual

to need constant reassurance from a parent that things are OK

Some kids may not let parents know about the thoughts, fears, and behaviors OCD causes. They may feel confused or ashamed about their fear and keep it to themselves. They may try to hide rituals they do. Some kids may have OCD symptoms for a while before their parents realize it.

How Can I Help My Child?

If you think your child may have OCD:

Talk with your child about what you've noticed. Talk in a supportive way, listen, and show love. Say something that works for your child's situation like, "I notice you fixing your socks a lot, trying to get them even. Getting them to feel right causes you a lot of stress."

Say that something called OCD might be causing the worry and the fixing. Tell your child that a checkup with a doctor can find out if this is what's going on. Let your child know that this can get better, and that you want to help.

Make an appointment with a child psychiatrist or psychologist. Your child's doctor can help you find the right person. To diagnose OCD, they will spend time talking with you and your child. They will ask questions about your child's symptoms that help point them to signs of OCD. If they diagnose OCD, they can explain the treatment.

Take part in your child's therapy. Part of treatment is coaching parents on how to respond to their child's OCD symptoms. Learn all you can about ways you can help. Learn how to support your child's progress without giving in to rituals.

Be patient. Overcoming OCD is a process. There will be many therapy visits. Be sure to go to them all. Help your child practice the things the therapist shows you. Praise your child's effort. Show how proud you feel. Remind them that OCD is not their fault.

Get support, and give it. There are lots of resources and support for families dealing with OCD. The International OCD Foundation is a good place to start. Knowing that you're not alone can help you cope. Sharing success stories with other parents can give you hope and confidence.

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OCD causes upsetting thoughts (obsessions) and the urge to do "ritual" behaviors (compulsions). Kids and teens get stuck in a stressful cycle of these thoughts, anxiety, and rituals. OCD can get better with the right attention and care.

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Attention-deficit/hyperactivity disorder (ADHD) in children - Symptoms and causes

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This condition affects children, and may continue into adulthood. It can include difficulty sustaining attention, hyperactivity and impulsive behavior.

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Adolescence is a challenging phase of life, so it's not uncommon for teens to develop their own quirks and idiosyncrasies as they attempt to navigate the turbulence. Unfortunately, for a small percentage of teens, these quirks and unusual behaviors are indicators of a serious mental health issue - obsessive-compulsive disorder. Typically referred to as OCD for short, this psychiatric disorder can cause significant distress. In more severe cases of the disorder, OCD can become debilitating.

Like all parents, you're faced with the difficult task of determining what's normal and what's not when it comes to your teen's behavior. This brief guide is designed to help you recognize the signs to watch for and know the steps to take if you believe your teen is suffering from OCD.

OCD Statistics and Facts

Following are a few statistics and facts pertaining to OCD:

OCD frequently starts in late adolescence or early twenties, although it occasionally begins in childhood

The onset of OCD occurs by age 14 in approximately 25% of cases

An estimated 1% of the population has OCD

Between 1% and 3% of children and teens have OCD, making it one of the more common psychiatric disorders in that age group

Up to 70% of individuals with OCD also have one or more other psychiatric disorders

For at least 4 out of every 10 individuals diagnosed with OCD, it becomes a chronic disorder

An estimated 40% of individuals who develop OCD in childhood will recover from the disorder by adulthood; for the other 60%, however, a childhood-onset often means the disorder will be both severe and chronic

Individuals with OCD have an increased risk of suicide; this risk is even higher if they also suffer from a mood or anxiety disorder

What is OCD?

Obsessive-compulsive disorder is a mental illness that's comprised, as the name suggests, of obsessive thoughts and compulsive behaviors. The obsessions present as repetitive thoughts, mental images, or urges that are both unwanted and intrusive. They are typically negative and can cause high levels of anxiety and distress. The frequent or constant bombardment of these unwanted thoughts can make it very difficult for teens to focus at school or work, let alone enjoy life.

Common types of obsessions include:

Worry about sexual orientation (often referred to as homosexual OCD or HOCD)

Fear of germs or contamination

Worry about becoming ill or dying

Fear of doing something violent

Worry about something bad happening

Disturbing sexual thoughts, urges, or images

Troubling thoughts that are religious in nature

In an attempt to reduce the anxiety and distress caused by the obsessions, individuals with OCD engage in compulsive behaviors, such as excessive hand washing, putting things in a certain order, or counting. For some individuals with OCD, these compulsive behaviors consume so much of their time that they're unable to be productive at all. The compulsive behavior brings temporary relief, at best.
Common compulsions include:

Excessive washing or cleaning

Constantly putting things in a certain order

Counting

Constantly checking (e.g. that the door is locked or stove turned off)

Doing something over and over until it's "just right"

Constantly seeking reassurance from others

Excessive praying

Checking and ordering are the two most common types of OCD. Compulsive hoarding, also very common, used to be considered a type of OCD. It's now classified as a separate disorder.

OCD is diagnosed only if the obsessions and compulsions are interfering with your teen's ability to function normally or cause significant distress. For example, if your teen is a "neat freak", that doesn't automatically mean he or she has OCD.

Co-Occurring Disorders

It's not uncommon for individuals with OCD to have one or more other psychiatric disorders as well. The most common co-occurring disorders are:

The presence of another psychiatric disorder often makes it more challenging to successfully treat the OCD.
Looking for and Recognizing the Signs of OCD
Obsessive-compulsive disorder can have an extremely negative impact on your teen. That's why it's so important to know what to look for and how to recognize the signs of OCD. The sooner you get your teen into treatment, the better. Without treatment, the obsessions and compulsions typically become worse over time.
Signs of OCD in teens may include:

Frequent irrational worries or fears (e.g. constantly worrying the front door isn't locked even after it's been checked)

Complaints of having frequent disturbing thoughts and feeling they can't control them

Unusual or illogical behaviors that your teen can't explain (e.g. washing already clean hands several times in a row or until the skin is raw)

Becoming upset or anxious if something is out of order, and needing to fix it right away

Engaging in unusual rituals, such as turning around three times before walking out the door

Compulsive behavior of any kind

Difficulties focusing at school or while doing homework

Constantly checking and re-checking something

Frequent worry that something bad is going to happen

Difficulty making or keeping friends

Getting upset or angry if they're unable to engage in a compulsive behavior or if it's interrupted before they're finished

Depressed mood or frequent anxiety

Suicidal thoughts and behaviors*

*Suicidal thoughts and behaviors are a risk associated with many disorders, including OCD. They should never be ignored. Don't assume your teen is just being "dramatic" or manipulative.
Knowing the First Steps to Take

Following are the first steps to take if you have reason to think your teen has or may be developing OCD:

1 - Talk to your teen. Let your teen know that you're worried about the behaviors you've been observing. Emphasize that you want to help in any way you can and that you're available and willing to listen.

Be prepared for a defensive response or even denial that anything is wrong. Your teen may feel ashamed of the symptoms he or she is experiencing. Avoid judgment, criticism, and shaming of any kind, as those will only make things worse.

2 - Have your teen evaluated. Your teen's pediatrician or your family doctor can do an initial evaluation, including a physical examination to rule out any underlying medical issues that may be contributing to or exacerbating his or her symptoms.

Since OCD can be a complex disorder, it's imperative to have your teen evaluated by a psychologist or psychiatrist. Look for someone who not only specializes in treating children and adolescents, but who also has substantial experience treating OCD. Your family doctor or pediatrician may be able to give you a referral or recommendation.

3 - Get your teen into treatment. OCD symptoms tend to worsen over time, so early intervention is important. Treatment for OCD typically includes a combination of psychotherapy and medication. If your teen's symptoms are more severe or if he or she has another psychiatric disorder as well, a more intensive level of treatment may be required for a period of time.

Individual psychotherapy or "talk therapy" - Psychotherapy can help your teen understand the obsessions and compulsions he or she is experiencing, including the underlying issues that drive them. Cognitive Behavioral Therapy (CBT), in the form of Exposure and Response Prevention (ERP), is one of the most effective types of therapy for OCD. Exposure response prevention involves carefully exposing the individual to the things that make him or her anxious and learning how to cope with the anxiety in a healthy way instead of engaging in the compulsive response.

Medication - Medication can play an important role in the treatment of OCD. Research shows that medication is more effective when used in combination with therapy rather than alone when treating OCD. The most commonly prescribed medications for OCD are:

SSRI antidepressants (selective serotonin reuptake inhibitors), such as Celexa, Paxil, or Zoloft

Clomipramine (Anafranil) - a tricyclic antidepressant medication

Medication may also be prescribed to alleviate symptoms of depression, anxiety, and other co-occurring disorders.

Family therapy - Family therapy can be an important part of treatment for OCD, as the disorder impacts everyone in the household. It includes teaching parents and other family members how to be supportive without accommodating and enabling your teen.

Dual diagnosis treatment - This is usually necessary if there is a co-occurring substance use disorder - see more below

Residential treatment - See below.

