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Just Ask. You Can Save a Life.

The Columbia-Suicide Severity Rating Scale (C-SSRS), the most evidence-supported tool of its kind, is a simple series of questions that anyone can use anywhere in the world to prevent suicide.

Get the Questions

Effective For Everyone

The C-SSRS can be used by anyone, anywhere. The Columbia Lighthouse Project provides the scale in more than 100 country-specific languages for use by:

"The advent of the C-SSRS and its dissemination could be seen as really a watershed moment, like the introduction of antibiotics. [The C-SSRS] has played a comparable role when it comes to mental illness and perhaps its most tragic consequence, suicide."

Former President, American Psychiatric Association

IF YOU OR SOMEONE YOU KNOW IS IN CRISIS, CALL 988

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The Lighthouse Project The Columbia Lighthouse Project

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The Columbia-Suicide Severity Rating Scale (C-SSRS), the most evidence-supported tool of its kind, is a simple series of questions that anyone can use anywhere in the world to prevent suicide. Get the Questions The C-SSRS can be used by anyone, anywhere.

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Whether you're looking for a therapist or just someone to talk to right now during some difficult times, 7 Cups is a place where you can be heard. Start for free today.

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If you are thinking about suicide and in need of immediate support, please call the TrevorLifeline at or select TrevorChat below to connect with a [...]

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Free, 24/7, confidential support is a click away. Our chat responders are available 24/7 to provide support and connect you with resources.

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Messaging to the public about suicide?

The Framework for Successful Messaging is a research-based resource that outlines four critical issues to consider when messaging to the public about suicide.

Messaging

WHY it's important

Because messaging matters! Certain types of public messaging about suicide can increase risk among vulnerable individuals.

Conversely, communications can be a powerful tool to promote resiliency, encourage help-seeking, publicize prevention successes, and encourage actions that help prevent suicide.

HOW it's unique

It's for suicide prevention messengers, rather than the media.

It addresses "public messaging": any communications released into the public domain. From posters, PSAs, and social media to websites, newsletters, fundraising appeals, event publicity, press interactions, public talks, and advocacy efforts, each contributes to the public's perceptions about suicide and suicide prevention.

Our Framework Handout provides an overview of the four elements to consider when messaging.

These examples are designed to bring the Framework for Successful Messaging to life and inspire you to think about the four elements of Strategy, Safety, Positive Narrative, and Guidelines when developing or choosing your own messages and materials.
Learn More About the Examples Gallery ‌

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Action Alliance Framework for Successful Messaging

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Skip to content The Framework for Successful Messaging is a research-based resource that outlines four critical issues to consider when messaging to the public about suicide. Because messaging matters! Certain types of public messaging about suicide can increase risk among vulnerable individuals.

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Mental Health First Aid USA - Mental Health First Aid

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Mental Health First Aid is a national program to teach the skills to respond to the signs of mental illness and substance use.

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The Texas Suicide Prevention Collaborative relies on generous contributions from community members like you to support our work. The fact is that persons who are impacted by mental illness or who need support for suicide prevention, suicide loss, or a previous attempt rarely come into contact with the public mental health system. Many go without treatment or support at all.

To help communities, we must build and support locally available resources for those who may be at risk of suicide-and that's the essential work of the Texas Suicide Prevention Collaborative. Given the size of Texas, this task is challenging, but with your support, we can accomplish it-together.

We now accept crypto donations along with traditional monetary donations. Please support those who need help in your community today.

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Texas Suicide Prevention | Know the Signs. Save a Life.

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The Texas Suicide Prevention Collaborative relies on generous contributions from community members like you to support our work. The fact is that persons who are impacted by mental illness or who need support for suicide prevention, suicide loss, or a previous attempt rarely come into contact with the public mental health system.

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Esta página también está disponible en español.

If You Know Someone in Crisis

Call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line ( text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential. Contact social media outlets directly if you are concerned about a friend's social media updates or dial 911 in an emergency. Learn more on the Lifeline's website or the Crisis Text Line's website.

The Veterans Crisis Line connects Service members and Veterans in crisis, as well as their family members and friends, with qualified, caring Department of Veteran's Affairs (VA) responders through a confidential toll-free hotline, online chat, or text messaging service. Dial 1-800-273-8255 and Press 1 to talk to someone or send a text message to 838255 to connect with a VA responder. You can also start a confidential online chat session at veteranscrisisline.net/get-help/chat.

Introduction

Suicide is a major public health concern. Over 48,000 people died by suicide in the United States in 2018; it is the 10th leading cause of death overall. Suicide is complicated and tragic, but it is often preventable. Knowing the warning signs for suicide and how to get help can help save lives.

Signs and Symptoms

Risk Factors

Treatments and Therapies

Ongoing Research

Latest News
More

Learn More

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Esta página también está disponible en español . Call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line ( text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889.

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American Foundation for Suicide Prevention

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Learn about suicide, how you can help prevent it, and resources for those affected, from the American Foundation for Suicide Prevention. Our mission: save lives and bring hope to those affected by suicide

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Skip to main content

We can all help prevent suicide. The 988 Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States.

988

¡Los servicios de texto y chat de 988 Lifeline ya están disponibles en español!
Haga clic aquí para obtener información sobre cómo acceder a todos los servicios en español.

Conocer más

Stock photo by iStock.

The 988 Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week in the United States. We're committed to improving crisis services and advancing suicide prevention by empowering individuals, advancing professional best practices, and building awareness.

About The Lifeline

Anyone could be struggling with suicide. Find more specific resources below.

I'm Struggling With Individuals with Neurodivergence

We understand that every struggle is different. Experience the stories of people like you, and how they overcame crisis to find hope and recovery.
read stories of hope & recovery

First, you'll hear an automated message featuring additional options while your call is routed to your local 988 Lifeline network crisis center.

We'll play you a little music while we connect you to a skilled, trained crisis worker.

A trained crisis worker at your local center will answer the phone.

This person will listen to you, understand how your problem is affecting you, provide support, and get you the help you need.

988 Lifeline Center calls are free and confidential, and we're available 24/7.

Show What Happens When You Call The Lifeline

Everyone Plays A Role In Suicide Prevention

Get in touch

Call the Lifeline

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Skip to main content We can all help prevent suicide. The 988 Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States. 988 ¡Los servicios de texto y chat de 988 Lifeline ya están disponibles en español!

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Advancing Counseling & Technological Literacy Among School Counselors and Educators

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Trauma and emotional distress can change us on a physiological level. If we are pushed too far, we may lose our ability to cope - and our bodies pay the price. Fortunately, you can mitigate your trauma response and enjoy better health. With Patricia Celan MD and Yasmin Akhunji MD

Trauma- especially early trauma - is linked to increased rates of anxiety, depression, suicidality, and post-traumatic stress disorder. But that's not all. Trauma, if not managed, can also impact your physical health - years after it's occurred.

Most of us are no stranger to life's many hardships, but the medical community hasn't always taken a trauma-informed approach to care (trauma-informed care presupposes that all patients have some form of trauma that may be affecting their well-being). Luckily, more and more doctors are discussing the inextricable link between our mental and physical health. The mind and body are connected after all.

When we go through a traumatic experience or a series of experiences (such as being abused, a parent dying, or getting into a car accident), our bodies trigger physiological responses as a way of adapting to the event or events. These responses aren't always up to us, of course. They're determined by our genes, our coping responses, and how our brains regulate. These responses are important mechanisms for survival - but sometimes they can work too well.

According to the Harvard T.H. Chan School of Public Health, lasting or latent trauma from events can trigger endocrine and immune problems (that a person may or may not have already been genetically predisposed to). These include chronic autoimmune illnesses, heart attack, diabetes, stroke, and even cancer.

You may be asking yourself if the trauma you endured was bad enough to cause health issues. The short answer: Yes. A traumatic event itself isn't necessarily the trigger, it's how our bodies uniquely respond to that trauma that can cause health problems. We all respond differently to stressors.

For example, if you were abused as a child, you may experience fear, anxiety, and distress when people yell or come too close to you. Even though you know you're safe, your body can be flooded with anxiety and stress, complete with heart palpitations and shallow, rapid breathing. This is your body's physiological, learned response to trauma. This response can be mitigated with intentional care, though!

