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What are Disruptive and Conduct Disorders? 

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What are Disruptive and Conduct Disorders? 

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As Good As It Gets - Depiction of Obsessive-Compulsive Disorder

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Early Development of Comorbidity Between Symptoms ofAttention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional DefiantDisorder (ODD)Elizabeth A. Harvey, Rosanna P. Breaux, and Claudia I. Lugo-CandelasUniversity of Massachusetts Amherst

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Early Development of Comorbidity Between Symptoms ofAttention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional DefiantDisorder (ODD)Elizabeth A. Harvey, Rosanna P. Breaux, and Claudia I. Lugo-CandelasUniversity of Massachusetts Amherst

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Early Development of Comorbidity Between Symptoms of Attention-Deficit:Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD).pdf

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Centers for Disease Control and Prevention

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Research on children's mental health in the community

Project to Learn About Youth - Mental Health

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

Study questions included:

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

How frequently did these disorders appear together?

What types of treatment were children receiving in their communities?

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

Other research

Read more about research on

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

Research on prevalence

Using different data sources

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

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

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

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

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

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

Differences between populations with or without health insurance

How estimates for mental health disorders change over time

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

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

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

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

Better understand the impacts of mental disorders,

Inform needs for treatment and intervention strategies, and

Promote the mental health of children.

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

Reference

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

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

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Centers for Disease Control and Prevention

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Summary
What is already known about this topic?
Infants, children, and adolescents who do not get sufficient sleep are at increased risk for adverse health outcomes. Most adolescents report sleeping less than the recommended amount. Little is known about sleep duration in infants and children.
What is added by this report?
During 2016-2018, approximately one third of children aged 4 months-17 years slept less than recommended for their age, particularly those from racial and ethnic minority groups, of low socioeconomic status, and with special health care needs. Infants, children, and adolescents with regular bedtimes were more likely to get enough sleep.
What are the implications for public health practice?
Public health practitioners, educators, and clinicians can advise parents about the importance of infants, children, and adolescents meeting recommended sleep durations, investigate the social and environmental context that affects sleep, and support parents in implementing consistent bedtimes.

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Infants, children, and adolescents who do not get sufficient sleep are at increased risk for injuries, obesity, type 2 diabetes, poor mental health, attention and behavior problems, and poor cognitive development ( 1). The American Academy of Sleep Medicine (AASM) provides age-specific sleep duration recommendations to promote optimal health ( 1). CDC analyzed data from the 2016-2018 National Survey of Children's Health (NSCH) to assess the prevalence of short sleep duration among persons in the United States aged 4 months-17 years. Overall, on the basis of parent report, 34.9% of persons aged 4 months-17 years slept less than recommended for their age. The prevalence of short sleep duration was higher in southeastern states and among racial and ethnic minority groups, persons with low socioeconomic status, and those with special health care needs. The prevalence of short sleep duration ranged from 31.2% among adolescents aged 13-17 years to 40.3% among infants aged 4-11 months. Persons aged 4 months-17 years with a regular bedtime were more likely to get enough sleep. Public health practitioners, educators, and clinicians might advise parents on the importance of meeting recommended sleep duration and implementing a consistent bedtime for healthy development.

NSCH is a population-based, nationally representative online and paper survey of parents or primary caregivers (parents) of noninstitutionalized U.S. persons aged ≤17 years. The survey is conducted by the U.S. Census Bureau under the direction of the Health Resources and Services Administration's Maternal and Child Health Bureau.* NSCH asks parents about the physical and emotional health of one person aged ≤17 years selected at random from the household, as well as health care access and family characteristics. The weighted overall response rates were 40.7% in 2016, 37.4% in 2017, and 43.1% in 2018. † Sleep duration questions were "During the past week, how many hours of sleep did this child get on an average day (count both nighttime sleep and naps)?" § for infants and children aged 0-5 years, and for children and adolescents aged 6-17 years, "During the past week, how many hours of sleep did this child get on an average weeknight?" ¶ On the basis of AASM recommendations ( 1), short sleep duration was defined as <12 hours for children aged 4-11 months, <11 hours for children aged 1-2 years, <10 hours for children aged 3-5 years, <9 hours for children aged 6-12 years, and <8 hours for adolescents aged 13-17 years. The bedtime question for all ages was "How often does this child go to bed at about the same time on weeknights?"** Regular bedtime was defined as a response of "always." The study included 99,842 persons aged 4 months-17 years †† with responses to the sleep duration question (48,748 in 2016, 21,124 in 2017, and 29,970 in 2018).

Prevalence and 95% confidence interval (CI) of short sleep duration and regular bedtime were calculated for persons aged 4 months-17 years overall, by age group, by state, and by selected characteristics of the child and parent. Pairwise differences by sex, race/ethnicity, special health care needs status, overall health status, and regular bedtime were determined using t-tests. Tests for linear trend were conducted for family income level §§ and parent education level. P-values <0.05 were considered statistically significant. Analyses accounted for weighting ¶¶ of the data and for the complex sampling design. SAS-callable SUDAAN (version 11.0.3; RTI International) was used to conduct all analyses. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.***

Overall, 34.9% of persons aged 4 months-17 years slept less than recommended for their age ( Table 1). The prevalence of short sleep duration ranged from 31.2% among adolescents aged 13-17 years to 40.3% among infants aged 4-11 months. The percentage of persons aged 4 months-17 years with a regular bedtime was 33.9% overall and ranged from 23.8% among adolescents to 43.5% among infants. Among children aged 4 months-17 years, the prevalence of short sleep duration was lowest among non-Hispanic White children (28.8%) and higher among non-Hispanic Black children (50.8%) than among Hispanic children (39.1%) or non-Hispanic children of any other race (other race) (34.6%) ( Table 2). The prevalence decreased with increasing family income level and parent educational attainment. The prevalence of short sleep duration was higher among persons aged 4 months-17 years with special health care needs than among those without special health care needs (38.3% versus 34.1%); and among those with good, fair, or poor health than among those with excellent or very good health (46.8% versus 33.5%). Overall, the prevalence of short sleep duration was lower among persons aged 4 months-17 years with a regular bedtime than among those without a regular bedtime (27.5% versus 38.6%). Similar patterns were observed within each age group.

State-level prevalence of short sleep duration overall ranged from 25.3% in Maine to 48.9% in Mississippi (Table 2). States with the highest prevalence of short sleep duration were concentrated in the Southeast ( Figure).

Discussion

During 2016-2018, approximately one third of persons aged 4 months-17 years (34.9%) got less sleep than is recommended for their age ( 1). Younger persons within this age group were particularly at risk for short sleep duration; the prevalence of short sleep duration decreased with age from infancy (40.3%) to adolescence (31.2%). Previous prevalence estimates of short sleep duration among adolescents were significantly higher: based on self-report from the 2015 Youth Risk Behavior Surveys, ††† nearly three quarters of high school students nationally and approximately one half of middle school students in nine states reported getting less sleep than recommended for their age ( 2). This difference might be explained by NSCH's reliance on parent report rather than self-report with Youth Risk Behavior Surveys. Parents might overestimate the amount of sleep their older children or adolescents receive ( 3). However, one study that compared total sleep time based on parent report and child or adolescent report with that measured by a sleep study (i.e., polysomnography §§§) found that children and adolescents overestimated total sleep time to a lesser extent than did their parents, but the difference between child or adolescent and parent reports was small ( 4). Agreement between parent and child or adolescent report was similar for children aged 9-12 years and adolescents aged 13-17 years ( 4).

Before 2016, the NSCH did not ask parents about hours of sleep, but rather asked, "During the past week, on how many nights did [child] get enough sleep for a child his/her age?" Patterns in the prevalence of inadequate sleep (defined as not enough sleep ≥1 night during the past week) contrast with the current report; specifically, the prevalence of inadequate sleep was highest among adolescents aged 14-17 years and lowest among children aged 6-9 years ( 5). Trends based on parent education and household income also differed ( 5).

In the current study, short sleep duration was elevated among racial and ethnic minority groups, especially among Black persons aged 4 months-17 years, among whom approximately one half had short sleep duration. Short sleep duration was also more prevalent among families with lower income or lower parental educational attainment. In previous research, sleep disparity was associated with various social determinants of health (e.g., poverty, food insecurity, and perceived racism), which can increase chronic and acute stress and result in environmental and psychological factors that negatively affect sleep duration and can compound long-term health risks ( 6). Some parents, particularly those affected by socioeconomic and racial disparities, might face additional challenges to ensuring their infants, children, and adolescents get sufficient, quality sleep. For example, parents who work multiple jobs or do shift work might have difficulty implementing a consistent bedtime ( 6). In addition, a family's housing situation could make achieving a quiet, comfortable sleep environment difficult because of noise, lack of sleeping space, or disruptive, unsafe, or violent neighborhoods ( 6).

The prevalence of short sleep duration was higher among persons aged 4 months-17 years whose current health was rated less positively and among those with special health care needs. Multiple conditions, including attention deficit/hyperactivity syndrome or other neurodevelopmental disorders, have been associated with sleep problems as well as sleep behaviors that might be amenable to behavioral intervention ( 7).

The prevalence of short sleep duration was highest in the Southeast, similar to geographic variation in adequate sleep observed for adults ( 8). This pattern might be partially explained by a higher prevalence of risks associated with poverty and racial and ethnic minority status in these states. ¶¶¶ In a previous report of short sleep duration among high school students in 30 states, most of the states with a high prevalence of short sleep duration were in the Midwest and Northeast ( 2). However, that report relied on self-report rather than parent report, did not include younger children, and excluded 20 states.

The findings in this report are subject to at least five limitations. First, sleep duration was obtained by parent report without objective measures, such as actigraphy**** or polysomnography. Second, parent reports of sleep duration might be less reliable than are self-report for older children or adolescents ( 3). Third, responses might be affected by recall bias, interpretation of items, or social desirability. Fourth, the statistical weighting might not completely account for nonresponse bias. Finally, the analyses with race/ethnicity were univariate and did not adjust for other covarying sociodemographic characteristics.

Insufficient sleep is an important risk factor for poor physical and mental health in infants, children, and adolescents ( 1). Parents can help persons aged 4 months-17 years get the sleep they need by supporting good sleep habits. Establishing a regular bedtime is a good foundation and is associated with more sleep ( 9, 10). The AASM's Bedtime Calculator †††† identifies appropriate bedtimes based on age-specific sleep duration recommendations and provides tips on bedtime routines for parents of infants and children and for adolescents and adults. Clinicians and educators can guide parents about the importance of sleep at all ages and discuss sleep routines and sleep problems with parents, children, and adolescents, paying attention to those with special health care needs ( 7). When advising parents on how to improve their infant's, child's, or adolescent's sleep, challenges that they might face because of their social and environmental context should be considered. School districts can support adequate sleep for adolescents by delaying school start times as recommended by several medical associations ( 2).

¹Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; ² Division of Human Development and Disabilities, National Center on Birth Defects and Developmental Disabilities, CDC.

Characteristic

% (95% CI)§

All persons aged
4 mos-17 yrs
(n = 99,842)

Infants aged
4-11 mos
(n = 2,499)

Children aged
1-2 yrs
(n = 10,147)

Children aged
3-5 yrs
(n = 15,290)

Children aged
6-12 yrs
(n = 36,179)

Adolescents aged
13-17 yrs
(n = 35,727)

Characteristic

% (95% CI)†

All persons aged
4 mos-17 yrs

Infants aged
4-11 mos

Children aged
1-2 yrs

Children aged
3-5 yrs

Children aged
6-12 yrs

Adolescents aged
13-17 yrs

Sex

Race/Ethnicity

Other, ¶ non-Hispanic

34.6 (32.9-36.4)

46.8 (36.8-57.2) §

35.6 (29.7-41.9)

32.3 (28.7-36.1)

34.8 (32.1-37.6)

33.4 (30.5-36.5)

Family income level**

Parent education

Less than high school

46.2 (42.4-50.0)

60.3 (34.7-81.2) §

39.7 (27.8-53.0) §

54.0 (43.1-64.5) §

53.7 (47.7-59.5)

34.1 (28.6-40.1)

Special health care needs††

Health status

Regular bedtime§§

State

FIGURE. Prevalence of short sleep duration* among persons aged 4 months-17 years, by state - National Survey of Children's Health, United States, 2016-2018

Abbreviation: DC = District of Columbia.

* Short sleep duration is defined as <12 hours for infants aged 4-11 months, <11 hours for children aged 1-2 years, <10 hours for children aged 3-5 years, <9 hours for children aged 6-12 years, and <8 hours for adolescents aged 13-17 years.

Suggested citation for this article: Wheaton AG, Claussen AH. Short Sleep Duration Among Infants, Children, and Adolescents Aged 4 Months-17 Years - United States, 2016-2018. MMWR Morb Mortal Wkly Rep 2021;70:1315-1321. DOI: http://dx.doi.org/10.15585/mmwr.mm7038a1external icon .

MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
References to non-CDC sites on the Internet are provided as a service toMMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed inMMWR were current as of the date of publication. All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) and/or the originalMMWR paper copy for printable versions of official text, figures, and tables. Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.

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sleep duration of children with regular bedtimes

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sleep duration of children with irregular bedtimes

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What is already known about this topic? Infants, children, and adolescents who do not get sufficient sleep are at increased risk for adverse health outcomes. Most adolescents report sleeping less than the recommended amount. Little is known about sleep duration in infants and children. What is added by this report?

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Centers for Disease Control and Prevention

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

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

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

Facts about mental health in U.S. children

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

Facts about mental disorders in U.S. children

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

ADHD 9.8% (approximately 6.0 million)

Anxiety 9.4% (approximately 5.8 million)

Behavior problems 8.9% (approximately 5.5 million)

Depression 4.4% (approximately 2.7 million)

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

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

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

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

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

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

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

Prevalence of mental disorders change with age

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

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

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

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

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

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

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

Access to mental health treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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

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

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

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Data and Statistics on Children's Mental Health | CDC

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Read data highlights about children's mental health.

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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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The Texas Model for Comprehensive School Counseling Programs

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The Texas Model for Comprehensive School Counseling Programs

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EDUCATION CODE



TITLE 2. PUBLIC EDUCATION



SUBTITLE F. CURRICULUM, PROGRAMS, AND SERVICES



CHAPTER 33. SERVICE PROGRAMS AND EXTRACURRICULAR ACTIVITIES



SUBCHAPTER A. SCHOOL COUNSELORS AND COUNSELING PROGRAMS



Sec. 33.002. CERTIFIED SCHOOL COUNSELOR. (a) From funds appropriated for the purpose or other funds that may be used for the purpose, the commissioner shall distribute funds for programs under this subchapter. In distributing those funds, the commissioner shall give preference to a school district that received funds under this subsection for the preceding school year and then to the districts that have the highest concentration of students at risk of dropping out of school, as described by Section 29.081. To receive funds for the program, a school district must apply to the commissioner. For each school year that a school district receives funds under this subsection, the district shall allocate an amount of local funds for school guidance and counseling programs that is equal to or greater than the amount of local funds that the school district allocated for that purpose during the preceding school year. This section applies only to a school district that receives funds as provided by this subsection.


(b) A school district with 500 or more students enrolled in elementary school grades shall employ a school counselor certified under the rules of the State Board for Educator Certification for each elementary school in the district. A school district shall employ at least one school counselor for every 500 elementary school students in the district.


(c) A school district with fewer than 500 students enrolled in elementary school grades shall provide guidance and counseling services to elementary school students by:


(1) employing a part-time school counselor certified under the rules of the State Board for Educator Certification;


(2) employing a part-time teacher certified as a school counselor under the rules of the State Board for Educator Certification; or


(3) entering into a shared services arrangement agreement with one or more school districts to share a school counselor certified under the rules of the State Board for Educator Certification.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 6.005(a), eff. Sept. 1, 2003.


Amended by:


Acts 2009, 81st Leg., R.S., Ch. 1328 (H.B. 3646), Sec. 39, eff. September 1, 2009.


Acts 2013, 83rd Leg., R.S., Ch. 443 (S.B. 715), Sec. 27, eff. June 14, 2013.


Acts 2013, 83rd Leg., R.S., Ch. 443 (S.B. 715), Sec. 28, eff. June 14, 2013.


Sec. 33.003. PARENTAL CONSENT. The board of trustees of each school district shall adopt guidelines to ensure that written consent is obtained from the parent, legal guardian, or person entitled to enroll the student under Section 25.001(j) for the student to participate in those activities for which the district requires parental consent.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.004. PARENTAL INVOLVEMENT. (a) Each school shall obtain, and keep as part of the student's permanent record, written consent of the parent or legal guardian as required under Section 33.003. The consent form shall include specific information on the content of the program and the types of activities in which the student will be involved.


(b) Each school, before implementing a comprehensive school counseling program under Section 33.005, shall annually conduct a preview of the program for parents and guardians. All materials, including curriculum to be used during the year that is not available digitally through an instructional materials parent portal under Section 31.154, must be available for a parent or guardian to preview during school hours. Materials or curriculum not included in the materials on an instructional materials parent portal or available on the campus for preview may not be used.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Amended by:


Acts 2019, 86th Leg., R.S., Ch. 352 (H.B. 18), Sec. 1.10, eff. December 1, 2019.


Acts 2023, 88th Leg., R.S., Ch. 818 (H.B. 1605), Sec. 47, eff. June 13, 2023.


Sec. 33.005. COMPREHENSIVE SCHOOL COUNSELING PROGRAMS. (a) A school counselor shall work with the school faculty and staff, students, parents, and the community to plan, implement, and evaluate a comprehensive school counseling program that conforms to the most recent edition of the Texas Model for Comprehensive School Counseling Programs developed by the Texas Counseling Association.


(b) The school counselor shall design the program to include:


(1) a guidance curriculum to help students develop their full educational potential, including the student's interests and career objectives;


(2) a responsive services component to intervene on behalf of any student whose immediate personal concerns or problems put the student's continued educational, career, personal, or social development at risk;


(3) an individual planning system to guide a student as the student plans, monitors, and manages the student's own educational, career, personal, and social development; and


(4) system support to support the efforts of teachers, staff, parents, and other members of the community in promoting the educational, career, personal, and social development of students.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 2001, 77th Leg., ch. 1487, Sec. 2, eff. June 17, 2001.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 443 (S.B. 715), Sec. 29, eff. June 14, 2013.


Acts 2019, 86th Leg., R.S., Ch. 352 (H.B. 18), Sec. 1.11, eff. December 1, 2019.


Sec. 33.006. SCHOOL COUNSELORS; GENERAL DUTIES. (a) The primary responsibility of a school counselor is to counsel students to fully develop each student's academic, career, personal, and social abilities.


(b) In addition to a school counselor's responsibility under Subsection (a), the school counselor shall:


(1) participate in planning, implementing, and evaluating a comprehensive developmental guidance program to serve all students and to address the special needs of students:


(A) who are at risk of dropping out of school, becoming substance abusers, participating in gang activity, or committing suicide;


(B) who are in need of modified instructional strategies; or


(C) who are gifted and talented, with emphasis on identifying and serving gifted and talented students who are educationally disadvantaged;


(2) consult with a student's parent or guardian and make referrals as appropriate in consultation with the student's parent or guardian;


(3) consult with school staff, parents, and other community members to help them increase the effectiveness of student education and promote student success;


(4) coordinate people and resources in the school, home, and community;


(5) with the assistance of school staff, interpret standardized test results and other assessment data that help a student make educational and career plans;


(6) deliver classroom guidance activities or serve as a consultant to teachers conducting lessons based on the school's guidance curriculum; and


(7) serve as an impartial, nonreporting resource for interpersonal conflicts and discord involving two or more students, including accusations of bullying under Section 37.0832.


(c) Nothing in Subsection (b)(7) exempts a school counselor from any mandatory reporting requirements imposed by other provisions of law.


(d) Except as provided by Subsection (e), the board of trustees of each school district shall adopt a policy that requires a school counselor to spend at least 80 percent of the school counselor's total work time on duties that are components of a counseling program developed under Section 33.005. For purposes of this subsection, time spent in administering assessment instruments or providing other assistance in connection with assessment instruments, except time spent in interpreting data from assessment instruments, is not considered time spent on counseling. Each school in the district shall implement the policy. A copy of the policy shall be maintained in the office of each school in the district and made available on request during regular school hours to district employees, parents of district students, and the public.


(e) If the board of trustees of a school district determines that, because of staffing needs in the district or at a school in the district, a school counselor must spend less than 80 percent of the school counselor's total work time on duties that are components of a counseling program developed under Section 33.005, the policy adopted under Subsection (d) shall:


(1) include the reasons why the counselor needs to spend less than 80 percent of the counselor's work time on duties that are components of the counseling program;


(2) list the duties the counselor is expected to perform that are not components of the counseling program; and


(3) set the percentage of work time that the counselor is required to spend on components of the counseling program.


(f) A school district may not include a provision in an employment contract with a school counselor under Chapter 21 that conflicts with the policy required by Subsection (d) or, except as provided by Subsection (g), has the effect of authorizing a school principal or school district superintendent to require a school counselor to generally perform duties that are not primarily related to a counseling function.


(g) A school district to which Subsection (e) applies may not include a provision in an employment contract under Chapter 21 with an affected school counselor that has the effect of requiring the counselor to generally perform a duty that is not primarily related to a counseling function unless the duty is specified in the district's policy under Subsection (e)(2).


(h) Each school district shall annually assess the district's compliance with the policy adopted under Subsection (d) and, on request by the commissioner, provide a written copy of the assessment to the agency on or before the date specified by the commissioner. The commissioner shall adopt rules to implement this subsection.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 2001, 77th Leg., ch. 1487, Sec. 3, eff. June 17, 2001.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 443 (S.B. 715), Sec. 30, eff. June 14, 2013.