Hospitalization - See below.

Supporting and Encouraging Your Child
One of the biggest challenges you may face as a parent of a teen with OCD is knowing how to best encourage and support him or her. Following are some helpful tips:

Always remember that OCD is an illness. It isn't a sign of weakness, nor is it something your teen can simply control or overcome with sheer willpower or determination

Learn everything you can about OCD. This will help you to have more empathy towards what your teen is experiencing, and understand what you can do to help

Help your teen stay focused on the goals of treatment and be patient with the process

Help your teen find ways to relax and manage his or her stress. For example, do yoga with your teen at home or have your teen take a yoga class

Don't judge, criticize, or minimize what your teen is experiencing, not matter how illogical, absurd, or strange your teens worry, fears, and behaviors may seem to you

Work with your teen's therapist to learn how to avoid accommodating your teen's obsessions and compulsions in a healthy way. Keep expectations and routines at home intact; enabling and accommodating your teen (e.g. by having a sibling do his chores because he's obsessed with germs) will ultimately make things worse for your teen, not better

Make yourself available (and willing) to listen and let your teen know you're there for him or her

Do your best to keep your wits about you even if you're feeling frustrated or scared; your teen needs to be able to rely on you for support and guidance

If situations arise that you're not sure how to handle, seek guidance from your teen's therapist or another mental health professional well-versed in OCD

Make sure the entire family is involved so no one is sabotaging your teen's recovery. Consider family therapy or see if your teen's therapist will meet with the whole family for a few sessions. Family therapy can also help address the impact mental illness has on the entire family

What to Do When Things Escalate

Individuals with OCD have an increased risk of suicide, especially if they're also battling depression, bipolar disorder, or another anxiety disorder. Their OCD symptoms may also worsen if they're dealing with something especially stressful or traumatic. Some teens may engage in non-suicidal self-harm, such as cutting or burning themselves, or turn to alcohol or drugs if they're having a tough time coping.

If things escalate and your teen's safety or wellbeing is at risk, don't hesitate to reach out for help. You can:

Contact your child's treatment provider asap

Enlist the help of a close family member or friend for immediate support or assistance

Call an emergency hotline

Take your child to the nearest hospital emergency room (if you can do so safely)

Call 911

When Individual Therapy isn't Enough

Teens with mild to moderate OCD may do well with individual therapy or a combination of therapy and medication. Those with more severe OCD, a comorbid disorder such as depression, bipolar disorder, or an eating disorder, or at risk of suicide may require a higher level of treatment for a period of time. If your teen:

Has symptoms that are interfering with his or her ability to go to school or function in other areas of his or her life

Is experiencing severe depression, anxiety, or other psychiatric symptoms that require a higher level of care

Is actively suicidal - threatening or planning suicide, and / or engaging in suicide gestures or attempts

Is actively using alcohol or drugs

then it's time to consider a more intensive level of treatment. This may involve:

Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how many times a week your teen is required to go. These programs are often the next step up from regular outpatient treatment.

Dual diagnosis treatment is often necessary if your teen has a substance use disorder in addition to PTSD. The substance use problem will almost always hinder the effectiveness of individual therapy alone. Enrolling your teen in a dual diagnosis program allows for both disorders to be treated simultaneously.

Residential treatment requires having your teen live at a non-hospital treatment facility that specializes in treating adolescents with OCD and other mental health disorders. Residential treatment typically lasts between 30 to 180 days, depending on the severity of symptoms and how well your teen is progressing in treatment.

Inpatient psychiatric treatment in a hospital setting is the highest and most intensive level of treatment for adolescents with OCD. In most cases, this level of treatment is used to treat severe depression, mania, anorexia, and / or suicide risk in teens with OCD, rather than the OCD itself. Patients are monitored 'round the clock. Hospitalization is usually relatively brief.
Taking Care of Yourself
Through no fault of his or her own, your teen's OCD is likely going to take a toll on you at times. You may feel frustrated, overwhelmed, helpless, or even despairing. That's why it's vital that you take care of yourself as well. Things that may help include:

Finding a support group for parents of teens with OCD or mental health issues in general

Reaching out to family, friends, and church for support when you're exhausted or struggling emotionally

Finding ways to manage and reduce your stress, such as yoga, meditation, or exercise

Making sure you're getting sufficient rest

No matter how bleak it may seem, your teen can learn how to manage his or her OCD or even overcome it. Staying positive and hopeful will benefit both you and your teen.

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Obsessive Compulsive Disorder (OCD) in Adolescents and Teens

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Adolescence is a challenging phase of life, so it's not uncommon for teens to develop their own quirks and idiosyncrasies as they attempt to navigate the turbulence. Unfortunately, for a small percentage of teens, these quirks and unusual behaviors are indicators of a serious mental health issue - obsessive-compulsive disorder.

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While working on a project together, you see a friend packing up their work supplies in a very neat fashion. You can't help but point out that they've organized all their pens to be lined up in order of color and all facing the same direction in their box. "Oh," they reply. "That's just my OCD."

While often thought of as a condition related to neatness and particularness, OCD is often so much more.

Children can be particularly affected by OCD. The onset of symptoms can begin at any time, sometimes as early as three years old.

Parents and teachers need to understand the risk factors to make sure that children and teenagers who are at risk of developing OCD receive appropriate attention.

When treated properly, OCD can be controlled. If it goes unaddressed, it could lead to serious quality-of-life issues, not only for the child but also for family members.

Keep Reading To Learn

The truth about OCD

How to recognize symptoms of OCD in children and adolescents

How to successfully manage and treat OCD in young people

What Is OCD?

Obsessive compulsive disorder is highlighted by a pattern of unwanted and intrusive thoughts, fears, images, or sensations that lead to feelings of distress (including anxiety, disgust, "not just right" sensations) and repetitive behaviors aimed at canceling out that distress.

Usually, these unwanted thoughts are called obsessions. Unwanted, repetitive behaviors or mental acts are called compulsions.

Throughout life, most people will experience unwanted thoughts every so often. If the person doesn't have OCD, these unwanted thoughts won't cause much distress because they won't be interpreted as meaningful. The hallmark of OCD is that obsessions and compulsions lead to a clinically adverse impact on the life of a child.

For example, unwanted thoughts might be so bad that children have trouble sleeping at night. The repetitive behaviors may be so impactful and obstructive that the child has trouble leaving the house to go to school, play sports, or participate in their daily routine.

OCD can be devastating for a child or teen, but there's hope for those who receive proper psychiatric care

The good news is that there has been plenty of research into OCD, and there are treatment options available. Similar to other mental health disorders, the sooner this condition is diagnosed, the faster it can be treated.

For children to get the care they need, it is important to take an in-depth look at the obsessions and compulsions that fuel OCD.

Obsessions: What Are They?

Obsessions, as they relate to OCD, are fears that children, teenagers, and other individuals cannot stop thinking about. People living with OCD are usually aware that something is "off," and they often understand that the thoughts they are having are not normal.

These thoughts can make them anxious, and despite their best efforts, they cannot seem to stop thinking about them.

Some of the most common examples of obsessions include:

Fearfulness that they are going to die or get sick, no matter what they do

Concern that a loved one is going to end up getting sick, hurt, or killed

Worry that they have broken a rule and deserve to be punished severely for it

Fear of touching items because they are potentially dirty

Obsession with making sure that every object is placed in a certain, even, orderly manner

Worry that unless something is done in a specific order, it is going to lead to a bad outcome

The truth is that everyone has unwanted thoughts from time to time. The difference between occasional unwanted thoughts and OCD is that, in OCD, children cannot stop thinking about these thoughts and may be paralyzed by them. Often, these obsessions are so bad that kids cannot think about anything else.

Compulsions: What Are They?

For a child to have OCD, they need to have both obsessions and compulsions.

Compulsions are behaviors or mental acts that are typically repetitive and rigid in nature. These compulsions often take the form of rituals and are designed to counteract stress or prevent fearful outcomes. Kids with OCD have to do these behaviors over and over again in a certain order. If they do not, the obsessions take over, and they are worried that there will be a negative outcome. These behaviors might involve safety, cleanliness, orderliness, or symmetry. They have to be done "just right" or children are compelled to start over.

In a sense, these behaviors are rituals that provide children with a source of power. They feel like if they do these repetitive behaviors in a certain way, they can control what happens next.

Some of the most common examples of compulsions include:

Having to wash or clean things in a certain way every time

Thinking phrases over and over again until it "feels right"

Having to erase and rewrite, redo, or re-read things in a certain manner multiple times

Repeating a certain word or phrase much more often than is necessary until it is said an exact number of times or in exactly the right way

Checking every door in the house multiple times to make sure that is locked or passing in and out of doors several times in a row

Inspecting every light in the house to make sure it is turned off before leaving

Checking each homework assignment a certain number of times to make sure it was done properly

Chewing each bite on each side of the mouth the same number of times

Having to place everything in a specific, even, symmetrical order

Counting all items and objects to certain good numbers to avoid unlucky numbers

It's important to note that compulsions often arise out of adaptive behaviors. For example, it is good for children to double-check their homework to make sure it is done properly. On the other hand, if children end up checking their homework a dozen times to the detriment of other activities, this starts to have a clinically adverse impact on not only their life but the lives of family members as well.