The physiological effects of trauma

Dr. Celan explains that trauma sensitizes something called the hypothalamic-pituitary-adrenal (HPA) axis, which is the body's central stress response system. You can think of this as the intersection of our central nervous system and endocrine system.

Because trauma impacts the HPA axis, it can affect our hormones, especially adrenaline, cortisol, and oxytocin. Trauma makes us more reactive to stressors, and more likely to increase the stress hormone cortisol.

In certain situations, hormones like cortisol are very important. Think: If you're being chased by a wild animal, adrenaline kicks in to help you get out of danger's reach. But when you're not actively in danger, trauma keeps your body in that revved-up state, putting serious mileage on your body.

"Cortisol can be toxic when it is chronically high, ultimately leading to increased risks of health conditions such as depression or heart disease," according to Dr. Celan.

Once the stressor is removed, the body's hormones should respond in kind. The only problem? "A body that is exposed to trauma long-term will continue to produce these hormones, which may lead to negative long-term effects on the body," according to Dr. Yasmin Akhunji, an endocrinologist with Paloma Health. "This puts you at an increased risk for anxiety, depression, heart disease, sleep disruption, weight gain, and memory/concentration damage."

Trauma also reduces the release of oxytocin, which is "the love hormone that promotes sociability and the relationship between a mother and a child as well as romantic partners," says Dr. Lina Velikova MD, PhD, a medical advisor at Supplements101. "Early trauma decreases the oxytocin levels in the brain and affects its receptors in childhood and later in life."

Oxytocin is responsible for mood boosts, while working as a protective buffer against stressors. Having lower levels of oxytocin could mean less protection and adaptability.

Trauma can also lead to increased and long-term inflammation, which is an immune response to foreign invaders or damaged tissue. While inflammation is good in the short term, it's a main culprit behind heart disease and autoimmune diseases if it is a chronic issue.

The physical and emotional pain of trauma can also lead to unhealthy habits like smoking or drinking to numb emotions or overeating as a way of self-comforting. "The famous ACE (Adverse Childhood Experiences) study found that as someone's quantity of traumatic experiences increased, so did the chances of engaging in negative health behaviors such as smoking or drug use," according to Dr. Celan. If this is you, you're not alone - but being aware of your behaviors and their possible root causes is important.

Mitigating trauma's impact on your body

Unfortunately, trauma is a part of life, but focusing on a healthy lifestyle and taking care of yourself sends a message to your body that it is safe and nourished. This can help it reset.

Adjust your lifestyle. Eat a healthy diet, get regular exercise, and sleep enough. Sounds easy enough in theory, right? But implementing lifestyle changes can be hard IRL, especially when you're feeling down. You can start by filling your plate with nutritious food and working on getting movement into your day every single day. Try to get at least seven hours of good, solid sleep. Making these actions a priority daily, especially when you don't feel like it, can help your body recalibrate.

Engage in joyous, oxytocin-increasing activities. Dr. Celan recommends regularly participating in activities that can help balance your hormones. "You can mitigate trauma-induced body responses by engaging in activities that increase oxytocin and decrease cortisol," she says. "For example, hugging people or pets, engaging in compassionate behavior, laughing at a stand-up comedy special or having a warm, relaxing bubble bath are all healthy ways to boost your oxytocin levels."

Decrease your cortisol levels with mindfulness meditation. Dr. Celan also suggests embracing mindfulness meditation, "which can actually cause beneficial changes in brain structure and neurochemical release." This is because it triggers the body's relaxation response.

In fact, a 2018 study in Psychiatry Research found that mindfulness meditation decreased inflammation as well as biological stress reactivity while improving resilience to stressors. The study had participants engage in breath-awareness, body-scanning, and gentle Hatha yoga.

One easy way to implement mindfulness meditations into your day is by downloading an app such as Calm, Headspace, or Breeth, which will guide you through mindfulness meditations. Or, you can simply sit for 10-20 minutes, calming breathing in and out. Focus on each and every breath. Return to the breath - nonjudgmentally - when you have distracting thoughts. Then keep returning to it until your timer pings.

Advocate for yourself. It is important to understand that you are not "crazy" or "imagining it" if you feel run-down, constantly sick, or chronically under the weather after experiencing a traumatic event. While a wide variety of factors contribute to illness, trauma's impact is real.

Be sure to discuss any emotional, psychological, or physical symptoms you are having with your doctor - and don't be afraid to advocate for yourself if you believe you need help or extra medical attention.

Unfortunately, most people don't get help when they experience trauma, which can worsen the damage. According to Harvard Health, the very thought of seeing a doctor or therapist can feel overwhelming - simply because you don't want to face the facts or dredge up old feelings and memories.

Working with a professional may be uncomfortable at first, but it can improve your psychological, endocrine, and immune health, which will make your life more fulfilling down the road. You can also confide in a close friend, family member, or even a journal as you begin to make lifestyle changes to heal both your body and your mind.

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Trauma and emotional distress can change us on a physiological level. If we are pushed too far, we may lose our ability to cope - and our bodies pay the price. Fortunately, you can mitigate your trauma response and enjoy better health.

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In response to the recent developments due to SkillsCommons and MERLOT have created this FREE online resource to help both Teachers and Students prepare to start teaching and learning online.

Free Teaching and Learning Online Materials

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In response to the recent developments due to SkillsCommons and MERLOT have created this FREE online resource to help both Teachers and Students prepare to start teaching and learning online. Free Teaching and Learning Online Materials

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Sharing ideas and resources with those who are passionate about school counseling.

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Sharing ideas and resources with those who are passionate about school counseling.

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Technology for Virtual School Counseling

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Technology for Virtual School Counseling

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CSWD - Suggested Technology for Virtual Counseling (1)

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Virtual School Counseling Resource Guide

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75 free school counseling resources for bullying, grief, kindness, LGBTQ, mindfulness, social emotional learning, trauma, and more from Speckled Moose Counseling.

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eLearning Hub

This resource center is designed to equip you with knowledge, resources, and a sense of hope for the future - for yourself or someone else you care about.

Check out our eLearning Hub to learn more about common behavioral health conditions.

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Find Resources or a Provider | You're Not Alone | Mental Health Texas

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Mental Health Texas provides learning and treatment opportunities for those coping with mental health conditions and those who support them.

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Even though worries are serious and can be quite distressing, helping kids learn to deal with worry doesn't have to be! Lots of relaxation and calming skills can be taught and learning through play or games. As you're planning for your next worry group, take a look at these anxiety games for kids to add to your lesson plans! Anxiety Games for Kids Biggest Bubble To help kids develop important controlled breathing strategies, play Biggest Bubble! Give students some bubbles [...]

Continue Reading

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Counselor Keri: A School Counseling Blog to Help You Spark Student Growth

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Even though worries are serious and can be quite distressing, helping kids learn to deal with worry doesn't have to be! Lots of relaxation and calming skills can be taught and learning through play or games. As you're planning for your next worry group, take a look at these anxiety games for kids to add to your lesson plans!

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school counseling; technology; solution focused

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Dr. Russell A. Sabella is currently a Professor in the Department of Counseling, Florida Gulf Coast University and President of Sabella & Associates. Learn more by visiting https://about.me/sabella

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School Counselors and Psychotic Disorders

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School Counselors and Psychotic Disorders

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INTRODUCTION

The most common time of onset for psychotic disorders is adolescence and early adulthood []. The onset of psychotic disorders is usually preceded by a prodromal period characterized by non-specific psychiatric and attenuated psychotic symptoms accompanied by functional decline []. "Ultra-high risk" (UHR) for psychosis is defined by the presence of attenuated positive psychotic symptoms without full impairment of reality testing. Recently, the UHR concept was included in "attenuated psychosis syndrome" (APS), a new diagnosis contained in Section 3 of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the section reserved for conditions requiring further research []. Among adolescents who reported psychotic-like experiences, those of 80% remitted, and the symptoms of 20% persisted []. The early detection and treatment of people at risk for psychosis is currently regarded as a promising strategy for preventing the devastating consequences of full-blown psychosis [].

As children and adolescents spend a large portion of their time at school, mental health problems are commonly identified in this setting. School-based detection of those at UHR for psychosis has the benefit of improving access to mental health treatment for students who have psychotic-like experiences. In Korea, mandatory school based mental health screening test for mental health problems of students has been conducted every year. Due to limited school mental health resources, school counselors perform non-counseling related activities beyond their training such as clinical expertise regarding to assessment and referral of clinical high risk students.