Acts 2013, 83rd Leg., R.S., Ch. 443 (S.B. 715), Sec. 31, eff. June 14, 2013.


Acts 2017, 85th Leg., R.S., Ch. 522 (S.B. 179), Sec. 10, eff. September 1, 2017.


Acts 2021, 87th Leg., R.S., Ch. 938 (S.B. 179), Sec. 1, eff. September 1, 2021.


Sec. 33.007. COUNSELING REGARDING POSTSECONDARY EDUCATION. (a) Each school counselor at an elementary, middle, or junior high school, including an open-enrollment charter school offering those grades, shall advise students and their parents or guardians regarding the importance of postsecondary education, coursework designed to prepare students for postsecondary education, and financial aid availability and requirements.


(b) During the first school year a student is enrolled in a high school or at the high school level in an open-enrollment charter school, and again during each year of a student's enrollment in high school or at the high school level, a school counselor shall provide information about postsecondary education to the student and the student's parent or guardian. The information must include information regarding:


(1) the importance of postsecondary education;


(2) the advantages of earning an endorsement and a performance acknowledgment and completing the distinguished level of achievement under the foundation high school program under Section 28.025;


(3) the disadvantages of taking courses to prepare for a high school equivalency examination relative to the benefits of taking courses leading to a high school diploma;


(4) financial aid eligibility;


(5) instruction on how to apply for federal financial aid;


(6) the center for financial aid information established under Section 61.0776;


(7) the automatic admission of certain students to general academic teaching institutions as provided by Section 51.803;


(8) the eligibility and academic performance requirements for the TEXAS Grant as provided by Subchapter M, Chapter 56;


(9) the availability of programs in the district under which a student may earn college credit, including advanced placement programs, dual credit programs, joint high school and college credit programs, and international baccalaureate programs;


(10) the availability of education and training vouchers and tuition and fee waivers to attend an institution of higher education as provided by Section 54.366 for a student who is or was previously in the conservatorship of the Department of Family and Protective Services; and


(11) the availability of college credit awarded by institutions of higher education to veterans and military servicemembers for military experience, education, and training obtained during military service as described by the informational materials developed under Section 302.0031(h), Labor Code.


(b-1) When providing information under Subsection (b)(10), the school counselor must report to the student and the student's parent or guardian the number of times the counselor has provided the information to the student.


(b-2) Information provided under Subsection (b)(11) must explain to any student who is enlisted or intends to enlist in the armed forces of the United States the informational materials developed under Section 302.0031(h), Labor Code.


(c) At the beginning of grades 10 and 11, a school counselor certified under the rules of the State Board for Educator Certification shall explain the requirements of automatic admission to a general academic teaching institution under Section 51.803 to each student enrolled in a high school or at the high school level in an open-enrollment charter school who has a grade point average in the top 25 percent of the student's high school class.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 973 (S.B. 282), Sec. 2, eff. June 15, 2007.


Acts 2009, 81st Leg., R.S., Ch. 1342 (S.B. 175), Sec. 4, eff. June 19, 2009.


Acts 2013, 83rd Leg., R.S., Ch. 211 (H.B. 5), Sec. 29(a), effective beginning with the 2014-2015 school year.


Acts 2013, 83rd Leg., R.S., Ch. 211 (H.B. 5), Sec. 30(a), eff. June 10, 2013.


Acts 2017, 85th Leg., R.S., Ch. 481 (H.B. 2537), Sec. 1, eff. June 9, 2017.


Acts 2017, 85th Leg., R.S., Ch. 550 (S.B. 490), Sec. 1, eff. June 9, 2017.


Acts 2019, 86th Leg., R.S., Ch. 37 (H.B. 114), Sec. 1, eff. May 16, 2019.


Sec. 33.009. POSTSECONDARY EDUCATION AND CAREER COUNSELING ACADEMIES. (a) In this section, "coordinating board" means the Texas Higher Education Coordinating Board.


(b) The coordinating board shall develop and make available postsecondary education and career counseling academies for school counselors and other postsecondary advisors employed by a school district at a middle school, junior high school, or high school.


(c) In developing academies under this section, the coordinating board shall solicit input from the agency, school counselors, the Texas Workforce Commission, institutions of higher education, and business, community, and school leaders.


(d) An academy developed under this section must provide counselors and other postsecondary advisors with knowledge and skills to provide counseling to students regarding postsecondary success and productive career planning and must include information relating to:


(1) each endorsement described by Section 28.025(c-1), including:


(A) the course requirements for each endorsement; and


(B) the postsecondary educational and career opportunities associated with each endorsement;


(2) available methods for a student to earn credit for a course not offered at the school in which the student is enrolled, including enrollment in an electronic course provided through the state virtual school network under Chapter 30A;


(3) general academic performance requirements for admission to an institution of higher education, including the requirements for automatic admission to a general academic teaching institution under Section 51.803;


(4) regional workforce needs, including information about the required education and the average wage or salary for careers that meet those workforce needs; and


(5) effective strategies for engaging students and parents in planning for postsecondary education and potential careers, including participation in mentorships and business partnerships.


(d-1) An academy developed under this section may include information regarding social-emotional learning and indicators of behavioral issues.


(e) The coordinating board shall develop an online instructional program that school districts may use in providing the instruction in high school, college, and career preparation required by Section 28.016. The program must be structured for use as part of an existing course.


(f) Repealed by Acts 2021, 87th Leg., R.S., Ch. 1001 (H.B. 2827), Sec. 2, eff. June 18, 2021.


(g) A teacher of a course described by Section 28.016(c)(2) or (3) may attend an academy developed under this section.


(h) From funds appropriated for that purpose, a school counselor who attends the academy under this section is entitled to receive a stipend in the amount determined by the coordinating board. If funds are available after all eligible school counselors have received a stipend under this subsection, the coordinating board shall pay a stipend in the amount determined by the coordinating board to a teacher who attends the academy under this section. A stipend received under this subsection is not considered in determining whether a district is paying the school counselor or teacher the minimum monthly salary under Section 21.402.


(i) From available funds appropriated for purposes of this section, the coordinating board may provide to school counselors and other educators curricula, instructional materials, and technological tools relating to postsecondary education and career counseling.


(j) Repealed by Acts 2021, 87th Leg., R.S., Ch. 1001 (H.B. 2827), Sec. 2, eff. June 18, 2021.


Added by Acts 2015, 84th Leg., R.S., Ch. 988 (H.B. 18), Sec. 5, eff. June 19, 2015.


Amended by:


Acts 2019, 86th Leg., R.S., Ch. 961 (S.B. 504), Sec. 1, eff. June 14, 2019.


Acts 2021, 87th Leg., R.S., Ch. 1001 (H.B. 2827), Sec. 1, eff. June 18, 2021.


Acts 2021, 87th Leg., R.S., Ch. 1001 (H.B. 2827), Sec. 2, eff. June 18, 2021.


SUBCHAPTER B. LIBRARIES



Sec. 33.021. LIBRARY STANDARDS. (a) In this section, "sexually explicit material" means any communication, language, or material, including a written description, illustration, photographic image, video image, or audio file, other than library material directly related to the curriculum required under Section 28.002(a), that describes, depicts, or portrays sexual conduct, as defined by Section 43.25, Penal Code, in a way that is patently offensive, as defined by Section 43.21, Penal Code.


(b) The Texas State Library and Archives Commission, in consultation with the State Board of Education, shall adopt voluntary standards for school library services, other than collection development, that a school district shall consider in developing, implementing, or expanding library services.


(c) The Texas State Library and Archives Commission, with approval by majority vote of the State Board of Education, shall adopt standards for school library collection development that a school district shall adhere to in developing or implementing the district's library collection development policies.


(d) The standards adopted under Subsection (c) must:


(1) be reviewed and updated at least once every five years; and


(2) include a collection development policy that:


(A) prohibits the possession, acquisition, and purchase of:


(i) harmful material, as defined by Section 43.24, Penal Code;


(ii) library material rated sexually explicit material by the selling library material vendor; or


(iii) library material that is pervasively vulgar or educationally unsuitable as referenced in Pico v. Board of Education, 457 U.S. 853 (1982);


(B) recognizes that obscene content is not protected by the First Amendment to the United States Constitution;


(C) is required for all library materials available for use or display, including material contained in school libraries, classroom libraries, and online catalogs;


(D) recognizes that parents are the primary decision makers regarding a student's access to library material;


(E) encourages schools to provide library catalog transparency;


(F) recommends schools communicate effectively with parents regarding collection development; and


(G) prohibits the removal of material based solely on the:


(i) ideas contained in the material; or


(ii) personal background of:


(a) the author of the material; or


(b) characters in the material.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Amended by:


Acts 2023, 88th Leg., R.S., Ch. 808 (H.B. 900), Sec. 2, eff. September 1, 2023.


Sec. 33.022. CONTRACT WITH COUNTY OR MUNICIPALITY. (a) A school district may enter into contracts with a county or municipality in which the district is located to provide joint library facilities.


(b) The board of trustees of the school district and the commissioners court of the county or governing body of the municipality must conduct public hearings before entering into a contract under this section. The hearings may be held jointly.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


SUBCHAPTER C. MISSING CHILD PREVENTION AND IDENTIFICATION PROGRAMS



Sec. 33.051. DEFINITIONS. In this subchapter:


(1) "Child" and "minor" have the meanings assigned by Section 101.003, Family Code.


(2) "Missing child" means a child whose whereabouts are unknown to the legal custodian of the child and:


(A) the circumstances of whose absence indicate that the child did not voluntarily leave the care and control of the custodian and that the taking of the child was not authorized by law; or


(B) the child has engaged in conduct indicating a need for supervision under Section 51.03(b)(2), Family Code.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 935 (H.B. 2398), Sec. 16, eff. September 1, 2015.


Sec. 33.052. MISSING CHILD PREVENTION AND IDENTIFICATION PROGRAMS. (a) The board of trustees of a school district or of a private school may participate in missing child prevention and identification programs, including fingerprinting and photographing as provided by this subchapter.


(b) The board of trustees of a school district may delegate responsibility for implementation of the program to the district's school administration or to the district's community education services administration.


(c) The chief administrative officer of each private primary or secondary school may participate in the programs and may contract with the regional education service center in which the school is located for operation of all or any part of the program through a shared services arrangement.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.053. FINGERPRINTS OF CHILDREN. (a) A missing child prevention and identification program may include a procedure for taking the fingerprints of each student registered in the school whose parent or legal custodian has consented in writing to the fingerprinting. Fingerprints obtained under this section may be used only for the identification and location of a missing child.


(b) The board of trustees of a school district or the chief administrative officer of a private school may establish a reasonable fee to cover the costs of fingerprinting not provided by volunteer assistance. The fee may not exceed $3 for each child fingerprinted. If the school charges a fee, the school may waive all or a portion of the costs of fingerprinting for educationally disadvantaged children.


(c) A representative of a law enforcement agency of the county or the municipality in which the school district is located or of the Department of Public Safety, or a person trained in fingerprinting technique by a law enforcement agency or the Department of Public Safety, shall make one complete set of fingerprints on a fingerprint card for each child participating in the program. If the school requests, the Department of Public Safety may provide fingerprint training to persons designated by the school.


(d) A fingerprint card shall include a description of the child, including the name, address, date and place of birth, color of eyes and hair, weight, and sex of the child.


(e) Except as provided by Section 33.054(b), the fingerprint card and other materials developed under this subchapter shall be made part of the school's permanent student records.


(f) A state agency, law enforcement agency, or other person may not retain a copy of a child's fingerprints taken under this program.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.0531. CHILD IDENTIFICATION PROGRAM. (a) The agency shall provide to all school districts and open-enrollment charter schools inkless, in-home fingerprint and DNA identification kits to be distributed through the district or school on request to the parent or legal custodian of any kindergarten, elementary, or middle school student.


(b) A parent or legal custodian who receives a fingerprint and DNA identification kit may submit the kit to federal, state, tribal, or local law enforcement to help locate and return a missing or trafficked child.


Added by Acts 2021, 87th Leg., R.S., Ch. 891 (S.B. 2158), Sec. 1, eff. September 1, 2021.


Sec. 33.054. PHOTOGRAPHS OF CHILDREN. (a) A participating school shall retain a current photograph of each child registered in the school whose parent or legal custodian has consented in writing. Photographs retained under this section may be used only for the identification and location of a missing child.


(b) The photograph shall be retained by the participating school until the photograph is replaced by a subsequently made photograph under this section or until the expiration of three years, whichever is earlier.


(c) On the request of a parent or legal custodian of a missing child, or of a peace officer who is engaged in the investigation of a missing child, a participating school may give to the parent, legal custodian, or peace officer a copy of that child's photograph held by the school under this section. Except as provided by this subsection, a photograph held under this section may not be given to any person.


(d) A participating school may charge a fee for making and keeping records of photographs under this section. If the school charges a fee, the school may waive this fee for educationally disadvantaged children.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.055. FINGERPRINTS AND PHOTOGRAPHS NOT USED AS EVIDENCE. (a) A child's fingerprint card made under Section 33.053 or a photograph of a child made or kept under Section 33.054 may not be used as evidence in any criminal proceeding in which the child is a defendant or in any case under Title 3, Family Code, in which the child is alleged to have engaged in delinquent conduct or in conduct indicating a need for supervision.


(b) This subchapter does not apply to the use by a law enforcement agency for an official purpose of a photograph published in a school annual.


(c) This subchapter does not prevent the use of a videotape or photograph taken to monitor the activity of students for disciplinary reasons or in connection with a criminal prosecution or an action under Title 3, Family Code.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.056. LIABILITY FOR NONPERFORMANCE. A person is not liable in any suit for damages for negligent performance or nonperformance of any requirement of this subchapter.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.057. DESTRUCTION OF FINGERPRINTS AND PHOTOGRAPHS. The agency shall adopt rules relating to the destruction of fingerprints and photographs made or kept under Section 33.053 or 33.054.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Amended by:


Acts 2021, 87th Leg., R.S., Ch. 891 (S.B. 2158), Sec. 2, eff. September 1, 2021.


SUBCHAPTER D. EXTRACURRICULAR ACTIVITIES



Sec. 33.081. EXTRACURRICULAR ACTIVITIES. (a) The State Board of Education by rule shall limit participation in and practice for extracurricular activities during the school day and the school week. The rules must, to the extent possible, preserve the school day for academic activities without interruption for extracurricular activities. In scheduling those activities and practices, a school district must comply with the rules of the board.


(b) A student enrolled in a school district in this state or who participates in an extracurricular activity or a University Interscholastic League competition is subject to school district policy and University Interscholastic League rules regarding participation only when the student is under the direct supervision of an employee of the school or district in which the student is enrolled or at any other time specified by resolution of the board of trustees of the district.


(c) A student who is enrolled in a school district in this state or who participates in a University Interscholastic League competition shall be suspended from participation in any extracurricular activity sponsored or sanctioned by the school district or the University Interscholastic League after a grade evaluation period in which the student received a grade lower than the equivalent of 70 on a scale of 100 in any academic class other than a course described by Subsection (d-1). A suspension continues for at least three school weeks and is not removed during the school year until the conditions of Subsection (d) are met. A suspension does not last beyond the end of a school year. For purposes of this subsection, "grade evaluation period" means:


(1) the six-week grade reporting period; or


(2) the first six weeks of a semester and each grade reporting period thereafter, in the case of a district with a grade reporting period longer than six weeks.


(d) Until the suspension is removed under this subsection or the school year ends, a school district shall review the grades of a student suspended under Subsection (c) at the end of each three-week period following the date on which the suspension began. At the time of a review, the suspension is removed if the student's grade in each class, other than a course described by Subsection (d-1), is equal to or greater than the equivalent of 70 on a scale of 100. The principal and each of the student's teachers shall make the determination concerning the student's grades.


(d-1) Subsections (c) and (d) do not apply to an advanced placement or international baccalaureate course, or to an honors or dual credit course in the subject areas of English language arts, mathematics, science, social studies, economics, or a language other than English. The agency shall review on a biennial basis courses described by this subsection to determine if other courses should be excluded from the requirement that a student be suspended from participation in an extracurricular activity under Subsection (c). Not later than January 1 of each odd-numbered year, the agency shall report the findings under this subsection to the legislature.


(e) Suspension of a student with a disability that significantly interferes with the student's ability to meet regular academic standards must be based on the student's failure to meet the requirements of the student's individualized education program. The determination of whether a disability significantly interferes with a student's ability to meet regular academic standards must be made by the student's admission, review, and dismissal committee. For purposes of this subsection, "student with a disability" means a student who is eligible for a district's special education program under Section 29.003(b).


(e-1) A student who is enrolled in a school district in this state or who participates in a University Interscholastic League competition shall be prohibited from participation in any future extracurricular activity sponsored or sanctioned by the school district or the University Interscholastic League if the state executive committee of the league determines that the student intentionally, knowingly, or recklessly causes bodily injury to a person serving as referee, judge, or other official of an extracurricular activity in retaliation for or as a result of the person's actions taken in performing the duties of a referee, judge, or other official of the extracurricular activity.


(e-2) A student prohibited from participation in an extracurricular activity under Subsection (e-1) may submit to the University Interscholastic League a request that the student be permitted to participate in future extracurricular activities sponsored or sanctioned by the University Interscholastic League if:


(1) the request is submitted at least:


(A) one year after the date the student engaged in the conduct that resulted in the prohibition under Subsection (e-1) if the student was enrolled in eighth grade or below at the time of the conduct; or


(B) two years after the date the student engaged in the conduct that resulted in the prohibition under Subsection (e-1) if the student was enrolled in ninth grade or above at the time of the conduct;


(2) the student:


(A) completed a course in anger management since engaging in the conduct that resulted in the prohibition under Subsection (e-1);


(B) completed any other course, activity, or action required by the school district in which the student is enrolled as a result of the conduct that resulted in the prohibition under Subsection (e-1); and


(C) demonstrates, to the satisfaction of the school district and the University Interscholastic League, that the student has been rehabilitated and is unlikely to again engage in the conduct described by Subsection (e-1); and


(3) a previous request submitted by the student under this section has not been denied during the school year in which the request is submitted.


(e-3) When determining whether to grant a request under Subsection (e-2), the University Interscholastic League:


(1) shall take into account the severity of the conduct that resulted in the prohibition under Subsection (e-1); and


(2) may set conditions for the student's future participation in extracurricular activities.


(e-4) The University Interscholastic League may prohibit a student from participating in any future extracurricular activity sponsored or sanctioned by the University Interscholastic League if the student violates a condition set by the University Interscholastic League under Subsection (e-3)(2).


(f) Except for a student prohibited from participation under Subsection (e-1), a student suspended under this section may practice or rehearse with other students for an extracurricular activity but may not participate in a competition or other public performance.


(f-1) A school district shall prohibit a spectator of an extracurricular athletic activity or competition, including a parent or guardian of a student participant, from attending any future extracurricular athletic activity or competition sponsored or sanctioned by the school district or the University Interscholastic League if the spectator engages in conduct that intentionally, knowingly, or recklessly causes bodily injury to a person serving as referee, judge, or other official of an extracurricular athletic activity or competition in retaliation for or as a result of the person's actions taken in performing the duties of a referee, judge, or other official of the extracurricular athletic activity or competition.


(f-2) A school district may establish an appeals process by which:


(1) a person may appeal to the district a prohibition imposed under Subsection (f-1); and


(2) the district may determine the facts associated with the conduct for which the school district imposed a prohibition under Subsection (f-1).


(f-3) A prohibition imposed under Subsection (f-1) must be for not less than one year after the date on which the prohibition is imposed but may not exceed five years from the date on which the prohibition is imposed.


(g) An appeal to the commissioner is not a contested case under Chapter 2001, Government Code, if the issues presented relate to a person's eligibility to participate in or attend an extracurricular activity, including issues related to a student's grades, the school district's grading policy as applied to a student's eligibility, a student's eligibility based on conduct described by Subsection (e-1), or a spectator's eligibility to attend an extracurricular athletic activity or competition under Subsection (f-1). The commissioner may delegate the matter for decision to a person the commissioner designates. The decision of the commissioner or the commissioner's designee in a matter governed by this subsection may not be appealed except on the grounds that the decision is arbitrary or capricious. Evidence may not be introduced on appeal other than the record of the evidence before the commissioner.


(h) A request made under Subsection (e-2) is not a contested case subject to Chapter 2001, Government Code.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 1999, 76th Leg., ch. 1482, Sec. 2, eff. June 19, 1999.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1327 (S.B. 1517), Sec. 1, eff. June 15, 2007.


Acts 2021, 87th Leg., R.S., Ch. 824 (H.B. 2721), Sec. 1, eff. June 16, 2021.


Acts 2023, 88th Leg., R.S., Ch. 833 (H.B. 2484), Sec. 1, eff. June 13, 2023.


Sec. 33.0811. SCHOOL DISTRICT POLICY ON ABSENCES TO PARTICIPATE IN EXTRACURRICULAR ACTIVITIES. (a) Notwithstanding Section 33.081(a), the board of trustees of a school district may adopt a policy establishing the number of times a student who is otherwise eligible to participate in an extracurricular activity under Section 33.081 may be absent from class to participate in an extracurricular activity sponsored or sanctioned by the district or the University Interscholastic League or by an organization sanctioned by resolution of the board of trustees of the district.


(b) A policy adopted by the board of trustees of a district under this section:


(1) prevails over a conflicting policy adopted under Section 33.081(a); and


(2) must permit a student to be absent from class at least 10 times during the school year.