The same can be said of checking to make sure that lights are turned off and doors are locked. It is good to make sure that the house is safe before leaving. However, if this prevents the family from leaving the house, this becomes a major issue.

Reclaiming Her Freedom

Read about one young patient's journey to overcome OCD.
MANAGING HER OCD
How Do You Recognize OCD in Children?

It's important for individuals, such as parents, teachers, and athletic coaches, to be able to recognize the potential signs of OCD in children. The sooner you can intervene at the start of a mental health challenge, the better their chance for a successful outcome.

There are lots of normal developmental rituals that are not attributable to OCD, like bedtime rituals. However, if a ritual is starting to affect how a child functions, that can help identify if it's more than a routine and may point to a sign of OCD.

OCD often develops slowly over time. With a gradual onset of symptoms, coupled with a parent's natural tendency to protect and soothe, it might be hard for adults to pick up on a child's symptoms of OCD when they start appearing.

It might be easier to recognize the impact that OCD has on the quality of life in children and those around them.

There are several things to watch for that may be signs of OCD.

The following aren't always signs of OCD. They are examples of behaviors that may signal that a child is in distress and may need help from a trained professional.

Homework

Children with OCD might take an excessive amount of time to complete their homework. This might include children having to read the same line over and over again, having to write each number perfectly for a math problem, or checking homework repeatedly to the point that it takes a very long time to finish.

Leaving the House

Children with OCD might slow the family down when leaving the house. For example, if a child is taking forever to get ready, then they might be checking every door, window, and light to make sure they are in the "right" positions or condition before leaving. They might throw a temper tantrum about leaving before this routine is finished. This behavior often makes the family chronically late for activities.

Handwashing

Handwashing is one of the most well-known compulsions when it comes to OCD. Handwashing may arise out of obsessions related to germs, feelings of disgust, or other forms of contamination such as "bad emotions" or fears of developing chronic stress, anxiety, or worry. If OCD is tied to handwashing, then it might be helpful to look at the hands for signs of raw, bleeding skin. If children are washing their hands dozens of times per day, the soap is going to make the skin raw, leading to scars, peeling skin, and bleeding.

Drugs or Alcohol

Sometimes when children are struggling to manage a condition, they may turn to substances as a coping mechanism. If a teen is facing mental health challenges, they may feel socially isolated, misunderstood, or overwhelmed. This occasionally leads to substance misuse.

Sleep Habits

OCD often disrupts bedtime or sleep. Children with OCD may have to go through a very specific routine before they get in bed and fall asleep. They may also have a hard time falling asleep if they have intrusive thoughts or worries that are more intense at night. If this routine is disrupted for any reason, they have to start the entire routine over. It is not unusual for OCD to lengthen the bedtime routine by 30 minutes, an hour, or even longer. This deprives children of much-needed sleep, which impacts school performance, emotional development, and relationships with their peers and family members. If sleep is disrupted consistently it can also negatively impact the effectiveness of OCD therapies, including CBT.

Keep in Mind

These behaviors do not include every way that OCD manifests in kids. It also does not mean that if a child experiences difficulty with these, then they have OCD.

These are several examples where a child may have uncomfortable thoughts, feelings, or sensations that are followed by behaviors or avoidance to feel relief from their discomfort or fear.

If this discomfort-relief cycle causes family distress or dysfunction, parents should consider speaking with a trained professional about the possibility of OCD.

Watch Now
Dr. Elizabeth McIngvale shines a light on obsessive compulsive disorder
What Causes OCD in a Child?

Similar to other mental health disorders, there is never a single reason why a child develops OCD.

The following list of risk factors is far from complete but does provide a small glimpse into what could lead to the development of OCD. It is critical to keep in mind that anyone is capable of developing any mental health disorder, including OCD.

Family History, Genetics, and Environment

OCD is heritable. This simply means that if there's someone in your family who has it, there's a higher likelihood that a child might have it. The familial pattern of OCD suggests a genetic component, though there are no specific genes that have been identified to be related to OCD at this point.

When discussing nature vs. nurture, it is important to note the environment plays a role as well. Obsessions and compulsions can be learned over time. If children watch family members and others go through OCD, they may latch onto these behavioral patterns as well. As a result, environmental exposures can play a role in the development of OCD.

Stressful Events

Stressful events can be a risk factor for kids with OCD who may have underlying vulnerabilities. Children who experience trauma may develop PTSD, which can be mistaken for OCD.

While unwanted and intrusive thoughts often occur with trauma and post-traumatic stress disorder (PTSD) and can look similar to OCD, trauma focuses on intrusive thoughts based on the past traumatic event, and OCD typically focuses on future uncertainties and attempts to lessen them.

OCD Can Be Treated and Maintained-Yes, There Is Hope!

It is important to note that there is no cure for OCD. At the same time, there are plenty of ways to manage this condition effectively.

Though people diagnosed with OCD will always have to deal with some symptoms, there are very effective ways to control obsessions and compulsions. Treatment can lead to improvements in quality of life, even if there are minimal symptoms that have to be managed regularly. Over time and with effective treatment, OCD may not have any impact on someone's quality of life.

When it comes to the treatment of a child with OCD, it is important to approach this comprehensively. When all facets of OCD are addressed appropriately, children have the best chance of making a meaningful recovery.

Several components play a role in the treatment of every child with OCD. Like each child's uniqueness, every diagnosis of OCD will respond in its own way to different treatments, and as a result, may require tailoring treatments to the individual to see what works best.

Therapy

Cognitive behavior therapy, usually shortened to CBT, is an effective treatment method for people with OCD. This therapy, and others similar to it, help patients connect behaviors and thoughts.

One of the most important components of CBT is called exposure and response prevention therapy. The goal of this type of therapy is to expose children to a feared object or obsession gradually.

With proper treatment, young people who struggle with OCD can live fulfilling and healthy lives

For example, a child who is afraid of germs might be exposed to dirt. Then, the child, with the guidance of a mental health professional, learns to resist the urge to complete compulsive rituals.

As OCD affects everyone in the family, parents and siblings need to learn how to best support children. Family-based approaches to therapy have been proven to be very successful. Also, there are even parent-led approaches to therapy for kids who are reluctant to go to treatment. The parent learns how to teach their child coping skills.

Even though this type of therapy takes time, it has been shown to vastly improve the quality of life in children with OCD.

Medications

Certain psychiatric medications can help children control the obsessions and compulsions that go along with OCD. If behavioral treatment is difficult to access or appears to be mildly effective, then a serotonin reuptake inhibitor (SRI), a specific class of antidepressant, may be helpful to add to the child's care plan.

Some of the most common antidepressants that might be used in children that have been diagnosed with OCD include:

Anafranil (clomipramine) is used in children ten years of age or older

Fluvoxamine is used in children eight years of age or older

Prozac (fluoxetine) is used in children seven years of age or older

Zoloft (Sertraline) is used in children six years of age or older

If considering medication, parents should speak with doctors in depth about all possibilities to understand the risks and benefits of each medication.

All psychiatric medications have potential side effects. Parents should understand possible side effects, the chances of these side effects developing, know how to spot them, and when to contact their provider about potentially stopping medication.

Many children who are placed on medication for OCD may be able to come off medication once they have learned exposure and response prevention skills and use them regularly.

Each OCD journey is different and should be treated as such by providers and parents alike. For some young people and their families, once-weekly outpatient visits aren't enough. If that's the case, it may be helpful to consider getting a consultation from a psychiatrist for medication. Additional options include a higher level of care, like intensive outpatient or residential treatment or a parent-only approach to help through familial support.

What Should I Do If My Child Might Have OCD?

Parents, caretakers, and family members need to remain vigilant and understand that there is nothing wrong with asking for help for their child. Also, kids and teens need to know that it's perfectly okay-and normal-to reach out for help if they are feeling troubled.

It is important to note that children with OCD are not damaged, broken, or harmed beyond repair. When children with OCD are approached with sympathy and understanding, it is easier for them to open up about their problems.

If you think you know someone who may be struggling with OCD, the first step is to not panic. While the disorder may feel crippling, there are many ways to get help that is tailored to what's needed for each child. Seeking help-and treatment-can provide a child and their family with the tools to feel empowered and in control of their mental health.

A potential diagnosis of OCD should be discussed with the child's care team to determine the next steps. Call your primary care physician or a local mental health facility, like McLean, to find the care you need.

How Does Someone Get Formally Diagnosed With OCD?