Given increasing recognition of the need to identify individuals with UHR risk status, school counselors are facing the challenge of how to understand and deal with these symptoms. Indeed, in view of the essential contribution of the identification of symptoms to the provision of effective mental health services, it is essential to recognize the potential role played by school counselors.

Thus, the current study examined how school counselors diagnose and define the appropriate treatment for those at UHR for psychosis. We assessed respondents' recognition of UHR for psychosis based their responses to a brief vignette depicting a hypothetical student reporting relevant symptoms.

METHODS

Participants

The sample for this anonymous cross-sectional survey, which was conducted in October 2015, consisted of school counselors. In total, 132 school counselors from 125 (81.7%) of the 153 schools and all of three Wee centers in Gwangju metropolitan city participated in the survey and completed the questionnaire. Data on sociodemographic characteristics were collected. The survey was approved by the the Chonnam National University Hospital Institutional Review Board (CNUH-2015-171).

Vignette

The vignette used in this study was developed by the corresponding author (KSW) () based on the vignette developed by Jacobs et al. [] and the manual of Personal Assessment and Crisis Evaluation (PACE) clinic of Orygen Youth Health in Melbourne, Australia []. The vignette described a fictional individual at UHR for psychosis according to the Comprehensive Assessment of At-Risk Mental States (CAARMS) criteria [,]. The protagonist in the vignette met criteria for subthreshold non-bizarre ideation and perceptual abnormality with functional decline. She also met criteria of the DSM-5 criteria for APS. Two authors (LJY and CYC) with extensive experience in this area discussed and further revised the vignette.

First, we asked participants whether the vignette depicted a psychiatric disorder (yes/no/don't know). Participants were asked to identify the most appropriate diagnosis for the hypothetical student from a list of 10 diagnoses. We also asked participants to recommend an appropriate referral and treatment approach for the student by asking them to rate 11 treatment options on the following scale: first choice, second-or-later choice, would not recommend, and no opinion. Participants who diagnosed the protagonist with schizophrenia, delusional disorder, or at UHR for psychosis were considered the "schizophrenia spectrum disorders group," and others were considered the "non-psychotic disorders group."

Statistical analyses

Basic demographic differences among respondents according to the diagnosis chosen were analyzed using the chi-square test. The percentage of respondents choosing each answer was calculated and is presented. SPSS for Windows software (ver. 21.0; IBM Corp., Armonk, NY, USA) was used to perform the statistical tests. All statistical tests were two-tailed, and p-values <0.05 were deemed to indicate statistical significance.

RESULTS

Demographic characteristics of participants

The sample consisted primarily of females (94.7%), and there were no significant differences in the demographic characteristics of respondents according to the diagnosis they selected ().

Diagnosis

In total, 123 (94.6%) respondents recognized that the vignette depicted someone with a mental disorder. The data regarding diagnoses are summarized in , which shows the percentage of respondents choosing each diagnosis. The most common diagnosis was schizophrenia (n=34, 28.1%), followed by delusional disorder (n=32, 26.4%), and depressive disorder (n=23, 19.0%). The diagnosis of UHR for psychosis was selected by 15 (12.4%) subjects.

Referral and treatment

shows the referral recommendations according to the diagnosis chosen by the school counselors. Most participants who diagnosed the protagonist with schizophrenia spectrum disorder selected psychiatric clinics as the optimal referral. Additionally, an average of 58.1% of respondents would refer to Wee center, which is school counseling services, and an average of 37.2% would refer to a private counseling center.

shows treatment preferences according to the diagnosis chosen by school counselors. School counselors who diagnosed the student depicted in the vignette with schizophrenia were likely to recommend antipsychotics (35.3%) and family therapy (35.3%) as the first-line treatment. School counselors who diagnosed the protagonist as being at UHR for psychosis were also likely to prefer family therapy (46.7%). In terms of the medication options for those at UHR for psychosis, antipsychotics were the most frequently chosen.

DISCUSSION

This is the first study to explore the recognition of Korean school counselors regarding students at UHR for psychosis. Participants were presented with a vignette depicting the case of a student who initially presents with recent-onset subsyndromal psychotic symptoms with functional decline. We found that most participants believed that the student was suffering from a psychiatric disorder. However, only 12.4% of the respondents correctly diagnosed her as at UHR for psychosis, whereas over half of respondents described her as suffering from a full-blown psychotic disorder. This reflects the fact that school counselors may be unfamiliar with the concept of high risk for psychosis, and lack confidence in treating this concept as a potential precursor of psychotic symptoms.

About 40% of school counselors did not consider the protagonist in the vignette to be suffering from schizophrenia spectrum disorder but, instead, believed she was dealing with a less severe condition, including depressive disorder (19.0%). Although the vignette did not portray severe depression, many school counselors nonetheless identified the problem in question as depressive disorder, which is a common psychiatric disorder among students. While most school counselors recommended psychiatric treatment for the protagonist in the vignette, a majority also considered a counseling center, which might not offer psychiatric services and might not operate according to the medical model, as would be appropriate for the treatment of a psychotic disorder. Early detection and intervention have an important role in reducing the duration of untreated psychosis (DUP) and ameliorating the presenting symptoms of UHR subjects [,]. However, appropriate psychiatric intervention is commonly delayed within mental health services, including school counseling systems [,]. Therefore, early referral and the timely delivery of transfer information by school counselors may play an important role in improving the diagnostic and treatment approach of subsequent practitioners.

Our findings reflected great variability in the treatment recommendations offered for the protagonist of the vignette. In particular, school counselors who diagnosed her with schizophrenia or at UHR for psychosis recommended both antipsychotics and family therapy. These results may be attributable to recognition on the part of school counselors that antipsychotics have been established as a standard treatment for persons with psychotic symptoms. Additionally, as school counselors are more frequently exposed to information related to familial and environmental problems, they may consider family therapy to be an important resource for treatment. Although low doses of antipsychotics appear to be effective for reducing the severity of the presenting symptoms of UHR subjects, premature recommendations for medication by school counselors may exacerbate a student's experience of being odd and stigmatized, especially if they are adolescents []. Furthermore, there is growing evidence that psychological interventions, such as cognitive-behavioral therapy, and newly emerging treatments, such as omega-3 fatty acids, may be effective in reducing the severity of the symptoms experienced by individuals at UHR for psychosis [⁻]. These results suggest that Korean school counselors were not familiar with preventive approaches to the development of psychotic disorders or with the importance of early intervention. Thus, we should develop educational materials to raise the awareness of school-based gatekeepers of access to mental health treatment regarding psychosis prevention and help school counselors expand their knowledge about treatment options for those at UHR.

This study has several limitations. First, the use of only one vignette to assess school counselors' recognition of UHR for psychosis may have led to difficulties in distinguishing this condition from other psychotic disorders. Second, we asked only two categorical questions regarding the diagnosis of, and treatment for, individuals at UHR for psychosis; that is, we did not assess such additional factors as respondents' experiences with, goals for, and opinions regarding treatment. Future research may benefit from adding vignettes that depict different levels of psychotic symptoms and elicit more information from respondents. Moreover, as there is no "golden standard" treatment for UHR, the range of recommended treatments in our study should be tested for relevance in futures.

In conclusion, this study suggests that Korean school counselors are not sufficiently familiar with the condition known as UHR for psychosis, although they generally recognize the vignette has mental health problems and needs help. To prevent delays in the implementation of appropriate school-based interventions for attenuated psychotic symptoms, school counselors should be provided with proper education and training.

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School Counselors' Recognition of the Ultra-High Risk for Psychosis

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The most common time of onset for psychotic disorders is adolescence and early adulthood []. The onset of psychotic disorders is usually preceded by a prodromal period characterized by non-specific psychiatric and attenuated psychotic symptoms accompanied by functional decline [].

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Suffering in Silence- Examining OCD in School Setting

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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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Working to deliver a better special education service

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Each child is an individual with different social, emotional, and academic strengths and weaknesses. Therefore, their educational needs may vary from one season or school year to the next.