Added by Acts 1999, 76th Leg., ch. 1482, Sec. 3, eff. June 19, 1999.


Sec. 33.0812. SCHEDULING EXTRACURRICULAR ACTIVITIES PROHIBITED IN CERTAIN CIRCUMSTANCES. (a) The State Board of Education by rule shall prohibit participation in a University Interscholastic League area, regional, or state competition:


(1) on Monday through Thursday of the school week in which the primary administration of assessment instruments under Section 39.023(a), (c), or (l) occurs; or


(2) if the primary administration of the assessment instruments is completed before Thursday of the school week, beginning on Monday and ending on the last school day on which the assessment instruments are administered.


(b) The commissioner shall determine the school week during the school year in which the primary administration of assessment instruments occurs for purposes of Subsection (a).


(c) The commissioner shall adopt rules to provide the University Interscholastic League with a periodic calendar of dates reserved for testing for planning purposes under this section. The periodic calendar must be provided at least every three years on or before May 1 of the year preceding the three-year cycle of reserved testing dates.


(d) In adopting rules under this section, the commissioner shall:


(1) include a procedure for changing, in exceptional circumstances, testing dates reserved under the periodic calendar;


(2) define circumstances that constitute exceptional circumstances under Subdivision (1) as unforeseen events, including a natural disaster, severe weather, fire, explosion, or similar circumstances beyond the control of school districts or the agency; and


(3) establish criteria for determining whether a University Interscholastic League area, regional, or state competition must be canceled if that event conflicts with a changed testing date.


(e) This section does not apply to testing dates on which assessment instruments are administered only to students retaking assessment instruments.


Added by Acts 2005, 79th Leg., Ch. 812 (S.B. 658), Sec. 1, eff. June 17, 2005.


Sec. 33.082. EXTRACURRICULAR ACTIVITIES; USE OF DISCRIMINATORY ATHLETIC CLUB. (a) An extracurricular activity sponsored or sanctioned by a school district, including an athletic event or an athletic team practice, may not take place at an athletic club located in the United States that denies any person full and equal enjoyment of equipment or facilities provided by the athletic club because of the race, color, religion, creed, national origin, or sex of the person.


(b) In this section, "athletic club" means an entity that provides sports or exercise equipment or facilities to its customers or members or to the guests of its customers or members.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.083. INTERSCHOLASTIC LEAGUES. (a) The rules and procedures of an organization sanctioning or conducting interscholastic competition, including rules providing penalties for rules violations by school district personnel, must be consistent with State Board of Education rules.


(b) The University Interscholastic League is a part of The University of Texas at Austin and must submit its rules and procedures to the commissioner for approval or disapproval. The funds belonging to the University Interscholastic League shall be deposited with The University of Texas at Austin for the benefit of the league and shall be subject to audits by The University of Texas at Austin, The University of Texas System, and the state auditor. Copies of annual audits shall be furnished, on request, to members of the legislature.


(c) The State Board of Education may seek an injunction to enforce this section.


(d) The University Interscholastic League shall file annually with the governor and the presiding officer of each house of the legislature a complete and detailed written report accounting for all funds received and disbursed by the University Interscholastic League during the preceding fiscal year. The form of the annual report and the reporting time are as provided by the General Appropriations Act.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 1999, 76th Leg., ch. 1482, Sec. 4, eff. June 19, 1999.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 1279 (H.B. 1675), Sec. 1.04, eff. June 14, 2013.


Sec. 33.0831. UNIVERSITY INTERSCHOLASTIC LEAGUE RULES: FISCAL IMPACT STATEMENT. (a) The legislative council of the University Interscholastic League may not take final action on a new or amended rule that would result in additional costs for a member school unless a fiscal impact statement regarding the rule has been completed in accordance with this section.


(b) For purposes of Subsection (a), final action by the legislative council means:


(1) submitting a rule to school superintendents, if the submission is required under the legislative council's procedures; or


(2) submitting a rule approved by the council to the commissioner for the commissioner's approval under Section 33.083(b), if the rule does not require submission to school superintendents under the legislative council's procedures.


(c) A fiscal impact statement regarding a rule must include:


(1) a projection of the costs to member schools of complying with the rule during the five-year period following the effective date of the rule; and


(2) an explanation of the methodology used to analyze the fiscal impact of the rule and determine the costs projection required by Subdivision (1).


(d) If a fiscal impact statement is prepared for a rule, a copy of the statement must be attached to the rule when it is submitted for approval to school superintendents, if applicable, and when it is submitted to the commissioner for approval.


Added by Acts 2011, 82nd Leg., R.S., Ch. 966 (H.B. 1286), Sec. 1, eff. September 1, 2011.


Sec. 33.0832. EQUAL OPPORTUNITY FOR CERTAIN STUDENTS TO PARTICIPATE IN UNIVERSITY INTERSCHOLASTIC LEAGUE ACTIVITIES. (a) In this section:


(1) "League" means the University Interscholastic League.


(2) "Non-enrolled student" means a student who receives instruction as described by Section 29.916(a)(1) from a nonpublic school.


(b) Nothing in this section may be construed to affect the holding in Texas Educ. Agency v. Leeper, 893 S.W.2d 432 (Tex. 1994), classifying home schools as private schools. The legislature finds that a home school is a private school for purposes of this section.


(c) Except as provided by Subsection (i), a public school that participates in an activity sponsored by the league may provide a non-enrolled student, who otherwise meets league eligibility standards to represent that school in a league activity, with the opportunity to participate in the activity on behalf of the school in the same manner that the school provides the opportunity to participate to students enrolled in the school.


(c-1) When assigning league classification to a public school based on student enrollment, the league must use the same student enrollment calculation formula for a school that allows a non-enrolled student to participate in a league activity as provided by Subsection (c) as the formula used to determine the student enrollment of a school that does not allow a non-enrolled student to participate in the league activity.


(d) A non-enrolled student who seeks to participate or participates in a league activity on behalf of a school is subject to the following relevant policies that apply to students enrolled in the school:


(1) registration for league activities;


(2) age eligibility;


(3) fees;


(4) insurance;


(5) transportation;


(6) physical condition;


(7) qualifications;


(8) responsibilities;


(9) event schedules;


(10) standards of behavior; and


(11) performance.


(e) A non-enrolled student may only participate in a league activity for the school in the school district that the student would be eligible to attend based on the student's residential address. A non-enrolled student who seeks to participate in a league activity on behalf of a school shall be required to establish minimum proof of residency acceptable to the district in the same manner as an applicant to attend a school in the district under Section 25.001.


(f) The parent or person standing in parental relation to a non-enrolled student is responsible for oversight of academic standards relating to the student's participation in a league activity. As a condition of eligibility to participate in a league activity during the first six weeks of a school year, a non-enrolled student must demonstrate grade-level academic proficiency on any nationally recognized, norm-referenced assessment instrument, such as the Iowa Test of Basic Skills, Stanford Achievement Test, California Achievement Test, or Comprehensive Test of Basic Skills. A non-enrolled student demonstrates the required academic proficiency by achieving a composite, core, or survey score that is within the average or higher than average range of scores, as established by the applicable testing service. For purposes of this subsection, a school district shall accept assessment results administered or reported by a third party.


(g) A non-enrolled student's demonstration of academic proficiency under Subsection (f) is sufficient for purposes of that subsection for the school year in which the student achieves the required score and the subsequent school year.


(h) After the first six weeks of a school year, the parent or person standing in parental relation to a non-enrolled student participating in a league activity on behalf of a public school must periodically, in accordance with the school's grading calendar, provide written verification to the school indicating that the student is receiving a passing grade in each course or subject being taught.


(i) A non-enrolled student is not authorized by this section to participate in a league activity during the remainder of any school year during which the student was previously enrolled in a public school.


(j) The league may not prohibit a non-enrolled student from participating in league activities in the manner authorized by this section.


(k) With respect to a non-enrolled student's education program, nothing in this section shall be construed to permit an agency of this state, a public school district, or any other governmental body to exercise control, regulatory authority, or supervision over a non-enrolled student or a parent or person standing in parental relation to a non-enrolled student beyond the control, regulatory authority, or supervision required to participate in a league activity.


(l) Subject only to eligibility requirements under this section for a non-enrolled student to participate in a league activity:


(1) the curriculum or assessment requirements, performance standards, practices, or creed of the education program provided to a non-enrolled student may not be required to be changed in order for the non-enrolled student to participate in a league activity; and


(2) for a non-enrolled student participating in an education program on January 1, 2021, the education program provided to that student may not be required to comply with any state law or agency rule relating to that education program unless the law or rule was in effect on January 1, 2021.


(m) Notwithstanding any other law, a non-enrolled student who participates in a league activity under this section is subject to the immunization requirements and exceptions of Section 38.001 in the same manner as a public school student.


Added by Acts 2021, 87th Leg., R.S., Ch. 996 (H.B. 547), Sec. 1, eff. September 1, 2021.


Amended by:


Acts 2023, 88th Leg., R.S., Ch. 483 (H.B. 699), Sec. 1, eff. June 10, 2023.


Sec. 33.0833. PARTICIPATION IN UNIVERSITY INTERSCHOLASTIC LEAGUE ACTIVITIES BY STUDENTS RECEIVING OUTPATIENT MENTAL HEALTH SERVICES. (a) This section applies to a student who:


(1) receives outpatient mental health services from a mental health facility, as defined by Section 571.003, Health and Safety Code; and


(2) is enrolled in a school district or open-enrollment charter school or otherwise receives public education services from a district or school.


(b) The University Interscholastic League shall ensure that league rules do not exclude from eligibility for participation in a league activity a student to whom this section applies based solely on the criteria described in Subsection (a)(1).


(c) A school district or open-enrollment charter school may not adopt or enforce policies that restrict participation in University Interscholastic League activities by a student to whom this section applies based solely on:


(1) the criteria described in Subsection (a)(1); or


(2) the student's absence during instructional time while receiving outpatient mental health services as described by Subsection (a)(1).


(d) This section does not exempt a student to whom this section applies from any eligibility requirement for participation in University Interscholastic League activities other than an eligibility requirement based solely on the criteria described in Subsection (a)(1).


Added by Acts 2021, 87th Leg., R.S., Ch. 235 (H.B. 1080), Sec. 1, eff. June 4, 2021.


Redesignated from Education Code, Section 33.0832 by Acts 2023, 88th Leg., R.S., Ch. 768 (H.B. 4595), Sec. 24.001(11), eff. September 1, 2023.


Sec. 33.0834. INTERSCHOLASTIC ATHLETIC COMPETITION BASED ON BIOLOGICAL SEX. (a) Except as provided by Subsection (b), an interscholastic athletic team sponsored or authorized by a school district or open-enrollment charter school may not allow a student to compete in an interscholastic athletic competition sponsored or authorized by the district or school that is designated for the biological sex opposite to the student's biological sex as correctly stated on:


(1) the student's official birth certificate, as described by Subsection (c); or


(2) if the student's official birth certificate described by Subdivision (1) is unobtainable, another government record.


(b) An interscholastic athletic team described by Subsection (a) may allow a female student to compete in an interscholastic athletic competition that is designated for male students if a corresponding interscholastic athletic competition designated for female students is not offered or available.


(c) For purposes of this section, a statement of a student's biological sex on the student's official birth certificate is considered to have correctly stated the student's biological sex only if the statement was:


(1) entered at or near the time of the student's birth; or


(2) modified to correct any type of scrivener or clerical error in the student's biological sex.


(d) The University Interscholastic League shall adopt rules to implement this section, provided that the rules must be approved by the commissioner in accordance with Section 33.083(b). The rules must ensure compliance with state and federal law regarding the confidentiality of student medical information, including Chapter 181, Health and Safety Code, and the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.).


Added by Acts 2021, 87th Leg., 3rd C.S., Ch. 2 (H.B. 25), Sec. 3, eff. January 18, 2022.


Sec. 33.084. INTERSCHOLASTIC LEAGUE ADVISORY COUNCIL. (a) The interscholastic league advisory council is composed of:


(1) two members of the State Board of Education appointed by the chair of the board;


(2) a member of the house of representatives appointed by the speaker of the house;


(3) a member of the senate appointed by the lieutenant governor;


(4) two members of the legislative council of the University Interscholastic League appointed by the chairman of the council;


(5) two public school board members appointed by the commissioner; and


(6) three members of the public appointed by the commissioner.


(b) A member of the advisory council serves at the will of the member's appointing authority.


(c) In appointing public members to the advisory council, the commissioner shall give special consideration to students, parents of students, and teachers.


(d) The advisory council shall select a chair from among its members and shall meet at the call of the chair.


(e) The advisory council shall review the rules of the University Interscholastic League and shall make recommendations relating to the rules to the governor, the legislature, the legislative council of the University Interscholastic League, and the State Board of Education.


(f) A member of the advisory council may not receive compensation but is entitled to reimbursement from the University Interscholastic League for transportation expenses and the per diem allowance for state employees in accordance with the General Appropriations Act.


(g) The advisory council shall study:


(1) University Interscholastic League policy with respect to the eligibility of students to participate in programs;


(2) geographic distribution of University Interscholastic League resources and programs; and


(3) gender equity.


(h) An action of the University Interscholastic League relating to the provision of additional programs of school districts may not be taken pending submission of a final report by the advisory council.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.085. AUTHORITY OF UNIVERSITY INTERSCHOLASTIC LEAGUE REGARDING ACTIVITIES INVOLVING SPORTS OFFICIALS. (a) In this section:


(1) "League" means the University Interscholastic League.


(2) "Sports official" means a person who officiates, judges, or in any manner enforces contest rules in any official capacity with respect to and during the course of an interscholastic athletic team competition and who is a member of a league-recognized local chapter or association of sports officials. The term includes a referee, umpire, linesman, judge, or any other person similarly involved in supervising competitive play. The term does not include a league board member or a league official who is acting in an official capacity to supervise, administer, or enforce the league constitution or league contest rules.


(b) The league may require a sports official, as a condition of eligibility to officiate a contest sponsored by the league, to:


(1) be registered with the league and comply with the registration requirements of Subsections (c) and (c-1);


(2) have completed initial and continuing education programs regarding league rules;


(3) be a member in good standing of a local chapter or association of sports officials recognized by the league for that purpose; and


(4) agree to abide by league rules, including fee schedules and travel reimbursement guidelines for payment by school districts or open-enrollment charter schools to a sports official.


(c) In registering with the league, a sports official must be required to provide directory information required by the league and undergo an initial criminal background check.


(c-1) To maintain registration with the league, a sports official must:


(1) maintain compliance with conditions of eligibility required by the league under Subsection (b); and


(2) undergo a subsequent criminal background check once every three years following the date of the initial criminal background check under Subsection (c).


(d) The league may not charge a sports official who completes a program under Subsection (b)(2) a fee for more than one program described by Subsection (b)(2).


(e) The league may charge and collect a registration fee only to defray the cost of registering sports officials and shall post the amount of the fee on the league's Internet website and make the information available at other places the league determines appropriate. The amount of the fee may not exceed the amount reasonably determined by the league to be necessary to cover the cost of administering registration.


(f) The league may revoke or suspend the league registration of a sports official determined by the league to have violated the provisions of the league constitution or contest rules governing sports officials or other league policy applicable to sports officials. Before the league may take action to revoke or suspend a sports official's registration, the league shall notify and consult with the local chapter or association of sports officials of which the sports official is a member. The local chapter or association may, on or before the 15th day after the date notice is received from the league, take action to adjudicate the alleged violation. If after the 15th day after the date notice is received from the league the local chapter or association has failed to take action against the sports official or takes action that the league finds to be insufficient, the league may take action against the sports official. The league shall adopt rules to provide a sports official with the opportunity for an appeals process before the league revokes or suspends the sports official's registration. In adopting rules under this subsection, the league shall make a determination of the actions and subsequent sanctions that would be considered sufficient under this subsection.


(g) The league may not sponsor or organize or attempt to sponsor or organize any association of sports officials in which the majority of the membership is composed of sports officials who officiate team sports.


(h) The league may set rates or fee schedules payable by a school district or open-enrollment charter school to a sports official.


(i) Before the league may take any action that amends rules related to the activities of sports officials, other than an action against an individual sports official under Subsection (f), the league must submit the proposed action for public review and comment, including:


(1) notifying registered sports officials of the proposed action by e-mail not later than the 30th day before the date set for action on the proposal; and


(2) posting the proposal on the league's Internet website for at least 30 consecutive days before the date set for action on the proposal.


Added by Acts 2013, 83rd Leg., R.S., Ch. 952 (H.B. 1775), Sec. 1, eff. June 14, 2013.


Amended by:


Acts 2017, 85th Leg., R.S., Ch. 335 (H.B. 1075), Sec. 1, eff. September 1, 2017.


Sec. 33.086. CERTIFICATION IN CARDIOPULMONARY RESUSCITATION AND FIRST AID. (a) A school district employee who serves as the head director of a school marching band or as the head coach or chief sponsor for an extracurricular athletic activity, including cheerleading, sponsored or sanctioned by a school district or the University Interscholastic League must maintain and submit to the district proof of current certification in first aid and cardiopulmonary resuscitation issued by the American Red Cross, the American Heart Association, or another organization that provides equivalent training and certification.


(b) Each school district shall adopt, in accordance with the policy adopted under Section 21.4515, procedures necessary for administering this section, including procedures for the time and manner in which proof of current certification must be submitted.


Added by Acts 1999, 76th Leg., ch. 396, Sec. 2.14(a), eff. Sept. 1, 1999. Amended by Acts 2003, 78th Leg., ch. 881, Sec. 1, eff. June 20, 2003.


Amended by:


Acts 2021, 87th Leg., R.S., Ch. 1045 (S.B. 1267), Sec. 14, eff. June 18, 2021.


Sec. 33.087. ELIGIBILITY OF STUDENTS PARTICIPATING IN JOINT CREDIT OR CONCURRENT ENROLLMENT PROGRAMS. A student otherwise eligible to participate in an extracurricular activity or a University Interscholastic League competition is not ineligible because the student is enrolled in a course offered for joint high school and college credit, or in a course offered under a concurrent enrollment program, regardless of the location at which the course is provided.


Added by Acts 2007, 80th Leg., R.S., Ch. 199 (H.B. 208), Sec. 1, eff. May 24, 2007.


Sec. 33.091. PREVENTION OF ILLEGAL STEROID USE; RANDOM TESTING. (a) In this section:


(1) "League" means the University Interscholastic League.


(2) "Parent" includes a guardian or other person standing in parental relation.


(3) "Steroid" means an anabolic steroid as described by Section 481.104, Health and Safety Code.


(b) The league shall adopt rules prohibiting a student from participating in an athletic competition sponsored or sanctioned by the league unless:


(1) the student agrees not to use steroids and, if the student is enrolled in high school, the student submits to random testing for the presence of illegal steroids in the student's body, in accordance with the program established under Subsection (d); and


(2) the league obtains from the student's parent a statement signed by the parent and acknowledging that:


(A) the parent's child, if enrolled in high school, may be subject to random steroid testing;


(B) state law prohibits possessing, dispensing, delivering, or administering a steroid in a manner not allowed by state law;


(C) state law provides that bodybuilding, muscle enhancement, or the increase of muscle bulk or strength through the use of a steroid by a person who is in good health is not a valid medical purpose;


(D) only a licensed practitioner with prescriptive authority may prescribe a steroid for a person; and


(E) a violation of state law concerning steroids is a criminal offense punishable by confinement in jail or imprisonment in the Texas Department of Criminal Justice.


(c) The league shall:


(1) develop an educational program for students engaged in extracurricular athletic activities sponsored or sanctioned by the league, parents of those students, and coaches of those activities regarding the health effects of steroid use; and


(2) make the program available to school districts.


(c-1) A school district shall require that each district employee who serves as an athletic coach at or above the seventh grade level for an extracurricular athletic activity sponsored or sanctioned by the league complete:


(1) the educational program developed by the league under Subsection (c); or


(2) a comparable program developed by the district or a private entity with relevant expertise.


(d) The league shall adopt rules for the annual administration of a steroid testing program under which high school students participating in an athletic competition sponsored or sanctioned by the league are tested at multiple times throughout the year for the presence of steroids in the students' bodies. The testing program must:


(1) require the random testing of a statistically significant number of high school students in this state who participate in athletic competitions sponsored or sanctioned by the league;


(2) provide for the selection of specific students described by Subdivision (1) for testing through a process that randomly selects students from a single pool consisting of all students who participate in any activity for which the league sponsors or sanctions athletic competitions;


(3) be administered at approximately 30 percent of the high schools in this state that participate in athletic competitions sponsored or sanctioned by the league;


(4) provide for a process for confirming any initial positive test result through a subsequent test conducted as soon as practicable after the initial test, using a sample that was obtained at the same time as the sample used for the initial test;


(5) require the testing to be performed only by an anabolic steroid testing laboratory with a current certification from the Substance Abuse and Mental Health Services Administration of the United States Department of Health and Human Services, the World Anti-Doping Agency, or another appropriate national or international certifying organization; and


(6) provide for a period of ineligibility from participation in an athletic competition sponsored or sanctioned by the league for any student with a confirmed positive test result or any student who refuses to submit to random testing.


(e) Results of a steroid test conducted under Subsection (d) are confidential and, unless required by court order, may be disclosed only to the student and the student's parent and the activity directors, principal, and assistant principals of the school attended by the student.


(f) From funds already appropriated, the agency shall pay the costs of the steroid testing program established under Subsection (d).