Several steps must take place to properly diagnose a child. Usually, this diagnosis is going to be made by a trained professional, such as a psychiatrist or psychologist, along with assistance from other doctors or health care providers, such as a pediatrician.

What to Expect

An evaluation to determine a diagnosis may include both self-and parent-reporting questionnaires and personal interviewing. These interviews include specific questions to identify the presence of obsessions and rituals.

A trained professional sits down and speaks with a child about feelings, thoughts, symptoms, and behavioral patterns. The goal is to identify any specific obsessions or compulsions.

Then, a psychological evaluation takes place in an attempt to identify the reason why these obsessions and compulsions are present. There has to be an anxiety or fear of a negative or "not right" experience that might happen if things are not done in a certain way.

Finally, it is important to determine whether or not these behaviors harm the child's quality of life. During this evaluation, the evaluator often speaks with the family members and friends as well.

To make the official diagnosis, the psychiatrist uses criteria that are published in the Diagnostic and Statistical Manual of Mental Health Disorders, usually shortened to DSM-5. This is published by the American Psychiatric Association and guides mental health professionals.

In diagnosing OCD, it is important to rule out alternative causes of this behavior. Therefore, a physical exam might take place to check for symptoms and problems that could be related to complications of OCD or a possible alternative diagnosis.

If this process is completed and the child meets the criteria for OCD, the treatment and recovery process can begin.

Help Your Child Feel More Like a Kid

Whatever mental health difficulties your child may be dealing with, McLean is here to help. Contact us today at 877.626.8140 to learn more about treatment options for children, teens, and young adults.
YOUTH MENTAL HEALTH
What You've Heard About OCD Likely Isn't True

Amongst mental health disorders, obsessive compulsive disorder is one of the most common. Despite this, there are prominent misconceptions about how OCD presents in individuals that can make it challenging for many to understand the condition.

Each case of OCD is as unique as the person diagnosed with it, and there are many misconceptions about the disorder. Along with many people loosely using the terminology "being OCD" to describe perfectionism, several myths have emerged about OCD.

Myth: People With OCD Want Everything to Be Perfect

People diagnosed with OCD may exhibit perfectionism-related behaviors or have perfectionism-related obsessions. However, they typically stem from attempts to reduce anxiety or distress associated with uncertainty or a specific feared outcome-not because they want everything to be perfect.

Myth: People With OCD Are Just Germaphobes

While it is true that some obsessions and compulsions are related to germs and handwashing, OCD comes in many shapes and forms and often does not manifest only with an aversion to germs.

Myth: People With OCD Should "Just Relax," and It'll Go Away

OCD is a serious mental health disorder. It is a medical condition that deserves the same level of care and compassion as cancer, diabetes, or heart disease. Those of us with OCD would love to relax. However, that may not be achievable through being told to calm down.

If your child is struggling, McLean offers world-class mental health care for children and teens with OCD and related disorders. Let us help you find the treatment option that's right for your child. Contact us today.

Want More Info?

Looking for even more information about OCD in children? You may find these resources helpful.

Interesting Articles and Videos and More

Learn more about youth mental health and what you can do if your child is displaying signs of OCD.

Helpful Links

These organizations may also have useful information:

International OCD Foundation
The mission of the International OCD Foundation is to help people affected by obsessive compulsive disorder and related disorders to live full and productive lives. The IOCDF aims to increase access to effective treatment through research and training, foster a hopeful and supportive community for those affected by OCD and the professionals who treat them, and fight stigma surrounding mental health issues.

OCD Massachusetts
As a non-profit affiliate of the IOCDF, OCD Massachusetts aims to provide public and professional education about OCD to raise awareness and improve the quality of treatment provided in Massachusetts. They also work to improve access to resources for those with OCD and their families and advocate and lobby for the OCD community in Massachusetts.

Not Alone Notes
Not Alone Notes is a nonprofit organization that mails free, handwritten letters to people with OCD and related disorders. Their goal is to remind others they aren't alone, encourage hope, and dispense resources.

Peace of Mind
Now part of the International OCD Foundation, provides educational resources and access to self-help tools, offers scholarship opportunities, supports professional training programs, and spreads awareness about OCD and related disorders.

Books About OCD

Obsessive Compulsive Disorder: Elements, History, Treatments, and Research
by Leslie J. Shapiro
(ABC-CLIO, 2020)

Stuff That's Loud: A Teen's Guide to Unspiraling When OCD Gets Noisy
by Ben Sedley and Lisa W. Coyne
(New Harbinger, 2020)

Acceptance and Commitment Therapy: The Clinician's Guide for Supporting Parents
by Koa Whittingham and Lisa W. Coyne
(Elsevier, 2019)

Understanding OCD: Skills to Control the Conscience and Outsmart Obsessive Compulsive Disorder
by Leslie J. Shapiro
(Praeger, 2015)

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Everything You Need To Know About OCD in Kids and Teens

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While working on a project together, you see a friend packing up their work supplies in a very neat fashion. You can't help but point out that they've organized all their pens to be lined up in order of color and all facing the same direction in their box.

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Does your child go through extreme changes in mood and behavior? Does your child get much more excited or much more irritable than other kids? Do you notice that your child goes through cycles of extreme highs and lows more often than other children? Do these mood changes affect how your child acts at school or at home?

Some children and teens with these symptoms may have bipolar disorder, a brain disorder that causes unusual shifts in mood, energy, activity levels, and day-to-day functioning. With treatment, children and teens with bipolar disorder can get better over time.

What is bipolar disorder?

Bipolar disorder is a mental disorder that causes people to experience noticeable, sometimes extreme, changes in mood and behavior. Sometimes children with bipolar disorder feel very happy or "up" and are much more energetic and active than usual. This is called a manic episode. Sometimes children with bipolar disorder feel very sad or "down" and are much less active than usual. This is called a depressive episode.

Bipolar disorder, which used to be called manic-depressive illness or manic depression, is not the same as the normal ups and downs every child goes through. The mood changes in bipolar disorder are more extreme, often unprovoked, and accompanied by changes in sleep, energy level, and the ability to think clearly. Bipolar symptoms can make it hard for young people to perform well in school or to get along with friends and family members. Some children and teens with bipolar disorder may try to hurt themselves or attempt suicide.

Most people are diagnosed with bipolar disorder in adolescence or adulthood, but the symptoms can appear earlier in childhood. Bipolar disorder is often episodic, but it usually lasts a lifetime.

Signs and symptoms of bipolar disorder may overlap with symptoms of other disorders that are common in young people, such as attention-deficit/hyperactivity disorder (ADHD), conduct problems, major depression, and anxiety disorders. Diagnosing bipolar disorder can be complicated and requires a careful and thorough evaluation by a trained, experienced mental health professional.

With treatment, children and teens with bipolar disorder can manage their symptoms and lead successful lives.

What causes bipolar disorder?

The exact causes of bipolar disorder are unknown, but several factors may contribute to the illness.

For example, researchers are beginning to uncover genetic mechanisms that are linked to bipolar disorder and other mental disorders. Research shows that people's chance of having bipolar disorder is higher if they have a close family member with the illness, which may be because they have the same genetic variations. However, just because one family member has bipolar disorder, it does not mean that other members of the family will have it. Many genes are involved in the disorder, and no single gene causes it.

Research also suggests that adversity, trauma, and stressful life events may increase the chances of developing bipolar disorder in people with a genetic risk of having the illness.

Some research studies have found differences in brain structure and function between people who have bipolar disorder and those who do not. Researchers are studying the disorder to learn more about its causes and effective treatments.

What are the symptoms of bipolar disorder?

Mood episodes in bipolar disorder include intense emotions along with significant changes in sleep habits, activity levels, thoughts, or behaviors. A person with bipolar disorder may have manic episodes, depressive episodes, or "mixed" episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that often last for several days or weeks. During an episode, the symptoms last every day for most of the day.

These mood and activity changes are very different from the child's usual behavior and from the behavior of healthy children and teens.

Children and teens having a manic episode may:

Show intense happiness or silliness for long periods of time.

Have a very short temper or seem extremely irritable.

Talk fast about a lot of different things.

Have trouble sleeping but not feel tired.

Have trouble staying focused, and experience racing thoughts.

Seem overly interested or involved in pleasurable but risky activities.

Do risky or reckless things that show poor judgment.

Children and teens having a depressive episode may:

Feel frequent and unprovoked sadness.

Show increased irritability, anger, or hostility.

Complain a lot about pain, such as stomachaches and headaches.

Have a noticeable increase in amount of sleep.

Have difficulty concentrating.

Feel hopeless and worthless.

Have difficulty communicating or maintaining relationships.

Eat too much or too little.

Have little energy and no interest in activities they usually enjoy.

Think about death, or have thoughts of suicide.

Can children and teens with bipolar disorder have other problems?

Young people with bipolar disorder can have several problems at the same time. These include:

Misuse of alcohol and drugs. Young people with bipolar disorder are at risk of misusing alcohol or drugs.

