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Types, Red Flags, Causes, Treatment

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From Dr. Tamar Chansky Creator of Worrywisekids.org

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Symptoms, Causes, Treatment

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National Institute of Mental Health (NIMH)

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Overview

Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms:

Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.

Hyperactivity means a person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.

Impulsivity means a person may act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.

Signs and Symptoms

Risk Factors

Treatment and Therapies

Join a Study

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Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms: Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.

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Confidentiality, Referral Process

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Symptoms, Intervention, Implications for School Counselors

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Symptoms, Statistics, Treatment

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Explained by a clinical psychologist.

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What Is Conduct Disorder? | Child Psychology

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Watch more How to Understand Child Psychology videos: http://www.howcast.com/videos/507697-What-Is-Conduct-Disorder-Child-Psychology Conduct disorder in children is very serious. It's a disorder of childhood and adolescence that is long term, that's chronic, where children have very aggressive impulses, where children are involved in difficulties with the law and really seem to have no regard for the rules or for authority.

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Types, Criteria for Diagnosis, Intervention, Referral Process

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Definitions, Signs, Tips for Educators, Parents, and Counselors

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Prevention: Cognitive Behavioral Therapy

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About 40 million American adults have an anxiety disorder each year. Rates are rising among young people and the use of anti-anxiety drugs is soaring. What can be done to reverse this mental health crisis?

Part of the answer soon may be to start putting more at-risk preschoolers-and their parents-in therapy.

A growing body of research is suggesting that treating kids who are at risk for anxiety disorders and depression -and their families-early may help keep mental illnesses at bay. And the move with the biggest impact (both in dollars saved and misery averted) will likely be to focus on anxiety. Anxiety disorders are the most common mental health issues and are among the earliest to arise; they can set in as early as age three. They are also increasingly being thought of as gateway illnesses. Depression, substance abuse and even suicidal behavior often begin as out-of-control anxiety.

There's a good chance that my eight-year-old daughter will struggle with anxiety. Having a first-degree relative-a parent or sibling, for example-with an anxiety disorder bumps a person's risk of developing one up to five times that of the general population. When I was a twenty-year-old college junior, I was diagnosed with panic disorder, an illness characterized by repeated episodes of a racing heart, shortness of breath and blinding terror. In a period before my diagnosis, I had been nearly paralyzed by fear: I skipped my finals, dropped classes and spent more than a month shaking on my parents' sofa. I've grappled with anxiety ever since. My father deals with depression; my aunt, bipolar disorder. My grandmother heard voices and, plagued by paranoia, once tried to burn down her own home with her husband and children inside. She spent three years in a psychiatric facility.

I'd certainly like to spare my own daughter the pain of mental illness. And, now, researchers are developing programs with the aim of preventing anxiety disorders. At-risk children are usually taught social skills and how to approach the situations (asking another kid to play, doing show-and-tell) they already fear. This "exposure" is the main component of cognitive behavioral therapy, the most evidence-based non-drug treatment for anxiety disorders. The research is still in its early stages, and it could be years before the programs are widely available to families, but some results are encouraging. Researchers at the University of Connecticut and Johns Hopkins University tested an eight-week therapy for healthy kids who each had at least one parent with an anxiety disorder. During the following year, 31% of kids who didn't receive the therapy developed an anxiety disorder, whereas only 5% of kids who received treatment developed one.

Researchers are also developing programs for preschool children who, because of their shy, socially reticent temperaments, are at greater risk of developing anxiety. About one third to one half of these "behaviorally-inhibited" children will go on to have anxiety disorders-most often social anxiety disorder-by adolescence. In the prevention programs, parents are often treated, too. Parents of anxious kids often become controlling and overprotective in an attempt to ease their children's distress. The trouble is, this sends the message that the world is a dangerous place and that kids can't cope on their own. Also, when parents allow their children to avoid scary or distressing situations, the kids have fewer opportunities to learn to master their fear. So parents are taught to refrain from rescuing their anxious children and to push them to confront scary situations.

MORE: Don't Tell Anxious Kids That Everything Will Be OK

I recently spent a spring Saturday morning at the University of Maryland sitting in on the final session of a program for behaviorally inhibited children. Six preschoolers sat in a circle, legs crisscrossed on colorful foam mats. It was the final meeting of the "Turtle Program" and a shiny gold sign exclaiming Congrats Grad! hung on the wall.