(g) The league may increase the membership fees required of school districts that participate in athletic competitions sponsored or sanctioned by the league in an amount necessary to offset the cost of league activities under this section.


(h) Subsection (b)(1) does not apply to the use by a student of a steroid that is dispensed, prescribed, delivered, and administered by a medical practitioner for a valid medical purpose and in the course of professional practice, and a student is not subject to a period of ineligibility under Subsection (d)(6) on the basis of that steroid use.


Added by Acts 2005, 79th Leg., Ch. 1177 (H.B. 3563), Sec. 1, eff. June 18, 2005.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1292 (S.B. 8), Sec. 1, eff. June 15, 2007.


Acts 2007, 80th Leg., R.S., Ch. 1292 (S.B. 8), Sec. 2, eff. June 15, 2007.


Sec. 33.092. STUDENT ELECTION CLERKS AND EARLY VOTING CLERKS. A student who is appointed as a student election clerk under Section 32.0511, Election Code, or as a student early voting clerk under Section 83.012, Election Code, may apply the time served as a student election clerk or student early voting clerk toward:


(1) a requirement for a school project at the discretion of the teacher who assigned the project; or


(2) a service requirement for participation in an advanced academic course program at the discretion of the program sponsor or a school-sponsored extracurricular activity at the discretion of the school sponsor.


Added by Acts 2009, 81st Leg., R.S., Ch. 517 (S.B. 1134), Sec. 4, eff. September 1, 2009.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 542 (S.B. 553), Sec. 2, eff. June 14, 2013.


Sec. 33.093. RECOGNITION OF PARTICIPATION IN SPECIAL OLYMPICS. If a school district allows high school students to earn a letter for academic, athletic, or extracurricular achievements, the district must allow high school students in the district to earn a letter on the basis of a student's participation in a Special Olympics event.


Added by Acts 2017, 85th Leg., R.S., Ch. 261 (H.B. 1645), Sec. 1, eff. May 29, 2017.


Sec. 33.094. FOOTBALL HELMET SAFETY REQUIREMENTS. (a) A school district may not use a football helmet that is 16 years old or older in the district's football program.


(b) A school district shall ensure that each football helmet used in the district's football program that is 10 years old or older is reconditioned at least once every two years.


(c) A school district shall maintain and make available to parents of students enrolled in the district documentation indicating the age of each football helmet used in the district's football program and the dates on which each helmet is reconditioned.


(d) The University Interscholastic League may adopt rules necessary to implement this section, provided that the rules must be approved by the commissioner in accordance with Section 33.083(b).


Added by Acts 2011, 82nd Leg., R.S., Ch. 239 (H.B. 675), Sec. 1, eff. September 1, 2011.


Sec. 33.096. CARDIAC ASSESSMENTS OF HIGH SCHOOL PARTICIPANTS IN EXTRACURRICULAR ATHLETIC ACTIVITIES. (a) A school district must provide a district student, who is required under University Interscholastic League rule or policy to receive a physical examination before being allowed to participate in an athletic activity sponsored or sanctioned by the University Interscholastic League, the following:


(1) information about sudden cardiac arrest and electrocardiogram testing; and


(2) notification of the option of the student to request the administration of an electrocardiogram, in addition to the physical examination.



Text of subsection effective until April 01, 2025



(b) A student may request an electrocardiogram from any health care professional, including a health care professional provided through the student's patient-centered medical home, as defined by Section 533.0029, Government Code, a health care professional provided through a school district program, or another health care professional chosen by the parent or person standing in parental relation to the student, provided that the health care professional is:


(1) appropriately licensed in this state; and


(2) authorized to administer and interpret electrocardiograms under the health care professional's scope of practice, as established by the health care professional's Texas licensing act.



Text of subsection effective on April 01, 2025



(b) A student may request an electrocardiogram from any health care professional, including a health care professional provided through the student's patient-centered medical home, as defined by Section 540.0712, Government Code, a health care professional provided through a school district program, or another health care professional chosen by the parent or person standing in parental relation to the student, provided that the health care professional is:


(1) appropriately licensed in this state; and


(2) authorized to administer and interpret electrocardiograms under the health care professional's scope of practice, as established by the health care professional's Texas licensing act.


(c) The University Interscholastic League shall adopt rules as necessary to administer this section.


(d) The rules adopted under Subsection (c) must include:


(1) criteria under which a school district may request an exemption from the requirements of Subsection (a);


(2) variances that allow for a delay of the implementation of the requirement to notify students of the option to request an electrocardiogram under this section;


(3) procedures to ensure students receiving the required annual physical examination are notified of the option to request an electrocardiogram; and


(4) provisions to ensure that the requirements under this section are minimum standards that provide a school district with the option to implement a program that exceeds the standards required by this section.


(e) This section does not create a cause of action or liability or a standard of care, obligation, or duty that provides a basis for a cause of action or liability against a health care professional described by Subsection (b), the University Interscholastic League, a school district, or a district officer or employee for:


(1) the injury or death of a student participating in or practicing for an athletic activity sponsored or sanctioned by the University Interscholastic League based on or in connection with the administration or interpretation of or reliance on an electrocardiogram; or


(2) the content or distribution of the information required under Subsection (a) or the failure to distribute the required information under this section.


Added by Acts 2019, 86th Leg., R.S., Ch. 1023 (H.B. 76), Sec. 1, eff. September 1, 2019.


Amended by:


Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.03, eff. April 1, 2025.


Sec. 33.097. INCLUSIVE SPORTS PROGRAM FOR STUDENTS WITH INTELLECTUAL DISABILITIES. (a) The University Interscholastic League shall ensure students with intellectual disabilities have an opportunity to participate in team athletic activities by establishing and maintaining an inclusive sports program.


(b) The University Interscholastic League shall adopt rules as necessary to establish, maintain, and expand the inclusive sports program. The rules must:


(1) accommodate inclusive team sports offered through the program at participating public middle schools, junior high schools, and high schools in the state;


(2) establish eligibility requirements for participation in each inclusive team sport offered through the program;


(3) identify best practices for school districts to incorporate inclusive sports; and


(4) require the program to incorporate activities that promote:


(A) bullying prevention;


(B) moral intelligence;


(C) character development;


(D) leadership development;


(E) physical fitness; and


(F) positive school culture.


(c) In adopting the rules under Subsection (b), the University Interscholastic League shall consider and incorporate as appropriate:


(1) federal guidance regarding providing access to extracurricular athletics for students with intellectual disabilities;


(2) guidance available from nationally recognized organizations that promote inclusion and acceptance among students with and without intellectual disabilities;


(3) information regarding inclusive sports programs that have been successfully implemented in this state, in other states, and by nonprofit organizations;


(4) input from school districts and the agency; and


(5) guidance provided by impacted stakeholders, including by parents of or persons standing in parental relation to students with intellectual disabilities.


(d) The University Interscholastic League may appoint a person to provide guidance on behalf of impacted stakeholders for purposes of Subsection (c)(5).


(e) In maintaining the inclusive sports program, the University Interscholastic League shall, to the greatest extent possible, require:


(1) students who participate in the inclusive sports program to be subject to the same rules and requirements as students who participate in other athletic programs offered by the league, including:


(A) grade and disciplinary requirements under Section 33.081(c); and


(B) requirements related to student safety in athletic activities under this chapter and Chapter 38; and


(2) team sports provided through the inclusive sports program to be organized similarly to other athletic programs offered by the league, including with respect to team practices, seasonal play, and local and statewide competitions.


(f) In addition to using funds available or appropriated for the purpose, the University Interscholastic League or a partner affiliated with the league may seek and accept gifts, grants, or donations of money from public and private sources for the purpose of establishing or expanding the inclusive sports program.


Added by Acts 2021, 87th Leg., R.S., Ch. 522 (S.B. 776), Sec. 2, eff. September 1, 2021.


Sec. 33.099. SAFETY OF OFFICIAL. A school district or open-enrollment charter school that holds an extracurricular athletic activity or a University Interscholastic League athletic competition on district or school property shall provide a peace officer, a school resource officer, an administrator, or security personnel to ensure the safety of a referee, judge, or other official of the activity or competition until the official departs district or school property if:


(1) a participant or spectator of the activity or competition engages in, attempts to engage in, or threatens violent conduct against the official or otherwise disrupts the duties or free movement of the official; or


(2) the district or school reasonably suspects that an incident described by Subdivision (1) may occur at the activity or competition.


Added by Acts 2023, 88th Leg., R.S., Ch. 833 (H.B. 2484), Sec. 2, eff. June 13, 2023.


SUBCHAPTER E. COMMUNITIES IN SCHOOLS PROGRAM



Sec. 33.151. DEFINITIONS. In this subchapter:


(1) Repealed by Acts 2007, 80th Leg., R.S., Ch. 1204, Sec. 4, eff. September 1, 2007.


(2) "Communities In Schools program" means an exemplary youth dropout prevention program.


(3) "Delinquent conduct" has the meaning assigned by Section 51.03, Family Code.


(4) "Student at risk of dropping out of school" means:


(A) a student at risk of dropping out of school as defined by Section 29.081;


(B) a student who is eligible for a free or reduced lunch; or


(C) a student who is in family conflict or crisis.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.001 by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Amended by Acts 1997, 75th Leg., ch. 165, Sec. 6.69, eff. Sept. 1, 1997. Redesignated from Labor Code, Sec. 305.001 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code, Sec. 264.751 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1204 (H.B. 1609), Sec. 4, eff. September 1, 2007.


Sec. 33.152. STATEWIDE OPERATION OF PROGRAM. It is the intent of the legislature that the Communities In Schools program operate throughout this state. It is also the intent of the legislature that programs established under Chapter 305, Labor Code, as that chapter existed on August 31, 1999, and its predecessor statute, the Texas Unemployment Compensation Act (Article 5221b-9d, Vernon's Texas Civil Statutes), and programs established under this subchapter shall remain eligible to participate in the Communities In Schools program if funds are available and if their performance meets the criteria established by the agency for renewal of their contracts.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.002 by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.002 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.752 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Sec. 33.154. DUTIES OF COMMISSIONER. (a) The commissioner shall:


(1) coordinate the efforts of the Communities In Schools program with other social service organizations and agencies and with public school personnel to provide services to students who are at risk of dropping out of school or engaging in delinquent conduct, including students who are in family conflict or emotional crisis;


(2) set standards for the Communities In Schools program and establish state performance goals, objectives, and measures for the program, including performance goals, objectives, and measures that consider improvement in student:


(A) behavior;


(B) academic achievement; and


(C) promotion, graduation, retention, and dropout rates;


(3) obtain information to determine accomplishment of state performance goals, objectives, and measures;


(4) promote and market the program in communities in which the program is not established;


(5) help communities that want to participate in the program establish a local funding base;


(6) provide training and technical assistance for participating communities and programs; and


(7) adopt policies concerning:


(A) the responsibility of the agency in encouraging local businesses to participate in local Communities In Schools programs;


(B) the responsibility of the agency in obtaining information from participating school districts;


(C) the use of federal or state funds available to the agency for programs of this nature; and


(D) any other areas concerning the program identified by the commissioner.


(b) The commissioner shall adopt rules to implement the policies described by Subsection (a)(7) and shall annually update the rules.


(c) Notwithstanding any provision of this subchapter, if the commissioner determines that a program consistently fails to achieve the performance goals, objectives, and measures established by the commissioner under Subsection (a)(2), the commissioner may withhold funding from that program and require the program to compete through a competitive bidding process to receive funding to participate in the program.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.012 by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.012 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.754 by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1204 (H.B. 1609), Sec. 1, eff. September 1, 2007.


Sec. 33.155. COOPERATION WITH COMMUNITIES IN SCHOOLS, INC. The agency and Communities In Schools, Inc. shall work together to maximize the effectiveness of the Communities In Schools program.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.013 by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.013 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.755 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1204 (H.B. 1609), Sec. 1, eff. September 1, 2007.


Sec. 33.156. FUNDING; EXPANSION OF PARTICIPATION. (a) The agency shall develop and implement an equitable formula for the funding of local Communities In Schools programs. The formula may provide for the reduction of funds annually contributed by the state to a local program by an amount not more than 50 percent of the amount contributed by the state for the first year of the program. The formula must consider the financial resources of individual communities and school districts. Savings accomplished through the implementation of the formula may be used to extend services to counties and municipalities currently not served by a local program or to extend services to counties and municipalities currently served by an existing local program.


(b) Each local Communities In Schools program shall develop a funding plan which ensures that the level of services is maintained if state funding is reduced.


(c) A local Communities In Schools program may accept federal funds, state funds, private contributions, grants, and public and school district funds to support a campus participating in the program.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 9.40(a), eff. Sept. 1, 1995. Renumbered from Labor Code Sec. 216.021 and amended by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.021 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.756 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Sec. 33.157. PARTICIPATION IN PROGRAM. An elementary or secondary school receiving funding under Section 33.156 shall participate in a local Communities In Schools program if the number of students enrolled in the school who are at risk of dropping out of school is equal to at least 10 percent of the number of students in average daily attendance at the school, as determined by the agency.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.022 and amended by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.022 and amended Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.757 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Sec. 33.158. DONATIONS TO PROGRAM. (a) The agency may accept a donation of services or money or other property that the agency determines furthers the lawful objectives of the agency in connection with the Communities In Schools program.


(b) Each donation, with the name of the donor and the purpose of the donation, must be reported in the public records of the agency.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.031 by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.031 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.758 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Sec. 33.159. AGENCY PERFORMANCE OF COMMUNITIES IN SCHOOLS FUNCTIONS REQUIRED. The agency, through the Communities In Schools State Office:


(1) must perform each function concerning the Communities In Schools program for which the agency is responsible; and


(2) may not contract with a private entity to perform a function described by Subdivision (1).


Added by Acts 2007, 80th Leg., R.S., Ch. 1204 (H.B. 1609), Sec. 2, eff. September 1, 2007.


SUBCHAPTER F. SAFETY REGULATIONS FOR CERTAIN



EXTRACURRICULAR ACTIVITIES



Sec. 33.201. APPLICABILITY. This subchapter applies to each public school in this state and to any other school in this state subject to University Interscholastic League rules.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.202. SAFETY TRAINING REQUIRED. (a) The University Interscholastic League shall develop and adopt an extracurricular activity safety training program as provided by this section. In developing the program, the league may use materials available from the American Red Cross, Emergency Medical Systems (EMS), or another appropriate entity.


(b) The following persons must satisfactorily complete the safety training program in accordance with the policy adopted under Section 21.4515:


(1) a coach, trainer, or sponsor for an extracurricular athletic activity; and


(2) a director responsible for a school marching band.


(c) The safety training program must include:


(1) certification of participants by the American Red Cross, the American Heart Association, or a similar organization or by the University Interscholastic League;


(2) current training in:


(A) emergency action planning;


(B) communicating effectively with 9-1-1 emergency service operators and other emergency personnel; and


(C) recognizing symptoms of potentially catastrophic injuries, including head and neck injuries, concussions, injuries related to second impact syndrome, asthma attacks, heatstroke, cardiac arrest, and injuries requiring use of a defibrillator; and


(3) a safety drill that incorporates the training described by Subdivision (2) and simulates various injuries described by Subdivision (2)(C).


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Amended by:


Acts 2019, 86th Leg., R.S., Ch. 439 (S.B. 1376), Sec. 2.01, eff. June 4, 2019.


Acts 2021, 87th Leg., R.S., Ch. 1045 (S.B. 1267), Sec. 15, eff. June 18, 2021.


Acts 2021, 87th Leg., R.S., Ch. 1045 (S.B. 1267), Sec. 24(9), eff. June 18, 2021.


Sec. 33.203. COMPLETION OF UNIVERSITY INTERSCHOLASTIC LEAGUE FORMS. (a) Each student participating in an extracurricular athletic activity must complete the University Interscholastic League forms entitled "Preparticipation Physical Evaluation--Medical History" and "Acknowledgment of Rules." Each form must be signed by both the student and the student's parent or guardian.


(b) Each form specified by Subsection (a) must clearly state that failure to accurately and truthfully answer all questions on a form required by statute or by the University Interscholastic League as a condition for participation in an extracurricular athletic activity subjects a signer of the form to penalties determined by the University Interscholastic League.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.204. CERTAIN UNSAFE ATHLETIC ACTIVITIES PROHIBITED. A coach, trainer, or sponsor for an extracurricular athletic activity may not encourage or permit a student participating in the activity to engage in any unreasonably dangerous athletic technique that unnecessarily endangers the health of a student, including using a helmet or any other sports equipment as a weapon.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.205. CERTAIN SAFETY PRECAUTIONS REQUIRED. (a) A coach, trainer, or sponsor for an extracurricular athletic activity shall at each athletic practice or competition ensure that:


(1) each student participating in the activity is adequately hydrated;


(2) any prescribed asthma medication for a student participating in the activity is readily available to the student;


(3) emergency lanes providing access to the practice or competition area are open and clear; and


(4) heatstroke prevention materials are readily available.


(b) If a student participating in an extracurricular athletic activity, including a practice or competition, becomes unconscious during the activity, the student may not:


(1) return to the practice or competition during which the student became unconscious; or


(2) participate in any extracurricular athletic activity until the student receives written authorization for such participation from a physician.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.206. COMPLIANCE; ENFORCEMENT. (a) In accordance with Chapter 552, Government Code, a school shall make available to the public proof of compliance for each person enrolled in, employed by, or volunteering for the school who is required to receive safety training described by Section 33.202.


(b) The superintendent of a school district or the director of a school subject to this subchapter shall maintain complete and accurate records of the district's or school's compliance with Section 33.202.


(c) A school campus that is determined by the school's superintendent or director to be out of compliance with Section 33.202, 33.204, or 33.205 with regard to University Interscholastic League activities shall be subject to the range of penalties determined by the University Interscholastic League.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.207. CONTACT INFORMATION. (a) The commissioner shall maintain an existing telephone number and an electronic mail address to allow a person to report a violation of this subchapter.


(b) Each school that offers an extracurricular athletic activity shall prominently display at the administrative offices of the school the telephone number and electronic mail address maintained under Subsection (a).


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.208. NOTICE REQUIRED. (a) A school that offers an extracurricular athletic activity shall provide to each student participating in an extracurricular athletic activity and to the student's parent or guardian a copy of the text of Sections 33.201-33.207 and a copy of the University Interscholastic League's parent information manual.


(b) A document required to be provided under this section may be provided in an electronic format unless otherwise requested by a student, parent, or guardian.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.209. INCORPORATION OF SAFETY REGULATIONS. The University Interscholastic League shall incorporate the provisions of Sections 33.203-33.207 into the league's constitution and contest rules.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.210. IMMUNITY FROM LIABILITY. This subchapter does not waive any liability or immunity of a school district or its officers or employees. This subchapter does not create any liability for or a cause of action against a school district or its officers or employees.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.211. LIMITATION ON LIABILITY. A person who volunteers to assist with an extracurricular activity is not liable for civil damages arising out of an act or omission relating to the requirements under Section 33.205 unless the act or omission is willfully or wantonly negligent.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


SUBCHAPTER G. EXPANDED LEARNING OPPORTUNITIES COUNCIL



Sec. 33.251. DEFINITION. In this chapter, "council" means the Expanded Learning Opportunities Council.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.252. EXPANDED LEARNING OPPORTUNITIES. (a) Expanded learning opportunities may be provided during:


(1) an extended school day;


(2) an extended school year; or


(3) structured learning programs outside of the regular school day, including before- and after-school programs and summer programs.


(b) Expanded learning opportunities may be provided by offering:


(1) rigorous coursework;


(2) mentoring;


(3) tutoring;


(4) physical activity;


(5) academic support; or


(6) educational enrichment in one or more subjects, including fine arts, civic engagement, science, technology, engineering, and mathematics.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.253. ESTABLISHMENT; PURPOSES. (a) The Expanded Learning Opportunities Council is established to:


(1) study issues concerning expanded learning opportunities for this state's public school students, including:


(A) issues related to creating safe places for children outside of the regular school day, improving the academic success of students who participate in expanded learning opportunities programs, and assisting working families; and


(B) other issues prescribed under Section 33.258; and


(2) make recommendations as provided by Section 33.259 to address issues studied under this subchapter.


(b) In conducting studies under this subchapter, the council shall focus on innovative, hands-on learning approaches that complement rather than replicate the regular school curriculum.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.254. SUNSET PROVISION. The council is subject to Chapter 325, Government Code (Texas Sunset Act). Unless continued in existence as provided by that chapter, the council is abolished and this subchapter expires September 1, 2029.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 938 (H.B. 3123), Sec. 2.01, eff. June 18, 2015.


Acts 2019, 86th Leg., R.S., Ch. 596 (S.B. 619), Sec. 4.02, eff. June 10, 2019.


Acts 2023, 88th Leg., R.S., Ch. 941 (S.B. 1659), Sec. 1.02, eff. June 18, 2023.


Sec. 33.255. COMPOSITION. The council is composed of 13 members appointed by the commissioner as follows:


(1) two members of the public, including one representing the business community and one parent of a public school student participating in an expanded learning opportunities program in this state;


(2) two members who are involved in research-based expanded learning opportunities efforts in this state so that at least one is involved in efforts to extend the school day or school year and at least one is involved in efforts to provide out of school time before or after the regular school day or during the period in which school is recessed for the summer;


(3) one member representing law enforcement;


(4) one member representing the agency;


(5) one member who is an educator, other than a superintendent, at the elementary school level;


(6) one member who is an educator, other than a superintendent, at the middle or junior high school level;


(7) one member who is an educator, other than a superintendent, at the high school level;


(8) one member who is a public school superintendent;


(9) one member representing a foundation that invests in expanded learning opportunities;


(10) one member representing a nonprofit organization that provides programs concerning good nutrition and prevention of or intervention to address childhood obesity; and


(11) one member who is a provider representing summer camps.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.256. MEETINGS. (a) The council shall meet in person at least three times each year and may hold additional meetings by conference call if necessary.