Attention-deficit/hyperactivity disorder (ADHD). Children and teens who have both bipolar disorder and ADHD may have trouble staying focused.

Anxiety disorders. Children and teens with bipolar disorder also may have an anxiety disorder.

Sometimes extreme behaviors go along with mood episodes. During manic episodes, young people with bipolar disorder may take extreme risks that they wouldn't usually take or that could cause them harm or injury. During depressive episodes, some young people with bipolar disorder may think about running away from home or have thoughts of suicide.

If your child shows signs of suicidal thinking, take these signs seriously and call your child's health care provider.
If you think your child is in crisis and needs immediate help, call 911. You also can call the National Suicide Prevention Lifeline (Lifeline) at 1‑800‑273‑TALK (8255), or text the Crisis Text Line (text HELLO to 741741). The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. These services are confidential, free, and available 24/7.

How is bipolar disorder diagnosed?

A health care provider will ask questions about your child's mood, sleeping patterns, energy levels, and behavior. There are no blood tests or brain scans that can diagnose bipolar disorder. However, the health care provider may use tests to see if something other than bipolar disorder is causing your child's symptoms. Sometimes health care providers need to know about medical conditions in the family, such as depression or substance use.

Other disorders have symptoms like those of bipolar disorder, including ADHD, disruptive mood regulation disorder, oppositional defiant disorder, conduct disorder, and anxiety disorders. It also can be challenging to distinguish bipolar disorder from depression that occurs without mania, which is referred to as "major depression." A health care provider who specializes in working with children and teens can make a careful and complete evaluation of your child's symptoms to provide the right diagnosis.

How is bipolar disorder treated?

Children and teens can work with their health care provider to develop a treatment plan that will help them manage their symptoms and improve their quality of life. It is important to follow the treatment plan, even when your child is not currently experiencing a mood episode. Steady, dependable treatment works better than treatment that starts and stops.

Treatment options include:

Medication. Several types of medication can help treat symptoms of bipolar disorder. Children respond to medications in different ways, so the right type of medication depends on the child. This means children may need to try different types of medication to see which one works best for them. Some children may need more than one type of medication because their symptoms are complex. Children should take the fewest number of medications and the smallest doses possible to help their symptoms. A good way to remember this is "start low, go slow." Medications can cause side effects. Always tell your child's health care provider about any problems with side effects. Do not stop giving your child medication without speaking to a health care provider. Stopping medication suddenly can be dangerous and can make bipolar symptoms worse.

Psychosocial Therapy. Different kinds of psychosocial therapy can help children and their families manage the symptoms of bipolar disorder. Therapies that are based on scientific research-including cognitive behavioral approaches and family-focused therapy-can provide support, education, and guidance to youth and their families. These therapies teach skills that can help people manage bipolar disorder, including skills for maintaining routines, enhancing emotion regulation, and improving social interactions.

What can children and teens expect from treatment?

With treatment, children and teens with bipolar disorder can get better over time. Treatment is more effective when health care providers, parents, and young people work together.

Sometimes a child's symptoms may change, or disappear and then come back. When this happens, your child's health care provider may recommend changes to the treatment plan. Treatment can take time, but sticking with the treatment plan can help young people manage their symptoms and reduce the likelihood of future episodes.

Your child's health care provider may recommend keeping a daily life chart or mood chart to track your child's moods, behaviors, and sleep patterns. This may make it easier to track the illness and see whether treatment is working.

How can I help my child or teen?

Help begins with the right diagnosis and treatment. Talk to your family health care provider about any symptoms you notice.

If your child has bipolar disorder, here are some basic things you can do:

Be patient.

Encourage your child to talk, and listen to your child carefully.

Pay attention to your child's moods, and be alert to any major changes.

Understand triggers, and learn strategies for managing intense emotions and irritability.

Help your child have fun.

Remember that treatment takes time: sticking with the treatment plan can help your child get better and stay better.

Help your child understand that treatment can make life better.

How does bipolar disorder affect caregivers and families?

Caring for a child or teenager with bipolar disorder can be stressful for parents and families. Coping with a child's mood episodes and other problems-such as short tempers and risky behaviors-can challenge any caregiver.

It is important that caregivers take care of themselves, too. Find someone you can talk to or consult your health care provider about support groups. Finding support and strategies for managing stress can help you and your child.

Where do I go for help?

If you're not sure where to get help, your doctor, pediatrician, or other family health care provider is a good place to start. A health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist, who has experience treating bipolar disorder and can evaluate your child's symptoms.

You can learn more about getting help and finding a health care provider on the National Institute of Mental Health website. Hospital health care providers can help in an emergency. The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online tool to help you find mental health services in your area.

I know someone who is in crisis. What do I do?

If you know someone who might be thinking about hurting themselves or someone else, get help quickly.

Do not leave the person alone.

Call 911 or go to the nearest hospital emergency room.

Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the toll-free TTY number at 1-800-799-4TTY (4889). You also can text the Crisis Text Line (text HELLO to 741741) or go to the National Suicide Prevention Lifeline website.

What should I know about clinical trials?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit the NIMH Clinical Trials webpage.

Reprints

This publication is in the public domain and may be reproduced or copied without permission from NIMH. Citation of NIMH as a source is appreciated. To learn more about using NIMH publications, please contact the NIMH Information Resource Center at 1-866‑615‑6464, email nimhinfo@nih.gov, or refer to our reprint guidelines.

For More Information

MedlinePlus (National Library of Medicine) ( En español)

ClinicalTrials.gov ( En español)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 20-MH-8081
Revised 2020

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Does your child go through extreme changes in mood and behavior? Does your child get much more excited or much more irritable than other kids? Do you notice that your child goes through cycles of extreme highs and lows more often than other children?

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Signs and Symptoms

Below is a list of common signs and symptoms that may be present if a person is struggling with an eating disorder. This is not a diagnostic tool; the presence or absence of any signs or symptoms does not necessarily mean someone does or does not have an eating disorder. Because each eating disorder presents itself differently, the signs and symptoms are broken down by diagnosis.

Anorexia Nervosa

Low body weight - may have dramatic weight loss

Feels as though he or she is overweight, even when that is clearly not the case

Denial of hunger

Preoccupation with body weight and shape (frequent weighing and comments regarding weight and shape)

Obsession with food and its nutrients (calories, fat, carbohydrates, etc.)

Food rituals (cutting into very small pieces, excessive chewing, etc.)

Excessive exercise and dieting

Anxiety regarding weight, meal time, and social activities or gatherings

Frequent fatigue and overall weakness

Dry, thinning, or loss of hair

Dry skin and brittle nails

Frequently cold, wearing multiple layers to hide body or to stay warm

Downy hair covering body, called lanugo

Amenorrhea (loss of menstruation in women)

Bulimia Nervosa

Frequent fluctuations in body weight

Frequent episodes of bingeing (consuming large amounts of food) followed by purging (compensatory behaviors including self-induced vomiting, misuse of diuretics, laxatives, or enemas)

Hiding food to eat in private

Feeling of loss of control during binge episodes

Feelings of shame and guilt when eating

Preoccupied with body weight and shape

Preoccupied with exercise and dieting

Signs of purging include frequent trips to bathroom (especially after meals), swollen cheeks, cuts or scabs on knuckles and back of hands, discolored teeth and tooth decay

Withdrawal from social activities and gatherings

Binge Eating Disorder

Frequent episodes of bingeing (consuming large amounts of food)

Feeling of loss of control during binge episodes

Hiding food to eat in private

Feelings of shame and guilt when eating

Eating when not physically hungry

Eating past the point of discomfort

Eating alone

Diabulimia

May have extreme weight loss

Disordered eating behaviors including restriction or bingeing

Secrecy around insulin administration

Frequent episodes of hypoglycemia

Nausea and vomiting

Increase of thirst and urnination

Diabetic ketoacidosis, DKA

Yeast infection, bladder infection

Liver disease

If you think you or someone you know is struggling with an eating disorder, express your concern and seek professional help immediately.

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Signs and Symptoms | Eating Disorder Foundation.org

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Below is a list of common signs and symptoms that may be present if a person is struggling with an eating disorder. This is not a diagnostic tool; the presence or absence of any signs or symptoms does not necessarily mean someone does or does not have an eating disorder.

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Bulimia nervosa is an eating disorder in which a person eats excessive amounts of food in a short period of time (binge eating), with a sense of lack of control over eating, and then engages in compensatory behaviors to prevent weight gain, such as vomiting, use of laxatives, diuretics, other medications, fasting or excessive exercise.

Bulimia usually begins in adolescence or young adulthood and is more likely to affect girls than boys.

Children and teenagers with bulimia are usually of normal- or low-body weight. They often take steps to hide their disorder by bingeing and purging in secret. Signs and symptoms of bulimia can vary, but may include:

Being preoccupied with body image.