"Can anyone remind us about some of the new things we've learned in circle time?" asked Danielle Novick, one of the program's leaders.

Marie, a little girl with curly brown hair and silver sneakers, shyly raised her hand. "Being brave," she says.

"Good job," replied Novick. "Thank you." She leaned over and put a sticker on Marie's knee, a reward for speaking up.

I watched this exchange from an adjacent room via a one-way mirror. The program is actually a study being conducted by researchers on the efficacy of an eight-week treatment to prevent anxiety disorders in behaviorally inhibited kids. The children in this group had all scored in the top 15% on a scale of behavioral inhibition. Many already had difficulties making friends, going to birthday parties and speaking up in preschool.

In the group, the children practiced introducing themselves, asking another kid to play and asking and answering questions. They learned to express their emotions and to negotiate conflict-first using puppets, which can be less stressful. The children also learned deep breathing, or what the program calls "balloon breathing," to help cope with anxiety. Ken Rubin, one of the lead investigators of the study, says that even as early as age four, behaviorally inhibited kids often have poor social skills, are being rejected by their peers and are internalizing negative feelings about themselves. "We're trying to interrupt that whole process," said Andrea Chronis-Tuscano, the other principal investigator.

MORE: Inside The Mindful Classroom

While the children were in circle time, their parents were in a room across the hall, where they were taught to ignore anxious and avoidant behavior and to praise brave behavior. Parents are also coached on how to create a fear hierarchy for their children consisting of incremental steps culminating in an ultimate goal. For example, if the ultimate goal is to ask another child to play, a first step might be to say hello to another child. The idea is for each step to be achievable, so that children have success and can gain confidence. The parents are coached on how to set up bravery practice (which is basically exposure therapy). They help their children to practice things like talking to a teacher or doing show-and-tell during the group. Therapists coach parents in the moment via earpieces, secret service style.

The researchers take pains to emphasize that they are not trying to change these kids' personalities-to turn shy and introverted children into extroverts. "Impairment is really the key," says Chronis-Tuscano. "We know how important social relationships are to people's happiness and success in life, and we don't want their inhibition to hold them back from doing anything." In an earlier small pilot study, the Turtle Program reduced anxiety symptoms in behaviorally inhibited kids. Before the treatment, nearly three-quarters of the kids met criteria for social anxiety disorder. Afterward less than a third did.

As a preschooler, my daughter was spirited and joyful, obsessed with Mary Poppins and her hot-pink scooter. She was also reserved and cautious. She hovered along the perimeter of birthday parties and music classes. But in the last couple of years, she's become markedly more confident. Still, if there's anything that worries me, it's her outsize fear of many kids' movies. She's not only petrified of movie monsters and villains but also hates it when anyone in a movie is nasty or mean. We got through only a few minutes of The Wizard of Oz. She made me turn it off at the appearance of Miss Gulch, the nasty woman who snatches Toto and later transforms into the Wicked Witch. I worry that these fears are an omen of greater anxiety to come. Researchers have found that phobias raise the risk of developing other anxiety disorders and depression. I myself had a childhood phobia of clowns.

So I've tried some of the prevention strategies. On the advice of child psychologist Ronald Rapee, a pioneer in the prevention of anxiety disorders in preschoolers, I took my daughter to see the movie Paddington, the movie about the talking bear that loves marmalade. (A free online version of Dr. Rapee's "Cool Little Kids" program is available at coollittlekids.org.au). But, by the first scenes, when an earthquake levels the wayward bear's home in Peru and kills his uncle, my daughter had scrambled onto my lap. When the evil taxidermist played by Nicole Kidman captured Paddington and threw him into a black van, my daughter began sobbing. We can go," I said, and moved to get up. "No," she wailed. So we stayed. But when the lights finally came up at the end, another mother shot me a judgmental look and proclaimed loudly, "That poor kid was so scared." I felt awful and embarrassed, like I was a terrible parent. I told my daughter how proud I was of her.

At the time I wasn't sure what, if anything, I accomplished. As with everything else in parenting, I'm winging it. But just a few weeks ago, my daughter, husband and I watched the original Ghostbusters from 1984. And when the demons attacked, I was the only one who had to close my eyes.

Adapted from the book On Edge: A Journey through Anxiety by Andrea Petersen, now available from Amazon.