(b) Section 551.125, Government Code, applies to a meeting held by conference call under this section, except that Section 551.125(b), Government Code, does not apply.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.257. COMPENSATION. A member of the council may not receive compensation for service on the council.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.258. POWERS AND DUTIES. (a) The council shall:


(1) study issues related to expanded learning opportunities for public school students;


(2) study current research and best practices related to meaningful expanded learning opportunities;


(3) analyze the availability of and unmet needs for state and local programs for expanded learning opportunities for public school students;


(4) analyze opportunities to create incentives for businesses to support expanded learning opportunities programs for public school students;


(5) analyze opportunities to maximize charitable support for public and private partnerships for expanded learning opportunities programs for public school students;


(6) analyze opportunities to promote science, technology, engineering, and mathematics in expanded learning opportunities programs for public school students;


(7) study the future workforce needs of this state's businesses and other employers; and


(8) perform other duties consistent with this subchapter.


(b) In carrying out its powers and duties under this section, the council may request reports and other information relating to expanded learning opportunities and students in expanded learning opportunities programs from the Texas Education Agency and any other state agency.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.259. STATEWIDE EXPANDED LEARNING OPPORTUNITIES PLAN; REPORT. (a) The council shall develop a comprehensive statewide action plan for the improvement of expanded learning opportunities for public school students in this state, including a timeline for implementation of the plan.


(b) The council shall submit to both houses of the legislature, the governor, and the agency on or before November 1 of each even-numbered year a written report concerning:


(1) the status of the development or implementation of the council's statewide action plan, as applicable;


(2) any action taken to further development or implementation of the plan;


(3) any area that needs improvement in implementing the plan;


(4) any recommended change to the plan; and


(5) programs and services that address expanded learning opportunities outside of the regular school day.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.260. GIFTS, GRANTS, AND DONATIONS. The agency may accept on behalf of the council a gift, grant, or donation from any source to carry out the purposes of this subchapter.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


SUBCHAPTER Z. MISCELLANEOUS PROVISIONS



Sec. 33.901. BREAKFAST PROGRAMS. (a) If at least 10 percent of the students enrolled in one or more schools in a school district or enrolled in an open-enrollment charter school are eligible for free or reduced-price breakfasts under the national school breakfast program provided for by the Child Nutrition Act of 1966 (42 U.S.C. Section 1773), the board of trustees of the school district or the governing body of the open-enrollment charter school shall either:


(1) participate in the national program and make the benefits of the national program available to all eligible students in the schools or school; or


(2) develop and implement a locally funded program to provide free meals, including breakfast and lunch, to each student eligible for free meals under federal law and reduced-price meals, including breakfast and lunch, to each student eligible for reduced-price meals under federal law, provided that the reduced price may not exceed the maximum allowable rate under federal law.


(a-1) A school district is permitted under Subsection (a) to participate in the national program at one or more campuses in the district and provide a locally funded program at one or more other campuses in the district.


(b) A school district campus or an open-enrollment charter school participating in the national school breakfast program provided by the Child Nutrition Act of 1966 (42 U.S.C. Section 1773) or providing a locally funded program in which 80 percent or more of the students qualify under the national program for a free or reduced-price breakfast shall offer a free breakfast to each student.


(c) The commissioner shall grant a waiver of the free breakfast requirements under Subsection (b), not to exceed one year, to a school district campus or an open-enrollment charter school if the board of trustees of the school district or the governing body of the open-enrollment charter school votes to request the waiver at the annual meeting of the board of trustees required under Section 44.004 or an annual meeting of the governing body called to adopt a budget for the open-enrollment charter school for the succeeding fiscal year. Before voting to request a waiver under this subsection, the board of trustees or the governing body shall list the waiver as a separate item for consideration on the meeting's agenda and provide an opportunity for public comment regarding the waiver at the meeting.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 130 (S.B. 376), Sec. 1, eff. September 1, 2013.


Acts 2015, 84th Leg., R.S., Ch. 1250 (H.B. 1305), Sec. 1, eff. June 20, 2015.


Sec. 33.902. PUBLIC SCHOOL CHILD CARE. (a) In this section, "school-age students" means children enrolled as students in prekindergarten through grade 7.


(b) Repealed by Acts 2011, 82nd Leg., 1st C.S., Ch. 8, Sec. 21(3), eff. September 28, 2011.


(c) Repealed by Acts 2011, 82nd Leg., 1st C.S., Ch. 8, Sec. 21(3), eff. September 28, 2011.


(d) The Work and Family Policies Clearinghouse may distribute money appropriated by the legislature to any school district for the purpose of implementing school-age child care before and after the school day and during school holidays and vacations for a school district's school-age students. Eligible use of funds shall include planning, development, establishment, expansion, or improvement of child care services and reasonable start-up costs. The clearinghouse may distribute money to pay fees charged for providing services to students who are considered to be at risk of dropping out of school under Section 29.081. The Texas Workforce Commission shall by rule establish procedures and eligibility requirements for distributing this money to school districts.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 1997, 75th Leg., ch. 118, Sec. 1, eff. Sept. 1, 1997.


Amended by:


Acts 2011, 82nd Leg., 1st C.S., Ch. 8 (S.B. 8), Sec. 21(3), eff. September 28, 2011.


Sec. 33.903. COMMUNITY EDUCATION CHILD CARE SERVICES. (a) The agency shall establish a pilot program for the development of community education child care services as provided by this section. From the total amount of funds appropriated to the agency, the commissioner shall withhold an amount specified in the General Appropriations Act and distribute that amount for programs under this section. A program established under this section is required only in a school district in which the program is financed by funds distributed under this section and any other funds available for the program.


(b) The legislature may make appropriations to the agency for the purpose of supporting before- and after-school child care programs in a school district that is operating a community education development project.


(c) The agency shall actively seek federal grants or funds to operate or expand a program established under this section.


(d) The State Board of Education by rule shall establish a procedure for distributing funds to school districts for child care programs under this section. The procedure must include a statewide competitive process by which the agency shall evaluate applications for child care programs submitted by eligible school districts and award funds to those districts whose applications the agency considers to possess the greatest merit. The State Board of Education by rule shall establish guidelines and objectives that the agency shall use in making evaluations for funding determination purposes. A school district is not entitled to administrative or judicial review of the agency's funding determination, except to the extent that the State Board of Education by rule provides for administrative review.


(e) The agency may not consider a school district's application for child care funding unless the application:


(1) contains a resolution by the district's board of trustees or governing body adopting a particular child care plan;


(2) states the anticipated funding requirements for the district's child care program and provides the agency with the data and any analysis used to prepare the funding estimate;


(3) includes or is accompanied by a statement outlining how the proposed project effectuates the goals of this section and complies with the guidelines and objectives established under Subsection (d);


(4) provides that the district will provide before- and after-school care between the hours of 7 a.m. and 6 p.m. for any student in kindergarten through grade eight whose parents or legal guardians work, attend school, or participate in a job-training program during those hours;


(5) specifies that the district's child care program outlined in the application will maintain a ratio of not less than one caregiver per 20 students in kindergarten through grade three and a ratio of not less than one caregiver per 25 students in grades four through eight and will provide age-appropriate educational and recreational activities and homework assistance; and


(6) states that the district has appointed a child care administrator.


(f) A school district's child care administrator shall administer and coordinate the program under the authority of the district superintendent or another administrator the superintendent designates. The child care administrator shall appoint a coordinator to oversee the child care activities at each school site under the authority of the school's principal. Each district is encouraged to collaborate with child care management system contractors and Head Start program providers.


(g) Each school district may provide full-day care for students on school holidays and teacher preparation days and during periods school is in recess, including summer vacation.


(h) A school district may supplement any funds received under this section with funds received through other government assistance programs, program tuition, or private donations. Any tuition charge may reflect only the actual cost of care provided to the student, and the agency or other appropriate governmental agency approved by the commissioner may audit a program to ensure compliance with this subsection. A school district shall use state funds awarded under this section to benefit educationally disadvantaged children before using those funds for the care of other children.


(i) A school district may not use funds awarded under this section for student transportation unless that transportation is incident to an activity related to the curriculum of the child care program.


(j) A school district may use funds awarded under this section to contract with a private entity for providing child care services. Each of those entities shall adhere to the requirements of this section. A contract under this subsection is not effective until approved by the agency. The agency shall review each contract to ensure that the services to be delivered comply with this section. Each contract shall be awarded without regard to the race or gender of the contracting party, notwithstanding any other law.


(k) Each school district receiving funds under this section shall adopt minimum training and skills requirements that each individual providing child care or staff assistance for a district program under this section must satisfy. The agency shall determine whether those minimum requirements fulfill the aims and policies of this section and shall suspend the payment of funds to any district whose minimum requirements fail to fulfill the aims and policies of this section. The State Board of Education by rule shall adopt criteria by which the agency shall evaluate district minimum training and skills requirements. Any suspension order is subject to Chapter 2001, Government Code. A district may seek review of a suspension order under the review process adopted under Subsection (m).


(l) The State Board of Education by rule may authorize a school district to receive technical and planning assistance from a regional education service center.


(m) The agency shall monitor and review programs receiving funds under this section and may suspend funds to a school district whose programs fail to comply with this section. The State Board of Education by rule shall adopt an administrative process to review a suspension. Both a suspension order and the administrative review process are subject to Chapter 2001, Government Code.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.9031. BEFORE-SCHOOL AND AFTER-SCHOOL PROGRAMS. (a) The board of trustees of a school district may establish before-school or after-school programs for students enrolled in elementary or middle school grades. A program established under this section may operate before, after, or before and after school hours.


(b) A student is eligible to participate in a school district's before-school or after-school program if the student:


(1) is enrolled in a public or private school; or


(2) resides within the boundaries of the school district.


(c) A school district shall conduct a request for proposals procurement process to enable the district to determine if contracting with a child-care facility that provides a before-school or after-school program, as defined by Section 42.002, Human Resources Code, to provide the district's before-school or after-school program would serve the district's best interests. Following the request for proposals procurement process, the district may enter into a contract with a child-care facility or implement a before-school or after-school program operated by the district. If the district enters into a contract with a child-care facility, the contract must comply with the requirements of Section 44.031 and may not exceed a term of three years.


(d) The board of trustees of a school district may adopt rules in accordance with Section 11.165 to provide access to school campuses before or after school hours for the purpose of providing a before-school or after-school program.


Added by Acts 2017, 85th Leg., R.S., Ch. 925 (S.B. 1566), Sec. 11, eff. September 1, 2017.


Sec. 33.904. LIAISON FOR CERTAIN CHILDREN IN CONSERVATORSHIP OF STATE. (a) Each school district and open-enrollment charter school shall:


(1) appoint at least one employee to act as a liaison officer to facilitate the enrollment in or transfer to a public school or open-enrollment charter school of a child in the district or area served by the charter school who is in the conservatorship of the state; and


(2) submit the liaison's name and contact information to the agency in a format and under the schedule determined by the commissioner.


(b) The agency shall provide information to the liaisons on practices for facilitating the enrollment in or transfer to a public school or open-enrollment charter school of children who are in the conservatorship of the state.


Added by Acts 2011, 82nd Leg., R.S., Ch. 725 (H.B. 826), Sec. 1, eff. September 1, 2011.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 579 (S.B. 832), Sec. 1, eff. June 14, 2013.


For expiration of this section, see Subsection (f).



Sec. 33.906. WEBSITE INFORMATION CONCERNING LOCAL PROGRAMS AND SERVICES AVAILABLE TO ASSIST HOMELESS STUDENTS. (a) Except as provided by Subsection (e), each school that maintains an Internet website shall post on the website information regarding local programs and services, including charitable programs and services, available to assist students who are homeless.


(b) A school to which Subsection (a) applies shall make a good faith effort to compile information described by that subsection and shall post the information compiled in a format and style that is easily understandable by students or parents, as appropriate based on the grade levels the school offers.


(c) A representative of a local program or service available to assist students who are homeless may request to have information concerning the program or service posted on a school's website. A school may determine the information that is posted on the school's website and is not required to post information as requested by the representative.


(d) A school district is not liable for any harm to a student that results in connection with a local program or service referred to on the website of a district school as provided by this section.


(e) This section does not apply to a school within a school district that:


(1) has an enrollment of fewer than 3,000 students; and


(2) is primarily located in a county with a population of less than 50,000.


(f) This section expires September 1, 2025.


Added by Acts 2015, 84th Leg., R.S., Ch. 1035 (H.B. 1559), Sec. 1, eff. June 19, 2015.


Amended by:


Acts 2019, 86th Leg., R.S., Ch. 597 (S.B. 668), Sec. 1.09, eff. June 10, 2019.


Sec. 33.907. DONATION OF FOOD. (a) In this section:


(1) "Donate" has the meaning assigned by Section 76.001, Civil Practice and Remedies Code.


(2) "Nonprofit organization" has the meaning assigned by Section 76.001, Civil Practice and Remedies Code.


(b) A school district or open-enrollment charter school may allow a campus to elect to donate food to a nonprofit organization through a person who is directly and officially affiliated with the campus, including a teacher or counselor, or through a parent of a student enrolled at the campus. The donated food may be received, stored, and distributed on the campus. Food donated by the campus may include:


(1) surplus food prepared for breakfast, lunch, or dinner meals or snacks served from the campus cafeteria, subject to any applicable local, state, and federal requirements; or


(2) food donated to the campus as the result of a food drive or similar event.


(c) The type of food donated under Subsection (b)(1) may include:


(1) packaged unserved food that is packaged on the campus of a school district or open-enrollment charter school and has not been removed from the campus cafeteria;


(2) packaged served food if the packaging and food are in good condition;


(3) whole, uncut produce; and


(4) wrapped raw unserved produce.


(c-1) Food that by law must be maintained at a certain temperature for safety may not be donated unless the campus has maintained the food at the required temperature.


(d) Food donated under this section to a nonprofit organization may be distributed at the campus at any time. Campus employees may assist in preparing and distributing the food as volunteers for the nonprofit organization.


(e) Under this program, a school district or open-enrollment charter school may adopt a policy under which the district or charter school provides food at no cost to a student for breakfast, lunch, or dinner meals or a snack if the student is unable to purchase breakfast, lunch, or dinner meals or a snack.


(f) The commissioner may adopt rules as necessary to implement this section.


Added by Acts 2017, 85th Leg., R.S., Ch. 569 (S.B. 725), Sec. 1, eff. June 9, 2017.


Amended by:


Acts 2021, 87th Leg., R.S., Ch. 610 (S.B. 1351), Sec. 1, eff. September 1, 2021.


Sec. 33.908. GRACE PERIOD POLICY FOR EXHAUSTED OR INSUFFICIENT MEAL CARD OR ACCOUNT BALANCE. The board of trustees of a school district that allows students to use a prepaid meal card or account to purchase meals served at schools in the district shall adopt a grace period policy regarding the use of the cards or accounts. The policy:


(1) must allow a student whose meal card or account balance is exhausted or insufficient to continue, for a period determined by the board, to purchase meals by:


(A) accumulating a negative balance on the student's card or account; or


(B) otherwise receiving an extension of credit from the district;


(2) must require the district to notify the parent of or person standing in parental relation to the student that the student's meal card or account balance is exhausted;


(3) may not permit the district to charge a fee or interest in connection with meals purchased under Subdivision (1); and


(4) may permit the district to set a schedule for repayment on the account balance as part of the notice to the parent or person standing in parental relation to the student.


Added by Acts 2015, 84th Leg., R.S., Ch. 875 (H.B. 3562), Sec. 1, eff. June 18, 2015.


Amended by:


Acts 2017, 85th Leg., R.S., Ch. 925 (S.B. 1566), Sec. 12, eff. September 1, 2017.


Sec. 33.909. PURPLE STAR CAMPUS. (a) In this section, "military-connected student" has the meaning assigned by Section 25.006.


(b) The agency shall designate a school district campus as a Purple Star Campus if the campus applies and qualifies for the designation under this section.


(c) To qualify as a Purple Star Campus, a campus must:


(1) designate a staff member as a military liaison, whose duties include:


(A) identifying military-connected students enrolled at the campus through the Public Education Information Management System (PEIMS);


(B) serving as the point of contact between the campus and military-connected students and their families;


(C) determining appropriate campus services available to military-connected students; and


(D) assisting in coordinating campus programs relevant to military-connected students;


(2) maintain on the campus Internet website an easily accessible web page that includes resources for military-connected students and their families, including information regarding:


(A) relocation to, enrollment at, registration at, and transferring records to the campus;


(B) academic planning, course sequences, and advanced classes available at the campus;


(C) counseling and other support services available for military-connected students enrolled at the campus; and


(D) the military liaison designated under Subdivision (1) and the liaison's duties under that subdivision;


(3) maintain a transition program led by students, where appropriate, that assists military-connected students in transitioning into the campus;


(4) offer professional development for staff members on issues related to military-connected students; and


(5) offer at least one of the following initiatives:


(A) a resolution showing support for military-connected students and their families;


(B) recognition of the Month of the Military Child or Military Family Month with relevant events hosted by the campus; or


(C) a partnership with a local military installation that provides opportunities for active duty military members to volunteer at the campus, speak at an assembly, or host a field trip.


(d) To comply with a requirement under Subsection (c)(2), (4), or (5), a school district campus may partner with the district to provide:


(1) an Internet website web page required under Subsection (c)(2) if the campus does not have an Internet website;


(2) professional development required under Subsection (c)(4); or


(3) an initiative required under Subsection (c)(5).


(e) The agency shall adopt rules as necessary to administer this section.


Added by Acts 2019, 86th Leg., R.S., Ch. 269 (S.B. 1557), Sec. 2, eff. May 28, 2019.


Sec. 33.913. TUTORING PROGRAM. (a) A member of a nonprofit teacher organization or a person who is not a member but meets the requirements under Subsection (b) may participate in a tutoring program in accordance with this section to provide supplemental instruction to students in kindergarten through grade 12 on an individualized or small-group basis.


(b) To participate in the program as a tutor, a person must:


(1) be an active or retired teacher;


(2) apply for the position in a manner specified by the nonprofit organization;


(3) designate in the application whether the person plans to provide tutoring:


(A) for compensation, on a volunteer basis, or both; and


(B) in person, online, or both; and


(4) not be included in the registry of persons not eligible for employment by a public school under Section 22.092.


(c) The superintendent or chief executive officer of each school district or open-enrollment charter school or the person designated by the superintendent or chief executive officer shall:


(1) oversee the tutoring program within the district or school; and


(2) not later than the last day of each semester, submit a report to the board of trustees of the district or the governing body of the school that includes, with respect to that semester:


(A) the number of active or retired teachers who contacted the district or school to offer tutoring services to students in the district or school; and


(B) the number of active or retired teachers who were used by the district or school as a tutor on a volunteer basis or employed by the district or school to provide tutoring services for compensation.


(d) A school district or open-enrollment charter school may use any available local, state, or federal funds to provide compensation to a person participating in the program as a tutor who is providing tutoring for compensation under the program.


(e) If an active or retired teacher who has been approved for participation in the tutoring program contacts a school district or open-enrollment charter school to provide tutoring to students in the district or school and the district or school needs tutoring assistance, the district or school may:


(1) if the teacher is providing tutoring services on a volunteer basis, use the volunteer tutoring services provided by the teacher; or


(2) if the district or school has local, state, or federal funds for purposes of the tutoring program and the teacher is providing tutoring services for compensation, employ the teacher as a tutor.


(f) At least quarterly, each nonprofit organization participating in the tutoring program shall provide to the organization's members:


(1) a description of the tutoring program and guidance on how to participate in the program; and


(2) the contact information of each person described by Subsection (c) for the school district in which the member resides, any open-enrollment charter schools located within that district, and any adjacent districts.


(g) This section does not create a cause of action or liability or an obligation or duty that provides a basis for a cause of action or liability against a nonprofit teacher organization approved by the commissioner for the purpose of participating in the tutoring program for any action taken by a member of the organization participating in the program as a tutor.


Added by Acts 2021, 87th Leg., R.S., Ch. 806 (H.B. 1525), Sec. 15, eff. September 1, 2021.


Added by Acts 2021, 87th Leg., R.S., Ch. 880 (S.B. 1356), Sec. 2, eff. June 16, 2021.

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EDUCATION CODE CHAPTER 33. SERVICE PROGRAMS AND EXTRACURRICULAR ACTIVITIES

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EDUCATION CODE TITLE 2. PUBLIC EDUCATION SUBTITLE F. CURRICULUM, PROGRAMS, AND SERVICES CHAPTER 33. SERVICE PROGRAMS AND EXTRACURRICULAR ACTIVITIES SUBCHAPTER A. SCHOOL COUNSELORS AND COUNSELING PROGRAMS Sec. 33.002. CERTIFIED SCHOOL COUNSELOR. (a) From funds appropriated for the purpose or other funds that may be used for the purpose, the commissioner shall distribute funds for programs under this subchapter.

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Newsletter 12/9/19 - HB 18 & the District Counseling Program - Texas School Procedures

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Is your District prepared to meet the requirements in HB 18 regarding the District Counseling Program? HB 18 was passed in the 86th legislative session and encompasses many topics dealing with mental health. This newsletter addresses the requirements of HB [...]