Eating large amounts of high-calorie foods in a short period of time.

Feeling a total lack of control during binge-eating episodes.

Forcing oneself to vomit after a binge-eating episode. Some people with bulimia use laxatives, an enema, or diuretic after binge eating.

Withdrawing from usual friends or activities.

Frequent trips to the bathroom after eating.

Exercising to excess.

Physical symptoms of bulimia may include:

Broken blood vessels in the eyes

Tooth enamel that is worn away, discolored or pitted

Swelling of the cheeks or jaw

Irregular or absent menstrual periods

Severe dehydration

Electrolyte imbalances

Bulimia is a complex condition that may involve genetic, biological, behavioral, psychological and social factors.

If you suspect your child or adolescent has an eating disorder, a psychiatrist or qualified mental health professional will take a detailed psychiatric history and will work with your child's pediatrician to perform laboratory tests and a physical exam to assess medical status.

Eating disorders can affect nearly every organ system in the body, so early treatment is essential. Treatment will depend on your adolescent's specific eating disorder as well as:

Age, overall health, and medical history

Extent of the symptoms

Tolerance for specific medications or therapies

Expectations for the course of the condition

Personal opinion or preference

Goals of treatment are for the person to:

Resume normal eating habits

Stop the binge/compensatory behavior cycle

Reach normal body weight

At Children's Hospital of Philadelphia (CHOP), our team of behavioral health eating disorder specialists will treat your child using a model we call Systems-Based Family Therapy. Family-centered therapy emphasizes the important role that families play in helping their child recover from an eating disorder and promoting their mental and physical wellness.

An individualized treatment plan will be developed based on your child's and family's needs. Research has proven the effectiveness of the family-centered approach to treatment, and we are one of the only programs in Pennsylvania to specialize in family treatment for eating disorders.

The beginning phases of the plan will focus on restoring nutrition and stopping eating disorder behaviors such as bingeing and compensatory behaviors. Later phases will focus on ongoing therapy for your child and the family as a whole. The goal is for your child to resume age-appropriate development, in the absence of eating disorder symptoms, with the support of the entire family unit.

Treatment usually progresses over one year, with visits often weekly for the first two to three months, then progressing to a lesser frequency. Relapse prevention sessions often occur during the first year of treatment. We work collaboratively with the Division of Adolescent Medicine, recommending medical appointments at regular intervals. Some patients may require medical stabilization as an inpatient at CHOP before beginning outpatient treatment. This is determined on a case-by-case basis.

Many people with eating disorders recover fully and lead normal, healthy lives with no lingering effects. But in some cases, managing an eating disorder like bulimia nervosa may require ongoing counseling and monitoring.

The Eating Disorder Program in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at CHOP offers comprehensive outpatient services to children and adolescents with anorexia nervosa and bulimia nervosa.

When enrolled in our program, your child will be treated by a dedicated team that includes doctors, nurses and psychosocial staff. Team members have a range of specialties including adolescent medicine, psychiatry, nutrition and social work.

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Bulimia nervosa is an eating disorder in which a person eats excessive amounts of food in a short period of time (binge eating), with a sense of lack of control over eating, and then engages in compensatory behaviors to prevent weight gain, such as vomiting, use of laxatives, diuretics, other medications, fasting or excessive exercise.

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Overview

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder.

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

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

Children can struggle with:

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

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

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

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

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

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

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

Inattention and restlessness

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

Attendance problems and clingy kids

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

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

Disruptive behavior

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

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

Trouble answering questions in class

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

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

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

Frequent trips to the nurse

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

Problems in certain subjects

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

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

Not turning in homework

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

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

Avoiding socializing or group work

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

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

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

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

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

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While summer offers preschool and elementary school children a welcome break and chances to navigate new friendships and activities, it can trigger anxiety in children upset by unstructured time, changes in routine and friend groups, and transitions involving new faces and places. Separation anxiety, social anxiety, and specific phobias are instantly recognizable: a sobbing child clings to a parent, refusing to set foot inside day care; a socially anxious child worries about attending a birthday party because "nobody will play with me;" or a child is so terrified by insects that simple summer fun like a nature stroll, digging in the dirt, or a picnic in the park is impossible.

Common symptoms of anxiety in children

Thumping heart, rapid breathing, sweating, tense muscles, nausea, and dread are familiar symptoms of anxiety that accompany a " fight, flight, or freeze " reaction triggered by real or imagined threats, like a snarling dog or new social experience. Anxious children may be clingy, startle easily, cry or have tantrums, sleep poorly, and have headaches or stomachaches.

But anxiety is not all bad. "It can motivate us, or help us avoid danger," says Dr. Mona Potter, medical director of McLean Anxiety Mastery Program and McLean Child and Adolescent Outpatient Services. "The problem is when anxiety gets out of hand and makes decisions for us that are no longer helpful - maybe even paralyzing." By that point, normal anxiety may have become an anxiety disorder.

What types of anxiety are common in children?

Separation anxiety: Very anxious and upset when parted from parents and caregivers; refusal to attend camp, sleepovers, or play dates; worry that bad things will happen to self or loved ones while separated.

Social anxiety: Strong fear of social situations; very anxious and self-conscious around others; worry about being judged or humiliated.

Specific phobia: Severe, irrational fear set off by a situation or thing, such as thunderstorms, worry about vomiting, or insects.

What makes some children more vulnerable to anxiety?

Anxiety may set deep roots due to a blend of

biological factors, such as genes and brain wiring

psychological factors, such as temperament and coping strategies

environmental factors, such as anxious parenting or troubling early childhood experiences and environment.

Sometimes, anxiety is a side effect of medicine. Ask your doctor about this possibility.

Treating anxiety in children

Occasional anxiety is normal. But talk to your pediatrician if anxiety causes your child to limit activities, worry often, or avoid camp or day care. A severe anxiety disorder can delay or derail child development.

Depending on developmental stage and level and type of anxiety, treatment may involve changes you and your child work toward yourselves. Or you might work with child mental health professionals, such as a psychiatrist, psychologist, or social worker. These experts can help parents and children learn to apply cognitive behavioral therapy (CBT), a highly effective treatment that addresses anxious thoughts and behaviors. "For example, we might encourage children to practice 'detective-thinking' to catch, check, and change anxious thoughts," says Dr. Potter. "We also encourage them to approach, rather than avoid, anxiety-provoking triggers."

Mindfulness techniques and antianxiety or antidepressant medicines also may be discussed. Often a combination of approaches works best.

Ways parents can help children learn to manage anxiety

Personalize and externalize: Ask your child to give anxiety a name. Your child can draw pictures of anxiety, too. Then, help your child acknowledge anxiety when it rears up: 'Is that spiky-toothed, purple Bobo telling you no one wants to play with you?' Labeling and distancing anxiety can help your child learn to be the boss of it.

Preview anxiety-provoking situations. Consider meeting camp counselors or touring new places ahead of time.

Model confidence: Children are emotional Geiger counters. They register anxiety radiating from parents. Try to be mindful of what you model through words and body language. Work on tempering overanxious reactions when appropriate.

Narrate their world: "Children are coding the world. Particularly through early childhood their brains are just sponges, taking everything in," says Dr. Potter. "We can help them with the narrative they're constructing: 'Is the world a safe place or a dangerous place where I have to be on guard all the time?'"

Allow distress: Avoiding distressing situations invites anxiety to ease temporarily, only to pop up elsewhere. Rational explanations won't work, either. The whirring emotional center of the brain known as the limbic system requires time and tools to calm down enough to let the thinking (cognitive) center of the brain come back online. Instead, try distress tolerance tools: one child might splash her face with cold water, another might charge up and down stairs to blow off anxious energy, or tense and relax her muscles, or distract herself by looking around to find every color in the rainbow.

Practice exposure: Gradual exposure helps rewire an anxious brain and shows a child he can survive anxious moments. Let's say your child is anxious about talking in public, ducking his head and squirming if addressed. Pick a pleasant, slow-paced restaurant for a fun weekly date. Then coach your child to take charge of ordering foods he likes in small steps. At first, he might whisper the order to you and you'll relay it to the waitress. Next, he might order just his drink or dessert, and finally a full meal as distress tolerance and confidence grows.

A few helpful resources
Anxiety and Depression Association of America CDC Key Findings: Children's Mental Health Report (2018)Key Findings: U.S. Children Diagnosed with Anxiety and Depression (2018)
You and Your Anxious Child, Anne Marie Albano, PhD, with Leslie Pepper (Avery: 2013)

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Anxiety in children - Harvard Health Blog

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While summer offers preschool and elementary school children a welcome break and chances to navigate new friendships and activities, it can trigger anxiety in children upset by unstructured time, changes in routine and friend groups, and transitions involving new faces and places.

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When children are chronically anxious, even the most well-meaning parents, not wanting a child to suffer, can actually make the youngster's anxiety worse. It happens when parents try to protect kids from their fears. Here are pointers for helping children escape the cycle of anxiety.