In the first section of our chapter, "School: A Child's World Beyond Home" we cover the legal evolution of the Individual with Disabilities Educational Act (IDEA 2004) and advise a parent how to initiate an Individual Education Plan (IEP), prepare for the IEP meeting (including rehearsal strategies), and locate educational consultants and attorneys.

But the more we talked to people in preparation for this chapter, the more we came to understand that both parents and educators were confused about the construction of an IEP for a student struggling with a bipolar disorder. A model IEP-one that specifically addresses the seasonal variations in mood, energy, attention, motivation, and behavior, as well as one that addresses the frequently co-occurring executive function deficits, needed to be developed.

Therefore, we asked special education advocate, Anne Marie Smith, M. Ed., from Agawam, Massachusetts, to construct an IEP that might provide guidelines for educating a middle school student throughout the school year.

With the hope that the following information is helpful to parents and educators alike, we excerpt the following from The Bipolar Child (pages 305-311.) Also see pages 295-303 in the book for a highly focused and very comprehensive list of accommodations, modifications, and special services that can be incorporated into an IEP.
From The Bipolar Child by Demitri Papolos, M.D. and Janice Papolos (Broadway Books, 2006). All rights reserved.

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Bipolar Children Individual Education Plan (IEP) Model

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Each child is an individual with different social, emotional, and academic strengths and weaknesses. Therefore, their educational needs may vary from one season or school year to the next.

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Accommodations for those with Bipolar Disorder

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Accommodations for those with Bipolar Disorder

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Not all students who have disabilities require specialized instruction. For students with disabilities who do require specialized instruction in the United States, the IDEA controls the procedural requirements and an IEP is developed. "Special education" under IDEA means the child has been identified as having unique educational needs related to his/her disability and is entitled to an Individualized Education Program (IEP) to meet these needs.

The IDEA process is more involved than that of Section 504 of the Rehabilitation Act. The IDEA requires that measurable growth and progress towards written goals and objectives be documented.

For students with disabilities who do not require specialized instruction but need the assurance that they will receive equal access to public education and services, a document is created to outline their specific accessibility requirements. Section 504 is a federal civil rights law. The purpose of Section 504 is to protect persons with disabilities against discrimination for reasons related to their disabilities.

While students with a 504 plan do not require specialized instruction, and specific goals and objectives are not necessarily outlines nor is data tracked, the plan should be reviewed annually to ensure that the student is receiving the most effective accommodations for his/her specific circumstances.

Unlike IDEA, Section 504 does not guarantee that a child with a disability will receive an individualized educational program that is designed to meet the child's individual educational needs. Rather, it guarantees that accommodations will be made relative to their specific medical needs.

Eligibility for protections under Section 504 depends on the child in question having a physical or mental impairment which must substantially limit at least one major life activity. Major life activities include walking, seeing, hearing, speaking, breathing, learning, reading, writing, performing math calculations, working, caring for oneself, and performing manual tasks. Section 504 requires an evaluation that draws information from a variety of sources.

A child who receives Section 504 protections has fewer rights than the child who receives special education services under the IDEA. The child who receives special education services under the IDEA is automatically protected under Section 504.

Section 504 is designed to guarantee that children with disabilities will not be discriminated against. It is also important to understand that if your child does not qualify for special education services under IDEA, your child does not have the procedural protections that are available under the IDEA.

Under Section 504, the child with a disability may receive accommodations and modifications that are not available to children who are not disabled. These accommodations and modifications are also available under IDEA. For example; accommodations could include, but not be limited to, such things as:

Tests taken in a separate location with time limits waived or extended.

The use of a word processor due to fine motor, visual motor deficits.

Shortened assignments.

Standardized tests answers written directly in the test booklet and transferred onto answer sheet by teacher or assistant.

Class notes provided rather than having the student copy from the chalkboard or overhead.

Allowing the child to leave the classroom 2 to 3 minutes early to avoid crowded hallways.

Preferential seating in the classroom.

Provision of a daily assignment sheet to be filled out by the student and verified by the teacher for accuracy. The parent could then check to make sure that all the work is accomplished. This would assist with homework prioritizing and management.

Please note: These are simply examples. All or none of these may be suitable for your child.

Students with bipolar disorder may or may not have a need for specialized instruction provided within an IEP. For some students, simply being granted accommodations that make allowance for the side effects of medications, related anxiety issues, or results of mood changes is sufficient.

Students with bipolar disorder who are well-controlled on medication may or may not be plagued by racing thoughts, distracting thoughts, an inability to concentrate, decreased energy; all of which will require modifications in the teaching environment or instructional strategies.

For other students, the side effects of medications may be significant enough to require changes in instruction provided or curriculum modifications. Some of the common side effects of medications include: tremors (trembling of hands), blurred vision, loss of coordination, slurred speech, sedation, ataxia (unsteady movement), dizziness, seizures. Some students with bipolar disorder may also have one of a number of other disabilities that impacts their access to the general education curriculum; such as vision or hearing impairment, learning disability, processing problems, or other disability. The co-morbidity rates of ADHD, anxiety disorder, conduct disorder, oppositional-defiant disorder and learning disabilities in students with bipolar disorder tell us that we should explore all avenues available to meet the educational needs of our children.

The following accommodations are meant to serve as a resource for parents unsure of what possibilities exist:

Students on some medications may need:

increased access to water, unlimited access to restrooms (particularly students taking Lithium)

decreased reading assignments or having books on tape or computer screen-reading due to blurred vision

modified school arrival, shortened day, scheduling of core content during the student's most alert time, reducing homework and extending deadlines, providing notes, allowing longer or more frequent breaks, allowing exercise or other movement due to sleep impairment or to sedation of medications

provision of notes and listening guides, work monitoring, extended time on assignments, extra set of books for home use, breaking assignments into more manageable pieces, use of checklists, providing written instructions and/or other visual cues, use of word banks on fill-in types of tests and other modifications that aid retrieval/memory, testing in a separate room, or extended test time, use of multiple choice formats, use of oral exams rather than written demands, use of noise-canceling headsets, - all for impaired concentration, memory

reducing or discontinuing homework may be necessary for some students due to difficulties with concentration, sleep patterns, mood irritability. For these students it may be necessary to schedule a resource room period at the beginning of the day to get assignments ready for the day, or at the end of the day to complete assignments before leaving school

preferential seating can be used to help with vision, focus, reduce visual or auditory distraction, allow for discrete monitoring

and while a 504 plan will simply list the type of accommodation needed and the reasons for it/them, an IEP must contain objectives that are written with specific criteria; such as -Given a grade level reading assignment of 1 chapter with 4 comprehension questions, (name) will answer the questions with 60/70/80% accuracy. Or given an assignment containing 5 long division problems, (name) will complete 3/4/5 problems at 80% accuracy.

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Accommodations for Students with Bipolar Disorder and Related Disabilities - International Bipolar Foundation

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Error! You must specify a value for the Video ID, Width, Height and Anchor parameters to use this shortcode! Not all students who have disabilities require specialized instruction. For students with disabilities who do require specialized instruction in the United States, the IDEA controls the procedural requirements and an IEP is developed.

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The Clinician's Pathway Program (CPP) and its assessment tools, the CBQ and JJ, were developed by Dr. Demitri Papolos. By clicking the links below you will leave www.jbrf.org and be redirected to the research site that contains the CPP and the CBQ & JJ assessments. If you have any questions or concerns regarding these tools please direct them to Dr. Papolos's system administrator at CPP@drpapolos.com To Set Up a New CPP Account To Access an Existing CPP Account
Scoring for assessments within the CPP is a fee-based service offered by the private practice of Demitri Papolos, M.D.; this service is independent of JBRF but may be accessed through the JBRF website. Dr. Papolos developed the CBQ & JJ measures and their automated scoring report with the support of JBRF. Questions and/or concerns with regard to the scored report should be addressed to CPP@drpapolos.com

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JBRF - Juvenile Bipolar Research Foundation

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The Clinician's Pathway Program (CPP) and its assessment tools, the CBQ and JJ, were developed by Dr. Demitri Papolos. By clicking the links below you will leave www.jbrf.org and be redirected to the research site that contains the CPP and the CBQ & JJ assessments.