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ASCA Ethical Standards for School Counselors

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ASCA Ethical Standards for School Counselors

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ASCA Ethical Standards for School Counselors - American School Counselor Association (ASCA)

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School Mental Health Roles and Responsibilities

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School Mental Health Roles and Responsibilities

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School Mental Health Roles and Responsibilities(1)

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From Dr. Tamar Chansky Creator of Worrywisekids.org

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School counselors design and deliver school counseling programs that improve student outcomes. "The ASCA National Model: A Framework for School Counseling Programs" outlines the components of a school counseling program that is integral to the school's academic mission and is created to have a significant positive impact on student achievement, attendance and discipline.

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ASCA School Counselor Professional Standards & Competencies

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ASCA School Counselor Professional Standards & Competencies

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Inside Higher Ed | Higher Education News, Events and Jobs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Abstract

Objective

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

Method

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

Results

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

Conclusions

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

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

INTRODUCTION

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

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

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

Method

Sample and Procedure

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

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

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

Table 1

Measures

Diagnostic assessment

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

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

Statistical Analysis

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

Results

Lifetime Prevalence

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

Table 2

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

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

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

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

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

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

Socio-demographic Correlates

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

Table 3

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

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

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

Discussion

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

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

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

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

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

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

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

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

Acknowledgments

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

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

Footnotes

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

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

Contributor Information

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

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

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

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

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

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

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

Dr. Katholiki Georgiades, McMaster University.

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

References

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

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

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

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

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

Inappropriate types of behavior or feelings under normal circumstances.

A general pervasive mood of unhappiness or depression.

A tendency to develop physical symptoms or fears associated with personal or school problems.

Emotional disability includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance.
General Characteristics of Emotional Disturbance vs. Social Maladjustment
A student who receives special education services under the category of Emotional Disability has emotional problems of some kind that are adversely affecting his/her educational performance. Usually schools look at grades, discipline records, and performance on achievement tests to quantify educational impact. In determining eligibility for Emotional Disability, several evaluations are typically completed. A school will conduct psychological testing by a school psychologist, which will include cognitive testing and social/emotional measures ( rating scales, interviews, observations). Educational testing is typically completed to determine current levels of achievement in reading, writing, math, and other educational areas. Additionally, a Sociocultural evaluation or interview by a school social worker is typically completed with a parent to rule out environmental factors and obtain a developmental history. (See SPED testing for more information)

Often, the most difficult part of determining eligibility for special education services in this category is determining if the student has an emotional disability or social maladjustment. The following is adapted from a chart that was shown at a training I attended by Bruce Bracken. He adapted it from Social Maladjustment: A Guide to Differential Diagnosis and Educational Options (Wayne County Regional Educational Service Agency - Michigan, 2004).

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A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance: An inability to learn that cannot be explained by intellectual, sensory, or health factors. An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

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Angelo State University - Library Online Resources

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

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Child Mind Institute: Treating Symptoms of Trauma in Children and Teenagers

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Child Mind Institute: Treating Symptoms of Trauma in Children and Teenagers

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Child Mind Institute | Transforming Children’s Lives.

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

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What do mental health professionals do in schools?

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What do mental health professionals do in schools?

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Appropriate and Inappropriate Activities for PSCs

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Appropriate and Inappropriate Activities for PSCs

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Pospech & Prewitt Anxiety Education and Information (800 × 2000 px) (800 × 3000 px) (800 × 4000 px).pdf

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How Do I Find Out If I Have an Eating Disorder?

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How Do I Find Out If I Have an Eating Disorder?

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How Do I Find Out If I Have Eating Disorder?

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Latest Updates In The Eating Disorder Field posted by EDReferral on EDReferral.com.

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Teaching Students with Emotional Disturbances: 8 Tips for Teachers

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Teaching Students with Emotional Disturbances: 8 Tips for Teachers

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National Eating Disorder Association (NEDA): Educator Toolkit

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National Eating Disorder Association (NEDA): Educator Toolkit

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Child Mind Institute | Transforming Children’s Lives.

# data[].attributes.attachment_link.description
The Child Mind Institute is an independent nonprofit dedicated to transforming the lives of children struggling with mental health and learning disorders.

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TEA: Student Referrals to the School Counselor Key Points to Remember

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TEA: Student Referrals to the School Counselor Key Points to Remember

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NPR.org: Children's Hospitals Saw Rise In Eating Disorder Cases During Pandemic

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NPR.org: Children's Hospitals Saw Rise In Eating Disorder Cases During Pandemic

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LULU GARCIA-NAVARRO, HOST:

Since the pandemic began, children's hospitals have seen a surge in admissions for eating disorders. And many parents feel desperate, knowing their child is sick but unable to access treatment because of a chronic shortage of therapists and programs that can help them. Kate Wells at Michigan Radio has this story of one family's struggle. And a note to our listeners - this story discusses eating disorders in detail.

GARCIA-NAVARRO: Amelia Haywood (ph) is a little bit nervous to talk about this, but she really wants to. She sits next to her mom in their home in suburban Grand Rapids, Mich. Her long, brown hair hangs loose over a red athletic jacket.

AMELIA HAYWOOD: Yeah. So my name is Amelia. I'm 15 years old. I play volleyball. And about six months ago, I was diagnosed with anorexia nervosa.

KATE WELLS, BYLINE: This disease has sent her to the emergency room four times. And she has been admitted to three different hospitals. It began in March of 2020 when the lockdown started. Suddenly, a girl who had been this athletic, high-achieving eighth-grader just felt lost.

HAYWOOD: People are dying. Everyone's getting sick. You can't see your friends. It was hard because I felt like I didn't have any control over anything except what I ate and how I exercised.

WELLS: So she was like, you know, I'm just going to eat healthy. I'm going to stay in shape. But as the shutdowns and isolation stretched into summer and then fall and then winter, her focus on food and exercise became more intense. It started to consume her. She would make these elaborate meals. And she'd post pictures to Instagram but then actually give them to her sister and lie and say she'd already eaten. She would skip time with friends to fit in yet another run. And she wore baggy sweats to cover up the weight loss. By January, Amelia just felt drained and exhausted all the time.

HAYWOOD: I had, like, basically no emotions. I was just, like, numb. All I wanted to do was, like, lay in my bed.

WELLS: So one Sunday morning, Amelia's mom, Jennifer Ackerman-Haywood (ph), confronted her daughter.

JENNIFER ACKERMAN-HAYWOOD: I just went in there. And I said, Amelia, I know something's up with you. And I'm not going to leave your room until, you know, as long as it takes. You can take your time telling me. But I'm not going anywhere until we have - we have to have a discussion about this because I'm very concerned.

HAYWOOD: And I finally said, I'm struggling with food. It was probably, like, the hardest thing I've ever said in my entire life because I was so scared.

ACKERMAN-HAYWOOD: I immediately was like, of course. Like, this explains everything. Like - and I could kind of like flashback the last month and kind of seeing her decline into a withdrawn person. And I immediately was like, OK. I think she has an eating disorder.

WELLS: The very next day, Jennifer brought Amelia to the pediatrician's. And that is when Amelia was first diagnosed with anorexia. But Jennifer says no one ever alerted her at an earlier checkup that Amelia's growth levels had slowed dramatically. And it wasn't until three weeks after Amelia's diagnosis that Jennifer found out Amelia's EKG had shown her heart rate had become dangerously low.

ACKERMAN-HAYWOOD: And I just thought, wow. We were that close to that. And we didn't know.

WELLS: Two months later, Amelia was so sick, she needed to be admitted to the hospital. Hospitals across the country have seen a surge of patients like Amelia. During the first year of the pandemic, a nationwide network of 15 different hospitals reported their average admissions for adolescent eating disorders doubled. Dr. Terry Bravender treats eating disorders at the University of Michigan CS Mott Children's Hospital. It's one of the places that Amelia was treated.

TERRY BRAVENDER: These are kids whose bodies are failing because of their poor nutritional intake. And the medical hospital is really a safety net rescue for them so that they don't starve to death.

WELLS: Experts believe the pandemic's isolation, social disruption and trauma acted as kind of a mass trigger for many kids and teens who were genetically predisposed to these diseases. Samantha DeCaro is a psychologist with the Renfrew Center. It's a national network of eating disorder clinics.

SAMANTHA DECARO: So the pandemic has created the perfect storm for an eating disorder and disordered eating in the past. It has resulted in a relapse.

WELLS: Even before the pandemic, there was already a shortage of therapists and specialists who know how to treat these illnesses. Doctors say they are hearing from frantic parents who are calling 20, even 60 therapists and cannot get their kid in anywhere. Amelia's mom, Jennifer, says navigating her daughter's illness felt like being in a maze.

ACKERMAN-HAYWOOD: It seems insane because if your child gets a cancer diagnosis or something else, you know, there's a protocol for cancer. You know, there's a protocol for some of these other illnesses out there. There isn't a universal protocol for eating disorders.

WELLS: Amelia kept getting sicker over the spring. And doctors eventually recommended that she get residential treatment at a psychiatric hospital that treats eating disorders.

HAYWOOD: Being able to talk to people who are going through the same thing helped me so much and realize that I'm not alone.

WELLS: Amelia is home now. She is doing so much better. She's on medication. She gets regular therapy. She's back to a healthy weight. She still has days where she struggles with old thought patterns about her body and food. But she wants others to know that it is possible to get better.

HAYWOOD: And I can - I'm starting to get activity back. I'm - I can hang out with my friends and live my life how I want to live. And I know it's really hard to just, like, reach out. But at the end of the day, it's so worth it.

WELLS: This fall, Amelia will be a sophomore. Like so many other kids, she is still grappling with the ways that the pandemic changed her. But she's no longer alone in her bedroom, feeling numb. Now, even on the hardest days, she's got help. For NPR News, I'm Kate Wells in Ann Arbor, Mich.

Copyright © 2021 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR's programming is the audio record.

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Children's Hospitals Saw Rise In Eating Disorder Cases During Pandemic

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LULU GARCIA-NAVARRO, HOST: Since the pandemic began, children's hospitals have seen a surge in admissions for eating disorders. And many parents feel desperate, knowing their child is sick but unable to access treatment because of a chronic shortage of therapists and programs that can help them.

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VISTAS Online: Counselors Role in Addressing Eating Disorders

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VISTAS Online: Counselors Role in Addressing Eating Disorders

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Home - MEDA - Multi-Service Eating Disorders Association

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Disorders.org - Find Therapists, Counselors, and Treatment Centers

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Caring specialists are available right now to help you find a treatment solution that's right for you. Don't wait... CALL NOW!

Disorders.org is a guide to understanding mental health disorders and available treatments. This website also has listings of Counselors, Therapists, Treatment Centers, Support and Therapy Groups and Psychiatrists near you to get the support you or someone close to you may need. After being diagnosed with a mental illness, you may have more questions than answers. No one wants to feel unwell, but a mental illness diagnosis can be especially hard to deal with. You may ask yourself, "Why did this happen to me?" You may also wonder how this diagnosis will change your life and the lives of those close to you. It is important to remember that you are not your diagnosis; it does not define who you are. You are someone who happens to be dealing with a mental disorder.

Why Me?

The most common question asked by people is why me? This is a very normal reaction. Learning that you have a mental disorder can be very hard to swallow at first. When you first experience the signs of a mental health disorder (delusions, depression) it can be quite frightening. Recognizing the signs, seeking help and getting diagnosed with a mental illness can actually be a very overwhelming process. The most important part of the process is seeking help. You may feel a combination of fear, hope, shock, denial, confusion, anger, grief, guilt and even relief. Do not feel a loss of control and/or loss of hope because there are a variety of effective treatment options available for many of these conditions. Seeking help early from a qualified mental health professional can help you and your family effective cope with your condition.

Coping with Mental Illness

Being diagnosed is the most important step in your path of recovery. Most people ask themselves: Is it my fault? and it's very important to remember that any kind of medical condition has a multifaceted origin, and it is never anyone's fault.
There are many factors that can contribute to a mental health disorder such as:

Genetics (family history)

Hormonal imbalances (puberty, pregnancy, puberty)

Stressful life events (loss of a loved one, divorce, marriage, a new addition to the family, unemployment, health problems, etc.)

Substance abuse

Just like any other condition, mental disorders are also best treated if early intervention is practiced. In most cultures around the world, there is a stigma associated with mental health. This should not be the case. The human mind, just like any other organ, is prone to diseases, disorders and pathologies. It is of the utmost importance that you educate yourself and others about mental health disorders.

In Their Own Words

REAL people tell their stories learn more

Steps You Can Take to Help Yourself

The most important step for you to take now is to understand your condition and ask questions from health professionals and groups that you can trust.
You need to ask yourself:

How will this disorder affect my life?

What kind of treatment and support is available for me?

What should I expect from treatment plans and recovery?

What can help me speed up my recovery journey?

What kind of role can my loved ones play?

Any disorder that inhibits a person from functioning optimally and interferes with his/her social, professional and personal life may be deemed a mental health disorder. The following symptoms may indicate mental health disorders:

Depression

Inability to express your desires

Inability to cope due to extreme stress

Overwhelming sadness and despair

Irregular sleep patterns (oversleeping or insomnia)

Overeating

Loss of appetite or deliberately avoiding food

Hopelessness

Suicidal thoughts

Substance misuse, abuse and/or addition

Excessive gambling

An unnatural preoccupation with food

If you or someone you love needs treatment, call 800-598-5053 ( Who Answers?) now to find treatment a treatment solution that's right for you.

Treatment, Recovery and Beyond

Recovery is often possible, but it is imperative that you seek help early. It is important to remember that your condition is not a life sentence. Learning to cope with your symptoms is the most important part of your recovery. Treatment for a mental disorder may include: a combination of medications, psychotherapy and/or lifestyle changes. Your treatment plan will be unique-there is no set formula that works for everyone. So it may take some time to find the best combination for you.

Your Experience Is Unique To You Alone

The mental health field is constantly changing and evolving so it is important that each case be individually assessed and examined in relation to the larger context. Seeking treatment early is the most critical step in the recovery process. There have been numerous advancements in the study and treatment of mental disorders. In addition to individualized psychotherapy, group therapy has proven beneficial in helping individuals and their families cope, with the often, confusing and stressful effects of mental illness. Many have reported that group therapy has not only helped them effectively manage their condition, it has also given them the support that they desperately need during this time.

The mission of Disorders.org is to present you with the most up-to-date knowledge available about mental health disorders and their treatment options and help you find therapists and treatment centers near you. Mental health disorders affect millions of people across the world. You are not alone... Find the help you need and live a healthier life.

© Copyright 2017 Disorders.org

DISCLAIMER: The information provided on this web site is for informational purposes only and is not medical or behavioral health care advice. Always seek qualified licensed professionals for your health issues. Disorders.org does not endorse or make any warranty as to the quality of providers listed, or their current license status. Conduct your own independent investigation of this website's information and your choice of healthcare provider.

Where do calls go?

Calls to numbers on a specific treatment center listing will be routed to that treatment center. Additional calls will also be forwarded and returned by a quality treatment center within the USA.

Calls to any general helpline (non-facility specific 1-8XX numbers) for your visit will be answered by a licensed drug and alcohol rehab facility, a paid advertiser on Disorders.org.

All calls are private and confidential.

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Find Therapists, Rehab Treatment Centers, Psychologists, Psychiatrists, and Group Therapy

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Caring specialists are available right now to help you find a treatment solution that's right for you. Don't wait... CALL NOW! Disorders.org is a guide to understanding mental health disorders and available treatments. This website also has listings of Counselors, Therapists, Treatment Centers, Support and Therapy Groups and Psychiatrists near you to get the support you or someone close to you may need.

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Educating Parents on Feeding and Eating Disorders: Professional Presentation

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Educating Parents on Feeding and Eating Disorders: Professional Presentation

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Pospech & Prewitt_ Professional Presentation_ Educating Others on Feeding and Eating Disorders

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

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

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Authors:

Cecilia A. Essau

Publication Information:

Mahwah, N.J. : Routledge. 2003

Resource Type:

eBook.

Description:

Recent decades have seen a steady rise in the incidence of antisocial behavior in youth. Possible direct consequences aside, such behavior is predictive of chronic emotional, educational, vocational, and emotional impairment that is associated with hundreds of millions of dollars in costs to overtaxed mental health, social services, special education, and juvenile justice systems. Written by an eminent group of international experts, Conduct and Oppositional Defiant Disorders: Epidemiology, Risk Factors, and Treatment offers the first comprehensive cutting-edge overview of all the major aspects of conduct disorder (CD) and oppositional defiant disorder (ODD) in children and adolescents. It is organized into three sections. The first summarizes classification and assessment, epidemiology and comorbidity, as well as course and outcome. The second examines factors that put children and adolescents at risk to develop CD and ODD: contextual, familial/genetic, and neuropsychological and neuroendocrine. The third presents numerous empirically supported approaches to prevention and treatment. An epilogue reviews recent progress and unresolved questions, and suggests needs for future research. Special attention is devoted to gender and developmental pathways in etiology, symptom expression, courses, and outcomes. This volume will be crucial reading for all mental health professionals whose work involves them with these exceptionally difficult clients.

Subjects:

Oppositional defiant disorder in adolescence
Behavior disorders in children
Behavior disorders in adolescence
Conduct disorders in children
Conduct disorders in adolescence
Oppositional defiant disorder in children
Children

Categories:

PSYCHOLOGY / Psychopathology / General
PSYCHOLOGY / Psychotherapy / General
PSYCHOLOGY / Mental Health

Related ISBNs:

9780805840612. 9781138003729. 9781135640170. 9781135640163. 9781135640149. 9781410607720.

OCLC:

52993908

Accession Number:

86781

Database:

eBook Collection (EBSCOhost)

Publisher Permissions:

Print/E-mail/Save 60 Pages
Unlimited Copy/Paste

Concurrent User Level:

Limited User Access (1 Copies Available)

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Angelo State University - Library Online Resources

# data[].attributes.headline
ADHD : A Guide to Understanding Symptoms, Causes, Diagnosis, Treatment, and Changes Over Time in Children, Adolescents, and Adults: Vol. Fifth edition. 

# data[].attributes.subject
ADHD : A Guide to Understanding Symptoms, Causes, Diagnosis, Treatment, and Changes Over Time in Children, Adolescents, and Adults: Vol. Fifth edition. 

# data[].attributes.body
Paul H. Wender, & David A. Tomb. (2017). ADHD : A Guide to Understanding Symptoms, Causes, Diagnosis, Treatment, and Changes Over Time in Children, Adolescents, and Adults: Vol. Fifth edition. Oxford University Press.

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

# data[].attributes.subject
ADHD : A Guide to Understanding Symptoms, Causes, Diagnosis, Treatment, and Changes Over Time in Children, Adolescents, and Adults

# data[].attributes.body
Authors:

Paul H. Wender
David A. Tomb

Publication Information:

Ed.: Fifth edition. New York, NY : Oxford University Press. 2017

Resource Type:

eBook.

Description:

Drawing on over forty years of clinical and research experience, Paul Wender and new coauthor David A. Tomb have created a classic, definitive model for identifying and treating children and adults who have Attention-Deficit Hyperactivity Disorder (ADHD). ADHD: Attention-Deficit Hyperactivity Disorder in Children and Adults, Fifth Edition offers insights into the progression of ADHD to those at any age and describes the best treatment. Wender and Tomb stress that drug therapy remains the most effective in treating the disorder, but psychological techniques, when combined with medication, can produce further improvement. In addition, extensive first-hand accounts from men, women, and children offer dramatic insight into what it feels like to have, and to receive medical treatment for, ADHD. Throughout, the book contains valuable information on where to seek help and what kinds of diagnostic tests exist and how reliable they are, as well as comprehensive instructions and rating scales to help parents best help their child and to help adults self-screen for the disorder. This concise and fully revised volume is a practical tool for individuals at any age, parents and teachers of children with ADHD, and clinicians.

Subjects:

Attention-deficit-disordered adults
Children
Adulthood
Attention-deficit hyperactivity disorder
Attention-deficit-disordered children
Attention-deficit disorder in adolescence

Categories:

PSYCHOLOGY / Clinical Psychology
MEDICAL / Psychiatry / Child & Adolescent
MEDICAL / Psychiatry / Psychopharmacology

Related ISBNs:

9780190240264. 9780190637675. 9780190240271. 9780190240288.

OCLC:

945625068

Accession Number:

1334163

Database:

eBook Collection (EBSCOhost)

Publisher Permissions:

Print/E-mail/Save 50 Pages
Restricted Copy/Paste

Concurrent User Level:

Unlimited User Access

# data[].attributes.attachment_link.title
Angelo State University - Library Online Resources

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

# data[].attributes.headline
Addressing Conduct Disorder in Elementary School Children: An Application of the ASCA National Model Stephen P. Demanchick University of Rochester Malathi Rangan

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Addressing Conduct Disorder in Elementary School Children: An Application of the ASCA National Model Stephen P. Demanchick University of Rochester Malathi Rangan

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Addressing Conduct Disorder in Elementary School Children- An Application of the ASCA National Model .pdf

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ADHD in the Schools, Third Edition: Assessment and Intervention Strategies

# data[].attributes.subject
ADHD in the Schools, Third Edition: Assessment and Intervention Strategies

# data[].attributes.body
ADHD in the Schools, Third Edition : Assessment and Intervention Strategies

Authors:

George J. DuPaul
Gary Stoner

Publication Information:

Ed.: Third edition. New York : The Guilford Press. 2014

Resource Type:

eBook.