None of us wants to see a child unhappy, but the best way to help kids overcome anxiety isn't to try to remove stressors that trigger it. It's to help them learn to tolerate their anxiety and function as well as they can, even when they're anxious. And as a byproduct of that, the anxiety will decrease over time.

Helping children avoid the things they are afraid of will make them feel better in the short term, but it reinforces the anxiety over the long run. Let's say a child in an uncomfortable situation gets upset and starts to cry - not to be manipulative, but just because that's how they feel. If their parents whisk them out of there, or remove the thing they're afraid of, the child has learned that coping mechanism. And that cycle has the potential to repeat itself.

You can't promise a child that their fears are unrealistic-that they won't fail a test, that they'll have fun ice skating, or that another child won't laugh at them during show & tell. But you can express confidence that they're going to be okay, that they will be able to manage it. And you can let them know that as they face those fears, the anxiety level will drop over time. This gives them confidence that your expectations are realistic, and that you're not going to ask them to do something they can't handle.

It's important to understand that validation doesn't always mean agreement. So if a child is terrified about going to the doctor because they're due for a shot, you don't want to belittle those fears, but you also don't want to amplify them. You want to listen and be empathetic, help them understand what they're anxious about, and encourage them to feel that they can face their fears. The message you want to send is, "I know you're scared, and that's okay, and I'm here, and I'm going to help you get through this."

Encourage your child to talk about their feelings, but try not to ask leading questions- "Are you anxious about the big test? Are you worried about the science fair?" To avoid feeding the cycle of anxiety, just ask open-ended questions: "How are you feeling about the science fair?"

What you don't want to do is be saying, with your tone of voice or body language: "Maybe this is something that you should be afraid of." Let's say a child has had a negative experience with a dog. Next time they're around a dog, you might be anxious about how they will respond, and you might unintentionally send a message that they should, indeed, be worried.

Let your child know that you appreciate the work it takes to tolerate anxiety in order to do what they want or need to do. It's really encouraging them to engage in life and to let the anxiety take its natural curve. We call it the "habituation curve." That means that it will drop over time as he continues to have contact with the stressor. It might not drop to zero, it might not drop as quickly as you would like, but that's how we get over our fears.

When we're afraid of something, the hardest time is really before we do it. So another rule of thumb for parents is to really try to eliminate or reduce the anticipatory period. If a child is nervous about going to a doctor's appointment, you don't want to launch into a discussion about it two hours before you go; that's likely to get your child more keyed up. So just try to shorten that period to a minimum.

Sometimes it helps to talk through what would happen if a child's fear came true-how would they handle it? A child who's anxious about separating from their parents might worry about what would happen if a parent didn't come to pick them up. So we talk about that. If your mom doesn't come at the end of soccer practice, what would you do? "Well I would tell the coach my mom's not here." And what do you think the coach would do? "Well he would call my mom. Or he would wait with me." A child who's afraid that a stranger might be sent to pick them up can have a code word from their parents that anyone they sent would know. For some kids, having a plan can reduce the uncertainty in a healthy, effective way.

There are multiple ways you can help kids handle anxiety by letting them see how you cope with anxiety yourself. Kids are perceptive, and they're going to take it in if you keep complaining on the phone to a friend that you can't handle the stress or the anxiety. I'm not saying to pretend that you don't have stress and anxiety, but let kids hear or see you managing it calmly, tolerating it, feeling good about getting through it.

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What to Do (and Not Do) When Children Are Anxious - Child Mind Institute

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How to help a child with anxiety? We bring expert parenting advice on assisting children to escape the cycle of anxiety. Learn what to do and not to do, anxiety treatments, and behavioral modification techniques.

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Research in psychology has contributed to the development of more effective treatment and prevention of mental health disorders in children, youth, and families, including programs targeting expectant mothers, children in school settings, and youth transitioning into adulthood and programs working at the following levels:

Individual - e.g., therapy or counseling for those with mental health disorders

Peer - e.g., peer-assisted learning programs aimed at improving reading, math, and science

Family - e.g., parent education on the needs of children at each stage of development

School - e.g., strategies for teachers for effective classroom management

Community - e.g., violence prevention programs administered through community/recreational centers or churches

Systemic - e.g., coordination of services in the health, juvenile justice, education, and child protection systems.

Psychologists working with children and youth are also trained to take into account developmental considerations on:

Culture, ethnicity and language also mediates the behavior of children and adolescents in numerous ways and as a result affects the methods of prevention and treatment of mental health disorders.

Psychologists have developed tools to assess the risk and protective factors for the mental health of children and youth, to test them for behavioral or emotional problems, and to continually monitor treatment progress.

Psychologists have also designed programs that effectively engage families, schools and communities, that is, the critical social supports that can guarantee lasting well-being for children and youth. For example, one successful family-centered program aimed at decreasing alcohol use in preteens engages parents and caregivers by training them on parenting skills such as setting limits, expressing clear expectations about substance abuse, communication and discipline while also simultaneously training youth on resistance skills and how to develop negative attitudes toward alcohol.

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Research in psychology has contributed to the development of more effective treatment and prevention of mental health disorders in children, youth, and families, including programs targeting expectant mothers, children in school settings, and youth transitioning into adulthood and programs working at the following levels: Individual - e.g., therapy or counseling

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Mental illness in children: Know the signs

Children can have the same mental health conditions as adults, but their symptoms may be different. Know what to watch for and how you can help.
By Mayo Clinic Staff
Mental illness in children can be hard for parents to notice. As a result, many children who could be helped by treatment don't get the help they need. Learn the warning signs of mental illness in children and how you can help your child.

What is a mental illness?

Mental health is the overall wellness of how you think, manage your feelings and behave. A mental illness may also be called a mental health disorder. It is patterns or changes in thinking, feeling or behaving that causes distress or gets in the way of being able to act.

Mental health conditions in children are most often defined as delays or changes in thinking, behaviors, social skills or control over emotions. These problems distress children. Mental health conditions disrupt their being able to act well at home, in school or in other social settings.

Barriers to treating childhood mental health disorders

It can be hard to detect mental health conditions in children because typical childhood growth is a process that involves change. Also, the symptoms of a condition may depend on a child's age. Young children may not be able to express how they feel or explain why they are behaving a certain way.

Concerns might keep parents from getting care for a child who might have a mental illness. Concerns may be about the stigma linked to mental illness, the use of medicines, the cost of treatment or problems getting help.

Common disorders among children

Mental health disorders in children may include the following:

Anxiety disorders. Anxiety disorders in children are outsized fears or worries that are hard to control. These worries disrupt children's being able to take part in play, school or social activities. Diagnoses include social anxiety, generalized anxiety and obsessive-compulsive disorders.

Attention-deficit/hyperactivity disorder (ADHD). Compared with most children of the same age, children with ADHD have trouble with paying attention, acting on impulse, being too active, called hyperactivity, or some mix of these problems.

Autism spectrum disorder (ASD). Autism spectrum disorder is a neurological condition that appears in early childhood, often before age 3. How severe ASD is varies. But children with this disorder have trouble talking with and connecting with others.

Eating disorders. Eating disorders are defined as an unhealthy focus on an ideal body type, disordered thinking about weight and weight loss, and unsafe eating and dieting habits. Eating disorders such as anorexia nervosa, bulimia nervosa and binge-eating disorder can result in not being able to act emotionally and socially. And they can cause life-threatening physical complications.

Depression and other mood disorders. Depression is lasting feelings of sadness, low or irritable mood, and loss of interest in typical activities. These get in the way of a child being able to do well in school and interact with others. Bipolar disorder results in big mood swings between depression and extreme emotional or behavioral highs. These highs can cause risky or unsafe actions.

Post-traumatic stress disorder (PTSD). PTSD is long-term emotional upset, worry, scary memories, nightmares and acting out. This is in response to violence, abuse, injury or other traumas a child has had or come into contact with.

Schizophrenia. Schizophrenia is a disorder in perceptions and thoughts. Schizophrenia causes a person to lose touch with reality, called psychosis. It most often starts in the late teens through the 20s. Schizophrenia can cause a person to see or hear things that aren't there, called hallucinations. It also can cause odd thoughts and behaviors.

What are the warning signs of mental illness in children?

Warning signs that your child may have a mental health disorder include:

Sadness that lasts two or more weeks.

Changes in being social or staying away from others.

Hurting oneself or talking about hurting oneself.

Talking about death or suicide.

Having outbursts or being very moody or testy.

Out-of-control behavior that can be harmful.

Big changes in mood, behavior or personality.

Changes in eating habits.

Loss of weight.

Trouble sleeping.

Getting headaches or stomachaches often.

Trouble concentrating.

Doing poorly in school.

Not going to school.

What should I do if I suspect that my child has a mental health condition?