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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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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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Heling Student Alleviate Anxiety through School Counseling Efforts

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Heling Student Alleviate Anxiety through School Counseling Efforts

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Alleviating Anxiety Through School Counseling Interventions

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If unaddressed, childhood and adolescent anxiety can have a lasting negative impact on students'...

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School Counselors Can Help Teens With Social Anxiety

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Social anxiety disorder is one of the most common disorders among adolescents. Research shows there is a way that school counselors can intervene and help.

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School Counselors and Helping Students with Anxiety

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School Counselors and Helping Students with Anxiety

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"My heart is pounding. I feel like I can't breathe. My stomachs hurts. I don't want to be here at school. I know I shouldn't be worried about it, but I

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When children have frequent emotional outbursts, it can be a sign that they haven't yet developed the skills they need to cope with feelings like frustration, anxiety and anger. Handling big emotions in a healthy, mature way requires a variety of skills, including:

Impulse control

Emotional self-regulation

Problem solving

Delaying gratification

Negotiating

Communicating wishes and needs to adults

Knowing what's appropriate or expected in a given situation

Other children may seem to struggle more with boundaries and following rules. They may be defiant, or ignore instructions or try to talk their way out of things that aren't optional. You may notice patterns of behavior that seem to crop up at certain times of the day (like bedtime) during certain tasks (like during homework) or with certain people. You also might notice that your child acts out particularly when she is at home but not when she is at school, or vice versa.

Tantrums and other kinds of acting out are often a normal and even healthy part of childhood. They are a sign that a child is becoming more independent - indications that a child is testing boundaries, developing skills and opinions, and exploring the world around them.

But when a child is acting out a lot, it can strain the parent-child relationship, creating regular frustration and resentment that isn't healthy in the family. Whether your child is in the early stages of learning about self-regulation and boundaries, or if your family has been struggling and you are looking for help, this guide is designed to explain more about how kids learn to manage their behavior, what parents can do to aid in the process and how to get more support if you need it.

Tantrums can be a learned behavior

Sometimes parents feel that tantrums and other instances of problem behavior are intentional or manipulative. However, clinicians who specialize in children's behavior agree that tantrums are generally not a voluntary behavior on a child's part - but they may be what is known as a "learned behavior." That means that kids learn that having a tantrum gets them the result that they want.

In other words, while a child who struggles to control her emotions might not be consciously calculating her tantrums, she might resort to them because she hasn't learned a better way to solve problems or communicate her needs. Well-meaning parents often respond to tantrums by trying to fix whatever caused the problem - by comforting the child or giving her whatever she is asking for. Unfortunately, this reinforces the tantrum behavior, making kids more likely to continue having tantrums and less likely to develop more sophisticated ways to manage their feelings.

When kids are acting out parents often feel powerless. You may have tried different techniques for discipline, but without much success. In fact, trying too many different strategies for managing disruptive behavior can sometimes be part of the problem, since kids respond better to firm boundaries that are consistently reinforced. But if you haven't seen progress before now, don't feel discouraged, because parents have more power than they may realize when kids are being oppositional. By using strategies that are informed by child psychologists who specialize in behavior management, you can begin to improve kids' behavior and even improve the parent-child relationship.

This section begins with some general rules of thumb recommended by behavior experts as effective strategies for responding to problem behavior in the moment. Next it examines problem behavior in greater depth, which can be helpful for parents who want to understand more about why kids act out, and how to tackle specific behaviors you would like to change.

Tips for responding in the moment:

Don't give in. Resist the temptation to end your child's tantrum by giving her what she wants when she explodes. Giving in teaches her that tantrums work.

Remain calm. Harsh or emotional responses tend to escalate a child's aggression, be it verbal or physical. By staying calm, you're also modeling for your child the type of behavior you want to see in him.

Ignore negative behavior and praise positive behavior. Ignore minor misbehavior, since even negative attention like reprimanding or telling the child to stop can reinforce her actions. Instead, provide lots of labeled praise on behaviors you want to encourage. (Don't just say "good job," say "good job calming down.")

Use consistent consequences. Your child needs to know what the consequences are for negative behaviors, such as time outs, as well as rewards for positive behaviors, like time on the iPad. And you need to show him you follow through with these consequences every time.

Specific (so expectations are clear to everyone in the family)

Observable

Measurable (so everyone can agree whether or not the behavior happened)

Wait to talk until the meltdown is over. Don't try to reason with a child who is upset. You want to encourage a child to practice negotiating when she's not blowing up (and you're not either).

Targeting specific behaviors

When you are trying to manage disruptive behavior, it is helpful to identify specific behaviors that you are trying to change (or encourage). It's true that when families are feeling overwhelmed sometimes it can seem like every interaction is a struggle. However, identifying specific behaviors is an important first step to effective discipline. Taking behaviors one at a time allows you to be more focused, gain a better understanding of why the behavior is happening, and have a greater sense of control. Of course, there may be multiple behaviors that you would like to change, but evaluating them one by one is important.
Potential triggers to avoid
Target behaviors should be:

Assuming your expectations are understood: Kids may not know what is expected of them - even if you assume they do. Demands change from situation to situation and when children are unsure of what they are supposed to be doing, they're more likely to misbehave.

Calling things out from a distance: Tell your children important instructions when you are face-to-face. Directions that are yelled from a distance are less likely to be remembered and understood.

Transitioning without warning: Transitions can be hard for kids, especially if they are in the middle of doing something they enjoy. When kids are given a warning and have a chance to find a good stopping place, transitions can be less fraught.

Asking rapid-fire questions, or giving a series of instructions: Delivering a series of questions or instructions limits the likelihood that children will hear, answer questions, remember the tasks, and do what they've been instructed to do.

Potential triggers to embrace
An example of a poorly defined behavior is "acting out" or "being good." A well-defined behavior would be running around the room (bad) or starting homework on time (good).

Adjusting the environment: Try to manage environmental and emotional factors that can make it much more difficult for children to rein in their behavior. Things to consider: hunger, fatigue, anxiety or distractions. When it's homework time, for instance, remove distractions like screens and toys, provide snacks, establish an organized place for kids to work and make sure to schedule some breaks.

Making expectations clear: You and your child should be clear on what's expected. Even if he "should" know what is expected, clarifying expectations at the outset of a task helps head off misunderstandings down the line.

Providing countdowns for transitions: Whenever possible, prepare children for an upcoming transition. For example, give her a 10-minute warning when it is time to come to dinner or start homework. Then follow up when there are 2 minutes left. Just as important as issuing the countdown is actually making the transition at the stated time.

Letting kids have a choice: As kids grow up, it's important they have a say in their own scheduling. Giving a structured choice - "Do you want to take a shower after dinner or before?" - can help them feel empowered and encourage them to become more self-regulating.

Before the behavior happens

When you are thinking about a particular behavior that you are targeting, it is important to think about what generally happens before that behavior and may be triggering it. This helps parents understand not only why a child might be acting out but also how anticipating certain triggers might help prevent those behaviors from happening. Parents can also examine the triggers that make positive behaviors (like obeying a command on the first time) more likely.

These things often lead to misbehavior.
Consequences that aren't effective
These are things that can bolster good behavior.

Giving negative attention: It seems counterintuitive, but consequences that seem negative to us (like raising your voice or spanking) can sometimes reinforce the very behavior we are trying to prevent. That's because children value attention from the important adults in their life so much that any attention - positive or negative - is better than none. That's why negative attention can actually increase bad behavior over time. Responding to behaviors with criticism or yelling can also adversely affect children's self-esteem.

Delayed consequences: Immediate consequences are the most effective. Children are less likely to link their behavior to a consequence if there is a lot of time between the two, which means delayed consequences are less likely to actually change a child's behavior.

Disproportionate consequences: Parents can sometimes become so frustrated that they overreact when giving consequences, which is understandable. However, a huge consequence can be demoralizing for children, and they may give up even trying to behave.

Consequences that are accommodating: When a child is slow to doing something you want him to do, like picking up his toys, many parents will become frustrated and just do it themselves. While this reaction is also understandable, it also increases the likelihood that he will dawdle again next time.

Consequences that are effective
After the behavior happens

Positive attention for positive behaviors:Praising children when you "catch them being good" makes them more likely to repeat that good behavior in the future. Positive attention is also a good thing for the parent-child relationship, improves a child's self-esteem, and feels good for everyone involved.