Description:

This highly regarded practitioner guide provides state-of-the-art tools for supporting the academic and behavioral success of PreK-12 students with attention-deficit/hyperactivity disorder (ADHD). The authors explain the learning and behavior difficulties associated with ADHD and describe screening and assessment procedures that facilitate data-based decision making. They show how to develop individualized intervention plans that integrate behavioral, academic, and social supports, in partnership with teachers and parents. Strategies for collaborating with physicians and monitoring students'medication response are also presented. Helpful reproducible forms and handouts can be downloaded and printed in a convenient 8 1/2'x 11'size. New to This Edition: •Reflects a decade's worth of research and clinical advances, plus the growth of multi-tiered service delivery models. •Discusses changes in DSM-5. •Separate chapter on interventions for middle and high school students, with new content on the transition to college. •Updated medication information, case examples, and more.

Subjects:

Attention-deficit hyperactivity disorder--Diagnosis
Attention-deficit-disordered children--Education--United States

Categories:

PSYCHOLOGY / Psychopathology / Attention-Deficit Disorder (ADD-ADHD)
EDUCATION / Counseling / General
EDUCATION / Special Education / General
MEDICAL / Psychiatry / Child & Adolescent
PSYCHOLOGY / Psychotherapy / Child & Adolescent
SOCIAL SCIENCE / Social Work

Related ISBNs:

9781462516711. 9781462526000. 9781462516810.

OCLC:

887853807

Accession Number:

814919

Database:

eBook Collection (EBSCOhost)

Publisher Permissions:

Print/E-mail/Save 30 Pages
Restricted Copy/Paste

Concurrent User Level:

Unlimited User Access

# data[].attributes.attachment_link.title
Angelo State University - Library Online Resources

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

# data[].attributes.headline
Treating Symptoms of Trauma in Children and Teenagers

# data[].attributes.subject
Treating Symptoms of Trauma in Children and Teenagers

# data[].attributes.attachment_link.title
Treating Symptoms of Trauma in Children and Teenagers.pdf

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

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

1. Emotional and Behavior Disorders (EBD)

2. Emotional Conflict (EC)

3. Serious Emotional Disturbance (SED)

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

General Strategies

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

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

Teacher Presentation

Laboratory

Group Interaction and Discussion

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

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

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

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

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

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

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

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

Reading

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

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

2. Reading in group or with others.

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

4. Demonstrating appropriate reading

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

Research

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

2. Use appropriate laboratory and field strategies.

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

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

Field Experiences

1. Use appropriate general strategies.

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

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

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

5. Use a buddy system.

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

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

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

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

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

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

Testing

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

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

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

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

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

Organizations

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

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

Resources

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

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

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

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Disorder Class: Attention Deficit and Disruptive Behavior Disorders

Disorder Class: Disruptive, Impulse-Control, and Conduct Disorders

A. A pattern of negativistic; hostile, and defiant behavior lasting at least 6 months, during which four (or more of the following are present:

1. Often actively defies or refuses to comply with adults requests or rules

2. Often deliberately annoys people

3. Often blames others for his or her mistakes or misbehavior

4. Is often touchy or easily annoyed by others

5. Is often angry and resentful

Note: Consider a criterion met only if the behavior occurs more frequently that is typically observed in individuals of comparable age and developmental level.
A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms of the following categories, and exhibited during interaction with at least one individual who is not a sibling:
Angry/Irritable Mood Argumentative/Defiant Behavior

4.

Often argues with authority figures or, for children and adolescents, with adults

5.

Often actively defies or refuses to comply with requests from authority figures or with rules

6.

Often deliberately annoys others

7.

Often blames others for his or her mistakes or misbehavior

Vindictiveness

8.

Has been spiteful or vindictive at least twice within the past 6 months.

Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from a behavior that is symptomatic. For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months unless otherwise noted (Criterion AB). For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months. Unless otherwise noted (Criterion AB). While these frequency criteria provide guidance on a minimal level of frequency to define symptoms, other factors should also be considered, such as whether the frequency and intensity of the behaviors are outside a range that is normative for the individual's developmental level, gender, and culture.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning,

B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues) or it impacts negatively on social, educational, occupational, or other important areas of functioning,

C. The behavior does not occur exclusively during the course of a Psychiatric or Mood Disorder.

C. The behavior does not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also the criteria are not met for disruptive mood dysregulation disorder.

D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 or older, criteria are not met for Antisocial Personality Disorder

Dropped

Specify current severity:

Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers).

Moderate: Some symptoms are present in at least two settings

Severe: Some symptoms are present in three or more settings.

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Disorder Class: Attention Deficit and Disruptive Behavior Disorders Disorder Class: Disruptive, Impulse-Control, and Conduct Disorders A.

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Disorder Class: Mood Disorders
Manic Episode

Disorder Class: Attention-Deficit and Disruptive Behavior Disorders
Oppositional Defiant Disorder

Disorder Class: Depressive Disorders
Disruptive Mood
Dysregulation Disorder

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present

1. Often actively defies or refuses to comply with adults' requests or rules

2. Often deliberately annoys people

3. Often blames others for his or her mistakes

4. Is often touchy or easily annoyed by others

5. Is often angry or resentful

6. Is often spiteful or vindictive

A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and or behaviorally (e.g., physical aggression) that are grossly out of proportion in intensity or duration to the situation or provocation

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1. Inflated self-esteem or grandiosity

2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

3. More talkative than usual or pressure to keep talking

4. Flight of ideas or subjective experience that thoughts are racing

5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

B. The temper outbursts are inconsistent with developmental level

I. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
Note: Developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation, should not be considered as a symptom of mania or hypomania.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of bipolar I disorder.

K. The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition

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Disorder Class: Mood DisordersManic Episode Disorder Class: Attention-Deficit and Disruptive Behavior DisordersOppositional Defiant Disorder Disorder Class: Depressive DisordersDisruptive MoodDysregulation Disorder A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). A.

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UNSTUCK: an OCD kids movie Official Trailer

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Kids, teens and adults with Obsessive Compulsive Disorder (OCD) are looking for help. They need help handling the symptoms, harmful obsessions, intrusive thoughts and constant rituals.

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Educational Purchase: https://www.newday.com/film/unstuck-ocd-kids-movie

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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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Suffering in Silence: Examining Obsessive Compulsive Behaviors in the School Setting

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Suffering in Silence: Examining Obsessive Compulsive Behaviors in the School Setting

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Counseling Movies: Films that Illustrate Mental Health

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Counseling Movies: Films that Illustrate Mental Health

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When I was getting my master's degree in counseling, I learned the power of using movies to illustrate family dynamics, show different parts of a story, and allow me to see how counselors are viewed in pop culture. While movies can illustrate how pervasive mental health issues, they also show how we process them as a society. If you are a counselor or studying to be one, here are some counseling movies (and TV shows) to check out!

(This post contains affiliate links. Check out our disclosure page for more info!)

Counseling Movies and TV Shows

Counselors in Pop Culture

As soon as I say I'm a counselor or therapist, these are the movies that everyone always asks me if I've seen. Some of them are better than others, but here are the "must-sees"!

50/50 - Anna Kendrick really shows the struggle of beginning counselors. Her first scene in the movie reminds me of the awkwardness of my first sessions. It also illustrates why ethics codes should be followed, and the slippery slope that leads to ethics violations. Now, the ending is a "what shouldn't happen if you want to keep your LPC," but the movie is also hysterical.

Substance Abuse

Mental Health

Family Dynamics

Any other counseling movies that you love? Share them in the comments and don't forget to pin!

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Counseling Movies: Films that Illustrate Mental Health - Unseen Footprints

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When I was getting my master's degree in counseling, I learned the power of using movies to illustrate family dynamics, show different parts of a story, and allow me to see how counselors are viewed in pop culture. While movies can illustrate how pervasive mental health issues, they also show how we process them as a society.

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Credit: Julius-Maximilians-Universität Würzburg, JMU

An overactive molecular signal pathway in the brain region of the amygdala can lead to obsessive-compulsive disorder (OCD). A research team from Würzburg has established this connection.

Some people have an extreme fear of dirt or bacteria. As a result, they may develop a habit of compulsive washing and repeatedly cleaning their hands or body. They are trapped in a vicious circle, as the fear of new contamination returns quickly after washing. Sufferers see no way out. They are even incapable of changing their behaviour when the excessive washing has led to skin irritation or damage.

Around two percent of the general population suffer from some kind of obsessive-compulsive disorder (OCD) at least once in their life. The disorder is characterised by persistent intrusive thoughts which the sufferers try to compensate for by repetitive ritualized behaviour.

Like depression, eating disorders and other mental diseases, OCD is treated with antidepressants. However, the drugs are non-specific, that is they are not tailored to the respective disease. Therefore, scientists have been looking for new and better targeted therapies that have fewer side effects.
Missing protein triggers urge to wash
Professor Kai Schuh from the Institute of Physiology at the Julius-Maximilians-Universität (JMU) Würzburg (Germany) and his team explore the underlying causes of obsessive-compulsive disorder in collaboration with the JMU's Departments of Psychiatry and Neurology.

"We were able to show in mouse models that the absence of the protein SPRED2 alone can trigger an excessive grooming behaviour," Schuh says. He believes that this finding is crucial as no clear trigger for this type of disorder has been identified until now. Previous research pointed to multiple factors being responsible for developing OCD.

Occurring in all cells of the body, the protein SPRED2 is found in particularly high concentrations in regions of the brain, namely in the basal ganglia and the amygdala. Normally, the protein inhibits an important signal pathway of the cell, the so-called Ras/ERK-MAP kinase cascade. When it is missing, this signal pathway is more active than usual.
Hyperactive signal cascade in the brain
"It is primarily the brain-specific initiator of the signal pathway, the receptor tyrosine kinase TrkB, that is excessively active and causes the overshooting reaction of the downstream components", biologist Dr. Melanie Ullrich explains.

Administering an inhibitor to attenuate the overactive signal cascade in the animal model improves the obsessive-compulsive symptoms. Moreover, the JMU research team was able to treat the OCD with an antidepressant, similarly to standard therapy in humans. Their detailed results have been published in the journal Molecular Psychiatry.
New targets for therapies pinpointed
"Our study delivers a valuable new model that allows the disease mechanisms to be investigated and new therapy options for obsessive-compulsive disorders to be tested," Professor Schuh says.

The recently discovered link between OCDs and the Ras/ERK-MAP kinase cascade also opens up new targets for therapy. Drugs that inhibit this cascade are already available and some of them are approved for human treatment.

According to Melanie Ullrich, these are cancer drugs, as overactivation of the Ras/ERK-MAP kinase cascade is also a frequent trigger of cancer: "So we are wondering whether such drugs could also be effective in the treatment of obsessive-compulsive disorders and whether they are beneficial in terms of side effects."

More information: M Ullrich et al. OCD-like behavior is caused by dysfunction of thalamo-amygdala circuits and upregulated TrkB/ERK-MAPK signaling as a result of SPRED2 deficiency, Molecular Psychiatry (2017). DOI: 10.1038/mp.2016.232

Provided by Julius-Maximilians-Universität Würzburg

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An overactive molecular signal pathway in the brain region of the amygdala can lead to obsessive-compulsive disorder (OCD). A research team from Würzburg has established this connection. Some people have an extreme fear of dirt or bacteria. As a result, they may develop a habit of compulsive washing and repeatedly cleaning their hands or body.

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

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

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

Obsessions Common in Kids With OCD

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

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

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

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

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

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

Behaviors You Might See in Students With OCD

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

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

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

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

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

Behaviors Often Confused With Another Disorder

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

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

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

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

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

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

How to Help Students With OCD

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

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

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

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

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

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

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

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

How to Minimize Behavioral Problems

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

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

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

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

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

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

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

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Module 6 Dysfunctional Behavior Portrayed in Film(2)(1)

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Uncovering OCD: The Truth About Obsessive Compulsive Disorder

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Uncovering OCD: The Truth About Obsessive Compulsive Disorder

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Uncovering OCD: The Truth About Obsessive Compulsive Disorder

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Abstract: | Obsessive-compulsive disorder (OCD) is a disorder characterized by persistent intrusive and uncontrollable thoughts and the subsequent need to perform specific behaviors repeatedly. The presence of obsessions or compulsions must be time-consuming, cause distress or impairment, and be recognized as excessive or unreasonable by the person with OCD. The obsessions and compulsions must not be caused by medication, drug abuse, or another medical condition. Obsessive-compulsive behavior is highly distressing because it feels as if one’s behavior or thoughts are no longer voluntarily controlled. The more frequently these uncontrolled alien and perhaps unacceptable thoughts or actions are performed, the more distress is induced. An individual with OCD may at various times have either obsessions (which are thought-related) or compulsions (which are action-related), or both.
Full Text Word Count: | 2856
Accession Number: | 86194355
PubType: | Reference
Database: | Research Starters
Obsessive-compulsive disorder
Anatomy or system affected: Psychic-emotional system
Definition: A disorder characterized by intrusive and unwanted but uncontrollable thoughts (obsessions) that lead to repeated behaviors (compulsions); the obsessions and/or compulsions cause severe stress, consume an excessive amount of time, and greatly interfere with a person’s normal routine, activities, or relationships.
Causes: Psychological factors; may involve genetic, cognitive, and/or neurobiological factors
Symptoms: Repetitive behaviors, anxiety, persistent intrusive and uncontrollable thoughts, irrational fears
Duration: Often chronic with acute episodes
Treatments: Psychotherapy, drug therapy
Causes and Symptoms
Obsessive-compulsive disorder (OCD) is a disorder characterized by persistent intrusive and uncontrollable thoughts and the subsequent need to perform specific behaviors repeatedly. The presence of obsessions or compulsions must be time-consuming, cause distress or impairment, and be recognized as excessive or unreasonable by the person with OCD. The obsessions and compulsions must not be caused by medication, drug abuse, or another medical condition. Obsessive-compulsive behavior is highly distressing because it feels as if one’s behavior or thoughts are no longer voluntarily controlled. The more frequently these uncontrolled alien and perhaps unacceptable thoughts or actions are performed, the more distress is induced. An individual with OCD may at various times have either obsessions (which are thought-related) or compulsions (which are action-related), or both.
According to the National Institute of Mental Health as of 2022, OCD affects around 1.2 percent of the US adult population in a given year, and the lifetime prevalence is about 2.3 percent among US adults. Onset is bimodal and typically occurs before the age of thirty; most of those afflicted begin suffering from the disorder in late childhood (mean age ten years) or early adulthood (mean age twenty-one years). Onset is often preceded by a stressful event such as pregnancy, childbirth, or family conflict. It may be closely associated with mood disorders such as depression or anxiety, with OCD developing soon after a mood disorder or the mood disorder developing as a result of the OCD. OCD affects men and women in roughly equal numbers.
Individuals with OCD generally recognize and are distressed by the irrational or excessive nature of their obsessions and compulsions. However, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specifiers for OCD related to the individual's degree of insight about the nature of their obsessions and compulsions, including good or fair insight, poor insight, and absent insight/delusional, which involves an absolute conviction that the OCD beliefs are valid and true. Obsessions generally fall into one of five recognized categories. Obsessive doubts are persistent doubts that a task has been completed; the individual is unwilling to accept and believe that the work is done satisfactorily. Obsessive thinking is an almost infinite chain of thought, targeting future events. Obsessive impulses are very strong urges to perform certain actions, whether they are trivial or serious, that would likely be harmful to the affected person or someone else or that are socially unacceptable. Obsessive fears are thoughts that the person has lost control and will act in some way that will cause public embarrassment. Obsessive images are continued visual pictures of either a real or an imagined event. Common obsessions relate to contamination, safety, the fear of committing a socially unacceptable behavior, the need for order, and sexual or aggressive thoughts.
Four factors are commonly associated with obsessive characteristics, not only in people with OCD but in the general population as well. First, obsessive individuals are unable to control their mental processes completely. Practically, this means the loss of control over thinking processes, such as intrusive thoughts of a loved one dying or worries about hurting someone unintentionally. Second, there may be thoughts and worries over the potential loss of motor control, perhaps causing impulses such as shouting obscenities in public or performing inappropriate sexual acts. Third, many obsessive individuals may be afraid of contamination and suffer irrational fear and worry over exposure to germs, dirt, or diseases. The last factor is checking behavior, or backtracking previous actions to ensure that the behavior was done properly, such as checking that doors and windows are shut, faucets are turned off, and so on.
Compulsions may be either mild or severe and debilitating. Mild compulsions might be superstitions, such as refusing to walk under a ladder, knocking on wood, or throwing salt over one’s shoulder. Severe compulsions become fixed, unvaried ritualized behaviors; if these compulsions are not practiced precisely in a particular manner or a prescribed number of times, then intense anxiety may result. These strange behaviors may be rooted in superstition; many of those suffering from the disorder believe that performing the behavior may ward off danger. Compulsive acts are not ends in themselves but are “necessary” to produce or prevent a future event from occurring. Although the enactment of the ritual may assuage tension, the act does not give the person with OCD pleasure.
Common compulsions include cleaning, checking, counting, arranging, touching objects, hoarding, seeking reassurance, and making lists. For people with repeating compulsions, they must do everything by numbers. Checking is another compulsive act; a compulsive checker believes that it is necessary to check and recheck that everything is in order. Cleaning is a behavior in which the person believes they must engage; they may wash and scrub repeatedly, especially if they think that they have touched something dirty. A fourth common compulsive action is avoidance; for certain superstitious or magical reasons, certain objects must be avoided. Some individuals with compulsions experience compelling urges for perfection in even the most trivial of tasks; often the task is repeated to ensure that it has been done correctly. Some determine that objects must be in a particular arrangement; these individuals are considered “meticulous.” A few people with OCD have hoarding compulsions; they are unable to throw away trash or rubbish. Many individuals have a constant need for reassurance; for example, they want to be told repeatedly that they have not been contaminated.
The direct cause of OCD is uncertain, and no single cause for OCD has been isolated. Sigmund Freud (1856–1939) first proposed that obsessive thoughts are a replacement for more disturbing thoughts or actions that induce guilt or anxiety in the sufferer. However, this view has been discredited, and today it is believed that OCD is caused by a complex interaction of genetic, behavioral, cognitive, cultural, and neurobiological factors. OCD tends to run in families; however, genes appear to be only partly responsible for causing OCD. Twin studies have suggested that genetic factors influence 45 to 65 percent of cases of childhood-onset OCD and 27 to 47 percent of adult-onset OCD. Other suspected influences include abnormalities with the neurotransmitter serotonin in the brain.
Treatment and Therapy
Diagnostic techniques evaluating OCD usually involve psychological evaluation. It is important to determine whether an individual is actually suffering from OCD or other potential problems such as schizophrenia or a mood disorder. Additionally, it is important to determine whether more than one disorder is present. OCD may occur in conjunction with other disorders, such as substance use disorders, eating disorders, and mood disorders. When this occurs, treatment must be adjusted. For example, when depression is also noted, both disorders must be addressed in treatment. OCD is related to other disorders characterized by repetitive behaviors and intrusive thoughts, including body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder.
In cases when differentiation is required between OCD and schizophrenia, the concern is to understand the nature of the dysfunctional thoughts and behaviors. For instance, a distinction can be made by determining the motive behind the ritualized behavior. Stereotyped behaviors are symptomatic of both disorders. In the person with schizophrenia, however, the behavior is triggered by delusions rather than by compulsions. People suffering from delusions do not resist the ideas inundating their minds, and ritualized behavior does not necessarily decrease the feelings associated with the intrusive ideas. On the other hand, people with OCD usually experience decreases in anxiety when they perform their rituals and may be absolutely certain of the need to perform their rituals, though other aspects of their thinking and logic are perfectly clear. They generally resist the ideas that enter their minds and realize the absurdity or abnormality of the thoughts to some extent. As thoughts and images intrude into the mind, the person may sometimes appear to have symptoms that mimic schizophrenia.
Other problems having symptoms in common with OCD are stimulant abuse, Tourette syndrome, and other tic disorders. What seems to separate the symptoms of these disorders from those experienced with OCD is that the former are organically induced. Thus, the actions of a sufferer from Tourette syndrome may be mechanical since they are not purposely enacted. In the case of the stimulant user, the acts may bring pleasure and are not resisted, but reinforced by the drug effects.
Most people experience obsessive thoughts on occasion; in fact, the obsessions of individuals without OCD are not significantly different from the obsessions of those with OCD. The major difference is that those with the disorder have longer-lasting, more intense, and less easily dismissed obsessive thoughts. The importance of this overlap is that mere symptoms are not a reliable tool to diagnose OCD, since some of the same symptoms are experienced by the general population.
Assessment of OCD separates the obsessive from the compulsive components so that each can be examined. Obsession assessment should determine the triggering fears of the disorder, both internal and external, including thoughts of unpleasant consequences. The amount of anxiety that these obsessions produce should be monitored. The compulsive behaviors then should be examined in the same light. DSM-5 criteria include the presence of time-consuming (more than one hour per day) obsessions and compulsions that cause significant distress; that interfere with or reduce the quality of the individual's social, academic, or occupational functioning; and that are not better explained by another mental disorder or substance use.
The greatest chance for successful treatment occurs with individuals who experience mild symptoms who seek help soon after the onset of symptoms and who had few problems before the disorder began. Many valuable and successful treatment strategies are available for OCD. The American Psychiatric Association and the US National Institute for Health and Care Excellence (NICE) recommend exposure-and-response-prevention, a form of cognitive-behavioral therapy (CBT), and/or selective serotonin reuptake inhibitors (SSRIs) as first-line treatments, depending on the patient's preference, the level of OCD complexity and severity, and the presence of depressive symptoms. The NICE recommends low-intensity CBT alone for mild cases of OCD.
The most effective treatment for controlling OCD is the behavioral therapy. CBT involves the identification of misperceptions and negative thoughts and repeated attempts to challenge these beliefs and replace them with less distressing thoughts. CBT may include psychoeducation, cognitive training, mapping OCD target symptoms, and exposure-and-response-prevention therapy. Exposure-and-response-prevention therapy (also called exposure-and-ritual-prevention therapy) is a form of CBT specifically designed to treat OCD symptoms. It involves gradual yet prolonged confrontation with the anxiety-producing stimuli in the presence of a supportive therapy. This exposure often begins with imagined stimuli or photographs and eventually progresses to real-life exposure to the anxiety-provoking stimuli. The exposure continues until the person's anxiety decreases, in a process called habituation. Exposure-and-response-prevention therapy also involves active abstinence from rituals and compulsive behaviors, although this approach does not involve active blocking of the person's compulsions. Exposure-and-response-prevention therapy is highly effective in the treatment of OCD, particularly when the client has less severe forms of OCD, does not have a comorbid diagnosis of depression, adheres to exposure homework early in the therapeutic process, has contamination fears or overt ritualistic behaviors, and has undergone no previous treatment.
Therapeutic approaches to the treatment of OCD may be supplemented with medications. Selective serotonin reuptake inhibitors (SSRIs) are considered to be the first-line agents for the treatment of OCD and often have remarkable effects on OCD, helping individuals to experience a change in their thinking and behavior, as well as providing relief. SSRIs appear to improve OCD symptoms compared with tricyclic antidepressants or monoamine oxidase inhibitors. Approximately 40 to 60 percent of persons with OCD will respond to SSRIs.
Some psychiatrists may recommend neurosurgery to relieve a patient’s symptoms in very severe or intractable cases. Cingulotomy and deep brain stimulation are reported to reduce symptom severity in patients with treatment-refractory OCD. Electroconvulsive therapy has also been reported to be effective in the treatment of OCD in case reports; however, no high-quality, placebo-controlled trials have studied the efficacy of this treatment. Alternative treatments for OCD that have demonstrated benefit include kundalini yoga, mindfulness meditation, and progressive muscle relaxation.
Perspective and Prospects
Descriptions of OCD-like behavior go back to medieval times; a young man who could not control his urge to stick out his tongue or blurt out obscenities during prayer was reported in the fifteenth century. Medical accounts of the disorder and the term “obsessive-compulsive” originated in the mid-nineteenth century. At that time, obsessions were believed to occur when mental energy ran low. Later, Freud attributed the characteristics to a regression to early childhood, when there are perhaps strong urges to be violent and/or to dirty and mess one’s surroundings. To avoid acting on these tendencies, he theorized, an avoidance mechanism is employed, and the symptoms of obsession and/or compulsion appear.
Although not totally disabling, OCD behaviors can be strongly incapacitating and cause a significant amount of distress. Most parents will agree that children commonly have rituals to which they must adhere or compulsive actions they carry out. A particular bedtime story may be read every night for months on end, and children’s games involve counting or checking rituals. It is also not atypical for adults without psychiatric disorders to experience some mild obsessive thoughts or compulsive actions, as seen in an overly tidy person or in group rituals performed in some religious sects. Excessively stressful events may trigger obsessions as well. Further research into the biopsychosocial causes of OCD will be important in developing future treatment approaches.
The global coronavirus disease 2019 (COVID-19) pandemic declared in March 2020 led some experts in psychological and psychiatric fields, due to past studies showing a link between traumatic, stressful events and the development or worsening of OCD behaviors, to focus on how the pandemic affected people already and newly diagnosed with OCD. It was reported that there were many cases of people with obsessions and compulsions related to germs and cleanliness experiencing an exacerbation of their OCD behaviors in response to the anxiety-inducing outbreak of the novel virus that continued to spread widely over the following months and years. At the same time, psychologists and psychiatrists also saw an increase in patients experiencing OCD behaviors who had not previously. Other concerns included analyzing how those with OCD who had already been receiving therapeutic treatment, as opposed to those were not, coped with the lifestyle changes brought on by the pandemic, and how people with OCD were distinguishing between their compulsions and the types of reactions and behaviors appropriate for healthy, safe living during a pandemic. Because of virus control measures such as lockdowns and physical distancing, the alternative to in-person treatment, telehealth, was used and tested on an unprecedentedly widespread scale for both physical and mental issues, including OCD, allowing experts to refine their approach to and use of this virtual method.
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Grant, Jon E., Samuel R. Chamberlain, and Brian L. Odlaug. Clinical Guide to Obsessive Compulsive and Related Disorders. Oxford: Oxford UP, 2014. Print.
Kring, Ann M., et al. Abnormal Psychology. 12th ed. Hoboken: Wiley, 2012. Print.
Menzies, Ross, and Padmal de Silva, eds. Obsessive Compulsive Disorder: Theory, Research, and Treatment. New York: Wiley, 2003. Print.
"Obsessive-Compulsive Disorder (OCD)." National Institute of Mental Health, US Department of Health and Human Services, www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd. Accessed 27 Jan. 2022.
Oltmanns, Thomas F., et al. Case Studies in Abnormal Psychology. 9th ed. Hoboken: Wiley, 2012. Print.