If you're worried about your child's mental health, consult your child's healthcare professional. Describe the behaviors that concern you. Talk to your child's teachers, close friends, relatives or other caregivers to see if they've noticed changes in your child's behavior. Share this information with your child's healthcare professional.

How do healthcare professionals diagnose mental illness in children?

Mental health conditions in children are diagnosed and treated based on symptoms and how the condition affects a child's daily life. To make a diagnosis, your child's healthcare professional might suggest that your child see a specialist. This might be a psychiatrist, psychologist, clinical social worker, psychiatric nurse practitioner or other mental healthcare professional. Seeing a specialist might include:

Complete medical exam.

Medical history.

History of physical or emotional trauma.

Family history of physical and mental health.

Review of symptoms and concerns with parents.

Timeline of how the child has matured.

School history.

Talking with parents.

Talking with the child and watching the behavior.

Mental health tests and questionnaires for the child and parents.

Healthcare professionals might use the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is a guide published by the American Psychiatric Association. It provides ways to make a diagnosis based on symptoms. Another diagnostic guideline is the International Classification of Diseases (ICD) from the World Health Organization.

Diagnosing mental illness in children can take time. Young children may have trouble knowing or saying how they feel. How children matures varies. A healthcare professional may change or adjust a diagnosis over time.

How is mental illness in children treated?

Common treatments for children who have mental health conditions include:

Psychotherapy. Psychotherapy, also called talk therapy or behavior therapy, involves talking with a psychologist or other mental health professional. With young children, psychotherapy may include playtime or games. During psychotherapy, children and teens learn how to talk about and manage thoughts and feelings. They learn new behaviors and coping skills.

Medicines. Your child's healthcare or mental health professional may suggest a medicine as part of the treatment plan. This medicine might be a stimulant, an antidepressant, an anti-anxiety medicine, an antipsychotic or a mood stabilizer. The healthcare professional most often reviews the hoped for benefits, possible risks and side effects of the medicine.

How can I help my child cope with mental illness?

You play a huge role in supporting your child's treatment plan. To care for yourself and your child:

Learn about the illness.

Consider family counseling that treats all members as partners in the treatment plan.

Ask your child's mental health professional for advice on how to respond to your child and handle tough behavior.

Enroll in parent training programs designed for parents of children with a mental illness.

Look for ways to handle stress and help you respond calmly.

Seek ways to relax and have fun with your child.

Praise your child's strengths and skills.

Work with your child's school to get the support your child needs.

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Show references

1. Use of the manual. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed Jan. 20, 2020.

2. Normal or not: When to get help. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Normality-022.aspx. Accessed Nov. 13, 2023.

3. What is children's mental health? Centers for Disease Control and Prevention. https://www.cdc.gov/childrensmentalhealth/basics.html. Accessed Sept. 20, 2023.

4. Kliegman RM, et al. Psychosocial assessment and interviewing. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Jan. 27, 2020.

5. Stigma, prejudice and discrimination against people with mental illness. American Psychiatric Association. https://www.psychiatry.org/patients-families/stigma-and-discrimination. Accessed Nov. 13, 2023.

6. Walter HJ, et al. Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 2020; doi:10.1016/j.jaac.2020.05.005.

7. Wolraich ML, et al. Clinical practice guideline for the diagnosis, evaluation and treatment of attention deficit/hyperactivity disorder in children and adolescents. American Academy of Pediatrics. 2019; doi:10.1542/peds.2019-2528.

8. Autism spectrum disorders. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Child-With-Autism-011.aspx. Accessed Nov. 13, 2023.

9. Depression in children and teens. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Depressed-Child-004.aspx. Accessed Jan. 22, 2020.

10. Bipolar disorder in children and teens. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Bipolar-Disorder-In-Children-And-Teens-038.aspx. Accessed Jan. 22, 2020.

11. Comprehensive psychiatric evaluation. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Comprehensive-Psychiatric-Evaluation-052.aspx. Accesssed Jan. 22, 2020.

12. Psychotherapy for children and adolescents: Definition. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/What-Is-Psychotherapy-For-Children-And-Adolescents-053.aspx. Accessed Jan. 22, 2020.

13. Psychiatric medication for children and adolescents: Part I - How medications are used. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Psychiatric-Medication-For-Children-And-Adolescents-Part-I-How-Medications-Are-Used-021.aspx. Accessed Jan. 22, 2020.

14. Learning to help your child and your family. National Alliance on Mental Illness. https://www.nami.org/find-support/family-members-and-caregivers/learning-to-help-your-child-and-your-family. Accessed Jan. 24, 2020.

See more In-depth

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Worried about your child's mental health?

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It can be hard to tell the difference between typical behavior and symptoms of mental illness in children. Find out what to look for and when to act.

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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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PACER Center Advocate Pat Anderson looks at ways to effectively communicate with your child's IEP Team and discusses the Due Process options in these videos.

Parents of children with disabilities often ask:

Can the school send my child home before the end of the school day?

Can the school district suspend my child?

Can the school district expel my child?

What happens to my child's educational services if he or she is sent home, suspended, or expelled?

This interactive guide will answer these and many other questions. Whether your child is on an Individualized Education Plan (IEP) or a Section 504 Plan, or if you suspect that your child has a disability that affects his or her behavior at school, this guide will help you understand the complex disciplinary process for Minnesota public school children with disabilities.

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blind deaf autistic children education programs

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Today PACER offers more than 30 programs for parents, students, professionals and other parent organizations. PACER is staffed primarily by parents of children with disabilities dedicated to educating other parents and improving the lives of children with disabilities throughout Minnesota.

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By The Understood Team

ADHD is a common condition that makes it hard to focus, keep still, and think before acting. Some people with ADHD mainly have trouble with focus. (This is also known as ADD.) ADHD can also impact other skills, including managing emotions.

It's not clear exactly how many people in the United States have ADHD. But estimates are between 5 and 11 percent.

ADHD doesn't just go away as people get older. Most of the time, hyperactivity and impulsivity lessen or disappear by the teen years or a little longer. But trouble with focus usually continues. Some people aren't diagnosed with ADHD until after high school or as adults.

No matter when people are diagnosed with ADHD, there are treatments that can make symptoms more manageable. And there are supports that can make things easier at school and at work.

People with ADHD have trouble with executive function, which is the "management system" of the brain. Because of that, people with ADHD often struggle with:

Managing time

Getting and staying organized

Setting priorities

Planning

Managing emotions

Paying attention and remembering things

Shifting focus from one thing to another

Getting started on and finishing tasks

Thinking before saying or doing things

There's one confusing sign of ADHD. People who have trouble focusing most of the time can often "hyperfocus" on tasks or activities they find really interesting.

Signs of ADHD can pop up at any age. Kids can show signs as young as preschool. But many don't show signs until later on, as school gets harder and they have more to juggle. Some people don't realize that what they experience is ADHD until they're in college or working.

The research shows that brain development is very similar. But the areas involved in executive function take longer to develop in people with ADHD. That's why kids with ADHD may act one to three years younger than other kids their age. Research also shows some differences in how the brain functions.

These differences have nothing to do with intelligence. People with ADHD are just as smart as people who don't have it.

Researchers are also looking at the role of genetics. ADHD tends to run in families. A child with ADHD has a one in four chance of having at least one parent who has it. And there's a strong likelihood that another close family member also has ADHD.

There are no tests for ADHD. Instead, evaluators use a variety of tools to determine if a child has ADHD. One is a questionnaire about behavior. Another is a clinical interview.

Here are some types of professionals who may diagnose ADHD:

General health care providers, including pediatricians

Psychiatrists

Developmental pediatricians

Neuropsychologists

Psychiatric nurse practitioners

Clinical psychologists

There are a few types of treatment for ADHD. They include:

Behavior therapy: This type of therapy involves creating a rewards system for changing a child's behavior. It's different from cognitive behavioral therapy (CBT), which helps people look at their thoughts, emotions, and behaviors, and make positive changes. CBT may be helpful to some people with ADHD, but it's not a treatment for ADHD.

Alternative treatments: There's no shortage of companies that claim to have an all-natural fix to ADHD. Most have no evidence to back up their claims. Learn more about alternative treatments for ADHD.

ADHD doesn't go away. But with the right treatments and supports in school, at home, and at work, people with ADHD can thrive.

Understood is not affiliated with any pharmaceutical company.

Key takeaways

ADHD is a biological condition that can impact focus, organization, and self-control.

ADHD is not a problem of laziness or willpower.

With the right support, people with ADHD can thrive.

Tell us what interests you

About the author

About the author

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

Reviewed by

Reviewed by

Thomas E. Brown, PhD is a clinical psychologist and clinical associate professor of psychiatry at the Keck School of Medicine of USC.

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ADHD is a common condition that makes it hard to focus, keep still, and think before acting. Some people with ADHD mainly have trouble with focus. (This is also known as ADD.) ADHD can also impact other skills, including managing emotions. It's not clear exactly how many people in the United States have ADHD.