Ignoring actively: This consequence might seem counterintuitive, but child behavior experts often teach "active ignoring" as an effective behavior management strategy. To perform active ignoring, deliberately withdraw your attention when a child starts to misbehave. As children learn that acting out doesn't get them your attention, they will begin to do it less. An important component of active ignoring is to immediately give a child positive attention as soon as he exhibits behavior you do want to see, like sitting calmly. Of course, this consequence should be used only for minor misbehavior - active ignoring is not appropriate when a child is being aggressive or doing something dangerous.

Reward menus:Rewards are a tangible way to give children positive feedback for desired behaviors. Rewards are most motivating when children can choose from a variety of desirable things: extra time on the iPad, a special treat, etc. Rewards should be linked to specific behaviors and always delivered consistently.

Time outs: Time outs are one of the most effective consequences parents can use, but also one of the hardest to do correctly. The next section in the guide gives parents tips on how to have a successful time out.

Considering what happens after a targeted behavior is important because consequences can affect the likelihood of a behavior recurring. That is true for consequences that are positive (like getting an extra 10 minutes of screen time) or negative (like getting a time out).
Set a specific behavior that you want to target
Some consequences are more effective than others. Ideally consequences create structure and help kids understand the difference between acceptable and unacceptable behaviors. However, consequences can also do more harm than good when they are sending the wrong message. Understanding how to use smart and consistent consequences makes all the difference.
Examine triggers
These types of consequences are common, but they generally don't have the desired effect.

Consequences that are more effective begin with generous attention to the behaviors you want to encourage.
Examine consequences
Example: Targeting a specific behavior

Stop jumping on the couch

Your daughter often starts jumping on the couch when you go to change the baby's diaper or give him a bath.

Possible solution: Come up with ways your daughter can "help" you do these tasks. Her assistance may slow you down slightly, but it gives her something positive to do - and it makes her feel like she's still getting your attention. When she helps out, praise her for being such a good big sister.

Ineffective consequence: Yelling, "I've told you this a million times, Katie, you can't jump on the couch! Why do you keep doing it?!"

Effective consequence: Send to time out immediately.

One common problem behavior trigger for many children is transitions. Whether it's getting ready for bed, or coming to dinner, or putting down the video game controller, in many families transitions can become a flashpoint that everyone learns to dread.

If transitions are a problem for your child, it is important to figure out what about the transition is difficult. Often kids don't like stopping an activity that they are enjoying (like playing on the computer) in order to do something less fun, like getting ready to leave the house. While no one enjoys stopping fun things, some kids struggle with it more than others. That can be a sign that they are still developing emotional self-regulation skills, but it is just one possible cause. Other children struggle to cope with unanticipated changes in schedule, or moving on from something that they feel like they haven't finished.

Struggling with transitions can even be a sign of a mental health disorder in some children. Children with ADHD, autism, anxiety and OCD are all more likely to struggle with transitions.

Techniques to make transitions easier

Once you've narrowed down what you think might be behind your child's resistance to transitions, then you can start brainstorming what you think might help. (Note: If you think your child might have an undiagnosed mental health disorder, taking your concerns to a clinician is important.)

Here are some techniques that you might want to try:

Preview and countdown: Every morning, lay out what the day will look like. Before each transition, give a timeframe and description of what will happen along with countdowns (in 20 minutes, then 10, then 5 it will be time to finish breakfast and head to school). This helps kids prepare emotionally.

Get their attention: For kids who struggle to regulate their attention, make a particular effort to capture theirs. Make eye contact, sit next to them, put your hand on their shoulder, or ask them to repeat back what you have said. It makes them more likely to follow through.

Use music: Songs can help kids (particularly young kids) ease into transitions. The "clean up" song is a popular example of this, but there are many songs that can be found or made up to suit a variety of situations from tying shoes to brushing teeth.

Visual cues: Posting a chart with pictures illustrating what to expect from a particular transition or the steps involved is a good visual reminder for children to fall back on.

Create routines: If there are transitions that your child struggles with every day, like going to bed, build some consistency and structure into that transition. For example, when it's close to bedtime, your child can pick one last thing she wants to do. Then, you both go upstairs to brush teeth and read a story, then it's lights out. Doing this routine consistently helps kids know what to expect and makes the transition easier.

Use rewards: Rewards can be an effective tool to use for difficult transitions until children have gotten used to them. Parents can use stickers, snacks, or a point system that leads to tangible rewards.

Appropriate consequences: If a transition isn't going well, think about what consequences you are (or aren't) giving. Yelling isn't an effective consequence, but active ignoring or a time out might be.

Use praise: When a child does follow through with a transition, make sure you give him some enthusiastic labeled praise to recognize his behavior. For example: "I really liked how you handed over the iPad right away and started brushing your teeth. Now we have more time to read!"

The point of a time out isn't to shame or punish your child, but to diffuse an emotional situation and help your child learn to manage frustration and regulate his own behavior. Using a time out is also a clear way to communicate that a particular behavior is unacceptable

Many parents have tried time outs before with varying degrees of success. To be most effective, time outs need to be done consistently and follow certain steps. Here are some guidelines to follow if you are learning how to use time outs, or want to troubleshoot your technique.

Use advance warning: Kids need to understand which behaviors are linked to which consequences. Work with your child to establish which behaviors (like hitting or not complying with an instruction from you) lead to a time out so she knows what to expect.

Establish a pre-determined place: Designating a special chair, or a place on the stairs, also helps a child know what to expect. It's a good idea to label the time out chair just that, and not "the naughty chair" or something similar. Time outs work better when they are focused on teaching children how to behave, not on punishing them.

Use a quick response: When a kid misbehaves in one of the ways you have discussed, make sure the following time out is immediate, and that you state the reason: "No hitting. Go to time out." Be specific, brief, and unemotional. This helps ensure that the child is able to link her action with its consequence. Delayed consequences are ineffective because kids tend to feel you are just being punitive.

Keep it brief: A standard formula for time outs is one minute per year of age. Some experts recommend a timer so a child can see that the time is being measured.

Keep it calm: The goal in a time out is for kids to sit quietly. Some experts recommend not starting the allotted time until your child is quiet. Others feel this is too hard for young children. They require that the child be completely quiet for 5 seconds before ending the time out. This way kids learn to associate good behaviors with the end of the time out and it sends the message that yelling and screaming during a time out won't work.

Pay no attention: Kids in time out should be ignored - no talking to them or about them, even if they're whining, crying or protesting. By withdrawing your attention during the time out, you're sending the message that misbehaving is not the way to get what they want.

Consistency is key: It's tempting to put kids in time out whenever they're acting inappropriately or pushing your buttons, but using time outs randomly makes it more difficult for kids to make the connection between specific misbehaviors and their consequences. Also, it is important that the time out occurs each and every time the specific target behavior occurs. If not, you are encouraging the child to think that he might be able to get away with it.

No rewarding stimuli: In the time out chair the child should have no access to television, electronic devices, toys or games. If you're away from home, pick any spot that removes the child from distracting stimulation.

If a child won't stay in time out: If a child breaks the rules by leaving the time out chair too soon, put him in a backup time out area that he cannot escape from (like a bedroom where there aren't any rewarding stimuli such as television, toys or games). Briefly explain that he must stay there for one minute and be calm and quiet before he is allowed to leave. Once he does that he should be returned to the time out chair, and the time he must stay there is restarted. If he leaves the chair again, the cycle repeats. Your child should learn quickly that it's in his best interest to stay in the chair until the time is up.

After the time out

When kids are given time outs for not complying with your instructions, once a time out is finished, they should be asked to complete whatever task they were asked to do before the time out. This helps them understand that time outs aren't escape routes.

Once the time out is over, you want to resume giving them attention, tuning in to whatever they are doing/working on/playing so that you can "catch them being good" and specifically praise them for a positive behavior. For example, if your child completes her time out and then she plays gently with the dog, you'd want to let her know what she was doing right ("I love how nicely you're playing with the dog! You are using such nice gentle hands!") This is reassuring your child that although she had to go to time out, she also is completely capable of doing good and positive things that make you proud and loving toward her.

Children will be more likely to understand and comply with your instructions if you follow these guidelines:

Be direct. Make statements rather than asking questions: "Please sit down," as opposed to "Are you ready to get out your homework?"