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Usage Guidelines

The People First Respectful Language Modernization Act of 2006 was enacted by the Council of the District of Columba on July 11, 2006 to "require the use of respectful language when referring to people with disabilities in all new and revised District laws, regulations, rules, and publications and all internet publications." ¹

"People First Language" (PFL) puts the person before the disability, and describes what a person has, not who a person is. PFL uses phrases such as "person with a disability," "individuals with disabilities," and "children with disabilities," as opposed to phrases that identify people based solely on their disability, such as "the disabled."

The phrase "mental retardation" is offensive and outdated. The terms "developmental disability," "cognitive disability," or "intellectual disability" may be substituted as more respectful options.

The following table gives examples, in alphabetical order, of ways to substitute PFL for outdated and/or offensive terminology.

¹ People First Respectful Language Modernization Act of 2006, page 1, lines 15-16

* Multiple examples taken from "People First Language" by Kathie Snow, 2005, available at http://www.disabilityisnatural.com.

Fact Sheet Prepared July 2006, by The Arc of the District of Columbia.

For more information, contact:

T.J. Sutcliffe, Director of Advocacy & Public Policy
817 Varnum Street, NE
Washington, DC 20017
Phone: (202) 636-2963

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Usage Guidelines The People First Respectful Language Modernization Act of 2006 was enacted by the Council of the District of Columba on July 11, 2006 to "require the use of respectful language when referring to people with disabilities in all new and revised District laws, regulations, rules, and publications and all internet publications."1

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Person First and Identity First Language

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Person First and Identity First Language

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Person-first language emphasizes the person before the disability, for example "person who is blind" or "people with spinal cord injuries." Identity-first language puts the disability first in the description, e.g., "disabled" or "autistic." Person-first or identify-first language is equally appropriate depending on personal preference. When in doubt, ask the person which they prefer.

It is important to note that while person-first language is often used in more formal writing, many people with disabilities, particularly younger people, are choosing to use identity-first language. How a person chooses to self-identify is up to them, and they should not be corrected or admonished if they choose not to use person-first language.

Affirmative Phrases

Negative Phrases

Person with an intellectual, cognitive, developmental disability

Retarded, Mentally defective

Person who is blind, Person who is visually impaired

The blind

Person with a disability

The disabled, Handicapped

Person who is deaf

The deaf, Deaf and dumb

Person who is hard of hearing

Suffers a hearing loss

Person who has multiple sclerosis

Afflicted by MS

Person with cerebral palsy

CP victim

Person with epilepsy, Person with a seizure disorder

Epileptic

Person who uses a wheelchair

Wheelchair bound, Confined to a wheelchair

Person who has muscular dystrophy

Stricken by MD

Person with a physical disability

Crippled, Lame, Deformed

Person who is unable to speak, Person who uses synthetic speech

Dumb, Mute

Person with a psychiatric disability

Crazy, Nuts

Person who is successful, productive

Has overcome his/her disability, Is courageous (when it implies the person has courage because of having a disability)

Person who is in recovery from a substance use disorder

Addict

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Learn more about the use of person-first and identity-first language when communicating about people with disabilities.

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Adolescent Onset Schizophrenia: 1 in 100 Young People

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Adolescent Onset Schizophrenia: 1 in 100 Young People

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These are cookies necessary for the services to function and are always active. They are usually only set in response to actions made by the user which amount to a request for services, such as setting privacy preferences, logging in, or filling in forms. ​

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Adolescent Onset Schizophrenia: 1 in 100 Young People

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Unlike schizophrenia that strikes in very early childhood, the adolescent-onset variety is frequently highly treatable, and young people have a greater likelihood of fully regaining their lives. But it's up to their families to act quickly and decisively - to recognize the symptoms, and be relentless in getting and maintaining the expert treatment their children need.

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The impact of ADHD on education

The hyperactive, impulsive and inattentive symptoms of ADHD may negatively impact functioning and behaviour of children and adolescents with ADHD in the school setting. ¹² A large, cross-sectional, European Lifetime Impairment Survey (sponsored by Shire, now part of Takeda) assessed parent-reported impairment and symptoms of ADHD in children and adolescents (n=535) compared with children and adolescents without ADHD (n=424). Their findings indicated that more parents of children with ADHD, compared to those of children without ADHD, tended to report impairments for their child at school, such as ²:

Becoming easily frustrated and distracted

Acting in ways others see as inappropriate in social situations

Difficulty following instructions

Failing to meet deadlines for assignments

Making careless errors in homework.

There is also research to suggest that some adults with ADHD may have had disrupted education in earlier life. It has been found that adolescents and adults with ADHD are less likely to have graduated from high school or have achieved a college degree. ¹ Potential reasons for this included the inability to handle large workloads, inattention, disorganisation, difficulty following instructions and making careless errors. ¹

The impact of ADHD on employment

Some adults with ADHD have been found to have occupational difficulties that may affect their productivity in the workplace and their reputation as an employee, with high job turnover and unemployment frequently observed. 1,4-6,13 Additionally:

Some adults with ADHD may be sporadic and disorganised in their job searches.¹³

ADHD symptoms may hamper some forms of employment, with difficulties in time management and impaired social skills, perhaps meaning that adults with ADHD find it difficult to retain a job.¹³

On the other hand, some forms of employment may be well suited to adults with ADHD, particularly more creative or active jobs.¹³

Some adjustments that could be made in the workplace to accommodate adults with ADHD include the option of working in a private space to reduce distraction or the use of incentives for task completion as encouragement.¹³

The impact of ADHD on family and relationships

Symptoms of ADHD can negatively affect family life and relationships. ADHD may affect the relationship between children and adolescents with their parents or carers. ² An Australian study reported poorer family functioning in children (aged 6-9 years) with ADHD (n=30), compared with children without ADHD (n=156). The outcome variables negatively affected by ADHD included family quality of life (emotional impact and family activities), parental psychopathology (depression, anxiety and stress), parental warmth, consistency of parenting and parental hostility. ⁸

Some adults with ADHD may have difficulty in maintaining relationships with the people around them. They may experience irritability, inattention, impulsive talking and forgetfulness which can contribute to misunderstandings in social interactions. ⁴ Impairments in partner relationships and social functioning have been reported to be associated with adult ADHD. ⁹

ADHD and problematic risk-taking behaviour

A study of 5-10-year-old children (ADHD group, n=103; non-ADHD group, n=100) showed a significant correlation (p<0.001) between symptoms of ADHD and greater risk-taking and reduced sensitivity to punishment. ¹⁰ However, a Norwegian study suggested that children with ADHD are not particularly risk-prone, but may not respond well to changing probabilities of success in a given task. When compared with an age-matched control group of children without ADHD (n=34), children with ADHD (n=36) showed significantly poorer risk-adjustment (p<0.01) and significantly more delay-aversion (p<0.01) during the Cambridge Gambling Task; however, reflection time and risk-proneness did not differ between the two groups. ¹¹

Symptoms of ADHD, such as impulsivity and increased risk-taking behaviour, ¹² may lead to adults breaking societal rules and norms.

Research has found that symptoms of ADHD in adults were associated with a higher incidence or risk of the following compared with people without ADHD:

Criminality and arrests1,14

Substance abuse⁴

Aggressive/reckless driving⁴

Traffic violations¹⁴

Suspension of driving licence¹⁴

Crash risk.¹⁵

The impact of ADHD on healthcare resource use

A major contributory factor to the societal burden of ADHD is the increased healthcare resource utilisation observed by individuals with ADHD. In the UK, estimated annual healthcare costs associated with the treatment of ADHD in adolescents have been reported as £670 million, with education and National Health Service (NHS) resources accounting for approximately 76% and 24% of spending, respectively. In 2010, this equated to a mean cost per adolescent for NHS, social care and education resources of £5493. ²²

An analysis of total national annual ADHD-related costs in Europe - using data from Belgium, Germany, Sweden and the UK and applying findings to the Netherlands (based on Dutch 2011 census data with cost estimates converted to Euros) - indicated that the total national annual ADHD-related costs for the Netherlands ranged from €1041-€1520 million. These costs related to education, productivity loss by family members due to ADHD-related activities of the child/adolescent, healthcare costs by family members, healthcare costs for children and adolescents, and social services costs ( Figure 1). ²³

Figure 1: National estimated ADHD-related costs (millions) by cost categories in Europe, using the Netherlands as a reference case. Reproduced with permission from Le HH et al. Eur Child Adolesc Psychiatry 2014; 23: 587-598.²³

The impact of ADHD on personal finances

UK results from the European Lifetime Impairment Survey (sponsored by Shire, now part of Takeda) found that adults with ADHD may experience a range of financial difficulties, such as ⁹:

Difficulty saving for retirement

Poor credit rating or debt

Buying on impulse

Difficulty saving and managing finances.

Furthermore, results of a series of European and North American focus groups (sponsored by Shire, now part of Takeda) found that adults with ADHD reported problems with wasteful spending and compulsive shopping, as well as difficulty remembering to pay bills and how much money they had. ⁴

Financial problems affecting parents of children with ADHD

There is some evidence that parents and carers of children with ADHD may experience financial difficulties, thus impacting the entire family:

The European Caregiver Perspective on Pediatric ADHD study (sponsored by Shire, now part of Takeda), reported that 38% of carers (n=2872) had been late for work in the past month due to their child's ADHD, and that 31% of carers (n=3688) had altered their employment status due to their child or adolescent's ADHD.²⁴

A US study found that carers of children with ADHD had significantly higher absence days (8 vs 7; p<0.0001) and turnover (5% vs 4%; p<0.01) compared with carers of children without ADHD.²⁵

References

1. Biederman J, Faraone SV, Spencer TJ, et al. Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry 2006; 67: 524-540.

2. Caci H, Doepfner M, Asherson P, et al. Daily life impairments associated with self-reported childhood/adolescent attention-deficit/hyperactivity disorder and experiences of diagnosis and treatment: results from the European Lifetime Impairment Survey. Eur Psychiatry 2014; 29: 316-323.

3. Fredriksen M, Dahl AA, Martinsen EW, et al. Childhood and persistent ADHD symptoms associated with educational failure and long-term occupational disability in adult ADHD. Atten Defic Hyperact Disord 2014; 6: 87-99.

4. Brod M, Pohlman B, Lasser R, et al. Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study. Health Qual Life Outcomes 2012; 10: 47.

5. De Graaf R, Kessler RC, Fayyad J, et al. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occup Environ Med 2008; 65: 835-842.

6. Shifrin JG, Proctor BE, Prevatt FF. Work performance differences between college students with and without ADHD. J Atten Disord 2010; 13: 489-496.

7. Halmøy A, Fasmer OB, Gillberg C, et al. Occupational outcome in adult ADHD: impact of symptom profile, comorbid psychiatric problems, and treatment: a cross-sectional study of 414 clinically diagnosed adult ADHD patients. J Atten Disord 2009; 13: 175-187.

8. Cussen A, Sciberras E, Ukoumunne OC, et al. Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. Eur J Pediatr 2012; 171: 271-280.

9. Pitts M, Mangle L, Asherson P. Impairments, diagnosis and treatments associated with attention-deficit/hyperactivity disorder (ADHD) in UK adults: results from the lifetime impairment survey. Arch Psychiatr Nurs 2015; 29: 56-63.

10. Humphreys KL, Lee SS. Risk taking and sensitivity to punishment in children with ADHD, ODD, ADHD+ODD, and controls. J Psychopathol Behav Assess 2011; 33: 299-307.

11. Sørensen L, Sonuga-Barke E, Eichele H, et al. Suboptimal decision making by children with ADHD in the face of risk: poor risk adjustment and delay aversion rather than general proneness to taking risks. Neuropsychology 2017; 31: 119-128.

12. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.

13. Adamou M, Arif M, Asherson P, et al. Occupational issues of adults with ADHD. BMC Psychiatry 2013; 13: 59.

14. Barkley RA, Murphy KR, Dupaul GI, et al. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning. J Int Neuropsychol Soc 2002; 8: 655-672.

15. Curry AE, Metzger KB, Pfeiffer MR, et al. Motor vehicle crash risk among adolescents and young adults with attention-deficit/hyperactivity disorder. JAMA Pediatr 2017; 171: 756-763.

16. Caci H, Asherson P, Donfrancesco R, et al. Daily life impairments associated with childhood/adolescent attention-deficit/hyperactivity disorder as recalled by adults: results from the European Lifetime Impairment Survey. CNS Spectr 2015; 20: 112-121.

17. Grenwald-Mayes G. Relationship between current quality of life and family of origin dynamics for college students with attention-deficit/hyperactivity disorder. J Atten Disord 2002; 5: 211-222.

18. O'Callaghan P, Sharma D. Severity of symptoms and quality of life in medical students with ADHD. J Atten Disord 2014; 18: 654-658.

19. Hoogman M, Stolte M, Baas M, et al. Creativity and ADHD: A review of behavioral studies, the effect of psychostimulants and neural underpinnings. Neurosci Biobehav Rev 2020; 119: 66-85.

20. Young S, Bramham J, Gray K, et al. The experience of receiving a diagnosis and treatment of ADHD in adulthood: a qualitative study of clinically referred patients using interpretative phenomenological analysis. J Atten Disord 2008; 11: 493-503.

21. Gudjonsson GH, Sigurdsson JF, Eyjolfsdottir GA, et al. The relationship between satisfaction with life, ADHD symptoms, and associated problems among university students. J Atten Disord 2009; 12: 507-515.

22. Telford C, Green C, Logan S, et al. Estimating the costs of ongoing care for adolescents with attention-deficit hyperactivity disorder. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 337-344.

23. Le HH, Hodgkins P, Postma MJ, et al. Economic impact of childhood/adolescent ADHD in a European setting: the Netherlands as a reference case. Eur Child Adolesc Psychiatry 2014; 23: 587-598.

24. Flood E, Gajria K, Sikirica V, et al. The Caregiver Perspective on Paediatric ADHD (CAPPA) survey: understanding sociodemographic and clinical characteristics, treatment use and impact of ADHD in Europe. J Affect Disord 2016; 200: 222-234.

25. Kleinman NL, Durkin M, Melkonian A, et al. Incremental employee health benefit costs, absence days, and turnover among employees with ADHD and among employees with children with ADHD. J Occup Environ Med 2009; 51: 1247-1255.

26. Kooij JJS, Bijlenga D, Salerno L, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry 2019; 56: 14-34.

Date of preparation: March 2021; Job code: C-ANPROM/EUC/NBU/0002

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The hyperactive, impulsive and inattentive symptoms of ADHD may negatively impact functioning and behaviour of children and adolescents with ADHD in the school setting. 12 A large, cross-sectional, European Lifetime Impairment Survey (sponsored by Shire, now part of Takeda) assessed parent-reported impairment and symptoms of ADHD in children and adolescents (n=535) compared with children and adolescents without ADHD (n=424).

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Double bookkeeping and schizophrenia spectrum- divided unifed phenomenal consciousness

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Prevalence and assessmentof self‑disordersin the schizophreniaspectrum: a systematic reviewand meta‑analysis

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Prevalence and assessmentof self‑disordersin the schizophreniaspectrum: a systematic reviewand meta‑analysis

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Prevalence and assessment of self‑disorders in the schizophrenia spectrum- a systematic review and meta‑analysis

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Definition

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

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

Prevalence

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

Characteristics

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

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

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

Impact on Learning

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

Teaching Strategies

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

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

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

Assistive Technology

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

Organizations

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

American Academy of Child and Adolescent Psychiatry

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

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

Web: www.aacap.org

Center on Positive Behavioral Interventions and Supports

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

5262 University of Oregon
Eugene, OR 97403-5262

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

Center for Disability and Development

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

Council for Exceptional Children

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

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

Federation of Families for Children's Mental Health

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

1101 King Street, Suite 420
Alexandria, VA 22314

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

National Alliance for the Mentally Ill (NAMI)

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

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

Web: www.nami.org

Mental Health America

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

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

Web: www.nmha.org

National Mental Health Information Center

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

P.O. Box 42557
Washington, DC 20015

Web: www.mentalhealth.org

References

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

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

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

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

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Diagnosing Psychotic Disorders: Mood and Psychosis

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Diagnosing Psychotic Disorders: Mood and Psychosis

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Child Mind Institute | Transforming Children’s Lives.

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

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School Mental Health Referral Pathways Toolkit

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School Mental Health Referral Pathways Toolkit

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A School Counselor’s Guide toThe Referral Process

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A School Counselor’s Guide toThe Referral Process

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Addressing Mental Health in School Crisis Prevention and Response

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Addressing Mental Health in School Crisis Prevention and Response

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