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About 40 million American adults have an anxiety disorder each year. Rates are rising among young people and the use of anti-anxiety drugs is soaring. What can be done to reverse this mental health crisis? Part of the answer soon may be to start putting more at-risk preschoolers-and their parents-in therapy.

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Guide: Behaviors, Behavioral Management

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

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

Obsessions Common in Kids With OCD

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

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

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

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

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

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

Behaviors You Might See in Students With OCD

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

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

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

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

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

Behaviors Often Confused With Another Disorder

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

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

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

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

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

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

How to Help Students With OCD

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

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

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

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

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

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

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

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

How to Minimize Behavioral Problems

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

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

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

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

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

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

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

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Both Individualized Education Programs (IEPs) and 504 plans can offer formal help for K-12 students who are struggling in school. They're similar in some ways but very different in others. This chart compares them side by side to help you understand the differences.

A blueprint or plan for a child's special education experience at school.

A blueprint or plan for how the school will provide support and remove barriers for a student with a disability.

To get an IEP, there are two requirements: A child has one or more of the 13 disabilities listed in IDEA. The law lists specific challenges, like learning disabilities, ADHD, autism, and others. And the disability must affect the child's educational performance and/or ability to learn and benefit from the general education curriculum. The child must need specialized instruction to make progress in school.

To get a 504 plan, there are two requirements: A child has any disability. Section 504 covers a wide range of different struggles in school. And the disability must interfere with the child's ability to learn in a general education classroom. Section 504 has a broader definition of a disability than IDEA. (It says a disability must substantially limit one or more basic life activities. This can include learning, reading, communicating, and thinking.) That's why a child who doesn't qualify for an IEP might still be able to get a 504 plan.

There are strict legal requirements about who participates. With a few exceptions, the entire IEP team must be present for IEP meetings. The team must include:

The rules about who's on the 504 team are less specific than they are for an IEP. A 504 plan is created by a team of people who are familiar with the child and who understand the evaluation data and special services options. This might include:

* The child's parent or caregiver

* General and special education teachers

* The school principal

* The child's parent or caregiver

* At least one of the child's general education teachers

* At least one special education teacher

* A school psychologist or other specialist who can interpret evaluation results

* A district representative with authority over special education services

The IEP sets learning goals and describes the services the school will provide. It's a written document. Here are some of the most important things the IEP must include:

There is no standard 504 plan. Unlike an IEP, a 504 plan doesn't have to be a written document. A 504 plan generally includes the following:

* Specific accommodations, supports, or services for the child

* Names of who will provide each service

* Name of the person responsible for ensuring the plan is implemented

* The child's present levels of academic and functional performance - how the child is currently doing in school

* Annual education goals for the child and how the school will track progress

* The services the child will get - this may include special education, related, supplementary, and extended school year services

* The timing of services - when they start, how often they occur, and how long they last

* Any accommodations - changes to the child's learning environment

* Any modifications - changes to what the child is expected to learn or know

* How the child will participate in standardized tests

* How the child will be included in general education classes and school activities

When the school wants to change a child's services or placement, it has to tell families in writing before the change. This is called prior written notice. Notice is also required for any IEP meetings and evaluations. Families also have "stay put" rights to keep services in place while there's a disagreement about the IEP.

The school must notify families about an evaluation or a "significant change" in placement. Notice doesn't have to be in writing, but most schools do so anyway.

How to resolve disputes

IDEA gives families several ways to resolve disputes (usually in this order):

Section 504 gives families several options for resolving disagreements with the school:

* Mediation

* Alternative dispute resolution

* Impartial hearing

* Complaint to the Office for Civil Rights (OCR)

* Lawsuit

* Mediation

* Due process complaint

* Resolution session

* Civil lawsuit

* State complaint

* Lawsuit

And if you need help navigating special education law in your state, consider reaching out to your local Parent Training and Information Center. The people there can answer questions and give practical advice on issues specific to your area.

Do you want to learn more about how IEPs and 504 plans compare? Watch as an expert explains the differences between them.

About the author

About the author

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

Reviewed by

Reviewed by

Andrew M.I. Lee, JD is an editor and attorney who strives to help people understand complex legal, education, and parenting issues.

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IEP vs. 504 Plan: What's the Difference?

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Individualized Education Programs (IEPs) and 504 plans are similar but different. See how they compare in what they provide and the processes and laws involved.

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Section 504 of the Rehabilitation Act