Be close. Give instructions when you are near your child, rather than calling out from across the room.

Use clear and specific commands. Instead of "Go ahead," say, "Please go start your reading assignment."

Give age-appropriate instructions. Speak to your child at a level he will understand. If your child is younger, keep things simple and use words you know he knows: "Please pick up the ball." With older children, it's important to be clear without being patronizing.

Give instructions one at a time. Especially for kids who have attention challenges, try to avoid giving a series of instructions: "Please put on your sneakers, get your lunch off the kitchen counter, and meet me in the front hall."

Keep explanations simple. Giving a rationale can increase the likelihood children will listen to a command, but not if the commands gets lost in it. For instance: "Go get your coat on because it's raining and I don't want you to catch a cold." Instead, try: "It's raining and I don't want you to catch a cold. Go get your coat on."

Give kids time to process. After you give an instruction, wait a few seconds, without repeating what you said. Children then learn to listen to calm instructions given once rather than learning that they don't need to listen because the instructions will be repeated.

One of the most unpleasant side effects of behavioral problems is the toll they take on the family dynamic. When a child has chronic behavior issues parents often aren't enjoying the time they spend with their child. This can be both frustrating and guilt-inducing. Children are also negatively affected when they receive frequent criticism or pick up on their parent's irritation, which can lead to resentment and may damage their self-esteem.

Improving the parent-child relationship should be a priority for all families dealing with chronic problem behavior. To that end, try to increase the number of interactions you have with your child that are positive and don't promote conflict. For example:

Use behavior management strategies that reinforce what you do want to see (like giving clear instructions in a neutral tone of voice or using lots of labeled praise) instead of comments that are critical or focus on what you don't want to see.

Pay attention to your own emotions and look for healthy ways to deal with stressful situations without escalating them. Use your own emotional self-regulation skills or give yourself a time out if you need a moment to cool down.

Like in any relationship you want to nurture, think about how you can build on (or create) meaningful bonds. Are there common interests you can cultivate? New relationship rituals you can establish?

Set aside a small amount of time every day to be present and nonjudgmental with your child.

How to establish daily quality time

Even a small amount of time set aside reliably every day can become something children and parents learn to look forward to. This should be a time for positive connection, without rules or commands, to help everyone in the family defuse stress and appreciate each other's company. This should be considered special time and should not be contingent on a child's good behavior. Here are some tips for success:

Aim for 5 minutes per day with younger kids, 15 minutes with teens

Let your child choose an activity she enjoys and you join in

Actively listen and let her lead the conversation

Validate her choices and interests

Focus on giving positive attention to good behavior

Ignore minor misbehavior

Avoid directing the activity or criticizing

Some children act out because they have a hard time regulating their own emotions. This is a common problem for young children who haven't yet developed the ability to cope with big emotions in a constructive way. Some children continue to struggle with self-regulation as they get older. Parents and teachers may notice that they seem particularly sensitive and have outsized emotional reactions compared to their siblings or peers.

The good news is that self-regulation is a skill that can be taught like any other, and parents can play a big role in helping kids learn how to handle their emotions, even very big emotions. Here are some techniques for helping kids calm down instead of act out.

Developing emotional IQ

Taking the time to notice and label emotions helps kids begin to pay attention to how they are feeling. This is important because paying attention to our emotions is the first step to learning how to manage them. Sometimes just articulating an emotion helps to defuse it. Too often we try to pretend we aren't feeling negative emotions until it's too late and we are feeling terrible. Acknowledging a negative feeling can make it seem less powerful and helps you begin to think constructively about what to do with that feeling.

Parents can help teach children to do this by modeling it in their own behavior. For example, if you are upset because you forgot something at the grocery store, share that feeling: "I'm so frustrated right now! I forgot to get milk!" Then, after you've acknowledged how you feel, you can model coping and problem solving skills. You might say, "I'm going to take some deep breaths to calm down - that often helps me." Then once you're feeling better, you can say, "Now how can I solve this problem?" and brainstorm ideas.

Children will begin to pick up on the skills that you are modeling for them, but they might also need some extra support as they begin to learn how to deal with their emotions. If you notice your child is beginning to look upset, ask her to describe how she is feeling. Can she label it?

Just make sure if your child tells you that she's feeling sad, or anxious, or angry, you don't immediately try to talk her out of it. Sometimes hearing "Oh, it isn't that bad!" can make kids feel like their emotions are wrong and inadvertently teach them that they shouldn't share how they are feeling. Instead, you can validate the emotion ("Yes, that does sound frustrating" or "You do look disappointed") and then encourage healthy ways of dealing with that feeling.

Heading off big emotions

Another important part of a child learning to consciously label his emotions is that it encourages him to start paying attention to how he feels, which means that he might notice an emotion earlier, before it starts to feel overwhelming.

Parents can sometimes be blindsided by the strong emotions children show during tantrums. But kids don't go from calm to sobbing on the floor in an instant - even if it seems like that. Emotions build over time, like a wave. Kids can learn to manage those emotions that seem overwhelming by noticing and labeling them earlier, before that wave gets too big.

Many kids benefit from ranking how strong their emotions are on a scale of 1 to 10, with 1 being calm and 10 being furious. You can model doing this, too. When you are feeling frustrated because you forgot to get milk at the grocery store, you might announce that you're at a 4. It might feel silly to do this at first, but it teaches kids to pause and notice how they are feeling. For kids who appreciate visual aids, something like a "feelings thermometer" might help.

When to get help

Most children have occasional tantrums or meltdowns. Acting out when it's time to go to bed or stop playing a game is par for the course. But when kids are having tantrums often, or it seems like they can't control their temper a lot of the time, you may be seeing something more extreme than typical problem behavior.

Here are some signs to look out for:

When problem behavior is interfering with his ability to make friends or get along with other kids.

When problem behavior is causing a lot of conflict at home and disrupting family life

When your child feels like she can't control her anger, and it is making her feel bad about herself
For more information about how to find a clinician who can help, read the Child Mind Institute's Parents Guide to Getting Good Care. Attention-deficit hyperactivity disorder (ADHD)
When his behavior is causing trouble at school with his teachers or his fellow students
Oppositional defiant disorder (ODD)
When her behavior is dangerous to herself or others
Disruptive mood dysregulation disorder (DMDD)
If you are worried about your child's behavior and are having a hard time managing it on your own, making an appointment with a clinician who has expertise in children's mental health can be very helpful. A clinician can perform a comprehensive evaluation to determine whether your child may have an undiagnosed mental health disorder that is contributing to her behavior issues, or recommend specific strategies or treatments that might be helpful.
Anxiety
Possible causes and diagnoses

Trauma
Below is a list of some mental health disorders and other challenges that may be associated with disruptive behavior.
Learning problems
Children with ADHD find it unusually difficult to concentrate on tasks, pay attention, sit still and control impulsive behavior. While disruptive behavior is not a symptom of ADHD itself, it is often the result of ADHD symptoms. Inattention and impulsivity can make it very difficult for kids to tolerate tasks that are repetitive, boring, or take a lot of effort. Because of this, children with ADHD are frequently overwhelmed with frustration, and throwing a shoe or pushing someone or yelling "shut up!" can be the result of their impulsivity. Some kids with ADHD can also develop negative behavior patterns, which are a response to years of finding themselves in conflict with adults.
Sensory processing issues
Children with ODD have a well-established pattern of behavior problems, with symptoms including arguing with authority figures, refusing to follow rules, blaming others for their mistakes, being unusually angry and irritable, and more. All children can have these symptoms from time to time. What distinguishes ODD from normal oppositional behavior is how severe it is, and how long it has been going on for.

Children with DMDD experience frequent, severe temper outbursts that seem grossly out of proportion to the situation at hand. In between tantrums they are chronically irritable. Their disruptive behavior is a result of their very big emotions and poor self-regulation skills. Children with DMDD often feel very apologetic after a tantrum is over.

Children who seem angry and defiant may be severely anxious. When children are having a hard time coping with situations that cause them distress, they may lash out. This may happen when the demands at home or school put a pressure on them that they can't handle. In an anxiety-inducing situation, your child's "fight or flight" instinct may take hold - she may have a tantrum or refuse to do something to avoid the source of acute fear.

Children who have been traumatized frequently mask their pain with behavior that is aggressive. As a result of their trauma they may be struggling with poor emotional self-regulation, negative thinking, and be overly alert to dangers - and more likely to jump into their "fight or flight" response in an effort to protect themselves.

Children who act out repeatedly in school or during homework time may have an undiagnosed learning disorder. They may be feeling frustrated and ashamed because they are struggling to do things that look easy for other kids, and they don't know why. Rather than ask for help, they may rip up assignments or act out to create a diversion from their real issues.
Parent-Child Interaction Therapy (PCIT)
Some children have trouble processing the sensory information they are getting from the world around them. Children who are under- or over-sensitive to stimulation can often feel uncomfortable, anxious, distracted and overwhelmed, which can frequently lead to disruptive behavior.

Autism: Children on the autism spectrum tend to be rigid - needing consistent routine to feel safe - and unexpected changes can lead to them having a tantrum. Autistic children can also struggle with sensory issues that leave them feeling overwhelmed. Some autistic children may also lack the language and communication skills to express what they want or need.
Parent Management Training (PMT)
Parent training programs

Parent training programs are designed to bolster the skills parents may need for managing a child's problem behavior and improve the parent-child relationship. These programs are led by psychologists and social workers and are evidence-based, which means they have been thoroughly tested and found to be effective for many families.
Defiant Teens
Below is a list of different kinds of parent training, including what makes them different and which families they may work best for.

Parents and children both participate in PCIT sessions, during which a clinician teaches them skills to interact in a positive, productive way. It is effective for kids between the ages of 2 and 7, and usually requires 14 to 17 weekly sessions.
Positive Parenting Program (Triple P)
In PCIT, parents receive live coaching (via a bug in the ear) from a therapist who watches from behind a one-way mirror as they and their child perform a series of tasks, and parents practice specific responses to both desired and undesired behavior.
The Incredible Years
In PMT, which is for children ages 3 to 13, parents are usually seen without the child present, although children may be asked to participate in some sessions. Skills to deal more effectively with challenging behaviors are taught and modeled by the therapist and then role-played with parents. After each session, parents are expected to practice the skills at home. Families usually participate in at least 10 sessions.

Since PMT is appropriate for all ages, it's a good choice when kids are too old for PCIT. It can also be a good option for families where the parent-child relationship is strong, but children might be struggling with things like anxiety, extreme impulsiveness or explosive anger.

Defiant Teens is for parents of teenagers who are 13-18 years old. The first half of this program involves only parents, and focuses on teaching more effective tools for interacting with their teenager, specifically for handling noncompliance or defiant behavior. But since teenagers are more autonomous than younger children and less influenced by their parents' guidance, the program also includes training for the adolescent to help him become a participant in changing the family dynamic.

In the second half, parents and teenagers are both trained in problem-solving communication. The aim is to provide family behavioral resources to help each family member develop more effective problem-solving, negotiation and communication skills and to correct any unreasonable beliefs that might be impeding their interactions.

Triple P's focus is on equipping parents with information and skills to increase confidence and self-sufficiency in managing child behavior. It can be utilized with a wide age range of children from toddlerhood through adolescence. With Triple P families can participate in different levels of intervention according to their needs. In some sessions clinicians will meet one-on-one with parents to discuss skills and strategies, and in some sessions kids with be included and the therapist will be provide live coaching.

The Incredible Years offers small-group-based training for parents of kids from infants through age 12. The programs are broken into four age groups (baby, toddler, preschool and school age) and they range from 12 to 20 weeks.

The program starts with a focus on improving parent-child relationships and positive attachment before moving on to consistent routines, rules and limit-setting. Finally it covers child management strategies such as ignoring, redirection, logical and natural consequences, time to calm down and problem-solving.
Note about Risperdal
For children from four to eight years old, Incredible Years offers children's groups that focus on helping them acquire emotion regulation strategies and social skills. Research shows that the kids' group works well at improving pro-social behavior and decreasing problem behaviors. Parents find that they learn not only from therapists but from other fellow parents in the group.

Medication

Parent training and behavior therapy are considered a more effecting and longer lasting way to help children learn to manage their difficult emotions and rein in disruptive behavior. But medications are sometimes used as an adjunct to behavioral therapy. Anti-psychotic medications like Abilify (aripiprazole) and Risperdal (risperdone), which have been shown to reduce aggression and irritability, may be used in cases where a child is at risk of being removed from the school or home. Stimulant medication may be used if a child has excessive impulsivity, including those who have an ADHD diagnosis. Antidepressants (SSRIs) may be helpful if a child has underlying depression or anxiety.

It is important to talk with your doctor about any concerns you may have about your child's treatment plan, progress or any side effects that you may be seeing. A good clinician will be ready to discuss the symptoms you are seeing and explain potential options for changing dosage or medication. If you don't feel that your child's doctor is taking your concerns seriously, or your doctor is not following best practices for changing dosage, or adding new medications, you should get a second opinion.

If you believe your child should stop taking a particular medication, make sure you tell your doctor, and discuss the pros and cons. Don't make adjustments or withdraw the medication without consultation. Many medications should be reduced gradually, and children should be monitored for side effects of withdrawing too quickly.

Risperdal can have serious side effects, including substantial weight gain and metabolic, neurological and hormonal changes that can be harmful. Children taking Risperdal or another atypical antipsychotic should be monitored by their doctors regularly over the course of treatment. Before treatment begins, they should be tested to establish baselines for height, weight, vital signs and levels of prolactin and blood fats and sugar. During the first few months of treatment, a child's levels should be measured frequently. If the child is using the medication long-term, he should continue to be monitored on a yearly basis.

For kids who struggle with their behavior in the classroom, establishing some school-specific behavior management strategies is important.

The first step is often asking the school to provide a functional behavior assessment. The goal of an FBA is to gather more information about when and why your child is acting out in class. This information is then used to come up with a plan for how to help. A school psychologist or behavioral specialist typically leads the FBA, and may speak to you, your child's teachers and your child as part of the assessment, as well as do some in-class observation.

Determining which specific things that your child struggles with is important. Just like in behavior management at home, it helps to get as much information as possible about the real-life situations that seem to lead to disruptive behavior, paying attention to what happens immediately before, during and after the behavior. Paying attention to when your child isn't acting out can also be informative.

Once this information has been gathered and analyzed, the school psychologist or behavioral specialist can work on creating a behavior intervention plan (or BIP) with ideas for preventing problem behaviors and rewarding positive behavior. This may include different teaching strategies, different consequences for misbehavior or changes to typical routines. Checking in periodically to monitor the effectiveness of these strategies (and make updates accordingly) is important.

How parents can support school behavior goals at home

Parents can also play a role in helping reinforce good behavior at school. You might tell your child's teacher that you want to be a partner in helping improve your child's behavior and select one or two goals at a time to work on, like turning in homework and not calling out in class, for example. Then you can ask the teacher to give you periodic reports on your child's progress. You don't want to overwhelm the teacher, but if you get a progress report every few days or every week then you can help reinforce the school's goals by either rewarding good school behavior at home or setting up appropriate consequences.

For example, if you hear that your child is doing a good job turning in his assignments, you might give him some extra screen time that weekend in recognition of his efforts. If he's doing a particularly good job then you might give him a bigger reward, like an outing to his favorite restaurant. Conversely, if you get a report that he isn't doing his homework, you might let him know that he won't get any screen time for the first two days of the upcoming week because he needs to prioritize homework.

For more information about working with schools on behavior issues, see our recommended reading list in the next section.

Behavior Interventions at Home:
The Everyday Parenting Toolkit, by Alan Kazdin

The Kazdin Method for Parenting a Defiant Child, by Alan Kazdin

Taking Charge of ADHD, by Russell Barkley
Behavior Interventions at School
Behavioral Interventions in Schools: Evidence-Based Positive Strategies, by Angeleque Akin-little, Steven G. Little, Melissa A. Bray and Thomas J. Kehle

Managing ADHD in School: The Best Evidence-Based Methods for Teachers, by Russell Barkley

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Parents Guide to Problem Behavior | Child Mind Institute

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When children have frequent emotional outbursts, it can be a sign that they haven't yet developed the skills they need to cope with feelings like frustration, anxiety and anger.